Exam 1 Flashcards

Question 1

Q

Before tracer administration, all of the following preparations are required for a 27-year-old woman referred for total body bone imaging except:

a. explaining the procedure to the patient
b. answering the patient’s questions
c. ruling out pregnancy
d. removing attenuating materials from the patient

Answer

A

d. Explaining the procedure and answering any questions the patient may have are preparations common to any procedure. If the patient is a female of childbaring age, the possibility of pregnancy must also be ruled out before administrating the tracer. Pregnancy is a contraindication for procedures involving radiation unless the procedure is being performed for emergency reasons. It is not necessary to have the patient remove any attenuating materials until just before he or she is imaged.

Question 2

Q

Which of the following structures normally appear as areas of increased activity on the bone images of children?

a. diaphyses of the long bones
b. breast tissue
c. costochondral junctions and epiphyseal plates
d. lumber spine and cranium

Answer

A

c. In children, normally increased tracer activity appears in areas of active bone growth. These areas include the epiphyseal plates at the ends of the long bones and the costochondral junctions in the ribs.

Question 3

Q

If tracer concentration is visualized in the skeleton, stomach, thyroid, and salivary glands on a bone image, the most likely explanation for these findings is that the:

a. patient was imaged too soon after tracer administration
b. radiopharmaceutical contained excess free Tc99m Pertechnetate
c. patient’s renal function is compromised
d. incorrect radiopharmaceutical was administered

Answer

A

b. Tc99m labeled bone agents are prepared by combining medromite or oxidronate with Tc99m Pertechnetate. Typically, about 3-10% of the pertechnetate does not bind to the medronate or oxidronate, so there is always some unbound or “free” pertechnetate in any bone tracer preparation. However, this percentage is small compared with the amount of Tc99m Medronate or Tc99m Oxidronate in the preparation and is not visualized on the bone image. If the radiopharmaceautical was not properly compounded, the excess Tc99m Pertechnetate taken up by the thyroid, salivary glands, and stomach is visualized on the bone image.

Question 4

Q

For interpretation of nuclear medicine lung images, a chest Xray is required to:

a. determine cardiac size
b. rule out a pulmonary embolus
c. rule out previous lung surgery
d. rule out possible causes of the patient’s symptoms

Answer

A

d. many of the symptoms of pulmonary emboli are similar to those of rib fracture, myocardial infarction, and pneumonia. A chest radiograph allows the interpreting physician to rule out certain of these conditions, thereby increasing the specificity of the lung image findings

Question 5

Q

An image showing spots after the administration of Tc99m MAA. Which of the following is the most likely explanation for the quality of this lung perfusion image?

a. the image shows lung pathology
b. blood clotted to MAA particles was injected intravenously
c. there is radioactive contamination on the patient’s skin or camera detector
d. too many MAA particles were administered to the patient

Answer

A

b. Blood that is withdrawn into the syringe and allowed to mix with the Tc99m MAA for a prolonged period may cause the MAA particles to clump together and the blood to clot. If this mixture is then injected into the patient, the clumped particles and “labeled” blood clots are trapped in the lung vasculature and appear as multiple small hot spots on the image

Question 6

Q

The purpose of a charcoal filter in a xenon delivery unit is to absorb:

a. bacteria
b. carbon dioxide
c. moisture
d. xenon gas

Answer

A

d. The NRC sets limits on the airborne concentration of Xe133. For this reason, Xe133 that the patient exhales must be trapped for decay. Certain xenon-delivery units use activated charcoal for trapping Xenon.

Question 7

Q

Radionuclide venography may be performed with which of the following radiopharmaceuticals?

a. Tc99m Pentetate
b. Tc99m Pertechnetate
c. Tc99m Exametazime
d. Tc99m MAA

Answer

A

d. The deep venous system of the lower extremities may be imaged with Tc99m MAA or Tc99m labeled Red Blood Cells (RBC’s). If Tc99m MAA is used, the lungs may be imaged after the venography to rule out pulmonary embolism.

Question 8

Q

If ectopic thyroid tissue is suspected, the technologist can expect to find it most commonly in which of the following areas?

a. in the brain
b. at the base of the tongue
c. in the mediastinum
d. at the base of the tongue or in the mediastinum

Answer

A

d. Sublingual thyroid tissue occurs when the tissue does not descend from the base of the tongue to the neck during fetal development. It is often associated with hypothyroidism. Metiastinal thyroid tissue is often discovered after investigation of an anterior mediastinal mass visualized on chest x-ray.

Question 9

Q

During parathyroid imaging, images of the chest as well as the neck are obtained to:

a. correct the image series for patient rotation
b. visualize substernal parathyroid tissue
c. visualize substernal thyroid tissue
d. diagnose hyperthyroidism

Answer

A

b. the upper mediastinum between the heart and the thyroid is imaged to visualize ectopic parathyroid tissue

Question 10

Q

When performing a gated equilibrium cardiac study, which of the following anatomical views best separates the right and left ventricles?

a. left lateral
b. left posterior oblique
c. left anterior oblique
d. anterior

Answer

A

c. The left anterior oblique view is the projection from which the ejection fraction (EF) is calculated. It is extremely important to separate the two ventricles to obtain an accurate EF value. Typically, 35-45 degree of rotation accomplishes the separation. However, the camera should be positioned according to the patient’s own anatomy to optimize separation of the two structures.

Question 11

Q

In preparation for Tl201 stress test, patients are instructed to fast to:

a. prevent gastrointestinal upsets during exercise
b. minimize tracer uptake in the gastrointestinal tract
c. enhance myocardial tracer uptake
d. standardize test conditions among patients

Answer

A

b. Digestion directs more of the cardiac output toward the gut. Although this probably will not significantly affect myocardial uptake of the tracer, excessive tracer in the upper abdominal viscera interferes with visualization of the myocardial wall, especially when the patient is supine.

