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Comment & Response
November 30, 2016

Arteriography for Lower Gastrointestinal HemorrhageClarity Needed in Defining Evidence Supporting Algorithm and Preceding Tests

Author Affiliations
  • 1Section of Nuclear Medicine, Department of Radiology, Christiana Care, Newark, Delaware
  • 2Section of Interventional Radiology, Department of Radiology, University of California, San Diego
JAMA Surg. Published online November 30, 2016. doi:10.1001/jamasurg.2016.4253

To the Editor Jacovides et al1 cited several logistical disadvantages of nuclear bleeding scans for lower gastrointestinal bleeding (GIB), including a long lead time to obtain the radiotracer, long acquisition times, and the need for specialized nuclear medicine training. In fact, nuclear bleeding scans can be readily labeled with a radiotracer using an onsite kit. Long acquisition times are actually an advantage of nuclear bleeding scans because patients can be scanned for many minutes or even hours until a bleeding episode is visualized. In comparison, patients must be actively bleeding during the few seconds that computed tomographic angiography (CTA) is acquired for GIB to be detected. Furthermore, nuclear bleeding scans can be acquired in multiple, shorter 10- to 15-minute sequences, so the physician can review 1 series while subsequent sequences are still being acquired. In tertiary academic centers, physicians with specialized nuclear medicine training are most likely the interpreters of nuclear bleeding scans. However, this is no different than having an emergent magnetic resonance imaging of the spine read by a neuroradiologist. In many smaller nonacademic centers, general radiologists often interpret nuclear bleeding scans.

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