HIDA with CCK

Last Updated: 1/27/2020

Indications: Abdominal pain, nausea, vomiting.
 
Patient Prep:

  1. NPO and no narcotic pain medications for a minimum of 5 hrs prior to imaging.
  2. Determine whether the patient has had a cholecystectomy. If so, consult with the nuclear medicine physician on duty; a Sphincter of Oddi study may be indicated.
 
Radiopharmaceutical and Route of Administration: 6.0 mCi Choletec IV.  For pediatric patients, use the following formula: (0.05)(weight in kg).
 
Contraindications:  
Paramaters for all images: 128x128 Matrix, LEHR, 1.23 zoom (Siemens only; ADAC set to “full field”)
 
Procedure:
  1. Start an IV line.
  2. With the patient under the camera, inject the Choletec and acquire flow and dynamic baseline images.
    1. Flow: 60 frames at 2 seconds/frame (2 minutes)
    2. Dynamic: 60 frames at 60 seconds per frame (60 minutes)
  3. Obtain a 300-second right lateral static.
  4. Confirm the presence of gallbladder and small intestine on the p-scope before proceeding with CCK.
    1. If the gallbladder does not visualize, acquire an anterior and right lateral static two (2) hours post-injection.
  5. CCK Preparation:
    1. Inject 5mL sterile water into a 5mg kinevac vial. Agitate. This will create a concentration of 1mg per 1mL (for 3mg vials, adjust the sterile water to 3ml to create a 1mg/1ml concentration).
    2. Calculate the amount of CCK to be infused according to the following formula:
      1. (weight in pounds/2.2)(0.02).  This will give the amount in ml to be withdrawn from the CCK vial. The maximum dose of CCK is 2.0
    3. Withdraw the calculated amount from the CCK vial and inject into a 50mL 0.9% normal saline bag.
    4. Attach an Alaris “SmartSite” IV tubing set (ref 2426-0500) and set up an Alaris IV pump:
      1. VTBI: 50
      2. Rate: 50
  6. Perform a CCK dynamic acquisition in the LAO projection. NOTE: DO NOT begin the CCK infusion until 45 minutes after the initial visualization of the gallbladder.
    1. 240 frames at 15 seconds/frame (60 minutes).
  7. Ask the patient if he/she experienced pain or nausea/vomiting which duplicates the symptoms during the CCK infusion. If so, ask the patient to rank it on a 0-10 scale. Record this information on the HIDA information sheet.
  8. Processing for Siemens HIDAs may be done on Sym1, Esoft3, Ecam, or Evo.
 
Optional  protocol for patients who cannot tolerate lying on the camera: (this should be used only in extreme circumstances):
  1. Halt the dynamic acquisition upon recognition of activity within the gallbladder and record the time (note that bowel visualization not required at this point).
  2. Return patient to imaging table 45 minutes after gallbladder visualization and acquire a right lateral.
  3. Acquire a 60-second “Pre-CCK” static in the LAO position. 
  4. Prepare and infuse the CCK according to step 4 above.  The patient may be sitting or in a recliner during the CCK infusion.
  5. When the CCK infusion is complete, return the patient to the camera as quickly as possible and acquire a 60-second “Post-CCK.”
  6. Ask the patient if he/she experienced pain or nausea/vomiting which duplicates the symptoms during the CCK infusion. If so, ask the patient to rank it on a 0-10 scale. Record this information on the HIDA information sheet.
Process the CCK statics with the “3. Static Proc” workflow on Sym1, Sym2,  Evo, and Esoft3.