Nuclear Imaging Flashcards
T or F. Nuclear Imaging utilizes Safe, Painless and Cost – effective techniques
T
T or F. Procedures in nuclear imaging are primarily physiologic showing function and anatomic details of the organs.
F. It shows function but DOES NOT provide anatomic details
This is a specialized equipment that detects, records and process radioactivity emanating from the patient who has been injected with radioactive material
Gamma Camera
An ideal radionuclide , used in >70% of nuclear imaging procedures which rapidly concentrates in salivary glands, choroid plexus, thyroid gland, gastric mucosa, functioning breast tissue and placenta
Technetium – 99 (TC99M)
Use for treatment of thyroid cancer and hyperthyroidism
Iodine – 131
Type radiation that is undesirable in diagnostic applications due to high radiation to patient (helium nuclei)
Alpha Particles
Scopes of Nuclear Medicine
Nuclear Imaging, Radioimmunoassay, Radioactive iodine Therapy, Bone Palliation, Bone Densitometry, PET
Highest bone density can be possibly achieved at what age?
30
Use in assessing the patency of nasolacrimal glands
Dacryoscintigraphy
Radioactive Iodine (RAI) therapy is used in these conditions
Grave’s Disease, Toxic Nodular Goiter, Thyroid Carcinoma (Papillary and Follicular)
Used in Bone Pain Palliation. Delivers a High Local radiation dose directly to the sites of bony metastasis through a single IV administration. Toxic effect is Platelet Depression
Strontium – 89
Samarium – 153
This is a functional renal examination which provides information on infrarenal kinetics of the intravenously administered radiopharm. This is done to know how the kidney is functioning, to monitor the flow of urine in ml/min, the degree of any blockage, to assess the effect of recurrent urinary tract infection, to know how the transplanted kidney is functioning.
Dynamic Renal Scintigraphy
This renal scan is used to assess renal function and urodynamics of native or transplanted kidneys
Basic Renal Scan
This renal scan is used to diagnose or exclude urinary tract obstruction
Diuretic Renal Scan
Renal scan used to diagnose or exclude renovascular hypertension
Captopril – augmented Renal Scan
Renal Scan used to detect changes/abnormalities in renal morphology, also to work – up for infection and in the diagnosis of pyelonephritis
Renal Cortex Scan – DMSA
Amount of blood completely cleared of material in 1 minute
125 ml/min
. T or F. In the proximal convoluted tubule, water is reabsorbed as well as Na+, Cl and HCO3 while glucose and amino acids are resorbed.
T
T or F. In the Loop of Henle, electrolytes and water are resorbed
F. Electrolytes are resorbed but not water
- Resorption of Na under the control of ADH or angiotensin system occurs in the distal convoluted tubule
T.
Kidney lies in what level of vertebrae
Retroperitoneally between T11 and L3
A glomerular filtration agent which is completely eliminated by filtration and no tubular secretion occurs. It is used in the local setting for quantitation of GFR, evaluation of urinary drainage, VUR, bladder function and urinary patency
99m Tc – DTPA (Technetium 99m diethylenetriamine pentaacetic acid
These agents are ideal for measuring effective renal plasma flow (ERPF)
Tubular Agents
This tubular agent is the gold standard for measurement of ERPF
paraaminohippuric acid (PAH)
Most commonly used tubular agent because of improved image quality and lack of particulate emission
99m TcMAG3 (Technetium 99m mercaptoacetyltriglycine)
This parenchymal agent is used for cortical imaging and in patients with recurrent UTI to check for scarring
Tc – 99m DMSA (Technetium – 99m dimercaptosuccinic acid)
. T or F. In doing renal scan for functional studies first thing to be assessed is the renal blood flow and following 25 – 30 minutes uptake and clearance are assessed.
T.
Phases of Normal Renogram
. Initial Blood flow (Perfusion Phase) (30 -60 seconds)
- Cortical Uptake phase (normally 1 – 3 minutes)
- Clearance phase representing cortical excretion and collecting stem clearance
. T or F. in the perfusion phase, peak of renal perfusion should occur no more than 3 seconds later than aortic peak.
T
In a normal renal scan, urine should already be seen in the urinary bladder in three minutes to say that the kidney has normal excretion
T
Normal value for GFR
80 – 125 ml/min
Normal value for Effective Renal Plasma Flow (ERPF)
500 – 600 ml/min
Normal Filtration Index
0.2
Normal Excretory Index
1
. In doing Diuretic Renal Scan to diagnose hydronephrosis, furosemide is used to induce urine flow and if the kidney is obstructed there is no wash out but if it is just dilated but not obstructed there will be wash out
T
Captopril – augmented Renal Scan is used to exclude these Renovascular Diseases
Renal Artery Stenosis (RAS)
Ischemic Nephropathy
Renovascular Hypertension (RVH)
A normal Tc-99m DMSA scan should show a homogeneous distribution throughout the renal cortex. The upper poles may often
appear less intense due to splenic impression on the cortex, fetal lobulation, and attenuation from liver and spleen.
T
The most common indication to do bone scan or scintigraphy
Search for Metastases
Contraindications of Bone Scan
Pregnancy and Brest – feeding
Used to accurately identify and locate cancerous tissue in the breasts.
Scintimammography
Agent used to define breast cancer in scintimammography
Sestamibi labelled with 99mTc
This imaging modality demonstrate leaks from the biliary tree after surgery, using 99m Tc – HIDA (bilirubin analogue)
Hepatobiliary scan
A necroinflammatory disease characterized by development of cholecystitis in a gallbladder either without gallstones or with gallstones
Acute acalculous cholecystitis
This imaging modality is done to identify source of bleeding in a patient with melena and hematochezia. Otherwise known as RBC tagging
Bleeding Scan
Meckel’s diverticulum is a remnant of this structure
Omphalomesenterial cap
. What is the rule of 2 for Meckel’s Diverticulum
At least 2% of the population, occurs in children 2 years and below, within 2 feet of the ileocecal valve, 2 inches in length, 2 types of heterotropic mucosa
Meckel’s diverticulum has the propensity to bleed without producing pain. This tendency to bleed is due to the presence of
Ectopic Gastric Mucosa
T or F. In perfusion scan the radiotracer is injected via IV while in the ventilation scan the radiotracer is inhaled by the patient.
T
. Most common isotope used in Thyroid Scan
99mTc as pertechnetate; administered dose 80 MBq
. T or F. Hot’ nodules need further investigation since there is a high incidence of malignancy.
F. Hot nodules usually does not need further investigation while cold nodules need to be further investigated due to risk of carcinoma (5%)
What is the normal RAI uptake
2 hour: 5-15% of thyroid should be seen.
At 24hours: 20-45% should be intense.
. T or F. When the thyroid is inflamed it appears almost invisible in the scan
T
. Tor F. In toxic goiter the thyroid is very active and takes a lot of tracers
T
T or F. In thyroiditis the presence of the virus disrupts the thyroid cells allowing escape of hormones into the bloodstream and the thyroid compensates by increasing its glandular activity appearing dense in scan
F. In thyroiditis although the patient is toxic due to thyrotoxicosis there is no glandular activity and the thyroid does not appear as dense like in toxic goiter
Testicular torsion will reveal this pattern in testicular scan
Halo sign
Most commonly used agent in parathyroid adenoma scan
99mTc Sestamibi, administered dose 900 MBq
. T. or F. The parathyroid scan can differentiate parathyroid adenoma from carcinoma
F. Cannot Differentiate
This scan is done to patients with thyroid carcinoma, who has undergone thyroidectomy and underwent iodine treatment for ablating thyroid carcinoma
Total Body Scan
