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Nuc med > Essentials of Nuclear Medicine and Molecular Imaging > Flashcards

Essentials of Nuclear Medicine and Molecular Imaging Flashcards

1
Q

All Isotopes

A

Have different number of neutrons

Have the same number of protons

Have the same chemical properties

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2
Q

Nuclear reactors best produce ______ rich radioisotopes, where a cyclotron best produces ______rich radioisotopes

A

Neutron

Proton

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3
Q

Are all radioisotopes used in Nuclear Medicine metastable (T/F)

A

True

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4
Q

Choose how the radioisotope is produced
F18
Tc99m
Rb82
I 123

A

Cyclotron
Generator
Generator
Cyclotron

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5
Q

What is the energy and half life of Tc99m

A

140 keV and 6 hours

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6
Q

What is the daughter nuclide of Mo99

A

Tc99m

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7
Q

2P + 2N released=atomic mass number decreasing

A

Alpha decay

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8
Q

Particle is emitted from the nucleus

A

Beta decay

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9
Q

An inner orbital electron is captured by a proton from the nucleus

A

Electron capture

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10
Q

Protons and neutrons are unchanged; decays from high to low excited state

A

Isomeric Transition

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11
Q

The excess nucleus energy transfers to an orbital electron

A

Internal conversion

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12
Q

This is released as a result of Isomeric Transition

A

Gamma Ray

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13
Q

The excess protons in a nucleus combine with an electron and release 2 photons

A

Positron decay

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14
Q

What is the appropriate shielding to the type of radioactive decay
Alpha
Beta
Gamma

A

Paper shielding
Plastic or thin aluminum
Lead

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15
Q

What form of decay results in a proton transforming into a neutron and a neutrino

A

Electron Capture

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16
Q

What is the Mo99 breakthrough limit

A

Mo99’s breakthrough limit is 0.15 micro Ci

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17
Q

What substance is a M099/Tc99m generator eluted with

A

NaCl Sodium Chloride

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18
Q

Most radioactive material that does not occur naturally can be produced by which two ways

A

Nuclear Fission

Bombardment

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19
Q

All isotopes of an element have the same number of protons and have a different number of what

A

Neutrons

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20
Q

Mo99 decays to Tc99m through what form of decay

A

Beta Decay

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21
Q

Gamma emission is ALWAYS preceded by Electron Capture, Alpha, Beta, or Positron Emission (T/F)

A

True

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22
Q

What does the “m” in Tc99m stand for

A

Metastable

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23
Q

Tc99m is best used in the application of nuclear medicine imaging whereas F18 is best used in the application of therapy or theranostics (T/F)

A

False, they are both excellent imaging radioisotopes.

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24
Q

Radionuclides are isotopes attempting to reach stability by emitting radiation (T/F)

