Wbnm patient questionnaire
Wide Bay
Nuclear Medicine
PLEASE C
ish MPLETE THIS F
ORM AND BRING IT WITH Y
ANDRE
WHEN Y
MRCP(UK),
ME
Independently owned
FOR YOUR SCAN.
Consultant Physicians in Nuclear Medicine
Your Name: _________
PA
_TI
_E
_N
_T
__
DE
_T
_AI
_L
_S
___________________________________________________________
All Appointments
4151 6880
Are you allergic to anything ?
□ Yes (Type ____________________)
Do you have D
Appointment Details iabetes ?
If yes, what type of treatment ?
Time:
forget to adjTe
u
hone
insulin dose on morning of test because you will be
fasting. Also bring with you yoG
u
(spe
c
m
ify)
onitoring device and
usual sugar su
Bundaberg p
site
plement.)
Have you ever
Hope Str
ha
d a heart attack ?
Phone 4151 6880
GNOSTIC NUCLEAR MEDICINE
Do you suffer from chest pain/an
loose pr
gin
osthesis,
a ? □
Thyroid nodules, goitre, all causes of hyperthyroidism, thyroiditis.
Do you use:
Parath
yr □ G
Localisation of parathyr ches □ An
Assessment of myocardial ischaemia and viability. For patients unable to
exercise dipyridamole or dobutamine (for asthmatics) are used.
Have you ever
Lung Scan
had heart surge
ry ?
entilation and perfusion-pulmonar
radiation than helical CTPA. Regional quantification. Right to left shunts.
Differential renal function, renovascular hypertension, ureteric obstruction
Or Angioplast
MAG3 is substituted in children. GFR quantification if requested.
ASSOCIATED SITE ?
Renal scarring and acute pyelonephritis (more sensitive than ultrasound).
Differential function (particularly if one kidney is small or ectopic).
Do you have an
Nuclear Medicine
Gallium Scan
irregular heaL
rt beat ?
coidosis. □ Not sure
Chronic infections, eg osteomyelitis and infected joint prosthesis.
Localisation of acute or subacute infection. Assessment of activity of
Do you have any medical condition
inflammator
s
el disease.
could prevent you from exercising
on our bicycle ?
er nodules (FNH) pain or arthritis)
Haemangioma of the liver. Gastrointestinal haemorrhage.
Acute cholecystitis. Biliary obstruction or dysfunction.
CCK used for chronic cholecystitis or sphincter of Oddi dysfunction.
Do you hav
L
e asth
ymphoscintigra
m
phy
a ?
Sentinel node localisation in breast cancer and melanoma. Assessment of
Signature
If yes, have you ever been hospitalised with asthma ?
Are you being tr
BUNDABERG 4670
e
Gastric Emptying
ated for High Blo
Quantitativ
od Pressure ? □ No
e assessment of solid gastric emptying using a labelled egg
sandwich. Half clearance time and % retained at 3 hours ar
Small and large bowel clearance using sequential images over 5 days.
Please list
all me
Lacrimal Scan dications you are currently taking
Functional nasolacrimal duct obstruction. (or attach list)
Report to be
Returned with Patient
____________________________________________________________________________________________
NUCLEAR MEDICINE THERAPY
www.ncnm.com.au
____________________________________________________________________________________________
Palliative treatment of painful osteoblastic bone metastases.
ombocythaemia □ No
If yes, who is your local Dr
_
(Can onl
____
y be pr
______
escribed b
_______
y a specialist)
______________
Patient Preparation
If you are u
!
nsure a
Bone Scan - w
b
ell h
out
ydrated.
any o
Images perf
f the questions pl
ormed 2-3 hours after injection and tak
ease le
e up to 1 hour.
ave them and our staff
My
will h
elp whe
dial perfusion scan (thallium,
n you come
for your appoin
or 3 hours after a light breakfast, then hav
No tea or coffee for 24 hours. Omit betablockers for at least 24 hours.
More detailed written information is provided.
Biliary Scans (HIDA, HIDA/CCK) fast for 4 hours.
ter
AFF USE O
y stenosis is being assessed A
NLY
□ Fasting !
