By Vvon Engineering Team | Published | Updated
The tracer decays to the theatre list, not to yours. Injection timing and the same-day against day-before choice, what the operating theatre needs, the handover that has to exist in writing, and the scheduling failures that waste a dose.
Nuclear medicine RFQ checklist (TXT)
Sentinel-node services require coordinated clinical selection, tracer preparation, imaging when indicated, surgery, pathology and radiation protection. Scheduling matters, but it does not replace a validated clinical and technical pathway.
So the useful way to plan this service is backwards: fix how the two departments talk to each other first, and treat the imaging as the easy part.
Tracer, injection route, imaging and surgical approach depend on the indication, approved product and specialist protocol. Technetium-labelled colloids and receptor-targeted agents are not interchangeable. This planning guide does not specify an injection technique; the nuclear-medicine and surgical teams must define and authorise it.
Technetium's roughly six-hour half-life gives you two workable patterns:
Same-day and previous-day arrangements can be considered where supported by the product and clinical protocol. Required activity and timing must be set by the responsible team, accounting for tracer behaviour and operative requirements. A day-before workflow does not remove the need to coordinate changes and cancellations.
Plan lymphoscintigraphy and any SPECT/CT according to the clinical indication and expected value. Dynamic, static and tomographic imaging have different roles; SPECT/CT is useful in selected circumstances but is not automatically required for every listed anatomical site.
Where skin marking is used, agree imaging and surgical positioning and communicate any change that affects localisation. A mark is one element of the localisation method and must not be treated as an exact substitute for the full imaging and intraoperative findings.
Assign ownership, storage, cleaning, performance checks and service cover for the intraoperative probe explicitly. It need not belong to a nuclear-medicine service contract; what matters is that theatre and nuclear medicine agree who is responsible.
Dye or other optical agents, where used, have their own product-specific clinical risks and consent requirements, including possible hypersensitivity. They do not remove the need for suitable equipment checks or a coordinated localisation protocol.
Agree theatre and nuclear-medicine timing jointly within the clinical and product constraints. Neither department can set a workable schedule independently.
Also decide in advance what happens when a patient is injected and the operation is then cancelled. It happens, it is nobody's fault, and it needs a recorded administered dose, an explanation to the patient, and a decision about whether the case can be rebooked within the useful life of the tracer or has to start again.
Before the patient goes to theatre there should be a written report and a map available to the surgical team, not a report dictated later that afternoon. It should state how many nodes were seen, in which basins, their relationship to the injection site, and anything unexpected such as drainage crossing the midline or to an unusual basin.
Two practical points. Do not assume the theatre has a PACS workstation, or that it is on the same network segment; if it does not, print the images and send them with the notes. And agree the counting convention with the surgeon in writing: what count rate constitutes a hot node, whether ex-vivo counting of the excised node is done and recorded, what background is measured against, and when the search stops. These are surgical protocol decisions, and the two teams need to be operating on the same rule rather than two similar ones.
Shine-through from the injection site is the standard difficulty in breast and head and neck cases. The report should say where the injection site activity is and how close it lies to the node, because that determines whether the surgeon can trust the probe near the primary.
Assess theatre and pathology exposure and contamination for the actual activity and tasks. Define specimen labelling, transport, processing, waste and staff protection under the approved local arrangements. Do not impose an automatic delay before pathology processing or assume that every worker exposure is negligible.
Agree the histopathology procedure with the laboratory before the first case, not when the first pot arrives with a radiation label on it. Their concern is legitimate and easily answered in advance; answered badly on the day, it can stop the service for a month.
Review both equipment and process risks with the clinical, theatre, pathology and radiation-protection teams before starting the service. Non-visualisation, probe faults and localisation errors can have technical or patient-specific causes as well as scheduling causes.
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