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. Consult the monthly Nuclear Medicine
On-Call Schedule (see below)
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
