(BQ) Part 2 book A Manual of laboratory and diagnostic tests has contents: Immunodiagnostic studies, nuclear medicine studies, cytologic, histologic and genetic studies, endoscopic studies, ultrasound studies, pulmonary function, arterial blood gases (ABGs)... and other contents.
Nuclear Medicine Studies Overview of Nuclear Medicine Studies / 669 • Principles of Nuclear Medicine / 669 • Principles of Imaging / 671 • General Procedure / 671 • Benefits and Risks / 672 • Clinical Considerations / 672 • Interventions / 672 • Pediatric Nuclear Medicine Considerations / 673 ● GASTROINTESTINAL STUDIES / 690 Hepatobiliary (Gallbladder, Biliary) Imaging With Cholecystokinin / 690 Gastroesophageal Reflux Imaging / 691 Gastric Emptying Imaging / 692 Gastrointestinal Bleeding Imaging / 694 Parotid (Salivary) Gland Imaging / 695 Liver/Spleen Imaging and Liver RBC Imaging / 696 Meckel’s Diverticulum Imaging / 697 ● CARDIAC STUDIES / 674 Myocardial Perfusion: Rest and Stress (Sestamibi/ Tetrofosmin/Thallium Stress Test) / 674 Myocardial Infarction (PYP) Imaging / 676 Multigated Acquisition (MUGA) Imaging: Rest and Stress / 677 Cardiac Flow Study (First-Pass Study; Shunt Imaging) / 678 ● NEUROLOGIC STUDIES / 698 Brain Imaging and Cerebral Blood Flow Imaging / 698 Cisternography (Cerebrospinal Fluid Flow Imaging) / 699 DaTscan Imaging / 700 ● ENDOCRINE STUDIES / 680 Thyroid Imaging / 680 Radioactive Iodine (RAI) Uptake Test / 681 Adrenal Gland (MIBG) Imaging / 683 Parathyroid Imaging / 685 ● GENITOURINARY STUDIES / 686 Renogram: Kidney Function and Renal Blood Flow Imaging (With Furosemide or Captopril/Enalapril) / 686 Testicular (Scrotal) Imaging / 687 ProstaScint Imaging / 688 Vesicoureteric Reflux (Bladder and Ureters) Imaging / 689 ● PULMONARY STUDIES / 701 Lung Scan (Ventilation and Perfusion Imaging) / 701 ● ORTHOPEDIC STUDIES / 703 Bone Imaging / 703 Bone Mineral Density (Bone Densitometry; Osteoporosis Imaging) / 705 ● TUMOR IMAGING STUDIES / 707 Gallium (67Ga) Imaging / 707 ● OVERVIEW OF MONOCLONAL ANTIBODY TUMOR IMAGING (ONCOSCINT, PROSTASCINT, OCTREOTIDE, AND OTHER PEPTIDES) / 709 Antibody and Peptide Tumor Imaging / 709 Iodine-131 Whole-Body (Total-Body) Imaging / 710 Breast Imaging (Scintimammography); Lymph Node Imaging (Lymphoscintigraphy) / 711 668 Fischbach_Ch09_printer_file.indd 668 11/4/13 10:27 PM ● ● INFLAMMATORY PROCESS IMAGING / 713 Leukocyte (WBC) Imaging (Indium- or CeretecLabeled WBCs) / 713 ● OVERVIEW OF RADIONUCLIDE (NON-RADIOIMMUNOASSAY) LABORATORY STUDIES / 714 Total Blood Volume; Plasma Volume; Erythrocyte (RBC) Volume / 714 Red Blood Cell (RBC) Survival Time Test / 716 Overview of Nuclear Medicine Studies 669 ● OVERVIEW OF POSITRON EMISSION TOMOGRAPHY (PET) IMAGING STUDIES / 717 Brain Imaging / 719 Cardiac Imaging / 720 Tumor Imaging / 721 OVERVIEW OF NUCLEAR MEDICINE STUDIES Nuclear medicine is a diagnostic modality that studies the physiology or function of any organ system in the body Other diagnostic imaging modalities, such as ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and x-ray, generally visualize anatomic structures A pharmaceutical is labeled with a radioactive isotope to form a radiopharmaceutical The radioisotope emits gamma and positron rays Radioisotopes are reactor produced (iodine-131 [131I]), cyclotron produced (fluorine-18 [18F] for positron emission tomography [PET]), or generator produced (technetium-99m [99mTc]) To visualize the function of an organ system, a radiopharmaceutical is administered A time delay (in some cases, up to several hours) may be required for the radiopharmaceutical to reach its target site, and then the organ of interest is imaged with a gamma camera Image formation technology involves the detection with very great density of a signal (gamma rays) emanating from the radioactive isotope There is very little signal in the image that does not come from the radiopharmaceutical The normal background level of radiation within the human body is minimal, with small amounts of radioactive potassium and some cesium Routes of radiopharmaceutical administration vary with the specific study Most commonly, a radiopharmaceutical is injected through a vein in the arm or hand Other routes of administration include the oral, intramuscular, inhalation, intrathecal (within the subdural or subarachnoid space), subcutaneous, and intraperitoneal (within the peritoneal cavity) routes See Table 9.1 for possible side effects of or adverse reactions to the administration of radiopharmaceuticals Nuclear medicine studies are performed by certified nuclear medicine technologists, interpreted by radiologists or nuclear medicine physicians, and performed in a hospital or clinic-based nuclear medicine department The collaborative approach to care is evidenced by interventions from pharmacists, laboratory personnel, and nurses, among others Principles of Nuclear Medicine The radiopharmaceutical is generally made up of two parts: the pharmaceutical, which is targeted to a specific organ, and the radionuclide, which emits gamma rays (high-energy electromagnetic radiation; short wavelength) and allows the organ to be visualized by the gamma camera Nuclear medicine imaging can yield quantitative as well as qualitative data A measurement of the ejection fraction of the heart is an example of quantitative data derived from a multigated acquisition (MUGA) or a myocardial stress procedure In general, nuclear medicine images visualize the distribution of a particular radiopharmaceutical, with hot, warm, or cold spots of activity indicating an abnormality In a hot spot, there is an increased area of uptake of the radiopharmaceutical in diseased tissue compared with the distribution in normal tissue Examples of this type of uptake can be seen on bone images An example of a warm spot would be in a thyroid nodule In a cold spot, there is an area of decreased uptake of the radiopharmaceutical compared with the distribution in normal tissue Liver and lung imaging are examples of this Fischbach_Ch09_printer_file.indd 669 11/4/13 10:27 PM 670 CHAPTER ● Overview of Nuclear Medicine Studies TABLE 9.1 Potential Side Effects in the Administration of Radiopharmaceuticals Radiopharmaceutical (Trade Name) Possible Side Effects Iodine-131 [131I] Chills, nausea, vomiting, headache, dizziness, diffuse rash, tachycardia Fluorine-18 [18F] None have been reported Thallium-201 [ Tl] Fever, flushing, diffuse rash, hypotension Technetium-99m [99mTc] 99mTc-pertechnetate (Minitec, UltratecKow) Chills, nausea, vomiting, headache, dizziness, diffuse rash, hypertension 201 99m Tc-tetrofosmin (Myoview) Angina, hypertension, hypotension, vomiting, dyspnea, dizziness, metallic taste, abdominal discomfort 99m Tc-pyrophosphate [99mTc-PYP] (Pyrolite, TechneScan PYP, Phosphotec) Chills, fever, nausea, vomiting, dizziness, diffuse rash, flushing, chest pain, syncope Tc-disofenin (Hepatolite) 99m Tc-mebrofenin (Choletec) None have been reported 99m Hives, urticaria Tc-sulfur colloid (AN-Sulfur Colloid, TechneColl, Tesuloid) Chills, fever, nausea, vomiting, headache, dizziness, diffuse rash, flushing, chest pain, vertigo, hypertension, hypotension, dyspnea 99m 99m Tc-bicisate dihydrochloride (Neurolite) Nausea, diffuse rash, dizziness, chest pain, seizures, syncope, vertigo 99m Tc methylenediphosphonate (MDP) (Osteolite, TechneScan) Chills, fever, nausea, vomiting, headache, dizziness, diffuse rash, flushing, chest pain, vertigo, hypertension, hypotension, syncope