□ Caffe
Most other pr
ine c
ocedur
eas
eparation.
nsulin dose adjusted
□ GTN Indicated
www.widebaynm.com.au
Wide Bay
Nuclear Medicine
Established 1994
DR ANDREW SOUTHEE MBBS(Hons), MRCP(UK), FRACP
Independently owned
Consultant Physicians in Nuclear Medicine
PATIENT DETAILS
How to Wind us…
All Appointments
4151 6880
Appointment Details
Bundaberg site
Phone 4151 6880
osteonecrosis, RSD and tumour staging.
all causes of hyperthyroidism, thyroiditis.
Localisation of parathyroid adenoma using myocardial perfusion isotopes.
Assessment of myocardial ischaemia and viability. For patients unable to
Ventilation and perfusion-pulmonary emboli. More sensitive and far less
radiation than helical CTPA. Regional quantification. Right to left shunts.
Differential renal function, renovascular hypertension, ureteric obstruction
MAG3 is substituted in children. GFR quantification if requested.
ASSOCIATED SITE
Renal scarring and acute pyelonephritis (more sensitive than ultrasound).
Differential function (particularly if one kidney is small or ectopic).
Nuclear Medicine
List of Com
Shop 2 46-48 Main Str
m
Lymphoma staging and response to treatment. PUO. Sarcoidosis.
Chronic infections, eg osteomyelitis and infected joint prosthesis.
OR
locker Drugs for your information
Localisation of acute or subacute infection. Assessment of activity of
Haemangioma of the liver. Gastrointestinal haemorrhage.
Acute cholecystitis. Biliary obstruction or dysfunction.
Sentinel node localisation in breast cancer and melanoma. Assessment of
Dementias and cognitive impairment and cerebrovascular diseaseat
e assessment of solid gastric emptying using a labelled egg
sandwich. Half clearance time and % retained at 3 hours are calculated.
Small and large bowel clearance using sequential images over 5 days.
Functional nasolacrimal duct obstruction.
Returned with Patient
NUCLEAR MEDICINE THERAPY
www.ncnm.com.au
Palliative treatment of painful osteoblastic bone metastases.
ycythaemia rubra vera and essential thrombocythaemia
Patient Preparation
Bone Scan - well hydrated. Images performed 2-3 hours after injection and take up to 1 hour.
Myocardial perfusion scan (thallium, sestamibi)- fast for 3 hours after a light breakfast, then have clear fluids sparingly.
No tea or coffee for 24 hours. Omit betablockers for at least 24 hours.
vided.S PHONE:
4124 3580
Biliary Scans (HIDA, HIDA/CCK) fast for 4 hours.
Renal Scans - well hydrated. If renal artery stenosis is being assessed ACE inhibitors need to be reviewed.
Most other procedures have no special preparation.
www.widebaynm.com.au
Source: http://www.widebaynm.com.au/examinations/downloads/files/wbnm_patient_form.pdf
RATE LIST OF BUNDI SAHAKARI UPBHOKTA HOLL SALE BHANDAR LTD. BUNDI Salt Name / Generic name Packing Proposed Bhandar Sale Rate M.R.P. Of ACECLOFENAC 100 mg + SERRATIOPEPTIDASE 10 mg ACECLOFENAC 100 mg + PARACETAMOL 500 mg Tab 12. ALPRAZOLAM 0.25 mg + PROPRANOLOL 20 mg Tab13. ALPRAZOLAM 0.25 mg + SERTALINE 50 mg Tab14. AMBROXOL HYD.+ TEBUTALIN + GUAIP. Syp. 20. AMLODIPINE 5 mg
La psicología científica y el Test de Rorschach1 En la edición previa de la revista The Clinical Psychologist , Lohr, Fowler yLilienfeld (2002) expresaron su preocupación acerca del uso de los métodos deevaluación y tratamiento que carecen de validación científica. Al describir estos métodoscomo “pseudociencia”, los autores se lamentan de la magnitud en que la popularidad deal