CV Review Flashcards
what is the best view on a MUGA for calculating LVEF?
45 LAO
What portion of the heart wall does the ANT planar image best assess in a MUGA study?
right atrial and ventricle size and wall motion
which will not reverse the effects of dipy (persantine)?
atropine
which of the following is NOT a contraindication for an exercise study?
beta blockers, calcium channel blockers, LBBB, caffeine
caffeine
if counts from the left atrium are included in the LV ROI, how will this affect the EF?
falsely lowers EF
pharmacological stress in an asthma patient would be done with this agent.
dipy, adenosine, persantine, dobutamine
dobutamine
which is most likely to cause artifactual ant or lat wall defects on MPI?
COR error, resp motion, LBBB, breast attenuation
breast attenuation
why must there be 2 separate injections of mibi for an MPI?
no redistribution in heart
which of the following situations could lead to a false negative MPI?
incorrect placement of ECG leads, LBBB, diaphragmatic attenuation, inadequate stress
inadequate stress
Which of following is correct regarding thallium localization? (select all)
A) localization by passive diffusion
B) localization by active transport
C) proportional to myocardial blood flow
D) according to myocardial viability
b, c, d
Check all that apply.
Which of the following are preparation for a 1 day dipyridamole MPI.
A) NPO for at least 4 hours
B) Place an IV
C) Discontinue caffeine for 24 hours
D) Discontinue xanthine meds for 48 hours
a, b, c, d
Which RP can be used to assess myocardial perfusion with the use of a single injection?
A) 201Tl chloride
B) 99mTc-RBC
C) 99mTc-tetrofosmin
D) 99mTc-sestamibi
A
What does the bulls eye display created after myocardial perfusion imaging represent?
A) Short axis images
B) An entire set of stress and rest SPECT images
C) All parts of the myocardial wall except apex
D) None of the above
A
Check all the apply.
Which of the following are differences between myocardial perfusion imaging with Tl versus mibi?
A) High resolution collimator can be used with thallium
B) Less soft tissue attenuation with Tl
C) Higher photon flux with mibi
D) Less respiratory motion with Tl stress images
a, c
Why do we wait 45-90 min between stress injection of Myoview and imaging?
A) To allow for respiratory motion to decrease
B) To allow for liver and lung activity to decrease
C) To allow time for uptake in the myocardium
D) To allow time to monitor the patient
B
What is an approximate effective dose for MPI imaging using 201Tl (with reinjection)?
5 mSv
13 mSv
22 mSv
40 mSv
40 mSv
Which of the following is an appropriate indication for MPI imaging?
Assessment of wall motion
Monitoring of LVEF and cardiotoxicity
Risk assessment in patient with episode of chest pain
Determine degree of mitral valve dysfunction
Risk assessment in patient with episode of chest pain
When stressing a patient with Dobutamine, when is the 99mTc-Mibi administered?
When HR reaches 220-age
When HR reaches (220-age) x 0.85
At 3 min into infusion
At 7 min into infusion
When HR reaches (220-age) x 0.85
Which of the following would NOT cause you to alert the stressing physician about stopping exercise?
ST segment elevation or depression on ECG
Increase in BP with mild chest pain
Patient complains of dizziness and fatigue
Blood pressure drops from baseline reading
Increase in BP with mild chest pain
Which of the following is correct regarding Dobutamine stressing?
Max dosage is 40ug/kg/min
RP injected 2min after infusion ends
Works as a vasodilator in the heart
Caffeine counteracts effects
Max dosage is 40ug/kg/min
How would aminophylline be used during an MPI protocol?
100mg IV for symptom relief after dipy stress
100mg IV for arrhythmias that may occur during exercise stress
500mg po for sypmtom relief after dipy stress
500 mg po for arrhythmias that may occur during exercise stress
100mg IV for symptom relief after dipy stress
After performing a 201Tl rest/redistribution protocol, the radiologist asks you to give a 37MBq dose of Tl and reimage in 15 min. What is the most likely reason for this request?
There was a reversible defect on the rest/redistirubtion portion
There was a fixed defect on the rest/redistribution portion
There were inadequate counts acquired in the rest/redistribution portion
There was motion in the rest/redistribution portion
There was a fixed defect on the rest/redistribution portion
What are appropriate dose and protocol parameters for a 2 day MPI study with 99mTc-MIBI?