Question 12

Q

Which of the following agents used for pharmacologic stress testing remains in the plasma for the greatest length of time?

a. dobutamine
b. adenosine
c. dipyridamole
d. nitroglycerin

Answer

A

c. Nitroglycerin is not used to indue pharmacologic stress. The plasma half-lives for the agents used in pharmacologic stress testing are:

adenosine (Adenocard) = less than 10 sec directly increases the level of adenosine in the patient’s blood

dobutamine (Dobutrex) = 2 min is a synthetic catecholamine that acts on alpha- and beta- adrenergic receptors producing inotropic and chronotropic effects that increase cardiac work

regadenoson (Lexiscan) = 1-3 min is a A2A adenosine receptor that activates the A2A adenosine receptor and produces coranry vasodilation which increases coronary blood flow

dipyridamole (Persantine)= 15-30 min indirectly increases the level of exogenous adenosine in the patient’s blood by deactivating adenosine deaminase

Question 13

Q

SPECT liver imaging with Tc99m Sulfur Colloid is performed how soon after tracer administration?

a. immediately
b. 10-15 mins
c. 30-45 mins
d. 1-2 hours

Answer

A

b. a 10-15 min time interval is necessary for the colloidal particles to be completely localized within the liver and spleen

Question 14

Q

Significantly increased serum bilirubin levels will most likely cause which of the following to be visualized on hepatobiliary images?

a. colon
b. kidneys
c. lungs
d. spleen

Answer

A

b. Increased serum bilirubin levels indicate poorly functioning hepatocytes. Therefore, these cells cannot efficiently remove the tracer from the blood, causing the tracer to be excreted through the urinary system.

Question 15

Q

Localization of Meckel’s diverticulum can be accomplished with which of the following radiopharmaceuticals?

a. Ga67 Citrate
b. Tc99m Pentetate
c. Tc99m Pertechnetate
d. Tc99m Sulfur Colloid

Answer

A

c. Tc99m Pertechnetate is used to visualize a Meckle’s diverticulum. Often the Meckle’s diverticulum is lined with gastric mucosa that concentrates this tracer.

Question 16

Q

In infants, 24 hr images are sometimes performed over what area to demonstrate gastroesophageal reflux?

a. lung fields
b. lower esophagus
c. stomach
d. upper small intestine

Answer

A

a. 24 hr images are useful in infants for demonstrating aspiration of stomach contents and aspiration occurs in the lungs

Question 17

Q

Effective renal plasma flow (ERPF) is measured with which of the following radiopharmaceuticals?

a. Tc99m Pentetate
b. Tc99m Disofenin
c. Tc99m Medronate
d. Tc99m Meritiatide

Answer

A

d. ERPF is primarily a measurement of tubular function; therefore, a renal agent that is secreted by the tubules must be used. Tc99m Meritiatide (MAG3) is secreted by the renal tubules and is useful to determine ERPF

Question 18

Q

Evaluating the quality of a bolus injection is best accomplished by which of the following techniques?

a. visually inspecting the bolus
b. calculating the cardiac transit time
c. generating a time- activity curve for the superior vena cava
d. imaging the injection site for residual activity

Answer

A

c. evaluating the quality of bolus injection is accomplished by generating a time activity curve over the superior vena cava and measuring the full width at half maximum (FMHM). If the left ventricular ejection fraction is being determined, an FWHM less than or equal to 1 second indicates a technically satisfactory bolus injection. For right ventricular ejection fraction, an FWHM of 2-3 sec is adequate

Question 19

Q

Which of the following is/are not normally visualized on a Ga67 image acquired 72 hr after tracer administration?

a. kidneys
b. lacrimal glands
c. sternum
d. liver

Answer

A

a. in the first 24hr after administration, the kidneys excrete almost one third of the Ga67 injected. Hence, renal activity is normally visualized on images up to 48hr after tracer administration. After 48hr; renal activity indicates disease.

Question 20

Q

Which of the following statements about transmission-based precautions is false?

a. These precautions are applied when a patient is known to be infected with a communicable disease.
b. These precautions must be implemented in the case of diseases such as varicella, tuberculosis, and mumps.
c. These precautions replace standard precautions.
d. These precautions include guidelines for airborne, droplet, and contact transmitted diseases.

Answer

A

c. Transmission based precautions are applied along with standard precautions when a patient is known to be infected with a communicable disease. They are second level of precautions that include additional safety measures depending on the method in which the disease is question is transmitted.

Question 21

Q

Which of the following statements about pentetreotide is true?

a. It is labeled with technetium 99 metastable.
b. It is labeled antibody.
c. It exhibits no human antimurine antibody (HAMA) effect.
d. It is excreted exclusively through the kidneys.

Answer

A

c. Pentreotide is an analog from the hormone somatostatin, which is labeled with Indium 111. It is a peptide rather than an antibody, and for this reason does not induce the HAMA effect in patients. The tracer is mostly excreted through the urinary system. But a small amount is also excreted through the gastrointestinal tract.

Question 22

Q

The purpose of using Acetazolamide in conjunction with a brain agent is too:

a. tranquilize the patient
b. evaluate cerebrovascular ischemia
c. localize the area of the brain from which seizures arise
d. localize brain tumors

Answer

A

b. Acetazolamide (Diamox (r)) is used in conjunction with SPECT brain imaging in patients with transient ischemic attacks, carotid artery disease, and cerebrovascular disease, among others. This technique is used to identify ischemic areas of the brain. Acetazolamide induces cerebral vasodilation. After the administration, normal blood vessels dilate, but diseased ones do not

Question 23

Q

The technologists responsibilities during tracer administration for a cisternogram include:

a. performing the lumbar puncture
b. obtaining consent to perform the procedure
c. monitoring the patient for any adverse reactions to the procedure
d. ensuring that personnel and the surroundings are not contaminated with radioactivity

Answer

A

d. Frequently the radiopharmaceutical first cisternography is administered outside the nuclear medicine department. It is typically the technologists who transports to trace it to the area where the lumbar puncture is being performed and overseas the administration. One of the responsibilities of the technologist is to protect personnel in the work environment by limiting the radiation exposure and confining radioactivity to prevent the spread of contamination. In this instance, the technologist is the on-site expert in handling radioactive materials. Therefore, the technologies should ensure that any contaminated materials used during the lumbar puncture are collected for proper disposal. The administration area and any personnel who handled the radiopharmaceutical should be monitored for contamination before they are permitted to leave the area.

