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METHODOLOGY II FALL 2024 FINAL Flashcards

1
Q

The physician orders a lung v/q study for an 8 year old patient. What range of particles would be appropriate for the 99mTc-MAA dose?

A

3 years old - 8 years old: <300K particles

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2
Q

What are the indications for Zevalin?

A

Relapsed or refractory low-grade, transformed, or follicular B-cell non-Hodgkin’s lymphoma

Not a first-line therapy.

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3
Q

Where is cerebrospinal fluid (CSF) formed?

A

1st and 2nd Lateral Ventricles

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4
Q

What is the primary function of the large intestine?

A

To absorb water and create feces.

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5
Q

What should be done if the gallbladder fails to visualize by 1 hr of HIDA imaging?

A

Continue study for up to 4 hours or administer morphine.

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6
Q

What is formed when DIT and DIT combine?

A

T4

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7
Q

Outline the steps for the lung ventilation study using 99mTc-DTPA.

A
  1. Place patient supine with lungs in FOV.
  2. Measure the count rate as the patient from the perfusion image in the POST view.
  3. Administer 99mTc-DTPA slowly into nebulizer (5 mL).
  4. Ask patient to breath at a normal rate for 10 - 12 minutes.
  5. Monitor the count rate as the patient inhales the aerosol and continue until the count rate equals 3 - 4 times the base count (~100K cpm).
  6. Acquire ANT/POST, RAO/LPO, RLAT/LLAT, RPO/LAO images for the same timeframe as the corresponding perfusion images.
  7. Turn off gas flow on nebulizer and wipe patients face and ask them to expel any saliva to keep activity out of the stomach.
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8
Q

Why is accurate diagnosis of hemangioma essential?

A

Inadvertent biopsy of a hemangioma can lead to significant hemorrhage.

Page No. 1

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9
Q

What is the patient position for hepatic artery perfusion imaging?

A

Supine.

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10
Q

What is the technique for LeVeen shunt evaluation?

A

Mix radiopharmaceutical with ascites and acquire ANT images.

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11
Q

What imaging technique is used for Meckel’s diverticulum?

A

Acquire dynamic image at 15 secs/frame for 29 minutes or 60 secs/frame for 30-60 minutes; acquire static images every 5 minutes up to 60 minutes at 500K counts

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12
Q

What does Zevalin target in treatment?

A

The CD20 antigen found on the surface of B-cells

This antigen plays a role in B-cell development and differentiation.

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13
Q

How is scintimammography often used in relation to mammography?

A

In conjunction for a more comprehensive assessment

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14
Q

What is the primary purpose of a gastric emptying study?

A

Diagnosis of functional gastric dysmotility.

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15
Q

What TSH levels are desirable for a patient undergoing thyroid imaging?

A

Serum TSH of >30 is desirable; >50 is optimum

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16
Q

What extra step can be taken during a lung ventilation study for patients with known COPD?

A

extend washout 3 - 5 minutes to assess regional airway trapping

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17
Q

Fill in the blank: The stomach can hold up to ______ at maximum distention.

A

1 gallon

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18
Q

What does DaTscan (I-123 Ioflupane) differentiate?

A

Differentiation of Parkinsonian syndromes from essential tremor

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19
Q

What is the purpose of embolic therapy with Y-90-microspheres?

A

To stop blood flow to tumor cells

Microspheres are injected through a catheter into the hepatic artery.

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20
Q

What is the body’s response to a noxious stimulus called?

A

Inflammation

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21
Q

What are the contraindications for the F-18 FDG viability study?

A

Pregnancy/breast feeding

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22
Q

What happens during iodine organification?

A

Iodine is bound to tyrosine, forming monoiodotyrosine (MIT) and diiodotyrosine (DIT)

MIT + DIT forms T3 and DIT + DIT forms T4.

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23
Q

In what position is the patient during planar image acquisition?

A

Prone position

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24
Q

What functions are associated with the Parietal lobe?