Tc-pentetate (diethylenetriaminepentaacetate [DTPA]) (TechneScan DTPA, Techneplex) Chills, fever, nausea, flushing, vomiting, headache, dizziness, diffuse rash, syncope, hypertension, hypotension, dyspnea 99m Tc-exametazime (Ceretec) Fever, flushing, diffuse rash, hypertension, hypotension, seizures, dyspnea 111 In-capromab pendetide (ProstaScint) Increase in bilirubin, hypotension, hypertension, injection site reactions, fever, rash, headache, production of human antimouse antibody (HAMA) Indium-111 [111In]-DTPA (MPI-DTPA) Fever, nausea, vomiting, flushing, headache, hypertension Indium oxine (111In) Fever 99m 123 I metaiodobenzylguanidine (MIBG) Nausea, flushing, hypertension, dizziness, vertigo, tachypnea Gallium citrate (67Ga) (Neoscan) Nausea, vomiting, flushing, diffuse rash, tachycardia, dizziness, vertigo, metallic or salty taste Cobalt (57Co) None have been reported Chromium-51 (51Cr) Flushing, hypertension, tachycardia Note: Most adverse drug reactions (ADRs) include such symptoms as nausea, vomiting, hypotension, rash, dyspnea, tachycardia, fever, and headaches; however, it is difficult to determine whether these are due to administration of the radiopharmaceutical or other medications the patient is taking The ADR rate has been estimated at about 0.003% (3 per 100,000) The half-life of radiopharmaceuticals ranges from a couple of minutes to several days Adapted from Silberstein EB, Ryan J, and Pharmacopeia Committee of the Society of Nuclear Medicine Prevalence of Adverse Reactions in Nuclear Medicine J Nucl Med 1996;37:185–192 Fischbach_Ch09_printer_file.indd 670 11/4/13 10:27 PM ● Overview of Nuclear Medicine Studies 671 type of uptake Prompt uptake in transplanted organs correlates with (1) adequate perfusion, such as reperfusion of the transplanted lungs or pancreas; (2) excretory function, such as in kidney transplants; and (3) evidence of cardiac viability and reinnervation Poor uptake and nonvisualization of the transplanted organ are evidence of rejection NOT E Units of measure: curie (Ci) or becquerel (Bq) ϭ radiation emitted by a radioactive material (1 Ci ϭ 3.7 ϫ 1010 Bq) rad or gray (Gy) ϭ radiation dose absorbed by a person (1 rad ϭ 0.01 Gy) rem or sievert (Sv) ϭ biological risk of exposure to radiation (1 rem ϭ 0.01 Sv) Principles of Imaging Gamma cameras all have basically the same components The camera may have one, two, or three heads, with the capability of imaging in multiple configurations The camera is networked with a multitasking computer capable of acquiring and processing the data Several methods of imaging are used: dynamic, static, whole-body, and single photon emission computed tomography (SPECT) These imaging capabilities are available on all current camera systems Dynamic imaging allows serial display of multiple frames of data, each frame lasting to seconds, to visualize the blood flow associated with a particular organ Static imaging is also known as planar imaging The camera acquires one image at a time, covering the field of view This image is twodimensional Whole-body imaging acquires both anterior and posterior sweeps of the patient’s body This type of imaging also gives two-dimensional information SPECT imaging has revolutionized the field of nuclear medicine SPECT imaging provides three dimensions of data SPECT imaging increased the specificity and sensitivity of nuclear imaging through improved resolution and is often combined with CT scans Recently, manufacturers have developed a combined gamma camera and CT scanner that allows both procedures to be performed without patient transfer Therefore, positioning is not compromised, and both abnormal and normal areas are visualized without position change General Procedure Alert the patient that he or she may be required to follow a study-specific preparation regimen before imaging determined by the type of nuclear medicine procedure (e.g., nothing by mouth [Latin: nil per os, NPO], no caffeine for 24 hours, hydration, bowel preparation) Administer a radiopharmaceutical through one of several routes: oral, inhalation, intravenous, intramuscular, intrathecal, or intraperitoneal On occasion, additional pharmaceuticals may be administered to enhance the function of the organ of interest A time delay may be necessary for the radiopharmaceutical to reach the organ of interest Imaging time depends on: a Specific study radiopharmaceutical used and the time that must be allowed for concentration in tissues b Type of imaging equipment used c Patient cooperation d Additional views based on patient history and nuclear medicine protocol e Patient’s physical size PROCEDURAL ALERT The nuclear medicine department should be notified if the patient may be pregnant or is breast-feeding or is younger than 18 years of age Fischbach_Ch09_printer_file.indd 671 11/4/13 10:27 PM 672 CHAPTER ● Overview of Nuclear Medicine Studies Benefits and Risks Benefits and risks should be explained before testing Patients retain the radioisotope for a relatively short period The radioactivity decays over time Some of the radioisotope is eliminated in urine, feces, and other body fluids 99m Tc, the most commonly used radiopharmaceutical, has a radioactive half-life of hours This means that half of the dose decays in hours Other radioisotopes, such as iodine, indium, thallium, and gallium, take 13 hours to days for half of the dose to decay Benefits a Nuclear medicine yields functional data that are not provided by other modalities b Nuclear imaging is relatively safe, painless (except for intravenous administration), and noninvasive Risks a Radiation exposure is minimal; toxicity is nil b Hematoma at intravenous injection site c Reactions to the radiopharmaceutical (hives, rash, itching, constriction of throat, dyspnea, bronchospasm, anaphylaxis [rare]) Clinical Considerations The following information should be obtained before diagnostic nuclear imaging: Pregnancy (confirmed or suspected) Pregnancy is a contraindication for most nuclear imaging Lactating women may be advised to stop nursing for a set period (e.g., to days with 99mTc) Most radiopharmaceuticals are excreted in the mother’s milk Radiopharmaceutical uptake from a recent nuclear medicine examination could interfere with interpretation of the current study The presence of any prostheses in the body must be recorded on the patient’s history because certain devices can shield the gamma rays from imaging Current medications, treatments, and diagnostic measures (e.g., telemetry, oxygen, urine collection, intravenous lines) Age and current weight This information is used to calculate the radiopharmaceutical dose to be administered If the patient is younger than 18 years of age, notify the examining department before testing The amount of radioactive substance administered is adjusted downward for anyone younger than 18 years of age Allergies Past history of allergies, especially to contrast substances (e.g., iodine) used in diagnostic procedures Interventions Pretest Patient Care and Standard Precautions for Nuclear Medicine Procedures Explain the purpose, procedure, benefits, and risks of the nuclear medicine procedure Assess for allergies to substances such as iodine Reassure the patient that the procedure is safe and painless Inform the patient that the procedure is performed in the nuclear medicine department Contact the department to determine the expected time and length of the procedure Have the patient appropriately dressed Obtain an accurate