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NUCLEAR PROCEDURE QUICK GUIDE PROCEDURE/CPT CODE PATIENT PREP/DURATION COMMON INDICATIONS

NUCLEAR CARDIAC STRESS TEST - NPO AFTER MIDNIGHT, EXCEPT - CHEST PAIN -78452- H20 - ABNORMAL EKG -93017- - IF ORDERED AS - CHF -A9502- (X2) TREADMILL/EXERCISE, - CAD WITHHOLD ALL BETA - PALPITATIONS + W/LEXISCAN (IF INDICATED) BLOCKERS 24 HRS. PRIOR (this - SOB -J2785- is not required for LEXI) - PRE-OPERATIVE EVAL. - WITHHOLD ALL NITRATES 24 - ANGINA PECTORIS HRS. PRIOR - CABG STATUS - IMPORTANT: BRING BP MEDS - ACUTE MI **USE CARDIAC STRESS FORM OR OTHER MEDS WITH YOU IF HELD FOR EXAM. **NEXT GEN NOTES FROM GOSHEN - CAFFEINE-FREE MIN. 12 HRS. HEALTH ** (THIS INCLUDES COFFEE, TEA, SODAS, CHOCOLATE, ENERGY SUPPLEMENTS/DRINKS, AND EXCEDRIN.) - WEAR COMFORTABLE SHOES/CLOTHING, PREFERABLY WITH NO METAL ON SHIRT - SHOWER, BUT NO LOTION OR OILS ON ABDOMEN/CHEST - BRING A SNACK OR MONEY FOR CAFETERIA - EXAM TIME: 3.5-4.0 HRS. BONE SCAN - NO PREP - POSSIBLE FRACTURE 3-PHASE - GENERAL HYDRATION IS - LOOSENING PROSTHESIS -78315- HELPFUL - OSTEOMYELITIS VS. -A9503- - EXAM TIME TOTAL: 4HRS. CELLULITIS - INITIAL: 15-30 MIN. - EVALUATION OF REFLEX SPECT/CT IF INDICATED - CIRCULATION TIME: 3 HRS. SYMPATHETIC -78999- PATIENT MAY LEAVE DURING DYSTROPHY THIS TIME. - SCAN TIME: 15-45 MIN. BONE SCAN - NO PREP - RELATED TO LIMITED - GENERAL HYDRATION IS A FOCAL AREA -78300- HELPFUL -A9503- - EXAM TIME TOTAL: 3.5- 4 HRS. - INJECTION: 15 MIN. SPECT/CT IF INDICATED - CIRCULATION TIME: 3 HRS. -78999- PATIENT MAY LEAVE DURING THIS TIME. - SCAN TIME: 30 MIN.

Revised 08/2019 NUCLEAR MEDICINE PROCEDURE QUICK GUIDE PROCEDURE/CPT CODE PATIENT PREP/DURATION COMMON INDICATIONS

BONE SCAN - NO PREP - STAGING, RE-STAGING WHOLE BODY (TOTAL) - GENERAL HYDRATION IS EVALUATIONS FOR ANY -78306- HELPFUL TYPE OF CANCER -A9503- - EXAM TIME TOTAL: 4 HRS. - METASTATIC - INJECTION: 15 MIN. - WIDESPREAD BONE SPECT/CT IF INDICATED - CIRCULATION TIME: 3 HRS. PAIN -78999- PATIENT MAY LEAVE DURING - PAGET’S DISEASE THIS TIME. - SCAN TIME: 45 MIN. **ALL CANCER PATIENTS MUST HAVE CLINIC NOTES. **FOR ALL PROSTATE CANCER PATIENTS, PULL PSA LAB VALUE HISTORY.

GASTRIC EMPTYING - STRICT NPO AFTER MIDNIGHT - GASTROPARESIS -78264- - DISCONTINUE SEDATIVES 12 - WEIGHT LOSS -A9541- HR. PRIOR - DELAYED GASTRIC - BRING MEDICATION LIST EMPTYING - CONTRAINDICATION: - NAUSEA, VOMITING, TO EGGS EARLY SATIETY, - EXAM TIME: 4.25 HRS. BLOATING, UPPER ABDOMINAL **USE GASTRIC FORM DISCOMFORT - EVALUATE MECHANICAL OBSTRUCTION HIDA - NO PREP - EVALUATION OF -78226- - EXAM TIME: 1.25 HRS. CHOLECYSTITIS, GALL -A9537- BLADDER INFLAMMATION, CYSTIC OR COMMON BILE DUCTS - EVALUATION OF OBSTRUCTION - EVALUATION AFTER FOR SUSPECTED LEAKAGE.

