We’re all familiar with the obstacles that radiotracers and subsequent gut activity presents during Myocardial Prefusion Imaging. When the radioisotope expands beyond the coronary arteries, it’s difficult to obtain quality SPECT MPI imaging of the heart. It’s a common problem that plagues many patients and physicians. So what do we do?
We’ve heard of everything from half & half, cold water, and even a certain type of soda post injection to reduce the dreaded gut activity. Since we weren’t aware of any tried and true solution, we polled our fellow nuclear specialists on LinkedIn to see if they could provide some tips, tricks and home remedies.
Wait Time is always going to be your best practice to assist with clearance but if that or your go-to response doesn’t always work, check out these suggestions and add them to your list:
If it is a bowel loop, we give them another cup of cold water and have them walk the hallway if they can. If they have a hiatal hernia or liver disease, we give them a longer wait time prior to scan to try to avoid the need for rescan. And we ask them all not to lay down, but to sit up instead when possible when waiting.
In my experience, the most effective method for reducing gut uptake and obtaining separation from the inferior margin is the combination of walking and ice cold water consumption. I have also heard of technologist giving patient’s Boost/Ensure after rest dosing and obtaining great images. This is done at the discretion of exercise stress, however.
Additional cold water – approximately 8 ounces. Drink fast. Walk around for 5-10 minutes, then have the patient lay on their right side to see if the loop will pull away from the bottom half of the heart. I had a tech that worked for me that came from Ohio State, and they would try this. Sometimes it would work and sometimes it wouldn’t. Always feed them. That, of course, helps for most.
We find that waiting is the best remedy but not always practical. Cold water gulped down for resting scan. Snack and a drink for the stress scan. Sometimes, particularly with hot livers, lying the patient on 2 pillows behind the shoulders, raising them will drop the activity away from the heart.
I have used carbonated sodas if walking and drinking water didn’t help. I used to use Diet Sprite, but I guess ginger ale is an option too. For stress images, fatty foods, ice cream, coffee, anything that helps bowel movement.
I’ve often placed a broad strip of pliable soft lead shielding over the patient’s abdomen at an angle, and this has often helped mitigate proximal intestinal activity. Otherwise, if you have the time, waiting 45-60 minutes post-injection to perform resting MPI has been fairly beneficial.
I like for my patients to have a drink of their choice (soda, water, coffee, etc.) and some crackers or small snack before their stress images. Some water only before rest images. Extra wait time for Cardiolite vs. Myoview, especially for liver clearance.