• Society of Nuclear Medicine. Procedure guideline for general imaging. Version 3.0. Reston (VA): Society of Nuclear Medicine; 2004 May 30. 10 p.

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for general imaging, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 36 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

Conditions for which general nuclear medicine imaging is indicated

Diagnosis
Evaluation

Nuclear Medicine
Radiology

Allied Health Personnel
Physicians

To provide nuclear medicine practitioners with general guidelines on imaging in the practice of nuclear medicine

Adults and children for whom nuclear medicine imaging procedures are indicated

General Imaging

1. Single photon scintillation cameras to obtain single photon emission computed tomographic (SPECT, also know as SPET) images
2. Positron cameras to obtain positron emission tomographic (PET) images
3. Nuclear medicine computer systems

Utility and safety of imaging procedures

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Literature searches were performed. In addition, references known to experts and references from the nuclear medicine community were considered.

Not stated

Not stated

Not applicable

Review

Not stated

Expert Consensus

Drafts of the guideline were submitted to members of the Guideline Development subcommittee (methodologists) and the Task Force (subject experts). These reviewers indicated on a line-by-line basis any suggestions or recommendations for the revision of the guideline. The percentage of agreement for all reviewers was calculated for each revision and compiled by the Society of Nuclear Medicine (SNM) central office. It is expected that the percentage of agreement will increase with each revision.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

When the Task Force and Guideline Development Subcommittee completed their edits, draft procedure guidelines were distributed to the Society of Nuclear Medicine (SNM) Sample Review Group for comment. (The SNM Sample Review Group is a cross-section of approximately 100 nuclear medicine practitioners representing every field of specialization).

The guideline was approved by the SNM Commission on Health Care Policy, the Board of Directors, and the House of Delegates.

The update was approved May 30, 2004.

Background Information and Definitions

The strength of nuclear medicine lies in its ability to image and quantify regional physiologic biochemical processes. This information may complement anatomic information provided by other modalities.

1. Single Photon Scintillation Cameras

   Single-photon scintillation cameras provide static, dynamic, or gated images of the distribution of radiopharmaceuticals within the body. Single photon emission computed tomographic (SPECT, also known as SPET) images may be obtained by reconstruction of a number of planar images taken at different angles. Computed tomography (CT) scanners have been combined with some single-photon cameras that have SPECT capability in order to provide attenuation correction capability as well as localizing information. Use of combined SPECT/CT scanners is likely to increase in the future.

2. Positron Cameras

   Positron cameras provide static, dynamic, or gated images of the distribution of positron-emitting radionuclides within the body by detecting pairs of photons produced in coincidence by the annihilation of a positron and an electron. Positron emission tomographic (PET) images are produced by reconstruction from the coincidence pair data. CT scanners have been combined with some positron cameras to provide attenuation correction capability as well as localizing information. Use of combined PET/CT scanners is rapidly increasing.

3. Nuclear Medicine Computer Systems

   Nuclear medicine computer systems collect, quantitate, analyze, and display the imaging information.

Procedure

The detailed procedure recommendations in the guideline address the following areas: patient preparation; information pertinent to performing the procedure (i.e., important data that the physician should have about the patient at the time the exam is performed and interpreted); precautions; and quality control.

None provided

The type of evidence supporting the recommendations is not specifically stated.

The intent of the procedure guideline is to describe general imaging studies, in order to maximize the diagnostic information obtained in the studies while minimizing the resources that are expended.