Revised 08/2019 NUCLEAR MEDICINE PROCEDURE QUICK GUIDE PROCEDURE/CPT CODE PATIENT PREP/DURATION COMMON INDICATIONS

HIDA W/EJECTION FRACTION - STRICT NPO 6 HRS. - RUQ PAIN -78227- - NO NARCOTICS MINIMUM 6 - ABDOMINAL PAIN -A9537- HRS. PRIOR - EVALUATION OF -J2805- - EXAM TIME: 2.5 HRS. + CHOLEYCYSTITIS - EVALUATION OF CHOLELITHIASIS; OBSTRUCTION - CALCULATION OF EJECTION FRACTION

PARATHYROID SCAN WITH SPECT/CT - NO PREP - ELEVATED PTH AND CA+ -78072- - PLEASE PROVIDE PTH AND CA+ LAB LAB RESULTS -A9500- RESULTS - DETECTION AND - EXAM TIME: 2.5 HRS. LOCALIZATION OF PARATHROID CA **PATIENT MUST HAVE PTH AND CA+ - DETECTION AND LAB VALUES WITHIN 30 DAYS. LOCALIZATION OF ADENOMAS OR PARATHYROID TISSUE GI BLEED STUDY - NO PREP - DETECTION AND -78278- - EXAM TIME: 1.5 HR. + LOCALIZATION OF -A9560- ACTIVE ABDOMINAL BLEEDING SITES UNLISTED SPECT/CT IF INDICATED -78999- MUGA - NO PREP - EVALUATE WALL -78472- - EXAM TIME: 1.25 HRS. MOTION -A9560- - CALCULATION OF EF, VENTRICULAR VOLUME, CARDIAC OUTPUT AND DIASTOLIC FUNCTION - ASSESSMENT OF CHF - EVALUATION PRE- OR POST- CHEMO OR - DYSPNEA SENTINEL NODE FOR BREAST - NPO FOR SURGERY - LOCALIZATION OF -38792- - EXAM TIME: 30 MINUTES LYMPH NODES FOR -A9520- SURGICAL **ORDER FROM DS SCHEDULING INTERVENTION SYSTEM. IT SHOULD STATE NM INJECTION, INDICATING APPROPRIATE SIDE.

Revised 08/2019 NUCLEAR MEDICINE PROCEDURE QUICK GUIDE PROCEDURE/CPT CODE PATIENT PREP/DURATION COMMON INDICATIONS

RENAL SCAN W/FLOW AND - PATIENT SHOULD BE WELL - EVALUATION OF KIDNEY FUNCTION HYDRATED TRANSPLANT -78707- - EXAM TIME: 30-45 MIN. - EVALUATION OF RENAL -A9562 TUBULAR FUNCTION AND PERFUSION RENAL SCAN W/FLOW, FUNCTION, - PATIENT SHOULD BE WELL - EVALUATION OF RENAL AND WASHOUT (LASIX) HYDRATED OBSTRUCTIVE -78708- - EXAM TIME: 45 MIN.-1 HR. NEPHROPATHY AND/OR -A9562- HYDRONEPHROSIS - EVALUATION OF KIDNEY TRANSPLANT - EVALUATION OF RENAL TUBULAR FUNCTION AND PERFUSION LYMPHOSCINTIGRAPHY WITH - NPO FOR SURGERY - LOCALIZATION OF SPECT/CT - EXAM TIME: 2 HRS. LYMPH NODE -78195- INVOLVEMENT FOR -A9520- **ORDER COMES FROM DAY SURGERY SURGICAL -78999- SCHEDULING SYSTEM. IT SHOULD INTERVENTION STATE NUCLEAR MEDICINE INJECTION - MELANOMA WITH IMAGING OR LYMPHOSCINTIGRAPHY , INDICATING LOCATION AND SIDE.

MECKEL’S DIVERTICULUM - NPO MINIMUM 4 HRS. - LOCALIZATION OF -78290- - EXAM TIME: 1.25 HRS. MECKEL’S -A9512- DIVERTICULUM

OCTREOSCAN SERIES WITH - PATIENT SHOULD BE WELL - DETECTION AND SPECT/CT HYDRATED LOCALIZATION OF -78804- - MILD LAXATIVE IF NEEDED SOMATOSTATIN -A9572- - EXAM TIME: RECEPTORS ON -78999- DAY1 INJECTION: 15 MIN. PRIMARY AND DAY 1 CIRCULATION: 4 HR. METASTATIC DAY 1 SCAN: 30 MIN. NEUROENDOCRINE DAY 2 SCAN: 1.5 HR. TUMORS

Revised 08/2019 NUCLEAR MEDICINE PROCEDURE QUICK GUIDE PROCEDURE/CPT CODE PATIENT PREP/DURATION COMMON INDICATIONS

LUNG PERFUSION/QUANTIFICATION - NO PREP - EVALUATE HIGH-RISK -78597- - SCAN TIME: 20 MINUTES PATIENTS -A9540- **CHEST X-RAY REQUIRED WITHIN PREOPERATIVELY FOR 24 HR. OF PERFUSION SURGICAL CANDIDACY - EVALUATION OF PULMONARY PERFUSION LUNG VENTILATION/PERFUSION - NO PREP - EVALUATION OF PE (V/Q) - SCAN TIME: 30 MINUTES - EVALUATION OF -78582- **CHEST X-RAY REQUIRED WITHIN PULMONARY -A9540- 24 HR. OF V/Q PERFUSION -A9558- - CP - SOB - LOW O2 SATURATION