weight because the radiopharmaceutical dose may be calculated by weight If a female patient is premenopausal, determine whether she may be pregnant Pregnancy is a contraindication to most nuclear imaging Irradiation of the fetus should be avoided whenever possible Fischbach_Ch09_printer_file.indd 672 11/4/13 10:27 PM ● Overview of Nuclear Medicine Studies 673 CLINICAL ALERT Nuclear medicine procedures are usually contraindicated in pregnant women Lactating women may need to discard their breast milk for several days following the procedure These precautions are also to be followed for the radionuclide laboratory procedures and PET imaging Posttest Patient Care and Standard Precautions for Nuclear Medicine Procedures Use routine disposal procedures for body fluids and excretions unless directed otherwise by the nuclear medicine department Special considerations for disposal must be followed for therapeutic procedures Record any problems that may have occurred during the procedure Monitor the injection site for signs of bruising, hematoma, infection, discomfort, or irritation Assess for side effects of radiopharmaceuticals Pediatric Nuclear Medicine Considerations Many of the nuclear medicine procedures that are performed on adults may be indicated in children Interventions Pediatric Pretest Care Be aware that depending on hospital policy, a valid consent form may be requested to be signed by the parents or legal guardians of the patient Explain the procedure and its purpose, benefits, and risks to the parents or legal guardians and to the patient Reassure the patient that the test is safe and painless Assess for allergy to medications Have the patient appropriately dressed, ensuring that there are no metal objects on the patient during the procedure Obtain an accurate weight; the dose is calculated based on the patient’s weight Because pediatric patients have a different body metabolism than adults, a lower dose is given Use of a “body surface area” (BSA) formula is recommended The most commonly used is the DuBois formula: BSA ϭ 0.007184 ϫ W0.425 ϫ H0.725 (W ϭ weight in kg and H ϭ height in cm) Remember that immobilization techniques are often used during the imaging of pediatric patients Wrapping an infant or small child is often necessary Head clamps, arm boards, or sandbags may be used for patient immobilization Administer sedative drugs to reduce patient motion during the examination Disadvantages of sedation may include nausea and vomiting Start an intravenous line for administration of radiopharmaceuticals Do not leave patients unattended during the procedure 10 Pediatric patients need constant reassurance and emotional support 11 Patient urination is often difficult to control A urinary catheter may be required 12 Verify that the adolescent female patient is not pregnant Pediatric Posttest Care Same as those stated for adults Observe pediatric patients for adverse reactions to radiopharmaceuticals Infants are more at risk for reactions Fischbach_Ch09_printer_file.indd 673 11/4/13 10:27 PM 674 CHAPTER ● Myocardial Perfusion: Rest and Stress CARDIAC STUDIES ● Myocardial Perfusion: Rest and Stress (Sestamibi/Tetrofosmin/ Thallium Stress Test) Tc sestamibi, thallium-201 (201Tl), and 99mTc tetrofosmin are the radioactive imaging agents available for myocardial perfusion imaging to diagnose ischemic heart disease and allow differentiation of ischemia and infarction This test reveals myocardial wall defects and heart pump performance during increased oxygen demands Nuclear medicine imaging may also be done before and after streptokinase treatment for coronary artery thrombosis, after surgery for great vessel translocation, and after transplantation to detect organ rejection and myocardial viability Pediatric indications include evaluation for ventricular septal defects and congenital heart disease and postsurgical evaluation of congenital heart disease Studies have shown the efficacy of performing SPECT imaging with 99mTc sestamibi when triaging diabetic patients arriving in the emergency department with symptoms suggestive of acute cardiac ischemia 201 Tl is a physiologic analogue of potassium The myocardial cells extract potassium, as other muscle cells 99mTc sestamibi is taken up by the myocardium through passive diffusion, followed by active uptake within the mitochondria Unlike thallium, technetium does not undergo significant redistribution Therefore, there are some procedural differences Myocardial activity also depends on blood flow Consequently, when the patient is injected during peak exercise, the normal myocardium has much greater activity than the abnormal myocardium Cold spots indicate a decrease or absence of flow A completely normal myocardial perfusion study may eliminate the need for cardiac catheterization in the evaluation of chest pain and nonspecific abnormalities of the electrocardiogram (ECG) SPECT imaging can accurately localize regions of ischemia Administration of dipyridamole (Persantine) or regadenoson (Lexiscan) is indicated in adults and children who are unable to exercise to achieve the desired cardiac stress level and maximum cardiac vasodilation This medication has an effect similar to that of exercise on the heart Physical stress testing may be initiated in children beginning at to years Candidates for drug-induced stress testing are those with lung disease, peripheral vascular disease with claudication, amputation, spinal cord injury, multiple sclerosis, or morbid obesity Dipyridamole stress testing is also valuable as a significant predictor of cardiovascular death, reinfarction, and risk for postoperative ischemic events and to reevaluate unstable angina Ejection fraction and wall motion can be assessed by computer analysis 99m Reference Values Normal Normal stress test: ECG and blood pressure normal Normal myocardial perfusion under both rest and stress conditions Procedure Myocardial perfusion general imaging a There are two phases to this procedure: the rest imaging and the stress imaging Either 201Tl, 99m Tc sestamibi, or 99mTc tetrofosmin may be used (1) Rest imaging (a) Perform an intravenous injection of the radioisotope Allow a 30- to 60-minute delay for the radioisotope to localize in the heart (b) Perform SPECT imaging Fischbach_Ch09_printer_file.indd 674 11/4/13 10:27 PM ● (2) Myocardial Perfusion: Rest and Stress 675 Stress imaging (a) The patient undergoes an exercise or a pharmacologic cardiac stress test At the peak level of stress, inject the patient with the radioisotope (b) SPECT imaging may begin 30 minutes after injection PROCEDURAL ALERT Myocardial perfusion imaging protocols vary among nuclear medicine departments Some departments use a rest-stress, stress-rest, dual-isotope, or 2-day protocol, separating the phases into different days b Pharmacologic stress tests may be performed with any of three routine stressing agents: (1) Infuse dipyridamole over to minutes Inject the radiopharmaceutical Two minutes later, administer aminophylline, an antidote to the dipyridamole, at the nuclear medicine physician or cardiologist’s discretion Patient monitoring may last 20 minutes Contraindication: caffeine (2) Infuse regadenoson over 20 seconds Inject the radiopharmaceutical minutes after the infusion NOT E Regadenoson has an extremely short half-life: once the infusion has stopped, any symptoms will subside Contraindications: caffeine and theophylline-based drugs (3) Infuse dobutamine until the predicted