A

Sensory

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25
What is cholelithiasis?
Gallstones composed of cholesterol, lecithin, and bile acids.
26
What does the thyroid gland trap and organify?
Iodine (I2)
27
What are the two main types of bone structure?
* Compact Bone * Spongy Bone
28
What is the dose for a Right-to-Left Shunt using 99mTc-MAA?
25 µCi (IV bolus) ## Footnote 99mTc-MAA is used to assess the distribution of activity in the lungs and systemic circulation.
29
What is the purpose of using co-registration in PET imaging?
To correlate PET images with CT or MRI for accurate interpretation.
30
What is the primary target of the Gallium study?
Areas of inflammation and tumors.
31
What imaging protocol is recommended for patients undergoing PET scans?
* Fasting for 4-6 hours prior * Hydration encouraged * Avoid strenuous exercise for 24 hours
32
What is the dosage for 177Lu-Dotatate used for neuroendocrine tumors?
200 mCi every 8 weeks for 4 doses or 6-12 weeks for 3-5 doses ## Footnote Infusion is regulated to ensure safety.
33
A PIOPED score ranging from 20% - 80% would suggest what?
Intermediate probability of PE NORMAL: no perfusion defects VERY LOW PROBABILITY: < 10% LOW PROBABILITY: < 20% INTERMIDATE PROBABLITY: 20% - 80% HIGH PROBABILITY: > 80%
34
What is the role of neuropeptides in imaging?
Radiolabeled neuropeptides are used to image tumors that express specific receptors, such as somatostatin receptors in neuroendocrine tumors
35
Which radiopharmaceutical is commonly administered for thyroid cancer treatment?
I-131 sodium iodide.
36
How many individuals should perform a pediatric imaging study and why?
Two individuals for safety
37
What is the significance of the Baylor Plan?
Designed a prototype plan for hospital pre-payment, leading to the creation of Blue Cross/ Blue Shield
38
What is the dosage for the therapeutic use of Zevalin?
Typically 0.4 mCi/kg with a maximum dose of 32 mCi ## Footnote Dosing is individualized based on body weight and platelet count.
39
What is the significance of the Fc region in antibodies?
The constant portion of the antibody that can trigger immune responses, differing between human and mouse antibodies
40
What is the effect of hyperthyroidism on the body?
Increases metabolism, leading to symptoms like weight loss and anxiety ## Footnote The body's cells work faster than normal.
41
What is the time frame for acquiring images during a Left-to-Right Shunt study?
0.5 sec/frame ## Footnote This time frame allows for the documentation of transit through the cardiopulmonary system.
42
What are the ROIs for Gastroesophageal Reflux imaging?
* Around the esophagus * Around the stomach
43
What types of tumors originate from the amine precursor uptake and decarboxylation (APUD) system?
Carcinoids, pituitary adenomas, pancreatic islet cell neoplasms, medullary carcinoma of the thyroid, pheochromocytomas, neuroblastomas, paragangliomas, small-cell lung cancers ## Footnote These tumors are characterized by neuroendocrine features.
44
List conditions that decrease the rate of gastric emptying.
* Diabetic gastroparesis * Hypothyroidism * Functional dyspepsia * Gastric ulcer
45
What is the purpose of a Pareto Chart?
A bar graph that ranks categories from highest to lowest frequency to determine areas to prioritize for improvement ## Footnote This helps focus efforts on the most significant issues.
46
What is the advantage of using 99mTc-Sulfur Colloid for gastrointestinal bleeding?
Minimizes background activity and promotes high contrast ratios.
47
What is an advantage of using immobilization techniques?
Immobilizes the patient
48
What is the dose for HIDA imaging in pediatric patients?
100 µCi/kg OR 140 µCi/kg
49
_____ is a progressive and IRREVERSIBLE condition characterized by diminished inspiratory and expiratory capacity of the lungs.
Chronic obstructive pulmonary disease (COPD)
50
Although no patient preparation is needed for the liver and spleen imaging, what test should not precede this scan? Why?
Iodinated or barium containing contrast agents should not precede this scan. ## Footnote Page No. 1
51
What is the formula for calculating uptake using the 2 Cap Method?
(Neck counts (cpm) - thigh counts (cpm)) X 100 / (Standard counts (cpm) - background counts (cpm)) ## Footnote Do not use a decay factor with this method.
52
What is the injection dose for GI Bleed imaging using 99mTc-Tagged RBCs?
20-30 mCi
53
What is In-111-pentetreotide used for?
To image neuroendocrine tumors, especially carcinoids and gastrinomas ## Footnote Also helpful for identifying pheochromocytomas, neuroblastomas, and paragangliomas.
54
What is the effect of Acetazolamide in cerebrovascular ischemia studies?
Evaluates blood flow changes in response to induced ischemia
55
What are the symptoms of COPD?
-shortness of breath w/ physical exertion -difficulty in inhaling or exhaling deeply -sometimes a chronic cough
56
What hormones mediate the muscular function in the stomach?
* Gastrin * Secretin * Cholecystokinin
57
Fill in the blank: MIBI uptake is suitable for detecting _______.
metabolically active tumors
58
What do normal lymphoscintigraphy findings show?
Clear and continuous flow of the radiotracer to regional lymph nodes.
59
What does the gastric emptying study diagnose?
Functional gastric dysmotility.
60
What do eosinophils primarily respond to?
Allergic reactions
61
What procedure requires that the patient be rolled from side to side to aid in mixing the radiopharmaceutical within the ascites?
Leveen Shunt Study ## Footnote This study evaluates the patency of shunts in patients with ascites.
62
What should be verified before a thyroid uptake study?
Patient's pregnancy status and medications
63
What are the predisposing factors of PE?
Predisposing factors are categorized into three main groups based on Virchow's Triad: 1. Hypercoagulability (conditions that increase the tendency of blood to coagulate: -polycythemia vera -pregnancy/postpartum (childirth) 2. Venous stasis (conditions/situations that impair blood flow): -stagnation or immobility -post-surgery -congestive heart failure 3. Endothelial injury (damage to the blood vessel wall that promotes clot formation): -surgery
64
What factor is crucial in determining surgical decisions for lung nodules?
Whether the nodule metabolizes FDG.
65
How is therapy delivered in the nuclear medicine department?
Therapy is delivered using unsealed sources, such as capsules or liquids.
66
What can be concluded from planar images of the liver and spleen?
Identification of defects, size, shape, and concentration/distribution of radiopharmaceutical.
67
What is the purpose of injecting 8-15 mCi of 99mTcO4 in Meckel's diverticulum imaging?
To increase the secretion of pertechnetate by ectopic gastric mucosa
68
What pharmaceutical may be given to aid in the differentiation of biliary atresia and neonate hepatitis?
Phenobarbital ## Footnote Used to differentiate between biliary atresia and neonatal hepatitis in infants.
69
What is the preferred method for explaining injection procedures to children?
Child should be told it will hurt but ok to cry
70
What is a critical patient safety guideline when imaging children?
NEVER leave a child alone
71
What is jaundice?
Severe damage causing yellowing of skin and sclera due to elevated bilirubin levels.
72
Define pyogenic abscess.
A localized collection of dead white cells and bacteria ## Footnote Often associated with infections.
73
What is the dose for a Left-to-Right Shunt using 99mTcO4?
25 mCi (IV bolus) ## Footnote 99mTcO4 is a radiopharmaceutical used in nuclear medicine.
74
What are the indications for an Esophageal Transit Study?
Evaluate and quantitate esophageal motility.
75
What is the primary pathology diagnosed by a Hepatobiliary Scan (HIDA)?
Acute cholecystitis.
76
Blood clots that form in the deep veins of the lower extremities that break off and travel back to the right side of the heart and into the lungs is known as a _________.
pulmonary embolism (PE)
77
What is exophthalmos?
Soft tissues and muscles around the eyes become swollen and inflamed
78
What is the purpose of scintimammography?
To differentiate malignant tumors from benign lesions in breast tissue.
79
What is Plummer’s Disease?
Toxic nodular goiter with single or multiple nodules overproducing thyroid hormones
80
What is the treatment for Follicular Thyroid Carcinoma?
Radioactive iodine, usually following surgery
81
In the ________________ study, a nasogastric tube may be inserted prior to the study and attached to suction to minimize the movement of radioactivity secreted by the stomach into the small intestine.
Meckel’s Diverticulum Study ## Footnote This technique helps in accurately locating the diverticulum.
82
What does the absence of radiotracer excretion into the gastrointestinal tract indicate?
Common bile duct obstruction (functional or anatomic) ## Footnote This absence is a key diagnostic indicator.
83
What is the preferred radioactivity for labeling white blood cells?
Tc99m or In111
84
What does HCPCS stand for?
Healthcare Common Procedure Coding System ## Footnote It is used by Medicare and Medicaid services.
85
What is inflammation?
The body’s response to harmful stimuli such as injury or infection, involving the attraction of white blood cells to the area
86
What factors influence the rate of gastric emptying?
* Volume * Composition * Physical state * Caloric content * Nutrient content * Viscosity * Acidity * Osmolarity
87
When administering 99mTc-MAA, what are some important thing to keep in mind?
-Patient must be supine. -Never draw blood into the syringe; can cause additional PE -Always agitate syringe before injecting to resuspend MAA particles
88
What imaging technique might be used to improve lesion localization?
SPECT/CT
89
What are the clinical process of care measures reported under VBP?
* Acute MI (30-day Mortality Rate) * Heart Failure (30-day Mortality Rate) * Pneumonia (30-day Mortality Rate) * Total Hip or Knee Arthroplasty (Complication Rate) * MRSA or Clostridium Difficile Infection * Catheter-associated urinary tract infection * Central Line associated bloodstream infections * Surgical site infection (Colon/Abdominal Hysterectomy) * Elective delivery prior to 39 completed weeks gestation
90
What are the indications for evaluating LeVeen shunts?
Evaluation of the patency of peritoneo-venous (LeVeen) shunts; Evaluation of the patency of other connections with the peritoneal cavity
91
What is the ictal state in seizure localization?
Blood flow and brain metabolism are increased at the site of onset
92
What happens when the body encounters an antigen?
B lymphocytes are sensitized and transform into plasma cells that produce specific antibodies targeting the antigen
93
What is Thyrogen?
A recombinant TSH that stimulates remaining thyroid tissue
94
Eighty percent of the hormones that the adrenal medulla synthesizes are ________.
epinephrine
95
Slow clearance of radiopharmaceutical in the washout phase may indicate what?
COPD
96
What are examples of magnifying devices used in pediatric imaging?
-Converging collimators -Pinhole collimators
97
What is periosteum?
A thin layer of dense, irregular connective tissue that covers the outer surface of a bone
98
What is the recommended patient preparation for evaluating Meckel’s Diverticulum?
Administer cimetidine and pentagastrin prior to the study.
99
What is the dose of 111-In DTPA used in cisternography?
1.5 mCi via intrathecal lumbar puncture
100
Why is a gastric emptying study using only anterior views prone to error?
The antrum's location may cause count rates to initially increase as food moves anteriorly.
101
What is septicemia?
Systemic infection in which pathogens are present in the circulatory bloodstream ## Footnote Can cause fever, chills, pain, headache, nausea, diarrhea.
102
What is the significance of the gallbladder ejection fraction (EF) in a HIDA scan?
It helps distinguish between acute and chronic cholecystitis.
103
How is 99mTc-DTPA adminstered?
using a positive pressure nebulizer
104
What is the main use of F-18 NaF in PET imaging?
Bone scans
105
Fill in the blank: The _______ node is a good indicator of the presence of metastatic tumor in a lymph node group.
sentinel ## Footnote It is the first node receiving lymphatic flow from the tumor.
106
What is the normal distribution of Tl-201-Cl?
Skeletal muscle, heart, liver, spleen, stomach, colon, choroids plexus, orbits, salivary glands, kidneys, and testes
107
What is the significance of a negative Vizamyl scan?
