Essentials of Nuclear Medicine and Molecular Imaging Flashcards
All Isotopes
Have different number of neutrons
Have the same number of protons
Have the same chemical properties
Nuclear reactors best produce ______ rich radioisotopes, where a cyclotron best produces ______rich radioisotopes
Neutron
Proton
Are all radioisotopes used in Nuclear Medicine metastable (T/F)
True
Choose how the radioisotope is produced
F18
Tc99m
Rb82
I 123
Cyclotron
Generator
Generator
Cyclotron
What is the energy and half life of Tc99m
140 keV and 6 hours
What is the daughter nuclide of Mo99
Tc99m
2P + 2N released=atomic mass number decreasing
Alpha decay
Particle is emitted from the nucleus
Beta decay
An inner orbital electron is captured by a proton from the nucleus
Electron capture
Protons and neutrons are unchanged; decays from high to low excited state
Isomeric Transition
The excess nucleus energy transfers to an orbital electron
Internal conversion
This is released as a result of Isomeric Transition
Gamma Ray
The excess protons in a nucleus combine with an electron and release 2 photons
Positron decay
What is the appropriate shielding to the type of radioactive decay
Alpha
Beta
Gamma
Paper shielding
Plastic or thin aluminum
Lead
What form of decay results in a proton transforming into a neutron and a neutrino
Electron Capture
What is the Mo99 breakthrough limit
Mo99’s breakthrough limit is 0.15 micro Ci
What substance is a M099/Tc99m generator eluted with
NaCl Sodium Chloride
Most radioactive material that does not occur naturally can be produced by which two ways
Nuclear Fission
Bombardment
All isotopes of an element have the same number of protons and have a different number of what
Neutrons
Mo99 decays to Tc99m through what form of decay
Beta Decay
Gamma emission is ALWAYS preceded by Electron Capture, Alpha, Beta, or Positron Emission (T/F)
True
What does the “m” in Tc99m stand for
Metastable
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.
Radionuclides are isotopes attempting to reach stability by emitting radiation (T/F)
True
Isotopes are
Atoms of the same element
Have the same number of protons, different number of neutrons.
Metastable refers to the intermediate time in which a daughter nucleus remains in the excited state (high energy) (T/F)
True
Beta decay
An excess neutron is emitted and transforms to a proton accompanied by an antineutrino
Electron capture
An inner orbital electron is captured by a proton from the nucleus
Alpha decay
Emits large particles that result in a decrease in atomic mass number; travel very small distances
Internal conversion
Results in excess energy in the nucleus transferring to an orbital electron; characteristic radiation occurs
Positron decay
To many protons are in the nucleus; loses energy and combines with an electron
Gamma emission
Always preceded by another form of decay.
What is the half-life of a radioactive isotope
The time it takes for the radioactivity to decay to half of its original value
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
Convert 1550 uCi to GBq
5.7 x 10^-2 Gbq
A nuclear reactor uses particulate bombardment to produce isotopes which are primarily proton rich (T/F)
False, they are neutron rich
A Curie is part of the international system of units (SI) (T/F)
False, becquerel is the international system of units
Convert 700 kBq to mCi
1.9 x 10^-2
What components make up a radiopharmaceutical
Radionuclide and pharmaceutical
A radiopharmaceutical kit includes components that cause a physical reaction when a radionuclide is added (T/F)
False, they cause a chemical reaction
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
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
Why must you agitate a syringe of Tc99m MAA before injecting it into the patient
Particles often settle to the bottom of the syringe
Which studies would Tc99m MAA be used for
LaVeen shunt patency
Pre Y90 verification imaging for liver malignancy
Lung perfusion imaging
What are some alternate names for Tc99m IDA
Mebrofenin
Disofenin
Hepatolite
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
Adverse reactions are not common in the field of nuclear medicine. Why is this
Pharmaceuticals are designed to reflect normal physiologic function
Localization is a process that determines how a radiopharmaceutical will be distributed to various tissues and organs in the body (T/F)
True
What is stannous chloride most often used for in kit preperation
A reducing agent
Why is it important to test radiopharmaceuticals using chromatography strips
Unbound Tc04 causes background artifacts when imaging
Why is functional assessment of the thyroid not possible when using Tc99m sodium pertechnetate
Tc99m sodium pertechnetate is trapped, but not organified
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
What radiopharmaceutical would you use to preform a bile leak study on a patient
Tc99m Mebrofrenin
How many particles should be in an ideal dose of Tc99m MAA
350,000 particles
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.
