GI Bleed

Question 1

RP

Dose

TTI

Answer 1

• 10-20 mCi Tc SC - Active
• 20-30 mCi Tc tagged RBCs - Intermittent
• 18 g needle for RBCs
• Image Immediately - Flow
• 20 min incubation for tagged RBC

Question 2

Indications

Answer 2

• Identify and localize GI bleed
• Active, intermittent, post-surg, anti-coag
• Black tarry stool - Upper GI
• Bright red stool - Lower GI

Question 3

Contrainidcations

Answer 3

• Recent contrast study
• Medically unstable patient - uncontrolled hypotension

Question 4

Patient Prep

Answer 4

• Urgent on call study
• Check patient vitals
• Void prior to imaging
• Blue chucks on camera table

Question 5

Positioning

Answer 5

• Supine with bottom of heart in upper FOV
• Point source from xyphoid around abdomen to position for flow

Question 6

Target Organ

Critical Organ

Route of excretion

Localization

Answer 6

• Target: Blood
• Critical: Liver Spleen
• Excretion: Bowel - SC: Not seen RES
• Localization: Compartmentalization

Question 7

Procedure

Answer 7

• Draw and tag blood - wait 20 min
• Flow: Position then inject. 1-5 s/f for 60 f
• ANT Dyn: 60 s/f for 60-90 f (RBC)
• ANT Dyn: 60 s/f for 20-30 f (SC)
• Delayed possible w/ RBC 2-6 hrs up to 24 hrs
• Dr. review images before pt leaves floor

Question 8

Acquisition

Answer 8

• LEAP
• Liver/GI - GI Bleed
• 64x64 for flow
• 128x128 for Dyn

Question 9

Processing

Answer 9

JS: GI Bleed - AB

Peg: Teach/ GI bleed - AB

Question 10

Normal

Abnormal

Answer 10

• Heart
• Liver
• Spleen
• Aorta
• Bifurcation of iliac vessels
• AB - activity in peritoneal cavity
• AB - focal area that moves

Question 11

Treatment

Answer 11

• Surgery
• Blood transfusion
• Fluid replacement
• Medication

Question 12

Labels

Answer 12

• Name
• DOB
• MRN
• Date of Exam
• Hospital
• Referring physician
• Dose
• Dose rate
• Frame rate
• View ID
• Right/ Left
• Tech Initials