A

True

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25
Isotopes are
Atoms of the same element Have the same number of protons, different number of neutrons.
26
Metastable refers to the intermediate time in which a daughter nucleus remains in the excited state (high energy) (T/F)
True
27
Beta decay
An excess neutron is emitted and transforms to a proton accompanied by an antineutrino
28
Electron capture
An inner orbital electron is captured by a proton from the nucleus
29
Alpha decay
Emits large particles that result in a decrease in atomic mass number; travel very small distances
30
Internal conversion
Results in excess energy in the nucleus transferring to an orbital electron; characteristic radiation occurs
31
Positron decay
To many protons are in the nucleus; loses energy and combines with an electron
32
Gamma emission
Always preceded by another form of decay.
33
What is the half-life of a radioactive isotope
The time it takes for the radioactivity to decay to half of its original value
34
A cyclotron produces isotopes by
Expelling radionuclides that primarily decay through electron capture or beta emissions An electromagnetic field that accelerates charged particles A process where positron rich radionuclides result
35
Convert 1550 uCi to GBq
5.7 x 10^-2 Gbq
36
A nuclear reactor uses particulate bombardment to produce isotopes which are primarily proton rich (T/F)
False, they are neutron rich
37
A Curie is part of the international system of units (SI) (T/F)
False, becquerel is the international system of units
38
Convert 700 kBq to mCi
1.9 x 10^-2
39
What components make up a radiopharmaceutical
Radionuclide and pharmaceutical
40
A radiopharmaceutical kit includes components that cause a physical reaction when a radionuclide is added (T/F)
False, they cause a chemical reaction
41
Radiopharmaceuticals that are prepared in an ambient air hot lab are single use only and must be used within an hour of mixing the kit (T/F)
True
42
What radiopharmaceutical would you inject when performing a study on a patient who is being considered for organ donation services due to lack of brain perfusion
Tc99m Bisisate
43
Why must you agitate a syringe of Tc99m MAA before injecting it into the patient
Particles often settle to the bottom of the syringe
44
Which studies would Tc99m MAA be used for
LaVeen shunt patency Pre Y90 verification imaging for liver malignancy Lung perfusion imaging
45
What are some alternate names for Tc99m IDA
Mebrofenin Disofenin Hepatolite
46
Tc99m sodium perechnetate (TcO4) is rapidly taken up into many tissues. Which areas of the body are taken up by the tracer
Salivary glands Gastric mucosa Thyroid tissue
47
Adverse reactions are not common in the field of nuclear medicine. Why is this
Pharmaceuticals are designed to reflect normal physiologic function
48
Localization is a process that determines how a radiopharmaceutical will be distributed to various tissues and organs in the body (T/F)
True
49
What is stannous chloride most often used for in kit preperation
A reducing agent
50
Why is it important to test radiopharmaceuticals using chromatography strips
Unbound Tc04 causes background artifacts when imaging
51
Why is functional assessment of the thyroid not possible when using Tc99m sodium pertechnetate
Tc99m sodium pertechnetate is trapped, but not organified
52
List the steps in order when preparing a kit
Tc99m sodium pertechnetate is eluted from generator Recontitute cold kit with saline Add Tc99m sodium pertechnetate to mix kit Agitate kit and allow for incubation time Dispense dose Administer radiopharmaceutical to patient
53
What radiopharmaceutical would you use to preform a bile leak study on a patient
Tc99m Mebrofrenin
54
How many particles should be in an ideal dose of Tc99m MAA
350,000 particles
55
Is it acceptable to puncture a radiolabeling kit more than once and draw multiple unit doses out of it when it is prepared in an ambient air hot lab (T/F)
False, in order to draw multiple unit doses out of a bulk vial kit, it must be produced in a sterile cleanroom suite.
56
A ligand is used for _____ within the body whereas, a reducing agent allows____ to occur
Localization and distribution Binding
57
Chromatography strips are used to test for the presence of unbound Tc99m in a given radiopharmaceutical (T/F)
True
58
Tc99m Bisciisate (Neurolite) is an ideal imaging agent for brain perfusion studies because
It is rapidly localized and crosses the blood brain barrier
59
When produced in a sterile setting, a multi-dose vial of MAA should be stored at room temperature for future use (T/F)
False, Multi use vials of Tc99m MAA should be stored in refrigeration to perserve sterility for future use
60
When injecting a patient with Tc99m IDA (Mebrofenin), Visualization of which structures should occur within 60 minutes
Liver Common bile duct Gallbladder Small intestine
61
What does a radiopharmaceutical consist of
Radionuclides and a pharmaceutical
62
What does the ideal radiopharmaceutical consist of
Easily produced Inexpensive Readily available Short half life Produces gamma rays
63
What is a ligand
Contributes to distribution Localization which reflects a bodily function or metabolic process They use small quantities
64
What is a reducing agent?
Allows for binding
65
Are adverse reactions normal?
No, there are less than 200 serious reactions reported worldwide ever. The radiopharmaceutical mimics the bodily function or process already works
66
Name some single photon emitters
Tc99m I123 I131 Xe 133 Ga67 In111 Tl201
67
Name some positron emitters
F18 C11 N13 O15
68
Tc99m half life and energy
6 hrs and 140 KeV, Decays by Isomeric Transition to Tc99
69
Tc99m Sodium Pertechnetate concentrates where
Salivary glands, Thyroid tissue, Choroid plexus, Gastric mucosa, and functioning breast tissue
70
What is Tc99m NaCl AKA TC04 used to image
Thyroid- taken up but not organified, good for size and location. Not functional assessment Meckel's Diverticulum-taken up into gastric mucosa Salivary glands Cystography
71
Tc99m Bicisate or Neurolite
Used for brain imaging because it can cross the blood-brain barrier. Localized within 5 mins Most commonly used for brain death imaging
72
Tc99 MAA, Macro-Aggregated Albumin
Sterile human albumin particles to be trapped in the capillary vasculature of the lungs Ideally 350,000 particles in 1-4 mCi Tc99m Used for Lung perfusion, LaVeen shunt patency, Intra-arterial liver
73
Tc99m IDA, Iminodiacetic acid, or Mebrofenin, or Hepatolite
Used for Hepatobiliary imaging, can visualize the liver, common bile duct, gallbladder, and small intestines. Typically used with Cholecystokinin CCK sincalide, morphine, or Phenobarbital
74
Tc99m Phosphates, Medronate and Oxidronate
Used for Skeletal imaging Pics taken 1-4 hours post injection
75
Tc99m MAG 3 or Mertiatide
This is the most common renal imaging agent
76
Tc99m DTPA or Pentetate
Used for renal imaging, Glomerular filtration, Aerosal lung ventilation, and brain but does not cross the blood-brain barrier
77
Tc99m Succimer or Dimercaptosuccinic acid (DMSA)
Used for renal imaging Bound to Protein Imaging 3 hours post-injection
78
Tc99m Sulfur Colloid
Partical size is 0.1 to 1 um Used for liver and spleen-IV Bone Marrow-IV Lymphoscintigraphy-Subcutaneous, used for mapping breast cancer or melanoma, GI Bleed-IV, Gastric emptying-Oral
79
Tc99m Sestamibi or Cardiolite
Used for Cardiac imaging, parathyroid, and Gallbladder in some cases
80
Tc99m Tetrofosmin or Myoview
Used for cardiac imaging Must dilute prior to adding Tc99m, and final concentration should not exceed 80 mCi/ml
81
Tc99m Pyrophosphate or PYP
First used for skeletal for osteogenesis, then cardiac for acute MI, now most commonly used for Cardia Amyloidosis
82
Tc99m Exametazime or Ceretec (HMPAO)
Has a very short shelf life Most often used for brain or WBC imaging Does cross the Blood Brain Barrier Must use within 30 mins
83
Tc99m Labeled WBC
Used to see inflammation, abscess or other infections
84
Tc99m Tilmanocept or Lymphoseek
Used for lymphatic mapping for breast cancer or melanoma Can be injected subcutaneously, intradermal, subareolar, or peritumoral Can be done with a single injection or multi injection
85
Tc99m Labeled RBC
Used for MUGA, GI bleed, and Liver hemangioma Invitro is superior for imaging
86
In vitro means
All tagging occurs outside the body then reinjected into the patient
87
In Vivo means
All tagging occurs inside the body, the labeling is inefficient
88
Indium 111
Cyclotron produced Half-life 67 hours Gamma photon
89
IN 111 Labeled WBC or Oxine or Ozyquinoline
Used for abscesses or other infections Easily crosses the WBC membrane
90
IN 111 DTPA or Pentetate
Cyclotron produced Used for Cisternography-injected into CSF to evaluate leak, and less common a liquid gastric emptying
91
IN 111 Pentetreotide or Octreotide
Binds to somatostatin receptors NET-Carcinoids, gastronomas, neuroblastomas, pituitary adenomas, medullary thyroid cancer
92
I131
Half-life is 8 days High energy gamma photon
93
I131 Sodium Iodide
Can come in a capsule or liquid Only administered orally Used for Thyroid uptake (Function)-5uCi Whole body imaging-2-5mCi Treatment-5mCi up to 250mCi
94
I123
Cyclotron produced Half-life is 13.2 hours Dual-energy gamma photons-28 keV and 159 keV
95
I123 Sodium Iodide
Comes in a capsule or liquid Administered orally Thyroid uptake function and scan Measured at 4 and 24 hours Trapped and bound into thyroid hormones
96
I123 or I131 MIBG
Used for detection of pheochromocytoma and treatment of neuroblastoma
97
I123 Ioflupane or Datscan
Maps dopamine transporters to brain, determines Parkinson's disease Pretreat with SSKI
98
XE 133 Gas
Noble gas Half-life is 5.2 days and a 14 day shelf life Used for ventilation
99
Tl201 Thallous Chloride
Cyclotron produced Half-life is 73 hours Decays through Electron capture Used for Myocardial viability evaluation and parathyroid hyperactivity, and can be used for myocardial profusion with reversible and non-reversible defects
100
F18
Cyclotron produced Decays through Electron capture and Beta + Half-life is 110 minutes PET imaging
101
F18 FDG or Florodeoxyglucose
Used for oncology, infection/inflammation, dementia, seizures, cardiology
102
F18 Sodium Fluoride
Used for bone imaging Defines osteogenic activity
103
F18 Fluciclovine or Axumin
Used for prostate cancer-suspected or recurrent 3-5 min uptake
104
F18 Pylarify (PSMA)
Used for recurrent/initial staging prostate cancer Prostate-specific membrane antigen (PSMA) positive lesions. 60 min uptake
105
F18 Florbetapir or Amyvid
Used for Alzheimer's and cognitive decline 30-50 min uptake
106
F18 Florbetaben or Neuroceq
Used for diagnosing Alzheimer's and cognitive decline 45-130 min uptake
107
F18 Flumetamol or Vizamyl
Used for Alzheimer's diagnosis 60-120 min uptake
108
CU 64 Dotatate or Detectnet
