Essentials of Nuclear Medicine and Molecular Imaging Flashcards by randy cart

All Isotopes

Have different number of neutrons

Have the same number of protons

Have the same chemical properties

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

Neutron

Proton

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

True

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Choose how the radioisotope is produced
F18
Tc99m
Rb82
I 123

Cyclotron
Generator
Generator
Cyclotron

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What is the energy and half life of Tc99m

140 keV and 6 hours

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What is the daughter nuclide of Mo99

Tc99m

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2P + 2N released=atomic mass number decreasing

Alpha decay

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Particle is emitted from the nucleus

Beta decay

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

Electron capture

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

Isomeric Transition

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The excess nucleus energy transfers to an orbital electron

Internal conversion

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This is released as a result of Isomeric Transition

Gamma Ray

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

Positron decay

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

Paper shielding
Plastic or thin aluminum
Lead

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

Electron Capture

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What is the Mo99 breakthrough limit

Mo99’s breakthrough limit is 0.15 micro Ci

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What substance is a M099/Tc99m generator eluted with

NaCl Sodium Chloride

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

Nuclear Fission

Bombardment

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

Neutrons

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Mo99 decays to Tc99m through what form of decay

Beta Decay

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

True

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What does the “m” in Tc99m stand for

Metastable

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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)

False, they are both excellent imaging radioisotopes.

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

True

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Isotopes are

Atoms of the same element

Have the same number of protons, different number of neutrons.

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Metastable refers to the intermediate time in which a daughter nucleus remains in the excited state (high energy) (T/F)

True

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Beta decay

An excess neutron is emitted and transforms to a proton accompanied by an antineutrino

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Electron capture

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

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Alpha decay

Emits large particles that result in a decrease in atomic mass number; travel very small distances

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Internal conversion

Results in excess energy in the nucleus transferring to an orbital electron; characteristic radiation occurs

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Positron decay

To many protons are in the nucleus; loses energy and combines with an electron

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Gamma emission

Always preceded by another form of decay.

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What is the half-life of a radioactive isotope

The time it takes for the radioactivity to decay to half of its original value

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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

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Convert 1550 uCi to GBq

5.7 x 10^-2 Gbq

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A nuclear reactor uses particulate bombardment to produce isotopes which are primarily proton rich (T/F)

False, they are neutron rich

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A Curie is part of the international system of units (SI) (T/F)

False, becquerel is the international system of units

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Convert 700 kBq to mCi

1.9 x 10^-2

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What components make up a radiopharmaceutical

Radionuclide and pharmaceutical

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A radiopharmaceutical kit includes components that cause a physical reaction when a radionuclide is added (T/F)

False, they cause a chemical reaction

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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

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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

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Why must you agitate a syringe of Tc99m MAA before injecting it into the patient

Particles often settle to the bottom of the syringe

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Which studies would Tc99m MAA be used for

LaVeen shunt patency

Pre Y90 verification imaging for liver malignancy

Lung perfusion imaging

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What are some alternate names for Tc99m IDA

Mebrofenin

Disofenin

Hepatolite

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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

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Adverse reactions are not common in the field of nuclear medicine. Why is this

Pharmaceuticals are designed to reflect normal physiologic function

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Localization is a process that determines how a radiopharmaceutical will be distributed to various tissues and organs in the body (T/F)

True

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What is stannous chloride most often used for in kit preperation

A reducing agent

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Why is it important to test radiopharmaceuticals using chromatography strips

Unbound Tc04 causes background artifacts when imaging

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Why is functional assessment of the thyroid not possible when using Tc99m sodium pertechnetate

Tc99m sodium pertechnetate is trapped, but not organified

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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

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What radiopharmaceutical would you use to preform a bile leak study on a patient

Tc99m Mebrofrenin

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How many particles should be in an ideal dose of Tc99m MAA

350,000 particles

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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.

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A ligand is used for _____ within the body whereas, a reducing agent allows____ to occur

Localization and distribution

Binding

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Chromatography strips are used to test for the presence of unbound Tc99m in a given radiopharmaceutical (T/F)

True

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Tc99m Bisciisate (Neurolite) is an ideal imaging agent for brain perfusion studies because

It is rapidly localized and crosses the blood brain barrier

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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

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When injecting a patient with Tc99m IDA (Mebrofenin), Visualization of which structures should occur within 60 minutes

Liver

Common bile duct

Gallbladder

Small intestine

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What does a radiopharmaceutical consist of

Radionuclides and a pharmaceutical

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What does the ideal radiopharmaceutical consist of

Easily produced

Inexpensive

Readily available

Short half life

Produces gamma rays

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What is a ligand

Contributes to distribution

Localization which reflects a bodily function or metabolic process

They use small quantities

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What is a reducing agent?

