BJ17-1195-4220 (02/17) BJ17-1195-4220

BMD (e.g., fluoride exposure). fluoride (e.g., BMD

BMD; 2) who are at risk for low BMD; or 3) who have suspected pathologically increased increased pathologically suspected have who 3) or BMD; low for risk at are who 2) BMD;

Indications include but are not limited to individuals: 1) with established or suspected low low suspected or established with 1) individuals: to limited not are but include Indications

estimation of future fracture risk, and to monitor response to therapy for these conditions. conditions. these for therapy to response monitor to and risk, fracture future of estimation

and other disease states characterized by abnormal bone mineral density (BMD), for the the for (BMD), density mineral bone abnormal by characterized states disease other and

Washington University’s Mallinckrodt Institute of Radiology. of Institute Mallinckrodt University’s Washington Dual-energy x-ray absorptiometry (DXA) is used primarily in the diagnosis of osteoporosis osteoporosis of diagnosis the in primarily used is (DXA) absorptiometry x-ray Dual-energy •

All exams are read by subspecialized radiologists from from radiologists subspecialized by read are exams All 30 minutes 30 Department: in Time least 24 hours before the study. the before hours 24 least

Patients should withhold oral calcium supplements (such as Tums) for at at for Tums) as (such supplements calcium oral withhold should Patients

Interfering Conditions). Interfering Monday – Friday and 7:30a.m. – 11:00a.m. on Saturdays. on 11:00a.m. – 7:30a.m. and Friday – Monday

(see (see radiopharmaceutical a or agents contrast oral of administration involving Outpatient Nuclear Medicine studies are available 7a.m. – 3:00p.m. 3:00p.m. – 7a.m. available are studies Medicine Nuclear Outpatient

CT colonography, or another radiology or nuclear medicine examination examination medicine nuclear or radiology another or colonography, CT Friday. – Monday 5:30p.m. – 7a.m. 877-992-7111, or 314-362-7111

examination should not be scheduled within 1 week after a barium enema, enema, barium a after week 1 within scheduled be not should examination

To schedule a Nuclear Medicine study please call Radiology Scheduling at at Scheduling Radiology call please study Medicine Nuclear a schedule To

examination involving administration of intravenous contrast material. The The material. contrast intravenous of administration involving examination reach the appropriate sub-specialty radiologist, please call 314-454-8945. 314-454-8945. call please radiologist, sub-specialty appropriate the reach

examination should not be scheduled within 1 day after another radiology radiology another after day 1 within scheduled be not should examination For questions regarding how to order any Nuclear Medicine study or how to to how or study Medicine Nuclear any order to how regarding questions For

Patients are scheduled through the centralized scheduling office. The The office. scheduling centralized the through scheduled are Patients Prep:

CPT Code 77080 Code CPT Pelvis or Spine Hip, sites, 2 – DXA Density Bone

any other radiation safety question, please feel free to call the nuclear medicine division. medicine nuclear the call to free feel please question, safety radiation other any

If you have specific questions regarding the radiopharmaceutical used for each procedure or or procedure each for used radiopharmaceutical the regarding questions specific have you If BMD (e.g., fluoride exposure). fluoride (e.g., BMD

BMD; 2) who are at risk for low BMD; or 3) who have suspected pathologically increased increased pathologically suspected have who 3) or BMD; low for risk at are who 2) BMD; before coming in for the procedure. the for in coming before

Indications include but are not limited to individuals: 1) with established or suspected low low suspected or established with 1) individuals: to limited not are but include Indications breast-feeding, please call and discuss all options with the nuclear medicine department department medicine nuclear the with options all discuss and call please breast-feeding,

estimation of future fracture risk, and to monitor response to therapy for these conditions. conditions. these for therapy to response monitor to and risk, fracture future of estimation with the ordering doctor prior to ordering the nuclear medicine procedure. If a patient is is patient a If procedure. medicine nuclear the ordering to prior doctor ordering the with

and other disease states characterized by abnormal bone mineral density (BMD), for the the for (BMD), density mineral bone abnormal by characterized states disease other and If there is a chance that a patient is pregnant, please make sure that this gets discussed discussed gets this that sure make please pregnant, is patient a that chance a is there If

Dual-energy x-ray absorptiometry (DXA) is used primarily in the diagnosis of osteoporosis osteoporosis of diagnosis the in primarily used is (DXA) absorptiometry x-ray Dual-energy •

nuclear medicine gamma cameras for diagnostic inquiries. diagnostic for cameras gamma medicine nuclear

30 minutes 30 Department: in Time least 24 hours before the study. the before hours 24 least

radioactivity gets injected for nuclear medicine exams. These tracers are then visualized by by visualized then are tracers These exams. medicine nuclear for injected gets radioactivity

Patients should withhold oral calcium supplements (such as Tums) for at at for Tums) as (such supplements calcium oral withhold should Patients and in most cases specifically for each patient. Generally, a small and safe amount of of amount safe and small a Generally, patient. each for specifically cases most in and

tracers). Each radiopharmaceutical is prepared for a specific imaging or therapeutic exam, exam, therapeutic or imaging specific a for prepared is radiopharmaceutical Each tracers).

Interfering Conditions). Interfering

There are many different types of nuclear medicine radiopharmaceuticals (diagnostic (diagnostic radiopharmaceuticals medicine nuclear of types different many are There

(see (see radiopharmaceutical a or agents contrast oral of administration involving

Nuclear Medicine Radiopharmaceuticals Medicine Nuclear CT colonography, or another radiology or nuclear medicine examination examination medicine nuclear or radiology another or colonography, CT

examination should not be scheduled within 1 week after a barium enema, enema, barium a after week 1 within scheduled be not should examination

BMD (e.g., fluoride exposure). fluoride (e.g., BMD

examination involving administration of intravenous contrast material. The The material. contrast intravenous of administration involving examination

BMD; 2) who are at risk for low BMD; or 3) who have suspected pathologically increased increased pathologically suspected have who 3) or BMD; low for risk at are who 2) BMD;

examination should not be scheduled within 1 day after another radiology radiology another after day 1 within scheduled be not should examination

Indications include but are not limited to individuals: 1) with established or suspected low low suspected or established with 1) individuals: to limited not are but include Indications

Patients are scheduled through the centralized scheduling office. The The office. scheduling centralized the through scheduled are Patients Prep:

estimation of future fracture risk, and to monitor response to therapy for these conditions. conditions. these for therapy to response monitor to and risk, fracture future of estimation

CPT Code 77080 Code CPT Pelvis or Spine Hip, site, 1 – DXA Density Bone

and other disease states characterized by abnormal bone mineral density (BMD), for the the for (BMD), density mineral bone abnormal by characterized states disease other and

BONE DENSITY BONE

Dual-energy x-ray absorptiometry (DXA) is used primarily in the diagnosis of osteoporosis osteoporosis of diagnosis the in primarily used is (DXA) absorptiometry x-ray Dual-energy •