IN-111 TAGGED - NO PREP - DETECTION AND STUDY - SEND ANY ASSOCIATED LAB LOCALIZATION OF LIMITED RESULTS ACUTE AND CHRONIC -78805- - ANTIBIOTICS DECREASE LEUKOCYTE OSTEOMYELITIS OF -A9547- CHEMOTAXIS FOCAL AREA - ACUTE FOCAL WITH SPECT/CT IF INDICATED ***MUST CONTACT NM COLLEAGUE ABSCESSES -78999- TO CHECK AVAILABILITY OF IF - PROSTHESIS REJECTION NEXT DAY ***MINIMUM 24 HR. SCAN: CAN ONLY START MONDAY-THURSDAY

IN-111 TAGGED WHITE BLOOD CELL - NO PREP - FEVER OF UNKNOWN STUDY - SEND ANY ASSOCIATED LAB ORIGIN WHOLE BODY RESULTS - ACUTE INFLAMMATORY -78806- - ANTIOBIOTICS DECREASE DISEASE -A9547- LEUKOCYTE CHEMOTAXIS - DIFFERENTIATION OF PULMONARY WITH SPECT/CT IF INDICATED ***MUST CONTACT NM COLLEAGUE INFILTRATES -78999- TO CHECK AVAILABILITY OF ISOTOPE IF NEXT DAY ***MINIMUM 24 HR. SCAN: CAN ONLY START MONDAY-THURSDAY

Revised 08/2019 NUCLEAR MEDICINE PROCEDURE QUICK GUIDE PROCEDURE/CPT CODE PATIENT PREP/DURATION COMMON INDICATIONS

THYROID UPTAKE ONLY - DAY 1, TIME INITIAL: 15 MINUTES - EVALUATION OF (RAIU) - CIRCULATION: 4 HRS OR -78012- - UPTAKE: 15 MINUTES HYPOTHYROIDISM -A9516- X3 - DAY 2, UPTAKE TIME: 15 MINUTES - TOXIC GOITER **DO NOT CALL** - THYROIDITIS **NEED LABS** - ABN THYROID SERUM -FREE T3 LAB RESULTS -FREE T4 - DIFFERENTIATION OF -TSH BENIGN VS. MALIGNANT THYROID NODULES ABLATION - CONTACT NUCLEAR MEDICINE @ - THYROID CANCER -78018- X2 -2605 -78020- -79005- -A9517- THYROID CA EVALUATION - CONTACT NUCLEAR MEDICINE @ - THYROID CANCER -78018- -2605 -78020-

THYROID UPTAKE AND SCAN - DAY 1 EXAM TIME INITIAL: 15 - EVALUATION OF (RAIU DIAGNOSTIC) MINUTES THYROID ANATOMY -78014- - CIRCULATION: 4 HRS - EVALUATION OF -A9516- X3 - UPTAKE AND SCAN: 30 MIN. HYPERTHYROIDISM OR - DAY 2 UPTAKE EXAM TIME: 15 HYPOTHYROIDISM MIN. - TOXIC GOITER - THYROIDITIS **DO NOT CALL** - ABN THYROID SERUM **NEED LABS** LAB RESULTS -FREE T3 - DIFFERENTIATION OF -FREE T4 BENIGN VS. MALIGNANT TSH THYROID NODULES

**USE THYROID FORMS (2)

Revised 08/2019 NUCLEAR MEDICINE PROCEDURE QUICK GUIDE

SPECIAL CONSIDERATIONS

**CHECK SCHEDULE AT 12 PM OR AFTER. ALL NEXT DAY ADD-ONS, NEXT DAY CANCELLATIONS, AND NEXT DAY TIME CHANGES MUST BE CONVEYED TO NUCLEAR MEDICINE COORDINATOR OR TECHNOLOGIST, SO THAT MAY BE ORDERED OR CANCELLED.

**I-123 UPTAKE AND SCANS REQUIRE FREE T3, FREE T4, AND TSH LAB VALUES, WITHIN 30 DAYS. PLEASE OBTAIN FROM EMR OR ’S OFFICE.

**PARATHYROID SCANS REQUIRE CA+ AND PTH LAB VALUES, WITHIN 30 DAYS. PLEASE OBTAIN FROM EMR OR PHYSICIAN’S OFFICE.

**CLINIC NOTES SHOULD BE PULLED ON ALL CANCER PATIENTS

**PSA LAB VALUE HISTORY SHOULD BE PULLED ON ALL PROSTATE CANCER PATIENTS

**ALL THERAPY PROCEDURES MUST BE SCHEDULED DIRECTLY WITH TECHNOLOGISTS.

Revised 08/2019