Allows for binding

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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

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Name some single photon emitters

Tc99m
I123
I131
Xe 133
Ga67
In111
Tl201

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Name some positron emitters

F18
C11
N13
O15

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Tc99m half life and energy

6 hrs and 140 KeV, Decays by Isomeric Transition to Tc99

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Tc99m Sodium Pertechnetate concentrates where

Salivary glands, Thyroid tissue, Choroid plexus, Gastric mucosa, and functioning breast tissue

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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

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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

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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

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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

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Tc99m Phosphates, Medronate and Oxidronate

Used for Skeletal imaging

Pics taken 1-4 hours post injection

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Tc99m MAG 3 or Mertiatide

This is the most common renal imaging agent

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Tc99m DTPA or Pentetate

Used for renal imaging, Glomerular filtration, Aerosal lung ventilation, and brain but does not cross the blood-brain barrier

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Tc99m Succimer or Dimercaptosuccinic acid (DMSA)

Used for renal imaging

Bound to Protein

Imaging 3 hours post-injection

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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

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Tc99m Sestamibi or Cardiolite

Used for Cardiac imaging, parathyroid, and Gallbladder in some cases

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Tc99m Tetrofosmin or Myoview

Used for cardiac imaging

Must dilute prior to adding Tc99m, and final concentration should not exceed 80 mCi/ml

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Tc99m Pyrophosphate or PYP

First used for skeletal for osteogenesis, then cardiac for acute MI, now most commonly used for Cardia Amyloidosis

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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

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Tc99m Labeled WBC

Used to see inflammation, abscess or other infections

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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

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Tc99m Labeled RBC

Used for MUGA, GI bleed, and Liver hemangioma

Invitro is superior for imaging

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In vitro means

All tagging occurs outside the body then reinjected into the patient

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In Vivo means

All tagging occurs inside the body, the labeling is inefficient

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Indium 111

Cyclotron produced

Half-life 67 hours

Gamma photon

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IN 111 Labeled WBC or Oxine or Ozyquinoline

Used for abscesses or other infections

Easily crosses the WBC membrane

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IN 111 DTPA or Pentetate

Cyclotron produced

Used for Cisternography-injected into CSF to evaluate leak, and less common a liquid gastric emptying

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IN 111 Pentetreotide or Octreotide

Binds to somatostatin receptors

NET-Carcinoids, gastronomas, neuroblastomas, pituitary adenomas, medullary thyroid cancer

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I131

Half-life is 8 days

High energy gamma photon

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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

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I123

Cyclotron produced

Half-life is 13.2 hours

Dual-energy gamma photons-28 keV and 159 keV

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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

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I123 or I131 MIBG

Used for detection of pheochromocytoma and treatment of neuroblastoma

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I123 Ioflupane or Datscan

Maps dopamine transporters to brain, determines Parkinson’s disease

Pretreat with SSKI

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XE 133 Gas

Noble gas

Half-life is 5.2 days and a 14 day shelf life

Used for ventilation

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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

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F18

Cyclotron produced

Decays through Electron capture and Beta +

Half-life is 110 minutes

PET imaging

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F18 FDG or Florodeoxyglucose

Used for oncology, infection/inflammation, dementia, seizures, cardiology

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F18 Sodium Fluoride

Used for bone imaging

Defines osteogenic activity

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F18 Fluciclovine or Axumin

Used for prostate cancer-suspected or recurrent

3-5 min uptake

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F18 Pylarify (PSMA)

Used for recurrent/initial staging prostate cancer

Prostate-specific membrane antigen (PSMA) positive lesions.

60 min uptake

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F18 Florbetapir or Amyvid

Used for Alzheimer’s and cognitive decline

30-50 min uptake

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F18 Florbetaben or Neuroceq

Used for diagnosing Alzheimer’s and cognitive decline

45-130 min uptake

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F18 Flumetamol or Vizamyl

Used for Alzheimer’s diagnosis

60-120 min uptake

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CU 64 Dotatate or Detectnet

Slow injection 1-2 mins

Half-life is 12.7 hours

Beta + decay

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Ga68 Dotatate or Netspot

Half-life is 68 mins

Beta+ Decay

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Which radiopharmaceutical(s) would one use to diagnose the source of an infection or inflammation?

Tc99m HMPAOWBC

F18 FDG

In111 Oxine WBC

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Tc99m half life

6 hours

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Xe133 half life

5.2 days

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I123 half life

13.2 hours

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I131 half life

8 days

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F18 half life

110 mins

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Ga68 half life

68 mins

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Cu64 half life

12.7 hours

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Tl201 half life

73 hours

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In111 half life

67 hours

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Co57 half life

270 days

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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

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What layer of the heart does Tc99m Sestamibi bind to?

Myocardium

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What isotope(s) would you use to measure thyroid uptake?

I131 Nal

I123 Nal

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What imaging agent would be used to visualize and evaluate the parathyroid?

Tc99m Sestamibi

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The following isotopes are _____emitters: F18, Cu64, N13, O15, whereas the following isotopes are ______ emitters: Xe133, In111, Ga67, I123.

Positron

Single Photon

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What ways can Tc99m Sulfer Collloide be administered to patients?

Oral

Subcutaneous

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What would one use Tc99m DMSA for?

Renal transplant imaging

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SPECT/CT images can be performed on a patient that has been injected with F18 FDG. (T/F)

False

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Is Tc99m lymphoseek only used for lymphatic mapping?

Yes-in breast cancer and melanoma

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What is the ideal tagging process for Tc99m labeled RBCs?

In Vitro

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Which radiopharmaceutical is used in diagnosing cardiac amyloidosis

Tc99m PYP

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Tc99m HMPAO can be used for both white blood cell imaging and brain imaging. (T/F)

True

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I131 is an imaging agent that can only be administered orally. (T/F)

False

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Which of the following are acceptable diagnoses to use F18?

Oncology

Seizures

MRSA infection

Recurrent Prostate Cancer

Defining osteogenic activity

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Which of the following radioisotopes are produced in a cyclotron?

In 111

I 123

F18

Cu64

Tl201

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Where would you inject a patient with In111 DTPA when evaluating CSF leak?

Subarachnoid Space

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Ga68 NETSPOT is used to help in diagnosing NET (T/F)

True

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What Pet agent would you use to discover the source of an infection?

