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Patient preparation (NM specific)

 

MRTs instruct patients regarding preparation and ensure compliance prior to initiating procedures

 

+ Importance of patient preparation

  • Standardized patient preparation is used for nuclear medicine procedures to achieve quality diagnostic results, improve accuracy and consistency of results and maintain patient safety.
    • Failure to comply with the patient preparation may cause a delay in performance or a decrease in diagnostic quality of the procedure

 

  • The patient preparation required depends on the procedure being performed and may vary by facility – examples of procedures may include, but are not limited to:
    • Abstaining from caffeine (e.g., MPI)1,2
    • Abstaining from strenuous exercise (e.g., 18F-FDG)3
    • Discontinuing medications (e.g., 14C, Thyroid Uptake)4,5
    • Increasing hydration (e.g., renal scan, bone scan)6
    • Undergoing bowel preparation (e.g., 67Ga-citrate, 111In-Octreotide)7
    • Administering antiemetics (e.g., 131I-NaI Therapy)8
    • Administering thyroid blockade (e.g., 131I-MIBG,  131I-Tositumomab)9
    • Restricting radiographic contrast for up to 3 weeks (e.g., thyroid uptake)4
    • Restricting barium for 72 hours (e.g., abdominal images)
    • Restricting other NM procedures within 48 hours (or longer), depending on the radiopharmaceutical6
    • Consuming a light meal (e.g., might be required 2-4 hours prior for biliary, iodine therapy)

 

  • MRTs are familiar with the specific set of requirements for each nuclear medicine procedure.

+ Instructions to patients

  • Patients are more likely to comply when they have an understanding of the reasons for the instructions.10,11
  • Instructions are given to the patient ahead of the procedure.
  • Instructions are worded in clear and simple terms, and provide information on all aspects of the procedure, including:
    • Pre-study preparations that need to be followed
    • The importance and reasons why pre-study preparations are necessary
    • Elements of the procedure

 

  • MRTs answer patient questions related to preparation and the procedure at the time the instructions are given.
    • Patients are provided the opportunity to clarify and ask further questions
    • Patients are provided with a contact number in case questions arise

+ Ensuring compliance with preparation

  • MRTs interview patients to confirm compliance with pre-study preparation.
  • In the event of non-compliance, the study may be delayed or rescheduled based on the advice of a supervising radiologist or nuclear medicine physician.
    • If the lack of preparation isn't critical (i.e., the loss of information won't affect patient outcome), the procedure can be continued, despite the effect to the results

+ References

  1. Juni JE, Waxman AD, Devous MD, et al. Procedure Guideline for Brain Perfusion SPECT Using 99mTC Radiopharmaceuticals. Available at: http://interactive.snm.org/docs/Brain_SPECT_Guideline_2003.pdf. Accessed March 22, 2013.
  2. Strauss HW, Miller D, Wittry MD, et al. Society of Nuclear Medicine Procedure Guideline for Myocardial Perfusion Imaging: version 3.0, approved June 15, 2002. Available at: http://interactive.snm.org/docs/pg_ch02_0403.pdf. Accessed March 22, 2013.
  3. Boellaard R, Doherty MLO, Weber WA, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Available at: http://www.eanm.org/publications/guidelines/gl_onco_fdgpet.pdf. Accessed March 22, 2013.
  4. Balon HR, Silberstein EB, Meier DA, et al. Society of Nuclear Medicine Procedure Guideline for Thyroid Uptake Measurement: version 3.0, approved September 5, 2006. Available at: http://interactive.snm.org/docs/Thyroid%20Uptake%20Measure%20v3%200.pdf. Accessed March 22, 2013.
  5. Balon HR, Roff E, Freitas JE, et al. Society of Nuclear Medicine Procedure Guideline for C-14 Urea Breath Test: version 3.0, approved June 23, 2001. Available at: http://interactive.snm.org/docs/pg_ch07_0403.pdf. Accessed October 17, 2013.
  6. Taylor AT, Blaufox MD, Dubovsky EV, et al. Society of Nuclear Medicine Procedure Guideline for Diagnosis of Renovascular Hypertension: version 3.0, approved June 20, 2003. Available at: http://interactive.snm.org/docs/pg_ch16_0403.pdf. Accessed March 22, 2013.
  7. Schakett P. Nuclear Medicine Technology: Procedures and Quick Reference 2nd ed. Baltimore, MD: Wolters Kluwer Lippincott Williams & Wilkins; 2009. 
  8. Silberstein EB, Alavi A, Balon HR, et al. The SNM Practice Guideline for Therapy of Thyroid Disease with 131I 3.0*. J Nucl Med 2012;53(10):1633-1651.
  9. Giammarile F, Chiti A, Lassmann M, Brans B, Flux G. EANM procedure guidelines for 131 I-meta-iodobenzylguanidine (131 I-mIBG) therapy. Eur J Nucl Med Mol Imag 2008;35:1039-1047.
  10. Cameron LD, Leventhal H, Eds.The self-regulation of health and illness behaviour. London, UK: Routledge; 2003.
  11. Greaves C, Senior V, Barnett J, Clark M, Pope J, Hinton P. Information to accompany patients undergoing nuclear medicine procedures. Available at: http://www.hse.gov.uk/research/rrpdf/rr416.pdf. Accessed March 22, 2013.

 

 

Validation

October 16, 2013

 

 
Canadian Association of Medical Radiation Technologists
85 Albert St, Suite 1000, Ottawa, ON, K1P 6A4
phone: 613 234-0012 / 800 463-9729
fax: 613 234-1097
www.camrt.ca