Can Plant-Based Burgers Be a Better Alternative for Allergy and Diet Restrictive Patients in a Nuclear Medicine Gastric Emptying Study?

Introduction: A nuclear medicine gastric emptying study is used to help diagnose gastroparesis or other pathologies resulting in delayed gastric emptying. The current standard meal given to patients includes radiolabeled egg whites along with toast and jam. However, some patient cannot tolerate the standard meal due to allergies or dietary restrictions. Current alternative options for these patients vary by institutions, are not universally accepted by all patients, and do not have the high binding capabilities of egg whites. This study evaluates plant-based burgers, which may be more universally accepted than the standard meal or current alternatives for comparable binding capabilities, consistency, and accuracy to the standard meal.

Methods: This research was conducted without the use of human subjects and performed as a benchtop experiment. The method of action included testing the binding capabilities of ten plant-based burger patties (Beyond Meat - Go Beyond®). 1 mCi of Tc-99m Sulfur Colloid was added into a thawed patty in a four-quadrant format and then cooked on a hot plate according to the directions (4 mins per side) on the package-. After cooking, the act of eating was simulated by breaking apart the patty on a disposable plate. A Geiger Muller meter was used for detecting residual radioactivity and contamination of the pan. Count measurements were taken directly from a dual headed gamma camera with the camera heads 20cm apart in distance: (1) Tc-99m Sulfur Colloid syringe- before and after injection, (2) Cooking pan with spatula- before and after cooking, (3) Patty on disposable plate, and (4) Disposable plate with utensils after simulation of consuming the meal. Unit counts were estimated for each cooking stage using generalized linear mixed models assuming negative binomial distribution, where observations were nested by replicate.

Results: The total count possible was 167,697 (95% CI [147,654, 190,460], but the total count of the meal was 112,206 (95% CI [98795, 127437]) — an overall average loss count of 47,406.86 or a 33% reduction (Figure 1). This discrepancy was largely accounted for by the residual count in the syringe (28,371.00 or 17%) and the residual count on the pan (20302-1763.85=18,538.15 or 11%), both of which account for a residual count of 46,909.15; after measuring residual count after eating (8084.14 or 5%), the total residual count was 54,993.29 (33%). Geiger counter reading in the pan before (0.05884, 95% CI [0.03987, 0.08684]) vs. after (10.5718, 95% CI [8.2444, 13.5563) was significantly higher, p<.001. Dose calibration before (0.8669, 95% CI [0.6868, 1.0943] vs. after (0.1469, 95% CI [0.1334, 0.1618] was also significantly lower, p<.001.

Conclusions: Most of the discrepancy between the total count in the syringe and the total count in the patient’s meal (47,406) can be accounted for by residual count in the syringe and pan. In comparison to a similar study involving egg whites, total loss of activity was 15% compared to the patties which was 33%. The most noticeable difference in measurements were noted when the pan was measured after cooking, residual activity for the egg whites was 0.4% and the patties 11%. There is a higher amount of activity lost with the patty vs. the standard meal, but current alternatives to the standard meal also have higher activity lost. Having a more universally accepted alternative meal with less allergies and dietary restrictions will result in less cancellations and improve patient care.

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