Meckel's

Question 1

RP

Dose

TTI

Answer 1

• 5-10 mCi Tc99m ADULT
• 200 uCi Tc99m PEDS
• Image Immediately

Question 2

Indications

Answer 2

• Locate MD with gastric mucosa
• Rectal Bleeding/ Bloody stool
• Abdominal Pain

Question 3

Rule of 2’s

Answer 3

• Occurs in 2% of the population
• Typically symptomatic by 2 years old
• 2 feet from iliocecal valve
• 2 inches in length

Question 4

Contraindications

Answer 4

• Contrast study with barium

Question 5

Patient Prep

Answer 5

• NPO 4 hours - decrease size of stomach
• Void or catheterize bladder
• Swaddle, papoose or sedate child
• Pre-treat with Pentagastrin, Cimetidine or Glucagon

Question 6

Pentagastrin

Cimetidine

Glucagon

Answer 6

• Pentagastrin: 6 ug/kg 15 min prior to exam
• Stimulates gastric uptake of Tc99m
• Cimetidine: 300 mg 4x daily for 24 hours
• Inhibits secretion of Tc into lumen of bowel
• Glucagon: 50 ug
• Decreases peristalsis

Question 7

Positioning

Answer 7

• Supine with Camera ANT
• Thyroid to Diaper
• Patient on left side to reduce digestion

Question 8

Target Organ

Critical Organ

Route of Excretion

Localization

Answer 8

Target: MD in ilium/ gastric mucosa

Critical: Stomach, thyroid

Excretion: Urinary

Localization: Active Transport

Question 9

Procedure

Answer 9

• Statics: ANT every 5 min for 60 min
• LATS, OBL to distinguish MD from ureter
• Dynamic: 60 s/f for 60 f
• MD should visualize same time as stomach

Question 10

Acquisition

Answer 10

• LEAP or LEHR
• Basic Statics/ Dynamic
• Statics: 500k-1M counts, 128x128 x2 zoom
• Dynamics: 60 s/f for 60 f, 128x128

Question 11

Processing

Answer 11

• gamma.wustl.edu
• Meckel’s Scintigraphy 1st or 3rd
• Both NORMAL

Question 12

Normal

Abnormal

Answer 12

• Normal - no focal hot spot
• Abnormal - Focal hot spot w/ same intensity as the stomach
• 2 hour delay - only MD will be hot

Question 13

Labels

Answer 13

• Name
• DOB
• MRN
• Date of exam
• Hospital
• Referring physician
• Dose
• Dose rate
• Frame rate
• Right/ Left
• View ID
• Tech Initials