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Authors: Helena R. Balon, MD, Chair (William Beaumont Hospital, Royal Oak, MI); Edward B. Silberstein, MD (University of
Cincinnati Medical Center, Cincinnati, OH); Donald A. Meier, MD (William Beaumont Hospital, Royal Oak, MI); N. David
Charkes, MD (Temple University Hospital, Philadelphia, PA); Henry D. Royal, MD (Mallinckrodt Institute of Radiology, St.
Louis, MO); Salil D. Sarkar, MD (Jacobi Medical Center, Bronx, NY); Kevin J. Donohoe, MD (Beth Israel Deaconess Medical
Center, Boston, MA)
The Society of Nuclear Medicine (SNM) has written and approved these guidelines as an educational tool designed to promote the cost-effective use
of high-quality nuclear medicine procedures or in the conduct of research and to assist practitioners in providing appropriate care for patients. The
guidelines should not be deemed inclusive of all proper procedures nor exclusive of other procedures reasonably directed to obtaining the same results.
They are neither inflexible rules nor requirements of practice and are not intended nor should they be used to establish a legal standard of care. For
these reasons, SNM cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.
The ultimate judgment about the propriety of any specific procedure or course of action must be made by the physician when considering the circum-
stances presented. Thus, an approach that differs from the guidelines is not necessarily below the standard of care. A conscientious practitioner may
responsibly adopt a course of action different from that set forth in the guidelines when, in his or her reasonable judgment, such course of action is
indicated by the condition of the patient, limitations on available resources, or advances in knowledge or technology subsequent to publication of the
guidelines.
All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the
needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
Advances in medicine occur at a rapid rate. The date of a guideline should always be considered in determining its current applicability.
2 • THYROID UPTAKE
2. Exposure to iodinated contrast A sodium iodide (NaI) crystal uptake probe with
3. Ingestion of iodine-rich foods suitable lead shielding and a flat field collimator
4. Pertinent laboratory data including the results of should be used. This is usually integrated with a
thyroid function tests multiple channel analyzer and recording com-
5. Pregnancy/nursing status puter.
Postponing administration of 131I to lactating 2. Measurement of Uptake
women until 6 or more weeks following cessa- a. The measurement of thyroid uptake is usu-
tion of lactation may decrease the radiation dose ally performed 18–24 hr after administration
to the breast. Breast-feeding following the ad- of the radioiodine. In some circumstances, it
ministration of 131I should be stopped to prevent may be performed between 2 and 6 hr after
an unnecessary radiation dose to the infant. radioiodine ingestion, as well.
6. Results of prior thyroid imaging tests The uptake is usually measured with 25–
7. Results of prior thyroid uptake measurement 30 cm between the face of the crystal and the
8. Recent administration of other radionuclides anterior neck or phantom. Neck counts, lower
C. Precautions thigh counts (body background), counts of a
Prolonged discontinuation of thyroid or antithyroid calibrated standard in a neck phantom and
medications may be hazardous in some patients. room background counts are preferably ob-
D. Radiopharmaceutical tained at each counting session. Alternatively,
1. Radioiodine is generally preferred. the radioiodine dose can be counted in the
2. Uptakes may be performed in conjunction with neck phantom before oral administration, and
99m
Tc-pertechnetate thyroid imaging. Careful the counts obtained can be corrected for decay
validation of this technique is required. at each patient counting session.
E. Data Acquisition The ORINS, IAEA or a comparable neck
1. Instrumentation phantom is recommended.
SOCIETY OF NUCLEAR MEDICINE PROCEDURE GUIDELINES • 3
References:
1. Michael G. Stabin, PhD, CHP: Radiation Internal Dose Information Center, Oak Ridge Institute for Science and Education, Oak
Ridge, TN, 1996.
2. ICRP Publication 53, Radiation Dose to Patients from Radiopharmaceuticals, 1994 edition.
3. Loevinger R, Budinger T, Watson, E: MIRD Primer for Absorbed Dose Calculations, Society of Nuclear Medicine, 1991.
4 • THYROID UPTAKE