NUCS ON CALL

MSBI Nucs policy
- Make sure the study is appropriate and order is active in IDX. 
- Call the nuclear medicine on call tech and notify them of the study. If the secretary or on-call tech manager are available, they can help you call the nucs tech.
- Techs have about 1 hour to arrive and begin. They will call you once the study is finished.
- Dictate a preliminary report and assign it to Dr. Goldfarb or Dr. Ongseng. Attendings will finalize the report in the morning.


MSW Nucs policy


Coverage: Scheduled RH Eve Resident (3-5830) to cover nuclear medicine until midnight every day.  Night Float resident to cover nuclear medicine from midnight to 8am.  NM backup resident available as needed.

Nuclear Back Up Resident On-call pager: 36722


Nuclear Medicine Resident On-Call Procedure

 

Step 1: Determine if the NM scan is appropriate. Note the following: 

·          We cannot accept scans to be performed 4am to 8am weekdays and 4am to 10am weekends due to isotope delivery schedule. 

·          The only exception is that a perfusion-only scan for pregnant patients to rule out PE after 4am, which can be performed with 5 mCi MAA, but this is determined on a case-by-case basis. Double check with the attending.

 

Step 2: Text a message to the cell phone of the attending on call, indicating to him/her that we have a case, i.e. "Patient name, VQ scan at RH or SL” .

Step 3: Determine if we have enough Tc99m pertechnetate for a particular study. Except for the very late night/early morning time intervals specified in Step 1, above, there should be adequate tracer for an on-call scan. The exception is if one or two on-call scans have already been performed, depleting our supply. 

    (Consult Nucs Protocols http://radiology.chpnet.org/physics/protocol/Protocol%20Manual.pdf = OPEN IN INTERNET EXPLORER, only works in house.  Commonly encountered study protocols attached below)

    On weekdays RH and SL have 150mCi Tc99m calibrated for 6pm.  

    On weekends RH and SL have 450mCi Tc99m calibrated for 10am.  

    The Tc-99m half-life is 6 hours.  It usually takes the tech at least 1 hour to come in from home, and 1 hour to get the patient set up.  If there IS NOT enough tracer, call Cardinal Health (Step 4). If there IS enough tracer, call in the technologist (skip to Step 5).   


Step 4: Call Cardinal Health for additionally Tc-99m pertechnetate, if needed.

    On call number :1-800-673-4269 (1-800-550-1291 is the regular office hours main number.)

    Order a 100 mCi Tc-99m pertechnetate dose calibrated for 4 hours after your phone call (3 hours transit time, 1 hour patient setup). 

    i.e. "We need Tc-99m pertechnetate 100mCi calibrated for midnight at RH".  

    Ask for an estimated time of delivery so that you can notify the tech to come in around the same time.

    The RH Account number is 5907, and the SL Account number is 5923.  


Step 5: Call the on-call technologist to come in

    For RH call the "RH Tech" - Igor or Emilia - first. If you cannot reach the RH Tech, then call the "Agency Tech".  

    For SL just call the "Agency Tech".


Step 6: The on-call tech should call you from the Hospital to verify the tracer vial when he/she is preparing the radiopharmaceutical. The resident should also verify that the tech has acquired a flood field and performed dose calibrator QC (applies only on weekends).

 

Step 7: The on-call tech should call you again to verify the patient DOB and MR# before he/she injects the dose.

 

Step 8:  The on-call technologist will send images to your computer or hand-held device in jpeg format for static images and dcm format for dynamic images (which you can open in Radiant, which resides on the computer in the SL Radiology residents’ lounge, or Osirix). Once images are available, verify the patient DOB and MR# on the images, and interpret the scan. Then, as soon as possible, notify the attending.  Dr DePuey prefers a cell text. Dr. Mircheva prefers a cell call.

 

Step 9: Remind the tech to send  images to PACS before leaving the lab.

 

Step 10: The tech will affix a stamp to the requisition and initial it verifying the camera flood, dose calibrator check, and the radiopharmaceutical preparation and prescribed dose. A copy of the requisition will be sent to you the following day for your initials. The initialed form should be sent to the chief technologist at the site where the scan was performed. 

 

Step 11: Once you read with the attending, notify the referring physician of the results.
For DICOM, you can use these viewers:  http://www.osirix-viewer.com/download_form/download_form.php  OR  http://www.radiantviewer.com/download.php


Step 12: Once complete, dictate the scan. Include the name of the physician you reported the findings to and the time of the call. Include the name of the individual to whom you called the results, and the time of that call.

 

General Study-Specific Notes:

HIDA:  If the patient is NPO>24hrs, pre-treat the patient with a dose of CCK (0.02 mcg/kg) (Technologist CANNOT administer CCK - DOH violation).  Ask the ER resident for patient’s weight, NPO status, and morphine meds. If necessary, a dose of morphine (0.04 mg/kg) is needed to assess cystic duct patency (see protocol for details).  The in-house referring physician should obtain that morphine dose for the on-call technologist and inject the drug.

GI bleed: The patient should be actively bleeding.

Brain death: Scans can be performed on weekends, but not at night : Text Igor (RH tech acting supervisor) 917 902 3679 or Linda Thompson (SL tech supervisor)  917 721 2007 to order the Brain Death study dose first thing the next morning.

Mobile (bedside) imaging is not available at either the SL or RH site.


XELERIS REBOOT REQUEST: See document at the bottom of the page





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