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Diagnostic

Updated : June 21, 2024





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

acetylcysteine 

Before the procedure, 1-2 mL of 20% solution or 2-4 mL of 10% solution should be nebulized or instilled intratracheally 2-3 times.



hexaminolevulinate 

Indicated for Bladder Cancer Diagnostic Agent:


Use an intravesical catheter to administer 50 mL of a reconstituted imaging agent into the empty bladder
To perform Blue Light Cystoscopy (BLCTM), which is used in the detection of carcinoma of the bladder.
An intravesical catheter is used to inject a reconstituted imaging agent into the patient's bladder during the procedure, which is carried out using a tool called the KARL STORZ D-Light C Photodynamic Diagnostic (PDD) system



cyclopentolate 

indicated for Cycloplegia/Mydriasis Diaganosis :

1 - 2

drops

of a 1% solution

eye

, repeated every five minutes as necessary; mydriasis and cycloplegia could last for 24 hours
In iris with high pigmentation, use 2%.



secretin 

Indicated for diagnosis of Pancreas dysfunction:


0.2mcg/kg intravenous infused for 1 minute

Indicated for diagnosis of Gastrinoma
0.4mcg/kg intravenous infused for 1 minute

Indicated for Identification of the Ampulla of Vater and Accessory Papilla During Endoscopic Retrograde Cholangiopancreatography
0.2mcg/kg intravenous infused for 1 minute



sodium iodide I-131 

Indicated for the performance of the radioactive iodide in the uptake test to evaluate thyroid function
For thyroid uptake, 5-15 microCi orally (or 0.185-0.555 MBq)
For scintiscanning, 50-100 microCi orally (or 1.85-3.7 MBq)
For localizing extra-thyroidal metastases, 1000 microCi orally (or 37 MBq)



technetium Tc 99m albumin aggregated injection 


Indicated for Lung scintigraphy
37-148 MBq (i.e., 1-4 mCi) intravenously, the generally recommended dose in adults for lung scintigraphy
Two-seven lakh particles/single injection is the generally recommended no. of particles, based on activity, the volume of final reconstituted item, volume of dose range from 0.2-1.9 ml
Peritoneovenous shunt scintigraphy
The recommended intraperitoneal dose range is 37-111 MBq (i.e., 1-3 mCi) for Peritoneovenous shunt diagnosis



technetium Tc 99m succimer 


Indicated for Renal Scintigraphy
74-222 MBq (i.e.,2-6mCi) intravenous bolus
For renal parenchymal disorders, it is generally used as a scintigraphic evaluation



choline C-11 

Indicated as Prostate Cancer Diagnostic Imaging Agent
10-20 mCi as an intravenous bolus injection based on dimensions of the patient’s body and image acquisition system characteristics
Imaging should be performed immediately after the choline C11 injection



indium In-111 capromab pendetide 

Indicated as diagnostic imaging:


0.5 mg of indium 111 chloride radiolabelled with 5 mCi. May need to be delivered again if there is infiltration or a scan that is not accurate enough.



indium In-111 capromab pendetide 

Indicated as diagnostic imaging:


0.5 mg of indium 111 chloride radiolabelled with 5 mCi. May need to be delivered again if there is infiltration or a scan that is not accurate enough.



indigo carmine 

Indicated for Localization of ureteral orifices :

Administer 5ml intravenously




Indicated for diagnostic imaging
200-500 microCi or 7.4-18.5 MBq) in adults weighing more than 70 kg




