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Gastric Emptying Solid and Liquid. By: Abby Cox NMT 1713 July 31,2007. Overview. What is Gastric emptying Radiopharmaceutical and Dose Localization & QC Administration Indications Contraindicatons Patient Preparation Eqiupment Procedure with solid Procedure with liquid

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gastric emptying solid and liquid

Gastric Emptying Solid and Liquid

By: Abby Cox

NMT 1713

July 31,2007

overview
Overview
  • What is Gastric emptying
  • Radiopharmaceutical and Dose
  • Localization & QC
  • Administration
  • Indications
  • Contraindicatons
  • Patient Preparation
  • Eqiupment
  • Procedure with solid
  • Procedure with liquid
  • Results (Normal and Abnormal)
  • Processing
  • Artifacts
conclusion
Conclusion
  • Gastric Emptying is a procedure that measures how much food or liquid is moving out of the stomach at a certain time.
  • The procedure is done with a solid meal, liquid, or both together.
gastric emptying
Gastric Emptying
  • Gastric emptying is a procedure that uses a radioactive material inserted in either a solid meal or liquid that measures the speed that the food or liquid is digested (emptied) through the stomach and enters into the small intestine.
  • Gastric emptying study is performed for patients who have symptoms of slow, or in rare cases rapid stomach emptying.
radiopharmaceutical
Radiopharmaceutical
  • Solid: 99mTc-Sulfur Colloid (SC)*, 99mTC-albumin colloid, In-111*, and Microlite (temporarily off the market)
  • Liquid: 99mTC-Diethylenetriaminepentaacetic acid (DTPA)*, and In-111*
  • Dose Range:

-Solid: 5 mCi 99mTC SC, 2 eggs, 2 toast bread, & 8 oz OJ

-Liquid: 500uCi 99mTC DTPA

125uCi In-111, DTPA

Water, OJ, kool-aid

* = Most common used

localization qc
Localization & QC
  • Localization: Compartmental; moves along with food through gastrointestinal tract
  • QC: Chromatography: SC, > 90%; particle size < 1um; Micorlite, >92% tagging. Use either within 6 hours. DTPA, > 90%; use within 1 hour.
  • Administration: Radiotracer usually mixed with 1 or 2 whole eggs or egg whites for solid study. Radiotracer mixed into 120 mL of water or other for liquid and ingested orally
indications
Indications
  • Evaluation of:

-Mechanical obstruction

-Anatomic obstruction (pyloric, postsurgical,postradiotherapy)

-Altered function (gastroparesis, scleroderma, amyloidosis, or anorexia nervosa

-Suspected tumors or surgery

-Nausea, vomiting, and early satiety

-Weight loss

-Gastric therapy (Reglan)

Determination of Delayed gastric emptying with quantitation of gastric emptying rate.

contraindications
Contraindications
  • Allergy to eggs; in this case you would use oatmeal, baby food, sweet potatoes, or chicken or beef liver.
patient preparation
Patient Preparation
  • Identify the patient
  • Verify Doctor’s order, and explain procedure
  • Ensure the diabetics receive orange juice 2 hours before test if necessary
  • Ensure Patient to be NPO 4-12 hours before examination
  • Physician to discontinue sedatives 12 hours before examination
  • Premenopausal women should be studied on day 1-10 of the menstrual cycle to avoid hormonal variation effects, if possible
equipment
Equipment
  • Camera: Large or Small field of view
  • Collimator: Low energy, all purpose, or low energy, high resolution or medium energy collimator if In-111 is used.
procedure with solid
Procedure with Solid
  • Baseline Solid Study:

-Prepare one or two eggs and mix in radiotracer

-Stir and Scramble

-Or prepare choice of gastronomic vehicle with radiotracer

-Administer to patient PO with 30-120 mL of water. Encourage patient to eat quickly.

  • Place Patient supine and start acquisition as quickly as possible after ingesting food.
  • Position camera anterior or LAO.
  • Instruct patient to remain motionless during imaging.
  • Static images: 60-120sec per frame every 5 minutes up to 30 minutes, and then every 15 minutes thereafter.
  • Dynamic images: 60sec/fr for 60-90min
  • Once complete draw a ROI around stomach and counts are generated
  • 64 x 64 or 128 x 128 matrix
baseline liquid study
Baseline Liquid Study
  • Add 500uCi of 99mTc-DTPA to 120mL of water or orange juice
  • Administer to patient PO. Encourage patient to drink quickly
  • Image same as solid study, although only imaged for 1.5 hours.
  • 64 x 64 or 128 x 128 matrix
solid and liquid procedure
Solid and Liquid Procedure
  • 500 uCi 99mTC SC injected into 2 raw eggs and then cooked.
  • 125uCi of In-111 in tap water or orange juice
  • Patient eats egg sandwich and drinks the tap water or orange juice
  • Imaging begins with camera peaked at two energy settings In-111(247 keV with a 20% window) and 99mTc (140 keV with a 20% window)
  • 64 x 64 or 128 x 128 matrix
  • 60 second images taken every 15 mins for 2 hours.
  • ROI is drawn around stomach and counts are generated for each image
results normal abnormal
Results (Normal & Abnormal)
  • Normal:

Liquid: 50% emptied 10-45 minutes or 80% in 1 hour

Solids: 50% movement out of stomach within a 32 – 120 minutes with a mean of 90 minutes.

Terminate study before 60 min if gastric emptying becomes > 95%

Abnormal: Very little or no movement from stomach after 60 minutes. Rapid emptying may occur in cases of “dumping syndrome”

processing
Processing
  • Calculate percent emptying by follow methods:
  • Computer program
  • Generate regions of interest (ROI) around stomach
  • Manual: Use counts taken in ROI, correct counts by following decay factors
  • Divide gastric counts by decay factor to obtain corrected counts
  • This is performed on each frame, then plotted on a semilogarithmic graph, and compared with a normal curve.
artifacts
Artifacts
  • Burn eggs; nonuniform mixing of radiotracer and eggs
  • Too little or to much food or water
  • Patient allergies or intolerance to eggs or to food
  • Patient unable to eat or may vomit or aspirate food and dose
  • Belt buckles or buttons
  • Camera or patient position changes
questions
Questions
  • 1.) What are the 3 methods of performing Gastric Emptying study?
  • 2.) What is the common radiopharmaceuticals used with Gastric Emptying study?
  • 3.)What is the dose for each?
  • 4.) Name 1 indication and 1 contraindication of Gastric Emptying.
  • 5.) What is the acquisition for each?
answers
Answers
  • 1.) Solid, Liquid, or solid and liquid
  • 2.) 99mTc-SC, 99mTc-DTPA, and In-111
  • 3.) 5 mCi 99mTc-SC, 500uCi 99mTC DTPA, 125uCi In-111, DTPA
  • 4.) Refer to slides 6 and 7
  • 5.) Refer to slides 10, 11, and 12
reference
Reference
  • Nuclear Medicine Technology Procedures and Quick References by Pete Shackett
  • Society of Nuclear Medicine Procedure Guideline for Gastric Emptying and Motility