Reduces the likelihood that cognitive impairment is due to Alzheimer's Disease.
108
What is considered hypothyroidism based on thyroid uptake values?
Lower than 12% ## Footnote Greater than 25% is an early indicator of hyperthyroidism.
109
What is the therapeutic dose of Y-90 Zevalin based on?
Based on body weight and platelet count, typically 0.4 mCi/kg, with a maximum dose of 32 mCi.
110
What is cancer (CA)?
An uncontrolled, abnormal overgrowth of cells characterized by biochemical changes before visible histologic changes ## Footnote Defined by cellular alterations viewed by a pathologist
111
What is the purpose of the HCAHPS survey?
Provides comparisons of hospitals and creates incentives for hospitals to improve quality of care
112
Where are somatostatin receptors predominantly found?
In numerous neuroendocrine and some non-neuroendocrine tumors ## Footnote High density in tumors is significant for imaging and therapeutic targeting.
113
What is the patient position for a GI bleed study?
Supine.
114
What are the part of the adrenal gland?
-outer portion: adrenal cortex -inner portion: adrenal medulla
115
What are anatomical abnormalities associated with GER?
* Esophageal Stricture * Tracheoesophageal Fistula * Hiatal Hernia
116
True or False: The HCAHPS survey asks patients how satisfied they are with their care.
False ## Footnote It asks how often rather than how satisfied.
117
What responsibilities does the nuclear medicine department have during scheduling?
Establishing protocols, being aware of conflicting exams or medications, obtaining basic patient information, and documenting contraindications and required preparations ## Footnote Basic patient information includes name, ID number, referring physician, clinical indications, room number, and mode of transportation for hospital patients.
118
What is the role of iodide in the thyroid?
Iodide is ingested, absorbed into the bloodstream, and trapped by the thyroid gland ## Footnote The trapping occurs via sodium-iodide transporters.
119
What type of survey is HCAHPS?
First national, standardized, publicly reported survey of patients’ perspectives of hospital care
120
How is breast imaging with MIBI performed?
Involves injecting 20–30 mCi of MIBI and imaging 10–20 minutes post-injection, with the patient in a prone position to allow the breast to hang freely
121
Give an example of a hydrophilic radiopharmaceutical.
99mTc-pertechnetate or 99mTc-DTPA
122
When should imaging be performed after the injection of I-123?
3 hours post injection ## Footnote This timing is important for optimal imaging results.
123
What are the two types of thyroid nodules?
Hot and cold nodules
124
What should be done if blood glucose levels are high before a PET scan?
Blood sugar must be lowered to < 200 mg/dL.
125
What is the patient position for LeVeen shunt evaluation?
Supine
126
What is Virchow's Triad?
an outline of the mechanisms of thrombosis (blood clot formation)
127
What body structures are normally seen during gastrointestinal bleeding imaging with 99mTc-Sulfur Colloid?
* Intravascular space * Liver * Spleen * Bone marrow * Genitals
128
How many lobes are in the left lung?
2
129
What is the Medicare Fraud Strike Force?
A joint effort to investigate and prosecute Medicare fraud, focusing on regions with high fraudulent activity. ## Footnote It uses data analysis to identify unusual billing patterns.
130
What is the primary route of excretion for FDG?
kidneys
131
What are the pharmacologic effects of somatostatin?
Inhibition of growth hormone plus other effects ## Footnote Somatostatin regulates the endocrine system and affects neurotransmission.
132
What type of cells are found in the colon mucosa and what do they produce?
Goblet cells, which produce mucus.
133
What is a major cost consideration for using Rubidium-82 in heart studies?
Generator life-span about 1 month with significant initial costs.
134
What is the primary function of T3 and T4?
Regulates tissue and body metabolism
135
What is the dose for gastroesophageal reflux (GER) imaging?
150 µCi (oral or via an orogastric or nasogastric tube)
136
What is a common method for detecting and quantifying cardiac shunts in pediatrics?
Using non-invasive imaging techniques
137
What are the two categories of dementia?
* Disease where dementia is the only symptom * Disease where dementia is associated with other clinical signs
138
What is the primary thyroid carcinoma type?
Papillary thyroid carcinoma, accounting for ~85% of thyroid cancer
139
What is the most common form of hyperthyroidism?
Grave’s disease, affecting 70-80% of hyperthyroid patients
140
What equipment is used for thyroid uptake measurement?
Single crystal probe with flat field collimator ## Footnote A thyroid phantom is used to count capsule and background prior to administration.
141
Which bones are classified as long bones?
* Femurs * Tibias * Fibulas * Humeri * Radii * Ulnas * Metacarpals * Metatarsals * Phalanges * Clavicles
142
What are indications for pediatric skeletal imaging?
* Infection * Occult trauma * Tumor localization * Sports injuries * Orthopedic disorders
143
What pre-medications are required before administering 177Lu-Dotatate?
Discontinue long-acting SSAs for at least 4 weeks and short-acting octreotide at least 24 hours prior ## Footnote Short-acting octreotide can be administered as needed.
144
What is achalasia?
A failure of smooth muscle fibers to relax, causing the esophageal sphincter to remain closed.
145
What is the most common GI malformation in pediatrics?
Meckel’s diverticulum
146
What does VBP stand for?
Value Based Purchasing
147
True or False: Neutrophils are the primary white blood cells involved in the response to infection.
True
148
The volume of air breathed out in a normal breath is the ______.
tidal volume
149
What does the term 'iodine trapping' refer to?
The thyroid gland's ability to absorb and concentrate iodide from the bloodstream ## Footnote This is facilitated by active biochemical mechanisms.
150
What is somatostatin?
A naturally occurring neuropeptide with pharmacologic effects including the inhibition of growth hormone, present in various organs
151
What should you verify when billing for medical services?
* Charges billed are consistent with allowed multipliers * Coding is accurate and up-to-date * Documentation supports the billed services
152
What is the adult dosage for OctreoScan using In-111 Pentetreotide?
6 mCi.
153
What imaging technique is performed with Tc-99m-sulfur colloid?
Bone marrow imaging
154
What is primary peristalsis?
The sphincter then contracts and a peristaltic wave carries the food bolus from the upper esophagus into the stomach through a relaxed lower esophageal sphincter. ## Footnote Page No. 1
155
What are the three lobes of the thyroid gland?
Right, pyramidal, and left
156
What happens to brain metabolism at the site of onset during seizures?
Increased ## Footnote Blood flow and brain metabolism are elevated during the ictal state.
157
What is primary hypothyroidism?
Low thyroid hormone caused by thyroid dysfunction (95% of cases)
158
What radiopharmaceutical is used in scintimammography?
99mTc-Sestamibi (MIBI).
159
What techniques can be used to entertain a child during imaging?
* Toy * Blanket * Children programming * Tape recordings * Music stories * Books
160
What indicates hyperthyroidism?
Increased levels of thyroid hormones and decreased TSH levels ## Footnote Symptoms include elevated heart rate, weight loss, increased metabolism, and anxiety.
161
What is the normal range of leukocytes in human blood per cubic millimeter?
5,000 to 10,000
162
What is the energy output of Technetium-99m (99mTc)?
140 keV
163
What is a premalignant lesion?
A stage before cancer where cells show progressive changes that may lead to cancer, associated with organs like skin, breast, lung, cervix, and colon ## Footnote Identified by changes in cell nuclei, cytoplasm, and cell orientation
164
What does the LES control?
The passage of food from the esophagus into the stomach and prevents reflux.
165
What equipment is needed for administering Zevalin?
Large field of view SPECT camera, medium energy parallel hole collimator, and specific energy windows for In-111 ## Footnote Energy windows: 15–20% at 171 keV and 245 keV.
166
Patients with Cushing's Disease may have previously been prescribed what medication?
Prednisone
167
What is the mechanism of action of 177Lu-PSMA in prostate cancer treatment?
Localizes and binds to PSMA receptors in prostate cancer tissues ## Footnote It is delivered via slow infusion drip.
168
What condition must be met for glucose to be administered before FDG injection?
Blood sugar (BS) must be < 150 mg/dl
169
What are the first impression rules during a patient encounter?
Quality perception is formed in the first 30 seconds, greet the patient professionally, clearly identify the patient, and verify the procedure scheduled ## Footnote Confirm no contraindications by reviewing patient history.
170
List conditions that increase the rate of gastric emptying.
* Dumping syndromes * Hyperthyroidism * Gastrinomas * Gastric motility medications
171
What is the result of insufficient thyroid hormone production?
Hypothyroidism ## Footnote Symptoms include decreased metabolism, weight gain, and lethargy.
172
What happens to labeled leukocytes if stored longer than 3 hours?
Significant loss of cell viability
173
What are Kupffer cells responsible for?
Phagocytosis in the liver.
174
Fill in the blank: The small intestine is the longest part of the alimentary canal at ______ long.
20 feet
175
What is the pathway of cerebrospinal fluid (CSF)?
Lateral Ventricles → Interventricular Foramen of Monro → 3rd Ventricle → Aqueduct of Sylvius → 4th Ventricle → Subarachnoid Space
176
What is the significance of imaging decisions typically being case by case?
Individual patient circumstances can vary greatly.
177
What is the composition of bone by weight?
* 5 – 10% water * 25 – 30% organic matter (collagen, ground substance, and cellular elements) * 65 – 70% inorganic matter (bone mineral)
178
What are hemangiomas?
Benign tumors.
179
What is the technique for injecting 99mTc-MAA in hepatic artery perfusion?
Inject through hepatic artery catheter or infusion pump at < 1 mL/minute
180
What is the maximum capacity of the stomach?
Can hold up to 1 gallon at maximum distention.
181
What part of the brain is associated with movement and affected in Parkinson's disease?
Basal ganglia ## Footnote This area is crucial for motor control.
182
What does MIT stand for in iodine metabolism?
Monoiodotyrosine
183
What is the role of of aldosterone?
-regulate salt and water in the body
184
The presence of ectopic gastric mucosa in the distal esophagus is called __________ esophagus.
Barrett’s Esophagus. ## Footnote Page No. 1
185
What 4 factors are required to induce reflux successfully in a patient who is prone to gastro-esophageal reflux?
* Oral administration of an acidified solution * Successful increased pressure applied to abdomen * Maintenance of a supine position * At least a 300ml volume in the stomach to oppose the applied pressure. ## Footnote Page No. 1
186
What does the Big Blue Procedure Manual indicate regarding myocardial perfusion?
Detection of ischemic, but viable myocardium, particularly hibernating myocardium
187
Fill in the blank: The federal health insurance program created in 1965 for people aged 65 and older is called _______.
Medicare
188
What condition is treated with 32P sodium phosphate?
Polycythemia vera.
189
Fill in the blank: PET imaging relies upon _______.
size and architectural structure
190
What must be checked before each administration of therapy requiring a written directive?
The patient's identity and adherence to the written directive.
191
What are the short-term and long-term planning timeframes in nuclear medicine?
Short Term Plan: 1 year or less; Long Term Plan: Normally extends to 3 years ## Footnote These plans should align with the overall strategy of the nuclear medicine facility.
192
What is the role of osteocytes?
Mature bone cells made from osteoblasts that have made bone tissue around themselves
193
When plotting the results of Gastric Emptying Study on a graph, the _____________ is on the X-axis and the _______________ is on the Y-axis.
Time - X-axis, CPM/Gastric ROI - Y-axis ## Footnote CPM refers to counts per minute, indicating radioactivity in the gastric region.
194
What does the hypothalamic-pituitary-thyroid feedback system do?
Signals and controls body functions including the release of thyroid hormone ## Footnote The hypothalamus acts as the master switchboard and the pituitary as the master gland.
