XXX Nuclear Facility
6021 University Blvd., Suite 500
Ellicott City, MD 21043
Phone: (123) 123-1234
Fax: (123) 123-1234
Phone (123)123-1234
Fax (123)123-1234
Patient Name: Doe, John
ID Number: 123456
BMI: 36
Date of birth: 4-2-33
Sex: Male
Referring physician: Dr. Jones
Date of the exam: 4-1-17
Radiopharmaceutical: 10.6 mCi 99mTc MAG-3
Renal Scan (SAMPLE) 1
NOTE: This is a SAMPLE only. Protocols submitted with the application MUST be customized to reflect current practices of the facility.
XXX Nuclear Facility
6021 University Blvd., Suite 500
Ellicott City, MD 21043
Phone: (123) 123-1234
Fax: (123) 123-1234
Phone (123)123-1234
Fax (123)123-1234
Renal Scan
Indications/History: Right renal obstructive uropathy
Procedure: Following intravenous administration of 10.6 mCi Tc99m MAG-3, posterior dynamic angiogram and sequential static images of the kidneys were obtained. 3.0 mg Lasix was administered intravenously 20 minutes into the study.
Findings: Sequential static images show prompt, symmetric radiotracer uptake in the kidneys bilaterally. The left kidney shows spontaneous excretion of radiotracer prior to the administration of Lasix. Excretion from the right kidney is spontaneous prior to Lasix administration but slower than that of its left counterpart.
The T1/2 of excretion of activity is 14.5 min for the right kidney and eight min for the left kidney (normal T1/2 is <10 min; dilated but not obstructed collecting system T1/2 is >10 but < 15 min and obstruction T1/2 is >15 - 20 min).
The estimated contribution of the right kidney to total renal function is 44% and that of the left is 56%.
Impression:
1. Dilated, non-obstructed right kidney
2. Normal left kidney
3. The estimated contribution of the right kidney to total renal function is 44% and that of the left is 56%.
Electronically signed by Maria Costello, M.D. on April 2, 2017 at 10:30 AM
Renal Scan (SAMPLE) 1
NOTE: This is a SAMPLE only. Protocols submitted with the application MUST be customized to reflect current practices of the facility.