F18 FDG

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ACD is added when labeling WBCs to enhance sedimentation (T/F)

False, Hetastarch is added to enhance sedimentation

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Why do we administer SSKI before injecting a patient with I123 Datscan?

To block the thyroid from iodine uptake

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What is the half-life of I131?

8 days

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Tc99m Sulfer Colloid is used in which of the following imaging studies

Gastric Emptying

Melanoma Mapping

Bone Marrow Mapping

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When would you inject morphine during hepatobiliary imaging

After administrating Tc99m Mebrofenin, if the patient’s gallbladder isn’t visualized

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What is considered a normal EF following the administration of Kinevac

> 38%

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What dose of Morphine should be administered to a patient if they weighed 237 pounds

4.3 mg

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Regadenosen (Lexiscan) is the ideal pharmaceutical to administer for pharmacological stress tests (T/F)

True

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Kinevac should be diluted and administered quickly as a bolus (T/F)

False

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A written directive is required for all nuclear medicine procedures (T/F)

False

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Lasix should be stored in an area protected from light (T/F)

True

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What should you do following the injection of Lexiscan

Administer the radiopharmaceutical

Flush with 5 mL of Saline

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If requested, during what study should Pepcid be administered

Meckle’s Diverticulum

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How long should documents of therapeutic radioactive procedures be saved

7 Years

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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

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How long after the occurrence of a medical event must it be reported to a governing agency

24 Hours

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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

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What is the occupational exposure limit for a radiation worker?

5 rem

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How large of an area should a wipe test be performed on a package?

100 square centimeters

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How many mg of Lasix should be administered during a normal renal flow and function study

40 mg

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Radioactive packages should be surveyed, received, and checked in within ______during a normal working day

3 hours

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Which medication is most ideal for patients when performing a pharmacological stress test

Lexiscan

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Which medication is most often used as a reversal agent for prolonged side effects during a pharmacological stress test

Aminophylline

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An authorized user oversees quarterly records, quality control, and over-exposure incidents within a facility (T/F)

False, the RSO oversees these things.

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Which of the following exams would a technologist inject Tc99m MAA to perform

Lung perfusion

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NRC regulations which govern the medical use of byproducts material can be found in

10 CFR 35

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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

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The physical half-life of a radionuclide is the time it takes

For the nuclide to decay to one-half of the original activity

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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

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Tc99m Neurolite is used for what type of imaging

Evaluation of a brain death

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Renal imaging on patients with obstruction of the collecting system may be augmented by the administration of

Furosemide

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Mo99 found in Tc99m is an example of a

Radionuclidic impurity

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Which of the following kits are boiled during preperation

MAG 3
Sulfer Colloid

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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

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The philosophy of the ALARA program is to keep the dose

As Low As Reasonably Achievable

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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

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If a patient chart discloses that they have acquired a nosocomial infection, it means

That their infection was received through hospital transmission

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What are the functions of ACD and Herastarch when used in WBC tagging

ACD=anticoagulant
Herastarch=enhances blood sedimentation

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A package arrives from the radiopharmacy with a surface reading of 5 mrem/hr. What classification should the package be labeled as

Yellow II

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The collection of blood for RBC labeling should be preformed

With a heparinized syringe
Through a large bore needle or IV

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What material are Y90 SIRsphere microspheres comprised of

Resin

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Allowed USP alumina breakthrough limit is _____ug alumina/mL

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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

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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

Tc99m MAG 3
2.Tc99m IDA
Tc99m HDP
I123 Ioflupane

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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

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Gaseous radiopharmaceuticals like Xe133 may only be used in rooms that

Have negative air pressure compared to surrounding rooms

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Which of the following exams would a technologist inject Tc99m MAA to perform?

Lung perfusion

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NRC regulations which govern the medical use of byproduct material can be found in

10 CFR 35

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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

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The physical half-life of a radionuclide is the time it takes

For the nuclide to decay to one-half of the original activity

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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

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Tc99m Neurolite is used for what type of imaging

Evaluation of the brain death

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Renal imaging on patients with obstruction of the collecting system may be augmented by the administration of _____

Furosemide

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Mo99 found in Tc99m is an example of a

Radionulidic impurity

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Which of the following kits are boiled during preparation

MAG3

Sulfur Colloid

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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

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If a radiopharmaceutical is spilled on the floor, the first priority is to

Cover the area with absorbent paper and restrict access around it

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The philosophy of the ALARA program is to keep the dose

As Low As Reasonably Achievable

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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

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If a chart discloses that they have acquired a nosocomial infection, it means that

That their infection was received through hospital transmission

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What are the functions of ACD and Herastarch when used in the WBC Tagging

ACD=Anticoagulant

Herastarch=Enhances blood sedimentation

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A package arrives from the radiopharmacy with a surface reading of 5 mrem/hr. Which classification should the package be labeled as

Yellow II

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The collection of blood for RBC labeling should be performed

With a heparinized syringe

Through a large bore needle or IV

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What material are Y90 SIRsphere microspheres comprised of

Resin

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Allowed USP alumina breakthrough limit is

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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

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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

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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

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Gaseous radiopharmaceuticals like Xe133 may only be used in rooms that

Have negative air pressure compared to surrounding rooms

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Beta emitters are effective for therapeutic procedures because

They have a short range in soft tissue

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FDG enters cells by what means

It is transported through the cell membrane using facilitated diffusion by the facilitative glucose transporters

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In selective internal radiation therapy (SIRT), Y90 microspheres are administered in incremental

Infusions into the hepatic artery

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Intrathecal medications should be administered

Into the subarachnoid space

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What federal agency is responsible for the regulation of the uses of products material

NRC

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A package received from a commercial manufacturer should be monitored and checked in within what time period from delivery

180 minutes

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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

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Mo99 decays to Tc99m through what form of decay

Beta decay

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Ga67 is an example of a radionuclide that is

Cyclotron produced

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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

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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

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Which of the following medications could be used to perform a pharmacological nuclear stress test on a patient

Atropine

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Testing radiopharmaceuticals through chromatography is an important step because

Unbound Tc99m creates impurities-this causes background noise and abnormal uptake in imaging

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Which of the following isotopes would be effectively shielded by a plastic syringe shield?

