🩺 Preparing for Your FDG PET/CT Scan for Cardiac Sarcoidosis

This specialized scan helps your doctor assess inflammation in the heart muscle caused by Sarcoidosis. To ensure the highest quality images, a specific and strict preparation regimen is essential. Please read these instructions carefully.

Why is Specific Preparation Required?

An F-18 FDG PET/CT scan uses a small amount of radioactive glucose (sugar) tracer. Normally, your heart muscle uses fatty acids for energy, but it can switch to using glucose. For this specific scan to work correctly, we must minimize the amount of glucose your normal heart muscle takes up so that the tracer highlights only the areas of inflammation related to Sarcoidosis.

The strict low-carbohydrate diet and prolonged fast force your heart muscle to use fat instead of sugar, allowing the tracer to focus on the active Sarcoidosis lesions.

🚨 Essential Preparation Instructions

Dietary Preparation: 24–72 Hours Before the Scan

You must adhere to a strict low-starch (low-carbohydrate) diet—often called a “Keto” diet—for 24 to 48 hours before your scheduled study. This is very important; please make sure you understand this instruction. If possible, following the diet for 72 hours is even better.

Foods to AVOID (Not Allowed) include: Bread, pasta, rice, cereal, crackers, potatoes, corn, peas, sugar, sweets, honey, milk, yogurt, and fruit/fruit juices.

Fasting and Hydration

Prolonged Fast: You must be NPO (nothing by mouth)—no food, sweets, gum, or mints—for 12 to 18 hours before the scan.
Water: You can drink water.
Caffeine: No caffeine is allowed for 6 hours prior to the study.

Exercise Restriction

Avoid all strenuous exercise for 24 to 48 hours prior to the PET/CT scan.

Medication Instructions (Especially for Diabetic Patients)

It is critical to follow these instructions exactly and to confirm them with your nuclear physician.

Medication Type | Instructions

Metformin | May be continued the day before the study, but should not be taken on the morning of the study.
Long-Acting Insulin (e.g., Protophane, Actraphane) | No long-acting insulin may be taken 48 hours prior to the study.
Fast-Acting Insulin (e.g., Actrapid) | No fast-acting insulin may be taken on the morning of the study.

Scanning Procedure: What to Expect

1. Injection: A small dose of the radiopharmaceutical (F-18 FDG) will be injected.
2. Uptake Period: The PET CT scan is performed 1 hour after the radiopharmaceutical is injected. You will rest quietly during this time.
3. Scanning: Yours arms will be positioned up above our head during the scan. The scan will run for approximately 20-minutes.
4. Scan Extent: The images will be focused over the chest (dedicated image), but a whole-body PET-CT might also be indicated.

After Your Scan

You can generally resume your normal diet, activity, and medication schedule immediately after the scan. Please drink plenty of fluids to help flush the small amount of remaining tracer out of your system.

What is a Ventilation-Perfusion Scan?

A ventilation-perfusion (VQ) scan is a diagnostic imaging test that helps identify conditions affecting blood flow and air movement in your lungs, particularly pulmonary embolism (blood clots in the lungs). The test has two parts:

1. Perfusion Scan: Examines blood flow through your lungs
2. Ventilation Scan: Shows how air fills your lungs

Why is this test performed?

This test helps your doctor:

• Detect blood clots in your lungs (pulmonary embolism)
• Evaluate lung function before surgery
• Assess damage from lung diseases

How does the test work?

When blood clots travel to the lungs, they block blood vessels and affect blood flow to sections of lung tissue. The VQ scan allows us to see these affected areas.

• Perfusion (Blood Flow) Component: We inject a small amount of radioactive protein particles (called MAA) into your bloodstream. These particles travel to your lungs and become trapped in tiny blood vessels (capillaries). In healthy lungs, the particles distribute evenly. If a blood clot is present, the particles cannot reach certain areas, creating “cold spots” on the scan image.
• Ventilation (Breathing) Component: You’ll inhale a small amount of radioactive gas or vapor. This shows how air fills your lungs. By comparing both scans, doctors can determine if reduced blood flow is caused by a clot or another condition.

What can I expect during the procedure?

1. You’ll lie comfortably on an examination table.
2. For the ventilation scan, your nose will be gently closed, and you’ll breathe in the radioactive gas or vapor through a mouthpiece.
3. A special camera will take images of your lungs while you breathe normally.
4. For the perfusion scan, a small amount of radioactive material will be injected into a vein in your arm.
5. The camera will take additional images of your lungs.
6. The entire procedure usually takes 30-60 minutes.