195
Describe the immune response to foreign stimuli.
The body mounts an immune response, where white blood cells, especially neutrophils, migrate to the site to engulf and digest foreign materials
196
What is the main blood flow regulator in the brain?
Oxygen/carbon dioxide concentration
197
What is the primary use of DaTscan I-123 Ioflupane?
Differentiation of Parkinsonian syndromes from essential tremor and dementia with Lewy bodies from Alzheimer’s disease ## Footnote Also used for detection of preclinical striatal dopamine transporter degeneration.
198
What is formed when MIT and DIT combine?
T3
199
After a patient has had a lung V/Q study, where might you find activity in the same patient 24 hours later?
-spleen -liver -Free Tech: kidneys and bladder
200
What immobilization devices can be used for pediatric patients?
* Sandbags * Velcro straps * Adhesive tape
201
What are the doses for I-123-MIBG and I-131-MIBG, and what preparation is done before dosing the patient?
I-123-MIBG: 3 - 15 mCi (PPT: 10 mCi) -Give thyroid blocking agent 24 hours before dosing and 3 times a day for 3 days after initial imaging I-131-MIBG: 0.5 mCi - 1 mCi -Give thyroid blocking agent 24 hours before dosing and 2 times a day for 6 days after initial imaging
202
What are the primary functions of the skeletal system?
* Store Minerals * Protection * Movement * Blood Formation * Structure and Support
203
What are the lobes of the liver?
Right lobe, left lobe, caudate lobe, quadrate lobe.
204
When do reduce the 99mTc-MAA dose?
-Patient is a pediatric patient. -Patient has pulmonary hypertension. -Patient has right-to-left shunt which can cause particles to pass through the systemic system and embolize the brains, kidneys heart, and other organs. -Patient had a pneumonectomy (only 1 lung).
205
What characterizes communicating hydrocephalus?
Defective reabsorption from the cerebral subarachnoid space
206
What radiopharmaceutical is commonly used in brain death imaging?
25mCi of 99mTc-DTPA or 99mTc-04 by bolus injection
207
What is the first step in the organification of iodine?
Ingestion of food and water
208
Defects seen in the equilibrium images of the lung ventilation can be associated with.....
-pneumonias -pulmonary infarctions -pulmonary edema
209
What radiopharmaceutical is commonly used in bone scans?
25 mCi of 99mTc-MDP or HMDP by IV injection
210
What does ICD-10 stand for?
International Classification of Disease - 10 ## Footnote It provides a common language for reporting and monitoring diseases.
211
Tumors with somatostatin receptors can be detected using __________ which is a somatostatin analog.
In-111-Octreoscan
212
Fill in the blank: An IgG molecule has a _______ shape.
Y
213
Who are considered customers in the nuclear medicine context?
Referring physician, third-party payer (insurance companies, HMOs), and internal customers within the department ## Footnote Internal customers may include staff involved in scheduling, preparing radiopharmaceuticals, and performing procedures.
214
When processing a lung quantification, the ROIs are drawn what structures and on which images?
-left and right lung -ANT and POST
215
What is evidence of a Right-to-Left Shunt?
Activity seen in other regions (kidneys, brain, & others) ## Footnote This suggests that some of the injected material bypassed the lungs.
216
What are antigens?
Large molecules recognized as foreign by the immune system, prompting the production of antibodies
217
What is the purpose of a Liver and Spleen Scan?
Assessment of chronic liver disease, liver/spleen size/configuration, diagnosis of focal nodular hyperplasia.
218
What is the typical dosage schedule for 177Lu-PSMA?
200 mCi every 6-8 weeks for 4 injections ## Footnote Doses can be adjusted based on patient condition.
219
What is the injection site for the Leveen Shunt?
Intra-peritoneal, lower left quadrant ## Footnote This site is chosen for optimal access to the peritoneal cavity.
220
What is observed in hyperthyroidism?
Overproduction of thyroid hormones and low TSH
221
True or False: An oral directive is acceptable if a written directive cannot be provided in time due to a patient's emergency condition.
True.
222
What does the Shewhart Cycle (PDCA) stand for?
Plan, Do, Check, Act ## Footnote This cycle is used for problem-solving and continuous improvement.
223
Name two benign conditions that can show increased MIBI uptake.
* Fibroadenomas * Fibrocystic Changes * Inflammation
224
What is the approximate dosage of I-131 for treating Grave's disease?
10 mCi.
225
What does DIT stand for in iodine metabolism?
Diiodotyrosine
226
What simple, inexpensive regimen may be used to resolve symptoms in most patients with esophageal reflux problems?
Use of antacids and changes to diet to include more protein. ## Footnote Page No. 1
227
The adrenal medulla synthesizes and secretes epinephrine and norepinephrine which are classified as ________.
catecholamines
228
What is the cost range for Rb-82 heart studies?
$20,000.00 to $30,000.00
229
What should be monitored closely during OctreoScan for patients with pheochromocytoma?
Blood pressure.
230
What should be done if a parent conveys apprehension to a child?
The NMT should be firm & authoritative to maintain control of the situation
231
List the subdivisions of the colon.
* Ascending colon * Transverse colon * Descending colon * Sigmoid colon
232
What is the definition of dementia?
Progressive impairment of intellect, memory, and personality without impairment of consciousness.
233
What is Tc-99m-MIBI used for?
Concentrates in breast and thyroid cancers and is commonly used for imaging parathyroid adenomas, suspected to enter cells due to its lipophilic nature
234
What are the indications for a brain perfusion study?
* Diagnosis of Alzheimer’s Disease * Localization of seizure foci * Evaluation of carotid blood flow prior to surgical occlusion
235
What is the difference between ictal and interictal imaging in epilepsy?
* Ictal: tracer injected during seizure * Interictal: tracer injected between seizures
236
What are indications for an I-131 metastatic survey?
* Confirmation of thyroid remnant presence * Determine therapy dose * Detection of metastases
237
What dosage is typically administered for Tc-99m-HMPAO-WBC’s?
10-25 mCi
238
What is the function of hepatocytes?
Bile production.
239
What is required for documentation in medical billing?
Must have an order from the referring physician ## Footnote Images should be on file and available for payor review if requested. Radiology report must contain all required information.
240
Pulmonary veins supply blood to the _______.
left ventricle
241
What is a potential reason for false negatives in scintimammography?
Lesions located medially near the heart
242
What is Meckel’s Diverticulum?
A congenital abnormality of the intestine typically presenting as a small pouch on the ileum.
243
Fill in the blank: The _______ must contain all required information for reimbursement.
radiology report
244
What is the purpose of administering phenobarbital before HIDA imaging?
To simulate biliary excretion of conjugated bilirubin
245
What is the annual cost for supplies and service contract in Rb-82 heart studies?
$10,000.00 per year
246
What is the purpose of radiolabeled monoclonal antibodies in non-Hodgkin’s lymphoma therapy?
To treat recurrent, difficult to treat, or resistant forms of non-Hodgkin’s lymphoma ## Footnote These antibodies target the CD20 antigen on B-cell lymphoma.
247
What is the prognosis for papillary thyroid carcinoma compared to follicular?
Better prognosis than follicular thyroid carcinoma
248
What is the function of osteoclasts?
Break down bone tissue
249
What is lymphoscintigraphy?
A technique used to study regional lymph node drainage pathways from malignant neoplasms ## Footnote Primarily performed with breast and skin malignancies.
250
What is the time frame for observing the gallbladder in chronic cholecystitis?
Delayed gallbladder visualization after 60 minutes (2-4 hours) ## Footnote Liver and common bile duct are seen by 60 minutes.
251
TRUE or FALSE. If the patient is over 3 years old, the examination only has to be explained to the patient and not the parent.
FALSE. The examination should be explained to both parent and patient.
252
Which study can be used for ruling out the diagnosis of congenital dilatation of the intrahepatic biliary radicles of the liver?
HIDA ## Footnote HIDA scans are useful in evaluating liver and biliary anatomy.
253
What radiopharmaceuticals are used to image the adrenal medulla?
I-123-MIBG and I-131-MIBG
254
What is the imaging frequency for LeVeen shunt evaluation?
Acquire ANT images of abdomen and chest at 5, 10, and 20 minutes for 1 min/frame
255
What is the typical uptake percentage for Grave’s disease?
24 hr uptake usually 50-80%
256
What are predisposing factors of COPD?
smoking
257
What do FDG images indicate about areas thought to be fixed on NM perfusion imaging?
FDG accumulation may be seen in those areas
258
What is the approximate dosage of 32P sodium phosphate for polycythemia vera?
3-6 mCi ## Footnote The dosage is based on the patient's body weight.
259
What are HCPCS Level I and Level II codes?
* Level I: Procedures, same numbering as CPT codes * Level II: Identifies products, supplies, and services not included in CPT codes
260
What is the significance of the cold nodule marker in thyroid imaging?
Indicates areas of reduced uptake, which may suggest potential malignancy ## Footnote Cold nodules are often further evaluated due to their association with cancer.
261
What is the purpose of thyroid imaging?
To evaluate the structure and functions of the thyroid gland ## Footnote It helps in differentiating hyperthyroidism and evaluating congenital hypothyroidism.
262
What is the patient position for hepatic artery perfusion imaging?
Supine
263
True or False: The liver has a dual blood supply.
True
264
What QP/QS ratio indicates a Left-to-Right Shunt?
1.2 to 3.0 ## Footnote QP/QS ratio represents the ratio of pulmonary to systemic flow.
265
What is the dose when using 99mTc-DTPA for the lung ventilation study? What is important to know regarding the dose?
25 - 40 mCi; the patient only receives 1 - 2 mCi is inhaled into the lungs
266
Ten percent of neuroendocrine tumors have __________ receptors.
somatostatin
267
What is the recommended dose of I-123 Ioflupane for a DaTscan?
3-5 mCi slow injection over 20 seconds ## Footnote This is the typical dosage for the procedure.
268
Why is it important for the patient to be supine when administering the radiopharmaceutical for the lung ventilation study?
In the supine position, the distribution is more uniform from the top to the bottom. In the upright position, ventilation is not uniform.
269
What is required for patient preparation before an Esophageal Transit Study?
Overnight fast and rehearse the swallowing technique.
270
A patient that is scheduled for a I-123-MIBG scan has had a recent barium contrast study. What patient preparation may be required and why?
-patient should take a laxative (10 mg bisacodyl) twice a day for 3 days before imaging to reduce bowel activity; patient may also need to take and emema the afternoon before imaging days -barium contrast may cause bowel artifacts
271
What must be included in the final report for a nuclear medicine study?
* Indications for the study * Location of injury or pain * Types of views taken * Radiopharmaceutical and dosage * Key structures evaluated * Final interpretation of procedure
272
True or False: Iodine was commonly deficient in the US before the 1920s.
True ## Footnote Areas affected were referred to as the 'Goiter Belt'.
273
What should technologists be certified in regarding patient care?
Pediatric CPR
274
What functions are associated with the Occipital lobe?
Sight
275
What should be the blood sugar level before FDG injection?
< 200 mg/dL
276
We occlude ____ percent of capillaries.
one
277
What is the primary use of KG ROI in the cardiovascular system?
To detect & quantify cardiac shunts ## Footnote KG ROI stands for Kinetic Gating Region of Interest.
278
What must be documented if an oral revision to a written directive is made?
Document the oral revision in the patient's record as soon as possible.
279
What is medical coding?
Medical coding is the language used to communicate information about procedures and supplies used in medical studies. ## Footnote It translates verbal descriptions of diseases, injuries, and procedures into alpha/numeric combinations.
