**Northern Lincolnshire and Goole NHS Foundation Trust - Nuclear Medicine** 

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[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wikifarm/nlag/data/meta/sops/database.db|
SELECT sop AS "SOP Code",title AS "Title",reviewdate AS "Review Date" FROM sops WHERE sop='REF011'|0]] 
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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|  Prof G Avery  |  ARSAC Licence Holder  |    |  2025-01-16  |

====== REF011 - DaTSCAN Imaging ======
See [[referral_criteria:ref000-how_to_refer_to_nlagnm|REF000 - Referring to Nuclear Medicine (NLAG)]] for details on how to refer. 

===== Description =====
Iodine-123 labelled Ioflupane marketed under the trade name DaTSCAN is a ligand that binds to dopamine transporter proteins on presynaptic nerve terminals.

[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wikifarm/nlag/data/meta/arsac/database2019.db|SELECT fullname AS "ARSAC Licence Holders" FROM practitionerlicences INNER JOIN practitioners,procedurecodes,praclicproc,nuclides,chemicalforms ON practitionerlicences.practitioner=practitioners.id AND praclicproc.plicid=practitionerlicences.id AND praclicproc.procid=procedurecodes.id AND procedurecodes.nuclide_id=nuclides.id AND procedurecodes.chemicalform_id=chemicalforms.id AND practitionerlicences.certificateactive='Y' WHERE procedure_code='123I-96-15'  AND date('now')<=expirydate  ORDER BY expirydate|0]]


^Typical Radiation Dose (mSv)  |4.6  | 

===== Staff Entitled to Refer =====
  * The referrer may be a clinician holding a current valid medical qualification and currently employed in secondary care as a Neurologist, Geriatrician or Psychiatrist. 
  * Referrals will be accepted if the investigation has been suggested by a Neurologist, Geriatrician or Psychiatrist. Details of such suggestions or discussions should be included on the request form.


===== Supplementary Drugs  =====
  * Sodium chloride for parenteral use (0.9% w/v).
  * Potassium iodide tablets or Lugol's solution for oral use.

===== Contraindications =====
^ Patient Demographics  | • Pregnancy \\ • Breast-Feeding Patients  \\  |
^ Other  | • Referrers are advised that the patient will need to remain motionless for approximately 40 minutes during the acquisition of images. The investigation will not be attempted in patients who will be unable to adhere to this requirement. |

===== Patient Preparation =====
To decrease thyroid accumulation of radioactive Iodine-123, the patient's thyroid gland must be blocked by a thyroid-blocking agent at least one hour before administration of the DaTSCAN.  
  * Thyroid Blockade: Typically 130mg potassium iodide tablets (usually 2 x 65mg tablets, equivalent to a total of 100mg of iodide) to be taken at least 1 hour before the injection.
     * If potassium iodide is unavailable, potassium iodide should **NOT** be prescribed; alternatives such as Lugol's solution can be used (0.8ml contains 104mg of iodide) - can be given with milk or water/cordial.
     * If patient is allergic to iodine, potassium iodide or Lugol's solution must **NOT** be given. The ARSAC licence holder should be consulted. In this circumstance, an alternative thyroid blocking agent may be used. 
     * See the ARSAC Notes for Guidance (section 8) for further details and alternatives[([[https://www.gov.uk/government/publications/arsac-notes-for-guidance|Notes for Guidance on the Clinical Administration of Radiopharmaceuticals and Use of Sealed Radioactive Sources. Administration of Radioactive Substances Advisory Committee. March 2024.]])]. 
  * Patients do not need to stop any medications prior to DaTSCAN (based on discussions with Prof Avery & Southampton University Hospitals) but should bring with them a list of their current medications.
  * A wide variety of drugs interact with the radiopharmaceutical uptake and may cause misleading results. Some of the drugs may remain active for a long time after withdrawal so it is necessary to check current and recent medication that the patient may have stopped. A full list of current and recent past medication should be recorded. This must be forwarded with the referral card for use at reporting. 


===== Clinical Indications =====
|To support the differential diagnosis between essential tremor and neurodegenerative parkinsonian syndromes.  |
|To help distinguish between DLB and other dementias (in particular, Alzheimer’s disease) |
|To support the differential diagnosis between parkinsonism due to presynaptic degenerative dopamine deficiency and other forms of parkinsonism, e.g. between IPD and drug-induced, psychogenic, or vascular parkinsonism |
|To detect early presynaptic parkinsonian syndromes |

NB Diagnosis of Lewy body Dementia cannot be made by a DaTSCAN in patients with pre-existing Parkinson’s Disease.  



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