Lymph

Lymph

Dose:

99mTc antimony sulphide colloid (ATC) - 40 MBq




Imaging Protocol:

Lay supine - AFFECTED ARM ABOVE HEAD

Dynamic:

  • 30 frames for 60-sec

Planar Statics:

  • Anterior, posterior and lateral of affected side (2 min each)

  • Transmission Image (place board behind patient to get outline of the body)

SPECT/CT:

  • 40sec/projection for 32 projections (30 mins)

  • Used for lineation of anatomical localisation; where SN is)



LYMPHODEMA:

Whole body scan (liver to feet): 10cm/min

  • Acquire at time of injection, 2 hours and 4 hours

Planar statics or SPECT/CT as required


Indications: Identification of sentinel node in relation to cancer OR identification of lymphatic blockages/delays. 

  • RP needs to rapidly clear into the lymphatic channel, obtain high-quality images, and stay within the lymph nodes to help surgeons during surgery. 

  • Use colloids as they are able to get lodged into the lymph nodes and accumulate

  • Only need to inject in area of interest soft tissue ; do not need vein. 

  • 99mTc - ATP used as uniform size, and good retention into lymphatic system. 

  • PARTICLE SIZE: 15-100 nm

    • Too small: leak into blood circulation

    • Too big: get trapped for an extended time period. 

Lymphedema:

  • The area of interest gets blocked and starts to swell, and fluid accumulates in this area or the legs. 

  • No cure; MEDICATION TO HELP NOT FIX

  • One side of Pt body does not look the same as the other (unilateral) or on both sides (bilateral)

  • Secondary lymphedema: Lymphedema is caused by something else. 

  • The lymph nodes are being blocked/stopped from working. 

  • Diagnosis is usually taken visually

  • Can be confirmed through ultrasound, CT/MRI or lymphoscintigraphy. 

  • Treatment: massaging, moisturising, keeping legs elevated, exercising

  • Injection sites: INTRADERMAL 

    • Arm lymphedema: in 3 web spaces between fingers. 

    • Leg lymphedema: in 2 web spaces between toes

    • Neck lymphedema: inject in face. 




Sentinel Node Studies:

  • The Sentinel node is the first node to receive drainage from the tumour. 

  • Also looking to see if any other vessels go from the tumour that the drainage may go to before the sentinel lymph node. 

  • Sentinel node is the first place to which cancer is likley to spread. 

  • Usually located in the armpit. 

  • Surgically removing the node will stop the drainage pathway for the mass.



Procedure explanation:

  • Looking for the first node to which your mass may drain to if it was to move.