Renal Scintigraphy (Diuretic Renogram) Report

Exam: Renal Scintigraphy – Diuretic Renogram

Patient: [name, MRN, DOB/age, sex]

Study Date: [date and time of acquisition]

Ordering Provider: [name and service]

Interpreting Physician: [name, credentials, signature]

Indication

[Clinical question and laterality if relevant] (1–3 sentences. If clinical history is limited, explicitly state this.)

Pertinent History

• Renal function: [creatinine and/or eGFR with date / Not documented]
• Prior imaging: [relevant ultrasound, CT, or prior renograms with key findings / Not documented]
• Urologic hardware: Ureteral stent: [present / absent / Not documented]; Nephrostomy tube: [present / absent / Not documented], [clamped / unclamped / Not documented]; Bladder catheter: [present / absent / Not documented]

Technique

Radiopharmaceutical: [agent], [administered activity in mCi and/or MBq], IV

Diuretic: [agent, dose in mg], [timing: F+20 / F+0 / F-15 / other / Not administered (reason)]

Hydration: [route and volume / no additional hydration administered]

Patient Preparation: Voided prior: [Yes / No]; Position: [supine / other]

Acquisition: [brief dynamic protocol]; Postvoid/upright views: [Yes / No]

Processing: [ROI method and background subtraction / vendor default]

Findings

Study Quality: [adequate / limited due to: motion, poor hydration/diuresis, bladder distention, extravasation, other]

Left Kidney: [size/position], [tracer uptake pattern], [washout/drainage pattern], [response to diuretic], [postvoid/upright changes if obtained]

Right Kidney: [size/position], [tracer uptake pattern], [washout/drainage pattern], [response to diuretic], [postvoid/upright changes if obtained]

Differential Renal Function: Left [X]% / Right [Y]% (Round to nearest whole percent.)

Drainage Indices:

• Left: Tmax [value / Not calculated]; T½ [value / Not calculated] (note method if nonstandard); [drainage ratios if calculated]
• Right: Tmax [value / Not calculated]; T½ [value / Not calculated] (note method if nonstandard); [drainage ratios if calculated]

[Clearance measurement if performed: method and value]

Impression

1. Obstruction status: Left: [No evidence of obstruction / Findings consistent with obstruction / Indeterminate (explain)]; Right: [No evidence of obstruction / Findings consistent with obstruction / Indeterminate (explain)] (Do not use "partial obstruction." If indeterminate due to technical factors, specify limitation and consider recommending repeat study.)
2. Differential function: Left [X]% / Right [Y]% (Comment if clinically significant asymmetry.)
3. [Ancillary findings if present: reduced global function, significant postvoid residual, interval change from prior] (Omit if none.)