280
What are the instructions for diabetic patients when performing a gastric emptying test?
Early in the mornings after receiving 2/3 of their usual insulin dose. ## Footnote Page No. 1
281
What is the purpose of administering cimetidine before a Meckel's diverticulum study?
To enhance the secretion of pertechnetate by ectopic gastric mucosa.
282
What is the primary purpose of sandbags in pediatric imaging?
To stop pediatric patients from moving
283
What is achalasia?
An esophageal motility disorder characterized by the inability of the esophagus to move food to the stomach.
284
What is the recommended patient preparation before a bone scan?
* Administration of 4 to 6 glasses of liquid * Have patient void before imaging
285
What is the principle source of energy for the brain?
Glucose
286
The volume of air in the lungs at the end of a normal breath is the ________.
functional residual capacity
287
Washout images with no present retention of Xenon is seen in patients with what pathology and why?
pneumonias because no Xenon can enter the fluid-filled alveoli
288
Which is true when using Xe-133 for a lung ventilation study? i. the lung perfusion scan is performed first ii. the study must be done in a negative pressure room iii. the dose administered is 10 - 20 mCi iv. images are acquired in the POSTERIOR projection
ii., iii., & iv. i. the ventilation study is performed first because Xe-133 has a lower energy peak (80 keV) than 99mTc (140 keV); if the perfusion study is performed first 99mTc's higher energy peak with mask Xe-133
289
What does the hepatobiliary scan (HIDA) evaluate?
Acute cholecystitis and extrahepatic biliary tract obstruction.
290
What is the dosage range for 99mTc-Filtered Sulfur Colloid in lymphoscintigraphy?
200 µCi-2 mCi.
291
What is the anatomical location of the gallbladder?
Hollow, pear-shaped organ located against the inferior surface of the liver.
292
Define the term sentinel node.
The first lymph node to receive lymphatic drainage from a tumor site, important for indicating whether metastases have spread
293
What happens in an autonomous nodule?
It loses the ability to be regulated by TSH and produces excess thyroid hormone
294
What characterizes Hashimoto’s Disease?
Body produces antibodies that attack the thyroid
295
Give an example of a lipophilic radiopharmaceutical.
99mTc-HMPAO (Ceretec) and 99mTc-ECD-Biscate (Neurolite)
296
What is Meckel’s diverticulum?
A congenital abnormality that can contain functioning gastric mucosa.
297
What are the preferred injection sites for pediatric patients?
* Veins on the dorsum of the hand * Veins on the foot
298
What is the typical uptake pattern for FDG in the brain?
Evenly distributed between lobes.
299
What is the role of the Blood-Brain Barrier (BBB)?
Protects the brain from toxic substances
300
What is the function of the liver?
Production and excretion of bile, metabolism of carbohydrates, lipids, proteins, and detoxification.
301
What is the role of the referring physician in the scheduling process?
Correlating the patient's history with the ordered procedure, determining contraindications, and communicating the order to the nuclear medicine department ## Footnote Communication methods include computer, chart, verbally, in-person, and written referral.
302
What are the common symptoms of sub-acute thyroiditis?
* Sudden onset pain * Enlarged gland * Fever * Hoarseness or difficulty swallowing
303
What are the contraindications for F-18 Tumor Imaging?
* Pregnant/breast feeding * Blood glucose levels greater than 150-200 mg/dL * Recent nuclear medicine scans
304
What do B-Lymphocytes produce?
Antibodies against specific antigens
305
Tidal volume, functional residual capacity, total lung capacity, and residual volume are all measured with _______.
standard pulmonary function tests
306
In which condition is the extraction of 99mTc-IDA compounds by hepatocytes severely reduced?
Jaundice ## Footnote This occurs when serum bilirubin approaches 15-20 mg/dL.
307
What is Medicare fraud?
Intentional deception or misrepresentation to collect money from the Medicare program illegitimately. ## Footnote It is estimated to be between 3-10% of Medicare spending annually.
308
What is the goal in viability imaging?
To determine if there is any salvageable myocardium
309
Fill in the blank: A patient may be released after therapy if the retained activity has decayed to or below _______.
33 mCi.
310
What can improve detectability when a 24 hr image shows activity within the intestine and active bleeding is suspected?
a second injection of 99mTc-RBC’s ## Footnote 99mTc-RBC is a radiopharmaceutical used to visualize blood flow.
311
What anatomical regions make up the stomach?
Fundus, corpus (body), antrum.
312
What is the structure of the thyroid gland?
Two symmetrical lobes joined by isthmus, wraps around trachea, each lobe about 4cm x 2cm ## Footnote The thyroid is usually not palpable if normal and slightly bigger in women.
313
What is the technique for an Esophageal Transit Study?
Instruct the patient to swallow a 15 mL aliquot of 99mTc-Sulfur Colloid followed by dry swallows every 15 secs for up to 9 minutes.
314
Which form of thyroxine is mostly present in the body?
Free T4
315
What minerals do bones store?
Calcium, phosphorus, and other minerals
316
Twenty percent of the hormones that the adrenal medulla synthesizes are ________.
norepinephrine
317
What do osteoblasts do?
Synthesize and secrete unmineralized ground substance
318
What is the patient position for GI Bleed imaging?
Supine
319
What is added to the syringe during blood drawing to prevent clotting?
Heparin or ACD solution
320
What is a mycotic aneurysm?
A dilation of an artery due to damage of the vessel wall by an infection
321
What act authorized the VBP program?
Patient Protection and Accountable Care Act of 2010
322
What is a common misconception about normal uptake in PET imaging?
Normal uptake in bowel, muscles, and uterus can be mistaken for tumor.
323
What is the structure of an IgG antibody?
A Y-shaped structure made up of two heavy and two light chains, with a variable region for binding specific antigens and an Fc region for immune response
324
What size are capillaries typically?
7 - 10 microns
325
What does the Deficit Reduction Act (DRA) of 2005 relate to?
Bundled exams
326
What are metastases?
The spread of cancerous cells to remote parts of the body from the primary site, leading to poor prognosis or death
327
Name the four lobes of the liver.
* Right lobe * Left lobe * Caudate lobe * Quadrate lobe
328
What is the first step in the DaTscan procedure?
Patient is supine, FOV – cranium ## Footnote The field of view is crucial for imaging.
329
What is the whole-body scan speed for Zevalin imaging?
7 cm/minute (PPT), 3 cm/minute (QRM)
330
What does an abnormal image of the basal ganglia look like in Parkinson's disease?
Looks like a period ## Footnote Normal appearance resembles a comma.
331
What is the purpose of the written procedures required by CFR 35.41?
To ensure high confidence that administrations are performed correctly and safely.
332
What are the disadvantages of using sedation for immobilization?
Drug takes 20 – 30 mins to work
333
What are the three subdivisions of the small intestine?
* Duodenum * Jejunum * Ileum
334
The volume of air in the lungs when as much air as possible is inhaled is the __________.
total lung capacity
335
What are common symptoms of B-cell non-Hodgkin's lymphoma?
Swollen lymph nodes, fever, night sweats, weight loss, fatigue ## Footnote Symptoms may vary depending on lymphoma location and stage.
336
True or False. We are able to image the adrenal cortex, but not the medulla.
False
337
What precautions should be taken to protect children from patients released after therapeutic administration of I-131?
Avoid direct or indirect contact with infants and young children for a specified period.
338
What is the purpose of a ventricular shunt study?
Evaluate the patency of shunts by direct injection of radiopharmaceutical
339
What is the technique for GI bleeding imaging?
Inject 20-30 mCi of 99mTc-Tagged RBCs and acquire flow images.
340
What is the risk of thyroid cancer associated with a single cold nodule?
25% chance of being cancerous
341
What comprises the appendicular skeleton?
* Upper Extremities * Lower Extremities * Shoulder Girdle * Pelvic Girdle
342
What is a crucial requirement for imaging instruments in pediatrics?
Great resolution is needed with imaging instrument
343
What are common symptoms of hyperthyroidism?
Hair loss, weight loss, tachycardia, nervousness, frequent bowel movements, perspiration, menstrual irregularities
344
What are the treatment options for hyperthyroidism?
* Medication * Surgery * I-131 treatment
345
What is the 'crossfire' effect in non-Hodgkin’s lymphoma therapy?
Kills targeted cells and adjacent cells ## Footnote This effect occurs due to the nature of radiolabeled antibodies.
346
What are the two types of joints based on movement?
* Synarthroses (rigid) * Diarthroses (freely movable)
347
What is the FOV for LeVeen shunt evaluation?
Abdomen and chest
348
What does normal scintimammography findings show?
Low, homogeneous MIBI uptake in normal breast tissue.
349
____________________ is secreted by the mucosa of the stomach as well as by any Ectopic gastric mucosa.
Pertechnetate ## Footnote Pertechnetate is used in various nuclear medicine imaging procedures.
350
What aids in the synthesis and storage of T3 and T4?
Thyroglobulin
351
What is the significance of the distribution pattern in whole body imaging?
It often defines the disease process such as in child abuse
352
What are the three classes of leukocytes?
* Granulocytes * Lymphocytes * Monocytes
353
What factors determine the administered dose for radionuclide imaging?
* Patient’s condition * Imaging technique desired * Imaging equipment used * The radio nuclide energy * The biologic half-life of Rp * Percentage of localization in the organ of interest
354
What is the patient preparation for thyroid imaging?
Avoid large meals for 2 hours before and after dosing, stop thyroid hormones and antithyroid medications ## Footnote No iodinated contrast for 3 weeks prior to imaging.
355
What is considered the normal % for a Gastric -Esophageal Reflux Test, and at what pressure?
Up to 5% at any pressure level ## Footnote Used to assess gastroesophageal reflux disease (GERD).
356
What percent of neuroblastomas overexpress the norepinephrine transporters?
90%
357
What is the dosage for 223Ra-Cl2 (Xofigo) based on patient weight?
1.49 uCi/kg ## Footnote Monitoring at the injection site is necessary for 15-30 minutes post-injection.
358
What does focal, intense MIBI uptake in the breast or axilla suggest?
Malignancy
359
What is the uptake time for imaging in scintimammography?
10–20 minutes after injection
360
Which cancers are commonly associated with metastases to bone?
* Lung Cancer * Breast Cancer * Prostate Cancer
361
What is sub-acute thyroiditis?
Inflammation of the thyroid gland usually following a viral infection, causing pain and low uptake of tracer
362
What preparations are needed before patient arrival in nuclear medicine?
Quality control on equipment, ensuring personnel training, assembling necessary supplies, assaying the radiopharmaceutical, and ensuring emergency equipment availability ## Footnote Quality control includes checking gamma cameras and dose calibrators.
363
What is the role of the cyclotron in PET imaging?
It produces F-18 Fluorodeoxyglucose (FDG) through proton irradiation.
364
What is the function of the thyroid gland?
Regulates basal metabolism, cell division, and normal growth ## Footnote Thyroid hormones are essential for normal body development and maintenance of function.
365
What is the adult dose for 99mTc-MAA?
2 - 6 mCi (gas ventilation), 1 mci (aerosol ventilation)
366
What is the half-life of Rubidium-82 used in cardiac imaging?
75 seconds.
367
What is administered to block the uptake of I-123 by the thyroid?
Potassium iodide solution, Lugol's solution, or potassium perchlorate ## Footnote These solutions are used prior to the DaTscan.
368
What tumors can be found with Tl-201-Cl?
Concentrates in viable tumors such as thyroid, lung, breast cancers, and glioblastomas, with lower uptake in benign tumors and inflammatory processes
369
True or False: Lesions smaller than 1 cm might be detected in scintimammography.
False
370
What are the main immobilization techniques used in pediatrics?
* Wrapping * Sandbagging * Sedation * Surgical tape
371