The amount of radiation used is very small and poses minimal risk. A nuclear medicine physician will analyze the images and send a report to your doctor.

Preparation

• No special preparation is needed
• You can eat and drink normally before the test
• Wear comfortable clothing
• Inform your doctor if you’re pregnant or breastfeeding

After the test

• You can resume normal activities immediately
• The radioactive material will naturally leave your body within 24 hours
• Your doctor will discuss the results with you during your follow-up appointment

What is a Thyroid Scan?

A thyroid scan is an imaging test that helps your doctor see how your thyroid gland is functioning. The thyroid is a butterfly-shaped gland in your neck that produces hormones important for regulating your metabolism and many other body functions.

How Does a Thyroid Scan Work?

The scan uses a small amount of radioactive material (Technetium-99m pertechnetate) that mimics iodine, which is naturally used by your thyroid gland to produce thyroid hormones. This radioactive tracer allows us to:

• See the size, shape, and position of your thyroid gland
• Measure how your thyroid is functioning, that is, is it overactive, functionally normally, or underactive
• Identify areas of abnormal thyroid tissue

Why Might I Need a Thyroid Scan?

Your doctor may recommend a thyroid scan to:

• Evaluate an overactive thyroid gland (hyperthyroidism)
• Investigate the cause of an enlarged thyroid gland
• Check for thyroid nodules
• Determine appropriate dosing for radioactive iodine treatment

What Can I Expect During the Procedure?

1. A small amount of radioactive tracer will be injected into a vein in your arm.
2. You’ll wait approximately 20 minutes while the tracer concentrates in your thyroid gland.
3. You’ll lie on an examination table with your neck slightly extended.
4. A special camera (gamma camera) will take images of your thyroid from different angles.
5. The entire procedure typically takes 30-45 minutes.

What Do the Results Mean?

• Uniform uptake: Normal thyroid tissue absorbs the tracer evenly
• Hot areas: Regions with increased tracer uptake may indicate overactive thyroid tissue
• Cold areas: Regions with decreased tracer uptake may indicate abnormal thyroid tissue that requires further evaluation

If cold areas are detected, your doctor may recommend:

• A second scan using a different tracer (99mTc-Sestamibi)
• An ultrasound examination

Preparation for Your Thyroid Scan

• Inform your doctor about all medications you’re taking – please share a full list of your medication with the technician performing your scan
• You may need to stop certain medications influence thyroid function or contain iodine (for example, neomercazole, carbimazole, amiodarone)
• You might need to fast for a few hours before the test
• Remove jewelry or metal objects from the neck area
• Tell your doctor if you are pregnant or breastfeeding

After the Procedure

• You can resume normal activities immediately
• Drink plenty of fluids to help flush the radioactive material from your body
• The small amount of radiation used in the test is generally considered safe and will naturally leave your body within a day

Your doctor will discuss the results with you during your follow-up appointment.

What is a PSMA PET/CT or PSMA SPECT/CT Scan?

A PSMA (Prostate Specific Membrane Antigen) scan is an advanced imaging test specifically designed to detect prostate cancer cells in your body. This scan can find prostate cancer that has spread beyond the prostate gland, even when other imaging tests might miss it. This scan may be performed using either PET/CT (Positron Emission Tomography) or SPECT/CT (Single Photon Emission Computed Tomography) technology, depending on your specific needs and the equipment available.

How Does a PSMA Scan Work?

The scan uses two key technologies working together:

1. Nuclear Medicine Imaging: Detects the radioactive signal from the prostate cancer cells
   • PET (Positron Emission Tomography): Uses tracers such as Ga-68 PSMA or F-18 PSMA
   • SPECT (Single Photon Emission Computed Tomography): Uses tracers such as Tc-99m PSMA
   • A small amount of the appropriate radioactive tracer is injected into your bloodstream
   • This tracer specifically binds to PSMA proteins found in high amounts on prostate cancer cells
   • Areas with prostate cancer will show up as “hot spots” on the scan
2. CT (Computed Tomography): Provides detailed anatomical images
   • Helps precisely locate where any cancer might be in your body
   • Allows doctors to see exactly where the “hot spots” are located

Why Might I Need This Scan?

