HomeStretch CRACK vol 1. NUCS Flashcards
Bone scan - relatively hotter kidney = ?
hemochromatosis or chemotherapy
Bone scan marked skull suture activity = ?
renal osteodystrophy
liver uptake on bonescan = ?
too much Al+3 chemical contamination in the Tc
Hepatoma or mets
Amyloidosis
Liver necrosis
Bone scan with muscle uptake?
Rhabdo
Particle size for MAA
MAA = 10-100 micrometers
Sulfur colloid (unfiltered) = 1 micrometer
Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers
Particle size for DTPA (inhaled)
MAA = 10-100 micrometers
Sulfur colloid (unfiltered) = 1 micrometer
Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers
Particle size for sulfur colloid (filtered)
MAA = 10-100 micrometers
Sulfur colloid (unfiltered) = 1 micrometer
Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers
Particle size for sulfor colloid (unfiltered)
MAA = 10-100 micrometers
Sulfur colloid (unfiltered) = 1 micrometer
Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers
When do you reduce the particle amount in a V/Q scan?
What is the normal amount of particles? what do you reduce it down to?
How about in a neonate?
Will this reduce the dose?
- Pregant people
- Right to left shunts
- Pulmonary HTN
- Children
- People with one lung
- Normal particle count = 500,000
- decrease it to 100,000
- down to 10,000-50,000 in a neonate
- Dose will not decrease. . .
Indium, Thallium, Gallium
Half-lives and energies
- Indium
- 67 hours
- 175 and 250
- Thallium = 73 hours
- major emissions are via characteristics xrays of its daughter product, Mercury 201
- 69 and 81 KeV
- major emissions are via characteristics xrays of its daughter product, Mercury 201
- Gallium = 78 hours
- 100, 200, 300, 400
Tc-99m in the thyroid - trapped or organified?
trapped and not organified
Breastfeeding versus Tc-99m, I-123 and I-131
Tc-99m = 12-24 hours
I-123 = 2-3 days
I-131 = contraindicated - pump and dump!
Does renal failure increase or decrease Iodine update
decrease it (since there is more circulating normal iodine)
Iodine uptake test
What dose do you give with I-131? How about I-123?
What is normal uptake at 6 hours? How about 24 hours?
I-131 = 5 micro curie
I-123 = 10-20 microcurie
normal uptake is 5-15 (say 10%) at 5 hours and 25 at 24 hours
Plummer disease
Multi-nodular toxic goiter
I-131 dosing for cancer therapy and for hyperthyroidism
- hyperthyroidism
- 15 mCi for graves
- 30 mCi for multinodular goiter
- Cancer: depends on stage
- 100 for thyroid only
- 150 for thyroid +nodes
- 200 for distal
When do I-131 treated patient’s need to be admitted to hospital?
NRC limit is 7mR/h at 1 meter from patient’s chest
33mCi of residual activity
What are the three renal tracers?
DTPA, MAG3, DMSA, (GH too)
Most common cause of hyperPTH?
hyperfunctioning adenoma
second is multiple gland hyperplasia
third is cancer
What are the three agents used in CNS nukes? Which two are similar?
HMPOA and ECD are similar (are extracted and can be used for parenchymal imaging; HMPOA washes out faster while ECD has better blood clearance [better brain to background ratio]).
DTPA: not extracted and can’t be used for parenchymal imaging. This has the advantage of being repeated without delay. main utility is for shunt studies, NPH and Brain death
DTPA
Filtered (GFR)
Good in people with normal renal function
critical organ = bladder
GI Bleed Sensitivity for RBC scan, CTA and Angiogram
RBC scan = 0.1 mL/min
CTA = 0.4 mL/min
Angiogram = 1.0 mL/min
What are you looking for in a GI bleed RBC scan?
- Tracer outside vascular distribution
- Tracer that moves like bowel
- Tracer that increases in intensity overtime
Dose of CCK?
Dose of Morpine?
Dose of phenobarb?