30 minutes 30 Department: in Time study. the before hours 24 least

(2) For head & neck and OB lymphoscintigraphy, SPECT/CT is often indicated. often is SPECT/CT lymphoscintigraphy, OB and neck & head For (2) • Patients should withhold oral calcium supplements (such as Tums) for at at for Tums) as (such supplements calcium oral withhold should Patients

obtained. obtained. Conditions).

lymph nodes. Because of timing issues related to surgery, on occasion, images may not be be not may images occasion, on surgery, to related issues timing of Because nodes. lymph (see Interfering Interfering (see radiopharmaceutical a or agents contrast oral of administration

SPECT/CT may be indicated to provide better anatomical localization of the sentinel sentinel the of localization anatomical better provide to indicated be may SPECT/CT (1) •

colonography, or another radiology or nuclear medicine examination involving involving examination medicine nuclear or radiology another or colonography,

2 hours or longer if deemed necessary by radiologist by necessary deemed if longer or hours 2 Department: in Time examination should not be scheduled within 1 week after a barium enema, CT CT enema, barium a after week 1 within scheduled be not should examination

examination involving administration of intravenous contrast material. The The material. contrast intravenous of administration involving examination injection(s). to prior antiseptic topical appropriate

examination should not be scheduled within 1 day after another radiology radiology another after day 1 within scheduled be not should examination an with cleaned is site injection The physician. their with times NPO discuss

Patients are scheduled through the centralized scheduling office. The The office. scheduling centralized the through scheduled are Patients should they then surgery, day same for scheduled is patient the unless None, Prep: Prep:

CPT Code 77081 Code CPT Forearm – DXA Density Bone 78803 Code CPT Tomographic Lymphoscintigraphy,

Updated 2017 Nuclear Medicine Ordering Guide

ENDOCRINE DaTScan Imaging CPT Code 78607 Prep: Interfering medications may exist, please discuss with referring Thyroid Uptake and Scan CPT Code 78014 physician and call Nuclear Medicine for further clarification. Prep: Interfering medications may exist, please discuss with referring Time in Department: 1 hour for injection, then return 3 hours later for physician and call Nuclear Medicine for further clarification. 1 hour of imaging Time in Department: 2 day test (1) DaTScan brain imaging is used to assist in the evaluation of adult patients with suspected Whole Body Scan with I-131 CPT Code 78018 parkinsonian syndromes (PS). Prep: Interfering medications may exist, please discuss with referring physician (2) This scan may be used to help differentiate essential tremor from tremor due to PS. and call Nuclear Medicine for further clarification. CSF Flow Study – Normal Pressure Time in Department: 2 days Hydrocephalus Cisternogram CPT Code 78630 Parathyroid Scan with SPECT-CT CPT Code 78072 Prep: None for Nuclear Medicine, please discuss with Interventional Radiology Prep: None Time in Department: 3 hours for exam specific prep. Time in Department: 1-3 days • Parathyroid scintigraphy is performed to localize parathyroid adenomas or hyperplastic • Radionuclide cisternography is most often performed for: (1) evaluation of patients with parathyroid glands in patients with documented hyperparathyroidism. It is particularly helpful suspected communicating hydrocephalus due to obstruction of cerebrospinal fluid (CSF) in patients who have persistent or recurrent hyperparathyroidism after parathyroidectomy. flow in the subarachnoid space, and especially in those thought to have so-called “normal- SPECT/CT is most useful in patients with prior neck surgery or in patients where the initial pressure hydrocephalus”; and (2) for evaluation of patients with a suspected CSF leak. planar images show a possible parathyroid adenoma in an ectopic location. CSF Flow Study – Shunt Evaluation CPT Code 78645 Prep: None Time in Department: 1-2 hours THERAPIES • Cerebrospinal (CSF) shunt scintigraphy is performed to determine the patency and function of I-131 Treatment for Hyperthyroid CPT Code 79005 a CSF shunt system. Prep: Interfering medications may exist, please discuss with referring physician and call Nuclear Medicine for further clarification. CSF Leak Detection / Localization – Cisternogram CPT Code 78650 Time in Department: Various Prep: None for Nuclear Medicine, please discuss with Interventional Radiology for exam specific prep. Time in Department: 2 days • Radionuclide cisternography for cerebrospinal fluid (CSF) leak detection is indicated for NEURO documenting and localizing the presence of a CSF leak in a patient in whom this diagnosis is Brain Scan with SPECT-CT CPT Code 78607 suspected (e.g., because of rhinorrhea, otorrhea, or recurrent meningitis). Prep: None Time in Department: 90 minutes • Brain perfusion SPECT is most commonly performed (1) to aid in identification of the All exams are read by subspecialized radiologists from epileptogenic focus in patients with medically refractory epilepsy (usually partial complex seizures) in whom surgical treatment is being considered; and (2) to evaluate the adequacy Washington University’s Mallinckrodt Institute of Radiology. of collateral cerebral blood flow in patients who are being evaluated before planned surgical sacrifice of an internal carotid artery. It is also occasionally used as an adjunctive diagnostic technique to assess cerebral blood flow patterns in patients with suspected cerebral vasculitis, dementia, or focal neurologic disease with normal CT or MRI.

To schedule a Nuclear Medicine study please call Radiology Scheduling at 314-362-7111 or 877-992-7111