Question 24

Q

Sodium Phosphate P32 may be used to treat which of the following conditions?

a. liver metastases
b. polycythemia vera
c. rheumatoid arthritis
d. malignant effusions

Answer

A

b. Sodium phosphate P32 is administered intravenously and maybe be used to treat polycythemia vera

Question 25

Q

Supersaturated potassium iodide solution may be administered to a patient for therapy with which of the following radiopharmaceuticals?

a. Sm153 Lexidronam
b. Sr89 Chloride
c. I131 Sodium Iodide
d. I131 Tositumomab

Answer

A

d. To minimize thyroid uptake of unbound iodine that may be present in the radiopharmaceutical, supersaturated potassium iodide is administered to a patient receiving I131 Tositumomab for treatment of non-Hodgkin’s lymphoma. The blocking agent is administered one day before and for the next 14 days during therapy.

Question 26

Q

The first step that a technologist should initiate when an adult patient experiences cardiac arrest is to:

a. perform chest compressions
b. establish an airway
c. call for help
d. perform rescue breathing

Answer

A

c. call for help

Question 27

Q

In111 Pentetreotide should not be administered through an intravenous line containing:

a. a total parenteral nutrition mixture
b. 0.9% sodium chloride
c. dextrose and water
d. glucose

Answer

A

a. a total parenteral nutrition mixture

because tracer may form a complex with components of the total parenteral nutrition mixture, because the chemical form of the tracer is now altered, its distribution in the body will be changed

Question 28

Q

Dual Isotope gastric emptying studies use which of the following radiopharmaceuticals for each phase of gastric emptying?

a. Tc99m Sulfur Colloid liquid phase : In111 Pentetate Solid phase
b. In111 Pentetate Liquid Phase : Tc99m Sulfur Colloid Solid Phase
c. Tl201 Thallous Chloride Liquid Phase : Tc99m Sestamibi Solid Phase
d. Tc99m Pentetate Liquid Phase : Tc99m Sulfur Colloid Solid Phase

Answer

A

b. In111 Pentetate Liquid Phase : Tc99m Sulfur Colloid Solid Phase

When Liquid and gastric emptying times are to be determined simultaneously, the solid phase labeled with Tc99m Sulfur Colloid, and the liquid phase is mixed with In111 Pentetate

Question 29

Q

Proper placement of a urine collection bag includes:

a. placing it across the patient’s lower legs to keep it near the level of the bladder
b. placing it on the stretcher near the patient’s feet so that it is out of the field of view of the camera
c. hanging it from an IV pole and raising it above the level of the bladder
d. hanging it from the imaging table so that it is lower than the level of the bladder

Answer

A

d. hanging it from the imaging table so that it is lower than the level of the bladder

for proper drainage, he urine collection bag must be lower than the urinary bladder. if it is lower, the urine may reflux back into the bladder, which may result in a urinary tract infection

Question 30

Q

Which of the following radiopharmaceuticals can be used to assess vesicoureteral reflux by the indirect method?

a. Tc99m pertechnetate
b. Tc99m sulfur colloid
c. Tc99m albumin
d. Tc99m pentetate

Answer

A

d. Tc99m pentetate

Radionuclide cystography is used to assess vesicoureteral reflux. This study maybe performed by the indirect method. In the indirect method, a renal agent is administered intravenously. When the tracer has cleared from the kidneys into the bladder, imaging of the ureters and kidneys is performed during and after the patient voids.

Question 31

Q

If 0.02ug/kg of cholecystokinin is needed for a hepatobiliary study, what volume needs to be drawn for a 175lb patient with a solution of 10ug/mL?

a. 0.115 mL
b. 0.159 mL
c. 0.175 mL
d. 0.192 mL

Answer

A

b. 0.159 mL

convert 175lbs to kg by dividing 175 by 2.2 which equals 79.54kg

figure out how much CCK is needed: 79.54kgs x 0.02ug/kg = 1.59 ug total needed for the patient

figure out how many mLs are needed: 1.59ug x 1mL/10ug = 0.159mL needed for the patient

Question 32

Q

Parenteral administration of a drug or radiopharmaceutical would include all of the following routes except?

a. intravenous
b. intramuscular
c. subcutaneous
d. oral

Answer

A

d. oral

the term parenteral means “other than through the intestine”

Question 33

Q

The red cell survival test is most often performed on a patient with suspected:

a. pernicious anemia
b. intestinal malabsorption
c. iron deficiency anemia
d. hemolytic anemia

Answer

A

d. hemolytic anemia

the red cell survival test is used to study the lifespan of red blood cells in patients with suspected hemolytic anemia. these patients will have a cell life span shorter than normal

Question 34

Q

A technologist confirms a referring physicians request for a nuclear medicine procedure for a hospitalized patient by?

a. locating the order for the test in the patients’ medical record
b. telephone the patient’s physician for confirmation
c. asking the patient why he/she came to the nuclear medicine department
d. conferring with the nuclear medicine physician

Answer

A

a. locating the order for the test in the patients’ medical record

the referring physician initiates orders for diagnostic testing and enters those orders in the patients’ medical record. it is the technologists responsibility to conform the order for a nuclear medicine test for each patient