Slow injection 1-2 mins Half-life is 12.7 hours Beta + decay
109
Ga68 Dotatate or Netspot
Half-life is 68 mins Beta+ Decay
110
Which radiopharmaceutical(s) would one use to diagnose the source of an infection or inflammation?
Tc99m HMPAOWBC F18 FDG In111 Oxine WBC
111
Tc99m half life
6 hours
112
Xe133 half life
5.2 days
113
I123 half life
13.2 hours
114
I131 half life
8 days
115
F18 half life
110 mins
116
Ga68 half life
68 mins
117
Cu64 half life
12.7 hours
118
Tl201 half life
73 hours
119
In111 half life
67 hours
120
Co57 half life
270 days
121
What is the ideal amount of time to wait between injection and imaging of a bone scan that is injected with Tc99m MDP
3 hours
122
What layer of the heart does Tc99m Sestamibi bind to?
Myocardium
123
What isotope(s) would you use to measure thyroid uptake?
I131 Nal I123 Nal
124
What imaging agent would be used to visualize and evaluate the parathyroid?
Tc99m Sestamibi
125
The following isotopes are _____emitters: F18, Cu64, N13, O15, whereas the following isotopes are ______ emitters: Xe133, In111, Ga67, I123.
Positron Single Photon
126
What ways can Tc99m Sulfer Collloide be administered to patients?
Oral IV Subcutaneous
127
What would one use Tc99m DMSA for?
Renal transplant imaging
128
SPECT/CT images can be performed on a patient that has been injected with F18 FDG. (T/F)
False
129
Is Tc99m lymphoseek only used for lymphatic mapping?
Yes-in breast cancer and melanoma
130
What is the ideal tagging process for Tc99m labeled RBCs?
In Vitro
131
Which radiopharmaceutical is used in diagnosing cardiac amyloidosis
Tc99m PYP
132
Tc99m HMPAO can be used for both white blood cell imaging and brain imaging. (T/F)
True
133
I131 is an imaging agent that can only be administered orally. (T/F)
False
134
Which of the following are acceptable diagnoses to use F18?
Oncology Seizures MRSA infection Recurrent Prostate Cancer Defining osteogenic activity
135
Which of the following radioisotopes are produced in a cyclotron?
In 111 I 123 F18 Cu64 Tl201
136
Where would you inject a patient with In111 DTPA when evaluating CSF leak?
Subarachnoid Space
137
Ga68 NETSPOT is used to help in diagnosing NET (T/F)
True
138
What Pet agent would you use to discover the source of an infection?
F18 FDG
139
ACD is added when labeling WBCs to enhance sedimentation (T/F)
False, Hetastarch is added to enhance sedimentation
140
Why do we administer SSKI before injecting a patient with I123 Datscan?
To block the thyroid from iodine uptake
141
What is the half-life of I131?
8 days
142
Tc99m Sulfer Colloid is used in which of the following imaging studies
Gastric Emptying Melanoma Mapping Bone Marrow Mapping
143
When would you inject morphine during hepatobiliary imaging
After administrating Tc99m Mebrofenin, if the patient's gallbladder isn't visualized
144
What is considered a normal EF following the administration of Kinevac
>38%
145
What dose of Morphine should be administered to a patient if they weighed 237 pounds
4.3 mg
146
Regadenosen (Lexiscan) is the ideal pharmaceutical to administer for pharmacological stress tests (T/F)
True
147
Kinevac should be diluted and administered quickly as a bolus (T/F)
False
148
A written directive is required for all nuclear medicine procedures (T/F)
False
149
Lasix should be stored in an area protected from light (T/F)
True
150
What should you do following the injection of Lexiscan
Administer the radiopharmaceutical Flush with 5 mL of Saline
151
If requested, during what study should Pepcid be administered
Meckle's Diverticulum
152
How long should documents of therapeutic radioactive procedures be saved
7 Years
153
Why is it important to start an IV on the opposite limb when a patient has had axillary nodes removed
Circulation isn't ideal following lymph node dissection, lymphedema can result
154
How long after the occurrence of a medical event must it be reported to a governing agency
24 Hours
155
A radioactive package is being sent to a facility. Survey measurements are preformed at 1 meter and surface. At 1 meter, the package is reading 0.2 mrem/hr. At surface, the package is reading 2.5 mrem/hr. The TI is 0.2. What should this package be classified as
Yellow II
156
What is the occupational exposure limit for a radiation worker?
5 rem
157
How large of an area should a wipe test be performed on a package?
100 square centimeters
158
How many mg of Lasix should be administered during a normal renal flow and function study
40 mg
159
Radioactive packages should be surveyed, received, and checked in within ______during a normal working day
3 hours
160
Which medication is most ideal for patients when performing a pharmacological stress test
Lexiscan
161
Which medication is most often used as a reversal agent for prolonged side effects during a pharmacological stress test
Aminophylline
162
An authorized user oversees quarterly records, quality control, and over-exposure incidents within a facility (T/F)
False, the RSO oversees these things.
163
Which of the following exams would a technologist inject Tc99m MAA to perform
Lung perfusion
164
NRC regulations which govern the medical use of byproducts material can be found in
10 CFR 35
165
A Type A package bears a DOT class yellow radioactive label and has a TI of 0.8. It contains 10 mCi of I123 Ioflupane. What is the exposure rate 3 feet from the package
0.8 mR/hr
166
The physical half-life of a radionuclide is the time it takes
For the nuclide to decay to one-half of the original activity
167
What is SSKI? What is it used for in nuclear medicine applications?
Potassium Iodide; pretreatment by blocking thyroid tissues so I 131 is not uptaken into healthy thyroid tissue
168
Tc99m Neurolite is used for what type of imaging
Evaluation of a brain death
169
Renal imaging on patients with obstruction of the collecting system may be augmented by the administration of
Furosemide
170
Mo99 found in Tc99m is an example of a
Radionuclidic impurity
171
Which of the following kits are boiled during preperation
MAG 3 Sulfer Colloid
172
If a radiopharmaceutical is spilled on the floor, the first priority is to
Cover the area with absorbent paper and restrict the access around it
173
The philosophy of the ALARA program is to keep the dose
As Low As Reasonably Achievable
174
After eluting the generator, the concentration of Mo99 found in the Tc99m is 0.10 uCi/mCi of Tc99m. The technologist should
Use the Tc99m as usual to make the kits
175
If a patient chart discloses that they have acquired a nosocomial infection, it means
That their infection was received through hospital transmission
176
What are the functions of ACD and Herastarch when used in WBC tagging
ACD=anticoagulant Herastarch=enhances blood sedimentation
177
A package arrives from the radiopharmacy with a surface reading of 5 mrem/hr. What classification should the package be labeled as
Yellow II
178
The collection of blood for RBC labeling should be preformed
With a heparinized syringe Through a large bore needle or IV
179
What material are Y90 SIRsphere microspheres comprised of
Resin
180
Allowed USP alumina breakthrough limit is _____ug alumina/mL
10
181
Which of the following applications are examples of when you would administer Tc99m sulfer colloid to a patient
Lymphoscintigraphy Bone marrow mapping Liver/Spleen imaging Gastric emptying
182
The patient scheduled board contains 4 different patients with the following histories. What would be ordered 1. Evaluate renal mass 2. Rule out chronic cholecystitis 3. Evaluate bone mets from prostate cancer 4. Rule out Parkinson's disease
1. Tc99m MAG 3 2.Tc99m IDA 3. Tc99m HDP 4. I123 Ioflupane
183
Why is it important for the blood glucose to be measured prior to the injection of F18 FDG
Increased blood glucose levels compete with FDG-this causes tissue uptake to be less than ideal, and decreases image quality
184
Gaseous radiopharmaceuticals like Xe133 may only be used in rooms that
Have negative air pressure compared to surrounding rooms
185
Which of the following exams would a technologist inject Tc99m MAA to perform?
Lung perfusion
186
NRC regulations which govern the medical use of byproduct material can be found in
10 CFR 35
187
A Type A package bears a DOT class II yellow radioactive label and has a TI of 0.8. It contains 10 mCi of I-123 loflupane. What is the exposure rate 3 feet from the package
0.8 mR/hr
188
The physical half-life of a radionuclide is the time it takes
For the nuclide to decay to one-half of the original activity
189
What is SSKI? What is it used for in nuclear medicine applications
Potassium Iodide, Pretreatment by blocking thyroid tissue so I-131 is not uptaken into healthy thyroid tissue
190
Tc99m Neurolite is used for what type of imaging
Evaluation of the brain death
191
Renal imaging on patients with obstruction of the collecting system may be augmented by the administration of _____
Furosemide
192
Mo99 found in Tc99m is an example of a
Radionulidic impurity
193
Which of the following kits are boiled during preparation
MAG3 Sulfur Colloid
194
A patient is being treated for hyperthyroidism with an I131 ablation. Out of the available options, how many mCi are they likely to recieve
27 mCi I131
195
If a radiopharmaceutical is spilled on the floor, the first priority is to
Cover the area with absorbent paper and restrict access around it
196
The philosophy of the ALARA program is to keep the dose
As Low As Reasonably Achievable
197
After eluting the generator, the concentration of Mo99 found in the Tc99m is 0.10 uCi/mCi of Tc99m. The technologist should
Use the Tc99m as usual to make the kits
198
If a chart discloses that they have acquired a nosocomial infection, it means that
That their infection was received through hospital transmission
199
What are the functions of ACD and Herastarch when used in the WBC Tagging
ACD=Anticoagulant Herastarch=Enhances blood sedimentation
200
A package arrives from the radiopharmacy with a surface reading of 5 mrem/hr. Which classification should the package be labeled as
Yellow II
201
The collection of blood for RBC labeling should be performed
With a heparinized syringe Through a large bore needle or IV
202
What material are Y90 SIRsphere microspheres comprised of
Resin
203
Allowed USP alumina breakthrough limit is
10
204
Which of the following applications are examples of when you would administer Tc99m sulfur colloid to a patient
Lymphoscintigraphy Bone marrow mapping Liver/Spleen imaging Gastric emptying
205
The patient schedule board contains 4 different patients with the following histories Evaluate renal mass Rule out chronic cholecystitis Evaluate bone mets from prostate cancer Rule out Parkinson's disease What are the most likely radiopharmaceuticals to order
Tc99m MAG 3 Tc99m IDA Tc99m HDP I123 Ioflupane
206
Why is it important for the blood glucose to be measured prior to the injection of F18 FDG