CARDIAC • I-123 MIBG Scintigraphy  Prep: None The patient should discuss with their physician possible medication Myocardial Perfusion Imaging, SPECT, multiple CPT Code 78452 adjustments that may need to be made. Prep: The patient should be fasting for 4 hours prior to appointment and abstain  Time in Department: Day of Injection 30-60 minutes, from caffeine and decaffeinated beverages for 12 hours. The patient Imaging Day (24 hours later) 2 hours should discuss with their physician possible medication adjustments that  Metaiodobenzylguanidine (MIBG) is an analog of norepinephrine and is taken up selectively may need to be made. Time in Department: 3-4 hours by the adrenal medulla, the sympathetic autonomic nervous system, and tumors derived • Evaluation of myocardial perfusion and viability in patients with known or suspected from these tissues. Uptake occurs chiefly via the energy-dependent type I amine uptake coronary artery disease. The most common indications include (1) diagnosing coronary artery mechanism. Retention of MIBG within the intravesicular hormone storage compartment disease in patients with clinical features indicating an intermediate probability of disease; of cells in the adrenal medulla, and in pheochromocytomas and neuroblastomas permits (2) determining the pathophysiological significance of known coronary artery stenoses; (3) their scintigraphic detection. MIBG can be labeled with either I-131 or I-123. Although it determining the extent of myocardial ischemia and assessing prognosis after myocardial is more expensive, I-123 MIBG is the preferred radiopharmaceutical because it produces infarction; (4) assessing for risk of cardiac events prior to noncardiac surgery; (5) detecting much better image quality with lower radiation exposure. coronary re-stenosis after angioplasty and graft occlusion after bypass surgery; and (6) evaluating the effectiveness of medical therapy. Tumor Imaging Tomographic CPT Code 78803 Prep: None Time in Department: 1 hour each MUGA / RVG – Cardiac Blood Pool Imaging, Resting CPT Code 78472 • These SPECT/CT exams are typically performed in conjunction with CPT 78802, or 78804. Prep: None Time in Department: 90 minutes • Cardiac blood-pool imaging [radionuclide ventriculography (RVG)] is primarily useful in Whole Body Tumor Imaging, 2+ Days CPT Code 78804 assessing ventricular function. Quantitative analysis provides an accurate measurement of • Octreoscan Tumor Imaging left ventricular ejection fraction. Ventricular function is frequently assessed in: (1) patients  Prep: Patient should be well hydrated. If the patient takes octreotide acetate receiving cardiotoxic chemotherapy; (2) patients with severe lung disease who are being therapy, they should discuss with their physician possible medication evaluated for lung volume reduction surgery or lung transplant; and (3) patients with cardiac adjustments. dysfunction due to an ischemic or nonischemic cardiomyopathy. Cardiac blood-pool imaging  Time in Department: Injection and Imaging Day 1, 30 minutes for injection, can also be used to assess cardiac dysfunction due to valvular disease. followed by a 4 hour break, then 1 hour for imaging. Imaging Day 2, 2 hours  Detection and staging of neuroendocrine tumors containing somatostatin receptors, especially TUMOR AND INFLAMMATION carcinoid tumors, paragangliomas, gastrinomas, and other pancreatic islet cell tumors. Whole Body Tumor Imaging CPT Code 78802 RENAL • Prostascint Tumor Imaging Renal Scan with Flow and Function CPT Code 78707  Prep: None is necessary on or before the day of the radiopharmaceutical injection. On the day prior to tumor imaging, and after breakfast on the Prep: The patient should be well hydrated Time in Department: 1-2 hours day of the examination, the patient should restrict food intake to a liquid • Evaluation of renal perfusion and relative renal function, especially in patients with renal failure; diet. Also, on the afternoon of the day prior to tumor imaging, the patient and assessment for obstruction (when done as the first phase of diuretic renal scintigraphy). should take a cathartic (one bottle magnesium citrate, or two bisacodyl • Evaluation of patients with known or suspected urinary tract obstruction. Some patients with [Dulcolax®] tablets in patients unable to tolerate magnesium citrate). pelvicalyceal or ureteral dilatation may not have physiologically significant obstruction. Diuretic renal scintigraphy is based on the concept that activity in an unobstructed system will clear  Time in Department: Day of Injection 30-60 minutes, rapidly as a result of the high urine flow rate that occurs following administration of a diuretic. Imaging Day (4-5 days later) 3 hours Conversely, a high flow rate will not be achieved in the presence of significant obstruction, and  Localization of primary, recurrent, or metastatic adenocarcinoma of the prostate. The there will be absent or slow clearance of pelvicalyceal and/or ureteral activity. test is most often employed (1) before initial therapy in men whose clinical staging data suggest a high likelihood of regional nodal metastasis; and (2) in men who have GFR – Glomerular Filtration Rate Study CPT Code 78725 undergone prostatectomy or prostatic irradiation as primary therapy and now have Prep: The patient should be well hydrated. Time in Department: 5 hours suspected recurrent or metastatic disease evidenced by a rising blood level of prostate- • Measurement of glomerular filtration rate (GFR) by radionuclide tracer methods is indicated specific antigen (PSA). when more precise information than that provided by the measurement of creatinine clearance is required or when the latter measurement is impractical (infants and small To schedule a Nuclear Medicine study please call children, incontinent patients) or likely to be unreliable (because of marked impairment of Radiology Scheduling at 314-362-7111 or 877-992-7111 renal function or because the patient is taking medications known to interfere with the tubular secretion of creatinine)

