THE STATE OF NEW HAMPSHIRE TOWN OF DEERING ZONING BOARD OF ADJUSTMENT NOTICE OF DECISION Re: Case No. 09-01, Appeal of Michael & Carol Martin On February 12, 2009, the Town of Deering (“Deering”) Zoning Board of Adjustment (“ZBA”) heard Case No. 09-01 , the appeal of Michael and Carol Martin (“Applicants”), requesting a variance from Sections 4.5.8, 4.5.
Nuclear medicine renal scanpressure medications should be stopped 4-7 days Nuclear Medicine Renal Scan
Please speak to your doctor or ring the nuclear medicine department of the hospital or private Contributors:
radiology practice where you are having the scan for Ms Merrin Angwin, DipAppSci (Medical Nucleography) instructions regarding preparation for the scan. Dr Timothy Cain, MBBS, FRANZCR, MBA If you think you may be pregnant or are breast Dr Dee Nandurkar, Ms Ann Revell, Dr Christine Walker, feeding you must inform your doctor or specialist who is referring you for the DTPA Scan and the radiology staff where you are having the DTPA Scan. They will discuss with you any need to stop breast What is a Nuclear Medicine Renal Scan?
feeding and minimise nonessential contact with your The kidneys filter the blood to remove waste substances such as urea (a nitrogen compound) and salt. The body discharges these wastes mixed in What happens during a Nuclear Medicine
water as urine. The fluid is collected in the kidneys and discharged through the ureters which join the Renal Scan?
kidneys to the bladder. The top of the ureter is On arrival, you will be measured for your height and called the renal pelvis and this joins the kidney to weight and also given some water to drink prior to the scan to make certain you are well hydrated. In a Nuclear Medicine (NM) Renal Scan, images are For the DTPA Scan, you will be lying down on the made of the delivery of fluid into the kidneys via the scanning bed, with the gamma camera under the bloodstream, concentration of wastes in the kidney bed. It is important to keep still during the test as and excretion or flow from the kidneys through the any movement of the body will blur the images and give poor scan results. The imaging itself does not A Nuclear Medicine Renal Scan can be performed with 2 different substances - DTPA or MAG3. DTPA is A small injection in a vein will be given, usually in the radiopharmaceutical used in a DTPA Renal Scan, the arm. A cannula (thin plastic tube) will be but sometimes the nuclear medicine specialist will inserted into your vein and will stay in the vein for decide that another radiopharmaceutical called the duration of the test. Apart from the initial prick MAG3 should be used. These radiopharmaceuticals this should not cause you any discomfort. are similar, but MAG3 gives significantly better images in some patients, particularly very young Through this cannula the radiopharmaceutical is children and those patients with poor kidney injected. This can be detected by the gamma function. The descriptions and explanations below camera and will provide clear images of the kidneys. for a DTPA renal scan apply also to a MAG3 renal After about 15 minutes of scanning, you may be scan. A Nuclear Medicine DTPA or MAG3 Renal Scan given a second injection through the same cannula is performed to look at the blood supply, function of a diuretic called frusemide (Lasix). This causes and excretion of urine from the kidneys. The test the kidneys to make more urine by decreasing the can find out what percentage each kidney amount of water that the kidneys resorb as part of contributes to the total kidney function. A DTPA the filtering process. There is also an increased flow Scan may also be undertaken to evaluate: of urine through the ureters which makes any obstruction of the ureters easier to see. Renal tubular function and perfusion (how the body fluids circulate through the kidneys) As with any drug there is a small chance of an allergic or adverse reaction. Please discuss this with your doctor or with the medical staff performing the pressure in the arteries of the kidneys) examination if you have any queries or concerns. The frusemide will help your kidneys to work harder, arteries that take blood to the kidneys) so your bladder will fill faster. At the end of the scan you may be asked to go to the toilet and empty your bladder, then return for a further 2 minutes of imaging. The cannula is removed before you leave How do I prepare for a Nuclear Medicine
It is important, prior to having the scan, that you
have plenty of fluid to drink and are well hydrated. If the study is being done to evaluate renal hypertension or renal artery stenosis, some blood A Quality Use of Diagnostic Imaging (QUDI) Initiative Where is a Nuclear Medicine Renal Scan
Are there any after effects of a Nuclear
Medicine Renal Scan?
A DTPA Scan is done in a nuclear medicine There are no after effects of a DTPA Scan. You will department of a hospital or a private radiology or nuclear medicine practice with nuclear medicine If a dose of a diuretic (frusemide) is given to cause an increased flow of urine, you may feel thirsty and need to drink plenty of fluids for the rest of the day When can I expect the results of my
so that your body does not dry out and you become Nuclear Medicine Renal Scan?
dehydrated. You may also need to visit the toilet The time that it takes your doctor to receive a written report on the test or procedure you have had How long does a Nuclear Medicine Renal
the urgency with which the result is needed The test itself will take approximately 30 to 60 minutes. The time varies because the rate at which the kidneys function will differ for each individual. your doctor before the examination can be interpreted by the radiologist What are the risks of a Nuclear Medicine
compared with this new test or procedure There are no known associated risks involved in the (this is commonly the case if you have a disease or condition that is being followed to The test involves a small dose of ionising radiation which is relatively small and similar to many other how the report is conveyed from the practice routine medical imaging tests. For more detailed or hospital to your doctor (in other words, Please feel free to ask the private practice, clinic, or If you are pregnant or breast feeding, please inform hospital where you are having your test or your doctor before booking the scan. Some of the procedure when your doctor is likely to have the medications that are used in nuclear medicine studies can pass into the mother's milk and to the It is important that you discuss the results with the baby. You may be asked to discontinue breast doctor who referred you, either in person or on the feeding for a short time after the scan and will need telephone, so that they can explain what the results to express from both breasts. Please discuss with the nuclear medicine physician or technologist when feeding can resume and if you need to limit contact What are the benefits of a Nuclear
Medicine Renal Scan?
This information is of a general nature only and is This test provides information on the blood supply, not intended as a substitute for medical advice. It is function and excretion of urine from the kidneys. designed to support, not replace, the relationship that exists between a patient and his/her doctor. It A DTPA Scan can help your doctor assess how each is recommended that any specific questions of your kidneys is working and find out what regarding your procedure be discussed with your percentage each kidney contributes to the total kidney function. It is important for your health that Who does the Nuclear Medicine Renal
A nuclear medicine technologist will give the
injection, perform the scan and process the images. A nuclear medicine specialist will review the images along with your medical history, and provide a written report for your referring doctor. See A Quality Use of Diagnostic Imaging (QUDI) Initiative Additional Information for Health Care
Obesity: Please contact the nuclear medicine department if the patient you are referring is Professionals
significantly over weight or obese. This is What are the prerequisites for having a
Nuclear Medicine Renal Scan done?
appropriate than DTPA. MAG3 has a higher extraction fraction than DTPA and is therefore hypertension will need to have their ACE inhibitors discontinued for 4-7 days prior to impaired function or suspected obstruction. Renal ultrasound may be required prior to requirements or side effects. The nuclear medicine physician will make this decision. suspicion of: duplex or dilated collecting systems, or polycystic kidney disease. What are the adverse effects of a Nuclear
If the patient has renal impairment, a nuclear Medicine Renal Scan?
medicine MAG3 renal scan may be preferred to DTPA. Please see below. There are no known associated risks; however, the patient will be receiving a dose of radiation. See What are the absolute contraindications
for a Nuclear Medicine Renal Scan?
Are there alternative imaging tests,
interventions or surgical procedures to a
What are the relative contraindications for
Nuclear Medicine Renal Scan?
a Nuclear Medicine Renal Scan?
Nuclear Medicine scanning is accepted as the most Patient has not discontinued ACE inhibitors if frequently used imaging method of renal function the scan is being performed to exclude renal Breast feeding: If the patient is breast feeding, please contact the nuclear medicine department in regards to proceeding with the scan. Some of the pharmaceuticals that are The QUDI Program is managed by the Royal used in nuclear medicine studies can pass Australian and New Zealand College of Radiologists into the mother's milk and subsequently the and funded by the Australian Commonwealth discontinue breast feeding for a short time Publication Date: May 1st 2009
after the scan and she will need to express from both breasts. Please discuss with the nuclear medicine physician or technologist The RANZCR is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them. The RANZCR intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers. The RANZCR recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, The RANZCR, its officers, councillors and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests. A Quality Use of Diagnostic Imaging (QUDI) Initiative
WELCOME! HEALTH HISTORY Dellin R. Bakkum, DDS Please complete BOTH sides. Date:_______ Name:_____________________________________________ Phones: _____________ Last Medical Exam:_________ Your Physician:_____________________________ Phone:_________ Second Physician:___________________ Phone:_________ Were you hospitalized in the last 5 years? Reason(s)__________________