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The construction and use of sealed 99mtc sources inserted into standard biopsy needles and catheters for anatomic localization by external radionuclide imaging. The technique facilitates proper placement and confirmation of position or direction of biopsy needles and catheters, especially for small targets deep in the body.
Typology: Lecture notes
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FIG. 1. @mTc.filledprobeswere preparedfrom commonly available needles and catheters. Variety of filling patterns are dem onstrated.
For the purpose of anatomic localization, a variety of sealed sources containing o9mTc were constructed. These sources, when inserted into biopsy needles and imaged with a portable scm tillation camera, served to direct the proper placement of those needles. Concomitant organ imaging was used to identify the target site for biopsy. indwelling CVP and Swan-Canz cathe ters filled with sterile sodium pertechnetate were localized against the mediastinal silhouette pro vided by a flooded field transmission source placed behind the patient. Larger diameter catheters containing sealed sources within their lumens were similarly imaged. These techniques have proven to be clinically useful.
Successful percutaneous biopsy depends on a cli nician's ability to direct a biopsy needle to its target. Biopsy should be easy to perform provided the tar get is large and its location certain. However, percu taneous biopsy of a large organ, such as the liver, is sometimes unsuccessful. Small targets deep in the body present an even more difficult task. In addition to the clinician's knowledge of anatomy and his abil ity to palpate and percuss, several adjunctive meth ods are available to guide him during needle biopsy.
biplane fluoroscopy, stereotatic devices, and ultra sound. Some clinicians use scintiphotography to localize organs for subsequent percutaneous biopsy (1). Rou tine radionuclide organ imaging is performed and the anatomic location of the “target―organ is out lined on the skin. The biopsy procedure is then per
indwelling catheters is usually accomplished with conventional radiographs or fluoroscopy. Van Dyke, Ct al have reported the added utility of a “radioac tive―catheter in the cardiac catheterization labora
This report outlines our experience in constructing
sterile polyethylene tubing or standard hypodermic
imaging in the appropriate projections with a scm tillation camera transported to the location where the biopsy on catheterization procedure is to be per formed.
MATERIALS AND METHODS
Received Mar. 13, 1973; original accepted Apr. 23, 1973. For reprints contact : Joseph P. Green, Div. of Nuclear Medicine, Dept. of Radiology, University Hospital, 225 W. Dickinson St., San Diego, Calif. 92103.
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SEALED SOURCES OF 99mTc INSERTED INTO
STANDARD BIOPSY NEEDLES AND CATHETERS:
USE IN ANATOMIC LOCALIZATION BY
EXTERNAL RADIONUCLIDE IMAGING
Joseph P. Green, William 1. Ashburn, Sheldon R. Hurwitz, and Samuel E. Halpern
University of California at San Diego, La Jolla, California
GREEN, ASHBURN, HURWITZ, AND HALPERN
propniate-sized hypodermic or spinal needles, or
hemostat (3). Polyethylene tubing was filled and
through the hub end to the tip and injecting as the
simple confirmation of position or insertion and positioning (re-positioning) under continuous “scm tigraphic― control.
such as central venous (CVP) or Swan-Ganz pul
eter with sterile ODmTc_sodium pertechnetate after
catheters was accomplished with a “portable―Anger
scribed, this device is fitted with oversized wheels to facilitate transportation to any location in the hos pital, e.g., patient's room, intensive care unit, open ating room, etc (4). Before insertion of the biopsy needle or catheter,
tered intravenously to permit visualization of the
was then performed in the usual manner up to the time when confirmation of position or direction of
jections. Technetium-labeled radiopharmaceuticals were selected for organ imaging. The activity of the source was adjusted to facilitate a single image which demonstrates both the position of the needle and the
of larger diameter indwelling catheters was accom pushed by inserting the appropriate length sealed source to the full length of the catheter followed by
The location of vascular catheters within the heart
large occipital lesion on left. Operating room study demonstrates proper position ing of biopsy needle which contains sealed tIomTcsource.
(^744) JOURNAL OF NUCLEAR MEDICINE
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optic bronchoscope has been followed during bron choscopy.
tube or catheter can be determined, provided that a
Concomitant organ imaging and/or the use of a flooded-field transmission source provides additional
tion of the radioactive sealed source. Numerous addi
for example, to follow the movement of a Miller
ACKNOWLEDGMENT This work was supported in part by Grant No. 74- from the American Heart Association.
1. TULLY Ri, STARKVJ, HOFFERPB, et al: Renal scan prior to renal biopsy—A method of renal localization. I _Nuci Med 13: 544—547,
mission source behind patient. (B) Composite image with transmis. sion source and linear @@mTcsource in tracheal suction catheter, showing catheter tip to be located in right main stem bronchus.
routine CVP and Swan-Ganz catheter visualization by scintiphotography would not appear to be a rou
cases where catheter placement is difficult or the final position is uncertain. The movement of tracheal suction catheters has been monitored during tracheal aspiration, an exam ple of which is shown in Fig. 5. Since this is nor
valuable to assure that both the right and left bronchi are suctioned during tracheal toilet, and it is sur prising how frequently the left main bronchus is never entered. Similarly, the movement of a fiber
First Annual Winter Meeting
Announcement
Attendees will register for the series of workshops in the topic of their choice. Continuing educa tion certificates will be awarded.
TECHNOLOGISTSECTION Society of Nuclear Medicine