Your doctor may recommend a PSMA PET or SPECT scan to:

• Determine if prostate cancer has spread beyond the prostate
• Check if cancer has returned after previous treatment
• Help plan the most appropriate treatment for your specific situation
• Monitor how well treatment is working

What to Expect During Your PSMA PET or PSMA SPECT Scan

Before the Scan

• No special dietary preparation or fasting is required
• You should drink water normally before your appointment
• Wear comfortable clothing without metal objects
• Tell your doctor if you are pregnant, breastfeeding, or have any allergies

During the Scan

1. You’ll receive an injection of the radioactive tracer into a vein in your arm
   • This injection is similar to a regular blood test and causes minimal discomfort
   • The type of tracer used will depend on whether you’re having a PET/CT (Ga-68 PSMA or F-18 PSMA) or a SPECT/CT (Tc-99m PSMA)
   • The tracer will not make you feel different or cause side effects
2. Waiting period (uptake phase)
   • You’ll be asked to sit quietly and relax for 30-60 minutes
   • During this time, the tracer circulates through your body and attaches to prostate cancer cells
   • You may be encouraged to drink water to help clear the tracer from your urinary system
3. Scanning procedure
   • You’ll lie on a table that moves through the scanner
   • The scanner has a large opening (not enclosed like an MRI)
   • The machine makes minimal noise
   • You’ll need to lie still during the scanning
   • The actual scanning takes approximately 30 minutes for PET/CT or SPECT/CT
   • The type of scanner used will depend on your specific situation and what your doctor has ordered
4. The entire procedure, including waiting time, typically takes 1.5-2 hours

After the Scan

• You can resume all normal activities immediately
• Drink plenty of fluids to help flush the tracer from your body
• The small amount of radiation from the tracer will naturally leave your body within a day
• A nuclear medicine specialist will analyze your images and send a report to your doctor
• Your doctor will discuss the results with you at your next appointment

Are There Any Risks?

The PSMA PET scan uses a very small amount of radiation. The benefits of the information gained from the scan far outweigh any potential risks from this minimal radiation exposure. The radioactive tracer is eliminated from your body naturally within 24 hours.

If you have any questions or concerns about your PSMA PET scan, please discuss them with your healthcare provider.

What is a Protein-Losing Enteropathy Scan?

A protein-losing enteropathy scan is a specialized imaging test that helps doctors diagnose conditions where proteins are abnormally lost through the intestines. This protein loss can lead to malnutrition and other health problems.

Why Might I Need This Scan?

Your doctor may recommend this scan if:

• You have unexplained low protein levels in your blood
• You’re experiencing symptoms of malnutrition despite adequate nutrition
• Other tests have not identified the cause of your symptoms
• Your doctor suspects protein is being lost through your digestive system

How Does the Scan Work?

The scan uses a natural protein found in your blood called human serum albumin:

1. This albumin is labeled with a small amount of radioactive material
2. The labeled albumin is injected into your bloodstream
3. Normally, this protein stays within your blood vessels
4. If you have a protein-losing condition, the protein will leak into your intestines
5. A special camera (gamma camera) can detect the radioactive signal from the albumin in your gastro-intestinal tract
6. This allows doctors to see exactly where protein is leaking or if there is widespread loss throughout your intestines

What to Expect During the Procedure

Before the Scan

• No special preparation is usually required
• You may be asked about medications you’re taking
• Let your doctor know if you’re pregnant or breastfeeding

During the Scan

1. You’ll lie on an examination table
2. A small amount of radioactively labeled albumin will be injected into a vein in your arm
3. Immediately after injection, imaging will begin
4. The gamma camera will take pictures continuously for up to 90 minutes
5. You’ll need to lie still during this time
6. The procedure is painless, but you may experience some discomfort from lying in one position

After the Initial Scan

• You may be able to leave the department temporarily
• You’ll be asked to return for a second set of images 4-6 hours after the injection
• This second scan helps identify patterns of protein loss over time
• The second imaging session is usually shorter than the first

After the Procedure

• You can resume normal activities immediately
• Drink plenty of fluids to help eliminate the radioactive material
• The small amount of radiation used in this test is considered safe and will leave your body naturally within a day or two
• The results will be analyzed by a specialist and sent to your doctor, who will discuss them with you

Are There Any Risks?

The amount of radiation used is very small and poses minimal risk. The benefits of diagnosing the cause of your protein loss generally outweigh any potential risks from the procedure.

If you have any questions or concerns about your protein-losing enteropathy scan, please discuss them with your doctor.

What is an F-18 FDG PET-CT Scan?

An F-18 FDG PET-CT scan combines two powerful imaging technologies into one examination:

• PET (Positron Emission Tomography): Shows how cells are functioning by tracking glucose (sugar) metabolism
• CT (Computed Tomography): Provides detailed anatomical images of body structures

This combination creates comprehensive images that show both the structure of your body and how cells are using energy. For cancer evaluation, this is particularly valuable because cancer cells typically use more glucose than normal cells.

