Frequently Asked Questions

1. What are the services offered by Nuclear Medicine Services

• Therapeutic: Peptide Receptor Radionuclide Therapy (MANDAUE)
  
  • Lutetium-177 PSMA
  • Lutetium-177 DOTATATE
    
    
• Therapeutic: Radioactive Iodine Therapy (RAI Tx)
  
  • Low Dose Therapy
  • High Dose Therapy
    
    
• Diagnostic: General Nuclear Medicine Scans:
  
  • Bone Scan
    
    • Whole Body Bone Scintigraphy/Whole Body Bone Scan/Total Body Bone Scan
    • Three Phase Bone Scan
  • Renal Scans
    
    • Nuclear GFR/GFR Scan
    • Renal Diuretic Scan
    • Renal Cortical Scan (DMSA Scan)
    • Renal MAG3 Scan
  • Cardiac Scans
    
    • Stress Sestamibi/Myocardial Perfision Scan or MPI/Stress MPI/Nuclear Stress Test/MPI-Exercise/Cardiac MIBI Stress; Cardiac MIBI Exercise/Cardiac Perfusion Scan
    • Cardiac MIBI Dipyridamole/MPI Dipyridamole/Dipyridamole Sestamibi/MPI-Pharmcalogical/Cardiac Dipyridamole
    • Cardiac Viability/Myocardial Perfusion Scan – Viability Study/Myocardial Scintigraphy – Viability
    • Cardiac Thallium/Cardiac Thallium Stress/Cardiac Tl-201/MPI Tl-201
  • Thyroid Studies
    
    • Thyroid Scan
    • Thyroid Uptake
    • Thyroid Uptake & Scan
  • Parathyroid Scans/Sestamibi Scan of Parathyroid
  • Whole Body I-131 Scan
  • Gastrointestinal Scintigraphy
    
    • Meckels Scan
    • GI Bleed/RBC Tagging
    • Gastroesophageal Reflux Scan/Milk Scan
  • Sentinel Lymph Node Mapping
  • I-131 MIBG Scintigraphy
  • Lymphoscintigraphy
  • VQ Scan/Lung Perfusion & Ventilation Scan
  • Lung Perfusion
  • HIDA Scan
  • Scintimammography

2. Is a written prescription needed for any of the procedures?

Yes. A written prescription from your Attending Physician/Referring Physician/Requesting Physician is required for us to schedule and perform the correct site/correct procedure and safely/appropriately prepare the patient for the specific TREATMENT/PROCEDURE

3. Are the procedures need to be booked or walk-in?

• ALL diagnostic procedures need to be booked/scheduled ahead of time due to limited supply of Radioisotope.
• We accept walk-in patients for RAI Therapy consultation from Monday-Friday, 8AM-4PM as long as the Nuclear Medicine Physician is still on site. Please note that our doctors do not have a fixed schedule and may not be available as soon as our diagnostic procedures are already done. A call inquiry is highly encouraged prior to walk-in consultation to make sure the doctor’s availability.

Virtual consultations are available upon prior request.

• Scheduling/booking of appointment can be done through walk-in or phone call.

4. How are the procedure charges processed?

• It can be processed either Cash-basis or thru Insurance.
• Cash Basis includes:
  • Cash
  • Debit Card
  • Credit Card
• Insurance Basis
  • Secure a LOA (Letter of Authorization) from your current Insurance Companies (HMO).
    NOTE: The LOA is suggested/recommended to be secured ahead 2 days prior to your procedure

• Kindly check the LOA of the following:
  • The specific procedure matches with the Written Prescription and quotation
  • The site/location (CHH Fuente)
  • For Cardiac procedures, it is advised that LOAs should be processed and dated on the day of the schedule to avoid over/underestimation of items used. Payment are usually settled on the day of the schedule to make sure accurate charging of items and/or medicines used.

5. What are the prices and preparation guidelines for Common Nuclear Medicine procedures?

NOTE: All Female patients that are breastfeeding, childbearing, who suspect pregnancy and or possibly pregnant should notify the Nuclear Medicine Staff for further assessment.