Y90

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The occupational exposure limit for any radiation worker is

5 Rem

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Annihilation reaction is a characteristic of

Positron decay

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Which of the following units measures absorbed dose

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Who oversees quarterly records, quality control, and over exposure incidents within a facility

Radiation Safety Officer (RSO)

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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

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What are the two parts that make up the composition of a radiopharmaceutical?

Radionuclide & Pharmaceutical

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What is important in preventing backflow of blood in the heart

Chordae tendineae

Papillary muscles

AV valves

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What circulatory pathway carries oxygenated blood from the left ventricle, through the arteries, to the capillaries in the tissues of the body

Systemic

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What term describes the narrowing of the blood vessels, in particular, the large arteries and small arterioles

Vasoconstriction

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Gas exchange is the process of absorbing inhaled atmospheric oxygen molecules into the bloodstream and offloading ____from the bloodstream into the atmosphere

Carbon Dioxide

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The right ventricle pumps deoxygenated blood into the main pulmonary artery, which bifurcates into the left and right pulmonary

Arteries

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Within the mediastinum, the heart is separated from the other structures by a tough membrane known as the

Pericardium

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These cardiac structures act as a receiving chamber and contract to push blood into the ventricles

Atrium

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The groove on the outer surface of the heart marking the division between the atria and the ventricles is called the

Coronary sulcus

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

The ______is functionally the main constituent of the heart and the thickest layer of all three heart layers

Myocardium

What artery distributes blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum

Left coronary artery

Which valve separates the right atrium from the right ventricle

Tricuspid

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

What is the large systemic vein that returns blood to the heart from the inferior portion of the body

Inferior vena cava

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

To prevent any potential backflow, the _____also contract, generating tension on the chordae tendineae

Papillary muscles

What is the correct photopeak selection when using Tc99m Sulfur Colloid for a gastric emptying study

140 KeV (20% window)

Which isotopes are used for solid and liquid portions of a Gastric Empty study

Tc99m Sulfur Colloid

Indium 111 DTPA

For gastric emptying, when should the first, second, third, and fourth images be taken?

Immediate

1 hour

2 hour

4 hour

On most occasions, IV injection of Tc99m Pertechnetate is used for most Gastric Emptying studies (T/F)

False ( Tc99m Sulfur Colloid is used)

What pharmaceuticals should be suspended for 48 hours prior to a gastric emptying

Omeprazole

Examples of Indications during a gastric emptying include

Gastric outlet obstruction

Gastric Motility

Gastoparesis

Abdominal pain and nausea

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

How are images acquired for a typical gastric emptying study exam?

Anterior/Posterior upright

What collimators should be used if 0.25-1.0mCi of Tc99m Sulfur Colloid was used for a reflux study?

Low energy high resolution

Indications during gastroesophageal reflux include

Reflux

Aspiration Risk

Gastric motility

Contraindications during a gastroesophageal reflux exam include

None

Patient prep for a gastroesophageal reflux exam include

NPO 2-4 hours

A common name for a Gastroesophageal reflux study is a Milk Study (T/F)

True

The dose for a Gastroesophageal Reflux study is administered via a

Bottle or NG tube

NG tubes may be used to insert______tube should be flushed. If the tube is left in place it may cause______

Sulfur Colloid

Reflux

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

The gauge of IV that should be used when drawing or injecting up RBC’s is

19-21G

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)

What indications match most correctly for indications for a GI Bleed Scan

Intermittent gastrointestinal bleeding

Active gastrointestinal bleeding

Images should be obtained for_____dynamically for_____when acquiring images for a meckel diverticulum scan

1 min

60 mins

What isotope is used for injection for a Meckel Diverticulum Scan for an adult

8-12 mCi (296-444MBq) Tc99m Pertechnetate

What two pharmaceuticals are still in use for patient preparation for Meckel Diverticulum Imaging

Famotidine (Pepcid)

Cimetidine (Tagamet HB)

Indications for Meckel Diverticulum include

Pain in the abdomen

Painless rectal bleeding

Perforation of Illeum

Contraindications for Meckel Diverticulum include

Recent Upper GI series with barium (3-4 days)

Recent in Vivo RBC labeling study

Active rectal bleeding

Patient preparation for a Meckel Diverticulum is

NPO 4-6 Hours

Patients should void before and after imaging for a Meckel Diverticulum scan (T/F)

True

Most Meckel scans are done on adult female patients (T/F)

False, they are done mostly on small children

Usually a positive Meckel Diverticulum scan has a focal area of increased activity in the

Right Lower Quadrant

For a Meckel Diverticulum scan what photopeak window should be selected

140 KeV (20% window)

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

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

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

For gastric emptying study dietary restrictions would include being ______ and considering allergies for________

NPO 4-6 hours

Eggs and or gluten

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

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.

