E2126. On Call Nuclear GI Imaging: Practical Tips for the Radiology Resident
  1. Megan Mercer; Medical University of South Carolina
  2. Lisa Blacklock; University of New Mexico
  3. Jonathan Revels; New York University
  4. Kevin Banks; San Antonio Military Medical Center
  5. Saeed Elojeimy; Medical University of South Carolina
Scintigraphy may be used in the emergency department to evaluate for acute diseases such as gastrointestinal (GI) bleed, cholecystitis, hepatic dysfunction, or biliary leak. In these rapid-paced scenarios, the goal is to keep morbidity and mortality as low as possible thus early detection is crucial. The radiologist plays a key role in the treatment team by both protocoling and interpreting GI focused scintigraphic studies.

Educational Goals / Teaching Points
Here, we review common indications for hepatobiliary and GI bleed imaging, showing case examples including cholecystitis, hepatic dysfunction, biliary leaks, bilomas, and small and large bowel bleeds. Our goal is to highlight important considerations and protocol modifications for hepatobiliary scans and GI-bleeding studies in both common and challenging clinical scenarios by demonstrating potential pitfalls in imaging and interpretation. The utility of SPECT/CT for problem solving is demonstrated, and correlative ultrasound and CT imaging is shown.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes an overview of hepatobiliary scintigraphy and GI bleeding studies; American College of Radiology (ACR) appropriateness criteria; hepatobiliary radiopharmaceutical(s), protocols, and protocol optimization (e.g., delayed imaging and pharmaceutical interventions including morphine). Pathologic findings include bilomas, biliary leaks, hepatocellular dysfunction, and cholecystitis (including correlation with a multimodality approach, such as CT and ultrasound). Additionally, an overview of GI bleeding radiopharmaceutical(s), protocols, and protocol optimization, as well as coordination with consultants, interpretation, and utility of SPECT/CT will be discussed.

GI bleeding and hepatobiliary pathologies are frequently encountered ailments in both the emergency department and in the hospital. Based on ACR appropriateness criteria, scintigraphy may be employed to evaluate the patient, and it is necessary for radiologists to be knowledgeable about how to perform and interpret these studies.