• BONE SCAN (Every Tuesday, Wednesday, Thursday)
  • Price: 11,350 Php
  • No fasting required prior to bone scan.
  • Continue maintenance medications and/or vitamins.
  • No radiographic contrast media (e.g., CT Scan/MRI with contrast) a day before the scan.
  • Bring doctor’s request for bone scan.
  • If available, bring a photocopy of official results of recent medical procedures done.
    Ex. CT Scan, MRI, Xray, ultrasound, biopsy, PSA (for prostate cancer). No need to bring the film.
  • If available, bring images and official report of previous bone scan study done outside Chong Hua Hospital
  • No other diagnostic procedure should be scheduled on the day of examination.
  • No accompanying pregnant and/or children 18 years old and below.
  • The whole procedure may last for 5-6 hours due to delayed imaging of 2-4 hours from the time of radiopharmaceutical injection.
  • While waiting, patients are encouraged to drink 1 liter of water (except for those with limitation of water intake) and to void frequently so as to minimize urinary bladder radiation exposure.
  • Scan time of 45 minutes to 1 hour (patient in supine position with little to no movements).
    
    
• RENAL SCANS (every Fridays) – CEBU
  • Price:
    Nuclear GFR: 9,300 Php
    Diuretic Renal Scan: 19,400
    + 3,000.00 estimated price for miscellaneous (Catheter and IV line)
    Renal Cortical Scan: 13,800
    + 2,800.00 surcharge for the reagent vial
  • Drink 500 mL – 1000 mL of water before the scan and do not hold bladder (good hydration 2-3 hours prior with frequent urination). Patient may void/urinate.
  • No need for fasting.
  • No radiologic contrast procedures 1 day prior (e.g. CT scan/MRI with contrast)
  • Bring creatinine results & ultrasound results, if available.
    
    
• RENAL SCANS (every Thursdays) – MANDAUE
  • Price: 9,300 Php (N. GFR), 19,400 (Diuretic Renal Scan), 13,800 (Renal Cortical Scan)
  • Drink 500 mL – 1000 mL of water before the scan and do not hold bladder (good hydration 2-3 hours’ prior, frequent urination)
  • No need for fasting.
  • No radiologic contrast procedures 1 day prior (e.g. CT scan/MRI with contrast)
  • Bring creatinine results & ultrasound KUB results, if available.
    
    
• THYROID SCAN
  • Price Thyroid Scan : 5,850 Php
  • Stop anti-thyroid drugs for 1 week
    (e.g., PTU, Strumazole, Carbimazole, Methimazole)
  • No fasting needed
  • Bring the following results: Thyroid Panel Tests (TSH, T3, T4), Thyroglobulin and Anti- Thyroglobulin, Neck Ultrasound
  • Scanning time may take 20 mins – 45 mins.
    
    
• CARDIAC SCANS
  
  

  BRANCH	SCHEDULE
  CEBU	Every MONDAY
  MANDAUE	Every TUESDAY

• • Price: 23,342 – 30,000 Php
  • May take light breakfast early in the morning (time of last meal will beindicated upon scheduling).
  • May take daily medications EXCEPT BETABLOCKERS & NITRATES. Betablockers and nitrates should be stopped temporarily 1 DAY BEFORE the schedule
  • No intake of any caffeinated drinks or food 1 DAY BEFORE the procedure.
    Example: coffee, cola, tea, chocolate
  • NO contrast ‘dye’ procedures 1 DAY BEFORE the schedule.
    Example: MRI or CT-Scan with contrast procedures
  • NO other procedures or any appointments on the day of the procedure. The patient will be radioactive for 6 hours and this procedure will last 5-6 hours estimated time
  • Must bring recent ECG, 2D echo, treadmill or dobutamine stress test, treadmill or dobutamine stress echo, angiogram/angioplasty.
  • Must bring a can of sprite (for non-diabetic patients). If diabetic, bring soda water or sparkling water.
  • For those who will undergo treadmill exercise, please wear or bring the following:
    • Loose blouse or polo with front open (except with metallic buttons or with zipper)
    • Jogging or loose pants
    • Rubber shoes
    • Face towel or handkerchief
      