Increased blood glucose levels compete with FDG-this causes tissue uptake to be less ideal, and decreases image quality
207
Gaseous radiopharmaceuticals like Xe133 may only be used in rooms that
Have negative air pressure compared to surrounding rooms
208
Beta emitters are effective for therapeutic procedures because
They have a short range in soft tissue
209
FDG enters cells by what means
It is transported through the cell membrane using facilitated diffusion by the facilitative glucose transporters
210
In selective internal radiation therapy (SIRT), Y90 microspheres are administered in incremental
Infusions into the hepatic artery
211
Intrathecal medications should be administered
Into the subarachnoid space
212
What federal agency is responsible for the regulation of the uses of products material
NRC
213
A package received from a commercial manufacturer should be monitored and checked in within what time period from delivery
180 minutes
214
A right handed nuclear medicine technologist puts on a ring badge before work. The ring should be worn
On the right hand with the TLD chip facing the palm
215
Mo99 decays to Tc99m through what form of decay
Beta decay
216
Ga67 is an example of a radionuclide that is
Cyclotron produced
217
Dipyridamole is administered to a patient as part of a pharmacologic stress test. The patient has an onset of angina pectoris. To reverse the adverse reaction of the Dipyridamole, the patient is given
Aminophylline
218
A patient tested positive for MRSA. Unfortunately, the area of infection in the body is unknown. What radiopharmaceutical must a technologist inject the patient with to find the source of the infection
F18 FDG
219
Which of the following medications could be used to perform a pharmacological nuclear stress test on a patient
Atropine
220
Testing radiopharmaceuticals through chromatography is an important step because
Unbound Tc99m creates impurities-this causes background noise and abnormal uptake in imaging
221
Which of the following isotopes would be effectively shielded by a plastic syringe shield?
Y90
222
The occupational exposure limit for any radiation worker is
5 Rem
223
Annihilation reaction is a characteristic of
Positron decay
224
Which of the following units measures absorbed dose
Gy
225
Who oversees quarterly records, quality control, and over exposure incidents within a facility
Radiation Safety Officer (RSO)
226
A patient arrives for their appointment with elevated lab work and a diagnosis of hypercalcemia. Based on your facility's protocol, it is determined the patient must be imaged with Tc99m sestamibi. What type of study are you performing on this patient?
Parathyroid imaging
227
What are the two parts that make up the composition of a radiopharmaceutical?
Radionuclide & Pharmaceutical
228
What is important in preventing backflow of blood in the heart
Chordae tendineae Papillary muscles AV valves
229
What circulatory pathway carries oxygenated blood from the left ventricle, through the arteries, to the capillaries in the tissues of the body
Systemic
230
What term describes the narrowing of the blood vessels, in particular, the large arteries and small arterioles
Vasoconstriction
231
Gas exchange is the process of absorbing inhaled atmospheric oxygen molecules into the bloodstream and offloading ____from the bloodstream into the atmosphere
Carbon Dioxide
232
The right ventricle pumps deoxygenated blood into the main pulmonary artery, which bifurcates into the left and right pulmonary
Arteries
233
Within the mediastinum, the heart is separated from the other structures by a tough membrane known as the
Pericardium
234
These cardiac structures act as a receiving chamber and contract to push blood into the ventricles
Atrium
235
The groove on the outer surface of the heart marking the division between the atria and the ventricles is called the
Coronary sulcus
236
The great veins, the superior and inferior vena cava and the great arteries, the aorta and pulmonary trunk, are attached to the superior surface of the heart, called the
Base
237
The ______is functionally the main constituent of the heart and the thickest layer of all three heart layers
Myocardium
238
What artery distributes blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum
Left coronary artery
239
Which valve separates the right atrium from the right ventricle
Tricuspid
240
Which of the following lists the valves in the order through which the blood flows from the aorta through the heart
Tricuspid, Pulmonary semilunar, Bicuspid, Aortic semilunar
241
What is the large systemic vein that returns blood to the heart from the inferior portion of the body
Inferior vena cava
242
What artery runs along the posterior portion of the interventricular sulcus toward the apex of the heart, giving rise to branches that supply the interventricular septum and portions of both ventricles
Posterior descending artery
243
To prevent any potential backflow, the _____also contract, generating tension on the chordae tendineae
Papillary muscles
244
What is the correct photopeak selection when using Tc99m Sulfur Colloid for a gastric emptying study
140 KeV (20% window)
245
Which isotopes are used for solid and liquid portions of a Gastric Empty study
Tc99m Sulfur Colloid Indium 111 DTPA
246
For gastric emptying, when should the first, second, third, and fourth images be taken?
Immediate 1 hour 2 hour 4 hour
247
On most occasions, IV injection of Tc99m Pertechnetate is used for most Gastric Emptying studies (T/F)
False ( Tc99m Sulfur Colloid is used)
248
What pharmaceuticals should be suspended for 48 hours prior to a gastric emptying
Omeprazole
249
Examples of Indications during a gastric emptying include
Gastric outlet obstruction Gastric Motility Gastoparesis Abdominal pain and nausea
250
Examples of Contrindication during gastric emptying include
Hyperglycemia in diabetics (blood glucose >_ 275 mg/dl) Inability to swallow and or lack of gag reflex Drugs affecting gastric motility Significant risk for choking and aspiration
251
How are images acquired for a typical gastric emptying study exam?
Anterior/Posterior upright
252
What collimators should be used if 0.25-1.0mCi of Tc99m Sulfur Colloid was used for a reflux study?
Low energy high resolution
253
Indications during gastroesophageal reflux include
Reflux Aspiration Risk Gastric motility
254
Contraindications during a gastroesophageal reflux exam include
None
255
Patient prep for a gastroesophageal reflux exam include
NPO 2-4 hours
256
A common name for a Gastroesophageal reflux study is a Milk Study (T/F)
True
257
The dose for a Gastroesophageal Reflux study is administered via a
Bottle or NG tube
258
NG tubes may be used to insert______tube should be flushed. If the tube is left in place it may cause______
Sulfur Colloid Reflux
259
The appropriate sequence that images should be acquired for a GI bleed are
1-3 second dynamic images for 1 min (Flow) 1 min dynamic images for 60-90 mins SPECT/CT
260
The gauge of IV that should be used when drawing or injecting up RBC's is
19-21G
261
What is the appropriate dose and isotope for RBC's labeling for a GI bleed for an adult
15-20 mCi Tc99m Pertechnetate (555-740 Mbq)
262
What indications match most correctly for indications for a GI Bleed Scan
Intermittent gastrointestinal bleeding Active gastrointestinal bleeding
263
Images should be obtained for_____dynamically for_____when acquiring images for a meckel diverticulum scan
1 min 60 mins
264
What isotope is used for injection for a Meckel Diverticulum Scan for an adult
8-12 mCi (296-444MBq) Tc99m Pertechnetate
265
What two pharmaceuticals are still in use for patient preparation for Meckel Diverticulum Imaging
Famotidine (Pepcid) Cimetidine (Tagamet HB)
266
Indications for Meckel Diverticulum include
Pain in the abdomen Painless rectal bleeding Perforation of Illeum
267
Contraindications for Meckel Diverticulum include
Recent Upper GI series with barium (3-4 days) Recent in Vivo RBC labeling study Active rectal bleeding
268
Patient preparation for a Meckel Diverticulum is
NPO 4-6 Hours
269
Patients should void before and after imaging for a Meckel Diverticulum scan (T/F)
True
270
Most Meckel scans are done on adult female patients (T/F)
False, they are done mostly on small children
271
Usually a positive Meckel Diverticulum scan has a focal area of increased activity in the
Right Lower Quadrant
272
For a Meckel Diverticulum scan what photopeak window should be selected
140 KeV (20% window)
273
For SPECT/CT imaging on a Meckel Diverticulum scan a patient should be imaged for_____for_____ ______ around the patient's area of interest
30-60 seconds 32 steps 360 degrees
274
Gastric emptying meals/Alternative meals
Oatmeal 30g of jam or jelly 120mL of water 1.0 mCi Tc99m Sulfur Colloid into liquid egg whites/egg beaters Cook until firm and temperature reads 63 degrees C (145 F) 2 slices of toasted white bread 75g of packaged Idli mix Savory cakes can be served with calorie-free sugar-free fat-free syrup for taste
275
A liquid meal substitute would consist of 237 ml Ensure Plus mixed with 30 mCi (1110 MBq) Tc99m Sulfur Colloid (T/F)
False, it is mixed with 0.5 mCi of Tc99m Sulfur Colloid
276
For gastric emptying study dietary restrictions would include being ______ and considering allergies for________
NPO 4-6 hours Eggs and or gluten
277
An infant who usually consumes 1.5 ounces of formula per feeding is scheduled for a "Milk Study." How much formula should you mix with the 0.5 mCi (18.5MBq) Tc99m Sulfur Colloid for the study
1.5 ounces, mix with the usual amount
278
Ultratag RBC kit for GI bleed prep order
1-3 ml of heparinized blood to Ultratag Vial (stannous chloride, NA citrate) and mix. Wait 5 mins Add syringe 1 to vial and mix gently (invert 4-5 times) Add syringe 2 to vial and mix gently (invert 4-5 times) Add Tc99m 10-100 mCi (370-3700 MBq) to the reaction vial Mix and allow to react for 20 mins with occasional mixing before rejecting Reinject tagged RBCs into patient.
279
What are the two biggest concerns when tagging RBCs for a GI bleed
RBCs injected into the wrong patient Using a needle gauge smaller than the 19-21g recommended on the repackage insert
280
For patients receiving Tc99m RBCs it is recommended to interrupt breastfeeding for
24 hours
281
As a technologist, you should ensure the detectors are as far away as possible for the best image quality (T/F)
False as close as possible
282
What criteria from a GI bleed scan will show a positive scan
Focal area moving bidirectionally in the bowel Isotope appears where there wasn't any before
283
Tc99m exams use a _______ collimator and a ______ photopeak should be used
Low energy high resolution 140 KeV (20% window)
284
What is the sequence of electrical events during one full contraction of the heart muscle?
SA node, AV node, Bundle of His, left and right bundle branch, Purkinje fibers
285
Which portion of the ECG wave demonstrates repolarization of the atria
