Your Doctor would like you to attend [your hospital's] radiology department for a Cardiac Nuclear Medicine Scan.

Scary stuff. Especially if you've never had a scan before, and even more so if this is your first 'health scare'.

The scan has been requested for a patient who has chest pain, but not sure if it is coming from the heart or not. It tells people in real time whether there's any ischaemia (lack of blood supply) in a particular area of the heart. It is usually done if a regular treadmill ECG¹ test is inconclusive, or the patient is unable to use a treadmill.

This entry is meant to give a brief explanation of what is involved and to answer some questions you may have before you attend. The information is taken from an actual appointment letter to a prospective patient after she had been recommended for a scan by her own GP. The procedure will be explained in detail when you arrive in the hospital department. A technician or Staff Nurse who works in the department will usually give this explanation. There may be a different procedure for your own appointment. Although you will have to starve before the procedure unless otherwise instructed, diabetics will receive special instructions and should ensure the Nuclear Medicine Department knows they are diabetic. This article is based on an example procedure, details may vary between hospitals.

What is a scan?

There are different types of scans used for different things. Ultrasound is one type and MRI² is another. The cardiac nuclear medicine scan which you are to have is not like these. It is a test in which a small amount of radioactivity (called a tracer) is used to obtain pictures, which will help the doctor understand your illness. This scan is also called a technetium heart scan; technetium (^99mTc) pyrophosphate scintigraphy; hot-spot myocardial imaging; infarct avid imaging; or a myocardial infarction scan. (This is not an exhaustive list but most names will be similiar to those listed.)

What does it involve?

The procedure usually takes place over two days. On the first day you will be given a small injection of radioactive technetium-99 (^99mTc)³. The injection is similar to having a blood test. It will not cause you to feel ill or have any other adverse effects. You will then be able to have a drink.
After 45 minutes you will be given a further drink and a sandwich. This is part of the test and improves the quality of the pictures. After another 15 minutes the first set of pictures will be started. They take about 30 minutes to complete. The pictures are taken by a special camera called a gamma camera. During the pictures you will have to lie on a bed. You will not normally need to undress for the pictures.
After they have finished taking the pictures, you will be free to leave the department. You will need to return on a second day for the second part of the test.

On the second day, your heart will be made to work harder. In some patients this may be achieved by walking on a treadmill. In other patients it may be made to work harder by injecting a chemical through a small needle (called a cannula) in the back of your hand. In a small number of patients the chemical can cause you to feel sick or lead to a mild headache. The radioactive material will then be injected through the cannula. You will then be able to have a drink. While all this is happening, you will be attached to a heart monitor. After 45 minutes you will be given a further drink and a sandwich. After another 15 minutes the second set of pictures will be started. They also take about 30 minutes to complete.
After they have finished taking the pictures the test is complete and you will be free to go home.

A Researcher's personal experience

First scan

As my scan was due to take place in the afternoon, my letter said I was permitted to have a slice of toast and a glass of orange juice for breakfast, but definitely no tea or coffee. Water may be drunk if tablets need to be taken. Take with you a list of medication you are currently taking.

Upon attending the right department, I sat down and waited (take a book or magazine). Eventually you are called to have your personal details checked and then you are weighed (as the medicine administered is proportionate to your weight). Then you go back to the waiting area. Someone else calls your name and you go to a room where the injection is given. A tip: offer your right arm first, because you will be required to raise your left arm for 15-20 minutes during the scan itself.

Then you have to wait an hour for your scan. However they do bring you a cup of tea (hooray!) and a choice of sandwiches about 45 minutes after the injection. When you are taken for the scan, you have to lie on a bed about a quarter of the size of the one you're used to sleeping on. They lower the bed for you to climb on, then they ask you to raise your left arm and put it behind your head. I was told there was a handle to grasp, which I declined to do, instead I placed my hand under my head as it felt comfortable. Big mistake.

The scanner itself is a large photo machine. It is lowered to just above you (quite alarmingly close) and my nurse gave it a 'trial run' over my chest and back again, before starting the scan properly. She then asked me to remain as still as I could as the scanner was going to take 32 pictures of my heart, from different angles. As she started it off, I was told it would take about 15 minutes to complete (my mother said it was nearer 20). After a few minutes the pressure on my shoulder was intense and I started to sweat. I couldn't take my mind off the pain that was building in my arm and the scanner moving and clicking above me seemed to be taking forever. The piped music of 'Lovely Day' which bizarrely played over and over again, only added to my torture.

Finally a little bell sounded and another person moved forward to extract me from the rack (I mean scan bed). The first nurse had disappeared and the person offering to help me off the bed was the same young man who had given me the injection. I gratefully accepted, as I was quite disoriented. My arm felt like it had been sawn off and reattached with a rusty needle and barbed wire. I felt quite dizzy and barely heard being told to return next week (which I knew) at a later time (which I didn't) and not to take the atenolol⁴ from Sunday until after the second test. Luckily this was all written down for me. I was then allowed to leave the hospital, grateful to get home for a cup of tea and look forward to the second scan with relish (I'm having the chemical injection as well as the nuclear one).

Keep away from babies and small children for the rest of the day.

Please be aware that for 24 hours after the test you are radioactive so don't go snail hunting after dark.

Second scan

Exactly the same as the first, with the addition of the cannula in the back of my hand (through which the chemical to speed up the heart was administered), whilst laid on a bed and attached to a heart monitor. The chemical did give me a headache but I was told the antidote is caffeine. So, the next cup of tea was for medicinal purposes. As I remembered to grasp the handle provided, I was quite comfortable throughout the scan, and it wasn't as scary as the first. All went well and now I'm just waiting for an appointment with the heart specialist.