heart rate is achieved The infusion protocol lasts minutes at each dose increment Tl a During the cardiac stress test, the patient is monitored by a nuclear medicine physician, cardiologist, a registered nurse, an electrophysiologist, or an ECG technician b Have the patient begin walking on the treadmill c When the monitoring person determines that the patient has reached 85% to 95% of maximum heart rate, inject radioactive thallium Take the patient for immediate imaging d SPECT imaging begins within minutes of injection e Acquire a second image approximately to hours later, with the patient at rest, to determine redistribution of the thallium f See Chapter guidelines for safe, effective, informed intratest care 201 PROCEDURAL ALERT Some nuclear medicine protocols may require the patient to return 24 hours later for delayed imaging Tc sestamibi and 99mTc tetrofosmin a Follow myocardial perfusion general imaging procedures b Observe standard precautions 99m Clinical Implications Imaging that is abnormal during exercise but remains normal at rest indicates transient ischemia Nuclear cardiac imaging that is abnormal both at rest and under stress indicates a past infarction Hypertrophy produces an increase in uptake The progress of disease can be estimated The location and extent of myocardial disease can be assessed Fischbach_Ch09_printer_file.indd 675 11/4/13 10:27 PM 676 CHAPTER ● Myocardial Infarction (PYP) Imaging Specific and significant abnormalities in the stress ECG usually are indications for cardiac catheterization or further studies Interfering Factors Inadequate cardiac stress Caffeine intake Injection of dipyridamole in the upright or standing position or with isometric handgrip may increase myocardial uptake Interventions Pretest Patient Care for Stress Testing Explain test purpose and procedure, benefits, and risks See standard nuclear medicine imaging pretest precautions Before the stress test has begun, start an intravenous line and prepare the patient Perform a resting 12-lead ECG and blood pressure measurement Advise the patient that the exercise stress period will be continued for to minutes after injection to allow the radiopharmaceutical to be cleared during a period of maximum blood flow The patient should experience no discomfort during the imaging Alert the patient that fasting may be recommended for at least hours before the stress test Caffeine intake must be eliminated for 24 hours before the stress test For dipyridamole administration: a Fasting may be required before the stress test, and avoidance of any caffeine products for at least 24 hours before the test is necessary b Blood pressure, heart rate, and ECG results are monitored for any changes during the infusion Aminophylline may be given to reverse the effects of the dipyridamole See Chapter guidelines for safe, effective, informed pretest care CLINICAL ALERT The stress study is contraindicated in patients who: a Have a combination of right and left bundle branch block b Have left ventricular hypertrophy c Are taking digitalis or quinidine d Are hypokalemic (because the results are difficult to evaluate) Adverse short-term effects of dipyridamole may include nausea, headache, dizziness, facial flush, angina, ST-segment depression, and ventricular arrhythmia Posttest Patient Care Observe the patient for possible effects of dipyridamole infusion Interpret test outcomes, counsel, and monitor appropriately Refer to nuclear scan posttest precautions Follow Chapter guidelines for safe, effective, informed posttest care ● Myocardial Infarction (PYP) Imaging Tc pyrophosphate (99mTc-PYP) is the radioactive imaging agent used to evaluate the general location, size, and extent of myocardial infarction 24 to 96 hours after suspected myocardial infarction and as an indication of myocardial necrosis to differentiate between old and new infarcts In some instances, the test is sensitive enough to detect an infarction 12 hours to days after its occurrence Acute infarction 99m Fischbach_Ch09_printer_file.indd 676 11/4/13 10:27 PM ● Multigated Acquisition (MUGA) Imaging: Rest and Stress 677 is associated with an area of increased radioactivity (hot spot) on the myocardial image This test is useful when ECG and enzyme studies are not definitive Reference Values Normal Normal distribution of the radiopharmaceutical in sternum, ribs, and other bone structures No myocardial uptake Procedure Myocardial imaging involves a 4-hour delay before imaging after the intravenous injection of the radionuclide During this waiting period, the radioactive material accumulates in the damaged heart muscle Alert the patient that imaging takes 30 to 45 minutes, during which time the patient must lie still on an imaging table See Chapter guidelines for safe, effective, informed intratest care Clinical Implications Imaging that is entirely normal indicates that an acute infarction is not present and the myocardium is viable Myocardial uptake of the PYP is compared with the ribs (2ϩ) and sternum (4ϩ) Higher uptake levels (4ϩ) reflect greater myocardial damage Larger defects have a poorer prognosis than small defects Interfering Factors False-positive infarct-avid PYP can occur in cases of chest wall trauma, recent cardioversion, and unstable angina Interventions Pretest Patient Care Imaging can be performed at the bedside in the acute phase of infarction if the nuclear medicine department has a mobile gamma camera Explain the purpose, procedure, benefits, and risks of the nuclear medicine study See standard pretest precautions Remember that imaging must occur within a period of 12 hours to days after the onset of symptoms of infarction Otherwise, false-negative results may be reported See Chapter for additional guidelines for safe, effective, informed pretest care Posttest Patient Care Interpret the outcome and monitor appropriately If heart surgery is needed, counsel the patient concerning follow-up testing after surgery Refer to standard precautions and posttest care Follow additional guidelines in Chapter for safe, effective, informed posttest care ● Multigated Acquisition (MUGA) Imaging: Rest and Stress The term gated refers to the synchronization of the imaging equipment and computer with the patient’s ECG to evaluate left ventricular function The primary purpose of this test is to provide an ejection fraction (the amount of blood ejected from the ventricle during the cardiac cycle) Once injected, the distribution of radiolabeled red blood cells (RBCs) is imaged by synchronization of the recording of cardiac images with the ECG This technique provides a means of obtaining Fischbach_Ch09_printer_file.indd 677 11/4/13 10:27 PM 1252 Index Screening, (continued) Serum proteins, 622–645, 631t–638t, 639t–644t group B streptococcal, 990t, 1026–1027 Sestamibi stress test, 674–676 maternal quadruple screen test, 985, 989t 72-Hour stool specimens, collection and transport maternal triple screen test, 985, 989t neonatal, 460–461 newborn, 824–826, 827c–831c, 831–832 of, 295 Severe acute respiratory syndrome (SARS), diagnosis of, 503–504 second trimester, 985, 986t–991t, 991–999 Severe combined immune deficiency (SCID), 824–825 third trimester, 990t–991t Sexual assault toxicology, 239 Scrotal imaging, 687–688 Scrotal sonogram, 898–899 Scrub typhus, 484t Se See Selenium specimen collection for, 1101–1106, 1102t, 1105t, 1106t STI risk after, 1106t Sexually transmitted infections (STIs) cervical, urethral, anal, and oropharyngeal