Microsoft word - 5.1.1_gastric_emtying_solid.doc

GASTRIC EMPTYING STUDY - SOLID

Overview
The Gastric Emptying Study demonstrates the movement of an ingested bolus
of solid from the stomach into the smal intestine. Various physiologic parameters may be quantified.
Indications
Diagnosis of functional gastric dysmotility (1-4).
Diabetes Malabsorption
Gastric outlet obstruction Anorexia
Weight Loss Nausea and Vomitting
Abdominal pain Abnoraml GI X-rays
Cachexia
Unspecified functional disorders of the stomach
*Exams ordered for indications which are not listed above need to be discussed
with the Nuclear Medicine Physician.
Examination Time
Variable, ranges from 1 hour to several hours.
Patient Instructions

Schedule in the morning or early afternoon, whenever possible as the
gastric emptying time varies with the time of day (5). The
patient must be NPO a minimum of 6-8 hours prior to imaging.
Patients with dentures should be advised to bring them.
Have the patient bring a list of al medications they are currently taking.
Anti-nausea medicine, such as Vistaril, Compazine, Tigan and Phenergan
should be held if possible, 24 hours prior to the study.
Prokinetic medications such as Zelnorm and Cisapride (Propulsid) should
be discontinued for 24 hours unless otherwise instructed.
NOTE: Try to have patients who are insulin dependent diabetics imaged
earlier in the day.

Lab / Image Correlation
Have any prior gastric emptying studies available for comparison.
If the patient has had an upper GI, attempt to have the report available.
Equipment & Energy Windows
Gamma camera: Large field of view. Preferably dual head.
Col imator: Low energy, high resolution, paral el hole.
Energy window: 20% window centered at 140 keV.
Matrix 128x128.
Radiopharmaceutical, Dose, & Technique of Administration
Radiopharmaceutical: Tc-99m-sulfur col oid tagged to one scrambled egg. NOTE: If the patient is al ergic to eggs, use instant oatmeal (1 package) reconstituted with water.
Dose: 1 mCi (37 MBq) P.O.
Patient Position & Imaging Field
Patient position: Standing. If patient is unable to tolerate a 45degree upright
position on a stretcher may be used. This must be clearly noted and the
same position must be used throughout the study.
Imaging field: Upper abdomen. Distal esophagus, stomach and smal bowel
must be in the field of view.
Acquisition Protocol (14)
Place the patient in a sitting position, LAO to the camera (15,16). If a dual
head camera is used image in the anterior / posterior position. Have the patient ingest the test meal as quickly as possible, fol owed by 120cc of tap water. Acquire serial 1 minute digital images at the fol owing times: (immediate,10,15,30,45,60,75,90,105,and 120 minutes). NOTE: The patient should remain quiescent between image acquisitions because exercise decreases gastric emptying times (17). Acquire images until the counts in the gastric region of interest have fal en by more than 95%, but at least for 1 hour. (Gastric counts can be determined for each image while waiting to begin the next acquisition.)
Data Processing
1. Draw a region of interest around the entire stomach, but exclude as much smal
intestine as possible in each image. Do not use a background region of interest.
2. The processing software wil correct the counts at each time period for
radioactive decay. If a dual head camera is used enable the geometric
mean processing.
3. The computer wil plot the results on a graph with "Time" on the X-axis and
"Gastric counts" on the Y-axis. The half emptying time wil be calculated
automatical y. Generate raw and fitted curves.
NOTE: For Tc-99m-SCOL labeled scrambled eggs the normal T1/2 is <90
minutes (70-90minutes wil be considered borderline). Residual gastric
activity of >15% is abnormal.
For Tc-99m-SCOL Labeled oatmeal the normal T1/2 is <60 minutes.