Question 35

Q

Which type of collimator should be used for organ counting during a red cell sequestration study?

a. low energy, high sensitivity parallel hole
b. high energy, low resolution parallel hole
c. pinhole
d. flat field

Answer

A

d. flat field

a probe system equipped with a flat field collimator should be used to obtain organ counts, this will allow adequate statistics in reasonable time periods and exclude counts coming from areas outside of the region of interest

Question 36

Q

If a plasma volume has been determined to be 15L, which of the following events has most likely occurred?

a. completion of satisfactory study
b. overhydrating of the patient
c. leakage of tracer from the circulation
d. infiltration

Answer

A

d. infiltration

Depending on the body weight and gender, total blood volume normally ranges from about 3-6L. If a plasma volume has been determined to be 15L, there most likely some technical error that caused this result. The most plausible explanation is that the tracer was infiltrated. When this occurs, it appears as if the amount of radioactivity thought to be injected has been diluted in a large volume, but what has actually happened is that not all the tracer was added to the circulation. Then, when a plasma sample in which the tracer has been diluted in a smaller volume. Or consider the formula used to calculate a plasma volume:

Plasma Volume (mL) = volume injected x cpm in mL std x dilution all divided by cpm in mL plasma

The lower the counts in the plasma sample. the smaller the number in the denominator of the plasma volume formula, hence, the larger the calculated plasma volume

Question 37

Q

A biohazard warning label would be found on all of the following except a :

a. contaminated sharps container
b. refrigerator containing potentially infectious materials
c. receptable for contaminated laundry
d. unit of blood released for clinical use

Answer

A

d. unit of blood released for clinical use

biohazard warning labels are attached to any container of regulated materials. These include refrigerators, freezers, and anything else used to store, transfer, or ship blood or infectious materials. Labels are not required on containers of blood that have been released for clinical use like blood transfusion

Question 38

Q

The total blood volume may be calculated by dividing the plasma volume measured with labeled albumin by the?

a. hematocrit
b. plasmacrit
c. corrected hematocrit
d. corrected plasmacrit

Answer

A

d. corrected plasmacrit

the formula for calculating the total blood volume (TBV) based on the plasma volume uses the corrected plasmacrit in the denominator. Correction is needed to account for trapped plasma and to adjust the venous hematocrit to an average whole-body hematocrit. the formula is: TBV = plasma volume / 1 - (HCT x 0.97 x 0.91)

Question 39

Q

If radioactivity in the circulation from a previous nuclear medicine test is unaccounted for, results of a plasma volume determination will be?

a. unaffected
b. falsely elevated
c. falsely decreased
d. impossible to predict

Answer

A

c. falsely decreased

When residual radioactivity is present in the circulation, it appears as if the amount of radioactivity injected has been diluted in a smaller volume than it actually has. Then when a plasma sample is counted, the counts are relatively high compared with a sample in which the tracer has been diluted in a large volume. The larger the counts in the plasma sample, the larger the number in the denominator of the plasma volume formula, hence, the smaller the calculated plasma volume.

Question 40

Q

The recommended amount of captopril to be given orally an hour before renal imaging in a hypertension study is?

a. 10-15 mg
b. 15-20 mg
c. 25-50 mg
d. 55-100 mg

Answer

A

c. 25-50 mg

Question 41

Q

Imaging with In111 Pentetreotide routinely includes what areas of the body?

a. head and chest
b. chest
c. abdomen
d. head to upper femurs

Answer

A

d. head to upper femurs

because detection of both the primary tumor and any metastases is the goal of the examination, if indicated the extremities may be included

Question 42

Q

A patient scheduled for scintimammography has symptoms involving her left breast. Which of the following sites is the best choice for injection of the radiopharmaceutical?

a. right antecubital area
b. right carotid artery
c. left carotid artery
d. left hand

Answer

A

a. right antecubital area

you want to inject at a site distant from the breast or lymph nodes, which may be involved as well as on the contralateral side of the body

Question 43

Q

Based on the net counts data shown here:

Right Lung = 175,362
Left Lung = 325,672

what is the percentage perfusion to the right lung?

a. 30%
b. 35%
c. 54%
d. 65%

Answer

A

b. 35%

% activity in ROI = counts in ROI/ (total counts in all ROIs) and the answer is multiplied by 100

so…

= 175,363 counts/501,034 counts = 0.35 x 100 = 35%

Question 44

Q

If 375mCi Tc99m are present on the column of Mo99/Tc99m generator and after elution 342mCi Tc99m are assayed in the elusion vial, the approximate elution efficiency of the generator is?

a. 110%
b. 91%
c. 33 %
d. 11%

Answer

A

b. 91%

Elution does not remove all Tc99m present on the generator column. Elution efficiency is expressed as the percentage of the Tc99m activity on the column that is eluted:

elution efficiency = Tc99m activity eluted / Tc99m activity on column and the answer is multiplied by 100

In this case:

elution efficiency = 342mCi / 375mCi = 0.912 x 100 = 91.2 %

Question 45

Q

Two hundred fifty kilobecquerels are equivalent to how many microcuries?

a. 0.25uCi
b. 6.76uCi
c. 9.25uCi
d. 9.250uCi

Answer

A

b. 6.76uCi

1Ci = 37GBq
1mCi = 37MBq
1uCi = 37kBq

to convert kilobecquerels to microcuries:

250kBq x 1uCi/37kBq = 6.75uCi

Question 46

Q

If a Mo99m/Tc99m generator is eluted on Monday @ 0600, the maximum Tc99m activity next be eluted at what time?