What drug may be given intravenously, at the time of imaging, to increase the likelihood or location of a GI Bleed?
Heparin ## Footnote Heparin is an anticoagulant that may enhance visualization of bleeding sites.
372
What hormones does the thyroid gland secrete?
T3 (triiodothyronine) and T4 (thyroxine)
373
What is the typical imaging protocol for patients with claustrophobia?
Consider sedation before the scan.
374
What are the diagnostic indications for adrenal medulla imaging?
-benign and malignant pheochromocytoma (overproduce epinephrine and norepinephrine) -paragangliomas (benign tumors that over produce epinephrine) -neuroblastomas -ganglioneuroblastoma and ganglioneuroma -carcinoid tumors -MEN-type 2
375
What is the typical dosage for Gallium-67 imaging?
5-10 mCi IV.
376
What is the indication for the hepatic hemangioma study?
Diagnosis of hepatic hemangiomas.
377
What are the classifications of bones based on shape?
* Long Bones * Flat Bones * Short Bones * Irregular Bones
378
What is cholestasis?
Blockage in the supply of bile into the digestive tract.
379
How is the % Right-to-Left Shunt calculated?
% Right-to-Left Shunt = (Total Body Counts – Total Lung Counts)/Total Body Counts ## Footnote This formula quantifies the proportion of shunted blood.
380
What does HCAHPS stand for?
Hospital Consumer Assessment of Healthcare Providers and Systems
381
When performing a lung ventilation study with 99mTc-DTPA on asthmatic patients, what can be done to improve the quality of the study?
pre-treat with patient with a bronchodilator
382
What are some common symptoms of neuroendocrine tumors?
Symptoms vary depending on tumor location and hormone production ## Footnote Neuroendocrine tumors can produce various hormones, leading to diverse symptoms.
383
Gas exchange between oxygen and carbon dioxide occurs where?
alveoli
384
What is the initial imaging technique for GI Bleed after injection?
Acquire ANT flow images at 1 min/frame for 30 minutes
385
What is a gastro-esophageal reflux study used for?
Detection and quantitation of gastro-esophageal reflux.
386
What is the purpose of a Fish Bone (Cause and Effect Diagram)?
To determine the root cause of a problem by mapping out potential causes categorized by methods, machines, people, materials, and measurements ## Footnote This visual mapping helps identify areas for improvement.
387
What is the primary use of lymphoscintigraphy?
To study the pathways of lymphatic drainage from malignant tumors to regional lymph nodes.
388
What techniques increase sensitivity in Gastroesophageal Reflux imaging?
* High acidity radiopharmaceutical solution * Supine positioning * Increased intra-abdominal pressure
389
What is the active growth of bacteria, fungi, or viruses in tissue known as?
Infection
390
Fill in the blank: The dose for a Left-to-Right Shunt is _______.
25 mCi (IV bolus)
391
What is the maximum percentage CMS can withhold in reimbursement payments under VBP?
2% in 2017 and subsequent years
392
Which stage of the lung ventilation study mostly closely resembles a chest x-ray?
equilibrium
393
Differentiate between Grave’s disease and Plummer’s disease.
Grave’s disease: Even distribution, no nodules; Plummer’s disease: Multiple cold, warm, and hot nodules
394
How should the intravenous administration of Y-90 Zevalin be performed?
Administered 7-9 days after the diagnostic imaging.
395
What is the imaging protocol for CSF leaks?
* Place absorbent sheet under patient’s nose * Obtain ANT, POST, LLAT, and RLAT images at 2, 6, and 24 hours
396
What is the radiopharmaceutical used in Gallium studies?
Gallium-67 citrate.
397
What is a critical factor affecting prognosis in melanoma?
Tumor thickness and depth of invasion.
398
Fill in the blank: The larger the defect(s) on NM stress images, the higher the probability that there is a mixture of ______ and ischemia.
infarct
399
What is cholelithiasis?
The presence of gallstones composed of cholesterol, lecithin, and bile acids.
400
What is the purpose of radiolabeled somatostatin analogs?
Used to image primary and metastatic sites ## Footnote They have a longer biological half-life than endogenous somatostatin.
401
What characterizes a 'cold' nodule?
Non-functioning nodule
402
What is the purpose of the room preparation for a patient receiving therapy?
To minimize contamination and ensure safety.
403
Pulmonary embolism shows up as a _____ on perfusion images.
cold wedge
404
What does the term 'hot nose' indicate?
Increased activity in the area without activity above the nose, an indicator of brain death
405
What percentage of business is typically Medicare & Medicaid for hospitals according to AHA?
>60%
406
What is the technique for mixing radiopharmaceuticals in LeVeen shunt evaluation?
Mix radiopharmaceutical (1.5-5 mCi of 99mTc-MAA or 3 mCi of 99mTc-Sulfur Colloid) within ascites by ballottement of the anterior abdomen or rolling the patient side to side
407
When was HCAHPS implemented?
Implemented by CMS in 2006, with the first results reported in 2008
408
What is the most common indication for a bone scan?
Staging of malignant disease
409
What is the characteristic of follicular thyroid carcinoma?
Presents as a cold nodule and is considered more aggressive than papillary
410
How do cancer cells grow?
Cancer cells proliferate uncontrollably and create new blood vessels (angiogenesis) for nutrients and oxygen, leading to central necrosis
411
What is a characteristic of Graves’ Disease?
Goiter (diffuse thyroid enlargement)
412
What is the HAMA reaction?
A reaction occurring when mouse-derived monoclonal antibodies are used, leading to an immune response against them, especially upon repeated exposure
413
The adrenal medulla is composed of chromaffin cells which are derived from _________ tissue.
neuroectodermal
414
What is the purpose of hepatic artery perfusion evaluations?
To evaluate perfusion through an indwelling hepatic artery shunt.
415
Why should sandbags not be adjusted if they are used to stop blood flow?
It will cause death
416
What are the four lobes of the cerebral hemispheres?
* Frontal * Parietal * Occipital * Temporal
417
What views are acquired for the lung perfusion study?
ANT/POST, RAO/LPO,RLAT/LLAT, RPO/LAO
418
What is upcoding in medical billing?
Billing for services at a higher level of complexity than what was actually provided. ## Footnote An example is billing for a motorized scooter while supplying a push wheelchair.
419
What is the length and function of the esophagus?
A muscular 10-inch long tube that transports food from the pharynx to the stomach through peristalsis.
420
What is the average improvement in contractility after CABG for patients with FDG uptake in cold areas?
80% of those patients undergo improvement
421
What are indications for using F-18 FDG in neurology?
* Grading tumors * Diagnosis of brain neoplasms * Localizing seizure focus
422
What are Recovery Audit Contractors (RAC)?
Auditors that identify improper Medicare payments through random visits and audits of medical records. ## Footnote They were created by the Tax Relief and Healthcare Act of 2006.
423
What is an example of an ICD-10 code for pain in the right shoulder?
M25.511 ## Footnote Each disease, disorder, and symptom has its own alpha-numeric code.
424
What is the normal distribution of bone marrow in adults?
Skull, sternum, ribs, proximal humerus and femur, vertebral column, pelvis
425
What is the FOV for hepatic artery perfusion imaging?
Chest, including entire lungs and entire liver
426
What is the FOV for GI Bleed imaging?
Abdomen and pelvis
427
Fill in the blank: The labeled leukocytes should be administered within _______ of completion of cell labeling.
1 hour
428
What indicates malignancy in scintimammography results?
Focal, intense MIBI uptake in the breast or axilla.
429
What is the imaging technique for Zevalin after administration?
Imaging Time Points: 2–24 hours and 48–72 hours after injection.
430
What are the three subdivisions of the small intestine?
* Duodenum * Jejunum * Ileum
431
Outline the adrenal biofeedback.
1. The hypothalamus detects low cortisol levels in the blood, secretes corticotropin hormone, and sends it to the pituitary glands. 2. The pituitary gland secretes adrenocorticotropic hormone. 3. ACTH stimulates the adrenal gland to release cortisol.
432
What is the normal ratio of intrathyroidal iodine to plasma iodine?
Approximately 6:1, may be as high as 10:1 in hyperthyroidism.
433
What is the normal adult range of particles in a 99mTC-MAA dose?
Patients over 8 years old: 200K - 700K particles but atleast 100K
434
What are the types of bone cells?
* Osteogenic Cells * Osteoblasts * Osteocytes * Osteoclasts
435
Define malignancy.
A condition where atypical cells have invaded surrounding tissues or blood vessels and can metastasize to distant parts of the body
436
What are the normal scintimammography findings?
* Low, homogeneous MIBI uptake in normal breast tissue * Minimal activity in surrounding fat
437
Medullary hormones work by... i. increasing glucose levels in the blood ii. maintaining smooth muscle tone iii. maintaining metabolic rate and temperature iv. increasing the force of cardiac contractions
ii., iii., & iv. (all are involved in the fight-or-flight response) i.: glucose inhibits fight-or-flight response and glucose production is regulated by cortisol which is synthesized and secreted by the adrenal cortex
438
What two radiopharmaceuticals are used to evaluate simultaneous gastric emptying of solid and liquid meal imaging?
99mTc Sulfur Colloid – solid, 111In-DTPA – liquid meal ## Footnote Other options include 99mTcDTPA-Liquid and 99mTc-Albumin Colloid.
439
What is Colloid Shift?
Increased sulfur colloid uptake in spleen and bone marrow, decrease in liver. ## Footnote Page No. 1
440
What is the dosage for Yttrium-90-Ibritumomab Tiuxetan (Zevalin) used in non-Hodgkin's lymphoma therapy?
0.3-0.4 mCi/kg (not to exceed 32 mCi) ## Footnote This dose is administered over 10 minutes to monitor for side effects.
441
What is the role of coding specialists in a facility?
Use coding specialists in your facility for accurate billing
442
What does F-18 Fluorodeoxyglucose (FDG) accumulate in?
pathologic tissues
443
What is required for patient preparation before Zevalin treatment?
Consent form, pregnancy test, HAMA screening, and non-radiolabeled rituximab infusion ## Footnote Rituximab infusion is done 4 hours prior to imaging and therapy doses.
444
What is the dose of 99mTc-ECD for a brain perfusion study?
20 mCi
445
Define a 'hot' nodule in terms of thyroid pathology.
Hyper-functioning nodule
446
What is the purpose of quality control during the blood labeling process?
To ensure leukocyte-rich plasma is separated correctly
447
What does the heart metabolize if glucose is not readily available?
Fatty acids
448
Fill in the blank: T3 is also known as _______.
Triiodothyronine
449
What is the importance of patient preparation prior to PET imaging?
To ensure accurate results and minimize interference from physiological factors.
450
Prolonged exposure to high levels of cortisol can cause ______.
Cushing's Disease
451
What major demographic change is mentioned that affects healthcare revenue?
More patients (Baby Boomers)
452
What is the function of the large intestine?
Absorb water and create feces.
453
What are the main components of the central nervous system (CNS)?
Two cerebral hemispheres, Cerebellum, and Brain Stem
454
What must be discontinued before a DaTscan procedure?
Cocaine and amphetamine ## Footnote These should be stopped for 4-5 plasma clearance half-lives.
455
Where is the thyroid gland located?
Between the thyroid cartilage and suprasternal notch
456
What are the subdivisions of the large intestine?
* Cecum * Appendix * Colon * Rectum * Anal canal
457
What is the patient position for Meckel's diverticulum imaging?
Supine, in LAO position
458
What is the advantage and disadvantage of using 99mTc-SC for GI Bleeding?
* Advantage: Minimize background level activity and promote the highest contrast ratios * Disadvantage: Must be actively bleeding. ## Footnote Page No. 1
459
What are the symptoms of hypothyroidism?
* Decreased metabolism * Weight gain * Lethargy
460
What is the Circle of Willis?
A connection of arteries in the brain that equalizes blood pressure and provides collateral blood flow
461
What percentage of 'fixed' defects by SPECT imaging may represent severely ischemic areas?
20–40%
462
What are the instructions for nursing personnel administering care to a patient after thyroid cancer therapy?