RESPIRATORY Hepatobiliary Imaging with Gallbladder Ejection Fraction CPT Code 78227 Prep: Patients must be fasting for at least 4 hours, and no more than 24 hours. Lung Scan, Ventilation/Perfusion, VQ CPT Code 78582 Time in Department: 2-3 hours Prep: None Time in Department: 45 minutes • Hepatobiliary imaging with gallbladder ejection fraction measurement is indicated in patients • Evaluation of regional pulmonary ventilation for use in conjunction with pulmonary perfusion with chronic abdominal pain that may be due to biliary dyskinesia or chronic cholecystitis. scintigraphy in the diagnosis of pulmonary embolism. • Pulmonary perfusion scintigraphy is indicated for diagnosis of pulmonary embolism (usually Gastric Emptying Study CPT Code 78264 in conjunction with pulmonary ventilation imaging). Prep: NPO after midnight the day before the test. Patients who are allergic to egg substitute should not have this study. Time in Department: 5 hours Lung Scan, Quantitative Perfusion CPT Code 78597 Prep: None Time in Department: 30 minutes • This study is primarily performed in patients suspected of having gastroparesis, a condition • Pulmonary perfusion scintigraphy is indicated for quantification of regional pulmonary defined as delayed gastric emptying in the absence of mechanical obstruction. These patients perfusion (e.g., in patients undergoing preoperative assessment for pneumonectomy, lung frequently have nausea and vomiting. The condition may be a consequence of diabetes. transplantation, or volume reduction or in patients undergoing follow-up evaluation after lung transplantation). LYMPHATIC Lung Scan, Quantitative Ventilation/Perfusion, VQ CPT Code 78598 Lymphoscintigraphy, complete CPT Code 78195 Prep: None Time in Department: 45 minutes Prep: None, unless the patient is scheduled for same day surgery, then they should • Evaluation and quantification of regional pulmonary ventilation: (1) before surgery for discuss NPO times with their physician. The injection site is cleaned with an lung cancer in patients with severe obstructive pulmonary disease; (2) before and after appropriate topical antiseptic prior to injection(s). lung transplantation; and (3) before and after bullectomy or volume reduction surgery for Time in Department: 2 hours or longer if deemed obstructive pulmonary disease. necessary by radiologist • Pulmonary perfusion scintigraphy is indicated for quantification of regional pulmonary • Lymphoscintigraphy is indicated to identify the axillary lymph node or nodes that receive the perfusion (e.g., in patients undergoing preoperative assessment for pneumonectomy, lung primary lymphatic drainage from a breast cancer (sentinel nodes). transplantation, or volume reduction or in patients undergoing follow-up evaluation after • Lymphoscintigraphy is indicated to determine the rate and pattern of drainage of lymph in lung transplantation). patients with suspected congenital or acquired lymphedema. • Lymphoscintigraphy is indicated to determine the lymphatic drainage of malignant melanomas MUSCULOSKELETAL and other skin cancers (e.g., squamous cell carcinoma and Merkel cell carcinoma). The goals Bone Scan, Whole Body CPT Code 78306 are to (1) determine the pathway(s) of lymphatic drainage and (2) identify the lymph node(s) Prep: None Time in Department: 3-4 hours that receive the primary lymphatic drainage from the tumor (the sentinel lymph nodes). • Evaluation for skeletal metastases, infection, or trauma. SPECT/CT may be indicated to provide better anatomical localization of the sentinel lymph nodes, especially for tumors in the head and neck region. Bone Scan, Three Phase CPT Code 78315 • Lymphoscintigraphy is indicated to determine the lymphatic drainage of head and neck Prep: None Time in Department: 3-4 hours cancers. The goals are to (1) determine the pathway(s) of lymphatic drainage and (2) identify (1) A three phase exam will better show trauma and infection rather than whole body imaging. the lymph node(s) that receive the primary lymphatic drainage from the tumor (the sentinel (2) This exam is also desirable in cases of prosthetic loosening evaluation. lymph nodes). SPECT/CT may be indicated to provide better anatomical localization of the sentinel lymph nodes. Bone Scan with SPECT CPT Code 78320 Prep: None Time in Department: 3-4 hours • Vulvar lymphoscintigraphy is indicated to determine the lymphatic drainage of vulvar carcinoma. The goals are to: (1) identify the sentinel lymph nodes; and (2) determine the sites • Evaluation for skeletal metastases, infection, or trauma. This exam specifically looks at one of lymphatic drainage. SPECT/CT may be indicated to provide better anatomical localization part of the body with high resolution. of the sentinel lymph nodes. Because of timing issues related to surgery, on occasion, images GASTROINTESTINAL may not be obtained. Hepatobiliary Imaging including Gallbladder if present CPT Code 78226 Prep: Patients must be fasting for at least 4 hours, and no more than 24 hours. Time in Department: 2-6 hours • The most common indication for hepatobiliary imaging is to determine if a patient has acute To schedule a Nuclear Medicine study please call cholecystitis. Less commonly, the study is ordered to evaluate for a bile leak. Rarely, the Radiology Scheduling at 314-362-7111 or 877-992-7111 study is requested to determine the patency of the common bile duct in an adult patient. CARDIAC • I-123 MIBG Scintigraphy  Prep: None The patient should discuss with their physician possible medication Myocardial Perfusion Imaging, SPECT, multiple CPT Code 78452 adjustments that may need to be made. Prep: The patient should be fasting for 4 hours prior to appointment and abstain  Time in Department: Day of Injection 30-60 minutes, from caffeine and decaffeinated beverages for 12 hours. The patient Imaging Day (24 hours later) 2 hours should discuss with their physician possible medication adjustments that  Metaiodobenzylguanidine (MIBG) is an analog of norepinephrine and is taken up selectively may need to be made. Time in Department: 3-4 hours by the adrenal medulla, the sympathetic autonomic nervous system, and tumors derived • Evaluation of myocardial perfusion and viability in patients with known or suspected from these tissues. Uptake occurs chiefly via the energy-dependent type I amine uptake coronary artery disease. The most common indications include (1) diagnosing coronary artery mechanism. Retention of MIBG within the intravesicular hormone storage compartment disease in patients with clinical features indicating an intermediate probability of disease; of cells in the adrenal medulla, and in pheochromocytomas and neuroblastomas permits (2) determining the pathophysiological significance of known coronary artery stenoses; (3) their scintigraphic detection. MIBG can be labeled with either I-131 or I-123. Although it determining the extent of myocardial ischemia and assessing prognosis after myocardial is more expensive, I-123 MIBG is the preferred radiopharmaceutical because it produces infarction; (4) assessing for risk of cardiac events prior to noncardiac surgery; (5) detecting much better image quality with lower radiation exposure. coronary re-stenosis after angioplasty and graft occlusion after bypass surgery; and (6) evaluating the effectiveness of medical therapy. Tumor Imaging Tomographic CPT Code 78803 Prep: None Time in Department: 1 hour each MUGA / RVG – Cardiac Blood Pool Imaging, Resting CPT Code 78472 • These SPECT/CT exams are typically performed in conjunction with CPT 78802, or 78804. Prep: None Time in Department: 90 minutes • Cardiac blood-pool imaging [radionuclide ventriculography (RVG)] is primarily useful in Whole Body Tumor Imaging, 2+ Days CPT Code 78804 assessing ventricular function. Quantitative analysis provides an accurate measurement of • Octreoscan Tumor Imaging left ventricular ejection fraction. Ventricular function is frequently assessed in: (1) patients  Prep: Patient should be well hydrated. If the patient takes octreotide acetate receiving cardiotoxic chemotherapy; (2) patients with severe lung disease who are being therapy, they should discuss with their physician possible medication evaluated for lung volume reduction surgery or lung transplant; and (3) patients with cardiac adjustments. dysfunction due to an ischemic or nonischemic cardiomyopathy. Cardiac blood-pool imaging  Time in Department: Injection and Imaging Day 1, 30 minutes for injection, can also be used to assess cardiac dysfunction due to valvular disease. followed by a 4 hour break, then 1 hour for imaging. Imaging Day 2, 2 hours  Detection and staging of neuroendocrine tumors containing somatostatin receptors, especially TUMOR AND INFLAMMATION carcinoid tumors, paragangliomas, gastrinomas, and other pancreatic islet cell tumors. Whole Body Tumor Imaging CPT Code 78802 RENAL • Prostascint Tumor Imaging Renal Scan with Flow and Function CPT Code 78707  Prep: None is necessary on or before the day of the radiopharmaceutical injection. On the day prior to tumor imaging, and after breakfast on the Prep: The patient should be well hydrated Time in Department: 1-2 hours day of the examination, the patient should restrict food intake to a liquid • Evaluation of renal perfusion and relative renal function, especially in patients with renal failure; diet. Also, on the afternoon of the day prior to tumor imaging, the patient and assessment for obstruction (when done as the first phase of diuretic renal scintigraphy). should take a cathartic (one bottle magnesium citrate, or two bisacodyl • Evaluation of patients with known or suspected urinary tract obstruction. Some patients with [Dulcolax®] tablets in patients unable to tolerate magnesium citrate). pelvicalyceal or ureteral dilatation may not have physiologically significant obstruction. Diuretic renal scintigraphy is based on the concept that activity in an unobstructed system will clear  Time in Department: Day of Injection 30-60 minutes, rapidly as a result of the high urine flow rate that occurs following administration of a diuretic. Imaging Day (4-5 days later) 3 hours Conversely, a high flow rate will not be achieved in the presence of significant obstruction, and  Localization of primary, recurrent, or metastatic adenocarcinoma of the prostate. The there will be absent or slow clearance of pelvicalyceal and/or ureteral activity. test is most often employed (1) before initial therapy in men whose clinical staging data suggest a high likelihood of regional nodal metastasis; and (2) in men who have GFR – Glomerular Filtration Rate Study CPT Code 78725 undergone prostatectomy or prostatic irradiation as primary therapy and now have Prep: The patient should be well hydrated. Time in Department: 5 hours suspected recurrent or metastatic disease evidenced by a rising blood level of prostate- • Measurement of glomerular filtration rate (GFR) by radionuclide tracer methods is indicated specific antigen (PSA). when more precise information than that provided by the measurement of creatinine clearance is required or when the latter measurement is impractical (infants and small To schedule a Nuclear Medicine study please call children, incontinent patients) or likely to be unreliable (because of marked impairment of Radiology Scheduling at 314-362-7111 or 877-992-7111 renal function or because the patient is taking medications known to interfere with the

tubular secretion of creatinine)