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

For patients receiving Tc99m RBCs it is recommended to interrupt breastfeeding for

24 hours

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

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

Tc99m exams use a _______ collimator and a ______ photopeak should be used

Low energy high resolution

140 KeV (20% window)

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

Which portion of the ECG wave demonstrates repolarization of the atria

None, Atrial repolarization is masked by ventricular depolarization

What cluster of cells manifest spontaneous depolarizations and are thus responsible for generating the normal cardiac rhythm

Sinoatrial node

Myocardial______cells initiate and propagate the action potential that travels throughout the heart and triggers the contractions that propel the blood

Conduction

Rapid depolarization is followed by the_____phase, in which membrane potential declines relatively slowly

Plateau

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

Without the SA node, the AV node would generate a heart rate of______beats per minute

40-60

In people with_____, the electrical signal that controls the heartbeat is partially or completely impeded from reaching the ventricles

Heart Block

Cardiac muscle cells act as a single unit called a

Functional syncytium

The delay in the______cardiac pulse ensures that the atria have ejected their blood into the ventricles first before the ventricles contract

AV node

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+

_______are abnormal pacemaker sites within the heart (outside of the SA node) that display automaticity

Ectopic foci

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

What is unique to cardiac muscle cells

Only cardiac muscle is capable of autoryththmicity

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

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

____is a measurement, expressed as a percentage of how much blood the left ventricle pumps out with each contraction

Ejection fraction

The ____system relies on several hormones that act to increase blood volume and peripheral resistance

Renin-angiotensin

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

All of the following pharmacological interventions for hypertension are considered first-line agents

Angiotensin-converting enzyme inhibitors

Thiazide diuretics

Calcium antagonists

Approximately 95% of patients with elevated arterial pressure have hypertension of unknown etiology, which is known as

Essential Hypertension

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

A blood pressure______is considered normal. Hypertension is defined as a blood pressure of_____mmHg

<120/80

130/80

Most patients with early hypertension have no symptoms attributed to high Blood pressure (T/F)

True

_______can be identified by echocardiography in nearly 30% of unselected hypertensive adults and in most patients with long-standing, severe hypertension

Left ventricular hypertrophy

Increased_____resulting from elevated peripheral vascular resistance and arterial stiffness is considered the principal determinant of myocardial hypertrophy in patients with hypertension

Ventricular afterload

Fibroblast proliferation and deposition of extracellular collagen accompany increases in _____size and contribution to ventricular stiffness and myocardial ischemia

Myocyte

More than_____of patients with heart failure have hypertension. Treating hypertension reduces the risk of heart failure by nearly ______

90%

50%

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%

When analyzing a HIDA scan is 30 min non-visualized GB post morphine normal, acute, or chronic

Acute

When analyzing the images for a HIDA is Visualizing all structures (Biliary tree, GB, Duodenum) within one hour normal, acute, or chronic

Normal

When analyzing images from a HIDA is GB visualized within 4 hours of injection normal, acute, or chronic

Chronic

When analyzing images for a HIDA is GB not visualized normal, acute, or chronic

Acute

When analyzing images for a HIDA if the liver fills within about 5 mins normal, acute, or chronic

Normal

When analyzing images for a HIDA is “can have Rim sign or pericholecystic hepatic activity sign” normal, acute, or chronic

Acute

When imaging a neonatal patient if activity shows up in the______after 16 hours it most likely indicates________

Biliary tree

Biliary Artesia

The term HIDA means

Hepatobiliary-Imino-Diacetic-Acid

What isotopes could be used for a HIDA scan

3-5 mCi mebrofenin (Choletec)

3-5 mCi of Disofenin (Hepatolite)

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

An appropriate fatty meal eaten within 24 hours before a HIDA scan could contain

A hamburger or something fatty

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

For an RBC Hemangioma, a patient should be NPO before proceeding with the scan (T/F)

False, there are no dietary restrictions

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

For RBC Hmenagioma a patient should observe a_______ period of interruption of breastfeeding when receiving Tc99m RBCs

24 hours

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

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

What are the indications to do an RBC Hemangioma scan

Cavernous Hemangioma

Tumors

Cysts

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

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)

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

What isotopes would be used for imaging Splenosis, with denatured RBCs

5-7 mCi Tc99m labeled RBCs

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%

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

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

The right coronary artery arises from the right coronary sinus and runs in the right______groove

Atrioventricular

The right coronary artery arises from the right coronary sinus and runs in the right______groove

Atrioventricular

The sinoatrial nodal and AV nodal coronary branches also arise from the

Right coronary artery

Heart dominance is described by which coronary artery branch gives rise to the_______ and supplies the inferior wall

Posterior descending artery

The LAD artery runs in the anterior introventricular groove toward the apex of the heart and supplies the_____wall of the _____ventricle

Left

Patients experiencing a _____should undergo emergent coronary angiography with the goal of establishing reperfusion with angioplasty

STEMI

What is used when performing a coronary angiogram

Catheter

Sheath

Guidewire

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

The Allen test assesses the patency of the arch circulation and involves the simultaneous compression of the_____and______arteries

Radial

Ulnar

To deliver contrast, the catheter is manipulated until it is coaxial with the_____of the coronary artery

Ostium

Comprehensive evaluation of the coronary arteries requires angiography in multiple views to ensure that all vessel segments are visualized without foreshortening or_____

Overlap

Coronary angiography delineates the vessel lumen but is unable to provide accurate information about the vessel wall (T/F)