cultures and smears for, 539–541, 540f, 541f Secobarbital saliva to plasma ratio for, 1099t urine screening for, 242t Second trimester screening, 985, 986t–991t, 991–999 Sedation and analgesia, 34, 36c–37c risk of, after sexual assault, 1106t Sexually transmitted infections, diagnosis of, 506, 507t–508t SG See Urine specific gravity intra-administration interventions for, 38 SGOT See Serum glutamic-oxaloacetic transaminase monitoring for effects after, 41–42 SGPT See Serum glutamic-pyruvic transaminase postadministration interventions for, 38–39 Shaded surface display, 767 preadministration interventions for, 35, 37–38 Shake test, amniotic fluid, 1020–1021 Sediment, urine See Microscopic examination of urine sediment Sedimentation rate (Sed rate), 106–108 drug effects on, 1195t Shape, stool, 283–285, 284t Shigellosis, 508t Shreds, urine, 231, 233t–234t Shunt imaging, 678–680 Segmental blood pressure, 905–907 Si See Silicon Segmented neutrophils (Segs), 71–75, 74t SIADH See Syndrome of inappropriate antidiuretic Seizure monitoring, 1043–1045 hormone Selenium (Se), 1171t Sialoglycoprotein, as tumor marker, 637t Self-monitoring of blood glucose (SMBG) testing, Sickle cell anemia, 40t, 126 336, 336f Semustine, 366 Sensitivity Sickle cell disease, 125–126, 828c Sickle cells, 103t Sickle cell test, 125–126 cultural, 23 Sickle cell trait, 125 latex, 29–34, 32c, 33t Sickledex test, 125–126 test, 11 Sideroblastic anemias, 96c Sentinel node location before biopsy, 776–778 Sideroblasts, 121 Serodiagnostic testing See Immunodiagnostic studies Siderocytes, 104t, 121 Serologic testing, microbiologic, 521, 554 SIDS See Sudden infant death syndrome Serotonin, as tumor marker, 633t Sigmoidoscopy, 857–859 Serum amylase, 3t Signal-averaged electrocardiogram (SAE), 1061–1062 Serum collection, for immunodiagnostic studies, 551 Silicon (Si), 1171t–1172t Serum creatinine, 267–270, 268t Silver (Ag), 1172t Serum glutamic-oxaloacetic transaminase (SGOT), Simple stains, 520 409–411 Single, random urine specimen collection, 184–186, 185t Serum glutamic-pyruvic transaminase (SGPT), 401–403 Single allergen IgE antibody test, 620–621 Serum immunofixation electrophoresis, 596–597 Single-energy x-ray absorptiometry (SXA), 706 Serum potassium, 3t Single photon emission computed tomography Serum protein electrophoresis (SPE), 593–596 Fischbach_Index_printer_file.indd 1252 (SPECT), 671 11/5/13 1:55 AM Index Sinus CT scan, 768–769 Somatosensory evoked response (SSER), 1045–1048, 1046c Sinus endoscopy, 873–875 Sirolimus, 429 Somatotropin, 384–385 SI units See Système International units Sonogram See Ultrasound studies Sjögren’s syndrome (SSA, SSB) antibodies test, 607–608, 608t Sonomammography, 877c, 895–897 SPE See Serum protein electrophoresis Skin cultures, 533–534 Special diagnostic studies, 1034 Skin immunofluorescence biopsy, 812–813 Special prebiopsy study, 776–778 Skin puncture, 55–56 Specific gravity, urine, 196–197 Skin test, two-step TB, 543–546, 546c drug effects on, 1214t Skin testing, tuberculin, 3t, 481–482, 543–546, 546c Specificity, 11 Skin tests, microbiologic, 521, 542–548, 546c Specimens Sleepiness test, 1087–1089 classification of, 1134c, 1135c Sleep stages, 1085 collection of, 25–28, 27t–28t Sleep studies, 1085–1090 classification of, 1084 types and indications of, 1083 SLO See Scanning laser ophthalmoscope Small bowel x-ray, 746–747 errors in, 26, 26t in forensic medicine, 1101–1106, 1102t, 1105t, 1106t precautions for (See Standard precautions) special, 1090–1106, 1099t, 1102t, 1105t, 1106t Smallpox infection, diagnosis of, 517–518 definition of, 1134c Sm antibodies test See Smith antibodies test transport and storage of, 1133–1134, 1134c, SMBG testing See Self-monitoring of blood glucose testing SM-C See Somatomedin C Smear, anal, 534–537, 535f, 539–541, 540f, 541f, 804–805 Smear, cervical, 539–541, 540f, 541f Smear, CSF, 313, 537–539 1135c, 1136f, 1137t–1139t, 1139–1140 SPECT See Single photon emission computed tomography Spectral broadening, 902, 903f Spectral trace, 902, 903f Sperm antibodies, immunodiagnostic studies for, 618–620 Smear, oropharyngeal, 539–541, 540f, 541f S phase, 779 Smear, Pap, 3t, 793, 794t–797t, 798c, 798–799, 799f, S-phase fraction (SPF), 782 800t, 801, 802f, 803–804, 803t Smear, stool, 534–537, 535f Spherocytes, 103t Spherocytosis, 112–113 Smear, urethral, 539–541, 540f, 541f Spinal block, 324 Smears, microbiologic, 520 Spinal tap, 307–310, 308f Smith (Sm) antibodies test, 607–608, 608t traumatic, 312, 313t Smudge cells, 74t Spine CT scan, 769–771 Sn See Tin Spiral CT scanners, 767 So2 See Oxygen saturation Spirochetal disease, diagnosis of, 492–493, 492t Sodium (Naϩ), 975–977 Spirometry, 917–921, 919f drug effects on, 1210t Sodium, quantitative (24-hour) and random in urine, 244–246 drug effects on, 1210t–1211t 1253 Spleen imaging, 696–697 Sporotrichosis, 490t Spotted fever, Rocky Mountain, 482, 483t Sputum cultures, 528 Sodium, stool, 300–301 Sputum specimen collection, 788–789, 1094–1101, 1099t Sodium citrate, 146 Squamous cell cancer antigen (SCCA), 632t Solution administration, 29 Squamous epithelial cells, 228 Somatic gene therapy, 819 SRD See Systemic rheumatic disease Somatomedin C (SM-C), 387–389, 388t SSA antibodies test See Sjögren’s syndrome drug effects on, 1211t Fischbach_Index_printer_file.indd 1253 antibodies test 11/5/13 1:55 AM 1254 Index SSB antibodies test See Sjögren’s syndrome antibodies test Stool occult blood testing, 3t, 286–290 Stool odor, 283–285, 284t SSER See Somatosensory evoked response Stool pH, 292–293 Stab cells, 71–73 Stool reducing substances test, 293–294 Stage III fibrinogen defects, 153–156, 154f, 155f Stool shape, 283–285, 284t Stainable iron in bone marrow, 121–122 Stool studies, 3t, 283–301, 284t Stained red cell/film examination, 101–102, 103t–104t analysis, 279–281, 280t Stains specimen collection for fecal fat, 296–297 iron, 121–122 leukemia, 83–88 microbiologic, 520 Standard precautions, 9, 24 for blood exposure, 1123 categories of body substances, secretions, and fluids, 1122–1123 environmental cautions, 1125, 1127 handwashing protocols, 1127 24-, 48-, 72-, and 96-hour collection and transport, 295 enteric pathogen specimen collection and transport, 281–282 interfering factors in, 282 ova and parasite specimen collection and transport, 281 patient care during, 282–283 random collection and transport, 281 specimen transport and storage for, 1137t–1138t HBV, HCV, or HIV exposure and, 1123, 1127 Stool trypsin, 299–300 medical waste disposal, 1125, 1126f Stool urobilinogen, 298–299 for nuclear medicine studies, 672–673 occupational exposure and, 1123, 1127 pandemic preparedness, 1129–1130, 1130f, 1131c drug effects on, 1214t Storage of specimens, 1133–1134, 1134c, 1135c, 1136f, 1137t–1139t, 1139–1140 personal protection equipment, 1124–1125 Strep throat, 478t protocols for first responders, 1129 Streptococcal antibody tests, 560–561 safe practice, 1123–1124 Streptococcal screening, group B, 990t, 1026–1027 safe practice domains for specific situations, 1127–1129 warning tag and sign placement, 1125 Streptodornase, 560–561 Streptokinase, 153, 155f, 165 Streptozyme, 560–561 Standards of care for diagnostic testing, 5, 7t–8t Stress echocardiography, 909 Static imaging, 671 Stress MUGA imaging, 677–678 Steatorrhea, 283–285, 284t, 296–297 Stress myocardial perfusion imaging, 674–676 Stent, coronary artery, 1072c Stress test, contraction, 990t, 999–1000 Steroid therapy, leukocyte response and, 68–69 Stress