Principle Radiation Emission Data - Tc-99m (30)
Physical half-life = 6.01 hours.
Radiation Mean % per disintegration Mean energy (keV)
Gamma-2 89.07 140.5
Dosimetry - Tc-99m-Sulfur Colloid Solid Meal (31)
Organ rads/1 mCi mGy/37 MBq
Large intestine 0.46 4.6
Smal intestine 0.24 2.4
Stomach 0.24 2.4
Ovaries 0.08 0.8
Whole body 0.02 0.2
Testes 0.004 0.04
References
1. Datz FL, Christian PE, Hutson WR, et al: Physiological and pharmacological
interventions in radionuclide imaging of the tubular gastrointestinal tract. Sem Nucl Med
21:140-152, 1991. 2. Domstad PA, Kin EE, Coupal JJ, et al: Biologic gastric emptying time in diabetic patients, using Tc-99m-labeled resin-oatmeal with and without metoclopramide. J Nucl Med 21:1098-1100, 1980. 3. Christian PE, Datz FL, Moore JG: Gastric emptying studies in the morbidly obese before and after gastroplasty. J Nucl Med 27:1686-1690, 1986. 4. Velchik MG, Kramer FM, Stunkard AJ, et al: Effect of the Garren-Edwards Gastric Bubble on gastric emptying. J Nucl Med 30:692-696,1989. 5. Goo RH, Moore JG, Greenberg E, et al: Circadian variation in gastric emptying of meals in humans. Gastroenterology 93:515-518, 1987. 6. Wright RA, Thompson D, Syed I: Simultaneous markers for fluid and solid gastric emptying: New variations on an old theme. J Nucl Med 22:772-776, 1981. 7. Knight LC, Malmud LS: Tc-99m-ovalbumin labeled eggs: Comparison with other solid food markers in vitro. J Nucl Med 22:P28, 1981. 8. McCallum RW, Saladino T, Lange R: Comparison of gastric emptying rates of intracellular and surface-labeled chicken liver in normal subjects. J Nucl Med 21:P65, 1980. 9. Horowitz M, Maddox AF, Wishart JM, et al: Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med 18:229-234, 1991. 10. Leb G, Lipp RW: Criteria for labelled meals for gastric emptying studies in nuclear medicine. Eur J Nucl Med 20:185-186, 1993. 11. Fitzpatrick ML, Alderson AM: Solid food label for measurement of gastric emptying. [Letter] Br J Radiol 52:920-921, 1979. 12. Klingensmith WC: Unpublished data. 13. Taillefer R, Souesnard JM, Beauchamp G, et al: Comparison of technetium-99m sulfur colloid and technetium-99m albumin colloid labeled solid meals for gastric emptying studies. Clin Nucl Med 12:597-600, 1987. 14. Datz FL: Considerations for accurately measuring gastric emptying. J Nucl Med 32:881-884, 1991. 15. Fahey FH, Ziessman HA, Collen MJ, et al: Left anterior oblique projection and peak-to-scatter ratio for attenuation compensation of gastric emptying studies. J Nucl Med 30:233-239,1989. 16. Ford PV, Kennedy RL, Vogel JM: Comparison of left anterior oblique, anterior and geometric mean methods for determining gastric emptying times. J Nucl Med 33:127-130, 1992. 17. Moore JG, Datz FL, Christian PE. Exercise increases solid meal gastric emptying rates in men. Dig Dis Sci 33:1592-1595, 1988. 18. Kroop HS, Long WB, Alavi A, et al: Effect of water and fat on gastric emptying of solid meals. Gastroenterology 77:997-1000, 1979. 19. Datz FL, Christian PE, Moore JG: Gender-related differences in gastric emptying. J Nucl Med 28:1204-1207, 1987. 20. Spencer RP: Effect of volume on gastric emptying: A new theory, and a study by radionuclide techniques. J Nucl Med 22:P28, 1981. 21. Datz FL, Christian PE, Moore JG: Loss of liquid-solid discrimination in gastric emptying of aged subjects. J Nucl Med 22:P28-29, 1981. 22. Fisher RS, Malmud LS, Bandini R, et al: Gastric emptying of a physiologic mixed solid-liquid meal. Clin Nucl Med 7:215-221, 1982. 23. Ziessman HA, Atkins FB, Vemulakonda US, et al: Lag phase quantification for solid gastric emptying studies. J Nucl Med 37:1639-1643, 1996. 24. Yung BCK, Sostre S: Lag phase in solid gastric emptying: Comparison of quantification by physiological and mathematical definitions. J Nucl Med 34:1701-1705, 1993. 25. Urbain JLC, Vekemans MC, Bouillon R, et al: Characterization of gastric antral motility disturbances in diabetes using a scintigraphic technique. J Nucl Med 34:576-581, 1993. 26. Christian PE, Datz FL, Moore JG: Confirmation of short solid-food lag phase by continuous monitoring of gastric emptying. J Nucl Med 32:1349-1352, 1991. 27. Eikman EA, Brady P, Tenorio L, et al: Delayed gastric emptying: A comprehensive test for diagnosis and assessment of treatment. J Nucl Med 31:800, 1990. 28. Urbain JLC, Charkes ND: Recent advances in gastric emptying scintigraphy. Sem Nucl Med 25:318-325, 1995. 29. Urbain JLC, Vekemans MC, Parkman H, et al: Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia. J Nucl Med 36:1579-1586, 1995. 30. 43-Tc-99m: In MIRD: Radionuclide Data and Decay Schemes, DA Weber, KF Eckerman, AT Dillman, JC Ryman, eds, Society of Nuclear Medicine, New York, 1989, pp 178-179. 31. Siegel JA, Wu LK, Knight LC, et al: Radiation dose estimate for oral agents used in upper gastrointestinal disease. J Nucl Med 24:835-837, 1983. 32. 49-In-111: In MIRD: Radionuclide Data and Decay Schemes, DA Weber, KF Eckerman, AT Dillman, JC Ryman, eds, Society of Nuclear Medicine, New York, 1989, pp 196-197. Normal Findings Kroop HS, Long WB, Alavi A, et al: Effect of water and fat on gastric emptying of solid meals. Gastroenterology 77:997-1000, 1979. Spencer RP: Effect of volume on gastric emptying: A new theory, and a study by radionuclide techniques. J Nucl Med 22:P28, 1981. Christian PE, Datz FL, Moore JG: Gastric emptying studies in the morbidly obese before and after gastroplasty. J Nucl Med 27:1686-1690, 1986. Datz FL, Christian PE, Moore JG: Gender-related differences in gastric emptying. J Nucl Med 28:1204-1207, 1987. Urbain JLC, Vantrappen G, Janssens J, et al: Intravenous erythromycin dramatical y accelerates gastric emptying in gastroparesis diabeticorum and normals and abolishes the emptying discrimination between solids and liquids. J Nucl Med 31:1490-1493, 1990. Vil anueva-Meyer J, Swischuk SLE, Cesani F, et al: Pediatric gastric emptying: Value of right lateral and upright positioning. J Nucl Med 37:1356-1358, 1996. Casson AG, Powe J, Inculet R, et al: Functional results of gastric interposition fol owing total esophagectomy. Clin Nucl Med 12:918-922, 1991. Phil ips WT, Schwartz JG, Blumhardt R, et al: Linear gastric emptying of hyperosmolar glucose solutions. J Nucl Med 32:377-381, 1991.
NOTE: This procedure adheres to ACR standards 1997.
This procedure adheres to the Society of Nuclear Medicine Procedure
Guidelines for Gastric Emptying and Motility. Version 1.0, 7 Feb 1999

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