A survey of thyroid gland scintigraphy.

UNLABELLED: The Society of Nuclear Medicine (SNM) published procedure guidelines for thyroid imaging in 1999. We wished to determine how many clinics performing thyroid imaging follow the guidelines and to what extent. Of particular interest to us was the choice of collimator. METHODS: We developed a 10-question survey to obtain information on how hospitals perform thyroid imaging. The questions were designed to cover the procedure recommendations of the SNM guidelines. The survey was sent to 350 hospitals randomly selected from 11 states in the northeastern United States. RESULTS: One hundred sixty-five surveys (47%) were returned. Most of the clinics that responded obtain a history, hyperextend the neck, and obtain anterior and anterior oblique views. Twenty-five percent of the respondents obtain all their images with a parallel-hole collimator. Seventy-five percent use a pinhole collimator or a combination of parallel-hole and pinhole collimators. The number of counts and time used for acquiring the images vary greatly. Less than half the respondents palpate the neck for correlation with the scan. CONCLUSION: The survey results indicated that many clinics do not follow the recommendations of the SNM guidelines. The major deviations from the guidelines were in the choice of collimator, the number of counts or amount of time used to acquire images, and the lack of neck palpation for correlation with the scan.

Compounded versus proprietary sincalide for evaluation of gallbladder ejection fraction.

OBJECTIVE: To report a comparison of compounded and proprietary sincalide in the evaluation of gallbladder ejection fraction during hepatobiliary scintigraphy. CASE SUMMARIES: Two patients were referred to nuclear medicine with symptoms consistent with hepatobiliary dysfunction. Both underwent hepatobiliary scintigraphy to evaluate anatomic and physiologic tract patency of the hepatobiliary system. Compounded sincalide, an adjuvant pharmaceutical used to evaluate gallbladder ejection fraction, was infused during hepatobiliary scintigraphy, and gallbladder ejection fractions were 11% and 24%, respectively. Hepatobiliary scintigraphy was repeated on both patients 72 hours later with proprietary sincalide used as the adjuvant pharmaceutical. The gallbladder ejection fractions were 32% and 72%, respectively. DISCUSSION: The use of sincalide to evaluate gallbladder ejection fraction in hepatobiliary scintigraphy is widely accepted in the surgical and nuclear medicine community. In late 2001, the sole manufacturer of sincalide announced indefinite unavailability of the product. Following the announcement, several compounding pharmacies began selling extemporaneously compounded sincalide as a replacement. Use of the compounded product has assumed therapeutic equivalence. CONCLUSIONS: Significant differences in gallbladder ejection fraction between compounded sincalide and sincalide in our patients are likely due to the intrinsic variability in response to sincalide. Clinicians should be aware of this variability, as well as the potential effect of concomitant medications.