None, Atrial repolarization is masked by ventricular depolarization
286
What cluster of cells manifest spontaneous depolarizations and are thus responsible for generating the normal cardiac rhythm
Sinoatrial node
287
Myocardial______cells initiate and propagate the action potential that travels throughout the heart and triggers the contractions that propel the blood
Conduction
288
Rapid depolarization is followed by the_____phase, in which membrane potential declines relatively slowly
Plateau
289
When two independently beating embryonic cardiac muscle cells are placed together, the cell with the higher_____sets the pace, and the impulse spreads from the faster to the slower cell to trigger a contraction
Inherent rate
290
Without the SA node, the AV node would generate a heart rate of______beats per minute
40-60
291
In people with_____, the electrical signal that controls the heartbeat is partially or completely impeded from reaching the ventricles
Heart Block
292
Cardiac muscle cells act as a single unit called a
Functional syncytium
293
The delay in the______cardiac pulse ensures that the atria have ejected their blood into the ventricles first before the ventricles contract
AV node
294
The action potential for the conductive cells consists of a prepotential phase with a slow influx of_______followed by a rapid influx of Ca2+ and outflux of K+
Na+
295
_______are abnormal pacemaker sites within the heart (outside of the SA node) that display automaticity
Ectopic foci
296
The______node is a specialized clump of myocardial conducting cells located in the superior and posterior walls of the right atrium in close proximity to the orifice of the superior vena cava
Sinoatrial
297
What is unique to cardiac muscle cells
Only cardiac muscle is capable of autoryththmicity
298
What group of specialized myocardial conductile cells transmit the impulse from the AV node through the interventricular septum; form the left and right atrioventricular bundle branches
Bundle of His
299
What clinical syndrome demonstrates a structural or functional change in the heart that leads to its inability to eject and/or accommodate blood within physiological pressure levels, thus causing a functional limitation and requiring immediate therapeutic intervention?
Decompensated heart failure
300
____is a measurement, expressed as a percentage of how much blood the left ventricle pumps out with each contraction
Ejection fraction
301
The ____system relies on several hormones that act to increase blood volume and peripheral resistance
Renin-angiotensin
302
What class of medication used for the treatment of high blood pressure work by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart
ACE inhibitors
303
All of the following pharmacological interventions for hypertension are considered first-line agents
Angiotensin-converting enzyme inhibitors Thiazide diuretics Calcium antagonists
304
Approximately 95% of patients with elevated arterial pressure have hypertension of unknown etiology, which is known as
Essential Hypertension
305
The lack of response to therapy with three or more medications and is evidence of a more severe stage of hypertension, with over a fourfold greater risk of a cardiovascular event compared with hypertensive patients achieving blood pressure targets is known as____hypertension
Resistant
306
A blood pressure______is considered normal. Hypertension is defined as a blood pressure of_____mmHg
<120/80 130/80
307
Most patients with early hypertension have no symptoms attributed to high Blood pressure (T/F)
True
308
_______can be identified by echocardiography in nearly 30% of unselected hypertensive adults and in most patients with long-standing, severe hypertension
Left ventricular hypertrophy
309
Increased_____resulting from elevated peripheral vascular resistance and arterial stiffness is considered the principal determinant of myocardial hypertrophy in patients with hypertension
Ventricular afterload
310
Fibroblast proliferation and deposition of extracellular collagen accompany increases in _____size and contribution to ventricular stiffness and myocardial ischemia
Myocyte
311
More than_____of patients with heart failure have hypertension. Treating hypertension reduces the risk of heart failure by nearly ______
90% 50%
312
Coronary heart disease risk increases in a continuous and graded fashion with both systolic Blood Pressure and diastolic Blood Pressure. A reduction in diastolic Blood Pressure of 5mmHg with drug therapy decreases the incidence of myocardial infarction by approximately______
20%
313
When analyzing a HIDA scan is 30 min non-visualized GB post morphine normal, acute, or chronic
Acute
314
When analyzing the images for a HIDA is Visualizing all structures (Biliary tree, GB, Duodenum) within one hour normal, acute, or chronic
Normal
315
When analyzing images from a HIDA is GB visualized within 4 hours of injection normal, acute, or chronic
Chronic
316
When analyzing images for a HIDA is GB not visualized normal, acute, or chronic
Acute
317
When analyzing images for a HIDA if the liver fills within about 5 mins normal, acute, or chronic
Normal
318
When analyzing images for a HIDA is "can have Rim sign or pericholecystic hepatic activity sign" normal, acute, or chronic
Acute
319
When imaging a neonatal patient if activity shows up in the______after 16 hours it most likely indicates________
Biliary tree Biliary Artesia
320
The term HIDA means
Hepatobiliary-Imino-Diacetic-Acid
321
What isotopes could be used for a HIDA scan
3-5 mCi mebrofenin (Choletec) 3-5 mCi of Disofenin (Hepatolite)
322
A patient weighs 200 pounds and needs kinevac for the GBEF portion of his HIDA scan. His weight should be converted to_______and the conversion factor from pounds is_______. After their weight has been converted it should be multiplied by______ to give the appropriate amount of Kinevac to be administered. The appropriate amount of Kinevac that should be used for this patient is_____
Kilograms 2.2 0.02 1.81
323
An appropriate fatty meal eaten within 24 hours before a HIDA scan could contain
A hamburger or something fatty
324
What are appropriate doses that could be used for an RBC Hemangioma scan
10 mCi Tc99m Pertechnetate labeled RBC 37 mCi Tc99m Pertechnetate labeled RBC 25 mCi Tc99m Pertechnetate labeled RBC
325
For an RBC Hemangioma, a patient should be NPO before proceeding with the scan (T/F)
False, there are no dietary restrictions
326
What is the correct sequence when mixing an RBC kit for a RBC Hemangioma
1-3 ml of heparinized blood to Ultratag Vial (Stannous chloride, NA citrate) and mix, wait 5 mins Add syringe 1 to vial and mix gently (4-5 times) Add syringe 2 to vial and mix gently (4-5 times) Add Tc99m 10-100 mCi to reaction vial Mix and allow to react for 20 mins with occasional mixing before reinjection
327
For RBC Hmenagioma a patient should observe a_______ period of interruption of breastfeeding when receiving Tc99m RBCs
24 hours
328
For the immediate initial image acquisition for an RBC Hemangioma scan the images would be acquired with
1-3 sec dynamic images for 1 min
329
For an RBC Hemangioma 1-3 hour delayed image the tumor activity would look similar to what other areas or organs
Heart blood pool Spleen
330
What are the indications to do an RBC Hemangioma scan
Cavernous Hemangioma Tumors Cysts
331
What are the criteria for a normal liver scan?
Homogenous distribution of Tc99m Sulfur Colloid through the liver More uptake in the Right lobe vs the Left lobe
332
What are the criteria for an abnormal liver scan
Any focal area of decreased activity (defect) Singular or multiple lesions Colloid shift (increased radiocolloid concentration by the spleen and bone marrow vs liver)
333
The liver and spleen use____as a common means to absorb the Tc99m Sulfur Colloid particles. The______extract 85% of the SC particles from the liver. The______of the spleen extract 10% of the SC particles. The______extracts 5% of the SC particles
Phagocytosis Kupffer Cells Macrophages Bone Marrow
334
What isotopes would be used for imaging Splenosis, with denatured RBCs
5-7 mCi Tc99m labeled RBCs
335
For the liver and spleen scan match the appropriate distribution percentage of Tc99m Sulfur Colloid to the appropriate organ
Kupffer cells of the liver-85% Bone marrow-5% Macrophages of the Spleen-10%
336
A common function that the liver and spleen share is Phagocytosis. Does this allow the Tc99m Sulfur Colloid particles to be extracted into the respective organs (T/F)
True
337
What is the criteria that would be used to evaluate a liver and spleen scan after imaging.
Size, shape, and position of the liver and spleen Presence of any focal defects in activity Relative distribution of colloid among the liver, spleen, and bone marrow Homogeneity of activity within the organs
338
The right coronary artery arises from the right coronary sinus and runs in the right______groove
Atrioventricular
339
The right coronary artery arises from the right coronary sinus and runs in the right______groove
Atrioventricular
340
The sinoatrial nodal and AV nodal coronary branches also arise from the
Right coronary artery
341
Heart dominance is described by which coronary artery branch gives rise to the_______ and supplies the inferior wall
Posterior descending artery
342
The LAD artery runs in the anterior introventricular groove toward the apex of the heart and supplies the_____wall of the _____ventricle
Anterior Left
343
Patients experiencing a _____should undergo emergent coronary angiography with the goal of establishing reperfusion with angioplasty
STEMI
344
What is used when performing a coronary angiogram
Catheter Sheath Guidewire
345
The______approach has become increasingly popular for angioplasty and may be the preferred strategy in patients with morbid obesity or severe peripheral artery disease
Radial artery
346
The Allen test assesses the patency of the arch circulation and involves the simultaneous compression of the_____and______arteries
Radial Ulnar
347
To deliver contrast, the catheter is manipulated until it is coaxial with the_____of the coronary artery
Ostium
348
Comprehensive evaluation of the coronary arteries requires angiography in multiple views to ensure that all vessel segments are visualized without foreshortening or_____
Overlap
349
Coronary angiography delineates the vessel lumen but is unable to provide accurate information about the vessel wall (T/F)
True
350
What diagnostic technology uses a coronary guidewire attached to a pressure transducer to measure the hemodynamic significance of a lesion
Fractional flow angiography
351
______uses a catheter, x-ray imaging guidance and an injection of contrast material to examine blood vessels
Angiography
352
What diagnostic technology can be used to assess the size of the artery, the vascular wall and plaque composition, and burden, and can be used to assess and optimize PI results
