XXX Nuclear Facility
6021 University Blvd #500
Columbia, MD 21043
Phone (123)123-1234
Fax (123)123-1234
Patient Name: Doe, Jane
ID Number: 123456
Date of birth: 4-2-79
Sex: Female
Referring physician: Dr. Jones
Date of the exam: 4-1-12
Clinical Indications: Hiatal hernia
Radiopharmaceutical: 2.1 mCi 99m Tc Sulfur
Colloid PO
Gastric Emptying Study
INDICATIONS/HISTORY: 29-year-old female with ulcer disease complaining of early satiety and weight loss.
PREVIOUS STUDY: No previous gastric emptying studies are available for review.
FINDINGS: Following oral administration of a solid meal (eggbeaters) labeled with 2.1 mCi of Tc99m sulfur
colloid, anterior and posterior imaging of the abdomen was performed through 90 minutes. Regions of interest were
then placed over the stomach and gastric retention was calculated for 0.5, 1 and 2 hours. Approximately 28% of the
administered radiopharmaceutical was retained in the stomach at 60 minutes (normal 30% or less).
IMPRESSION: Normal gastric emptying study.
Mary Beth Farrell, MD (electronically signed)
Date of interpretation: 4-2-12
Date of final report: 4-3-12
Gastric Emptying Study (SAMPLE)
1
NOTE: This is a SAMPLE only. Protocols submitted with the application MUST be customized to reflect current practices of the facility.