a. 1200 Monday
b. 1800 Monday
c. 0600 Tuesday
d. 0600 Wednesday

Answer

A

c. 0600 Tuesday

maximum Tc99m activity obtained after the last elution is about 24hrs

Question 47

Q

According to the NRC, Mo99 contamination in Tc99m eluate must be measured how often?

a. weekly
b. daily
c. after each elution
d. only after the first elution

Answer

A

d. only after the first elution

Question 48

Q

The results shown here were obtained when Tc99m eluate was assayed for Mo99m breaktrough at 0600, immediately after elution:

Mo99 = 10uCi
Tc99m = 416mCi

Which of the following statements about this elution at 1700 is true?

a. the eluate should not be used to label compounds with Tc99m
b. the eluate does not contain sufficient Tc99m activity
c. the eluate may be administered to patients
d. the eluate must not be administered to patients

Answer

A

c. the eluate may be administered to patients

@ 0600 the Mo99 contamination in the eluate is below the maximum allowable limit of 0.15 uCi Mo99 per mCi of Tc99m:

10uCi Mo99/416mCi Tc99m = 0.024uCi Mo99/mCi Tc99m

To determine the Mo99 concentration in the eluate at 1700, decay correct both Mo99 and Tc99m activities obtained @ 0600 for 11hr (0600 to 1700 = 11hr)

Mo99: 10uCi x 0.891 = 8.9 uCi
Tc99m: 416mCi x 0.282 = 117 mCi

At 1700 then, Mo99 concentration is equal to:

8.9uCi Mo99/ 117mCi Tc99m = 0.08 uCi Mo99/mCi Tc99m

Question 49

Q

A technologist performs an aluminum ion breakthrough test on Tc99m eluate and obtains the following results: When the indicator paper is spotted with aluminum ion solution, a faint red color is observed, but when the paper is spotted with eluate, no color change is observed. These results indicate?

a. the absence of radionuclide impurities in the eluate
b. that the aluminum ion concentration in the eluate is below the U.S. Pharmacopeia (USP) limit
c. that the eluate should be discarded
d. that the aluminum ion solution contains less aluminum than the eluate

Answer

A

b. Aluminum is a chemical impurity that is measured using a colorimetric test consisting of a special indicator paper and a reference solution of known aluminum ion concentration. No color change represents an aluminum ion concentration below 10ug/mL of eluate, the USP limit. Therefore, this eluate may be administered to patients and used to prepare other Tc99m labeled radiopharmaceuticals. Tc99m does contain radionuclide impurities such as Mo99, but these are assayed in a different manner.

Question 50

Q

All of the following maybe performed with Tc99m Sulfur Colloid except:

a. gastric emptying study
b. gastroesophageal reflux study
c. gastrointestinal-bleeding localization
d. Meckel’s diverticulum localization

Answer

A

d. Meckel’s diverticulum localization

You use Tc99m pertechnetate to localize Meckel’s diverticulum

Question 51

Q

Based on the day’s clinical schedule shown here:

Patient A Thyroid uptake and imaging
Patient B Therapy for hyperthyroidism
Patient C Cisternogram

a technologist should prepare or order which of the following radiopharmaceuticals?

a. I131 human serum albumin, I131 sodium iodide, and Tc99m pertechnetate
b. Tc99m pertechnetate
c. In111 oxine and I123 sodium iodide
d. I131 sodium iodide and In111 chloride

Answer

A

c. In111 oxine and I123 sodium iodide

I131 sodium iodide is the agent used for treatment of hyperthyroidism. I123 sodium iodide is the agent of choice for thyroid uptake and may be used for thyroid imaging as well. In111 pentetate is administered for cisternography.

Question 52

Q

If an MAA kit must be reconstituted with 3.5 mL of Tc99m pertechnetate, what are the consequences if only 2.0 mL are added to the kit?

a. patients will receive fewer MAA particles per milliliter of Tc99m MAA
b. patients will receive more MAA particles per milliliter of Tc99m MAA
c. patients will receive the recommended number of particles if the correct activity is administered
d. the resulting perfusion lung images will have the appearance of decreased uptake

Answer

A

b. patients will receive more MAA particles per milliliter of Tc99m MAA

The volume added to an MAA kit governs the number of particles in each milliliter or radiopharmaceautical and, therefore, the number of particles a patient will receive. For example, if a vial of MAA contains 2 million particles and 2 mL Tc99m pertechnetate are added to the vial, there will be approximately 1 million particles per milliliter. If only 1 mL is added, there will be twice as many particles in each milliliter. Therefore, a patient would receive twice as many particles in a unit dose from the second preparation.`

Question 53

Q

Reconstitute “cold” pyrophosphate is administered to the patient in which red blood cell labeling method (s)?

a. in vitro method
b. in vivo method
c. modified in vivo method
d. both the in vivo method and the modified in vivo method

Answer

A

d. both the in vivo method and the modified in vivo method

In both the in vivo and modified in vivo techniques, reconstituted “cold” pyrophosphate, containing stannous ions that permit Tc99m pertechnetate to permeate red cell membranes, is administered intravenously to the patient. In the in vitro method, the entire labeling process takes place outside the patient. A blood sample is collected, to which stannous ions are added. After an incubation period Tc99m pertechnetate is added to the red cells after they have been isolated from plasma. After another incubation period, the red cells are washed to remove unbound tracer, reconstituted, and injected back into the patient.