RESPIRATORY Hepatobiliary • I-123 MIBG Imaging Scintigraphy with877-992-7111 Gallbladderor Ejection314-362-7111 at Fraction Scheduling CPTRadiology Code 78227

CARDIAC Prep: Patients mustcall be please fastingstudy for at leastMedicine 4 hours,Nuclear a and no moreschedule To than 24 hours. Lung Scan, Ventilation/Perfusion, VQ CPT Code 78582  Prep: None The patient should discuss with their physician possible medication

Myocardial Perfusion Imaging, SPECT, multiple CPT Code 78452 adjustments that may need to be made. Time in Department: 2-3 hours Prep: None Time in Department: 45 minutes MRI. or CT normal with disease neurologic focal or dementia, vasculitis,

Prep: The patient should be fasting for 4 hours prior to appointment and abstain  • Hepatobiliary Time in Department: imaging with Daygallbladder of Injection ejection 30-60 fraction minutes, measurement is indicated in patients • Evaluation of regional pulmonary ventilation for use in conjunction with pulmonary perfusion cerebral suspected with patients in patterns flow blood cerebral assess to technique

from caffeine and decaffeinated beverages for 12 hours. The patient with chronic abdominal painImaging that may Day be due (24 tohours biliary later) dyskinesia 2 hours or chronic cholecystitis. scintigraphy in the diagnosis of pulmonary embolism. diagnostic adjunctive an as used occasionally also is It artery. carotid internal an of sacrifice

should discuss with their physician possible medication adjustments that  Metaiodobenzylguanidine (MIBG) is an analog of norepinephrine and is taken up selectively • Pulmonary perfusion scintigraphy is indicated for diagnosis of pulmonary embolism (usually Gastricsurgical Emptyingplanned Studybefore evaluated being are who patients in flow blood cerebral CPT Codecollateral 78264of

may need to be made. Time in Department: 3-4 hours by the adrenal medulla, the sympathetic autonomic nervous system, and tumors derived seizures) in whom surgical treatment is being considered; and (2) to evaluate the adequacy adequacy the evaluate to (2) and considered; being is treatment surgical whom in seizures)

in conjunction withRadiology. pulmonaryof ventilationInstitute imaging).Mallinckrodt University’s Washington Prep: NPO after midnight the day before the test. Patients who are allergic to egg

• Evaluation of myocardial perfusion and viability in patients with known or suspected from these tissues. Uptake occurs chiefly via the energy-dependent type I amine uptake epileptogenic focus in patients with medically refractory epilepsy (usually partial complex complex partial (usually epilepsy refractory medically with patients in focus epileptogenic

All exams are read by subspecialized radiologists from from radiologists subspecialized by read are exams All substitute should not have this study. Time in Department: 5 hours

Lung coronaryScan, Quantitative artery disease. Perfusion The most common indications include (1) diagnosing CPT coronary Code 78597 artery mechanism. Retention of MIBG within the intravesicular hormone storage compartment Brain perfusion SPECT is most commonly performed (1) to aid in identification of the the of identification in aid to (1) performed commonly most is SPECT perfusion Brain •

Prep:disease None in patients with clinical features indicating anTime intermediate in Department: probability 30 of minutes disease; • This ofstudy cells is in primarily the adrenal performed medulla, in andpatients in pheochromocytomas suspected of having and gastroparesis, neuroblastomas a condition permits 90 minutes 90 Department: in Time None Prep:

(2) determining the pathophysiological significance of known coronary artery stenoses; (3) defined as delayed gastric emptying in the absence of mechanical obstruction. These patients

• Pulmonary perfusion scintigraphymeningitis). recurrent isor indicatedotorrhea, for quantificationrhinorrhea, of because of regional(e.g., pulmonarysuspected their scintigraphic detection. MIBG can be labeled with either I-131 or I-123. Although it CPT Code 78607 Code CPT SPECT-CT with Scan Brain

determining the extent of myocardial ischemia and assessing prognosis after myocardial frequently have nausea and vomiting. The condition may be a consequence of diabetes.

documenting and localizing the presence of a CSF leak in a patient in whom this diagnosis is is perfusiondiagnosis this (e.g., inwhom patientsin patient undergoinga in leak preoperativeCSF a of assessmentpresence the forlocalizing pneumonectomy,and documenting lung is more expensive, I-123 MIBG is the preferred radiopharmaceutical because it produces

infarction; (4) assessing for risk of cardiac events prior to noncardiac surgery; (5) detecting NEURO Radionuclide cisternography for cerebrospinal fluid (CSF) leak detection is indicated for for indicated is detection leak (CSF) fluid cerebrospinal for cisternography Radionuclide • transplantation, or volume reduction or in patients undergoing follow-up evaluation after much better image quality with lower radiation exposure.

coronary re-stenosis after angioplasty and graft occlusion after bypass surgery; and (6)

2 days 2 Department: in Time for exam specific prep. specific exam for

lung transplantation). LYMPHATIC

Various Department: in Time

evaluating the effectiveness of medical therapy. Tumor Imaging Tomographic CPT Code 78803 None for Nuclear Medicine, please discuss with Interventional Radiology Radiology Interventional with discuss please Medicine, Nuclear for None Prep:

Lymphoscintigraphy, complete CPT Code 78195

physician and call Nuclear Medicine for further clarification. further for Medicine Nuclear call and physician

Lung Scan, Quantitative Ventilation/Perfusion, VQ CPT Code 78598 Prep: None Time in Department: 1 hour each

CPT Code 78650 Code CPT Cisternogram – Localization / Detection Leak CSF

MUGA / RVG – Cardiac Blood Pool Imaging, Resting CPT Code 78472 Prep: None, unless the patient is scheduled for same day surgery, then they should Interfering medications may exist, please discuss with referring referring with discuss please exist, may medications Interfering Prep: Prep: None Time in Department: 45 minutes • These SPECT/CT exams are typically performed in conjunction with CPT 78802, or 78804.

