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## Complete Summary

#### GUIDELINE TITLE

Procedure guideline for general imaging.

#### BIBLIOGRAPHIC SOURCE(S)

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

#### GUIDELINE STATUS

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).

### 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)

Conditions for which general nuclear medicine imaging is indicated

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation

#### CLINICAL SPECIALTY

Nuclear Medicine\
Radiology

#### INTENDED USERS

Allied Health Personnel\
Physicians

#### GUIDELINE OBJECTIVE(S)

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

#### TARGET POPULATION

Adults and children for whom nuclear medicine imaging procedures are
indicated

#### INTERVENTIONS AND PRACTICES CONSIDERED

**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

#### MAJOR OUTCOMES CONSIDERED

Utility and safety of imaging procedures

### 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 May 30, 2004.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**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.

A.  *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.

B.  *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.

C.  *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.

#### 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 general imaging
studies, in order to maximize the diagnostic information obtained in the
studies while minimizing the resources that are expended.

#### POTENTIAL HARMS

-   A few diagnostic nuclear medicine studies (e.g., ^131^I 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., ^131^I 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.

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

-   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., ^131^I
    whole-body imaging), breastfeeding must be stopped for 1-2 months;
    therefore, it is impractical to resume breastfeeding for that child.

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

#### ADAPTATION

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

#### DATE RELEASED

1999 Feb (revised 2004 May 30)

#### 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*: 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)

#### 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 general imaging, 2.0. Reston (VA): Society of
Nuclear Medicine; 1999 Feb. 36 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=792&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 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