Medications: Singular, Vitaplex, Crestor, Tricor, Prevacid, Lisinopril, Coumadin, Insulin s1

XXX Nuclear Facility 6021 University Blvd., Suite 500 Ellicott City, MD 21043 Phone (123)123-1234 Fax (123)123-1234

Patient Name: Doe, John Referring physician: Dr. Jones ID Number: 123456 Date of the exam: 4-1-17 Date of birth: 4-2-29 Radiopharmaceutical: 6.3 mCi 99mTc Choletec IV Sex: Male Height: 70 in Weight: 180 lb

Hepatobiliary Scan

INDICATIONS/HISTORY: 79-year-old male with abdominal pain

PREVIOUS STUDY: Sonogram of the abdomen dated 3/31/16 demonstrating irregular thickening of the gallbladder was but no definite shadowing gallstone.

FINDINGS: Immediately following the IV administration of 6.3 mCi Tc99m Choletec, hepatobiliary scan was performed through 4 hours. Images were obtained in the anterior projection. The study demonstrates prompt uptake of radiopharmaceutical by the liver but prolonged intrahepatic transit time. The biliary tree and gallbladder were first visualized at 30 minutes and there was progressive filling of the gallbladder through 4 hours but delayed visualization of bowel which was not seen until 4 hours. The intrahepatic portion of the biliary tree was not optimally seen. There was no obvious biliary dilatation.

IMPRESSION:

1. Prolonged intrahepatic transit time suggestive of hepatocellular disease. Correlation with the patient’s hepatic function tests is recommended. 2. Patent cystic duct. No scintigraphic evidence for acute cholecystitis. 3. Delayed visualization of bowel which first visualized at 4 hours which could be due to preferential filling of the gallbladder in the prolonged intrahepatic transit time. 4. Poor visualization of the pancreatic portion of the common bile duct of uncertain significance. A CT scan of the abdomen might be helpful in further evaluation of the pancreas.

Electronically signed by Maria Costello on April 2, 2017 at 09:30AM

Hepatobiliary Scan (SAMPLE) 1 NOTE: This is a SAMPLE only. Protocols submitted with the application MUST be customized to reflect current practices of the facility.