test, exercise, heart, 1064–1066 STIs See Sexually transmitted infections Stress test, exercise, pulmonary, 938–940, 939t Stomach, contrast x-ray of, 744–745 Stress test, thallium-201, 674–676 Stomatocytosis, 103t Stroke, PET imaging of, 719 Stool amount, 283–285, 284t Strongyloidiasis, 487t Stool analysis, 279–281, 280t Subarachnoid block, 324 Stool blood testing, 3t, 286–290 Subarachnoid hemorrhage (SAH), 168, 312, 313t Stool color, 286–287 Submaximal effort test, 1064–1066 drugs affecting, 1176 Stool consistency, 283–285, 284t Substance abuse, urine drug investigations for, 239–243, 240c, 242t Stool cultures/smears, 534–537, 535f Succinylcholine, 363–364 Stool electrolytes, 300–301 Sudan black B (SBB) stain, 83–84 Stool fat stain, 296–297 Sudden infant death syndrome (SIDS), 1113c Stool form, 283–285, 284t Sufentanil (Sufenta), 37c Stool leukocytes, 294–295 Sugar, blood, 332–353, 336f, 345t Stool mucus, 291–292 Stool muscle fiber, 297–298 Fischbach_Index_printer_file.indd 1254 drug effects on, 1197t–1198t Sugar, urine, 212–214 11/5/13 1:55 AM Index Sulfhemoglobin, 128–129 1255 Technetium-99m diethylenetriaminepentaacetate (DTPA), 689–690, 702 Sulkowitch test, 251 Supplies for diagnostic testing, 28–29 Technetium-99m disofenin, 690–691 Suppressor genes, 637t–638t Technetium-99m exametazime, 698, 713–714 Surfactant components in amniotic fluid, 1018–1020 Technetium-99m labeled RBCs, 694–695, 697–698 Surfactant-to-albumin (S/A) ratio, 1018–1020 Technetium-99m macroaggregated albumin (MAA), 702–703 Susceptibility studies of bacteria to antimicrobial agents, 479 Technetium-99m mebrofenin, 690–691 Suxamethonium anesthesia, 363–364 Technetium-99m mertiatide, 686–687 Swab, nasopharyngeal, 530–531 Technetium-99m methylenediphosphonate (MDP), 704 Swab, rectal, 534–537, 535f Swab, throat, 529–530 Technetium-99m pentetate, 689–690, 702 Swallowed blood, 290–291 Technetium-99m pertechnetate, 687–688, 695–698 Sweat test, 980–982 Technetium-99m pyrophosphate imaging, 676–677 SXA See Single-energy x-ray absorptiometry Technetium-99m sestamibi stress test, 674–676 Syndrome of inappropriate antidiuretic hormone (SIADH), 376–377, 977–979 Syphilis, 492t, 507t Technetium-99m sulfur colloid, 691–693, 696–697 Technetium-99m tetrofosmin stress test, 674–676 TEE See Transesophageal echocardiogram Syphilis antibody IgG, prenatal testing, 986t Temazepam, 434t Syphilis detection tests, 554–557, 554t, 555t Template bleeding time, 147–148 Syphilis serology, CSF, 329 Tennessee antigen glycoprotein, as tumor marker, 637t Syphilis serum fluorescent treponemal antibody test See Fluorescent treponemal antibody test Terminal deoxynucleotidyl transferase, as tumor marker, 632t Système International (SI) units, 18, 19t–21t Systemic rheumatic disease (SRD), immunodiagnostic Terminal deoxynucleotidyl transferase (TDT) stain, studies for, 604–610, 608t 85–86 Tes-Tape, 212 T Testicular imaging, 687–688 T3 See Triiodothyronine Testosterone, total and free, 396–398 T3 U See Triiodothyronine uptake T4 See Thyroxine drug effects on, 1211t Test results T7 See Free thyroxine index abnormal, 39, 40t, 41 TA-4 See Tumor-antigen availability of, 42 Tacrolimus, 429 expected and unexpected, 45, 47–48, 49t Tapeworm disease, 486t patient response to, 44–45, 47t Target cells, 103t pretest phase and, 17 Tart cells, 74t Tartrate-resistant acid phosphatase (TRAP) stain, 87–88 reference values/ranges/intervals, 17, 19t–21t Tetanus, 478t Tetanus toxoid skin test, 547–548 TB See Tuberculosis Tetrofosmin stress test, 674–676 TBG See Thyroxine-binding globulin Tg See Thyroglobulin 99m Thalassemia, 123–124 T cells, 79, 82–83 ␣-Thalassemia, 132–133 Tco2 See Total carbon dioxide -Thalassemia trait, 124 TCT See Thrombin clotting time Thallium (Tl), 1173t TDT stain See Terminal deoxynucleotidyl transferase Thallium-201, 670t, 672 Tc See Technetium-99m stain Thallium-201 stress test, 674–676 Teardrop cells, 104t THC, urine screening for, 242t Technetium-99m (99mTc), 670t, 672 tHcy See Homocysteine Technetium-99m bicisate, 698 Theophylline, 434t, 1099t Fischbach_Index_printer_file.indd 1255 11/5/13 1:55 AM 1256 Index Therapeutic drug management, 428–430, 428f, 429f, 430f, 431t–435t Timed urine tests, 243–274, 261t, 268t Timed vital capacities, 917, 920–921 Therapeutic window, 429, 430f Time of death, 1108–1109 Thiamine, 1154t Tin (Sn), 1173t ThinPrep Pap Test, 798–799, 801 Tinea barbae, 490t Thiocyanate, 1099t Tinea capitis, 490t Thiopental, 434t Tinea corporis, 490t Third trimester screening, 990t–991t Tinea cruris, 490t 30-Day event monitoring, 1062–1064 Tinea pedis, 490t Thoracentesis, cell study, 810–812, 810t Tinea unguium, 490t Thoracic aortography, 762 Tissue biopsy See Biopsy Thoracic gas volume (Vtg), 934–936, 935f Tissue cultures, 542 Thoracoscopy, 843–845 Tissue donation, 1116–1118, 1117t Throat cultures/swabs/washings, 529–530 Tissue folate depletion, 1150t Thrombin clotting time (TCT), 153–156, 154f, 155f Tissue oxygenation See Oxygenation status Thrombin formation, 140t Tissue plasminogen activator (tPA), 153 Thrombin time (TT), 153–156, 154f, 155f Tissue polypeptide antigen (TPA), as tumor marker, drug effects on, 1211t 636t Thrombocythemia, 141, 149–150 Tissue studies See Cytologic studies Thrombocytopenia, 141, 150 Tissue transplantation, immunodiagnostic studies for, Thrombocytosis, 141, 149–150 665–666, 665t Thrombosis, 141, 142t Tl See Thallium Thrombospondin-1 (Tsp-1), 780 TLC See Total lung capacity Thymidylate synthase (TS), 780 TNF-␣ See Tumor necrosis factor-␣ Thyroglobulin (Tg), 461–462 TNF- See Tumor necrosis factor- drug effects on, 1211t Thyroglobulin antibody tests, 609–610 Thyroid antibody tests, 609–610 TNM system See Tumor-node-metastasis system Tobramycin (Nebcin), therapeutic and toxic levels of, 434t Thyroid function panel, 332t Tocainide (Tonocard), 434t Thyroid function tests, 3t, 452–468, 458t, 469t ␣-Tocopherol, 1145t Thyroid imaging, 680–681 Topotecan HCl (Hycamtin), 804 Thyroid microsomal antibody tests, 609–610 TORCH test, 590–591 Thyroid sonogram, 901–902 Total blood volume, 714–716 Thyroid-stimulating hormone (TSH), 3t, 462–463 Total-body iodine-131 imaging, 710–711 drug effects on, 1211t Total carbon dioxide (Tco2), 951–952, 953t–954t Thyroid-stimulating hormone, neonatal, 459 Total cell count, CSF, 314–317, 314t, 315t, 316t Thyroperoxidase antibody tests, 609–610 Total estrogens, 236–239 Thyroxine (T4), free, 456–457 Total hemolytic complement (CH50) test, 600–602, drug effects on, 1212t 601f Thyroxine, neonatal, 460–461 drug effects on, 1200t Thyroxine, total, 465–466 Thyroxine-binding globulin (TBG), 463–464 drug effects on, 1211t–1212t TIBC See Total iron-binding capacity Tick-borne disease Lyme disease, 477t, 492t, 493 North Asian rickettsiosis, 483t Queensland tick typhus, 483t Timed urine specimen collection, 185t, 186, 187t–191t, 191–192 amino acids, 274–276, 275t, 276t Fischbach_Index_printer_file.indd 1256 Total iron-binding capacity (TIBC), 116–119, 119t, 1166t Total lung capacity (TLC), 923f, 927–928, 929f Total protein, CSF, 322–324 drug effects on, 1209t Toxic agent removal, for genetic disorder treatment, 819 Toxic granulation, 74t Toxicology screening, 239 See also Drug investigations/screening Toxic shock syndrome, 478t 11/5/13 1:55 AM Index Toxins 1257 Triphasic blood flow, 902, 903f disclosure of, 45c Triple screen test, maternal, 985, 989t in donor organs, 1117t Trisomy 13, 988t Toxoplasmosis (TPM), 487t Trisomy 18, 985, 988t Toxoplasmosis antibody tests, 