A ligand is used for _____ within the body whereas, a reducing agent allows____ to occur
Localization and distribution
Binding
Chromatography strips are used to test for the presence of unbound Tc99m in a given radiopharmaceutical (T/F)
True
Tc99m Bisciisate (Neurolite) is an ideal imaging agent for brain perfusion studies because
It is rapidly localized and crosses the blood brain barrier
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
When injecting a patient with Tc99m IDA (Mebrofenin), Visualization of which structures should occur within 60 minutes
Liver
Common bile duct
Gallbladder
Small intestine
What does a radiopharmaceutical consist of
Radionuclides and a pharmaceutical
What does the ideal radiopharmaceutical consist of
Easily produced
Inexpensive
Readily available
Short half life
Produces gamma rays
What is a ligand
Contributes to distribution
Localization which reflects a bodily function or metabolic process
They use small quantities
What is a reducing agent?
Allows for binding
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
Name some single photon emitters
Tc99m
I123
I131
Xe 133
Ga67
In111
Tl201
Name some positron emitters
F18
C11
N13
O15
Tc99m half life and energy
6 hrs and 140 KeV, Decays by Isomeric Transition to Tc99
Tc99m Sodium Pertechnetate concentrates where
Salivary glands, Thyroid tissue, Choroid plexus, Gastric mucosa, and functioning breast tissue
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
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
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
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
Tc99m Phosphates, Medronate and Oxidronate
Used for Skeletal imaging
Pics taken 1-4 hours post injection
Tc99m MAG 3 or Mertiatide
This is the most common renal imaging agent
Tc99m DTPA or Pentetate
Used for renal imaging, Glomerular filtration, Aerosal lung ventilation, and brain but does not cross the blood-brain barrier
Tc99m Succimer or Dimercaptosuccinic acid (DMSA)
Used for renal imaging
Bound to Protein
Imaging 3 hours post-injection
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
Tc99m Sestamibi or Cardiolite
Used for Cardiac imaging, parathyroid, and Gallbladder in some cases
Tc99m Tetrofosmin or Myoview
Used for cardiac imaging
Must dilute prior to adding Tc99m, and final concentration should not exceed 80 mCi/ml
Tc99m Pyrophosphate or PYP
First used for skeletal for osteogenesis, then cardiac for acute MI, now most commonly used for Cardia Amyloidosis
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
Tc99m Labeled WBC
Used to see inflammation, abscess or other infections
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
Tc99m Labeled RBC
Used for MUGA, GI bleed, and Liver hemangioma
Invitro is superior for imaging
In vitro means
All tagging occurs outside the body then reinjected into the patient
In Vivo means
All tagging occurs inside the body, the labeling is inefficient
Indium 111
Cyclotron produced
Half-life 67 hours
Gamma photon
IN 111 Labeled WBC or Oxine or Ozyquinoline
Used for abscesses or other infections
Easily crosses the WBC membrane
IN 111 DTPA or Pentetate
Cyclotron produced
Used for Cisternography-injected into CSF to evaluate leak, and less common a liquid gastric emptying
IN 111 Pentetreotide or Octreotide
Binds to somatostatin receptors
NET-Carcinoids, gastronomas, neuroblastomas, pituitary adenomas, medullary thyroid cancer
I131
Half-life is 8 days
High energy gamma photon
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
I123
Cyclotron produced
Half-life is 13.2 hours
Dual-energy gamma photons-28 keV and 159 keV
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
I123 or I131 MIBG
Used for detection of pheochromocytoma and treatment of neuroblastoma
I123 Ioflupane or Datscan
Maps dopamine transporters to brain, determines Parkinson’s disease
Pretreat with SSKI
XE 133 Gas
Noble gas
Half-life is 5.2 days and a 14 day shelf life
Used for ventilation
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
F18
Cyclotron produced
Decays through Electron capture and Beta +
Half-life is 110 minutes
PET imaging
F18 FDG or Florodeoxyglucose
Used for oncology, infection/inflammation, dementia, seizures, cardiology
F18 Sodium Fluoride
Used for bone imaging
Defines osteogenic activity
F18 Fluciclovine or Axumin
Used for prostate cancer-suspected or recurrent
3-5 min uptake
F18 Pylarify (PSMA)
Used for recurrent/initial staging prostate cancer
Prostate-specific membrane antigen (PSMA) positive lesions.
60 min uptake
F18 Florbetapir or Amyvid
Used for Alzheimer’s and cognitive decline
30-50 min uptake
F18 Florbetaben or Neuroceq
Used for diagnosing Alzheimer’s and cognitive decline
45-130 min uptake
F18 Flumetamol or Vizamyl
Used for Alzheimer’s diagnosis
60-120 min uptake
CU 64 Dotatate or Detectnet
Slow injection 1-2 mins
Half-life is 12.7 hours
Beta + decay
Ga68 Dotatate or Netspot
Half-life is 68 mins
Beta+ Decay
Which radiopharmaceutical(s) would one use to diagnose the source of an infection or inflammation?
