The Lymphoscintigraphy Procedure
Doctor Yves JACQUES, head of the nuclear medicine department at the Brussels Saint Michel Hospital (a member of the Hospitals of Europe Group) had the kindness to authorise us the publication of his protocol of lymphoscintigraphy which we used in our clinical studies. We warmly thank him for that.
1. Aim of the examination:
Study of the lymphatic flux (drainage) at the level of lower and upper limbs in order to discover any lymphathic failure, any obstacle in the lymphatic circuit or possible lymphatic leakage.
2. Physiological principles:
The small dimensions of nanocolloïds allow them to be captured by the lymphatic network when being injected intradermically (interstitium) and drained along the lymphatic vessels. This enables to follow their migration in the lymphatic collectors and their concentration in lymph nodes.
The microcolloïds are injected in the first interdigital space of both feet (lower limbs) or both hands (upper limbs). The gamma camera is directed towards the first inguinal (lower limbs) or axillar (upper limbs) lymph nodes. They study the duration of the migration between the injection site and the first ganglionic link (transit time). Gathering the data takes 30 minutes.
The examination is complemented with subsequent late imaging realised 45 minutes and 5 hours after the injection, focusing on the lower or upper limbs in order to visualise the lymphatic network (superficial and deep routes) and the different lymph nodes of the lymphatic network
3. Indications :
To determine the lymphatic component of edema.
- Familial lympho-edema, elephantiasis, lympho-edema following stripping of varicose veins, edema connected with venous failure, post-phlebitic edema, post-surgical lympho-edema.
- A lymphoscintigraphic classification of the edema is being established with an eye to their physiotherapeutic cure.
4. Counter-indications :
- Pregnancy
5. Preparation :
-No particular preparation
- The patient need not be on an empty stomach
-Medical data: the demand for an examination must include the indication to the examination.
6. Preparation of the radio-pharmaceutical substance ;
7. 7. Proceeding of the examination and data collection :
PROCEDURE of the lymphoscintigraphic examination :
TRACER : NANOCOLL
ISOTOPE : Tc 99 m
DOSE / ADULT PATIENT : 2 seringes of 4 mCi
APPLICATION MODE : hypodermic
WAITING TIME BEFORE EXAMINATION : 0
INSTRUCTION TO THE PATIENT : one hour after the injection the patient has to step during about ½ hour or to have a 10-minute biking;
ACCESSORIES : - leaden cover (injection site)
- extension table
COURSE OF THE EXAMINATION :
- Preparation of data collection
- Positioning of the patient (field of collection = groin area)
1. Dynamic collection over 30 minutes, with the camera posed at inguinal or axillar level : Start immediately after injection + light start massage at the fore-feet or hand level.
2. Planar image from the pelvis to the feet, with data collection protocol Whole Body (covering fore-feet with lead) or static images : shoulders and 2 arms (with lead under the carpi) 45 minutes after the injection.
3. Stepping or biking
4. Late image during Whole Body (lower limbs) or static (upper limbs) at 5 hours (covering fore-feet and hands with lead).
PROTOCOL OF DATA COLLECTION for DYNAMIC examination of Lymphography of lower or upper limbs :
ISOTOPE : Tc 99m
ENERGY : 140 Kev
WINDOW : 10
RATE MODE : NORM
COLLIMATOR : 35
BYTE / WORD : WORD
FRAME SIZE : 128
HEADS : 1
ZOOM : 1
ROTATION : 0° ou 180°
MIRROR : N
INTERVALS : 1
DELAY TIME FRAME RATE FRAME TIME
0 1800’’ 1/15’’ 15’’
PROTOCOL OF DATA COLLECTION for planar examination Whole Body for lymphography of lower limbs (at45 min and 5 hours) :
ISOTOPE : Tc 99m
ENERGY : 140 Kev
WINDOW : 10
COLLIMATOR : 35
HEADS : 1,2
STEP-SHOOT : N
SCAN TYPE : SPS
CONTOUR : Y
VELOCITY : 8
PROTOCOL OF DATA COLLECTION for planar examination static for lymphography of upper limbs (at45 min and at 5 hours) :
ISOTOPE : Tc 99m
ENERGY : 140 Kev
WINDOW : 10
RATE MODE : NORM
COLLIMATOR : 35
BYTE / WORD : BYTE
HEADS : 1 ou 2
ZOOM : 1.2
ROTATION : 180°
MIRROR : N
PRESET TIME : 0 / 300 – 600 sec
PRESET COUNT : 0 (minimum 300 Kc)
OVERFLOW : N
8. Later control :
No particular control
9. Protocol :
The protocol includes the names, first name and date of birth of the patient, the prescribing doctor and the clinical indication.
Determination of the duration of lymphatic drainage (transit time) and description of the lymphatic system and of the ascertained anomalies.