HIDA

Question 1

RP

Dose

TTI

Answer 1

• Tc99m Disofenin or Mebrofenin
• 3-10 mCi adult/ min Peds 1mCi
• Image immediatly

Question 2

Indications

Answer 2

• Rule out acute vs chronic cholecystitis
• Rule out biliary leak and blockage
• Liver transplant evaluation
• Rule out biliary atresia
• Evaluation of abdominal pain

Question 3

Contraindications

Answer 3

• Recent food intake
• No CCK if patient has gallstones
• No morphine if patient is allergic
• Known CBD or intestinl obstruction

Question 4

Patient Prep

Answer 4

• NPO 4-12 hours
• No opiods or morphine derivatives 4-6 hours
• US prior to exam
• DO YOU HAVE A GALLBLADDER?
• LFTs - Alkaline phosphate, BUN, bilirubin
• CCK pre-treat

Question 5

CCK Pre and Post-treatment

Answer 5

• 0.02 ug/kg
• 5 ug vile reconstituted w/ 5cc sterile water
• 1 ug/kg
• Dilute in 3-5 mL saile
• Injected over 3-5 minutes
• Must wait 30 minutes to inject Tc99m
• Post: Dilute to 20-30 mL saline
• IV over 20 minutes

Question 6

Positioning

Answer 6

• Patient Supine wih Camera ANT
• Liver in upper FOV
• 30° RAO to seperate GB from bowel
• RLAT at 60 minutes to differentiate GB from bowel
• Static first 5 min to measure liver

Question 7

Target Organ

Critical Organ

Route of Excretion

Localization

Answer 7

• Target: Liver and GB
• Critical: Large and Small intestines, GB wall
• Excretion: Bowel
• Localization: Active Transport

Question 8

Procedure

Answer 8

• Static: Immediately then every 5 for the first 30. Every 10-15 min after 30.
• Dyn: 60 s/f for 60-90 min.
• IF GB and bowel at 30-45 stop study and give CCK, or keep imaging for 90 min
• IF no GB at 40-60 min give MS, 0.04ug/kg or delay
• Image 30 min after MS
• IF GB but no bowel - delay
• Flow possible

Question 9

Acquisition

Answer 9

• LEHR
• Liver/GI - Hepatobiliary
• Statics: 500k-1M counts
• Dynamics: 60 s/f for 60 min
• 64x64 for flow
• 128x128 - 256x256 for functional

Question 10

Processing

Answer 10

• JS: Hida 3/ Hepatobiliary for GBEF - N
• Peg: Hepatobiliary - N
• Xel: Hida Scan - AB

Question 11

Normal

Answer 11

• Heart first
• Liver within 5 minutes post injection
• Bile ducts and GB at 10 – 15 minutes
• Small bowel and full GB at 30 – 60 minutes
• Normal – GB and bowel must visualize w/i an hour

Question 12

Cholecystitis

Answer 12

• Acute - Delayed visualization
• Chronic - No visualization

Question 13

Treatment

Answer 13

• Surgery – laparoscopic or open
• Bile salts tablets to dissolve gallstones
• Sound wave therapy
• Lithotripsy
• Topical gallstone dissolution – given through a catheter

Question 14

Lables

Answer 14

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