Question 54

Q

Which of the following radiopharmaceutical kit formulations is light sensitive?

a. sestamibi
b. oxidronate
c. mertiatide
d. exametazime

Answer

A

c. mertiatide

the contents in the mertiatide reaction vial are light sensitive and must be protected from light

Question 55

Q

When performing radiochromatography on a radiopharmaceutical sample, the solvent front is located 8.5 cm from the origin and the radiopharmaceutical impurity is at the origin. Wheat is the Rf value of the radiochemical impurity?

a. 0
b. 0.85
c. 1.0
d. 8.5

Answer

A

a. 0

The Rf value is the distance traveled by a given radiochemical compound compared with the solvent front:

Rf = distance from origin to radiochemical component / distance from origin to solvent front

In this example, the radiochemical component is question is the radiochemical impurity. Because the impurity remained at the origin, the distance from the origin to the impurity is zero. Thus, the value for the radiochemical impurity is:

Rf = 0 cm / 8.5 cm = 0

Question 56

Q

According to USP, to be administered to patients, most Tc99m labeled radiopharmaceuticals should have a radiochemical purity of at least what percentage?

a. 98%
b. 95%
c. 90%
d. 88%

Question 57

Q

A technologist must administer 8mCi Tc99m mebrofenin to a patient at 1100. On the basis of the vial labeled information shown here:

Calibration: 0700 August 4
Total Activity: 100mCi
Total Volume: 8.5mL
Concentration: 11.8mCi/mL
Expiration: 1500 August 4

what volume of Tc99m mebrofenin should be administered to the patient?

a. 0.13mL
b. 0.68mL
c. 0.92mL
d. 1.1mL

Answer

A

d. 1.1mL

The elapsed time between calibration and unit dose administration is 4hr. From the decay factor table. the decay factor for 4hr is 0.631. The initial concentration is decay corrected to determine the concentration at 1100:

C(t) = C (o) x DF = 11.8mCi/mL x 0.631 = 7.4mCi/mL @ 1100

Question 58

Q

A technologist must administer 37Mbq Tl201 thallous chloride at 1000 on February 16. On the basis of the vial labeled information shown here:

Calibration: 1200 February 14
Total Activity: 222Mbq
Total volume: 4mL
Concentration: 55.5Mbq/mL
Expiration: 1200 February 17

what volume should be administered to the patient?

a. 0.44mL
b. 0.84mL
c. 1.0mL
d. 2.3mL

Answer

A

c. 1.0mL

The elapsed time between calibration and unit dosage administered is 46hr. From a decay factor table, the decay factor for Tl201 at 46hr is approximately 0.646. The initial concentration is decay corrected for 46hr to determine the concentration at 1000, February 16.

C (t) = C (o) x DF = 55.5Mbq/mL x 0.646 = 35.8Mbq/mL at 1000 on Feb 16

Question 59

Q

A technologist needs 4mCi Tl201 thallous chloride at 0800 on June 29. The label on the radiopharmaceutical vial contains the following information:

Total activity: 10mCi
Total volume: 5.5mL
Assay: 1200 July 1

What volume is required to obtain the necessary activity on June 29?

a. 3.6mL
b. 1.35mL
c. 0.74mL
d. 0.28mL

Answer

A

b. 1.35mL

The elapsed time between calibration and dosage calculation is 52hr. In this example, the radiopharmaceutical is being used before the calibration time. Therfore, the initial concentration on June 29 is the unkown, and the known concentration is divided by the decay factor. The concentration on July 1 is 1.8mCi/mL (10mCi/5.5mL):

C (o) x 0.609 = 1.8mCi/mL => C (o) = 1.8mCi/mL / 0.609 = 2.96mCi/mL

then, determine the required volume

volume = activity required / C (t) = 4mCi / 2.96mCi/mL = 1.35

Question 60

Q

Which radiopharmaceutical is used to label red blood cells with Tc99m?

a. Tc99m albumin
b. Tc99m exametazime
c. Tc99m pertechnetate
d. Tc99m sestamibi

Answer

A

c. Tc99m pertechnetate

The three methods of labeling red blood cells with Tc99m all use Tc99m pertechnetate. Tc99m pertechnetate enters the red blood cell and binds to hemoglobin. Part of the red blood cell labeling process involves administration of a reconstituted “cold” pyrophosphate kit to provide the stannous compound necessary for labeling to occur. Tc99m albumin is a blood-pool agent; that is, it remains is the circulation for a period of time after intravenous injection. It does not bind to the red blood cells. Tc99m exametazime is used to label white blood cells

Question 61

Q

Which of the following radiopharmaceuticals is used to label white blood cells with Tc99m?

a. Tc99m bicisate
b. Tc99m exametazime
c. Tc99m pertechnetate
d. Tc99m sestamibi

Answer

A

b. Tc99m exametazime

Tc99m exametazime is used to label white blood cells. Tc99m pertechnetate is used to label red blood cells. Tc99m bicisate is used to demonstrate regional brain perfusion. Tc99m sestamibi is used for myocardial imaging as well as other applications.

Question 62

Q

When Tc99m exametazime is used to label white blood cells, which of the following reagents is omitted from its preparation?

a. Tc99m pertechnetate
b. 0.9% sodium chloride
c. methylene blue stabilizer
d. ACD solution

Answer

A

c. methylene blue stabilizer

Question 63

Q

Four millicuries of Tl201 thallous chloride is the prescribed unit dosage. According to the NRC, which of the following dose calibrator measurements verifies that a dosage within acceptable limits has been dispensed into the syringe?

I. 3.6mCi
II. 4.0mCi
III. 4.3mCi
IV. 4.5mCi

a. II only
b. II and III only
c. I, II, and III only
d. I, II, III, or IV

Answer

A

d. I, II, III, or IV

The NRC states that the administration dosage must fall within the prescribed dosage range or may not differ from the prescribed dosage more than 20%. If the prescribed dosage is 4mCi, the measured dosage must be between 3.2 and 4.8mCi.

Question 64

Q

In labeling red blood cells with radiochromium, the order of components to be added to the vial containing ACD solution is:

a. patient blood, radiochromium, ascorbic acid
b. radiochromium, patient blood, ascorbic acid
c. radiochromium, ascorbic acid, patient blood
d. ascorbic acid, radiochromium, patient blood

Answer

A

a. patient blood, radiochromium, ascorbic acid

Radiochromium should not be added to the ACD solution before the patient’s blood because ACD may change the valence of the radiochromium before labeling can take place. Ascorbic acid is added at the end of the labeling procedure to stop the tagging before the blood is returned to the patient.