Dose of CCK = 0.02 microgram/KG over 60 minutes.
Dose of Morpine = 0.02 mg/kg over 60 minutes.
Dose of phenobarb = 5 mg/kg x 5 days
In a HIDA scan, what medications can cause prompt uptake with delayed biliary excretion?
Erythromycin, Estrogen (contraceptives), Anabolic steroids, chlorpromazine, sometimes statins
HIDA SCAN BLITZ!
No bowel activity + persistent blood pool = ?
No bowel activity + blood pool goes away normally = ?
No gallballder activity x 4 hours (or 1 hour + morphine) = ?
Abnormal GB emptying (EF < 20%) = ?
Hepatic dysfunction (hepatitis)
CBD obstruction
Acute chole
Chronic chole
Diffuse pulmonary activity on a sulfur colloid scan = ?
excess aluminium in the colloid
renal activity on sulfur colloid = ?
CHF
Alternatively in renal transplant can indicate rejectoins
other rare causes = coxsackie b virus, DIC and TTP
MAG 3
secreted (threecreated) (ERPF)
concentrated better in poor kidney function
critical organ is bladder
DMSA
binds to renal cortex
critical organ = kidney
How does a kidney with renal artery stenosis look when using MAG3? How about DTPA?
MAG 3 = the sick kidney holds on the the tracer
DTPA = the sick kidney has decreased uptake and flow.
Renal transplant nucs renogram - ATN versus rejection
both will have delayed excretion, but ATN has preserved flow and rejection has decreased flow
Meningiomas can be hot on what scans?
Hot on Octreotide and MDP
What medications interfere with the workings of MIBG?
Kids with neuroblastoma don’t need TLC or cocaine!
TCA’s, labetalol, Ca channel blockers and cocaine
MIBG versus Octreotide
MIBG is superior for neuroBlastoma and non-malignant (adrenal) pheos
oCtreotide = superior for Carcinoid and malignant (extra-adrenal) pheos
Critical organs for:
Indium prostascint (PMSA)
Indium WBC
Indium octreotide
- Indium prostascint (PMSA) = Liver
- Indium WBC = Spleen
- Indium octreotide = Spleen!
What is the best view for a MUGA scan?
left anterior oblique
What gives a false low EF on MUGA?
Screwed up view with overlap of LV by the RV or great vessels
What gives a false high EF on MUGA?
Wrong (high) background ROI (over the spleen)
What is the only pet agent made with a generator? half life?
Rb-82; super short half life
Cardiac scan artifacts
Breast tissue
left hemidiaphragm
LBBB
Breast tissue = anterior wall
left hemidiaphragm = inferior wall
LBBB = septal defect sparing apex
Dipyridamole
vasodilator - inhibits breakdown of adenosine, lower side effect profile
no caffeine
adenosine
vasodilator, no caffeine, worse side-effects relative to dipyridamole
Ragedenoson
vasodilator (selective A2a)
fewer side effects
no caffeine
Dobutamine
Beta 1 agonist
better in patients with COPD or Asthma
avoid with LBBB
aminophyline
antidote for adenosine
half-life shorter than dipryidaomele
What are the three agents used for treatment of boner pain?
Strotium 89
Samarium 153
Radium 223 Xofigo
Sr89
Pure beta emitter
Most boner marrow toxicity (longest recovery)
renal excretion
Sm153
Beta emmitter with some immageable gamma rays
less boner marrow toxicity
renal excretion
Ra223
alpha emmitter
least bone marrow toxicity
GI excretion
improved survival for prostate mets
Long half life of 11.4 days
Yttrium-90
pure betta emmiter, maximum tissue penetration = 1 cm
particle size = 20-40 microns
dose typically is 100-1000 Gy
can image it’s 175 and 185 keV emissions
half-life = 64 hours
What is radioimmune therapy?
- first line or refractory treatment for NH-lymphoma
- basically bind Y-90 to a mab
- dont give with plt under 100K