Prep: None Time in Department: 90 minutes discuss NPO times with their physician. The injection site is cleaned with an a CSF shunt system. shunt CSF a CPT Code 79005 Code CPT Hyperthyroid for Treatment I-131

• Evaluation and quantification of regional pulmonary ventilation: (1) before surgery for

• Cardiac blood-pool imaging [radionuclide ventriculography (RVG)] is primarily useful in Whole Bodyappropriate Tumor Imaging, topical antiseptic 2+ Days prior to injection(s). CPT Code 78804

Cerebrospinal (CSF) shunt scintigraphy is performed to determine the patency and function of of function and patency the determine to performed is scintigraphy shunt (CSF) Cerebrospinal • lung cancer in patients with severe obstructive pulmonary disease; (2) before and after THERAPIES

assessing ventricular function. Quantitative analysis provides an accurate measurement of • Octreoscan Tumor Imaging 1-2 hours 1-2 Department: in Time None Prep: lung transplantation; and (3) before and after bullectomy or volume reduction surgery for Time in Department: 2 hours or longer if deemed

left ventricular ejection fraction. Ventricular function is frequently assessed in: (1) patients  Prep: Patient should be well hydrated. If the patient takes octreotide acetate CPT Code 78645 Code CPT Evaluation Shunt – Study Flow CSF

obstructive pulmonary disease. necessary by radiologist

receiving cardiotoxic chemotherapy; (2) patients with severe lung disease who are being therapy, location. they shouldectopic an in discussadenoma with theirparathyroid physicianpossible a possibleshow images medicationplanar

• Pulmonary perfusion scintigraphy is indicated for quantification of regional pulmonary • Lymphoscintigraphy is indicated to identify the axillary lymph node or nodes that receive the SPECT/CT is most useful in patients with prior neck surgery or in patients where the initial initial the where patients in or surgery neck prior with patients in useful most is SPECT/CT

evaluatedleak. CSF for lung volumesuspected a reductionwith patients surgeryof or lungevaluation transplant;for (2) and and (3) patientshydrocephalus”; with cardiacpressure adjustments.

perfusion (e.g., in patients undergoing preoperative assessment for pneumonectomy, lung primary lymphatic drainage from a breast cancer (sentinel nodes). in patients who have persistent or recurrent hyperparathyroidism after parathyroidectomy. parathyroidectomy. after hyperparathyroidism recurrent or persistent have who patients in

dysfunction“normal- so-called due tohave anto ischemicthought or nonischemicthose in especially cardiomyopathy. and space, Cardiac blood-poolsubarachnoid the in imagingflow  Time in Department: Injection and Imaging Day 1, 30 minutes for injection,

transplantation, or volume reduction or in patients undergoing follow-up evaluation after • Lymphoscintigraphy is indicated to determine the rate and pattern of drainage of lymph in parathyroid glands in patients with documented hyperparathyroidism. It is particularly helpful helpful particularly is It hyperparathyroidism. documented with patients in glands parathyroid

suspected communicating hydrocephalus due to obstruction of cerebrospinal fluid (CSF) (CSF) can alsofluid be used tocerebrospinal assess of cardiac obstruction dysfunction to due due to valvularhydrocephalus disease. communicating suspected followed by a 4 hour break, then 1 hour for imaging. Imaging Day 2, 2 hours

lung transplantation). patients with suspected congenital or acquired lymphedema. Parathyroid scintigraphy is performed to localize parathyroid adenomas or hyperplastic hyperplastic or adenomas parathyroid localize to performed is scintigraphy Parathyroid • Radionuclide cisternography is most often performed for: (1) evaluation of patients with with patients of evaluation (1) for: performed often most is cisternography Radionuclide •

 Detection and staging of neuroendocrine tumors containing somatostatin receptors, especially

1-3 days 1-3 Department: in Time for exam specific prep. specific exam for

3 hours 3 Department: in Time None Prep:

• Lymphoscintigraphycarcinoid tumors, isparagangliomas, indicated to determine gastrinomas, the and lymphatic other pancreatic drainage islet of malignant cell tumors. melanomas

None for Nuclear Medicine, please discuss with Interventional Radiology Radiology Interventional with discuss please Medicine, Nuclear for None Prep:

CPT Code 78072 Code CPT Parathyroid Scan with SPECT-CT SPECT-CT with Scan Parathyroid TUMORMUSCULOSKELETAL AND INFLAMMATION and other skin cancers (e.g., squamous cell carcinoma and Merkel cell carcinoma). The goals

CPT Code 78630 Code CPT Hydrocephalus Cisternogram Cisternogram Hydrocephalus

WholeBone Scan, Body Whole Tumor BodyImaging CPT Code 7880278306 are to (1) determine the pathway(s) of lymphatic drainage and (2) identify the lymph node(s) 2 days 2 Time in Department: in Time

RENAL

•Prep: Prostascint None Tumor Imaging TimePressure in Department:Normal – Study 3-4 hoursFlow CSF that receive the primary lymphatic drainage from the tumor (the sentinel lymph nodes).

RenalSPECT/CT Scan with may Flow be indicated and Function to provide clarification. better further anatomical for localizationMedicine ofNuclear theCPT call sentinel Codeand 78707lymph

 • Evaluation Prep: None for skeletal is necessary metastases, on infection, or before or trauma. the day of the radiopharmaceutical Interfering medications may exist, please discuss with referring physician physician referring with discuss please exist, may medications Interfering Prep: (2) This scan may be used to help differentiate essential tremor from tremor due to PS. to due tremor from tremor essential differentiate help to used be may scan This (2)

Prep:nodes, The especially patient forshould tumors be in well the headhydrated and neck region.Time in Department: 1-2 hours

CPT Code 78018 Code CPT Whole Body Scan with I-131 I-131 with Scan Body Whole

injection. On the day prior to tumor imaging, and after breakfast on the

Bone Scan, Three Phase (PS). syndromes CPT Codeparkinsonian 78315 • Evaluation Lymphoscintigraphy of renal perfusion is indicated and relative to determine renal function, the lymphatic especially drainage in patients of with head renal and failure; neck

DaTScan brain imaging is used to assist in the evaluation of adult patients with suspected suspected with patients adult of evaluation the in assist to used is imaging brain DaTScan (1) day of the examination, the patient should restrict food intake to a liquid

2 day test day 2 Time in Department: in Time

Prep: None Time in Department: 3-4 hours andcancers. assessment The goals for areobstruction to (1) determine (when done the pathway(s)as the first ofphase lymphatic of diuretic drainage renal andscintigraphy). (2) identify 1 hour of imaging of diet.hour 1 Also, on the afternoon of the day prior to tumor imaging, the patient

physician and call Nuclear Medicine for further clarification. further for Medicine Nuclear call and physician