925MBq 64 projections/25 sec each
925MBq, 128 projections/20 sec each
370MBq, 64 projections/25 sec each
370MBq, 128 projections/20 sec each
925MBq 64 projections/25 sec each
Which parameters are appropriate for acquiring a a low dose attenuation correction CT scan as part of a MPI study?
Current 50 mA, slice thickness, 0.5-1 mm, breath hold
Current 50 mA, slice thickness 2-5 mm, tidal breathing
Current 5mA, slice thickness, 0.5-1 mm, breath hold
Current 5mA, slice thickness 2-5 mm, tidal breathing
Current 5mA, slice thickness 2-5 mm, tidal breathing
What would you expect on the MPI perfusion images if exercise stress was performed on a patient with LBBB?
defect on lateral wall on stress images, normal on rest
defect on septal wall on stress images, normal on rest
defect on lateral wall on rest images, normal on stress
defect on septal wall on rest images, normal on stress
defect on septal wall on stress images, normal on rest
Choose the best artifact to match the description.
____ hurricane sign on processed images
____ defect on septal wall on stress images
____ ant wall defect, usually fixed
____ inferior wall defect usually fixed
____ may mask or cause inferior wall defects
____most common with Tl stress study, reversible inferior wall defect
- LBBB
- Breast attenuation
- Diaphragmatic attenuation
- Hot Bowel
- Cardiac creep
- Motion
motion - hurricane sign on processed images
LBBB - defect on septal wall on stress images
breast attenuation - ant wall defect, usually fixed
diaphragmatic attenuation - inferior wall defect usually fixed
hot bowel - may mask or cause inferior wall defects
cardiac creep - most common with Tl stress study, reversible inferior wall defect
Which is correct regarding the LHR performed with 201Tl imaging?
ROI drawn on Ant image, normal is less than 0.35
ROI drawn on LAO image, normal is less than 0.35
ROI drawn on Ant image, normal is less than 0.5
ROI drawn on LAO image, normal is less than 0.35
ROI drawn on Ant image, normal is less than 0.5
What is the method of localization for tagged RBC’s to image the blood pool?
a) Compartmental
b) Active Transport
c) Passive Diffusion
d) Cell sequestration
A
What is an advantage of using Ultratag compared to other RBC labeling methods?
a) less centrifugation is required
b) Decreased radiation dose to the patient
c) Higher % tag
d) Less expensive
C
What is the expected % tag for in-vivo labelled RBCs?
a) > 95%
b) 90-95%
c) 70-80%
d) 50-60%
C
placement of 3 lead ecg when performing MUGA?
- one over the apex of each lung + one on upper left abdomen
What is the advantage of acquiring 32 over 16 frames/cardiac cycle?
a) Increased accuracy on volume curve
b)Increased statistics per frame
c) Less chance of visualizing artifacts like flicker artifact
d)There is no advantage of acquiring 32 frames
A
Which planar MUGA view best demonstrates wall motion of the inferior wall of the heart?
a) ANT
b) LAO
c) LLAT
d) RPO
C
What would be the result of excluding a portion of the LV in your ROI for ejection fraction?
a) Overestimation of ejection fraction
b) Underestimation of ejection fraction
c) There would be no effect on ejection fraction
B
Which of the following is a normal gated equilibrium result?
a) LVEF 52%
b) EDV 50ml
c) LVEF 45%
d) EDV 210mL
A
If a patient’s heart rate increases during a gated equilibrium study, what is most likely to occur?
EDV falsely decreased
EDV falsely increased
ESV falsely increased
ESV falsely decreased
EDV falsely decreased
How is the analysis of left ventricular end systole on a MUGA study best described?
Place an ROI around the left ventricle on the frame with the highest number of counts
Place an ROI around the left ventricle on the frame with the lowest number of counts
Place an ROI around both ventricles on the frame with the lowest counts
End systole is not used when analyzing a MUGA study
Place an ROI around the left ventricle on the frame with the LOWEST number of counts
Dose for MUGA
740-1850 MBq
Dose for rest MPI (1 day protocol)
296-370 MBq
Dose for stress MPI (1 day protocol)
925-1110 MBq
Dose for MPI stress (2 day protocol)
740-1110 MBq
Dose of 201Tl-Cl for MPI
74-148 MBq
Dose of 99mTc-PYP for amyloidosis scan
370-740 MBq