True

What diagnostic technology uses a coronary guidewire attached to a pressure transducer to measure the hemodynamic significance of a lesion

Fractional flow angiography

______uses a catheter, x-ray imaging guidance and an injection of contrast material to examine blood vessels

Angiography

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

_____is characterized by chest discomfort or anginal equivalent that is provoked with exertion and alleviated at rest or with nitroglycerin

Stable angina

The major complications that can occur during or immediately after coronary angiography include death, stroke, and ______

Myocardial infarction

All of the following are considered relative contraindications to coronary angioraphy

Acute renal failure

Pregnancy

Acute stroke

___is a scoring system from 0-3 referring to levels of coronary blood flow assessed during angiography

TIMI

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

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

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

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

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

The______encompasses the region between the end of ventricular depolarization and beginning of ventricular repolarization on the ECG

ST segment

The______is located at the junction of the superior vena cava and the right atrium

Sinus node

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

The development of abnormal_____indicates absent conduction through the infarcted region and may last indefinitely

Q waves

Bundle branch blocks alter the shape and duration of the

QRS complex

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

The distance from the beginning of the P-Wave to the beginning of the Q wave is called

PR intervals

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

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

The electrical activity of the atrial repolarization is electrocardiographically silent because it occurs during the_____

QRS complex

The_____represents the period in which the myocardium maintains contraction to expel blood from the ventricles

ST segment

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

What isotope would be used in renal cortical imaging to evaluate pyelonephritis

5 mCi (185 MBq) Tc99m DSMA

What collimators could be used for a renal cortical scan

Low energy high resolution

Pinhole

Imaging of a Renal Cortical Tc99m DMSA scan, the imaging quality is considered inadequate (T/F)

False

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

What Isotopes would be used for a renal function test

10 mCi Tc99m Mercaptoacetyriglycine (MAG 3)

10 mCi Tc99m Diethylentiaminepentaacetic Acid (DTPA)

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.

Which exams would use Tc99m MAG3 or Tc99m DTPA for evaluating Renal Function

Renal perfusion/Function

Renal diuretic (renogram)

ACE inhibitor

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

On most occasions IV injection of Tc99m Pertechnetate is used for most gastric emptying studies (T/F)

False, Tc99m Sulfur Colloid

According to the package insert________should be pushed via IV_______to prevent_________

Furosemide (lasix)

Slowely

Deafness

What is the correct photopeak selection when using Tc99m Sulfur Colloid for a gastric Emptying Study

140 KeV (20% window)

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

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)

What are the most correct indications for a GI Bleed Scan

Intermittent gastrointestinal bleeding

Active gastrointestinal bleeding

What isotope is used for injection for a Meckel Diverticulum Scan for an adult

8-12 mCi Tc99m Pertechnetate

For a Captopril renal scan the acronym Ace means

Angiotensin Converting Enzyme

For patients receiving Tc99m-RBCs it is recommended to interrupt breastfeeding for

24 hours

Original method for RBC labeling

In vivo

Used for patients who cannot receive blood products for religious reasons

In Vivo

Withdraw 5-8 ml of blood into a shielded syringe with Tc99m (keep syringe attached-its closed procedure)

Modified in Vivo (in vitro)

Inject Stannous Pyrophosphate (closed procedure)

Modified In Vivo (In vitro)

Labeled efficiency >97%

In Vitro

Labeled efficiency 75-80%

In Vivo

1-3 ml heparinized blood to Ultratag Vial (Stannous chloride, NA citrate) and mix. Wait 5 mins

In Vitro

Labeled efficiency 85-90%

Modified In Vivo (In Vitro)

Most commonly used tagging method

In Vitro

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

A dose of Furosemide (Lasix)______is given usually 10-15 mins post radiopharmaceutical injection during a renal_______scan

40mg/4ml

Diuretic

What isotopes would be used for a HIDA scan

3-5 mCi Disofenin (Hepatolite)

3-5 mCi Mebrofenin (Choletec)

For a RBC Hemangioma 1-3 hour delayed image the tumor activity would look similar to what other areas/organs

Spleen

Heart Blood Pool

What are two pharmaceuticals still in use for patient preparation for Meckel Diverticulum Imaging

Famotidine (Pepcid)

Cimetidine (Tagamet HB)

What Isotope would be used for imaging Splenosis, with denatured RBCs

5-7 mCi Tc99m Labeled RBCs

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

What isotope would be used in Renal Cortical imaging to evaluate pyelonephritis

5 mCi Tc99m DSMA

What isotopes would be used for a renal function test

10 mCi Tc99m Mercaptoacetyriglycine (MAG3)

10 mCi Tc99m Diethylentiaminepentaacetic acid (DTPA)

The dose for a Gastroesophageal Reflux study is administered via a

Bottle or NG tube

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

What type of heart rhythm can cause the loss of consciousness

Ventricular Fibrillation

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

45 degree LAO is the best position to demonstrate what in the heart

The ventricular septal wall

Oxygenated blood returns to which heart chamber

Left atrium

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

Oversubtraction of background in an EF of the heart will cause

A false high LVEF

The gated blood pool study can demonstrate the presence of myocardial infarction by the presence of

Regional wall motion abnormalities

Regional wall motion abnormalities on a rest MUGA is or can be due to

Myocardial infarction

Stunned myocardium

Hibernating myocardium

In a bundle branch block ventricular contraction is delayed. What might this look like on an ECG