How F-18 FDG PET-CT Works in Cancer Detection

The scan uses a radioactive form of glucose called F-18 FDG (fluorodeoxyglucose). This works because:

1. Cancer cells generally grow more rapidly than normal cells
2. To fuel this rapid growth, cancer cells consume more glucose (sugar)
3. The F-18 FDG tracer mimics glucose but contains a radioactive component
4. Cancer cells absorb this tracer more eagerly than most normal cells
5. The PET scanner detects the radiation emitted from these areas
6. Areas with high tracer uptake (potential cancer sites) appear as “hot spots” on the scan
7. The CT portion provides precise anatomical location of these hot spots

This makes F-18 FDG PET-CT particularly effective for detecting many types of cancer, often before structural changes are visible on conventional imaging.

Oncology Applications of F-18 FDG PET-CT

This scan is used in cancer care for:

Cancer Diagnosis and Staging

• Determining if a suspicious mass is cancerous
• Finding the primary tumor site when cancer has been detected elsewhere
• Determining if and where cancer has spread (metastasized)
• Establishing the extent of disease (staging) to guide treatment decisions

Treatment Planning and Monitoring

• Helping plan radiation therapy or surgical approaches
• Evaluating response to chemotherapy, immunotherapy, or radiation
• Detecting residual cancer after treatment
• Distinguishing between active tumor and scar tissue

Surveillance and Recurrence Detection

• Monitoring for cancer recurrence after treatment
• Regular surveillance in high-risk patients
• Investigating new symptoms in cancer survivors

Common Cancer Types Evaluated with F-18 FDG PET-CT

This scan is particularly valuable for evaluating:

• Lung cancer
• Lymphoma
• Colorectal cancer
• Breast cancer
• Melanoma
• Head and neck cancers
• Esophageal cancer
• Cervical cancer
• Ovarian cancer
• Many other less common malignancies

Can F-18 FDG PET-CT be used for other, non-oncology indications?

Yes, FDG PET-CT can be used to help physicians better understand other disease processes – notably infection / inflammation, neurological processes such as dementia, and cardiac pathology.

Compared to PET-CT for Infection/Inflammation

While both cancer and infection/inflammation show increased FDG uptake:

• Cancer typically shows more intense, focused uptake patterns
• Infection often shows more diffuse uptake patterns
• The clinical context and specific uptake patterns help differentiate between them
• Your doctor’s knowledge of your specific situation guides interpretation
• Follow-up scans may be needed to monitor changes over time

Compared to Brain PET-CT

• Oncology PET-CT: Focuses on detecting abnormal glucose metabolism throughout the body
• Brain PET-CT: Evaluates normal vs. abnormal patterns of glucose metabolism within the brain
• Brain scans require different patient preparation (brain rest before imaging)
• Brain scans use different imaging parameters and interpretation criteria

Compared to Cardiac PET-CT

• Oncology PET-CT: Evaluates cancer activity throughout the body
• Cardiac PET-CT: Assesses heart muscle viability and blood flow
• Cardiac scans often require special dietary preparation and medications

Preparing for Your F-18 FDG PET-CT for Cancer Evaluation

Dietary Preparation (Very Important)

12 hours before your appointment:

• Follow a strict low-carbohydrate diet to reduce background glucose levels
• Foods allowed:
  • Meat (beef, chicken, fish)
  • Hard cheese
  • Tofu
  • Eggs
  • Butter
  • Non-starchy vegetables (broccoli, spinach, cauliflower)
• Foods NOT allowed:
  • Cereal and grains
  • Pasta and rice
  • Milk and yogurt
  • Bread and crackers
  • Sugar, honey, and sweets
  • Starchy vegetables (potatoes, corn, peas)
  • Fruit and fruit juices

6 hours before your appointment:

• Stop eating completely
• Continue drinking water as normal
• Take regular medications unless instructed otherwise

Special Instructions for Diabetic Patients

• Inform the department about your diabetes when scheduling
• For morning appointments:
  • Don’t eat any food on the morning of your appointment
  • If you take insulin for treatment of your diabetes, please discuss this with the us directly and the nuclear physician who will report your scan – we may need to adjust your insulin dose on the morning of your scan
• Your blood glucose will be tested before the scan
• Ideal blood glucose level should be below 8.3-10 mmol/L
• If your blood sugar is too high, you may receive insulin or your scan may need to be rescheduled

Additional Preparation

• Avoid strenuous exercise for 24 hours before the scan
• Wear warm, comfortable clothing without metal components
• Bring any previous scan results or reports if done at other facilities
• Plan to spend 2-2½ hours at the imaging facility

