TRA Medical Imaging BILIARY SCAN Protocols

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Last reviewed:

Contact: (866) 761-4200 and choose option 1.

Purpose:

To evaluate the function of the gallbladder, gallbladder ejection

fraction, bile leak, or post-surgical changes in biliary excretion.

Pt Prep:

NPO 4 hours
No morphine or opioids for at least 4hours before the study.

Radiopharm and Dose:

Tc-Mebrofenin (Choletec), 6 mCi, IV

Equipment Set-Up:

LFOV Camera with LEHR Collimators

Time Required:

1 Hours for routine Biliary + GB EF

Other Materials Required:

CCK (0.02 ug/kg to a max of 2.5 ug)
Morphine (if indicated)

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2.
3.
4.
5.
6.

Biliary with Ejection Fraction

Biliary without Ejection Fraction
Biliary with Morphine
Bile Leak Study
Biliary SOD
BILIARY S.O.D. WORKSHEET

1. Biliary with Ejection Fraction

1) Inject patient with 6 mCi Tc-Mebrofenin. Leave IV in for use with CCK.
2) At 40 min post-injection, do 2 static images (RLAT and LAO 20-25 degrees) to determine if
the gallbladder has filled.
3) If GB is not visualized, image every 10 min out to 60 min or until visualized.
4) When GB has filled, proceed to dynamic GB EF study (NOTE: gallstones do not contraindicate
CCK) :
a) Add CCK (0.02 ug/kg to a max of 2.5 ug) to a 250 ml bag of normal saline.
b) Infuse IV at a rate which delivers the entire 250 ml in 30 min.
c) Begin dynamic image acquisition at the same time as the infusion (30 frames at 60 sec
each)
5) Determine the GB EF on Pegasys through Global Q -> General Nuc Med -> GALLBLADDER
EJECTION FRACTION
6) Snapshot all results and send to PACS
Processing Note: Please indicate on film if patient experienced symptoms or not, during or
following the injection of CCK

2. Biliary without Ejection Fraction

1.
2.
3.
4.

Inject patient with ~ 6 mCi Tc-Mebrofenin.

Immediately begin a dynamic acquisition for 60 minutes, 1 min/frame
When dynamic images finish, do a static image of the right lateral.
Frame compress images for display to 3 min/frame, and display 20 frames on a 24
format.

If at the end of the dynamic images the Choletec has not progressed past the Sphincter of
Oddi, give the patient a can of BOOST to drink. Have them sit for a while, and when there is
camera time (30-60 min after BOOST), do a 3 min static image to see how far the Choletec
has progressed.

3. Biliary with Morphine

If gallbladder is not seen by 60 minutes, check with nuc med MD re: morphine intervention.
NOTE: Pt must not drive an automobile for several hours after receiving morphine.

o If the pt must drive, morphine will not be used and delayed imaging will be done
between 2 and 4 hours post-injection. You will need enough camera time to perform a
CCK-EF if the gallbladder shows.
o If the pts schedule or the cameras schedule do not permit imaging in the 2 to 4 hour
timeframe, reschedule the pt for a no-charge repeat when the pt can bring a driver.
Administer 2 mg morphine sulfate, IV, slowly injected over 2 min. (Dr. Sam, 9-8-11)
Acquire spot views every few minutes for another 30 minutes.
Always check with nuc MD before terminating exam and releasing patient.

4. Bile Leak Study

(no prep required)
Inject 6 mCi Choletec. Immediately begin a 45 min anterior dynamic acquisition, 1 min/frame.
This dynamic acq must continue until tracer is seen in small bowelextend the dynamic if
necessary. After dynamic images are complete, have patient lie on their right side for 5 minutes.
Finish the exam by acquiring a 2 minute anterior static while the patient remains in this rightdecubitus position. (Dr. Sam, 12/09/2011)

5. Biliary SOD
For the identification of Sphincter of Oddi Dysfunction in post-cholecystectomy patients who
develop RUQ pain.
Acquisition
1. Pre-treat patient with CCK (0.02 ug /kg). Infuse CCK in 3 min.
2. 15 minutes after completion of CCK infusion inject 6 mCi Tc-Mebrofenin, and

immediately begin a dynamic acquisition.

3. Acquire data for 60 minutes at 1 min/frame.
Processing
1. Extract the following frames to be displayed as static images: 3, 5, 10, 15, 30, 45, and 60.
2. Draw regions of interest over the liver and the common bile duct, to generate time
activity curves over each area. Be sure to draw the CBD ROI over the lowest portion of
the duct which is not superimposed by bowel activity.
3. From the liver curve determine the time of hepatic peak.
4. From the CBD curve determine the % CBD emptied.
[(peak CBD-60 min CBD)/peak CBD]
If the CBD is continuously rising, use the 30 minute count as the peak.
Send all data to PACS and provide the reading radiologist with the attached score sheet. Scores
of 0-4 are normal. Scores of 5-12 indicate Sphincter of Oddi dysfunction.
(Scoring sheet on next page.)

6. BILIARY S.O.D. WORKSHEET

Reference: Sostre S, Wagner H, et al.; A Noninvasive Test of Sphincter of Oddi Dysfunction in Postcholecystectomy Patients: The Scintigraphic Score; Journal of Nuclear Medicine, June
1992; p. 1216
PATIENT :
Criteria
Peak Time of Liver
a. Less then 10 min
b. 10 or more min
Time of Biliary Visualization
a. Less than 15 min
b. 15 or more min

DATE :
Value

Score

0
1

_____

0
1

_____

Prominence of Biliary Tree

a. Not prominent
b. Prominent major intrahepatic ducts 1
c. Prominent small intrahepatic ducts 2

0
_____

Bowel Visualization
a. Less than 15 min
b. 15-30 min
c. More than 30 min

0
1
2

_____

CBD Emptying
a. By more than 50%
b. Less than 50%
c. No change
d. Shows increasing activity

0
1
2
3

_____

CBD-to-Liver Ratio
a. CBD@60 < / = Liver@60
b. CBD@60 > LIVER@60, but
Lower than LIVER@15
c. CBD@60 > LIVER@60 and
= to LIVER@15
d. CBD@60 > both LIVER@60
and LIVER@15

0
1
2
3

_____

TOTAL
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