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Radiology.emory.edu

Renal Imaging

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_____________________________ _______ ___________________________ _________ With renal scintigraphy, the relative amount of the radionuclide extracted from the blood by a kidney is proportional to that kidney’s function. The radiopharmaceutical (Tc-99m MAG3) passes through the
vascular system, renal tubular cells, tubular lumens and collecting system, allowing for the evaluation of renal
perfusion, renal clearance, renal parenchymal transit time and collecting system patency.
INDICATIONS:
To evaluate renal perfusion and function, renal trauma, renal collecting system obstruction and renal transplants.
EXAM TIME:

PATIENT PREPARATION:
The patient should be well hydrated before coming to the hospital for the study (at least 500 ml water 30

minutes before the study).
The patient should void before beginning the study.
RADIOPHARMACEUTICAL: Tc-99m MAG3 10 mCi (370 MBq)

ROUTE OF ADMINISTRATION: Intravenous (bolus for dynamic flow acquisition)
MATERIALS AND EQUIPMENT:
1) Gamma camera: Large field of view 2) Collimators: Low-energy high resolution parallel hole collimator
INSTRUMENTATION & SETUP PARAMETERS: 20% window centered at 140 KeV
Emory University Hospital
General Nuclear Medicine Protocol Manual PATIENT POSITIONING: Supine. The patient should not move during acquisition. Field of view should
include kidneys and bladder.
ACQUISITION PROTOCOL:
a) Acquire images using QuantEMTM software. b) For counting pre injection syringes, follow QuantEM acquisition software. c) Flow study: start acquisition immediately after bolus injection in the posterior projection, 2 sec/frame for 48 seconds, matrix size 64x64, no magnification. d) Dynamic images: following the flow study, posterior projection, 15 sec/frame for 4 minutes, matrix size 128x128, no magnification, followed by 30 sec/frame for 20 minutes. e) Static bladder image in the anterior projection x 1 minute, matrix size 128x128, no magnification. f) Have the patient void and re-image the bladder in the anterior projection x 1 minute, matrix size g) Static image of the kidneys in the posterior projection x 1 minute, matrix size 128x128, no h) For counting post injection syringes, follow QuantEM acquisition software.
DATA PROCESSING:
Use QuantEMTM software.
OPTIONAL MANEUVERS:
Transplanted kidney imaging
1) The patient is positioned supine. 2) Images are acquired in the anterior projection. 3) The field of view includes the transplanted kidney and bladder (entire pelvis). 4) The acquisition and quantification is otherwise the same as for native kidneys. 1) Hydrate the patient: oral fluids or intravenous if necessary. 2) Catheterize the bladder in neonates. 3) Perform the routine Tc-99m MAG3 renal study. 4) At the end of the 24-minute study, the patient is asked to void and furosemide is given intravenously. The resident checks the serum creatinine level and decides the dose to be given If creatinine < 2 mg/dl, give 40 mg. If creatinine > 2 mg/dl, then give 60-80 mg. 5) Place indwelling catheter in patients with ileal conduit or significant post-void residual. 6) Re-start acquisition in the posterior projection (30 sec/frame) for 20 minutes, matrix size 128x128, no 7) Check for the presence of flank pain after diuretic administration and notify resident if so.

PACS:
Gray scale screen capture of result summary page.
REFERENCES:

1) Taylor A, Radionuclide renography: a personal approach. Semin Nucl Med 1999;29(2):102-27. 2) ent of renal function with technetium-99m-MAG3 in children and adults. J Nucl Med 1996;37(4):588-93. General Nuclear Medicine Protocol Manual

Source: http://www.radiology.emory.edu/fileadmin/user/Forms__Processes___Procedures/NucMed/GenNucMed/Renal_Imaging.pdf

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