(1) A three phase exam will better show trauma and infection rather than whole body imaging. • Evaluationthe lymph node(s)of patients that with receive known the or primary suspected lymphatic urinary drainage tract obstruction. from the Sometumor patients(the sentinel with

1 hour for injection, then return 3 hours later for for later hours 3 return then injection, for hour 1 should take a cathartic (one bottle magnesium citrate,Department: in or twoTime bisacodyl

Interfering medications may exist, please discuss with referring referring with discuss please exist, may medications Interfering Prep:

(2) This exam is also® desirable in cases of prosthetic loosening evaluation. pelvicalyceallymph nodes). or SPECT/CT ureteral dilatation may be mayindicated not have to physiologicallyprovide better significantanatomical obstruction.localization Diureticof the

[Dulcolax ]clarification. tablets further in patientsfor unableMedicine to tolerateNuclear call magnesiumand citrate).physician

CPT Code 78014 Code CPT Scan and Uptake Thyroid

renalsentinel scintigraphy lymph nodes. is based on the concept that activity in an unobstructed system will clear

Interfering medications may exist, please discuss with referring referring with discuss please exist, may medications Interfering Prep:  Time in Department: Day of Injection 30-60 minutes,

Bone Scan with SPECT CPT Code 78320 rapidly as a result of the high urine flow rate that occurs following administration of a diuretic.

• Vulvar lymphoscintigraphy is indicated to determine the lymphatic drainage of vulvar ENDOCRINE CPT Code 78607 Code CPT Imaging DaTScan Prep: None Imaging Day (4-5 days later)Time 3 hoursin Department: 3-4 hours Conversely,carcinoma. Thea high goals flow are rate to: (1)will identify not be achievedthe sentinel in the lymph presence nodes; of and significant (2) determine obstruction, the sites and • Evaluation Localization for skeletal of primary, metastases, recurrent, infection, or metastatic or trauma. adenocarcinoma This exam specifically of the prostate. looks at Theone

thereof lymphatic will be absentdrainage. or slowSPECT/CT clearance may ofbe pelvicalyceal indicated to and/orprovide ureteral better anatomicalactivity. localization part testof the is bodymost with often high employed resolution. (1) before initial therapy in men whose clinical staging

data suggest a high likelihood of regional nodal metastasis; and (2) in men who have GFR –of Glomerular the sentinel lymphFiltration nodes. Rate Because Study of timing issues related to surgery, on CPT occasion, Code images 78725 may not be obtained. GASTROINTESTINALundergone prostatectomy or prostatic irradiation as primary therapyGuide and now have Prep:Ordering The patient should be well hydrated. Medicine Time in Department: 5 hoursNuclear suspected recurrent or metastatic disease evidenced by a rising blood level of prostate- • Measurement of glomerular filtration rate (GFR) by radionuclide tracer methods is indicated Hepatobiliaryspecific Imaging antigen including(PSA). Gallbladder if present CPT Code 78226 when more precise information than that provided by the measurement of creatinine Prep: Patients must be fasting for at least 4 hours, and no more than 24 hours. clearance is required or when the latter measurement is impractical (infants and small Time in Department: 2-6 hours To schedule a Nuclear Medicine study please call children, incontinent patients) or likely to be unreliable (because of marked impairment of

• The most common indication for hepatobiliary imaging is to determine if a patient has acute Radiology Scheduling at 314-362-7111 or 877-992-7111 renal functionTo or schedule because thea Nuclear patient is Medicine taking medications study please known callto interfere2017 withUpdated the cholecystitis. Less commonly, the study is ordered to evaluate for a bile leak. Rarely, the tubular secretionRadiology of creatinine) Scheduling at 314-362-7111 or 877-992-7111 study is requested to determine the patency of the common bile duct in an adult patient.

