CEA-Scan® (arcitumomab) General Imaging Protocol


PLEASE CONSULT FULL PRESCRIBING INFORMATION AVAILABLE FROM IMMUNOMEDICS BY CALLING (888) 605-8200 OR VISIT THE www.cea-scan.com WEBSITE BEFORE USING CEA-Scan.

PATIENT PREPARATION
Administer 20 to 30 mCi of Tc-99m labeled CEA-Scan and image 2 1/2 hrs post injection. Ensure that the patient is well hydrated. It is best to have the patient drink plenty of fluids the day before the injection and stop taking additional fluids a few hours before injection. Hydrating patients in this manner can reduce the concentration of CEA-Scan in the kidneys, which in many cases, helps reduce artifacts. An added benefit is that bladder-filling artifacts are minimized if the patient can not be catheterized.

Unless medically contraindicated bladder catheterization prior to imaging is recommended for the patient with known or suspected disease within the pelvis. Urinary catheter should also be strongly considered for any patient who cannot empty the bladder, such as patients with benign prostatic hypertrophy (BPH). If bladder catheterization is being considered, the Nuclear Physician should consult with the patient's Doctor to determine if there are any contraindications. 

The time between the injection and the scan can be used to catheterize the bladder, or for changing the ostomy bag. If the patient has a colostomy, the bag MUST be changed prior to imaging, because activity within the ostomy bag can complicate scan interpretation. 

IMAGING PROTOCOL

• Begin imaging at 2.5 hours post injection with the pelvic SPECT.

• Use a large field of view camera with a low-energy high-resolution collimator.

• Energy setting should have a 20% window width centered at 140 keV 99mTc peak.

• Acquire images in the following order: 
  

  1. SPECT IMAGING OF PELVIS: Use a 128 X 128 X 16 matrix for best results. Images should be acquired using step and shoot technique with 3-degree stops for multi-head detectors. Use 6-degree stops for single-head systems and acquire each projection for 30 to 40 seconds per stop. 

  2. PLANAR WHOLE BODY IMAGING: Acquire anterior and posterior whole body scan at a speed of 8 - 10cm / minute or spot view images for 10 minutes per view.

  3. SPECT IMAGING OF ABDOMEN: Acquired in the same manner as the SPECT of pelvis above. Liver should be centered in the field of view.

  4. DELAY SPECT IMAGING AT 8 – 18 hrs: If needed, use a multi-head detector and a 64 X 64 X 16 matrix with 6-degree step and shoot technique. Acquire each projection for 60 to 70 seconds per stop.
     

SPECT PROCESSING & DISPLAY

• Use a Butterworth or low pass filter with the order set between 6 and 10, with a cutoff frequency of 0.26 - 0.45. The cutoff frequency may be lower on some systems.

• Apply attenuation correction to abdominal reconstructed images.

• Volume-rendered 3-D or reprojected images are very useful in study interpretation.

• MoAb studies MUST be read from the computer monitor and by varying the intensity one may enhance areas of subtle tumor uptake.

• A low intensity is necessary to properly view the liver and the tissues near hot structures such as the kidneys and bladder.

• Use of a triangulation program can facilitate disease detection. The reader should sweep through the image planes, stopping to compare suspicious areas on all three planes.
  

Below are three strips of CEA-Scan images of the chest, abdomen and pelvis respectively. Each image illustrates the difference appearance when the cut-off frequency is changed. On each row, the image on the left was processed with a low cut-off frequency, the one in the middle is optimal and the one on the right was processed with a higher cut-off. Note that on the optimally filtered images, the vascular structures have well defined, sharp edges.

Normální biodistribuce

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