Optical coherence tomography Intravascular ultrasound
353
_____is characterized by chest discomfort or anginal equivalent that is provoked with exertion and alleviated at rest or with nitroglycerin
Stable angina
354
The major complications that can occur during or immediately after coronary angiography include death, stroke, and ______
Myocardial infarction
355
All of the following are considered relative contraindications to coronary angioraphy
Acute renal failure Pregnancy Acute stroke
356
___is a scoring system from 0-3 referring to levels of coronary blood flow assessed during angiography
TIMI
357
The ___is routinely used in surgical revascularization and typically arises anteriorly from the left subclavian artery, several centimeters distal to the vertebral artery
Left internal mammary artery
358
The sequence of ECG changes associated with acute ischemia and infarction is as follows
Peaking of the T-wave ST segment elevation or depression Development of abnormal Q waves T-wave inversion
359
Acute myocardial ischemia and infarction cause a series of metabolic, ionic, and pathological changes in the region supplied by the____that cause characteristic changes in the ST segment, QRS complex, and T wave
Occluded coronary artery
360
The_____reflects depolarization of the atria, the_____reflects depolarization of the ventricles, and the_____reflects repolarization of the ventricles
P-wave QRS complex ST segment and T wave
361
The____is primarily an electrical gatekeeper between the atria and ventricles and introduces a delay between atrial and ventricular excitation, allowing for efficient ventricular filling
Atrioventricular node
362
The______encompasses the region between the end of ventricular depolarization and beginning of ventricular repolarization on the ECG
ST segment
363
The______is located at the junction of the superior vena cava and the right atrium
Sinus node
364
Elevation or depression of the_____indicates the presence of voltage gradients during the plateau and or resting phases of the ventricular action potential and are most often a manifestation of cardiac disease
ST segment
365
The development of abnormal_____indicates absent conduction through the infarcted region and may last indefinitely
Q waves
366
Bundle branch blocks alter the shape and duration of the
QRS complex
367
An______is a disturbance of the cardiac rhythm frequently related to the electrical conduction system of the heart, in which beats arise from fibers or group of fibers outside the region in the heart muscle ordinarily responsible for impulse formation
Ectopic beat
368
The distance from the beginning of the P-Wave to the beginning of the Q wave is called
PR intervals
369
The amplitude of the____is subject to a variety of factors, including the thickness of the left ventricular and right ventricular walls, the presence of pleural or pericardial fluid, or an increase in chest wall thickness or body mass
QRS complex
370
Subendocardial ischemia such that associated with subtotal coronary occlusion and which is often brought on by exercise in patients with flow limiting coronary artery obstruction, does not extend to the epicardium and appears on an ECG as
ST depression
371
The electrical activity of the atrial repolarization is electrocardiographically silent because it occurs during the_____
QRS complex
372
The_____represents the period in which the myocardium maintains contraction to expel blood from the ventricles
ST segment
373
The shape and duration of the_____are determined by the sequence of atrial depolarization and the time required to depolarize the cells of both atria
P wave
374
What isotope would be used in renal cortical imaging to evaluate pyelonephritis
5 mCi (185 MBq) Tc99m DSMA
375
What collimators could be used for a renal cortical scan
Low energy high resolution Pinhole
376
Imaging of a Renal Cortical Tc99m DMSA scan, the imaging quality is considered inadequate (T/F)
False
377
Within 1-2 seconds after the IV bolus injection both kidneys would symmetrically appear without any delay on a typical renal function exam (T/F)
True
378
What Isotopes would be used for a renal function test
10 mCi Tc99m Mercaptoacetyriglycine (MAG 3) 10 mCi Tc99m Diethylentiaminepentaacetic Acid (DTPA)
379
When imaging a transplanted kidney the technologist should select the posterior camera head for the best image quality (T/F)
False, use the anterior camera since the kidney is put in the anterior side of the patient.
380
Which exams would use Tc99m MAG3 or Tc99m DTPA for evaluating Renal Function
Renal perfusion/Function Renal diuretic (renogram) ACE inhibitor
381
For a renal diuretic scan select what would be the most appropriate time per frame and total time for the dynamic flow portion of the exam
60 sec frames for 30 mins
382
On most occasions IV injection of Tc99m Pertechnetate is used for most gastric emptying studies (T/F)
False, Tc99m Sulfur Colloid
383
According to the package insert________should be pushed via IV_______to prevent_________
Furosemide (lasix) Slowely Deafness
384
What is the correct photopeak selection when using Tc99m Sulfur Colloid for a gastric Emptying Study
140 KeV (20% window)
385
When imaging a transplanted kidney the technologist should select the posterior camera head for the best imaging quality (T/F)
False, transplanted kidneys are on the anterior side of the body
386
Indications for renal cortical and renal functional imaging
Masses Hydronephrosis Pyelonephritis Infection Renal transplant Horseshoe kidney Renal scarring Polycystic kidney Obstructions in kidneys, ureters, bladder Hypertension (ACE, Captopril)
387
What are the most correct indications for a GI Bleed Scan
Intermittent gastrointestinal bleeding Active gastrointestinal bleeding
388
What isotope is used for injection for a Meckel Diverticulum Scan for an adult
8-12 mCi Tc99m Pertechnetate
389
For a Captopril renal scan the acronym Ace means
Angiotensin Converting Enzyme
390
For patients receiving Tc99m-RBCs it is recommended to interrupt breastfeeding for
24 hours
391
Original method for RBC labeling
In vivo
392
Used for patients who cannot receive blood products for religious reasons
In Vivo
393
Withdraw 5-8 ml of blood into a shielded syringe with Tc99m (keep syringe attached-its closed procedure)
Modified in Vivo (in vitro)
394
Inject Stannous Pyrophosphate (closed procedure)
Modified In Vivo (In vitro)
395
Labeled efficiency >97%
In Vitro
396
Labeled efficiency 75-80%
In Vivo
397
1-3 ml heparinized blood to Ultratag Vial (Stannous chloride, NA citrate) and mix. Wait 5 mins
In Vitro
398
Labeled efficiency 85-90%
Modified In Vivo (In Vitro)
399
Most commonly used tagging method
In Vitro
400
When evaluating an image for a Meckels Diverticulum scan, a positive scan usually has a focal area of increased activity in the
Right lower quadrant
401
A dose of Furosemide (Lasix)______is given usually 10-15 mins post radiopharmaceutical injection during a renal_______scan
40mg/4ml Diuretic
402
What isotopes would be used for a HIDA scan
3-5 mCi Disofenin (Hepatolite) 3-5 mCi Mebrofenin (Choletec)
403
For a RBC Hemangioma 1-3 hour delayed image the tumor activity would look similar to what other areas/organs
Spleen Heart Blood Pool
404
What are two pharmaceuticals still in use for patient preparation for Meckel Diverticulum Imaging
Famotidine (Pepcid) Cimetidine (Tagamet HB)
405
What Isotope would be used for imaging Splenosis, with denatured RBCs
5-7 mCi Tc99m Labeled RBCs
406
What are the criteria that would be used to evaluate a Liver/Spleen scan after imaging
Size, shape, and position of the liver and spleen Relative distribution of colloid among the liver, spleen, and bone marrow Homogeneity of activity within the organs
407
What isotope would be used in Renal Cortical imaging to evaluate pyelonephritis
5 mCi Tc99m DSMA
408
What isotopes would be used for a renal function test
10 mCi Tc99m Mercaptoacetyriglycine (MAG3) 10 mCi Tc99m Diethylentiaminepentaacetic acid (DTPA)
409
The dose for a Gastroesophageal Reflux study is administered via a
Bottle or NG tube
410
What are the exams that would be used for a Tc99m MAG3 or Tc99m DTPA for evaluating Renal function
Renal diuretic (renogram) ACE inhibitor Renal perfusion/function
411
What type of heart rhythm can cause the loss of consciousness
Ventricular Fibrillation
412
Normal fetal circulation in utero, has a foramen ovale, which purpose is
To shunt blood from the right atrium to the left atrium and bypass the fetal lungs
413
45 degree LAO is the best position to demonstrate what in the heart
The ventricular septal wall
414
Oxygenated blood returns to which heart chamber
Left atrium
414
In viewing a gated blood pool cineangiogram, you will see all four heart chambers of the heart in which view
You cannot see all four chambers simultaneously in any view
414
Oversubtraction of background in an EF of the heart will cause
A false high LVEF
415
The gated blood pool study can demonstrate the presence of myocardial infarction by the presence of
Regional wall motion abnormalities
416
Regional wall motion abnormalities on a rest MUGA is or can be due to
Myocardial infarction Stunned myocardium Hibernating myocardium
417
In a bundle branch block ventricular contraction is delayed. What might this look like on an ECG
A long QRS interval
418
When performing a MUGA scan, increased activity is detected in the thyroid. This is probably because
There is free Tc99m Pertectnetate
419
Normal MUGA ejection fractions
Have higher EF for the left ventricle than for the right ventricle
420
Normal ejection fraction for the LVEF is
50-70%
421
Normal heart in the thoracic cavity place it
To the left of the midsagittal plane Apex inferior to the cardiac base Base posterior compared to the apex Apex angling to the anterior and the left compared to sagittal and coronal planes
422
What might be a contraindication for a MUGA study
Pregnancy of the patient Breastfeeding of an infant Irregular heartbeat which would impede the gated imaging process
423
Procedure for performing a gated blood pool study include
Dose of 20-30 mCi of a blood pool label radionuclide Imaging is begun 3-5 minutes after injection
424
QRS on an EKG represents what
Right and left ventricular systole
425
When listening to the heart beat with a stethoscope
The LUB sounds are the rt and lt atrial contractions, while the DUB are when the rt and lt ventricles contract
426
The T wave represents
Repolarization and relaxation of ventricles
427
What is pericarditis
Inflammation of the pericardium, which may or may not compromise cardiac function
428
Dyskinetic has what type of motion
Systolic outward motion
429
The purpose for the MUGA imaging study includes
Patient workup for Chemotherapy Determination of ventricular ejection fraction Evaluate ventricular wall motion
430
