GI Bleeding Scan Report

Patient Name: [Patient full name]

MRN: [Medical record number]

DOB: [Date of birth]

Study Date: [Study date]

Accession: [Accession number]

Injection Time: [Injection time]

Imaging Start Time: [Imaging start time]

Imaging End Time: [Imaging end time]

Interpreting Physician: [Physician name, credentials]

Clinical Information

[Indication for study]. [Bleeding presentation: [hematemesis / melena / hematochezia / occult blood positive]]. [Suspected anatomic level if stated: [upper GI / small bowel / colonic / anorectal / unknown]]. [Relevant clinical markers: hemodynamic status, recent hemoglobin trend, transfusion requirements]. [Pertinent prior workup: endoscopy, CTA, angiography, capsule endoscopy]. [Relevant surgical history]. (Summarize succinctly in 1–2 sentences using only provided details. If no clinical history provided, state: "Clinical history: not provided.")

Comparison

[Prior relevant imaging with dates and key findings: tagged RBC scintigraphy, CTA GI bleed protocol, endoscopy/colonoscopy, catheter angiography] (Include only studies that are available. If none, state: "No prior relevant imaging available for comparison.")

Technique

• Radiopharmaceutical: 99mTc-labeled autologous RBCs; administered activity: [value] [mCi / MBq]; labeling method: [in vitro / in vivo / modified in vivo].
• Pre-injection imaging: [obtained / not obtained].
• Flow phase: [performed / not performed]; [frame duration] for [total duration].
• Dynamic planar imaging: [frame duration] for [total duration] starting at [time relative to injection]; views: [anterior planar / additional projections]. Field of view includes abdomen and pelvis: [yes / no].
• Delayed imaging: [obtained at specified times / not obtained].
• SPECT/CT: [performed / not performed]; region: [abdomen / pelvis / abdomen and pelvis]; CT type: [low-dose for localization / diagnostic]. (Include only if performed)
• Study limitations: [none / motion artifact / incomplete anatomic coverage / bladder activity obscuring rectosigmoid / suspected poor RBC labeling / other]. (Include only if applicable)

Findings

Study quality: [Adequate / Suboptimal] [due to limiting factors if any].

Bleeding Focus [number]

(Create a separate subsection for each suspected bleeding focus. If no suspicious activity, omit subsections and use only the negative statement below.)

• Active bleeding criteria: [met / not met] (Assess: new appearance, persistence/intensification, movement within bowel).
• Onset: [time of first appearance relative to injection].
• Initial location: [abdominal quadrant] — [most likely bowel segment].
• Intensity: [less than / similar to / greater than] liver activity.
• Movement: [stationary / moving]; direction: [antegrade / retrograde / bidirectional]; extent: [segments traversed].
• End-of-study location: [final observed location].
• Pitfalls assessed: [varices / vascular structures / urinary activity / other] [excluded / cannot be excluded]. (Include only when relevant)

(If SPECT/CT performed) SPECT/CT correlation: [Localization improved / not improved]; [anatomic correlation].

(If no bleeding identified) No scintigraphic evidence of active gastrointestinal bleeding during the imaging interval. Physiologic radiotracer distribution is unremarkable.

Impression

1. [Positive / Negative / Equivocal] for active gastrointestinal bleeding during [total imaging duration].
2. (If positive or equivocal) Localization: [Localizes to (high confidence) / Most consistent with (moderate confidence) / Possible (low confidence)] [anatomic site of first appearance]. Movement: [antegrade / retrograde / bidirectional] transit [extent described].
3. (If applicable) Likely [upper GI / lower GI / small bowel] source; findings may assist targeting [angiography / endoscopy].
4. (If negative or limited) Intermittent or slow bleeding cannot be excluded. [Impact of any study limitations on sensitivity or localization].

Communication

(Include only when active bleeding is identified or findings require urgent attention. Omit for routine negative studies.)

• Notified: [Name and service/role]
• Method: [phone / page / secure message / in-person]
• Time: [date and time]