Clinical Indications and Contraindications Boards review

• determine PE

• post PE treatment

• ventilation pathology

• evaluation perfusion

• lung transplant eval

• lung/lobe resection eval

• R-L shunt

• CODP eval/staging

pulmonary clinical indications

• pregnancy (relative)

• breastfeeding

• severe pulmonary HTN

• severe syncope, chest pain, dyspnea

• recent surgery

• allergy to human serum albumin products

pulmonary contraindications

why would you do a NM lung scan over a CTA

• low clinical probalility

• pregnancy

• CXR normal

• contraindication to iodinated contrast

• RUQ pain

• acute/chronic cholecystitis

• biliary system patency

• biliary leak

• biliary atresia

• live transplant assessment

• GBEF

• enterogastric reflux

• choledochal cysts

Hepatobiliary clinical indication

• hypersensitivity to hepato compound

• recent meal

• prolonged fasting

• recent opiate/narcotic use

• pregnancy/BF

hepatobiliary contrainidactions

• renal function

• infection/inflammation

• acute renal failure

• transplant eval

• obstruction vs stasis

• RAS

• vesicoureteral reflux

• congenital abnormalities

renal clinical indications

• assess function and appearance

• locate eptopic tissue

• evaluate neck mass

• differentiate pathologic diseases

• Hyper vs Hypo

• pre ablation imaging

• abnormal lab values

• nodules

• carcinoma

• neoplasm

endocrine clinical indications

• pregnancy/BF

• recent NM scan

• recent CT (iodine) within 6 weeks

• thyroid med use within 4 weeks

• not NPO for 4 hrs prior

  • had high iodine foods

endocrine contraindications

• CAD

• chest pain

• previous MI

• assess therapy and interventions

• myocardial viability

cardiac clinical indications

• acute MI (<4 days)

• severe angina

• high risk unstable angina

• uncontrolled CHF

• uncontrolled HTN

• uncontrolled arrhythmias

• acute PE

• acute aortic dissection

• severe pulmonary HTN

Absolute contraindications for exercise stress

• know left main CAD

• moderate angina

• hypertropic obstructive cardiomyopathy

• significant tachy or brady arrhythmias

• high degree AV block

• electrolyte abnormalities

• mental or physical imapirment

• LBBB, pacemakers

relative contraindications for exercise stress

• no caffeine (12-24 hrs)

• no methyxanthines

• hypersenitive to agents

• high grade AV block

• asthmatic with wheezing

• low BP

contraindications to pharmacologic stress

what is significant about dobutamine contraindications?

same as exercise stress test

• skeletal mets

• primary bone tumors

• stress fx and shin splints

• osteomyelitis vs cellulitis

• avascular necrosis

• arthritis

• bone pain of unknown origin

skeletal clinical indications

• pregnancy/BF

• recent CT w/ contrast

• recent NM study

skeletal contraindications

• fever of unknown origin (FUO)

• retroperitoneal fibrosis

• suspected osteomyelitis

• diskitis

• inflammation or infection (acute/chronic)

• abscess detection

• pelvic inflammation

• shunt infection

infection clinical indications

• pregnancy/BF

• recent MRI with gadolinium contrast

• recent NM study

infection contraindications

Tc99m infection use

extremity infection or acute abscess detection

In-111 infection use

abdominal infections or osteomyelitis

Ga-67 citrate infection use

chronic infections or gallium avid tumors

• epilepsy

• dementia

• parkinsons

• cerebral vascular disease

• brain death

• brain tumors

• trauma

• strokes

brain imaging clinical indications

• pregnancy/BF

• recent contrast

• recent NM study

• acetazolamide sulfa allergy

brain contraindications

• nausea, vomiting

• stomach pain

• fullness

• loss of appetite

• previous surgery

• gastric reflux

gastric emptying clinical indications

• pregnancy/BF

• allergic to meal

• poorly control diabetic

• prokinetic agents stopped 2 days prior

• pain meds/nicotine use stopped

• not on menstrual cycle

gastric emptying contraindications

• bloody stool

• actively bleeding

• recent surgery

GI bleed clinical indications

unstable rapid hemorrhage

GI bleed contraindication

• localize ectopic gastric mucosa

• children with rectal bleeding

• unexplained GI bleed

meckels clinical indications

• patient actively bleeding

• no aspirin 3 days prior

meckels contraindications

• assess size and shape

• liver mets

• evaluate hepatic functions in acute or chronic liver disease

• differentiate hepatic hemangiomas and focal nodular hyperplasia

• identifying functioning splenic tissue

• hepatomegaly, cirrhosis, trauma

liver spleen clinical indications

• pregnancy/BF

• recent nm study

• recent CT contrast

liver spleen contraindications