588–589 Trisomy 21, 985, 988t, 991 tPA See Tissue plasminogen activator Troponin I See Cardiac troponin I TPA See Tissue polypeptide antigen Troponin T See Cardiac troponin T TPM See Toxoplasmosis True negative, 11 TP-PA See Treponema pallidum test True positive, 11 Trace minerals, 1155 TRUS See Transurethral ultrasound TRALI See Transfusion-related acute lung injury Trypanosomiasis, 487t Tranquilizers, 35, 36c–37c, 38 Trypsin in stool, 299–300 Transesophageal echocardiogram (TEE), 909, 911–912, 1075–1076 Tryptase, 422–423 TS See Thymidylate synthase Transfer factor, 915, 928–930 TSH See Thyroid-stimulating hormone Transferrin, 1167t Tsp-1 See Thrombospondin-1 Transferrin tests, 116–119, 119t TST See Tuberculin skin testing Transfusion reactions, 655 TT See Thrombin time HLA test for, 663–664 T-tube cholangiogram, 751–752 leukoagglutinin test for, 661–662 Tube gastric analysis, 1091–1093 platelet antibody detection test for, 662–663 Tuberculin skin testing (TST), 3t, 481–482, 543–546, types of, 660–661 Transfusion-related acute lung injury (TRALI), 660–661 Translocations, 818 Transplantation See Organ transplantation Transport of specimens, 1133–1134, 1134c, 1135c, 1136f, 1137t–1139t, 1139–1140 546c Tuberculosis (TB), 478t diagnosis of, 3t, 478t, 480–482, 480t prenatal testing, 987t Tuberculosis blood test, 3t Tuberculosis skin test, two-step, 543–546, 546c Transudates, cell study, 810–812, 810t Tubular necrosis See Acute tubular necrosis Transurethral ultrasound (TRUS), 897–898 Tubular reabsorption, 208 Transvenous digital subtraction, 762–765 Tularemia, 478t TRAP stain See Tartrate-resistant acid phosphatase Tularemia infection, diagnosis of, 518–519 stain Trastuzumab (Herceptin), 780 Trauma cases, specimen collection for, 1101–1106, 1102t, 1105t, 1106t Tumor See also Cytologic studies; Histologic studies breast screening for, 733–738, 733t, 735c, 736f, 737c, 737f, 738f classification and staging of, 775 Trazodone (Desyrel), 434t Tumor aneuploidy, 813–815 Trematodes, 487t Tumor-antigen (TA-4), 636t Trench fever, 484t Tumor imaging, 67Ga, 707–709 Treponema pallidum test (TP-PA), 554–557, 554t, Tumor imaging, MAB, 709–713 555t Trichinosis, 487t Tumor imaging, PET, 721 Tumor markers, 628–630, 631t–638t, 639t–644t, 645 Trichomoniasis, 487t, 508t breast cancer risk, 805–806 Trichuriasis, 487t in CSF, 307t Tricyclic antidepressants, in donor organs, 1117t Triglycerides, 445–447, 446t, 448c–449c drug effects on, 1212t–1213t Triiodothyronine (T3), free, 456–457 drug effects on, 1212t predictive and prognostic, 778–783, 781t Tumor necrosis factor-␣ (TNF-␣), 644t Tumor necrosis factor- (TNF-), 644t Tumor-node-metastasis (TNM) system, 775 Turbidity, CSF, 312, 312t Triiodothyronine, total, 466–467 Turk cells, 81 Triiodothyronine uptake (T3 U), 468, 469t 2-Hour urine specimens, collection of, 185t, 186, drug effects on, 1212t Fischbach_Index_printer_file.indd 1257 191–192 11/5/13 1:55 AM 1258 Index 24-Hour stool specimens, collection and transport of, 295 24-Hour urine specimens, collection of, 185t, 186, 187t–191t, 191–192 24-Hour urine tests, 207–211, 236–239, 243–262, 261t, 270–271, 273–276, 275t, 276t Unconjugated bilirubin, 354–356 Unconjugated estradiol (uE3), prenatal testing, 989t Undulant fever, 477t Uni-Gold Recombigen HIV, 573 Uniparental disomy (UPD), 818 Universal precautions See Standard precautions Two-dimensional (2D) echocardiography, 909 Unsaturated VB12–binding capacity (UBBC), 135 Two-step TB skin test, 543–546, 546c UPD See Uniparental disomy Type diabetes, 333, 817 UPE See Urine protein electrophoresis Type diabetes, 333, 817 UPP See Urethral pressure profile Typhoid, 478t Upper extremity arterial (UEA) duplex scans, 905–906 Typhus Upper extremity venous (UEV) duplex scans, 907–908 endemic, 483t Upper GI (UGI) endoscopic study, 845–847 epidemic, 483t Upper GI (UGI) series, 744–745 Queensland tick, 483t Upper respiratory tract infection, 494c scrub, 484t Urea, 179–180 Typing, DNA, 1093–1094 Urea nitrogen, 359–361 Tyrosinemia, 830c Ureter imaging, 689–690 Urethral cultures/smears, 539–541, 540f, 541f U Urethral pressure profile (UPP), 867–870 UA See Urinalysis Urethritis, 234t UBBC See Unsaturated VB12–binding capacity uE3 See Unconjugated estradiol UEA duplex scans See Upper extremity arterial duplex scans UEV duplex scans See Upper extremity venous duplex scans UGI endoscopic study See Upper GI endoscopic study NGU, 508t nonspecific, 508t Uric acid, 368–369 drug effects on, 1213t–1214t Uric acid, quantitative (24-hour) in urine, 248–249 drug effects on, 1214t Urinalysis (UA), 3t, 181c, 193–223, 222t UGI series See Upper GI series dipstick testing for, 181–183, 182t, 183f, 196 UIC-2 shift assay, 780 laboratory testing for, 180 Ultrasound studies, 876 normal values in, 192, 192t abdominal, 877c, 888–895 breast, 877c, 895–897 during pregnancy, 987t sample of, 193f–194f eye and orbit, 899–900, 1041–1043 Urinary bladder sonogram, 890–891 fetal echocardiography (fetal Doppler), 884–885, 909 Urinary system, 181c gynecologic, 877c, 885–888 Urinary tract infections (UTIs), 180, 199, 202–205, heart, 877c, 909–912 implications of, 879 obstetric, 877c, 879–880, 881c, 882–884, 985, 988t–989t, 991, 991t principles and techniques for, 878–879 prostate, 897–898 scrotal, 898–899 thyroid, 901–902 uses of, 877c, 877–878 vascular (duplex scans), 902–908, 903f 217–219, 499t Urine constituents of, 179–180 drug discoloration of, 1177 formation of, 179 types of specimens of, 180 Urine ⌬-ALA, quantitative (24-hour) and random, 260–262, 261t Urine albumin, 207–211 drug effects on, 1179t–1180t Ultratrace minerals, 1155 Urine alcohol content, 239, 242t Umbilical artery Doppler tests, 989t, 991 Urine amino acids (random and 24-hour), 274–276, Umbilical blood sampling, percutaneous, 990t, 1006–1007 Fischbach_Index_printer_file.indd 1258 275t, 276t drug effects on, 1181t–1182t 11/5/13 1:55 AM Index Urine amylase excretion and clearance (random and timed), 262–264 Urine appearance, 199–200 Urine bilirubin, 219–221, 222t drug effects on, 1187t Urine blood or Hb, 204–207 Urine calcium, quantitative (24-hour), 249–251 drug effects on, 1189t–1190t Urine catecholamines, quantitative (24-hour), 258–259 Urine cell study, 807–808 Urine chemistry, 235–239 1259 Urine pH, 202–204 Urine phenylalanine, 264–266 Urine porphobilinogens, quantitative (24-hour) and random, 260–262, 261t drug effects on, 1207t Urine porphyrins, quantitative (24-hour) and random, 260–262, 261t drug effects on, 1207t Urine potassium, quantitative (24-hour) and random, 246–248 drug effects on, 1208t Urine chloride, quantitative (24-hour), 243–244 Urine pregnancy test, 235–236 Urine color, 200–201 Urine pregnanediol, quantitative (24-hour), 254–255 drugs affecting, 1177 drug effects on, 1208t Urine CrCl (timed), 267–270, 268t Urine pregnanetriol, quantitative (24-hour), 255–256 Urine creatinine, 267–270, 268t Urine protein, 207–210 drug effects on, 1193t drug effects on, 1209t–1210t Urine crystals, 231, 232t Urine protein electrophoresis (UPE), 593–596 Urine culture, 3t, 523–526 Urine red blood cells/red blood cell casts, 224–226, 225t prenatal testing, 987t sample of, 193f–194f Urine cystine, quantitative (24-hour) and random, 270–271 Urine drug investigations, 239–243, 240c, 242t Urine d-xylose absorption (timed), 266–267 Urine epithelial cells/epithelial casts, 227–228 Urine estradiol, 236–239 Urine estriol, 236–239 Urine estrogen, total and fraction, 236–239 Urine glucose, 212–214 drug effects on, 1198t–1199t drug