Answer 64

A

c. 650,000

The concentration at 1000 is:

148MBq/0.75mL = 197MBq/mL

At 1600, after correcting for decay, the concentration is:

197MBq/mL x 0.5 = 98.5MBq/mL

Therefore, the volume of unit dosage at 1600 is:

148MBq/98.5MBq/mL = 1.5mL

The number of particles in 1mL remains constant over time and is:

325,000 particles/0.75mL = 433,333 particles

Therefore, the 1600 dosage contains twice as many particles as the 1000 dosage, because the 1600 dosage contains twice the volume to obtain the same unit dosage of 148MBq:

433,333 particles/mL x 1.5mL = 650,000 particles

Answer 65

A

d. 0.27mL

Determine the concentration: concentration = total activity/total volume = 4.5mCi/1.2mL = 3.75mCi/mL

Determine the volume that will contain the required activity:

Volume = activity required/concentration = 3.5mCi/3.75mCi/mL = 0.93mL

Determine the volume that will need to be removed from the syringe:

Total volume - volume required = volume removed

1.2mL - 0.93mL = 0.27mL

Answer 66

A

c. 4.4mL

Determine the concentration:

350mCi/7mL = 50mCi/mL

Determine the volume of Tc99m pertechnetate needed to obtain the required activity:

30mCi / 50mCi/mL = 0.6mL

because the activity must be contained in a specific volume 5mL, sterile, preservation-free saline must be added to make up the required volume:

5mL - 0.6mL = 4.4mL

Answer 67

A

c. 10min

In this case, the centrifuge cannot provide necessary relative centrifuge force (RCF) identified in the protocol. However, by adjusting the time, the same degree of centrifugation may be administered. The relationship is:

T1G1 = T2G2

where T1 and G1 are the minimum time centrifugation and RCF, respectively, and T2 and G2 are the alternative time and RCF, respectively. Solving for the alternative time:

T2 = T1G1 / G2 = (5min) (5000g) / 2500g = 10min

Answer 68

A

b. “Caution: Radioactive Materials”

The NRC requires that restricted areas, such as imaging rooms, be posted with specific signs depending on the radiation level present. A “Caution: Radioactive Materials” sign should be posted in areas where certain quantities of radioactivity materials are used or stored. These quantities are those exceeding 10 times the quantities specified in the Appendix C to to CFR Part 20. The quantities for commonly used radiopharmaceuticals that will results in required posting include an excess of 10mCi of Tc99m, Ga67, Xe133, or Tl201; an excess of 1mCi of I123 or In111; more than 10uCi of I131.

Answer 69

A

a. 56mR/hr @ surface and 3.5mR/hr @ 1m

The label types and exposure rate limits for packages containing radioactive materials are:

Cat 1 (white) less than or equal to 0.5 @ surface and no detectable radiation @ 1m
Cat 2 (yellow) less than or equal to 50 @ surface and less than or equal to 1 @ 1m
Cat 3 (yellow) less than or equal to 200 @ surface and less than or equal to 10 @ 1m

Answer 70

A

b. 4.2mR/hr

Use the inverse square law = (I1) (D1) squared = (I2) (D2) squared

For this example it is:

(30mR/hr) (15cm) squared = (I2) (40cm) squared

Isolate the unkown and solve: I2 = (30mR/hr) (15cm) squared / (40cm) squared = 4.2mR/hr

Answer 71

A

Each half-value layer (HVL) will decrease the activity to one-half of the previous activity.

0 HVL = 12mR/hr
1 HVL = 6mR/hr
2 HVL = 3mR/hr
3 HVL = 1.5mR/hr

Thus 3 HVLs are required to decrease the exposure rate to less than 2mR/hr. Hence, of lead required 3 times the HVL, or 3 x 0.3cm = 0.9cm.

Answer 72

A

d. The situation describes a medical event requiring notification of NRC.

A licensee must notify the NRC of medical events, which are defined as an administration of licensed material that results in an effective equivalent dose greater than 5rem, a dose to an organ or tissue greater than 50rem, or shallow dose exposure to the skin greater than 50rem because of the following:

The total dosage delivered differs from the prescribed dosage by 20% or more
The total dosage falls outside the prescribed range
The wrong radioactive drug was administered by the wrong route
The radioactive dosage was administered to the wrong person

When a medical event (misadministration) occurs, NRC requires the licensee to notify the NRC, the referring physician, and the involved individual, unless the referring physician determines, on the basis of medical judgement, that such notification would be harmful to the patient.

Answer 73

A

b. 150mSv

According to the NRC, the annual occupational dose limit to the eye is 15rem or 150mSv

Answer 74

A

b. Return the vial to storage

According to NRC regulations, decay in storage of radioactive materials requires that the materials remain in storage until the radioactivity is indistinguishable from background radiation using a survey meter on the most sensitive scale and without any shielding in place.

Answer 75

A

a. on a reasonable basis

NRC regulations require survey of areas where radiopharmaceuticals that require a written directive are prepared or administered. This would include therapeutic radiopharmaceuticals and dosages of I131 greater than 30uCi. As of October 2002, the NRC no longer requires daily surveys and weekly wipe tests. Instead, it allows facilities to establish s survey and wipe test schedule. The schedule must be reasonable, based on the need to determine radiation levels, concentrations or quantities of radioactive materials, the potential radiological hazards.