Indicated for diagnostic imaging
200-500 microCi or 7.4-18.5 MBq) in adults weighing more than 70 kg



flotufolastat F18 


Indicated for PET Imaging for Prostate Cancer
296 MBq (i.e., 8 mCi), which is administered as an intravenous bolus



fluorescein ophthalmic 


Indicated for Examination of Eye
Diagnostic staining:
During ophthalmic assessments, Ocular strips are recommended for staining the front section of the eye
Hydrate by administering 1 to 2 drops of a sterile isotonic irrigation solution or alternative ophthalmic solution
Application: While the patient gazes the downwards, glide the applicator tip along the bulbar conjunctiva towards the fornix; instruct the patient to blink for multiple times
Other types of applications, like having the patient close the lid firmly over the strip until the required amount of staining occurs for the examination
Ophthalmic angiography:
If there is a possibility of an allergen reaction, use the 0.05 ml of the intradermal test dose; after injection, evaluate for 30 to 60 minutes; a negative test dose does not exclude the potential for an allergic reaction During the process, instant therapy for anaphylaxis, like epinephrine 1:1000, have to be available
Intravenous administration by utilizing a 23 gauge needle which is attached to a small syringe
Administer 500 mg intravenously as a single dose into the antecubital vein. In some cases, like using a highly sensitive imaging system such as a scanning laser ophthalmoscope, administering 200 mg intravenously as a single dose into the antecubital vein for over 5 to 10 seconds; following injection, luminescence appears for nearly 7 to 30 seconds
Oral administration as off-label:
1 gm of injection administered orally



gallium citrate Ga-67 


Indicated for Scintigraphy for the inflammation/infection
150 MBq to 220 MBq (i.e.,4 mCi to 6 mCi) intravenously
Scintigraphy for Tumor
185 MBq to 370 MBq (i.e.,5 mCi to 10 mCi) intravenously
Manufacturer’s Label
74 MBq to 185 MBq (i.e.,2 mCi to 5 mCi) intravenously, which is the suggested average adult dose



gadofosveset 


Indicated for Magnetic resonance angiography
0.12 ml/kg of body weight (i.e.,0.03 mmol/kg of body weight) intravenously for a duration of 30 sec and after given a 25 ml to 30 ml normal saline flush



technetium Tc-99m tetrofosmin 

Indicated for Ventricular function imaging; Myocardial perfusion imaging:


Administer 5 to 33 mCi intravenously.
When stress and rest imaging are done on the same day. Administer a first dose of 5 to 12 mCi (185 to 444 MBq), then administer a second dose of 15 to 33 mCi (555 to 1221 MBq) 1 to 4 hours later.



fluorine F18 DCFPyL 

This clinical trial studies how well fluorine F 18 DCFPyL positron emission tomography (PET)/computed tomography (CT) works in imaging of prostate cancer. A PET scan uses radioactive material such as fluorine F 18 DCFPyL injected into the blood to show the internal workings of the body



perflubutane 

perflubutane is an investigation imaging agent that is used to evaluate perfusion by ultrasound and to detect coronary artery disease. FDA approval is currently pending



patent blue 

Identification of Lymphatic Vessels::

It is administered into subcutaneous tissue in an amount of around 1 mL.
Identifying Arterial Territories:
To accurately situate the catheter for intra-arterial chemotherapy, inject 50 millilitres of the following solution:
A solution of isotonic in 80 millilitres of water
2.5% of patent blue sodium in 40 millilitres
A 20 mL solution containing 1% xylocaine



bentiromide 

500 mg is given and immediately after the dosing, 250 ml of water are administered, followed by another 500 ml of water 2-4 hours later



 

cyclopentolate 

indicated for Cycloplegia/Mydriasis Diaganosis  :


1-2 drops of a 1% solution in the eye, repeated every five minutes as necessary; mydriasis and cycloplegia could last for 24 hours
In iris with high pigmentation, use 2%



technetium Tc 99m albumin aggregated injection 


Indicated for Lung scintigraphy
7.4-18.5 MBq (i.e., 0.2-0.5 mCi) intravenously, the generally recommended dose in newborns for lung scintigraphy
0.925-1.85 MBq/kg (i.e., 0.025-0.05 mCi/kg) intravenously, the generally recommended dose in pediatric patients (i.e., children) for lung scintigraphy