Tc99m HMPAOWBC
F18 FDG
In111 Oxine WBC
Tc99m half life
6 hours
Xe133 half life
5.2 days
I123 half life
13.2 hours
I131 half life
8 days
F18 half life
110 mins
Ga68 half life
68 mins
Cu64 half life
12.7 hours
Tl201 half life
73 hours
In111 half life
67 hours
Co57 half life
270 days
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
What layer of the heart does Tc99m Sestamibi bind to?
Myocardium
What isotope(s) would you use to measure thyroid uptake?
I131 Nal
I123 Nal
What imaging agent would be used to visualize and evaluate the parathyroid?
Tc99m Sestamibi
The following isotopes are _____emitters: F18, Cu64, N13, O15, whereas the following isotopes are ______ emitters: Xe133, In111, Ga67, I123.
Positron
Single Photon
What ways can Tc99m Sulfer Collloide be administered to patients?
Oral
IV
Subcutaneous
What would one use Tc99m DMSA for?
Renal transplant imaging
SPECT/CT images can be performed on a patient that has been injected with F18 FDG. (T/F)
False
Is Tc99m lymphoseek only used for lymphatic mapping?
Yes-in breast cancer and melanoma
What is the ideal tagging process for Tc99m labeled RBCs?
In Vitro
Which radiopharmaceutical is used in diagnosing cardiac amyloidosis
Tc99m PYP
Tc99m HMPAO can be used for both white blood cell imaging and brain imaging. (T/F)
True
I131 is an imaging agent that can only be administered orally. (T/F)
False
Which of the following are acceptable diagnoses to use F18?
Oncology
Seizures
MRSA infection
Recurrent Prostate Cancer
Defining osteogenic activity
Which of the following radioisotopes are produced in a cyclotron?
In 111
I 123
F18
Cu64
Tl201
Where would you inject a patient with In111 DTPA when evaluating CSF leak?
Subarachnoid Space
Ga68 NETSPOT is used to help in diagnosing NET (T/F)
True
What Pet agent would you use to discover the source of an infection?
F18 FDG
ACD is added when labeling WBCs to enhance sedimentation (T/F)
False, Hetastarch is added to enhance sedimentation
Why do we administer SSKI before injecting a patient with I123 Datscan?
To block the thyroid from iodine uptake
What is the half-life of I131?
8 days
Tc99m Sulfer Colloid is used in which of the following imaging studies
Gastric Emptying
Melanoma Mapping
Bone Marrow Mapping
When would you inject morphine during hepatobiliary imaging
After administrating Tc99m Mebrofenin, if the patient’s gallbladder isn’t visualized
What is considered a normal EF following the administration of Kinevac
> 38%
What dose of Morphine should be administered to a patient if they weighed 237 pounds
4.3 mg
Regadenosen (Lexiscan) is the ideal pharmaceutical to administer for pharmacological stress tests (T/F)
True
Kinevac should be diluted and administered quickly as a bolus (T/F)
False
A written directive is required for all nuclear medicine procedures (T/F)
False
Lasix should be stored in an area protected from light (T/F)
True
What should you do following the injection of Lexiscan
Administer the radiopharmaceutical
Flush with 5 mL of Saline
If requested, during what study should Pepcid be administered
Meckle’s Diverticulum
How long should documents of therapeutic radioactive procedures be saved
7 Years
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
How long after the occurrence of a medical event must it be reported to a governing agency
24 Hours
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
What is the occupational exposure limit for a radiation worker?
5 rem
How large of an area should a wipe test be performed on a package?
100 square centimeters
How many mg of Lasix should be administered during a normal renal flow and function study
40 mg
Radioactive packages should be surveyed, received, and checked in within ______during a normal working day
3 hours
Which medication is most ideal for patients when performing a pharmacological stress test
Lexiscan
Which medication is most often used as a reversal agent for prolonged side effects during a pharmacological stress test
Aminophylline
An authorized user oversees quarterly records, quality control, and over-exposure incidents within a facility (T/F)
False, the RSO oversees these things.
