Endocrine Abstracts

The requirement for Sestimibi imaging of the parathyroid glands has increased over recent years, partly due to advances in surgical techniques and the need for accurate pre-operative localisation. We audited sestimibi imaging to ensure efficient and appropriate use of this tool in the face of increasing demand. Over two and a half years 128 scans were identified by Nuclear Medicine. We obtained biochemistry and operative status for these using the hospital patient administration system. We examined the notes of a subgroup (68) to obtain more detailed information about the use of the scan in clinical decision-making. Only 70 (52%) of the scans were requested by endocrinology with the largest other users being Rheumatology and Nephrology, jointly requesting 41 (32%) scans. A total of 53 operations were identified, 43% of patients undergoing a scan. A total of 19 (15%) scans were requested with normal calcium of which 4 also had a normal parathyroid hormone (PTH). Those operated on were younger (57.58 yrs v 63.65 yrs, P=.03) with higher calcium (2.97 mmol/l v 2.67 mmol/l, P<.001). The requesting speciality also influenced the likelihood of operation (endocrinology 51%, Renal 45%, Rheumatology 19% and others 33%, P=.004). The reasons for these potentially unhelpful scans were examined in our subgroup. These included 12 scans (18%) in patients with secondary hyperparathyroidism and 22 (32%) where a contraindication to surgery was already present. Overall 41 (63%) scans played no role in preoperative decision-making, a significant waste of resources. On this basis each year 30 scans are being performed inappropriately, as a test for isolated PTH or in patients for whom surgery is not appropriate or contraindicated. Scanning needs to be directed at those who require it to reduce delays in those that need surgery. We believe a dedicated parathyroid clinic, run jointly with an endocrine surgeon will achieve this.