Which EKG point represents the electrical activity of the sinoatrial node. This point creates atrial systole
P wave
431
If the______segmant of an ECG exceeds .12 seconds (three small boxes), branch bundle block is probably present
QRS
432
The AV node stimulates contraction of the
Ventricles
433
Which EKG point represents the electrical activity of the atrioventricular node. This point creates ventricular systole
QRS
434
The EKG signal that is used for the trigger in a gated cardiac procedure is
R
435
Normal ejection fraction for the right ventricle is greater than the left ventricle (T/F)
False
436
A 12 lead ECG has 12 wires and 12 ECG patches (T/F)
False, it has 10
437
In gated cardiac blood pool procedures, imaging occurs
Continuously throughout the procedure using EKG timing to image at predetermined phases of the cardiac cycle
438
P cells in the heart are
Pacemaker cells, and are cells which create rhythm or a pace in the heart
439
Akenesis has what type of motion
No systolic wall motion
440
AV block is seen in what portion of an ECG
The PR interval
441
The_____is responsible for pumping oxygenated blood throughout the body
Left ventricle
442
The hearts primary electrical impulse is generated by the
SA node
443
Deoxygenated blood returns to which heart chamber
Right atrium
444
In gated blood pool imaging, the views most often taken include
LAO (to separate the right and left ventricles) Left lateral (to view the left ventricle) Anterior view
445
The percent of difference between ventricular systolic and diastolic volume is the
Ejection fraction
446
When performing a MUGA study
The LAO positioning of the patient may vary somewhat between 45-60 degrees and is the best view to demonstrate the interventricular septum
447
When mixing an ultratag kit with Tc99m pertechnetate
Mix the vial gently so as not to disrupt the Tc99m from tagging to RBCs
448
Hypokenesis has what type of motion
Reduced systolic motion
449
How long do we wait post injection of radiopharmaceutical before acquiring images in a MUGA gated study
3-5 mins
450
What is considered a normal blood pressure in a healthy adult
110 systolic and 70 for diastolic
451
A delayed image for a 3 phase bone scan of the shoulder would be taken______post injection to allow adequate absorption of_______in bone mineral
3-4 hours Phosphorus
452
What isotopes would be used for skeletal imaging
MDP (Methylene Diphosphonate) HMDP (Hydroxymethylene Diphosphonate)
453
For a 3 phase bone scan for hardware loosening, what isotope would be used
10-20 mCi Tc99m MDP
454
When doing a 3 phase bone scan of the knees it isn't necessary to obtain prior x rays for the radiologist (T/F)
False
455
Organize the phases in the correct order for a 3 phase skeletal exam of the hips
Flow Pool Delay Extended delay SPECT/CT
456
Calcium labeled with technetium is the most common and widely used method for bone imaging (T/F)
False
457
What are some indications for a bone scan
Hypercalcemia Skeletal Metastases Bone Lesions
458
_______act as a_______analog in the mineral portion of the bone
Diphosphonates Phosphorus
459
Patients having PET/CT scans using F-18 FDG should have a glucose reading <_____mg/DI for most scans. Diabetic patients should not take diabetic medications prior to imaging for________hours
200 4-6
460
For SPECT/CT and PET/CT imaging patients are placed prone feet first (T/F)
False, Supine with arms up or down depending on whats being looked at in the exam
461
A basic model for SPECT/CT bone imaging would be ________with_______and approximately_________ (answer is numbers)
360 degree rotation 60-120 stops 15-30 sec/stop
462
What pharmaceuticals can be used for bone imaging for PET/CT scans
F-18 Sodium Flouride F-18 Florodeoxyglucose (FDG)
463
______are frequently used in patients presenting with NSTE-ACS. They decrease myocardial oxygen demand by decreasing the heart rate, contractility, and systemic blood pressure
Beta Blockers
464
Common symptoms of_____include sudden onset of retrosternal chest pain with radiation to the neck, jaw, and/or arms. The pain typically occurs at rest or with minimal exertion and lasts for 10 mins
NSTE-ACS
465
_______is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs
Thrombolysis
466
Non ST-segment elevation myocardial infarction is distinguished from unstable angina by elevated levels of
Cardiac enzymes
467
______reduce myocardial oxygen demand and increase coronary blood flow by reducing preload via peripheral vasodilation and endothelium-independent dilation of the epicardial coronary arteries
Nitrates
468
The Global Registry of Acute Coronary Events (GRACE) risk score and the______are commonly used risk stratification tools and can be easily and quickly implemented in the assessment of NSTE-ACS patients
(TIMI) Thrombolysis in Myocardial Infarction
469
Thrombal occlusion of epicardial coronary arteries leads to______of the underlying subendocardium. Loss of non-regenerative and contractile cardiomyocytes results in reduced cardiac output and predisposes to heart failure
Necrosis
470
The pathogenesis of______is sudden plaque rupture followed by thrombus formation and partial occlusion of coronary blood flow. These plaques consist of atherosclerotic lesions with lipid-rich cores and fibrous cap.
NSTE-ACS
471
An initial loading dose of 162 to 325 mg of______should be given to all patients suspected of having NSTE-ACS
Asprin
472
Plaque rupture that results in ACS is more likely to occur in lesions with <50% luminal stenosis due to less developed______
Fibrous Cap
473
All of the following are anticoagulant therapies
Bivalirudin Low-molecular-weight heparin Fondaparinux
474
All of the following are P2Y12 receptor inhibitors
Ticagrelor Prasugrel Clopidogrel
475
Current guidelines recommend that dual antiplatelet therapy with______and an______be continued for a minimum of 12 months following drug eluting stent percutaneous coronary intervention
Asprin P2Y12 receptor antagonist
476
_____is the most commonly used systemic anticoagulant therapy in NSTE-ACS due to its fast onset of action, relatively low cost, and universal availability.
Unfractionated heparin
477
The physical examination in NSTE-ACS patients focuses on evaluating for signs of_______instability and heart failure
Hemodynamic
478
The four key components of managing patients with NSTE-ACS include 1) risk satisfaction, 2) Overall management strategy, 3) antiplatelet and anticoagulation therapy, and 4) _______therapy
Anti-ishemic
479
_____have become the preferred markers of myocardial necrosis due to their increased sensitivity and specificity for myocardial damage
Cardiac troponins
480
_______is caused by decreased cerebral blood flow leading to transient loss of consciousness and postural tone and is associated with spontaneous recovery
Syncope
481
Serial_____at 15-30 minute intervals should be performed in all patients with suspected ACS
Electrocardiograms
482
Approximately 30% of patients may present with atypical symptoms, which include isolated dyspnea, fatigue, pleuritic chest pain and______
Epigastric discomfort
483
The term________refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina, non ST segment elevation myocardial infarction, and ST segment elevation myocardial infarction
Acute coronary syndrome
484
Acute ST elevation myocardial infarction is usually caused by______rupture and subsequent acute______occlusion of a coronary artery
Plaque Thrombotic
485
Silent heart attacks often occur in patients who have_____, thier symptoms lack intensity because the nerves that conduct pain from the heart may have become damaged as part of a complication of their disease.
Diabetes
486
The______encompasses the region between the end of ventricular depolarization and the beginning of ventricular repolarization on the ECG
ST segment
487
_______dysfunction remains the most important predictor of death after survival of the acute phase of STEMI
Left ventricle
488
What drug reduces mortality and is the first choice antiplatelet drug that every patient who experiences STEMI should recieve as soon as possible independent from the planned revascularization strategy
Asprin
489
In the absence of contraindications, _______ therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.
Fibrinolytic
490
The use of drug eluting stents is advocated in the treatment of STEMI patients because of the reduced risk of _______
Restenosis
491
Treatment options that lower the mortality in acute STEMI focus on early reperfusion with _____ or _____
PCI Thrombolytic therapy
492
Adhesion of platelets to the ulcerated plaque, with subsequent platelet activation and aggregation, leads to thrombin generation and conversion of _______ to _______
Fibrinogen Fibrin
493
The interruption of blood flow in an _______ coronary artery causes the zone of myocardium supplied by that vessel to lose the ability to perform contractile work
Epicardial
494
Dyssynchrony, hypokinesis, akinesis, and dyskinesis are examples of abnormal myocardial _______ patterns. Myocardial dysfunction in an area of ischemia is typically complemented by ______ of the remaining normal myocardium.
contraction Hyperkinesis
495
Disruption of normal cardiac _____ integrity results in the loss into the extracellular space of intracellular constituents including detectable levels of a variety of biologically active cystosolic and structural proteins such as troponin, creatine kinase, myoglobin, heart-tyoe fatty acid binding protien, and lactate dehydrogenase
Myocyte
496
What is the correct sequence of myocardial injury during coronary occlusion
Normal state, Ischemia, injury, infarction
497
Typically, the ______ artery supplies blood to the sinoatrial and atrioventricular nodes, which regulate the heart rhythm.
Right Coronary
498
The only biomarker that is recommended to be used for the diagnosis of acute MI is cardiac _______ due to its superior sensitivity and accuracy.
Troponin
499
Which coronary syndrome is described as: The plaque ruptures and thrombus forms around the ruptured plaque, causing a partial occlusion. Angina pain occurs at rest or progresses rapidly over a short period of time.
STEMI
500
What two vessels are used for coronary artery bypass
Radial artery Saphenous Vein
501
For a ventilation study using Tc99m what would be the correct photopeak window
140 KeV Photopeak
502
For a ventilation study using Xe133 what would be the correct photopeak window
81 KeV Photopeak window
503
A normal DTPA vent shows images homogeneous and symetrical aerosol deposition from apex to base of the lungs (T/F)
True
504
What projections are associated with an aerosol ventilation of the lung
LPO AP LT Lat
505
For a Xe133 ventilation study what is the appropriate time for the Equilibrium portion of the study
3 Static images for 30-90 seconds each
506
For a Xe133 ventilation study what is the appropriate time for the Initial Breath portion of the study