• A few diagnostic nuclear medicine studies (e.g., ¹³¹I whole-body imaging) may have severe consequences for the developing fetus. The risk of performing these studies in a pregnant woman should be weighed against the benefits.
• Current Nuclear Regulatory Commission regulations require that written instruction be given to breastfeeding women if the potential radiation dose to the infant is likely to exceed 5 mSv (500 mrem); oral instructions are required if the potential radiation dose to the infant is likely to exceed 1 mSv (100 mrem). Pathways for exposure include ingestion of tracer concentrated in breast milk and external exposure as a result of close contact during breastfeeding. There is considerable uncertainty about the actual dose to the infant since little data are available for excretion into breast milk for most radiopharmaceuticals.
• For a few diagnostic studies (e.g., ¹³¹I whole-body imaging), the radiation dose to the lactating breast can be large (10 cSv [10 rem] or greater)--as much as 10 times the dose to the nonlactating breast. When possible it is best to delay these studies for at least 4 weeks after breastfeeding has stopped.
• Medical personnel should be instructed in the proper care of patients after radioisotope administration. Generally, the hazard to personnel is small and measures taken to protect workers from biological hazards are sufficient to protect workers from radiological hazards.
• In general, precautions taken to avoid biological hazards from patient excreta are more than sufficient to avoid the often much smaller radiation hazard.
• Instructions should be provided on methods of minimizing radiation exposure to the patient's family and to the general public, where appropriate.
• In general, there is no scientific or regulatory reason why a pregnant nurse cannot provide routine care to a patient who has had a diagnostic imaging study. The risk of caring for a patient receiving therapy is small; however, it may be prudent not to assign pregnant nurses to care for these patients.

• Elective diagnostic nuclear medicine procedures should be delayed until a patient is no longer pregnant or breastfeeding.
• For nonelective diagnostic procedures, breastfeeding should be interrupted for an amount of time appropriate for the radiopharmaceutical used. For a few diagnostic studies (e.g., ¹³¹I whole-body imaging), breastfeeding must be stopped for 1-2 months; therefore, it is impractical to resume breastfeeding for that child.

• The Society of Nuclear Medicine (SNM) has written and approved these guidelines as an educational tool to promote the cost-effective use of high quality nuclear medicine procedures or in the conduct of research and to assist practitioners in providing appropriate care for patients. The guidelines should not be deemed inclusive of all proper procedures nor exclusive of other procedures reasonably directed to obtaining the same results. They are neither inflexible rules nor requirements of practice and are not intended nor should they be used to establish a legal standard of care. For these reasons, SNM cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.
• The ultimate judgment about the propriety of any specific procedure or course of action must be made by the physician when considering the circumstances presented. Thus, an approach that differs from the guidelines is not necessarily below the standard of care. A conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in his or her reasonable judgment, such course of action is indicated by the condition of the patient, limitations on available resources, or advances in knowledge or technology subsequent to publication of the guidelines.
• All that should be expected is that practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
• Advances in medicine occur at a rapid rate. The date of a guideline should always be considered in determining its current applicability.

An implementation strategy was not provided.

Getting Better
Living with Illness

Effectiveness
Safety

• Society of Nuclear Medicine. Procedure guideline for general imaging. Version 3.0. Reston (VA): Society of Nuclear Medicine; 2004 May 30. 10 p.

Not applicable: The guideline was not adapted from another source.

1999 Feb (revised 2004 May 30)

Society of Nuclear Medicine, Inc - Medical Specialty Society

Society of Nuclear Medicine (SNM)

Task Force

Authors: J. Anthony Parker, MD, PhD (Beth Israel Hospital, Boston, MA); Margaret E. Daube-Witherspoon, PhD (University of Pennsylvania, Philadelphia, PA); L. Stephen Graham, PhD, FACR (West Los Angeles VA Medical Center/UCLA School of Medicine, Los Angeles, CA); Henry D. Royal, MD (Mallinckrodt Institute of Radiology, St. Louis, MO); Andrew E. Todd-Pokropek, PhD (University College of London, United Kingdom); Michael V. Yester, PhD (University of Alabama at Birmingham, Birmingham, AL)

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine. Procedure guideline for general imaging, 2.0. Reston (VA): Society of Nuclear Medicine; 1999 Feb. 36 p. (Society of Nuclear Medicine procedure guidelines; no. 2.0).

None available

This summary was completed by ECRI on July 20, 1999. It was verified by the guideline developer as of August 5, 1999.This summary was updated on May 18, 2005. The updated information was verified by the guideline developer on June 30, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.