technetium Tc 99m succimer 


Indicated for Renal Scintigraphy
1.85 MBq/Kg (i.e.,0.05 mCi/kg)
The range is 19-74 MBq (0.5-2 mCi) intravenous bolus
For renal parenchymal disorders, it is generally used as a scintigraphic evaluation
Body weight <11 kg: 19 MBq (i.e., 0.5 mCi)
Body weight 11-12 kg: 21 MBq (i.e., 0.6 mCi)
Body weight 13-14 kg: 26 MBq (i.e., 0.7 mCi)
Body weight 15-16 kg: 30 MBq (i.e., 0.8 mCi)
Body weight 17-18 kg: 33 MBq (i.e., 0.9 mCi)
Body weight 19-20 kg: 37 MBq (i.e., 1 mCi)
Body weight 21-22 kg: 41 MBq (i.e., 1.1 mCi)
Body weight 23-24 kg: 44 MBq (i.e., 1.2 mCi)
Body weight 25-26 kg: 49 MBq (i.e., 1.3 mCi)
Body weight 27-28 kg: 52 MBq (i.e., 1.4 mCi)
Body weight 29-30 kg: 56 MBq (i.e., 1.5 mCi)
Body weight 31-32 kg: 59 MBq (i.e., 1.6 mCi)
Body weight 33-34 kg: 63 MBq (i.e., 1.7 mCi)
Body weight 35-36 kg: 67 MBq (i.e., 1.8 mCi)
Body weight 37-38 kg: 70 MBq (i.e., 1.9 mCi)
Body weight >39 kg: 74 MBq (i.e., 2 mCi)



indigo carmine 

Indicated for Localization of ureteral orifices:

Children and infants-Administer less than 5ml intravenously
Dosages less than the typical adolescent/adult dose of 5 mL are required to prevent skin discoloration
During the cystoscopy procedure, 5 mL has also been injected locally into the ureter



fluorescein ophthalmic 


Indicated for Examination of Eye
Diagnostic staining:
During ophthalmic assessments, Ocular strips are recommended for staining the front section of the eye
Hydrate by administering 1 to 2 drops of a sterile isotonic irrigation solution or alternative ophthalmic solution
Application: While the patient gazes the downwards, glide the applicator tip along the bulbar conjunctiva towards the fornix; instruct the patient to blink for multiple times
Other types of applications, like having the patient close the lid firmly over the strip until the required amount of staining occurs for the examination
Ophthalmic angiography:
If there is a possibility of an allergen reaction, use the 0.05 ml of the intradermal test dose; after injection, evaluate for 30 to 60 minutes; a negative test dose does not exclude the potential for an allergic reaction During the process, instant therapy for anaphylaxis, like epinephrine 1:1000, have to be available
Intravenous administration by utilizing a 23 gauge needle which is attached to a small syringe
Administer 3.5 mg/lb (i.e., 7.7mg/kg) intravenously as a single dose into the antecubital vein for over 5 to 10 seconds
It should not exceed 500 mg; following injection, luminescence appears for nearly 7 to 30 seconds



gallium citrate Ga-67 


Age >5 years
1.5 MBq/Kg to 2.6 MBq/Kg of body weight (i.e.,0.04 mCi/Kg to 0.07/kg mCi of body weight) intravenously



 

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References

Diagnostic

Updated : June 21, 2024




acetylcysteine 

Before the procedure, 1-2 mL of 20% solution or 2-4 mL of 10% solution should be nebulized or instilled intratracheally 2-3 times.



hexaminolevulinate 

Indicated for Bladder Cancer Diagnostic Agent:


Use an intravesical catheter to administer 50 mL of a reconstituted imaging agent into the empty bladder
To perform Blue Light Cystoscopy (BLCTM), which is used in the detection of carcinoma of the bladder.
An intravesical catheter is used to inject a reconstituted imaging agent into the patient's bladder during the procedure, which is carried out using a tool called the KARL STORZ D-Light C Photodynamic Diagnostic (PDD) system



cyclopentolate 

indicated for Cycloplegia/Mydriasis Diaganosis :

1 - 2

drops

of a 1% solution

eye

, repeated every five minutes as necessary; mydriasis and cycloplegia could last for 24 hours
In iris with high pigmentation, use 2%.



secretin 

Indicated for diagnosis of Pancreas dysfunction:


0.2mcg/kg intravenous infused for 1 minute