What to Expect During Your F-18 FDG PET-CT for Cancer

Upon Arrival

1. Your blood glucose level will be checked
2. A brief medical history will be taken
3. An IV line will be placed in your arm or hand

Tracer Injection and Uptake Period

1. The F-18 FDG radioactive tracer will be injected through your IV
2. You’ll rest quietly in a warm, comfortable room for 60-90 minutes
3. It’s essential to remain still and relaxed during this time
4. Minimal talking or movement is recommended to prevent muscle uptake of the tracer
5. You may be asked to drink water to help flush the tracer through your kidneys

Scanning Procedure

1. You’ll lie on an examination table that moves through the scanner
2. The scanner has a large ring opening (not enclosed like an MRI)
3. The scanning process is quiet and painless
4. You’ll need to lie still during the scan
5. The actual scanning takes approximately 20-30 minutes
6. For some cancer types, additional delayed images may be taken

After Your Scan

• You can resume normal activities and diet immediately
• Drink plenty of fluids to help flush the tracer from your body
• The small amount of radiation will leave your body naturally within 24 hours
• Avoid close contact with pregnant women and young children for 6 hours after the scan
• A nuclear medicine physician will analyze your images and send a report to your doctor
• Your doctor will discuss the results with you at your follow-up appointment

Understanding Your Results

• Positive findings: Areas with higher tracer uptake than background tissue may indicate cancer
• Negative findings: No abnormal uptake suggests absence of active cancer in detectable amounts
• False positives: Some non-cancerous conditions can show increased uptake (inflammation, infection, recent surgery sites)
• Limitations: Very small tumors or certain types of cancer may not show increased FDG uptake

It’s important to understand that while F-18 FDG PET-CT is highly sensitive for detecting many cancers, your doctor will interpret the results in context with your clinical history, physical examination, laboratory tests, and other imaging studies.

Medical Aid Coverage

Most medical schemes and private insurance companies cover F-18 FDG PET-CT imaging for cancer indications, especially for staging and treatment evaluation. Coverage usually follows prescribed minimum benefit guidelines. Contact your insurance provider for specific information about your coverage. Our staff can assist with providing motivation letters if needed for insurance approval.

If you have any questions or concerns about your F-18 FDG PET-CT scan for cancer evaluation, please contact our department or discuss them with your healthcare provider.

What are the Parathyroid Glands?

• Most people have four small parathyroid glands located behind the thyroid gland in the neck
• These glands regulate calcium levels in your body
• Sometimes one or more of these glands becomes overactive (hyperparathyroidism), producing too much parathyroid hormone
• This excess hormone causes high calcium levels in your blood, which can lead to various health problems

Why Might I Need a Parathyroid Scan?

Your doctor may recommend this scan if:

• You’ve been diagnosed with hyperparathyroidism (based on blood tests showing high calcium and parathyroid hormone levels)
• You have symptoms of high calcium levels, such as bone pain, kidney stones, fatigue, or digestive problems
• Surgery is being considered to remove the overactive parathyroid gland(s)
• The surgeon needs to know exactly which gland(s) to remove

How Does a Parathyroid Scan Work?

This scan uses a substance called Sestamibi that is labeled with a small amount of radioactive material (Tc-99m pertechnetate). The test works because:

1. Sestamibi concentrates in overactive parathyroid tissue (adenomas)
2. A special camera (gamma camera) detects the radiation emitted by the Tc-99m Sestamibi
3. The overactive parathyroid gland(s) appear as “hot spots” on the images
4. The concentration of Sestamibi increases over time in parathyroid adenomas, while decreasing in normal tissue

Sometimes, the thyroid gland also takes up the Sestamibi, making it difficult to distinguish parathyroid abnormalities. In these cases, a second radioactive tracer (pertechnetate) that only accumulates in thyroid tissue may be used. By comparing or subtracting these two sets of images, we can more clearly identify parathyroid abnormalities.