Inhale and hold breath for 10-20 seconds
507
For a Xe133 ventilation study what is the appropriate time for the Wash Out portion of the study
Static images for 30-90 seconds for 5 mins
508
For ventilation studies, what are the static projections that are typically acquired for a gas ventilation lung study
Posterior obliques Anterior Posterior
509
The counts per image for a perfusion scan are between 200,000-250,000 counts (T/F)
False, they should be between 450,000-600,000 counts
510
Focal hot spots throughout the lung are an indication of what on a perfusion lung test
Injected blood clots
511
When identifying mismatched wedge-shaped defects from ventilation and perfusion imaging the wedges should be described in what ways
Size, number, location, shape, intensity
512
When injecting Tc99m MAA into a patient, what line should not be used
Swan-ganz, you can only inject into lines that do not have filters on them
513
Patients should be in a seated position when injecting Tc99m MAA for a lung perfusion scan (T/F)
False, they need to be laying down for the best distribution throughout the lung
514
For a lung perfusion quantification scan what exam projection is the most common
AP/PA
515
During a 3 phase bone scan the flow phase is usually acquired for _____ seconds per frame for a ________ period of time
1 to 3 seconds 1 min period of time
516
Patients having a PET/CT scan using F18 FDG should have a glucose reading < _____mg/DI for most scans. Diabetic patients should not take diabetic medications prior to imaging for _____ hours
200 4-6 hours
517
The patient should void prior to PET/CT and or bone scans to increase the sensitivity for the reading radiologist in the pelvis region (T/F)
True
518
When reviewing 3 phase bone scan imaging what would markedly asymmetrical perfusion indicate
Acute condition
519
A basic model for SPECT/CT bone imaging would be ______ rotation with ______ stops and approximately _______ sec/stop
360 degree 60-120 15-30
520
For SPECT/CT and PET/CT imaging patients are placed prone feet first (T/F)
False, supine feet first
521
What factors influence the imaging time for patients receiving PET/CT scans
Administered activity Patient body weight Sensitivity of PET scanner
522
________ act as a ______ analog in the mineral portion of the bone
Diphosphonates Phosphorus
523
For a PET/CT scan imaging what would be an acceptable acquisition time per bed
3 min beds
524
Calcium labeled with technetium is the most common and widely used method for bone imaging (T/F)
False, MDP
525
Approximately how many counts would be acceptable for imaging the chest for a static image during a whole body bone scan delay image
500,000 counts
526
Hydroxyapatite in bone is composed of what materials
Phosphate Hydroxyl ions Calcium
527
When acquiring a SPECT/CT bone image on a Siemens camera for a patient that has a large body habitus and is unable to keep their arms up it is best to use which orbiting factor to limit detector collisions with the patient
Circular
528
What are the potential consequences of aortic valve dysfunction
Impairment of LV outflow Valvular incompetence with regurgitation
529
What are common symptoms of aortic stenosis due to its impact on LV outflow
Dyspnea Angina Syncope
530
What distinguishes TAVR from traditional surgical aortic valve replacement in treatment of aortic stenosis
TAVR involves a minimally invasive procedure using a catheter to implant a new valve
531
In the context of congenital heart disease which condition is known for its significant prevalence (aprox 1.3% in the general population) and its specific association with the risk of ascending aortic dilation
Bicuspid aortic valve disease
532
What are potential causes of aortic regurgitation
Aortic valve annulus dilation Abnormality of the aortic valve itself
533
What is the primary compensatory mechanism of the left ventricle in response to pressure overload from valve stenosis
Concentric left ventricular hypertrophy
534
When evaluating a patient with suspected valvular heart disease, what key aspects can a complete a transthoracic echocardiogram provide
Detection of associated valvular abnormalities Assessment of the severity of valvular obstruction Information of left ventricular function
535
What are common causes of acute aortic regurgitation
Infective endocarditis Spontaneous rupture or prolapse of a valve cusp
536
Pharmacologic stress tests may be performed using
Dobutamine Regadenoson Adenosine
537
Matching defects on a stress/rest study is indicative of
Infarct area
538
The left ventricle myocardium is thicker than the right ventricle myocardium (T/F)
True
539
The largest of the coronary arteries and the most dangerous if occluded is the
Left anterior descending
540
3-5 mCi of Tl201 is commonly used in imaging studies because
Thallium decays to mercury; therefore low dosages are necessary to prevent toxicity Thallium has a long half life which prevents high dosages
541
The posterior and lateral wall of the left ventricle is nourished by the
Left circumflex artery
542
When performing a rest/stress cardiac imaging using a radionuclide such as Cardiolite, it is necessary to use ________times more activity for the second study on a single day protocol to prevent shine through.
three
543
Regarding a one-day cardiolite protocol for cardiac imaging, you would administer
8-10 mCi resting dose, followed by a 24-36 mCi dose after peak stress
544
Angina is what, and may be caused by what
A condition characterized by chest pain, or tight feeling often radiating to the left shoulder and caused by insufficient blood to the coronary muscle
545
ST depression on an EKG is indicative of
Ischemia
546
Adverse effects of dipyridanole are reversed with
100-200 mg of IV Aminophylline
547
What is dilated when dipridamole, adenosine, and regadenoson are used instead of physical stress
Normal coronary arteries
548
Stress myocardial perfusion defect that fills in on the resting perfusion study is
Reversible and is an indication of ischenmia
549
Contraindications for stress exercise include
Lt Branch Bundle Block Exercise intolerance, or disability Patient is on a beta blocker
550
In PET imaging what happens
Two 511 kev emissions occur when the positron annihilates an electron
551
What heart imaging agents redistribute
Tl201 is the only one that redistributes
552
When performing a Tc99m Sestamibi for heart imaging, image acquisition must begin immediately after injection (T/F)
False, 30-60 mins after
553
What does not show up on rest on myocardial imaging
Ischemia
554
Rubidium PET imaging has a resolution of about 4mm compared to 12mm with SPECT imaging (T/F)
True
555
Stress cardiac imaging would not be performed when
The patient cannot take pharmacologic stress and cannot exercise. Patient is experiencing chest pain Patient has extremely high blood pressure
556
For an exercise stress test to be adequate, the patient should achieve at least 85 % of their maximum predicted heart rate (T/F)
True
557
What is a positron
A positively charged particle with the mass of an electron
558
Rest/Stress imaging may be performed using
Tl201 stress imaging followed by rest imaging One day protocol using two injections of Tc99m sestamibi One day protocol using Tl201 Tc99m Sestamibi.
559
Regadenoson (lexiscan) is reversed by
Aminophylline or Caffeine
560
What radionuclide is considered the Gold standard when assessing myocardial viability
FDG18 PET imaging
561
At what point in the cardiac cycle do the coronary arteries receive blood for the heart
During Diastole when the ventricles are at rest and the aortic valve is closed
562
The most common cause of false negative exams in cardiac imaging is
Submaximal stress
563
Major advantages of using sestamibi or tetrofosmin over Tl201 include
imaging with 140 kV gammas Higher level of activity may be injected due to shorter half life of Tc99m Sestamibi and tertrofosmin do not redistribute
564
Advantages of PET cardiac imaging when compared to SPECT imaging included
High energy photon emission Dual photon emission Short half life nuclides allow for high dose injections for count rich studies Increased spatial resolution
565
Why do we wait after an injection of sestamibi or tetrofosmin prior to imaging the heart
To allow for hepatobiliary clearance
566
A major disadvantage with the use of dipyridomole for pharmacologic stress is that there are no effective reversing agents which can be given to counteract the effects of dipyridamole (T/F)
False, Aminophylline
567
MNost nuclear medicine departments use SPECT rotating gamma scintigraphy and image ______degrees for cardiac imaging
180 degrees
568
The inferior and posterior walls of the left ventricle, and the right ventricle are nourished by the
Right coronary artery
569
Bruce protocol indicates maximum stress is determined by
220 bpm minus patient's age
570
Hibernating myocardium is a significant finding because
it means the myocardium in question is still viable and not infarcted
571
During a stress for myocardial perfusion imaging, the patient must be injected
During the stress
572
A focal decrease in perfusion occuring on a rest image is most commonly caused by
Previous myocardial infarction
573
Which nuclide behaves similarly to Tl201 by utilizing sodium and potassium pumps
Rubidium 82
574
When considering a Stress/rest sestamibi protocol, when could the stress only be performed
When stress images demonstrate normal radionuclide distribution
575
Flourodeoxyglucose FDG is produced in a
Cyclotron by accelerating protons into target atoms
576
Water or food may be given to the patient after the final Tc99m sestamibi injection to clear activity out of the
Digestive system Gallbladder Liver
577
Regarding short axis cardiac plane, which statements are correct
Creates a plane or slices from the base to the apex Top of the donut is anterior portion of the heart Right side is the lateral wall Left side is the septal wall Bottom of the donut is the inferior portion of the heart
578
During the Bruce protocol, a patient should continue to exercise for at least ______ following dose administration of the radiopharmaceutical
1-2 minutes
579
The disadvantages of Tl201 when compared to sestamibi or myoview include
Tl201 has a much longer half life than technetium 99m Tl201 studies require small amounts of radionuclide, therefore, they tend to be count poor Tl201 has a lower energy photon than Tc99m
580
ST elevation on an EKG is indicative of
Infarct
581
The anterior wall of the left ventricle is nourished by
Left anterior descending artery
582
One day protocol, with dual radioisotope imaging, which of the following would be necessary
Use lower energy photon emitter first Use lower amount of activity first Use three times more activity second to prevent shine through
583

Nuc med (3 decks)

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