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Procedures > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Rationale for parathyroid imaging

A

Hyperparathyroidism, localization of parathyroid adenomas

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2
Q

Parathyroid contraindications

A

Pregnant, breast feeding, recent nuc med study, inability to stay still

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3
Q

Parathyroid pt prep

A

No special prep, just focused Hx and labs

Serum calcium and PTH levels measured 1 month prior

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4
Q

Parathyroid RP and doses

A

99mTc Sestamibi 20-30mCi

99mTc sodium pertechnetate 2-10mCi

I123 Sodium iodide 200-600 uCi oral

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5
Q

Parathyroid RP injection to imaging time

A

10 mins with Sestamibi

30 mins with pertechnetate

4 hours with I123

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6
Q

Parathyroid collimator

A

LEHR and pinhole

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7
Q

3 ways parathyroid imaging protocols

A

Dual phase Sestamibi

Dual isotope with tech and Sestamibi

Dual isotope with i123 and sestamibi

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8
Q

Parathyroid dual phase protocol

A

-Inject Sestamibi
-Take ANT images 10-30 mins after inj
-Wait 1.5-2.5 hours and take delay ANT images
-take spect or pinhole images in ANT and ANT OBL

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9
Q

Parathyroid dual isotope tech/Sestamibi protocol

A

-Inject either one first but wait 10 mins with Sestamibi and 30 mins with tech
-obtain images of head and neck after appropriate wait times
*can immediately inject next RP after images are taken of first RP

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10
Q

Parathyroid dual isotope i123/sestamibi

A

*administer i123 FIRST and wait 4 hours
-take ANT images
-inject sestamibi and wait 10 mins
-take ANT images

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11
Q

Parathyroid subtraction technique

A

For tech/sestamibi: subtract the tech images from the sestamibi images

For i123/sestamibi: subtract the i123 images from the sestamibi images

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12
Q

What reconstruction method is recommended for spect parathyroid

A

Iterative reconstruction

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13
Q

How is iodine/iodide localized

A

Accumulated in thyroid follicular cells by an active transport mechanism (trapping) and then oxidized and bound to tyrosyl residues on thyroglobulin (organification)

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14
Q

Indications of thyroid imaging

A

-Differentiation of hyperthyroidism (graves vs toxic nodular goiter)
-Detection and evaluation of hyperthyroidism and hypothyroidism
-localization of ectopic thyroid tissue
-exaltation of neck mass
-differentiation of thyroiditis

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15
Q

Indications of thyroid uptake

A

-determination of i131 therapy dose
-differentiation of subacute or painless thyroiditis and factitious hyperthyroidism from graves
-confirmation of hyperthyroidism due to Graves’ disease

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16
Q

Contraindications to thyroid uptake and imaging

A

Pregnant, breast feeding, recent nuc med study

Pt not properly prepped

17
Q

Pt prep for thyroid uptake and imaging

A

AVOID:
-thyroid hormones and antithyroid drugs
-iodine containing medications
-food rich in iodine
-large meals for 2 hours prior and 2 hours post administration

18
Q

How long to D/C contraindicated meds for thyroid uptake and imaging

A

-Antithyroid drugs withheld 2-4 days
-T4 therapy withheld 4-6 weeks
-T3 therapy withheld 2 weeks

-iodinated contrast within 3 weeks
-Amiodarone d/c for 6 months
-Betadine within 2-4 weeks

19
Q

Thyroid uptake and imaging RPs

A

I123 sodium iodide 100-300 uCi

99mTc pertechnetate 2-10 mCi

I131 sodium iodide 0.004 - 0.01 mCi

20
Q

Collimator for thyroid imaging

A

Pinhole

21
Q

Thyroid administration to uptake time

A

Tech: immediately

I123: 2-6 and 18-24 hrs

I131: 2-6 and 18-24 hrs

22
Q

Thyroid administration to imaging time

A

Tech: 15-30 minutes

I123: 3-4 hours

I131: not recommended for imaging, uptake only

23
Q

Which RP is not recommended for thyroid imaging, uptake only

A

I131

24
Q

Thyroid imaging views

A

ANT
LAO, RAO
ANT with marker

25
Q

Where to put radioactive markers for thyroid imaging

A

Sternal notch and thyroid cartilage

On nodules

26
Q

Where/how to use uptake probe

A

25-30 cm and take counts for 1 min

Neck
Thigh
Phantom
Room background

27
Q

Collimator for WB thyroid imaging

A

LEAP

28
Q

Percent Radioiodine uptake (RAIU) formula

A

Neck counts - thigh counts
______________________________
Phantom counts - background counts

29
Q

I131 is no longer useful for:

A

Imaging the thyroid gland, as a diagnostic tracer

30
Q

I131 is useful for

A

WB imaging after a thyroidectomy,

therapy for hyperthyroidism, thyroid remnant ablation, and thyroid cancer

31
Q

I131 T1/2 and energy

A

T1/2: 8.01 days

363 keV

32
Q

I131 emission

A

Beta and gamma

33
Q

I131 produced by

A

Fission/nuclear reactor

34
Q

I123 decays by

A

Electron capture

35
Q

I123 T1/2 and energy

A

T1/2: 13 hr

159 keV

36
Q

I123 uses

A

Thyroid imaging + uptake

Calculating an uptake only, pretreatment diagnostic mets survey for thyroid cancer

37
Q

Normal values for 4 hr uptake

A

6-18%

38
Q

Normal values for 24 hr uptake

A

10-35%

39
Q

In parathyroid study, tech and i123 go where? Ate sestamibi and thallium go where? And which is subtracted from which?

A
  1. Tech and i123 go to thyroid
  2. Mibi and thallium go to thyroid and abnormal parathyroid (but wash out of thyroid
  3. Subtract 1-2

Procedures (17 decks)

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