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## Complete Summary

#### GUIDELINE TITLE

Procedure guideline for gallium scintigraphy in inflammation.

#### BIBLIOGRAPHIC SOURCE(S)

Society of Nuclear Medicine. Procedure guideline for gallium
scintigraphy in inflammation. Version 3.0. Reston (VA): Society of
Nuclear Medicine; 2004 Jun 2. 5 p.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine.
Procedure guideline for gallium scintigraphy in inflammation, 2.0.
Reston (VA): Society of Nuclear Medicine; 1999 Feb. 21 p. (Society of
Nuclear Medicine procedure guidelines; no. 2.0).

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Fever of unknown origin

-   Pulmonary and mediastinal inflammation/infection

-   Lymphocytic or granulomatous inflammatory processes, such as
    sarcoidosis or tuberculosis

-   Osteomyelitis and/or disk space infection

-   Retroperitoneal fibrosis

-   Drug-induced pulmonary toxicity

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation

#### CLINICAL SPECIALTY

Nuclear Medicine\
Radiology

#### INTENDED USERS

Allied Health Personnel\
Physicians

#### GUIDELINE OBJECTIVE(S)

To assist nuclear medicine practitioners in recommending, performing,
interpreting, and reporting the results of ^67^gallium (^67^Ga)
inflammation scintigraphy

#### TARGET POPULATION

Adults and children with clinical indications for ^67^gallium (^67^Ga)
inflammation scintigraphy

#### INTERVENTIONS AND PRACTICES CONSIDERED

^67^Gallium (^67^Ga) inflammation scintigraphy, including regional,
whole-body, planar, and single-photon emission computed tomographic
(SPECT) scintigrams, or any combination performed after intravenous
injection of ^67^Ga-citrate

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

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

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

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

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

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.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

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

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

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 June 2, 2004.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Background Information and Definitions**

^67^Gallium (^67^Ga) scintigraphy may include regional, whole-body,
planar, and single-photon emission computed tomographic (SPECT)
scintigrams, or any combination performed after intravenous injection of
^67^Ga-citrate.

**Examples of Clinical or Research Applications**

A.  Whole-body survey to localize source of fever in patients with fever
    of unknown origin (FUO)

B.  Detection of pulmonary and mediastinal inflammation/infection,
    especially in the immunocompromised patient

C.  Evaluation and follow-up of active lymphocytic or granulomatous
    inflammatory processes, such as sarcoidosis or tuberculosis

D.  Diagnosing osteomyelitis and/or disk space infection. ^67^Ga is
    preferred over labeled leukocytes for disk space infection and
    vertebral osteomyelitis

E.  Diagnosis and follow-up of medical treatment of retroperitoneal
    fibrosis

F.  Evaluation and follow-up of drug-induced pulmonary toxicity (e.g.,
    bleomycin, amiodarone)

**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; information regarding the radiopharmaceutical
(i.e., ranges of administered activity, organ receiving the largest
radiation dose, effective dose), image acquisition; interventions;
processing; interpretation/reporting; quality control, and sources of
error.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

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

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

The intent of the procedure guideline is to describe gallium
scintigraphy in inflammation, in order to maximize the diagnostic
information obtained in the study while minimizing the resources that
are expended.

#### POTENTIAL HARMS

Not stated

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

Lactation and pregnancy are relative contraindications. If the patient
is willing to permanently discontinue breastfeeding and the gallium
study is not emergent, the patient should be asked to stop breastfeeding
2 weeks before the gallium injection. This precaution will significantly
decrease the radiation dose to the breast.

If the examination is urgent, the breastfeeding patient must be asked to
discontinue breastfeeding for approximately 2 to 4 weeks after the
gallium injection. This precaution will significantly decrease the
radiation dose to the nursing infant.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   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.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness\
Safety

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Society of Nuclear Medicine. Procedure guideline for gallium
scintigraphy in inflammation. Version 3.0. Reston (VA): Society of
Nuclear Medicine; 2004 Jun 2. 5 p.

#### ADAPTATION

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

#### DATE RELEASED

1999 Feb (revised 2004 Jun 2)

#### GUIDELINE DEVELOPER(S)

Society of Nuclear Medicine, Inc - Medical Specialty Society

#### SOURCE(S) OF FUNDING

Society of Nuclear Medicine (SNM)

#### GUIDELINE COMMITTEE

Task Force

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Authors*: Christopher J. Palestro, MD (Long Island Jewish Medical
Center, New Hyde Park, NY); Manuel L. Brown, MD (Henry Ford Hospital,
Detroit, MI); Lee A. Forstrom, MD, PhD (Mayo Clinic, Rochester, MN);
Bennett S. Greenspan, MD (Harry S. Truman VA Medical Center, Columbia,
MO); John G. McAfee, MD (George Washington Hospital, Washington, DC);
Henry D. Royal, MD (Mallinckrodt Institute of Radiology, St. Louis, MO);
Donald S. Schauwecker, PhD, MD (Richard L. Roudebush VA Medical Center,
Indianapolis, IN); James E. Seabold, MD (Carl T. Hayden VA Medical
Center, Phoenix, AZ); Alberto Signore, MD (University La Sapienza, Rome,
Italy)

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Society of Nuclear Medicine.
Procedure guideline for gallium scintigraphy in inflammation, 2.0.
Reston (VA): Society of Nuclear Medicine; 1999 Feb. 21 p. (Society of
Nuclear Medicine procedure guidelines; no. 2.0).

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [Society of Nuclear Medicine (SNM)
Web site](http://interactive.snm.org/index.cfm?PageID=1928&RPID=772).

Print copies: Available from SNM, Division of Health Care Policy, 1850
Samuel Morse Dr, Reston, VA 20190-5316; Phone: 1-800-513-6853 or
1-703-326-1186; Fax: 703-708-9015; E-Mail:
[ServiceCenter@snm.org](mailto:servicecenter@snm.org).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Society of Nuclear Medicine. Procedure guideline for guideline
    development. Reston (VA): Society of Nuclear Medicine; 2001 Jun
    (version 3.0). Electronic copies: Available from the [Society of
    Nuclear Medicine Web
    site](http://interactive.snm.org/index.cfm?PageID=793&RPID=772).

-   Society of Nuclear Medicine. Performance and responsibility
    guidelines for NMT. Reston (VA): Society of Nuclear Medicine; 2003.
    Electronic copies: Available from the [Society of Nuclear Medicine
    Web
    site](http://interactive.snm.org/index.cfm?PageID=1929&RPID=772).

Print copies: Available from SNM, Division of Health Care Policy, 1850
Samuel Morse Dr, Reston, VA 20190-5316; Phone: 1-800-513-6853 or
1-703-326-1186; Fax: 703-708-9015; E-Mail:
[ServiceCenter@snm.org](mailto:servicecenter@snm.org).

#### PATIENT RESOURCES

None available

#### NGC STATUS

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
by ECRI on May 18, 2005. The updated information was verified by the
guideline developer on June 30, 2005.

#### COPYRIGHT STATEMENT

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

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008