Sentinel Lymph Node Breast Protocol

Preparation
1. No patient preparation
Isotope administration
1. For same day surgery the patient will receive 2 subdermal injections of 0.5 mCi Tc^99m labeled buffered sulfur colloid to each breast as ordered.
  1. The right breast in the upper outer quadrant and 9 o’clock location near the areola
  2. The left breast in the upper outer quadrant and 3 o’clock location near the areola
2. For day prior to surgery the patient will receive 2 subdermal injections of 1 mCi Tc^99m labeled buffered sulfur colloid to each breast as ordered.
  1. The right breast at the 12 and 9 o’clock location near the areola
  2. The left breast at the 12 and 3 o’clock location near the areola
3. The breast indicated to be injected on the prescription will be correlated with the operating room schedule and an office note or an imaging report.
4. The patient will be identified by name and date of birth.
5. The injection procedure will be reviewed with the patient to include site of administration and breast to be injected. The patient will be offered a chaperone to be present in the room. Any discrepancy between the patients expected procedure and the written directive will cause the procedure to stop until the ordering physician can confirm exam and side to be injected.
6. Patients with breast implants, erupting masses, or any other unusual presentation will be injected by an advanced practitioner or radiologist.
7. Patients with specific instructions for injection from the surgeon will be performed by an advanced practitioner or radiologist.
8. All technologist performing breast injections will have 3 supervised injections by an advanced practitioner or radiologist prior to performing breast injections independently.
9. Male nuclear medicine technologist will require a female chaperone present in the room while performing breast injections.
Camera Parameters Planar imaging
1. LEHR collimators used for imaging
2. Matrix: 256X256
3. Zoom: 1.23
4. Camera peaked at Tc^99m with a 15% window
5. Images acquired using detector 1 and a cobalt sheet source placed on detector 2 for transmission imaging.
Scanning protocol
1. Patient will be scanned 2 or more hours post injection.
2. Injection site will be covered with a lead shield for imaging
3. A Co⁵⁷ flood source placed below patient on detector 2.
4. 5 minute anterior image acquired with patient supine with arms above head
5. 5 minute anterior oblique views acquired with patient position laying on side with injected area near detector 1 and arms above head
6. As needed visualized nodes will be marked on the patients skin per surgeons preference.
Post processing/Display/Achieve
1. All acquired images will be adjusted for optimal viewing and appropriate labeling. Images and paperwork will be sent to the PAC’s system for archiving