Pregnant nurses should not deliver care, and nurses should wear monitoring devices.
463
What is the ratio of white blood cells to red blood cells?
1:600-700
464
True or False: T4 is the metabolically active hormone.
False ## Footnote T3 is the metabolically active hormone.
465
What are the implications of a positive scan result for beta-amyloid plaque?
Consistent with diagnosis of Alzheimer's Disease.
466
What does normal uptake in Zevalin indicate?
Visualized in the liver, spleen, kidneys, bladder, and bowel.
467
What is the radiopharmaceutical used for thyroid imaging?
I123 (Oral) and Tc-99m-pertechnetate (IV) ## Footnote I123 is used in a range of 100-300 uCi.
468
What is the half-life of Iodine-131 (I-131)?
8.1 days
469
What is Graves’ Disease?
An autoimmune disease causing hyperthyroidism
470
What are the two thyroid hormones?
Triiodothyronine (T3) and Thyroxine (T4) ## Footnote T3 is the metabolically active hormone.
471
What functions are associated with the Temporal lobe?
Hearing & Proprioception
472
How long should iodinated contrast be stopped before a thyroid uptake?
At least 3 weeks
473
Thyroid blocking agents are used to inhibit the thyroid from taking up free iodine. What are some thyroid blocking agents and the dose given to patients for an I-123-MIBG or I-131-MIBG study?
SSKI (potassium iodide): 60 mg Lugol's Solution: 1 drop Potassium perchlorate: 400 mg (iodine allergy)
474
True or False: The use of 'Rule Out' or 'Possibility of' can be used in diagnosis coding.
False ## Footnote ICD-10 codes must be provided without ambiguity.
475
In the evaluation of Hepatic Artery catheter placement, what organs are the regions of interest drawn around?
right lung, left lung, liver ## Footnote Important for assessing the distribution of blood flow.
476
What is the outcome of the tumor uptake hypothesis for Ga-67?
Ga-67 uptake in tumors is facilitated by tumor-cell-transferrin receptor, involving endocytosis and binding to various proteins
477
What is the purpose of the Radiology Information System (RIS)?
To manage medical imaging and associated data, tracking patient workflow within the radiology department. ## Footnote It allows integration with Electronic Health Records.
478
What can cause a transient worsening of lesions during chemotherapy?
Chemotherapy may cause lesions to show an apparent worsening.
479
What is the dose range for 99mTc-Sestamibi in scintimammography?
20–30 mCi IV.
480
What is the patient position for a Meckel’s Diverticulum study?
Supine, in LAO position.
481
What is an antigen?
Large molecules recognized as foreign by the immune system ## Footnote They stimulate the immune system to develop antibodies.
482
What can compromise the integrity of the BBB?
Injury related to disease, trauma, or toxins
483
What is the diagnostic value of a bone marrow scan in relation to osteomyelitis?
Shows increased uptake if osteomyelitis is present; if normal, osteomyelitis is absent
484
What is the standard preparation process for a white blood cell study?
Explain process to patient, blood draw, send to pharmacy for labeling
485
What is the typical dosage of I-131 for treating Plummer's disease?
15-29 mCi.
486
Fill in the blank: A matched defect shows no uptake on resting images and no uptake on ______ images.
viability
487
When acquiring images for the lung perfusion study, how many counts are collected?
500K - 1000K counts/frame
488
What dosage is typically administered for In-111-WBC’s?
500 uCi
489
What is the administration method for 223Ra-Cl2 (Xofigo)?
Intravenous injection slowly over 1 minute ## Footnote A 10 mL normal saline flush is required after injection.
490
What are the two radiopharmaceuticals used for pain reduction in bone cancer patients?
* 89Sr-chloride (Metastron) - 40 to 60 microcuries/kg * 153Sm-EDTMP (Quadramet) - 1 mCi/kg.
491
What is the field of view (FOV) for Meckel's diverticulum imaging?
Abdomen and pelvis, including right lower quadrant (xiphoid to pubis)
492
True or False: The periosteum covers all areas of the bone, including joints.
False
493
What is a significant impact of revenue on healthcare facilities?
Affects hiring/lay-off decisions, equipment purchases, and expansion projects
494
What is the interictal state in seizure localization?
Blood flow and brain metabolism are reduced at the site of onset
495
What is the function of the esophagus?
To transport food from the pharynx to the stomach by contractions of the peristalsis.
496
What is considered abnormal distribution in a Zevalin scan?
Abnormal increased uptake in organs not related to the known tumor.
497
What is the normal level of reflux in adults?
Less than 4% at all levels of binder pressure.
498
What are the key components of a written directive according to CFR 35.40 when using a Rp other than I-131?
It must include the patient's name, dosage, radioactive drug, and route of administration.
499
What is the 'Rules of 2' for Meckel’s diverticulum?
* 2% of population * Under age 2 * Within 2 feet of ileocecal valve * 2 inches in length * 2 types of heterotrophic mucosa * 2:1 male to female ratio
500
What is the cost range for a refurbished infusion delivery system?
$350,000 to $450,000
501
Name two radiolabeled somatostatin analogs.
* I-123-Octreotide * In-111-Pentetreotide (OctreoScan) ## Footnote These analogs are crucial for imaging neuroendocrine tumors.
502
What is the anatomy of the stomach?
Crescent-shaped, pouch-like organ that lies just below the diaphragm with regions including fundus, corpus, and antrum.
503
What is the time frame for discontinuing pain medications before HIDA imaging?
2-6 hours before study.
504
What is the iodine requirement for thyroid hormone production?
Intake less than 20ug/day can lead to iodine deficiency hypothyroidism
505
Which study is used for the evaluation of liver transplants, and what is the fasting requirement?
Hepatobiliary, no fasting required ## Footnote Gallbladder is not evaluated in this context.
506
What are the indications for GI bleeding localization?
* Localization of GI bleeding sites * Localization of non-GI bleeding sites
507
What important patient prep should be done before a lung perfusion study?
Patient should have a recent chest x-ray within 24 hours of the study
508
What is PIOPED?
Prospective Investigation of Pulmonary Embolism Diagnosis Study
509
How many items are in the HCAHPS survey?
27 item survey
510
What is the significance of metabolic activity in tumors?
Metabolic activity increases before anatomic changes occur and can be identified months earlier.
511
What is the maximum total effective dose equivalent to other individuals from a released individual not to exceed?
5 mSv (0.5 rem).
512
What are the indications for GI Bleed imaging?
Localization of GI bleeding sites, Localization of non-GI bleeding sites
513
What are the most common radiopharmaceuticals used for localization of the hepatobiliary system?
* 99mTc-IDA * 99mTc-HIDA * 99mTc-DISIDA. ## Footnote Page No. 1
514
What are the three sections into which PET is divided?
* Oncology * Neurology * Cardiology
515
How long does imaging continue for GI Bleed studies?
Until the site of bleeding is localized, the patient can no longer lie under the camera, or other specified conditions are met
516
What are the symptoms of pulmonary embolism?
-dyspnea (shortness of breath) -sudden chest pain -shock -cyanosis
517
What is the primary function of neutrophils?
Involved in phagocytic response to infection and inflammation
518
What factors can affect the Standard Uptake Value (SUV)?
* Serum glucose * Dose delivered * Body mass * Uptake period * ROI size * Pixel size * Brown fat
519
What is the injection dose for hepatic artery perfusion imaging using 99mTc-MAA?
1-5 mCi slowly over 3 minutes
520
What percentage of Medicare spending accounted for total federal spending in 2019?
14% ## Footnote Medicare spending in 2019 hit $644 billion.
521
What should be done if overheating occurs in an emergency with a wrapped child?
NMT must unwrap child
522
MIBG is chemically similar to which hormone?
norepinephrine
523
What anatomical structures are observed in acute cholecystitis at 60 minutes post-injection?
Liver, common bile duct, GI tract ## Footnote No gallbladder is seen after 60 minutes or by 4 hours.
524
How many lobes are in the right lung?
3
525
Fill in the blank: Bone cells respond to traumas, such as fractures, by giving rise to __________.
[bone-forming cells and bone-destroying cells]
526
What is the typical dose range for I-131 in thyroid ablation.
70-200 mCi (PPT), 30-300 (QRM)
527
What are the three parts of the adrenal cortex?
-Zona glomerulosa: secretes mineralocorticoids like aldosterone -Zona fasciculata: secretes glucocorticoids like cortisol -Zona reticularis: secretes gonadotropins like testosterone
528
What are the minimal amount of counts acquired in the single breath portion of the lung ventilation study? Equilibrium portion?
Single breath: 100K counts Equilibrium: 300K counts/frame
529
What is the typical treatment for polycythemia vera?
Hydroxyurea ## Footnote Polycythemia vera is characterized by the overproduction of red blood cells.
530
What is the primary application of PET in the medical field?
Oncology ## Footnote PET is primarily used to detect and monitor tumors.
531
What is a lumboperitoneal shunt?
A surgical procedure that redirects excess CSF from the subarachnoid space to the abdominal cavity
532
What is the function of basophils?
Secrete histamine and heparin
533
What functions are associated with the Frontal lobe?
Memory & Motor
534
What defines hydrophilic brain radiopharmaceuticals?
Doesn't cross an intact BBB and attracts water molecules
535
What does it indicate if no right-to-left lung shunt is detected?
More than 95% of injection is trapped in pulmonary bed ## Footnote This indicates a normal pulmonary function without shunting.
536
What is the generator life-span for Rb-82 heart studies?
About 1 month
537
What percentage of cardiac output and oxygen does the brain receive?
20%
538
What should be included in the FOV when imaging pediatric patients?
Include ONLY the area of interest
539
What is the typical imaging position for patients during a PET scan?
supine with arms above head
540
What is the purpose of a 3-phase bone scan?
Used to rule out infection in the extremities, stress fractures, avascular necrosis, or primary bone tumors
541
What are the two key performance areas for hospitals under VBP?
* How well they perform on specific defined outcomes * How well they improve on each measure compared to their performance in the baseline period
542
How does 99mTcMAA pass from the liver to the lung in the Hepatic Artery Perfusion Study?
arterio-venous shunts ## Footnote This mechanism is crucial for evaluating hepatic perfusion.
543
What defines lipophilic brain radiopharmaceuticals?
Crosses BBB and tends to attract or absorb fat
544
What is the normal gallbladder ejection fraction within 3 minutes?
> 33%
545
How does Ga-67 citrate localize in tumors?
Ga-67 citrate binds to transferrin receptors on tumor cells and accumulates in areas where white blood cells are active in fighting infections
546
What hormone is known as the stress hormone and increases glucose in the bloodstream, suppressing the immune system?
Cortisol
547
True or False: Hepatitis is the inflammation of the liver.
True
548
What abnormal results might be seen in a Gallium study?
Increased uptake in areas of active infection or tumor involvement.
549
What is septicemia?
A severe condition where bacteria from an infection enter the bloodstream, causing a systemic inflammatory response
550
What is subacute thyroiditis?
Acute inflammatory disease of the thyroid, often viral in origin
551
What radiopharmaceutical is used in lymphoscintigraphy?
99mTc-Filtered Sulfur Colloid.
552
What is the typical time frame for maximum uptake of FDG in the brain?
About 35 minutes.
553
What indicates abnormal results in lymphoscintigraphy?
Lymphedema or lymph node metastasis.
554
What is the primary indication for myocardial viability assessment?
Determine the usefulness of revascularization in patients with diminished regional blood flow and left ventricular function
555
Ninety percent of MAA particles in a 99mTc-MAA dose are what size?
10 - 90 microns
556
What is the function of calcitonin?
Regulates levels of calcium and phosphate in the blood ## Footnote It increases calcium excretion in urine and promotes osteoblastic activity.
557
The volume of air in the lungs after complete exhalation is called ________.
residual volume
558