Which of the following exams would a technologist inject Tc99m MAA to perform
Lung perfusion
NRC regulations which govern the medical use of byproducts material can be found in
10 CFR 35
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
The physical half-life of a radionuclide is the time it takes
For the nuclide to decay to one-half of the original activity
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
Tc99m Neurolite is used for what type of imaging
Evaluation of a brain death
Renal imaging on patients with obstruction of the collecting system may be augmented by the administration of
Furosemide
Mo99 found in Tc99m is an example of a
Radionuclidic impurity
Which of the following kits are boiled during preperation
MAG 3
Sulfer Colloid
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
The philosophy of the ALARA program is to keep the dose
As Low As Reasonably Achievable
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
If a patient chart discloses that they have acquired a nosocomial infection, it means
That their infection was received through hospital transmission
What are the functions of ACD and Herastarch when used in WBC tagging
ACD=anticoagulant
Herastarch=enhances blood sedimentation
A package arrives from the radiopharmacy with a surface reading of 5 mrem/hr. What classification should the package be labeled as
Yellow II
The collection of blood for RBC labeling should be preformed
With a heparinized syringe
Through a large bore needle or IV
What material are Y90 SIRsphere microspheres comprised of
Resin
Allowed USP alumina breakthrough limit is _____ug alumina/mL
10
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
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
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
Gaseous radiopharmaceuticals like Xe133 may only be used in rooms that
Have negative air pressure compared to surrounding rooms
Which of the following exams would a technologist inject Tc99m MAA to perform?
Lung perfusion
NRC regulations which govern the medical use of byproduct material can be found in
10 CFR 35
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
The physical half-life of a radionuclide is the time it takes
For the nuclide to decay to one-half of the original activity
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
Tc99m Neurolite is used for what type of imaging
Evaluation of the brain death
Renal imaging on patients with obstruction of the collecting system may be augmented by the administration of _____
Furosemide
Mo99 found in Tc99m is an example of a
Radionulidic impurity
Which of the following kits are boiled during preparation
MAG3
Sulfur Colloid
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
If a radiopharmaceutical is spilled on the floor, the first priority is to
Cover the area with absorbent paper and restrict access around it
The philosophy of the ALARA program is to keep the dose
As Low As Reasonably Achievable
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
If a chart discloses that they have acquired a nosocomial infection, it means that
That their infection was received through hospital transmission
What are the functions of ACD and Herastarch when used in the WBC Tagging
ACD=Anticoagulant
Herastarch=Enhances blood sedimentation
A package arrives from the radiopharmacy with a surface reading of 5 mrem/hr. Which classification should the package be labeled as
Yellow II
The collection of blood for RBC labeling should be performed
With a heparinized syringe
Through a large bore needle or IV
What material are Y90 SIRsphere microspheres comprised of
Resin
Allowed USP alumina breakthrough limit is
10
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
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
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
Gaseous radiopharmaceuticals like Xe133 may only be used in rooms that
Have negative air pressure compared to surrounding rooms
Beta emitters are effective for therapeutic procedures because
They have a short range in soft tissue
FDG enters cells by what means
It is transported through the cell membrane using facilitated diffusion by the facilitative glucose transporters
In selective internal radiation therapy (SIRT), Y90 microspheres are administered in incremental
Infusions into the hepatic artery
Intrathecal medications should be administered
Into the subarachnoid space
What federal agency is responsible for the regulation of the uses of products material
NRC
A package received from a commercial manufacturer should be monitored and checked in within what time period from delivery
180 minutes
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
Mo99 decays to Tc99m through what form of decay
Beta decay
Ga67 is an example of a radionuclide that is
Cyclotron produced
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
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
Which of the following medications could be used to perform a pharmacological nuclear stress test on a patient
Atropine
Testing radiopharmaceuticals through chromatography is an important step because
Unbound Tc99m creates impurities-this causes background noise and abnormal uptake in imaging
Which of the following isotopes would be effectively shielded by a plastic syringe shield?
Y90
The occupational exposure limit for any radiation worker is
5 Rem
Annihilation reaction is a characteristic of
Positron decay
Which of the following units measures absorbed dose
Gy
Who oversees quarterly records, quality control, and over exposure incidents within a facility
Radiation Safety Officer (RSO)
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
What are the two parts that make up the composition of a radiopharmaceutical?
Radionuclide & Pharmaceutical
What is important in preventing backflow of blood in the heart
Chordae tendineae
Papillary muscles
AV valves
What circulatory pathway carries oxygenated blood from the left ventricle, through the arteries, to the capillaries in the tissues of the body
Systemic
What term describes the narrowing of the blood vessels, in particular, the large arteries and small arterioles
Vasoconstriction
Gas exchange is the process of absorbing inhaled atmospheric oxygen molecules into the bloodstream and offloading ____from the bloodstream into the atmosphere
Carbon Dioxide
The right ventricle pumps deoxygenated blood into the main pulmonary artery, which bifurcates into the left and right pulmonary
Arteries
Within the mediastinum, the heart is separated from the other structures by a tough membrane known as the
Pericardium
These cardiac structures act as a receiving chamber and contract to push blood into the ventricles
Atrium
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
Anterior
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
R
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
AP
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
Anterior
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