What to Expect During the Procedure

Before the Scan

• No special preparation is typically required
• You can eat and drink normally before the test
• Wear comfortable clothing without metal objects in the neck area
• Inform your doctor if you are pregnant or breastfeeding

During the Scan

1. You’ll receive an injection of the Sestamibi tracer into a vein in your arm
   • This feels similar to having blood drawn
   • The tracer will not make you feel different
2. Multiple imaging sessions will be performed:
   • First images taken about 15 minutes after injection
   • Additional images taken at 1 hour, 2 hours, and 3 hours after injection
   • Each imaging session takes about 15-20 minutes
   • You’ll need to lie still with your neck in a slightly extended position
   • A CT scan will be also be acquired to better localise the hyperfunctioning parathyroid tissue anatomically
3. For some patients, at the 3-hour mark:
   • A second tracer (pertechnetate) may be injected
   • Additional images will be taken about 20 minutes after this injection
4. Between imaging sessions, you may be able to wait in a designated area or leave the department temporarily

After the Scan

• You can resume all normal activities immediately
• Drink plenty of fluids to help flush the tracer from your body
• The small amount of radiation will naturally leave your body within a day
• A nuclear medicine specialist will analyze your images and send a report to your doctor
• Your doctor will discuss the results with you at your next appointment

Are There Any Risks?

The parathyroid scan uses a very small amount of radiation. The benefits of identifying the overactive parathyroid gland(s) far outweigh any potential risks from this minimal radiation exposure.

If you have any questions or concerns about your parathyroid scan, please discuss them with your healthcare provider.

Oesophageal Scan

Patient Information Sheet

What is an Oesophageal Scan?

An oesophageal scan is a specialized imaging test that evaluates how food and liquids move through your oesophagus (the tube connecting your mouth to your stomach) and checks for any reflux (backward flow of contents) from the stomach. This test uses a small amount of radioactive tracer added to food or liquid, which is then tracked by a special camera (gamma camera) as it travels through your digestive system.

Why Might I Need an Oesophageal Scan?

Your doctor may recommend this scan to:

In Children:

• Detect anatomical abnormalities of the oesophagus present from birth
• Evaluate swallowing difficulties or abnormal swallowing patterns
• Investigate repeated chest infections that might be caused by food or liquid entering the lungs
• Assess gastroesophageal reflux (when stomach contents flow back up)

In Adults:

• Evaluate swallowing problems or food getting stuck
• Investigate chest pain or discomfort during eating
• Assess motility disorders (abnormal movement of the oesophagus)
• Investigate persistent reflux symptoms or respiratory problems that might be related to reflux

How Does an Oesophageal Scan Work?

The scan works by:

1. Adding a small amount of radioactive tracer (Tc-99m pertechnetate) to food or liquid
2. As you swallow, a special camera (gamma camera) tracks the movement of this tracer
3. The camera creates images showing how the food or liquid moves through your oesophagus
4. Additional images track whether any material returns up the oesophagus (reflux) or enters the lungs
5. For some patients, the test also measures how quickly food moves through the oesophagus (transit time)

Preparing for Your Oesophageal Scan

• You will need to fast (not eat or drink) for 4-6 hours before the test
  • Adults: Usually overnight fasting is required
  • Children: Your doctor will provide specific instructions based on your child’s age
• Continue taking your regular medications unless instructed otherwise
• Inform your doctor if you are pregnant or breastfeeding
• Wear comfortable clothing without metal in the chest area

What to Expect During the Procedure

For Adults:

1. Practice Phase
   • You’ll be given normal fluid to practice swallowing before the actual test
2. Swallowing Phase
   • You’ll be positioned in front of the gamma camera
   • First, you’ll be asked to dry swallow (without liquid) for 30 seconds while being imaged
   • Then you’ll swallow 4 small amounts of liquid containing the radioactive tracer
   • This initial imaging takes about 4 minutes
3. Monitoring Phase
   • You’ll continue to be imaged every 10 seconds for the next hour
   • This monitors how the tracer moves through your oesophagus and stomach
   • You’ll need to remain relatively still during this time
4. Follow-up Images
   • Additional images may be taken at 4-6 hours after the test
   • In some cases, a final image may be taken 24 hours later
   • These later images check if any material has entered the lungs

For Children:

1. The procedure is similar but adapted for children
2. Instead of individual swallows, children are typically given a bottle with milk or formula containing the tracer
3. The child drinks normally for about 4 minutes
4. Imaging continues as with adults, though the timing may be adjusted based on the child’s age and cooperation

After Your Oesophageal Scan

• You can resume eating and drinking as soon as the initial imaging is complete
• You should return for any scheduled later images (if applicable)
• No special precautions are needed after the test
• The small amount of radiation used will naturally leave the body, primarily through urine and stool
• A nuclear medicine specialist will analyze your images and send a report to your doctor
• Your doctor will discuss the results with you at your next appointment

Are There Any Risks?

The oesophageal scan uses a very small amount of radiation. The benefits of the information gained from the scan far outweigh any potential risks from this minimal radiation exposure. The test is non-invasive and painless.

