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RRC Cards > Nuclear Medicine > Flashcards

Nuclear Medicine Flashcards

1
Q

meckel diverticulum scan

A

Tc99m pertechnetate

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2
Q

FNH scan

A
  • sulfur colloid

- HIDA (Tc99m iminodiacetic acid analog)

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3
Q

what is used for HIDA

A
  • Tc99m disofenin

- Tc99m mebrofenin

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4
Q

pulmonary radiotracers

A
  • perfusion: Tc99m macroaggregated albumin MAA

- ventilation: Xenon 133, Tc99m DTPA, Technegas (T99m)

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5
Q

1/2 life T99m

nrg

A

6 hours

low nrg 140 kev

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6
Q

1/2 life I 123

nrg

A

13 hours

low nrg 159 kev

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7
Q

1/2 life I 131

nrg

A

8 days

high nrg 365 kev

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8
Q

test for pNET

A

In-111 octreotide

Dotatate

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9
Q

test for splenule

A

T99m sulfur colloid

T99m damaged RBC

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10
Q

1/2 life gallium 68

A

68 minutes

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11
Q

1/2 life Fluorine 18 (FDG)

nrg

A

110 minutes
high nrg 511 kev

analog sugar

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12
Q

1/2 life gallium 67

A

3.3 days (78 hours)
nrg peaks are medium
100 (40%), 200 (20%), 300 (20%), 400 (5%)
analog is iron

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13
Q

1/2 life sulfur colloid

A

2-3 minutes (Tc99m)

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14
Q

1/2 life In-111

A

67.2 hours

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15
Q

gallium 67 > indium 111 WBC scan when?

A

disc space infection

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16
Q

medication to stop before I-123 MIBG

A

TCA, CCB, labetalol, sympathomimetics, reserpine

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17
Q

what is yttrium-90 ibritumomab (zevalin)

A

murine anti-CD20 monoclonal antibody conjugated to the radioisotope yttrium-90
for non-hodgkins lymphoma (follicular)

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18
Q

Tc-99m sulfur colloid scintigraphy is taken up by which cells?

A

reticuloendothelial - liver, spleen, bone marrow

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19
Q

Nuclear Regulatory Commission (NRC) dose limits for annual whole body occupational exposure

A

50 mSv = 5 rem

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20
Q

radiotracer for nuclear medicine cisternogram

A

In-111 DTPA

administered into CSF via lumbar puncture

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21
Q

how frequent must a radiation survey be performed in areas of radionuclide waste storage?

A

weekly

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22
Q

cold lesions on MDP bone scan

A

late radiation tx changes/osteitis (segmental)
early osteonecrosis
infarction (very early or late)
anaplastic tumor (renal, thyroid, neuroblastoma, myeloma)
artifact from prosthesis, pacemaker, spine stimulator
hemangioma (variable**)
bone cyst (without fracture)
mature heterotopic ossification

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23
Q

why do you do bone scan for heterotopic ossification

A

to see if it’s mature (cold) for surgical resection (if painful or joint mobility affected)
- follow active HO (hot) until mature

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24
Q

feature of osteomalacia best seen on a bone scan

A

pseudofractures/Looser zones
- contain fibrous tissue & poorly mineralized callus
- ribs, femoral neck, pubic rami, axillary margins of scapulae
(other features of demineralization & coarsened trabeculae better seen on radiography)

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25
Q

annual limit of radiation exposure to the public as defined by the NRC

A

1 mSv = 100 mrem

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26
Q

bone scan with tracer in stomach, thyroid, or salivary glands: what’s the cause?

A

free pertechnetate

  • d/t not enough stannous ion (during preparation from kit with MDP & stannous ion) or
  • d/t air in vial or syringe causing oxidation

thin layer chromatography (TLC) used to identify free pertechnetate in the presence of a radiopharmaceutical

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27
Q

causes of super scan

A

diffuse skeletal metastatic activity (MC breast, prostate)

metabolic bone pathology (hot skull)

  • hyperparathyroidism
  • renal osteodystrophy
  • Paget
  • severe thyrotoxicosis
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28
Q

how do you block the thyroid gland from unintended radiation from unbound I-123 or I-131 in a MIBG scan?

A

Lugol’s iodine, perchlorate, or SSKI (super saturated potassium iodide)

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29
Q

normal biodistribution of MIBG

A

liver, spleen, colon, salivary glands, heart
+/- adrenals faintly
+/- brown fat (around shoulders/traps), which has sympathetic innervation

kidneys & bone NOT seen
thyroid is NOT seen if pretreated with Lugol’s iodine

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30
Q

what is a MIBG scan for?

A

any catecholamine producing tumor (analog of noradrenaline)

  • neuroblastoma (classic)
  • pheochromocytoma
  • paraganglioma
  • carcinoid
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31
Q

LVEF equation for MUGA

A

(end diastolic counts - end systolic counts)/(end diastolic counts - background)

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32
Q

cause of false high EF on MUGA

A

high background

e.g. wrong background ROI over spleen: over subtraction

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33
Q

cause of false low EF on MUGA

A

low background
inclusion of left atrium counts (e.g. if LA enlarged)
erroneous LAO view: can cause overlap of LV with LA, RV or great vessels

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34
Q

dose for radioactive ablation of hyperfunctioning thyroid nodule

A

empiric dosing with 30 mCi of I-131 sodium iodide

  • hyperfunctioning adenomas are difficult to treat and may not respond to smaller doses
  • more than 15 mCi for Graves
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35
Q

dose for radioactive ablation for Graves disease

A

15 mCi

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36
Q

lymphoscintigraphy indications

A

identifying sentinel lymph node

  • node that receives afferent drainage directly from a primary cancer
  • melanoma with lesion 1-4mm deep, breast ca

functional evaluation of lymphatic channels

  • points of blockage
  • lymphedema
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37
Q

how long must a licensee maintain records of the disposal of licensed materials according to the NRC?

A

3 years

record must include:

  • date of the disposal
  • survey instrument used
  • background radiation level
  • radiation level measured at surface of each waste container
  • name of individual who performed survey
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38
Q

radiotracers with normal biodistribution in liver, spleen and bone marrow

A

In-111 WBC

Tc-99m sulfur colloid

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39
Q

radiotracers with normal biodistribution in liver, spleen, kidneys, bowel and urinary bladder

A

In-111 pentetreotide

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40
Q

I-131 whole body scan post radioactive iodine ablation + diffuse uptake in lungs

A

iodine-concentrating metastases

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41
Q

I-131 whole body scan + uptake is seen in liver

A

post radioactive iodine ablation scan

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42
Q

annual limit of occupational radiation exposure to ocular lens as defined by the NRC

A

150 mSv = 15 rem

43
Q

annual limit of (occupational) total equivalent organ dose as defined by the NRC

A

500 mSv = 50 rem

44
Q

annual limit of (occupational) total equivalent extremity dose as defined by the NRC

A

500 mSv = 50 rem

45
Q

annual limit of total dose to embryo/fetus over entire 9 months as defined by the NRC

A

5 mSv = 0.5 rem

if fetus already got 5 mSv at time of declaration, NRC states you can get 0.5 mSv more for remainder of pregnancy

46
Q

unit conversion rad, rem, Gy, mSv

A

1 rad = 1 rem = 0.01 Gy

1 mSv = 100 mrem = 0.1 rem

47
Q

extraosseous uptake in heart on bone scintigraphy

A

amyloidosis (if diffusely in LV myocardium)

prior myocardial infarction 2/2 to microcalcifications

48
Q

uptake in skull sutures on bone scintigraphy

A

can be normal

renal osteodystrophy if marked

49
Q

extraosseous uptake in breast on bone scintigraphy

A

normal if mild diffuse uptake in younger women

cancer if focal uptake

50
Q

extraosseous uptake in renal cortex on bone scintigraphy

A

hemochromatosis if renal cortex hotter than adjacent lumbar spine
chemotherapy

otherwise normal
if you can’t see kidneys, think super scan

51
Q

extraosseous uptake in kidneys diffusely on bone scintigraphy

A

chemotherapy

urinary obstruction

52
Q

extraosseous uptake in liver on bone scintigraphy

A

too much aluminum contamination in Tc
cancer: HCC, mets
amyloidosis
liver necrosis

53
Q

extraosseous uptake in spleen on bone scintigraphy

A

auto-infarcted spleen in sickle cell patients

- will also have scattered hot and cold areas from multiple bone infarcts

54
Q

extraosseous uptake in lung on bone scintigraphy

A 
heterotopic calc'n (dystrophic or metastatic)
osteosarcoma mets, primary lung tumor
radiation changes
sarcoid, berylliosis
alveolar microlithiasis
Wegener/GPA
fibrothorax
55
Q

extraosseous uptake in muscle on bone scintigraphy

A

localize to injured skeletal muscle

rhabdomyolysis if diffuse bilateral quadriceps, calves, shoulders in marathon runner or military recruit

56
Q

diffusely decreased skeletal uptake on bone scintigraphy

A

free Tc

bisphosphonate therapy

57
Q

rim sign

A

curved area of increased hepatic activity along GB fossa on HIDA scan

  • suggests more significant cholecystitis
  • in emphysematous cholecystitis, 20% of gangrenous cholecystitis
  • mechanism: result of inflammation causing regional hepatic hyperemia, with more radiopharmaceutical delivered to this area
58
Q

complex regional pain syndrome on bone scintigraphy

A

scan with 3 phase scan:
↑ uptake in affected limb on flow & blood pool + diffusely periarticular ↑ uptake on delayed phase

  • ↑ uptake on all 3 phases: seen in <50%, but highest dx accuracy
  • infxn & arthritis: false-positive findings
59
Q

MUGA radiotracer

A

Tc99m labelled RBC

60
Q

octreotide vs MIBG

A

MIBG does not have intense renal activity

61
Q

hallmark location of PET hypometabolism in Lewy body dementia

A

occipital lobes

62
Q

MC pattern of loss seen with Parkinson’s disease in dopamine transporter SPECT imaging

A

loss of activity in the putamen first before the caudate

63
Q

Deauville criteria lymphoma

A

1: no uptake
2: =< mediastinum
3: > mediastinum, =< liver
4: > liver
5:&raquo_space; liver or new lesions
X: new areas uptake unlikely lymphoma

64
Q

parathyroid adenoma studies

A

1) single tracer dual phase sestamibi
2) dual tracer sestamibi & I123 (or Tc99m pertechnetate)
3) 4D CT

65
Q

difference between HMPAO and ECD

A

HMPAO: fast washout, uptake favours frontal lobe, thalamus, cerebellum

ECD: slow washout, better background clearance, no intracerebral redistribution, favours parietal & occipital lobes

66
Q

thallium:

  • production
  • energy decay
  • half life
  • major emissions
  • daughter product
A
  • cyclotron
  • electron capture
  • 3 days (73 hours)
  • 69 & 81 keV
  • mercury 201
67
Q

normal thallium distribution

A
  • thyroid & salivary glands
  • lungs & heart
  • skeletal muscle
  • liver & spleen
  • bowel
  • kidneys & bladder
68
Q

stop & maintain what drugs for gastric emptying?

A

STOP: 2 days before

  • prokinetics (ex metoclopramide)
  • opiates
  • anticholinergic/antispasmodic (ex donnatal)

KEEP:
- serotonin receptor antagonist (ex zofran)

69
Q

drugs for HIDA scan

A

CCK (GB contract): 0.02 microgram/kg over 60 mins

morphine (sphincter oddi contract): 0.02 mg/kg over 30-60 mins

70
Q

drugs causing cholestasis with delayed excretion (HIDA)

A
  • chlorpromazime
  • erythromycin
  • birth control (estrogen)
  • anabolic steroids
  • +/- statins
71
Q

colloid shift

  • what is it
  • what causes it
A
  • normally 85% sulfur colloid to liver (10% spleen, 5% bone marrow)
  • change in uptake to spleen and bone
  • diffuse hepatic dysfunction
  • portal HTN
  • hypersplenism
  • bone marrow activation

specifically: cirrhosis, diffuse liver mets, diabetes, blunt splenic trauma.

72
Q

renal function radiotracers

A 
Tc DTPA: almost all filtered, for function
Tc MAG3: secreted, for renal plasma flow, better for poor renal fxn 
Tc GH (glucoheptonate): filtered, structural or functional imaging

critical organ = bladder for all

73
Q

renal structure radiotracers

A

Tc DMSA: binds cortex, cleared slowly, kidney critical organ

Tc GH: binds & filtered, bladder critical organ

74
Q

SUV calculation

A

SUV = FDG concentration at time T/(dose/body weight)

75
Q

FDG uptake

A
  • FDG into cells by GLUT1 transporter
  • phosphorylated by hexokinase to FDG6 phosphate
  • locked in cell

N biodist’n = brain, heart, liver, spleen, GI, blood pool, salivary glands, testes

critical organ = bladder

76
Q

indium 111
1/2 life
photopeaks
normal uptake

A

1/2 life - 67 hours

peaks: medium nrg 173 & 247 kev
uptake: thyroid, liver, GB, spleen, kidneys, bladder, GI
- early imaging avoids bowel activity

77
Q

medications to hold pre MIBG

A
  • CCBs
  • labetalol
  • reserpine
  • TCAs
  • sympathomimetics
78
Q

MIBG scan

A
  • bound to I123 (better quality), I131 (longer 1/2 life)
  • block thyroid w/ lugol’s, perchlorate, SSKI
  • dist’n: liver, spleen, colon, salivary +/- adrenals
79
Q

scans for MIBG vs octreotide

A

MIBG: non malignant (adrenal) pheo, neuroblastoma

octreotide: carcinoid, gastrinoma, extra adrenal pheo, paraganglioma, medullary thyroid ca

80
Q

critical organ for indium:
prostascint
WBC
octreotide

A
  • liver
  • spleen
  • spleen
81
Q

lymphoscintigraphy agent

A

10-50 nm (<0.2 microns/200nm) Tc99m sulfur colloid

82
Q

LBBB classic artifact on myocardial perfusion

A

reversible perfusion defect at septum

83
Q

Y90 1/2 life, emissions, particle size, radiation dose

A

1/2 life 2.67 days
emissions: 175 & 185 kev
particle size: 20-40 micrometre
dose: 100-1000 Gy, at least 70 for monotherapy success

84
Q

protocol for zevalin radioimmune therapy

A
  • used for refractory NHL
  • give rituximab to block CD20 in circulating B cells & optimize biodist’n
  • give In111 to assess dist’n
  • ok dist’n give ibritumomab tiuxetan (zevalin) w/ Y90
85
Q

altered dist’n of In 111 for NHL RIT

A
  • uptake in lungs > heart day one, or >liver day 2 & 3
  • uptake in kidneys > liver day 3
  • uptake in bowel fixed and/or > liver
  • uptake bone marrow >25%

don’t give if plts <100k

86
Q

xenon 133 1/2 life

nrg

A

physical 1/2 life 125 hours
biologic 30 seconds

low nrg 81 kev

87
Q

scan for neuroblastoma bone mets

A

I123 and I131 MIBG

88
Q

bone uptake on MIBG, I131, octreotide:

normal or abnormal

A

abN

concerning for mets

89
Q

bone scan or skeletal survey for:
blastic mets
lytic mets
myeloma

A

blastic - bone scan

lytic & myeloma - skeletal survey

90
Q 
breastfeeding recommendations for:
Tc99m
I123
I131
FDG PET
A

Tc99m resume in 12-24 h
I123 resume in 2-3 days
I131 pump and dump

FDG PET continue; however, can get some external radiation from the skin so locally suggest no close contact 1st day

91
Q

normal thyroid uptake values
4-6 hours
24 hours

A

4-6 hours: 5-15%
24 hours: 10-35%

correction of neck - thigh counts

92
Q

max radiation dose worker/year

A

5 rem (50 mSv)

93
Q

osseous radionuclide agent that can be imaged:

A

samarium 153 (alpha and beta emission)

strontium 89, phosphate 32 beta only
radium 223 alpha only

94
Q

perfusion defect artifacts on cardiac imaging

A

diaphragm attenuation: inferior (RCA)
breast: anteroseptal apex (LAD)

no associated wall motion abN

95
Q

scans for neuroblastoma

A

bone scan can show mass

MIBG better for bone mets, combined can be better

96
Q

hot lacrimal glands

A
  • gallium 67

- free Tc99m pertech (higher count/quality, spleen uptake)

97
Q

decrease scatter

A

1) collimator: decrease off axis, increase resolution, but decrease sensitivity
2) pulse height analyzer: select narrow range
3) time of flight & coincidence detection: on PET

98
Q

cardiac uptake

A
  • sestamibi
  • thallium
  • MIBG
99
Q

super hot spleen

A

1) tagged WBC (In111, Tc99)
2) octreotide (+ kidney, no bone)
3) sulfur colloid if colloid shift (+ bone)

100
Q

high cardiac & high renal

A

1) Tc99m sestamibi

or thallium but unlikely to have whole body scan
MIBG cardiac, no kidney

101
Q

how often to check accuracy of dose calibrator?

how often to calibrate geiger mueller counter?

A

annually

102
Q

how often is linearity checked on a dose calibrator?

A

quarterly

103
Q

sestamibi radionuclide?

A

Tc99m

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