      
• WHOLE BODY I-131 SCAN
  • Price: 10,830 Php – Fuente
  • Price : 13,615 Php – Mandaue
  • Medications to be stopped:
    • 4 weeks- Thyroid hormone
      (e.g., Eltroxin, Thyrax, Euthrox)
  • 1 week – Anti-thyroid drugs
    (e.g., PTU, Strumazole, Carbimazole, Methimazole)
  • Fasting 1-2 hours prior to scan and/or uptake
  • Low iodine diet (NO intake of seafood, including fish)
  • No radiographic contrast media for 4 weeks (e.g., CT-scan with contrast)
  • No iodinated medications for 4 weeks (e.g., amiodarone)
  • Bring the following results: Thyroid Panel Tests (TSH, T3, T4)
  • Thyroglobulin and Anti-Thyroglobulin, Neck Ultrasound
  • Scanning will be made 48 hours after I-131 Solution Ingestion and may take 20 mins – 45 min
    
    
• PET CT SCAN (F-18 FDG, GA-68 PSMA/DOTATATE) – MANDAUE
  • PETCT Sectional Plain: 56,778 Php
  • PETCT Sectional with Contrast: 67,594 Php
  • Whole Body F-18 FDG PETCT Plain: 75,705 Php
  • Whole Body F-18 FDG PETCT Contrast: 81,113 Php
  • Whole Body Ga-68 Dotatate Plain: 132,00 Php
  • Whole Body Ga-68 Dotatate with Contrast: 145,00 Php
  • Whole Body Ga-68 PSMA Plain: 148,00 Php
  • Whole Body Ga-68 PSMA with Contrast: 163,00 Php

PREPARATIONS FOR PET-CT F-18 FD

DIETARY INSTRUCTIONS

• HAVE nothing to eat or drink (apart from water) for 4 hours prior to your appointment time.
• You should drink plenty of plain water ONLY. No flavored drinks, tea, coffee etc.
• Prior to start of fasting, drink at least 1 liter of plain water as tolerated and not all at once. After scan completion, continue hydration as tolerated to enhance F18-FDG excretion.
• Patients on TPN (Total Parenteral Nutrition) should stop administration 6 hours prior to the procedure.

24 HOURS BEFORE THE SCAN:

• HIGH protein (beef, pork, fish, chicken, eggs), LOW carbohydrate diet is required.
• Carbohydrates/sugar or food containing sugar TO BE AVOIDED. Cereals, cookies, cupcakes, muffins, donuts, pasta, peanut butter, nuts, fruits, fruit juice, potatoes and carrots.
• Absolutely NO SUGAR including candy, chewing gum, breath mints, soft drinks, flavored water, artificial sweeteners and cough drops.
• NO coffee, caffeinated drinks and alcoholic beverages are allowed.
• AVOID smoking.
• AVOID strenuous activities. NO EXERCISE (e.g. jogging, biking, weight lifting), strenuous house work, sexual activity and chewing of gum.

ARRIVING FOR YOUR APPOINTMENT

• Please allow plenty of time to get to the department as your radioactive tracer is specially ordered and limited, and scan times cannot normally be delayed.

WHAT WILL HAPPEN ON THE DAY OF THE SCAN?

• This will depend on what type of PET scan you are having. Our staff will fully explain the procedure to you when you arrive for your appointment.
• A needle will be inserted into a vein in your arm or hand. We will then take a small blood sample to check your blood sugar.
• A small amount of a radioactive tracer will be injected through this needle.
• You will then sit and relax quietly for 60 to 90 minutes before having the scan.
• We will then ask you to lie on your back on the scanner table. Most scans last approximately 40 to 60 minutes.
• PLEASE DO NOT BRING CHILDREN OR PREGNANT FRIENDS OR RELATIVES WITH YOU.

HOW LONG WILL I BE IN THE DEPARTMENT FOR?