Hepatobiliary Imaging with Gallbladder Ejection Fraction CPT Code 78227 Lymphoscintigraphy,RESPIRATORY Tomographic CPT Code 78803 Bone Density DXA – Forearm CPT Code 77081 Prep: Patients must be fasting for at least 4 hours, and no more than 24 hours. Lung Prep: Scan, None, Ventilation/Perfusion, unless the patient is VQ scheduled for same day surgery, thenCPT theyCode should 78582 Prep: Patients are scheduled through the centralized scheduling office. The Time in Department: 2-3 hours Prep: discussNone NPO times with their physician. TheTime injection in Department: site is cleaned 45 minutes with an examination should not be scheduled within 1 day after another radiology • Hepatobiliary imaging with gallbladder ejection fraction measurement is indicated in patients • Evaluationappropriate of regional topical pulmonary antiseptic ventilation prior for to useinjection(s). in conjunction with pulmonary perfusion examination involving administration of intravenous contrast material. The with chronic abdominal pain that may be due to biliary dyskinesia or chronic cholecystitis. scintigraphyTime in in Department: the diagnosis of 2 pulmonaryhours or longerembolism. if deemed necessary by radiologist examination should not be scheduled within 1 week after a barium enema, CT • (1)Pulmonary SPECT/CT perfusion may be scintigraphy indicated to is provideindicated better for diagnosis anatomical of pulmonary localization embolism of the sentinel(usually Gastric Emptyingcolonography, Study or another radiology or nuclear medicine examination CPT Code involving 78264 in conjunctionlymph nodes. with Because pulmonary of timing ventilation issues relatedimaging). to surgery, on occasion, images may not be Prep: administrationNPO after midnight of oral the contrast day before agents the or atest. radiopharmaceutical Patients who are (seeallergic Interfering to egg obtained. Conditions).substitute should not have this study. Time in Department: 5 hours Lung Scan, Quantitative Perfusion CPT Code 78597 • (2) For head & neck and OB lymphoscintigraphy, SPECT/CT is often indicated. • This Patientsstudy is primarily should performedwithhold inoral patients calcium suspected supplements of having gastroparesis,(such as Tums) a condition for at Prep: None Time in Department: 30 minutes least 24 hours before the study. Time in Department: 30 minutes • Pulmonary perfusion scintigraphy is indicated for quantification of regional pulmonary defined as delayed gastric emptying in the absence of mechanical obstruction. These patients • Dual-energy x-ray absorptiometry (DXA) is used primarily in the diagnosis of osteoporosis BONEperfusion DENSITY (e.g., in patients undergoing preoperative assessment for pneumonectomy, lung frequently have nausea and vomiting. The condition may be a consequence of diabetes. and other disease states characterized by abnormal bone mineral density (BMD), for the Bonetransplantation, Density DXA –or 1 volumesite, Hip, reduction Spine or inPelvis patients undergoing follow-up CPT evaluation Code 77080 after estimation of future fracture risk, and to monitor response to therapy for these conditions. lung transplantation). LYMPHATIC Prep: Patients are scheduled through the centralized scheduling office. The Indications include but are not limited to individuals: 1) with established or suspected low Lung Scan,examination Quantitative should Ventilation/Perfusion, not be scheduled VQwithin 1 day after another CPT Code radiology 78598 Lymphoscintigraphy,BMD; 2) who are atcomplete risk for low BMD; or 3) who have suspected pathologically CPT Code increased 78195 Prep: examinationNone involving administration of intravenousTime in Department: contrast material. 45 minutes The Prep:BMD None, (e.g., unlessfluoride the exposure). patient is scheduled for same day surgery, then they should examination should not be scheduled within 1 week after a barium enema, • Evaluation and quantification of regional pulmonary ventilation: (1) before surgery for discuss NPO times with their physician. The injection site is cleaned with an CT colonography, or another radiology or nuclear medicine examination lung cancer in patients with severe obstructive pulmonary disease; (2) before and after Nuclearappropriate Medicine topical Radiopharmaceuticals antiseptic prior to injection(s). lung involvingtransplantation; administration and (3) before of oral and contrast after bullectomy agents or or a volume radiopharmaceutical reduction surgery (see for There are many different types of nuclearTime medicine in Department: radiopharmaceuticals 2 hours or (diagnostic longer if deemed obstructiveInterfering pulmonary Conditions). disease. tracers). Each radiopharmaceutical is prepared for a specific imagingnecessary or therapeutic by radiologist exam, • Pulmonary Patients perfusion should scintigraphy withhold oralis indicated calcium forsupplements quantification (such of regional as Tums) pulmonary for at and• Lymphoscintigraphy in most cases specifically is indicated for each to identify patient. the Generally, axillary lympha small node and orsafe nodes amount that receiveof the perfusionleast (e.g.,24 hours in patients before undergoing the study. preoperative assessmentTime in Department: for pneumonectomy, 30 minutes lung radioactivityprimary lymphatic gets injected drainage for nuclear from a medicinebreast cancer exams. (sentinel These nodes).tracers are then visualized by • Dual-energytransplantation, x-ray or absorptiometryvolume reduction (DXA) or inis usedpatients primarily undergoing in the follow-updiagnosis evaluationof osteoporosis after nuclear• Lymphoscintigraphy medicine gamma is camerasindicated for to diagnostic determine inquiries. the rate and pattern of drainage of lymph in andlung othertransplantation). disease states characterized by abnormal bone mineral density (BMD), for the If therepatients is a withchance suspected that a patient congenital is pregnant, or acquired please lymphedema. make sure that this gets discussed estimation of future fracture risk, and to monitor response to therapy for these conditions. with• Lymphoscintigraphy the ordering doctor is prior indicated to ordering to determine the nuclear the lymphatic medicine drainage procedure. of malignant If a patient melanomas is MUSCULOSKELETALIndications include but are not limited to individuals: 1) with established or suspected low breast-feeding,and other skin please cancers call (e.g., and discusssquamous all celloptions carcinoma with the and nuclear Merkel medicine cell carcinoma). department The goals BMD; 2) who are at risk for low BMD; or 3) who have suspected pathologically increased before coming in for the procedure. Bone Scan, Whole Body CPT Code 78306 are to (1) determine the pathway(s) of lymphatic drainage and (2) identify the lymph node(s) BMD (e.g., fluoride exposure). If you have specific questions regarding the radiopharmaceutical used for each procedure or Prep: None Time in Department: 3-4 hours that receive the primary lymphatic drainage from the tumor (the sentinel lymph nodes). any other radiation safety question, please feel free to call the nuclear medicine division. Bone • EvaluationDensity DXA for skeletal – 2 sites, metastases, Hip, Spine infection, or Pelvis or trauma. CPT Code 77080 SPECT/CT may be indicated to provide better anatomical localization of the sentinel lymph Prep: Patients are scheduled through the centralized scheduling office. The nodes, especially for tumors in the head and neck region. Bone Scan, Three Phase CPT Code 78315 examination should not be scheduled within 1 day after another radiology For• Lymphoscintigraphyquestions regarding is indicated how to to order determine any Nuclearthe lymphatic Medicine drainage study of head or how and neckto Prep: None Time in Department: 3-4 hours examination involving administration of intravenous contrast material. The reachcancers. the The appropriate goals are to sub-specialty(1) determine the radiologist,pathway(s) of lymphaticplease call drainage 314-454-8945. and (2) identify (1) Aexamination three phase exam should will betternot be show scheduled trauma and within infection 1 week rather after than wholea barium body imaging.enema, To theschedule lymph node(s) a Nuclear that receive Medicine the primary study lymphatic please calldrainage Radiology from the Schedulingtumor (the sentinel at (2) ThisCT examcolonography, is also desirable or another in cases ofradiology prosthetic or loosening nuclear evaluation. medicine examination lymph314-362-7111 nodes). SPECT/CT or 877-992-7111, may be indicated 7a.m. to provide – 5:30p.m. better Monday anatomical – Friday.localization of the sentinel lymph nodes. Bone Scaninvolving with SPECT administration of oral contrast agents or a radiopharmaceutical CPT Code 78320 (see Outpatient Nuclear Medicine studies are available 7a.m. – 3:00p.m. Prep: InterferingNone Conditions). Time in Department: 3-4 hours • Vulvar lymphoscintigraphyMonday – Friday is andindicated 7:30a.m. to determine – 11:00a.m. the onlymphatic Saturdays. drainage of vulvar carcinoma. The goals are to: (1) identify the sentinel lymph nodes; and (2) determine the sites • Evaluation Patients for skeletalshould metastases,withhold oral infection, calcium or trauma. supplements This exam (such specifically as Tums) looks for at oneat of lymphatic drainage. SPECT/CT may be indicated to provide better anatomical localization part leastof the 24body hours with beforehigh resolution. the study. Time in Department: 30 minutes All exams are read by subspecialized radiologists from of the sentinel lymph nodes. Because of timing issues related to surgery, on occasion, images • Dual-energy x-ray absorptiometry (DXA) is used primarily in the diagnosis of osteoporosis may Washingtonnot be obtained. University’s Mallinckrodt Institute of Radiology. GASTROINTESTINALand other disease states characterized by abnormal bone mineral density (BMD), for the Hepatobiliaryestimation Imaging of future includingfracture risk, Gallbladder and to monitor if present response to therapy for CPT these Code conditions. 78226 Prep:Indications Patients include must but be are fasting not limited for atto leastindividuals: 4 hours, 1) with and established no more orthan suspected 24 hours. low BMD; 2) who are at risk for low BMD; or 3) who have suspected pathologically increased Time in Department: 2-6 hours BMD (e.g., fluoride exposure). • The most common indication for hepatobiliary imaging is to determine if a patient has acute To schedule a Nuclear Medicine study please call cholecystitis. Less commonly, the study is ordered to evaluate for a bile leak. Rarely, the Radiology Scheduling at 314-362-7111 or 877-992-7111 BJ17-1195-4220study is (02/17)requested to determine the patency of the common bile duct in an adult patient.