A long QRS interval

When performing a MUGA scan, increased activity is detected in the thyroid. This is probably because

There is free Tc99m Pertectnetate

Normal MUGA ejection fractions

Have higher EF for the left ventricle than for the right ventricle

Normal ejection fraction for the LVEF is

50-70%

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

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

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

QRS on an EKG represents what

Right and left ventricular systole

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

The T wave represents

Repolarization and relaxation of ventricles

What is pericarditis

Inflammation of the pericardium, which may or may not compromise cardiac function

Dyskinetic has what type of motion

Systolic outward motion

The purpose for the MUGA imaging study includes

Patient workup for Chemotherapy

Determination of ventricular ejection fraction

Evaluate ventricular wall motion

Which EKG point represents the electrical activity of the sinoatrial node. This point creates atrial systole

P wave

If the______segmant of an ECG exceeds .12 seconds (three small boxes), branch bundle block is probably present

QRS

The AV node stimulates contraction of the

Ventricles

Which EKG point represents the electrical activity of the atrioventricular node. This point creates ventricular systole

QRS

The EKG signal that is used for the trigger in a gated cardiac procedure is

Normal ejection fraction for the right ventricle is greater than the left ventricle (T/F)

False

A 12 lead ECG has 12 wires and 12 ECG patches (T/F)

False, it has 10

In gated cardiac blood pool procedures, imaging occurs

Continuously throughout the procedure using EKG timing to image at predetermined phases of the cardiac cycle

P cells in the heart are

Pacemaker cells, and are cells which create rhythm or a pace in the heart

Akenesis has what type of motion

No systolic wall motion

AV block is seen in what portion of an ECG

The PR interval

The_____is responsible for pumping oxygenated blood throughout the body

Left ventricle

The hearts primary electrical impulse is generated by the

SA node

Deoxygenated blood returns to which heart chamber

Right atrium

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

The percent of difference between ventricular systolic and diastolic volume is the

Ejection fraction

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

When mixing an ultratag kit with Tc99m pertechnetate

Mix the vial gently so as not to disrupt the Tc99m from tagging to RBCs

Hypokenesis has what type of motion

Reduced systolic motion

How long do we wait post injection of radiopharmaceutical before acquiring images in a MUGA gated study

3-5 mins

What is considered a normal blood pressure in a healthy adult

110 systolic and 70 for diastolic

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

What isotopes would be used for skeletal imaging

MDP (Methylene Diphosphonate)

HMDP (Hydroxymethylene Diphosphonate)

For a 3 phase bone scan for hardware loosening, what isotope would be used

10-20 mCi Tc99m MDP

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

Organize the phases in the correct order for a 3 phase skeletal exam of the hips

Flow
Pool
Delay
Extended delay
SPECT/CT

Calcium labeled with technetium is the most common and widely used method for bone imaging (T/F)

False

What are some indications for a bone scan

Hypercalcemia

Skeletal Metastases

Bone Lesions

_______act as a_______analog in the mineral portion of the bone

Diphosphonates

Phosphorus

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

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

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

What pharmaceuticals can be used for bone imaging for PET/CT scans

F-18 Sodium Flouride

F-18 Florodeoxyglucose (FDG)

______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

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

_______is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs

Thrombolysis

Non ST-segment elevation myocardial infarction is distinguished from unstable angina by elevated levels of

Cardiac enzymes

______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

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

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

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

An initial loading dose of 162 to 325 mg of______should be given to all patients suspected of having NSTE-ACS

Asprin

Plaque rupture that results in ACS is more likely to occur in lesions with <50% luminal stenosis due to less developed______

Fibrous Cap

All of the following are anticoagulant therapies

Bivalirudin

Low-molecular-weight heparin

Fondaparinux

All of the following are P2Y12 receptor inhibitors

Ticagrelor

Prasugrel

Clopidogrel

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

_____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

The physical examination in NSTE-ACS patients focuses on evaluating for signs of_______instability and heart failure

Hemodynamic

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

_____have become the preferred markers of myocardial necrosis due to their increased sensitivity and specificity for myocardial damage

Cardiac troponins

_______is caused by decreased cerebral blood flow leading to transient loss of consciousness and postural tone and is associated with spontaneous recovery

Syncope

Serial_____at 15-30 minute intervals should be performed in all patients with suspected ACS

Electrocardiograms

Approximately 30% of patients may present with atypical symptoms, which include isolated dyspnea, fatigue, pleuritic chest pain and______

Epigastric discomfort

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

Acute ST elevation myocardial infarction is usually caused by______rupture and subsequent acute______occlusion of a coronary artery

Plaque

Thrombotic

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

The______encompasses the region between the end of ventricular depolarization and the beginning of ventricular repolarization on the ECG

ST segment

_______dysfunction remains the most important predictor of death after survival of the acute phase of STEMI

Left ventricle

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

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

The use of drug eluting stents is advocated in the treatment of STEMI patients because of the reduced risk of _______

Restenosis

Treatment options that lower the mortality in acute STEMI focus on early reperfusion with _____ or _____

PCI

Thrombolytic therapy

Adhesion of platelets to the ulcerated plaque, with subsequent platelet activation and aggregation, leads to thrombin generation and conversion of _______ to _______

Fibrinogen

Fibrin

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

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

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

What is the correct sequence of myocardial injury during coronary occlusion

Normal state, Ischemia, injury, infarction

Typically, the ______ artery supplies blood to the sinoatrial and atrioventricular nodes, which regulate the heart rhythm.