What are the advantages of using KG ROI compared to cardiac catheterization and contrast angiography?
Non-invasive, rapid & low radiation dose ## Footnote These advantages make KG ROI a preferred choice in many clinical settings.
559
What is the advantage of using 99mTc-Tagged RBCs for gastrointestinal bleeding?
Better for intermittent bleeding and allows repetitive imaging up to 36 hours.
560
What is osteomyelitis?
Inflammation of the bone & bone marrow
561
What is somatostatin?
A naturally occurring neuropolypeptide synthesized and released by endocrine or nerve cells ## Footnote Particularly released in various organs, especially the hypothalamus.
562
What are main indications of a lung ventilation study?
-diagnosis of PE -evaluation of regional ventilation
563
What is the normal variant lobe of the thyroid gland called?
Pyramidal lobe
564
What is the maximum time allowed from blood draw to injection of labeled leukocytes?
5 hours
565
What pathologies are detected using 99mTc-IDA derivatives in pediatric and congenital abnormalities?
Choledochal cysts, biliary atresia, other congenital abnormalities ## Footnote These conditions can be evaluated with imaging techniques.
566
Define GERD.
Gastroesophageal reflux disease, a disorder where stomach contents regurgitate back into the esophagus.
567
What imaging technique is used in DaTscan?
SPECT ## Footnote The SPECT scan involves 360 degrees, 120 stops, and takes 15-25 seconds.
568
What are common causes of hip pain in pediatric patients?
* Toxic Synovitis * Septic Arthritis * Slipped capital femoral epiphysis * Avascular necrosis of femoral head
569
What is the patient position for the Day 1 4-hour uptake measurement?
Sitting
570
What are neuropeptides?
Synthesized and released mostly by the brain, gut, endocrine system, and lymphatic tissue ## Footnote Neuropeptides are small protein-like molecules used by neurons to communicate with each other.
571
What is the purpose of having the patient NPO after midnight before a viability study?
To ensure no glucose is available
572
What does the Standard Uptake Value (SUV) help confirm?
visual impression of lesions
573
What is the labeling efficiency for in-vivo techniques?
60-90%.
574
What does a mismatch between resting images and FDG viability scan indicate?
Highly predictive of recovery of wall motion function after revascularization
575
What are the two types of labeling for white blood cells?
In-vivo or in-vitro
576
What important patient preparation should be down before a lung ventilation study?
practice the breathing technique
577
What factors must be considered when imaging pediatrics?
-Equipment -Patient Safety -Nursing Care -Immobilization Techniques -Patient & Parent Psychology -Injection Technique -Technical Requirements for Specific Procedures
578
What is the significance of coding accuracy in medical billing?
It is essential for appropriate patient treatment, reimbursement, research, and financial decision-making. ## Footnote Errors can lead to non-reimbursement from insurance companies.
579
What is the crystalline structure of bone mineral called?
Hydroxyapatite, Ca10(PO4)6(OH)2
580
What should be avoided to prevent tourniquet effect artifact during injections?
Loosen all restraints for a short period before injecting
581
What is the role of sentinel nodes in lymphoscintigraphy?
First node to receive regional lymphatic flow from the tumor site, indicating the presence or absence of metastatic tumor ## Footnote A reliable biopsy indicator.
582
What causes Addison's disease?
decreased levels of cortisol and aldosterone due to: -sudden drop in long-term steroid use -pituitary gland stops producing ACTH -removal of ACTH producing tumor
583
What is the maximum dose for skeletal imaging in pediatrics?
0.25 mCi/kg (15 mCi MAX)
584
How is the projection of the camera for imaging Hepatic Hemangioma determined?
Previous imaging studies, ex. CT, Ultrasound ## Footnote Important for accurate localization of the hemangioma.
585
What does the gallbladder do after a meal?
Contracts and dumps bile into the duodenum.
586
587
This study evaluates the patency of connections between the peritoneal cavity and the venous system.
Leveen Shunt ## Footnote Important for assessing shunt functionality in patients with ascites.
588
What is the shape of the thyroid gland?
Butterfly shape
589
Where are the adrenal glands located?
on top of the kidneys
590
What is the function of the gallbladder?
Stores and concentrates bile, releasing it into the duodenum after meals.
591
What must be done before administering a therapeutic dose of I-131?
Prepare a written directive as per CFR 35.40.
592
What is lymphoscintigraphy?
A procedure involving injecting Tc-99m-sulfur colloid to identify the sentinel lymph node that receives drainage from a tumor
593
Outline the steps for the lung ventilation study using Xe-133.
1. Patient is placed supine and positioned on the camera with lungs in the FOV. 2. Instruct patient to take a deep breath and bolus inject Xe-133. Ask patient to hold their breath for as long as possible. 3. Ask patient to breath normally for 3 minutes (45 secs/frame x 4 frames). 4. Continue imaging and acquire a minimum if 4 images at 15 - 20 secs/frame until no Xe-133 gas is seen.
594
Which radiopharmaceutical is best for evaluating inflammatory bowel disease?
Tc-99m-HMPAO-WBC’s
595
Fill in the blank: The small intestine is the longest part of the alimentary canal, measuring ______ feet long.
20
596
What effect does 32P sodium phosphate have on red blood cells?
Kills them ## Footnote It attaches to red blood cells and induces cell death.
597
What does a normal cisternogram show?
Activity in the basal cisterns by 2-3 hours with flow over the convexities by 24 hours
598
What is the imaging technique for differentiating septic arthritis, cellulitis, and osteomyelitis?
3 Phase Bone Scan
599
What is factitious hyperthyroidism?
Caused by taking too much exogenous thyroid hormones
600
True or False: Positive lymphoscintigraphy scans indicate the absence of metastases.
False ## Footnote Positive scans show foci of increased activity, indicating potential tumors.
601
What is the significance of monoclonal antibodies in imaging?
Monoclonal antibodies adhere to specific antigens on tumor sites, localizing the tumor for imaging purposes
602
What type of supplies are differentiated in billing?
* Sterile vs. non-sterile * Billable vs. non-billable
603
What is the imaging technique for breast cancer with MIBI?
Imaging performed 10–20 minutes post-injection with the patient in a prone position, showing discrete focal activity indicating possible lesions
604
What do T-Lymphocytes do?
Directly attack infected or cancerous cells
605
Why is medical coding important?
It is crucial for reimbursement from insurance companies for services performed. ## Footnote Without correct documentation and coding, providers do not receive payment.
606
What can expect to see in both ventilation and perfusion images when imaging a patient with pulmonary embolism and abnormalities of pulmonary vasculature?
ventilation will show no defects and the perfusion will be abnormal
607
What is achalasia?
A disorder affecting esophageal motility.
608
What is the technique for imaging Meckel’s Diverticulum?
Inject 8-15 mCi of 99mTcO4 and acquire flow and dynamic images.
609
What is the most common type of thyroid cancer?
Papillary Carcinoma
610
What is the likelihood of improved function after therapeutic intervention for matched defects?
Low likelihood of improved function
611
For each alveolus, there _____ capillaries.
1000
612
What is the recommended practice regarding radiopharmaceutical codes?
Put system in place periodically verify correct Rp codes are being used
613
What is the preferred PET cardiac perfusion radiopharmaceutical (RP)?
N-13 Ammonia
614
What is the imaging technique used in a bone scan?
Whole body imaging, usually with the patient supine or prone
615
What comprises the axial skeleton?
* Skull * Sternum * Ribs * Vertebral Column
616
What hormones mediate the muscular function in the stomach?
Gastrin, secretin, cholecystokinin.
617
618
Why is the lung ventilation study performed after the lung perfusion study when using 99mTc-DTPA?
because both radiopharmaceuticals have the same energy peak (140 keV), the lung perfusion study is performed first because 99mTc-MAA is administered at a lower dose
619
How long must records of the release of individuals containing unsealed byproduct material be retained?
For 3 years after the date of release.
620
How should the patient's head be positioned during a DaTscan?
In an off the table head holder with minimized motion using head straps ## Footnote This helps ensure clear imaging.
621
What is the most significant technical problem in gastric emptying studies?
Lack of standardization of the procedure.
622
What is Hashimoto's disease?
An autoimmune disease that damages the thyroid gland, leading to hypothyroidism
623
What are CPT Codes?
Current Procedural Terminology codes used to describe medical, surgical, and diagnostic services. ## Footnote They consist of 5-digit codes.
624
What does LES stand for?
Lower esophageal sphincter.
625
What influences MIBI uptake?
Cellular metabolism and blood flow
626
What is the indication for brain angiography?
Determination of brain death and evaluation of flow in major organs
627
What is the function of the large intestines?
Absorb water and create feces
628
What is the significance of OctreoScan?
Targets somatostatin receptors found on neuroendocrine tumors for detection and localization ## Footnote Somatostatin regulates various bodily functions including growth hormone release.
629
What is the role of lymphoscintigraphy?
To visualize the lymphatic system and assess cancer spread.
630
Results for patients with COPD will show matched defects in both the ventilation and perfusion portions of the study. What are some conditions that will show these defects?
-asthma -foreign bodies obstructing the bronchus -bronchiectasis: no blood flow and no air flow -chronic bronchitis -cancer of the bronchus -tuberculosis -cystic fibrosis: defects seen in upper lobes -bronchial tumors -bronchial asthma -emphysema
631
What are the three categories of CPT codes?
* Category I: Describes medical, surgical, and diagnostic services * Category II: Supplemental tracking codes for performance measurement * Category III: Temporary codes for emerging technologies and services
632
What is the purpose of cisternography?
Show the flow of CSF along normal and abnormal pathways
633
True or False: Metabolic activity in PET is specific to particular tumors or organs.
False
634
In the Gastro-Esophageal Reflux Test, what patient position is needed to document passage of the bolus into the stomach?
Sitting ## Footnote Positioning is critical for accurate reflux assessment.
635
List three indications for a white blood cell study.
* Evaluation of fever of unknown origin * Detection of abscesses & infection in soft tissues * Diagnosis of osteomyelitis
636
What is the biological residence time of N-13 Ammonia compared to Rb-82?
Longer biological residence time than Rb-82
637
What is the typical dosage of F-18 FDG for viability studies?
5 mCi F-18 FDG (may be adjusted for weight)
638
How much higher is the concentration of trapped iodine in the thyroid compared to the bloodstream?
20X higher
639
What is the half-life (T1/2) of N-13 Ammonia?
10 minutes
640
What is the first part of the lung ventilation study? What is the purpose and what happens during this stage?
single breath: distribution of a single breath and a bolus of Xe-133 -inhaled with air to total lung capacity -reflects regional ventilation rate
641
What is the effect of brown fat on FDG uptake?
It can increase FDG uptake; keeping the patient warm can reduce this effect.
642
Dyspepsia refers to what gastric ailment?
Gastric symptoms such as abdominal pain or discomfort, early satiety, fullness, distension, bloating, nausea. ## Footnote Mostly common in healthy adults. Page No. 1
643
What is the purpose of hepatic artery perfusion imaging?
Evaluations of perfusion through an indwelling hepatic artery shunt prior to injecting a therapeutic substance
644
Patients with known hypersensitivity to steroids or iodine may be given what medication 1 hour before dosing?
an oral antihistamine like Benadryl
645
What is the thyroid uptake procedure?
Involves measuring the uptake of radioactive iodine by the thyroid gland ## Footnote This helps determine the appropriate I131 therapy dosage.

Methodology (1 decks)

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