If you have any questions or concerns about your oesophageal scan, please discuss them with your healthcare provider.

What is Myocardial Perfusion Imaging?

Myocardial Perfusion Imaging (MPI) is a specialized test that shows how blood flows to your heart muscle. This test helps your doctor:

• Detect blockages in your coronary arteries
• Assess the impact of these blockages on your heart
• Evaluate the effectiveness of previous treatments like stents or bypass surgery
• Determine your risk for future heart problems

The test uses small amounts of radioactive tracers (such as Tc-99m Sestamibi) that travel through your bloodstream to your heart. A special camera detects these tracers, creating images that show how blood flows to different areas of your heart muscle both during stress and at rest.

What is a Viability Scan?

A viability scan determines whether areas of your heart muscle that appear damaged are:

• Dead tissue from a previous heart attack, or
• “Hibernating” tissue (alive but not functioning properly) that could potentially recover with improved blood flow

This distinction is crucial because hibernating heart tissue may benefit from procedures to restore blood flow, while dead tissue will not.

Why Might I Need These Tests?

Your doctor may recommend these tests if:

• You have symptoms like chest pain, shortness of breath, or fatigue
• You have known coronary artery disease
• You’ve had a previous heart attack
• You’ve had treatments like stents or bypass surgery
• Other tests have been inconclusive
• Your doctor needs to determine if heart surgery would be beneficial

Preparing for Your Test

Before Your MPI (myocardial perfusion imaging) Scan:

• Fast for 4-6 hours before the test (specific instructions will be provided)
• Avoid caffeine (coffee, tea, chocolate, cola) for 24 hours before the test
• Do not smoke on the day of the test
• Certain medications may need to be temporarily stopped, including:
  • Beta-blockers
  • Calcium channel blockers
  • Nitrates
  • Aminophylline derivatives
• Important: Consult with your doctor before stopping any medications
• Wear comfortable clothes and walking shoes if you’ll be exercising
• Bring a snack to eat after the test is complete

Before Your Viability Scan (if needed):

• For PET-CT viability scans, you’ll need to fast overnight

What to Expect During the MPI Procedure

The MPI Test (Two Parts):

Part 1: Stress Test

1. Preparation
   • An IV line will be placed in your arm
   • Monitoring equipment will be attached to check your heart rate and blood pressure
2. Stress Portion (one of the following):
   • Exercise Stress: You’ll walk on a treadmill that gradually increases in speed and incline
     • The goal is to exercise until you reach your target heart rate or experience symptoms
     • If you have mobility issues, please inform us in advance
   • Medication Stress: If you cannot exercise, you’ll receive a medication that mimics the effects of exercise on your heart
     • You may feel flushing, shortness of breath, or chest discomfort – this is normal
     • These sensations will disappear quickly after the medication is stopped
3. Tracer Injection
   • At peak stress, the radioactive tracer will be injected through your IV
   • You’ll continue exercising or receiving the medication for a short time
4. Imaging
   • After 45-60 minutes of waiting, you’ll lie on an examination table
   • A camera will rotate around your chest, taking pictures of your heart
   • This imaging takes approximately 25 minutes
   • You’ll need to lie still with your arms above your head

Part 2: Rest Test

1. Usually performed on a different day or earlier on the same day as the rest study
2. You’ll receive the same radioactive tracer while at rest
3. After waiting 60-90 minutes, imaging will be performed for about 25 minutes
4. No exercise or medication stress is involved in this portion

What to Expect During a Viability Scan (If Needed)

PET-CT Viability Scan:

1. You’ll receive a glucose-rich meal upon arrival
2. Your glucose levels will be monitored with a glucose monitor that requires a pin-prick blood sample
3. A radioactive glucose tracer will be injected
4. After 40 minutes, imaging will be performed for approximately 30 minutes

For Diabetic Patients:

• Your blood sugar will be carefully monitored with a glucose monitor
• You may receive insulin to bring your blood sugar to an optimal level
• The scan proceeds as above once your blood sugar is properly controlled

After Your Test

• You can resume normal activities immediately
• Drink plenty of fluids to help flush the tracer from your body
• You can resume taking any medications that were stopped for the test
• The small amount of radiation used will leave your body naturally within 1-2 days
• A nuclear medicine specialist will analyze your images and send a report to your doctor
• Your doctor will discuss the results with you at your next appointment

Results and Follow-up

Your doctor will receive a detailed report that shows:

• How blood flows to different areas of your heart muscle
• Whether there are areas with reduced blood flow
• If reduced blood flow occurs only during stress or also at rest
• Whether areas of your heart muscle are viable (alive) or non-viable (dead)

This information helps your doctor determine the best treatment plan for your specific condition.