effects on, 1187t Urine sediment, microscopic examination of, 223–231, 223t, 225t, 232t, 233t–234t Urine shreds, 231, 233t–234t Urine sodium, quantitative (24-hour) and random, 244–246 drug effects on, 1210t–1211t Urine specific gravity (SG), 196–197 drug effects on, 1214t Urine studies, 178 See also Urinalysis Apt test/swallowed blood, 290–291 chemistry, 235–239 Urine granular casts, 229–230 dipstick testing, 181–183, 182t, 183f, 196 Urine hCG test, 235–236 drug investigations, 239–243, 240c, 242t Urine 5-HIAA, quantitative (24-hour), 255–256 laboratory investigations, 180, 233t–234t drug effects on, 1200t Urine hyaline casts, 228–229 microscopic examination of urine sediment, 223– 231, 223t, 225t, 232t, 233t–234t Urine hydroxyproline (timed), 271–273 overview of, 179–180 Urine immunofixation electrophoresis, 596–597 specimen collection for, 184, 185t Urine ketones, 214–217 drug effects on, 1202t Urine leukocyte esterase, 218–219 Urine lysozyme, quantitative (24-hour) and random, 273–274 Urine magnesium, quantitative (24-hour), 251–252 drug effects on, 1204t Urine 2-microglobulin, 211–212 Urine nitrate, 217–218 drug investigation samples, 240–243 long-term, timed, 185t, 186, 187t–191t, 191–192 single, random, 184–186, 185t specimen transport and storage for, 1137t specimen types used in, 180 timed, 243–274, 261t, 268t Urine uric acid, quantitative (24-hour), 248–249 drug effects on, 1214t Urine odor, 202 Urine urobilinogen, 221–223, 222t Urine oxalate, quantitative (24-hour), 252–253 Urine VMA, quantitative (24-hour), 258–259 drug effects on, 1204t Fischbach_Index_printer_file.indd 1259 drug effects on, 1214t 11/5/13 1:55 AM 1260 Index Urine waxy casts, 230 Ventilation and perfusion imaging, 701–703 Urine white blood cells/white blood cell casts, 226–227 Ventilatory impairments, 914, 915t Urinometer, 196 VER See Visual evoked response Urobilinogen, stool, 298–299 drug effects on, 1214t Verapamil (Calan, Isoptin, Covera), 435t Vertebral artery duplex scans, 902, 904 Urobilinogen, urine, 221–223, 222t Very-low-density lipoprotein (VLDL), 441–443, 443t Urodynamic studies, 867–870 Vesicoureteric reflux imaging, 689–690 Urography, intravenous and excretory, 752–755, 756c Vessel wall structure Urokinase, 153, 165 Uroporphyrinogen I synthase test, 111 Uterine mass ultrasound diagnosis, 885–888 Uterine x-rays, 760–762 UTIs See Urinary tract infections acquired abnormalities of, 141 congenital defects of, 141 Violent crimes, specimen collection for, 1101–1106, 1102t, 1105t, 1106t Viral antibody tests to assess immune status, 576–585 Viral disease diagnosis, 494c, 494–495, 496t–499t, V 500–501 V See Vanadium VAB See Vacuum-assisted biopsy Viral immunodiagnostic studies, 563–576, 565t, 566t, 570t, 571t, 573t, 574c, 575f Vaccinia, 497t Viral load, 567 Vacutainer system, 56–57 Virtual colonoscopy (VC), 859–862 Vacuum-assisted biopsy (VAB), 735c Virtual enteroscopy, 851–853 Vagina, cell study of, 3t, 793, 794t–797t, 798c, 798–799, Visceral larva migrans, 487t 799f, 800t, 801, 802f, 803–804, 803t Viso V See Volume of isoflow Vaginitis, nonspecific, 508t Visual evoked response (VER), 1045–1048, 1046c Valproic acid, 434t Visual field testing, 1034–1035, 1034f, 1036f Vanadium (V), 1174t Vital capacity (VC), 923f, 926–927 Vancomycin, 435t Vitamin A, 1143t–1144t Vanillylmandelic acid (VMA), quantitative (24-hour) in Vitamin B1, 1154t urine, 258–259 drug effects on, 1214t Vitamin B2, 1151t–1152t Vitamin B3, 1152t Varicella status, prenatal testing, 987t Vitamin B6, 1153t Varicella-zoster antibody test, 580–581 Vitamin B12 (VB12), 96c, 134–136, 1149t Varicella-zoster virus (VZV), 497t drug effects on, 1214t Variegate porphyria, 260 Vitamin C, 1147t Vascular endothelial growth factor (VEGF), 780 Vitamin D, 1144t Vascular ultrasound, 902–908, 903f Vitamin E, 1145t Vascular x-ray, 762–765 Vitamin K, 1146t VB12 See Vitamin B12 Vitamin testing, 1141–1142, 1143t–1154t VC See Virtual colonoscopy; Vital capacity VLDL See Very-low-density lipoprotein VDRL tests See Venereal Disease Research VMA See Vanillylmandelic acid Laboratory tests Vo2 max test See Maximum oxygen consumption test Vectorcardiogram, 1054–1061, 1055f, 1058f, 1058t Voiding cystourethrography, 756c VEGF See Vascular endothelial growth factor Volume, urine, 193–196 Venereal Disease Research Laboratory (VDRL) tests, Volume of isoflow (Viso V), 933–934 554–557, 554t, 555t prenatal testing, 986t Venereal warts, 508t Venipuncture, 56–58 Venography, 762 Venous thrombosis, 141, 142t Ventilation, pulmonary, 914 Fischbach_Index_printer_file.indd 1260 von Willebrand’s disease, 162–164 Vtg See Thoracic gas volume V-T tracing See Forced expiratory maneuver volumetime spirogram Vulva, cell study of, 3t, 793, 794t–797t, 798c, 798–799, 799f, 800t, 801, 802f, 803–804, 803t VZV See Varicella-zoster virus 11/5/13 1:55 AM Index W WNV See West Nile virus Wakefulness, test of maintenance of, 1087–1089 Wood’s light test, 260 Warfarin, 160, 435t Worms See Parasitic disease Warm spots, in nuclear medicine, 669 Wound cultures, 531–533 1261 Warning tag and sign placement, 1125 Warts, venereal, 508t X Washings, throat, 529–530 Xanthochromic CSF, 312–313, 312t, 313t Water balance, electrolytes and, 243, 246 Xenon-133, 702 Water-loading antidiuretic hormone suppression test, X-linked recessive inheritance, 817c, 818 977–980 X-ray studies, 722–723 See also Computed tomography Water-soluble contrast media, 723 contrast agent use in Water-soluble vitamins, 1141, 1147t–1154t Waxy casts, 230 adverse reactions to, 723, 724t, 725–727 WB See Western blot barium, 727–728 iodine, 724t, 725–727 WBC See White blood cell count Weil’s disease, 492t contrast x-rays/radiography, 743–767, 756c Western blot (WB), 552t general precautions during, 729 West Nile virus (WNV), diagnosis of, 501–502 ordering, scheduling, and sequencing of, 730–731 Wet prep, prenatal testing, 987t plain conventional x-rays/radiography, 731–743, 733t, 735c, 736f, 737c, 737f, 738f White blood cell count (WBC), 64–70, 64t, 67 White blood cell imaging, 713–714 pregnancy precautions during, 730 White blood cells/white blood cell casts in urine, radiation risks with, 728, 728t, 729t, 730t safety measures during, 729 226–227 White blood cell tests, 64–83, 64t, 74t White stool, 286 Y Whole blood buffer base, 957 Yaws, 492t Whole-body iodine-131 imaging, 710–711 Yellow fever infections, diagnosis of, 514–516 Whooping cough, 478t Wilms’ tumor gene, 638t Z Wilson’s disease, 622–623 Zinc (Zn), 1174t–1175t Witnessed urine sampling, 240–243 Zinc glycinate marker (ZGM), 637t Fischbach_Index_printer_file.indd 1261 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1262 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1263 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1264 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1265 11/5/13 1:55 AM Fischbach_Index_printer_file.indd 1266 11/5/13 1:55 AM ... wavelength) and allows the organ to be visualized by the gamma camera Nuclear medicine imaging can yield quantitative as well as qualitative data A measurement of the ejection fraction of the heart is an... dietary habits Administer a liquid form or a tasteless capsule of radioactive iodine orally Measure the amount of radioactivity by an uptake calculation of the thyroid gland to and 24 hours later... trauma, and liver damage due to radiation therapy Most liver and spleen imaging evaluates for metastatic disease and for the differential diagnosis of jaundice Post–liver transplantation scans