• This will depend on what type of scan you are having but expect to be with us for between two and three hours. This includes preparation and scanning time.
• Please note: the radioactive injection given to you is made off site and on occasions there can be delays and failures that may result in the cancellation of your scan.

NON-DIABETIC PATIENTS

• Maintain blood sugar at 150 mg/dl or lower.
• All prescription medications should be taken as directed.

DIABETIC PATIENTS

• Maintain blood sugar at 200 mg/dl or lower.
• Discontinue Metformin for 2 days prior to scan.
• For patients with impaired renal function who will undergo IV contrast injection, withhold Metformin 2 days after the procedure.
• Insulin requiring: Upon dng tecturetion of attending physician. (text partially unclear in image)
• Rapid-acting or Short-acting: NO insulin injection at least 4 hours before the scan.
• Intermediate-acting: Insulin administration should be done the night before the procedure.
• Use of Long-acting insulin should be avoided for 24 hours.

PET/CT WITH CONTRAST

• For those patient with known ALLERGY, please inform us for premedication may be given.
• For CT with contrast: must bring serum Creatinine result of not more than 1 month old.
  • Limits:
    • Male: not more than 1.2 mg/dl
    • Female: not more than 1.0 mg/dl
  • If levels are above the limit, must secure nephron clearance prior to the procedure.
  • Any pre-existing medical problem can potentially increase risk for radiographic contrast related adverse events (including contrast-induced acute kidney injury and hyper sensitivity).

OTHER CLINICAL INFORMATION

• Please inform your physician if you are PREGNANT OR BREASTFEEDING
• Patient Medical History:

FOR IN-PATIENTS

• No D5 containing water, lactated ringers and parenteral supplements during fasting period.
• Only PNSS is allowed for 4 hours prior to procedure.

RADIATION PRECAUTION

• No contact restrictions after procedure.

• RADIOACTIVE IODINE THERAPY (LOW DOSE / HIGH DOSE)
  • Patients are required to present their referral letter, biopsy report, record of operation, lab results, ultrasound result and have a consultation first with the Nucmed Physician before we give them the preparations including price quotations because the cost will depend on the number of days, the type of treatment and the consumables to be used. This is also to avoid over/under estimation of the actual cost. Senior Citizen, PWD discounts and PhilHealth deductions will be posted upon billing out or discharge.
  • Our consultants are accepting virtual or walk-in consultations; they just need to call first so that it will be coordinated or endorsed accordingly.
  • Low Dose can be done as Outpatient or Inpatient
  • High Dose normally done as Inpatient which requires isolation.

6. What is the process flow for Radioactive Iodine (RAI) Therapy and Diagnostic Procedures in Nuclear Medicine?

• Process Flow for RAI Therapy
  • Consultation with the Nucmed Physician (via walk-in process and varies with the Nucmed Physician’s availability. Please refer to RAI Therapy Consultation)
  • Patient will be given the preparations by the Nucmed Physician
  • Price quotation is given upon request to the Nucmed physician
  • Patient will be scheduled for his / her therapy and will pay for the capsule a week prior the scheduled date.
  • (Inpatient) On the day of the therapy, the patient is asked to get the Admitting Orders at Nuclear Medicine Department and will present to Admitting Section.
  • Fasting of at least 2 hours is required prior to therapy/radioactive iodine dose administration)
  • The Iodine capsule will be given at the patient’s isolation room (5A)
  • Patient will be admitted for at least 3-5 days.
  • Post therapy Scan will be performed prior to discharge.
    
    
• Process Flow for Diagnostic Procedures in Nucmed
  • Patient will call or come in for inquiries and scheduling of the procedure.
  • Patient will be given the instructions and may settle the payment on/before the scheduled date.
  • Patient will be asked to bring the Doctor’s Order along with photocopies of recent results like biopsy, lab results, and imaging results.
  • For any procedure that requires special need, it will be handled and referred by our Nucmed Nurse, Chief NMT and Consultant.
  • Depending on the procedure, results will be released 24 hours after.