Right Coronary

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

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

What two vessels are used for coronary artery bypass

Radial artery

Saphenous Vein

For a ventilation study using Tc99m what would be the correct photopeak window

140 KeV Photopeak

For a ventilation study using Xe133 what would be the correct photopeak window

81 KeV Photopeak window

A normal DTPA vent shows images homogeneous and symetrical aerosol deposition from apex to base of the lungs (T/F)

True

What projections are associated with an aerosol ventilation of the lung

LPO

LT Lat

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

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

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

For ventilation studies, what are the static projections that are typically acquired for a gas ventilation lung study

Posterior obliques

Posterior

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

Focal hot spots throughout the lung are an indication of what on a perfusion lung test

Injected blood clots

When identifying mismatched wedge-shaped defects from ventilation and perfusion imaging the wedges should be described in what ways

Size, number, location, shape, intensity

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

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

For a lung perfusion quantification scan what exam projection is the most common

AP/PA

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

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

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

When reviewing 3 phase bone scan imaging what would markedly asymmetrical perfusion indicate

Acute condition

A basic model for SPECT/CT bone imaging would be ______ rotation with ______ stops and approximately _______ sec/stop

360 degree

60-120

15-30

For SPECT/CT and PET/CT imaging patients are placed prone feet first (T/F)

False, supine feet first

What factors influence the imaging time for patients receiving PET/CT scans

Administered activity

Patient body weight

Sensitivity of PET scanner

________ act as a ______ analog in the mineral portion of the bone

Diphosphonates

Phosphorus

For a PET/CT scan imaging what would be an acceptable acquisition time per bed

3 min beds

Calcium labeled with technetium is the most common and widely used method for bone imaging (T/F)

False, MDP

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

Hydroxyapatite in bone is composed of what materials

Phosphate

Hydroxyl ions

Calcium

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

What are the potential consequences of aortic valve dysfunction

Impairment of LV outflow

Valvular incompetence with regurgitation

What are common symptoms of aortic stenosis due to its impact on LV outflow

Dyspnea

Angina

Syncope

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

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

What are potential causes of aortic regurgitation

Aortic valve annulus dilation

Abnormality of the aortic valve itself

What is the primary compensatory mechanism of the left ventricle in response to pressure overload from valve stenosis

Concentric left ventricular hypertrophy

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

What are common causes of acute aortic regurgitation

Infective endocarditis

Spontaneous rupture or prolapse of a valve cusp

Pharmacologic stress tests may be performed using

Dobutamine

Regadenoson

Adenosine

Matching defects on a stress/rest study is indicative of

Infarct area

The left ventricle myocardium is thicker than the right ventricle myocardium (T/F)

True

The largest of the coronary arteries and the most dangerous if occluded is the

Left anterior descending

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

The posterior and lateral wall of the left ventricle is nourished by the

Left circumflex artery

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

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

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

ST depression on an EKG is indicative of

Ischemia

Adverse effects of dipyridanole are reversed with

100-200 mg of IV Aminophylline

What is dilated when dipridamole, adenosine, and regadenoson are used instead of physical stress

Normal coronary arteries

Stress myocardial perfusion defect that fills in on the resting perfusion study is

Reversible and is an indication of ischenmia

Contraindications for stress exercise include

Lt Branch Bundle Block

Exercise intolerance, or disability

Patient is on a beta blocker

In PET imaging what happens

Two 511 kev emissions occur when the positron annihilates an electron

What heart imaging agents redistribute

Tl201 is the only one that redistributes

When performing a Tc99m Sestamibi for heart imaging, image acquisition must begin immediately after injection (T/F)

False, 30-60 mins after

What does not show up on rest on myocardial imaging

Ischemia

Rubidium PET imaging has a resolution of about 4mm compared to 12mm with SPECT imaging (T/F)

True

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

For an exercise stress test to be adequate, the patient should achieve at least 85 % of their maximum predicted heart rate (T/F)

True

What is a positron

A positively charged particle with the mass of an electron

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.

Regadenoson (lexiscan) is reversed by

Aminophylline or Caffeine

What radionuclide is considered the Gold standard when assessing myocardial viability

FDG18 PET imaging

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

The most common cause of false negative exams in cardiac imaging is

Submaximal stress

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

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

Why do we wait after an injection of sestamibi or tetrofosmin prior to imaging the heart

To allow for hepatobiliary clearance

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

MNost nuclear medicine departments use SPECT rotating gamma scintigraphy and image ______degrees for cardiac imaging

180 degrees

The inferior and posterior walls of the left ventricle, and the right ventricle are nourished by the

Right coronary artery

Bruce protocol indicates maximum stress is determined by

220 bpm minus patient’s age

Hibernating myocardium is a significant finding because

it means the myocardium in question is still viable and not infarcted

During a stress for myocardial perfusion imaging, the patient must be injected

During the stress

A focal decrease in perfusion occuring on a rest image is most commonly caused by

Previous myocardial infarction

Which nuclide behaves similarly to Tl201 by utilizing sodium and potassium pumps

Rubidium 82

When considering a Stress/rest sestamibi protocol, when could the stress only be performed

When stress images demonstrate normal radionuclide distribution

Flourodeoxyglucose FDG is produced in a

Cyclotron by accelerating protons into target atoms

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

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

During the Bruce protocol, a patient should continue to exercise for at least ______ following dose administration of the radiopharmaceutical

1-2 minutes

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

ST elevation on an EKG is indicative of

Infarct

The anterior wall of the left ventricle is nourished by

Left anterior descending artery

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

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