If you have any questions or concerns about your myocardial perfusion or viability scan, please discuss them with your healthcare provider.

What is a MUGA Scan?

A MUGA (Multi-Gated Acquisition) scan is a specialized test that provides detailed information about how well your heart muscle is pumping. This test creates precise measurements of your heart’s pumping efficiency by tracking the movement of your own blood cells through your heart chambers.

Why Might I Need a MUGA Scan?

Your doctor may recommend a MUGA scan to:

• Determine how well your heart is pumping blood (your ejection fraction)
• Evaluate heart function before, during, or after chemotherapy treatments, as some cancer medications can affect the heart
• Assess damage after a heart attack
• Monitor heart function in heart failure
• Evaluate heart valve function
• Check heart function before and after heart surgery
• Follow up on abnormal findings from other cardiac tests

How Does a MUGA Scan Work?

The test works by:

1. Labelling your red blood cells with a radioactive substance (this process is called “tagging”)
2. Alternatively, a small amount of your blood is drawn and mixed with a substance that makes your red blood cells slightly radioactive. These tagged blood cells are then injected back into your bloodstream
3. As the tagged red blood cells flow through your heart, they emit tiny amounts of radiation (gamma rays)
4. A special camera detects these gamma rays and creates images of your heart as it beats
5. The computer synchronizes these images with your ECG (electrocardiogram) to show your heart throughout its pumping cycle
6. This allows precise calculation of your ejection fraction (the percentage of blood pumped out with each heartbeat)

Preparing for Your MUGA Scan

• No special dietary restrictions are typically required
• Continue taking your regular medications unless instructed otherwise
• Wear comfortable clothing without metal buttons or zippers at chest level
• You may be asked to avoid caffeine for 24 hours before the test
• Important: Inform your doctor if you:
  • Are or might be pregnant
  • Are breastfeeding
  • Have an irregular heartbeat (arrhythmia)
  • Have had allergic reactions to medical procedures in the past
  • Have difficulty lying flat for extended periods

What to Expect During the Procedure

Before the Scan

1. You’ll be asked to complete a brief questionnaire about your medical history
2. A healthcare professional will check your vital signs and explain the procedure
3. An IV line will be placed in your arm for blood drawing and later injection

Blood Labeling Process

1. A small amount of radioactive substance will be added to your blood that will label your red-blood cells
2. Alternatively, a small amount of your blood (about 3-5 teaspoons) will be drawn
3. This blood will be mixed with the radioactive substance in a special lab
4. This process takes approximately 20-30 minutes

During the Scan

1. ECG leads (small adhesive patches) will be placed on your chest to monitor your heart rhythm
2. Your tagged red blood cells will be injected back into your bloodstream through the IV
3. You’ll lie on an examination table under a gamma camera
4. You’ll need to lie still during the imaging, which typically lasts about 10-15 minutes
5. The camera will take multiple images of your heart as it beats
6. You may be asked to change positions for additional views
7. The camera does not produce radiation – it only detects the minimal radiation from your tagged blood cells

Potential Discomfort

• The test itself is painless
• You may experience minor discomfort from:
  • The needle insertion for blood drawing and IV placement
  • Lying still on the examination table
  • The table may be hard and slightly cold

After Your MUGA Scan

• You can resume all normal activities immediately
• There are no restrictions on eating or drinking after the test
• The radioactive substance loses its radioactivity quickly and is eliminated from your body naturally within 24 hours
• A cardiologist or nuclear medicine specialist will analyze your scan
• Your doctor will discuss the results with you at your next appointment

What Do the Results Mean?

• The main measurement from a MUGA scan is the ejection fraction
• A normal ejection fraction is typically between 50% and 70%
• Lower values may indicate that your heart is not pumping as efficiently as it should
• Your doctor will interpret these results in the context of your specific medical situation

Are There Any Risks?

The MUGA scan involves exposure to a very small amount of radiation. The benefits of the information gained from the scan far outweigh any potential risks from this minimal radiation exposure. The amount of radiation received during a MUGA scan is comparable to what you would receive from natural background radiation over a few months.

How Long Will the Entire Procedure Take?

The entire procedure typically takes about 1½ hours:

• 30 minutes for blood drawing and tagging
• 15 minutes for setup with ECG leads
• 15-20 minutes for the actual scanning
• Additional time for preparation and possible extra views

If you have any questions or concerns about your MUGA scan, please discuss them with your healthcare provider.