Answer 76

A

b. put on disposable gloves

because it has not been determined that the package is free of contamination, gloves should be put on before the pakcage or its contents are handled

Answer 77

A

a. no more contamination can be removed from the area

decontamination of a radioactive spill should continue until the residual radioactivity is below the action level set by the licensee or until no further contamination can be removed by cleaning the area. If residual radioactivity is present after thorough decontamination, the area should be covered as a reminder for personnel to limit their time in that area

Answer 78

A

c. likely to exceed 10% of the annual maximum allowable occupational exposure

the NRC requires monitoring of occupationally exposed individuals if they are likely to exceed 10% of the annual allowable limit for external exposure or internal uptake

Answer 79

A

c. 0.5rem

According to the NRC, an individual who has received a therapeutic dosage of radiopharmaceutical can be released if no other individual is likely to receive a total effective dose equivalent exceeding 0.5rem (5 mSv) as a result of contact with the person who received the radiopharmaceutical.

Answer 80

A

c. 6 half-lives

0 HVLs = 3mR/hr
1 HVLs = 1.5mR/hr
2 HVLs = 0.75mR/hr
3 HVLs = 0.37mR/hr
4 HVLs = 0.19mR/hr
5 HVLs = 0.09mR/hr
6 HVLs = 0.05mR/hr

Answer 81

A

b. 3 years

Answer 82

A

c. tungsten

Tungsten is recommended because it will absorb more radiation than the same thickness of lead

Answer 83

A

d. The exposure from the X-ray examination must not be included in the occupational exposure record

Only radiation exposure directly related to the practice of nuclear medicine as an occupation is recorded in the individual’s dosimetry record. Personal diagnostic and therapeutic exposures are not included

Answer 84

A

c. use a correction factor to determine true activities

The NRC requires that dose calibrators be tested for proper functioning according to nationally recognized standards. The standard of practice dictates that the measured activity should be within plus or minus 10% of the expected activity when the instrument is tested for linearity. If the instrument exceeds this level of error, a correction factor should be calculated and applied to all measurements in the affected activity range.

Answer 85

A

b. constancy

Using a long-lived source, a reading is obtained for each of the commonly used preset buttons on the dose calibrator. Although this does not provide an accurate (true) reading, it shows whether the instrument is performing with precision (reproducibility). The reading should be withing plus or minus 10% of the expected decay-corrected reading.

Answer 86

A

d. recalibrate the operating voltage

Voltage may drift slightly from one day to the next, causing the gamma ray spectrum to shift to the right or left, out of the preset window. From the data, it appears that this is what may have happened. Before using the instrument for clinical studies or sending it for repair, the technologist should recalibrate the operating voltage by observing the counting rate at the most recent voltage setting and voltage settings just above and below that setting. If the counting rate increases when counts are obtained off the original voltage, the voltage should be adjusted until a maximum counting rate is reached. The voltage at which a maximum counting rate is obtained is the new operating voltage. If there is significant voltage fluctuation from day to day, the instrument should be serviced.

Answer 87

A

b. quarterly

Answer 88

A

b. Cs137

The reference source used for monitoring dose calibrator constancy must be long-lived to permit comparison of measured and predicted activities over an extended period. Co57 half-life = 270 days and Cs137 half-life = 30years.

Answer 89

A

b. the lower the cutoff frequency, the nosier the image

The cutoff frequency of a filter determines which frequencies are passed unchanged and which are altered or suppressed. Lowering the cutoff frequency eliminates more of the high-frequency signal that gives the image its sharp detail. As more of the high frequencies are removed, the image becomes smoother or less detailed, eventually decreasing resolution.

Answer 90

A

c. framing rate

Temporal resolution is the ability to demonstrate changes in radiopharmaceutical distribution over time. Therefore, this is a factor in dynamic and multiple-gated acquisitions, both of which acquire data in sequential frames. Teh framing rate is the acquisition time per frame. If the framing rate is too long, changes in radiopharmaceutical distribution can be missed. If the framing rate is too short, too few counts will be acquired in each frame, and the resolution of the images may be affected.

Answer 91

A

b. gated-equilibrium cardiac function study

Temporal smoothing is used in dynamic studies to produce a gradual variation in counts and smoother motion from one frame to the next. Therefore, it is useful in gated studies, but it is not useful in static imaging, such as thyroid or whole-body images or nongated SPECT.

Answer 92

A

b. 2.73 x 2.73 mm

Pixel size is determined by the matrix dimensions and the size of the field of veiw:

350/128pixels = 2.73mm

Because pixels are square, the dimensions of each pixel in this 128 x 128 matrix are 2.73 x 2.73.

Answer 93

A

c. well counter

When Gieger-muller counter readings no longer decrease as the cleanup progresses, a wipe test, which is measured in a well counter, is performed. If the wipe test shows activity does not exceed background levels, then all removable contamination has been eliminated. If nonremovable activity remains, shielding of the spill area may be necessary.

Answer 94

A

a. 64 x64 byte

A blood flow study of the feet would be acquired at a frame rate of 2-4 sec/frame, so few counts would be obtained in each frame. Therefore, a small matrix must be used: 64 x 64. Because there will be few counts per frame, byte mode will be adequate, as it can store up to 255 counts per pixel. in word mode, about 65,000 counts can be acquired for each pixel; however, twice as much computer storage space is needed. Because this level of activity will not be present, it is wasteful - but not harmful - to use word mode.

Answer 95

A

b. 3-5 million

For a small-field-of-view camera, 3 million counts should be acquired; for a large field of view, 5 million counts should be acquired. More counts are required as the crystal becomes larger to ensure of noise and assures an adequate count density so that uniformity can be accurately evaluated.

Answer 96

A

b. the gland will appear smaller

Answer 97

A

a. 0.84

When the geometric variation varies from the expected by more than 10%, a correction factor must be calculated and applied whenever that configuration and activity range are measured. To determine the correction factor equation is used:

correction factor = expected activity/actual activity

for this example:

212uCi/253uCi = 084

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