SALIVARY GLAND IMAGING

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SALIVARY GLAND IMAGING

• By
• Carolina Narvaez
• NMT 1713

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OBJECTIVES

• Learn about the Radiopharmaceutical,
  localization, dosage, QC, dosage and method of
  administration of salivary gland imaging
  procedure.
• Learn about the indication and contraindications.
• Learn about what patient preparation and history
  to be taken.

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RADIOPHARMACY

• Radionuclide
• Tc99m
• T1/2 6 hours
• Energy 140 keV
• Radiopharmaceutical
• Na 99mTcO4- (pertechnetate)
• Localization
• Parenchyma cells of the parotid gland

• QC
• Moly-Al breakthrough
• Adult Range Dose
• 8-12 mCi (10 mCi)
• Method of Administration
• IV Injection (good bolus for flow)

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INDICATIONS CONTRAINDICATIONS

• Indications
• Tumors
• Salivary gland function
• Masses in parathyroid
• Salivary tissue
• Anatomic size position of salivary glands

• Contraindications
• NONE

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PATIENT HISTORY PREPARATION

• Patient History
• Do you have history of family history of cancer,
  salivary dysfunction?
• Dry mouth?
• Pain or palpable lumps in or under jaw?
• Labial biopsy (minor salivary gland tissue)?
• Patient Preparation
• Withhold thyroid blocking meds (ex. iodine) for
  48 hrs.
• Administer patient gum to stimulate salivary
  glands

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PROCEDURE (60-90 minutes)

• Patient in supine position
• Pillow under shoulders
• Neck extended camera as close as possible
• Administer injection to patient Start camera
• Obtain one of the following
• Flow dynamic 30-60 min Anterior marker, left
  right laterals
• Flow with statics15 min PI3 min/view Anterior
  marker, left right laterals
• Statics only15 min PI3 min/view some images at
  2,5,10,15,20, , 30 min Anterior marker, left
  right laterals

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PROCEDURE.continued

• Lemon Phase
• Place lemon extract or gauze soaked with lemon
  juice on both sides of mouth
• (some do this at 40 min dynamic or after
  dynamics statics- use 2 ml of lemon juice
  through straw)
• Remove gauze after 5 min allow patient to
  expectorate excess saliva rinse with water
• Repeat anterior, left, right laterals at 15-30
  min after lemon administration

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PROCEDURES ..continued

• Salivary function evaluation
• Draw ROI around thyroid, submandibular, parotid
  glands, backgrounds-lateral/anterior views
• Record counts repeat for all sequential timed
  images

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RESULTS

• normal

• abnormal

• Symmetric uptake in the parotid submandibular
  glands
• Uptake in sublingual, thyroid glands nasal
  cavity
• Significant reduction of activity in salivary
  glands after lemon admin

• Asymmetrical uptake on one/both sides of face
• Activity remains local after lemon admin
• Increased activity in mass (Warthins tumor)
• Patchy decreases in activity (Sjogrens
  syndrome-dry mouth)
• Inflammation of salivary glands

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CONCLUSION

• With the lemon extract administration, the
  salivary glands are evaluated to rule out tumors,
  lesions, or infections.

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QUESTIONS

1. How much Na 99mTcO4- (pertechnetate) should be
   administered to the patient?
2. What is the method of localization of the
   salivary glands?
3. What views are acquired in the salivary gland
   imaging?

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ANSWERS

1. 10 mCi Na 99mTcO4-
2. Parenchyma cells of the parotid gland and
   salivary glands
3. Anterior marker, left and right laterals