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

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SELECT sop AS "SOP Code",title AS "Title",reviewdate AS "Review Date" FROM sops WHERE sop='REF016'|0]] 
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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|  Prof G Avery  |  ARSAC Licence Holder  |    |  2025-01-21  |

====== REF016 - Salivary Gland Imaging Referral Criteria ======
See [[referral_criteria:ref000-how_to_refer_to_nlagnm|REF000 - Referring to Nuclear Medicine (NLAG)]] for details on how to refer. 

===== Description =====
Technetium-99m pertechnetate is taken up by salivary glands and secreted by the ductal epithelium.  A salivary gland scan can provide physiological information about the ability of the salivary glands to accumulate the radiopharmaceutical and about the drainage of saliva[([[https://www.richtlijnendatabase.nl/gerelateerde_documenten/f/17975/Salivary%20Gland%20Scintigraphy.pdf|MWJ Versleijen, Antoni van Leeuwenhoek. Salivary Gland Scintigraphy]])]

Rapid sequential images should show progressive concentration of activity within the salivary glands and the mouth.  The thyroid is also visualised and the intensity of activity is generally similar to that in the salivary glands.  During imaging, the salivary glands are stimulated to drain by giving the patient lemon juice.  When the salivary ducts are patent, this causes prompt salivation and drainage of the glands into the mouth.

In the normal subject, the four salivary glands all accumulate the radiopharmaceutical at the same rate and drain rapidly following stimulation.  When a duct is obstructed, the uptake by the gland may be normal or slower than normal and there is no fall of activity following stimulation.

[[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='99mTc-132-117'  AND date('now')<=expirydate  ORDER BY expirydate|0]]

[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wikifarm/nlag/data/meta/employers_procedures/drl_database.db|
SELECT nuclide AS Nuclide, pharmaceutical_form AS "Pharmaceutical Form",  
local_drl AS "Local DRL (MBq)" FROM drls INNER JOIN nuclides ON drls.nuclide_id=nuclides.id 
WHERE drls.id=30|0]]

^Typical Radiation Dose (mSv)  | 0.44mSv (for 35 MBq) | 

===== Staff Entitled to Refer =====
  * The referrer may be any clinician holding a current valid medical qualification and currently employed in Secondary Care.
  * Referrals from Primary Care will be accepted if the investigation has been suggested by a Consultant Radiologist in a report from a previous investigation or following discussion with a Consultant Radiologist or Secondary Care Specialist.  Details of such suggestions or discussions should be included on the request form.

===== Supplementary Drugs =====
  * Sodium chloride for parenteral use (0.9% w/v).

===== Contraindications =====
^Patient Demographics  | Pregnancy    |
^Allergies  | Allergy to lemon juice  |

===== Patient Preparation =====
  * Patients must fast for at least 2 hours prior to the investigation. They may NOT be given perchlorate[(#1)].
  * Anticholinergic medication should be stopped during 24 h prior to the examination[(#1)].
  * The patient should not take any thyroid blocking agents for up to 48 hours prior to scanning.


===== Clinical Indications =====
| Obstruction of the salivary glands without an obvious cause  |
| Traumatic abnormalities and fistulas  |
| Following surgery (e.g. stenosis operations, symptoms following subtotal parotidectomy, transposition of the duct orifice or surgical denervation to prevent drooling)  |
| Following irradiation or high dose 131I therapy  |
| Salivary gland aplasia  |
| Sjogren’s syndrome  |
| Warthin’s tumour  |
| As an alternative to sialography e.g. in patients with a sensitivity to radiographic contrast agent or in failure to cannulate the duct  |




~~DISCUSSION~~