Nuclear Medicine Imaging Guidelines

Pre-Scan Preparation

• Patients undergoing a DTPA scan should be well-hydrated before and for at least one day after the procedure, avoid food for at least 4 hours prior to the scan, and empty their bladder immediately before imaging to minimize radiation exposure and optimize image quality, as recommended by the European Journal of Nuclear Medicine and Molecular Imaging 1
• Patients on somatostatin analogue therapy should temporarily interrupt treatment (short-acting analogues for 24 hours, long-acting preparations for 5-6 weeks) before the scan, according to the European Journal of Nuclear Medicine and Molecular Imaging 1
• Patients should avoid nonsteroidal anti-inflammatory drugs and discontinue medications that could transiently affect kidney function before the procedure, as suggested by the Kidney International guidelines 2
• For FDG PET/CT scans, patients must fast for at least 4 hours, maintain adequate hydration by drinking approximately 1 liter of plain water during the 2 hours before FDG injection, and have blood glucose levels below 11 mmol/L to ensure optimal image quality and diagnostic accuracy, as recommended by the European Journal of Nuclear Medicine and Molecular Imaging 3

Special Considerations

• In patients with significant renal failure, high blood pool activity may hamper visualization of uptake foci; interpretable scans can be obtained after hemodialysis, as recommended by the European Journal of Nuclear Medicine and Molecular Imaging 1
• Plasma clearance methods may be inaccurate in patients with edema or ascites; alternative methods should be considered, according to the Kidney International guidelines 2
• Reschedule the scan if the patient has an acute illness that may transiently affect kidney function, as suggested by the Kidney International guidelines 2
• Patients should avoid strenuous exercise for at least 6 hours before the scan, preferably 24 hours, and remain seated or recumbent and quiet during the FDG uptake phase to minimize muscle uptake and ensure optimal image quality, as recommended by the European Association of Nuclear Medicine (EANM) 3, 4

Contraindications and Precautions

• Wait at least 7 days after administration of iodinated contrast media before undergoing a DTPA scan to ensure complete washout, as recommended by the Kidney International guidelines 2
• Clinical decision is necessary to weigh benefits against possible harm in pregnant patients, according to the European Journal of Nuclear Medicine and Molecular Imaging 1
• Breastfeeding should be discontinued for an appropriate period after the procedure (typically 4 days for similar radiopharmaceuticals), as recommended by the European Journal of Nuclear Medicine and Molecular Imaging 1

Radiation Exposure

• The effective dose equivalent is approximately 0.054 mSv/MBq in adults and 0.16 mSv/MBq in children, as reported by the European Journal of Nuclear Medicine and Molecular Imaging 1
• Recent contrast studies can interfere with scan results if performed within 7 days, according to the Kidney International guidelines 2
• Emptying the bladder immediately before the scan can maximize patient comfort, reduce radiation exposure to the bladder, and minimize scatter and halo artifacts, as recommended by the European Association of Nuclear Medicine (EANM) 5, 4

Patient Preparation and Safety

• Completing MRI safety screening using a standardized checklist is essential for identifying potential contraindications, such as previous contrast agent reactions, implants, vascular stents, coils, active implants, and claustrophobia, as recommended by the European Association of Nuclear Medicine (EANM) 5
• Implants should be categorized as "MRI unsafe", "MRI conditional", or "MRI safe" to ensure safe scanning practices, according to the European Association of Nuclear Medicine (EANM) 5
• Patients should follow a low carbohydrate diet for 24 hours prior to the PET/CT study, or at least have a low carbohydrate meal before starting the 6-hour fasting period, to help switch the myocardium from using glucose to using fatty acids as an energy source and improve image quality, as suggested by the European Association of Nuclear Medicine (EANM) guidelines 3
• The following table summarizes the recommendations for patient preparation: