Acute gastrointestinal bleeding is often intermittent and the bleeding source may be difficult to locate, resulting in delay of potentially life-saving treatment. The aim of this study was to determine the clinical utility of 99mTc labelled red blood cell imaging and [99mTc]pertechnetate (Meckel's scan) imaging in a series of 137 patients admitted over a 5 year period to hospital for management of acute gastrointestinal bleeding. Of the 137 patients, 70 had positive 99mTc red blood cell studies. Eleven of 24 patients who had imaging performed beyond 3 h had positive scans that would otherwise have been missed. Only 47 patients had a definite final diagnosis at the time of hospital discharge, of which six were negative on 99mTc red blood cell imaging. The correct site of bleeding was localized in seven of 21 patients with foregut bleeding, and 15 of 20 patients with colonic bleeding. Endoscopy yielded a diagnosis in 13 of the 47 patients (28%). Eleven patients had Meckel's scans but all were negative. Angiography was diagnostic in one of 17 patients studied. 99mTc red blood cell imaging is a useful test in the management of acute gastrointestinal bleeding. Imaging beyond 3 h may further improve the bleeding detection rate. This test, however, may be an unreliable means of localization of bleeding, particularly in the foregut.

Fluoroscopy is used to track a catheter as it enters a heart or coronary arteries. However, radiation exposure, which is highly dependent on the complexity of procedures and the optimization of imaging parameters applied by clinicians, is a major concern during diagnosis. The exposure dose of a phantom protected with an optimized radiation protection device (a lead sheet directly under treatment bed) was measured using optically simulated luminescent dosimeters and compared with those in unprotected arrangement. The radiation doses of operator were significantly lower (p < 0.001) in the lens, thyroid, and gonad regions with protection (190.0 ± 39.2, 206.7 ± 43.3, and 273.3 ± 56.4 μGy, respectively) than without it (221.7 ± 11.8, 235.0 ± 49.0, and 310.0 ± 65.5 μGy). The patients without radiation protection were exposed to relatively high radiation doses in the brain, gonad, or lens regions. Thus, suitable protection against the radiation exposure should be minimized during cardiac catheterization.

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