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Nuclear - Radiation Safety, Radiopharmaceuticals Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the uniformity standard performance parameter for detectors in SPECT?

A
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2
Q

Describe the findings

A

Uniformity test

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3
Q

Describe the findings

A

Cracked crystal

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4
Q

Describe how to measure change in sensitivity?

A

record the time taken to acquire a preset number of counts using a set dose

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5
Q

What is the cause of “ring artifact” on SPECT imaing?

A

non-uniformity on SPECT

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6
Q

How frequently should these QC measures be performed:

  • COR
  • Plexiglas phantom
  • Uniformity correction
A
  • COR –> weekly or monthly
  • Plexiglas phantom –> quarterly or annually
  • Uniformity correction –> manufacturer recommendation
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7
Q

What are examples of COR artifacts?

A
  • Doughnut artifact (360 degrees)
  • Tuning fork artifact (180 degrees)
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8
Q

What is a survery meter (Geiger counter, Geiger-Mueller counter, GM counter)?

A

used daily to detect radioactive contamination in labs

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9
Q

What are QC checks that should be done on survey counters daily?

A
  • Battery check
  • Source check
    • ensure meter responds to radiation
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10
Q

How often should survey counter calibration be performed?

A

annually

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11
Q

What are the standard testing done on dose calibrators?

A
  • Background
  • Voltage
  • Accuracy
  • Constancy
  • Linearity
  • Geometry
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12
Q

What are common isotopes used for annual dose calibrator accuracy testing?

A
  • Co-57
  • Cs-137

*** Results must be within 5%

****sources must be traceable to the National Institute of Standards and Technology (NIST)

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13
Q

What does a geometry test measure?

A

ability of the dose calibrator to measure accurately with consistent activity at different volumes

  • performed at installation, recalibration, “plug-in”
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14
Q

What is a constancy test?

A
  • designed to show that a long half-life source yields reproducible readings
    • within 5% of decay corrected accuracy readings
    • check each setting (isotope) button
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15
Q

What is a linearity test?

A

assesses ability to read both high and low activity (range)

  • performed quarterly
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16
Q

What is a Rad?

A
  • radiation absorbed dose
  • energy absorbed in material
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17
Q

What is a Gray?

A

100 Rad = 1 Gray

SI unit for Radiation Absorbed Dose

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18
Q

Define Relative Biological Effectivenss (RBE)

A
  • ratio of biological effectiveness of one type of ionizing radiation relative to another, given the same amount of absorbed energy
  • different types of radiation have diffierent biologic burdens
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19
Q

How can you calculate a Roentgen Equivalent Man (Rem)?

A

Rem = Rad x QF

  • 1 Rad gamma rays = 1 Rem
  • 1 Rad alpha particles = 20 Rem
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20
Q

What is the international unit for Rem

A

Sievert (Sv)

  • 100 Rem = 1 Sv
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21
Q

Describe the radiological units summary

  • Roentgen (R)
  • Rad
  • Rem
  • SI units
    • Gray (Gy)
    • Sievert (Sv)
A
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22
Q

What are the Quality Factors (QF):

  • XR, Gamma rays
  • Beta particles
  • Neutrons and Protons
  • Alpha particles
A
  • XR, Gamma rays –> 1.0
  • Beta particles –> 1.0
  • Neutrons and Protons –> 10
  • Alpha particles –> 20
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23
Q

What is the international unit to express dose equivalent?

A

Sievert (Sv)

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24
Q

What are the assumptions and limitations of the Medical Internal Radiation Dose (MIRD) method?

A
  • radioactivity is uniformly distributed in the organ
  • organ size assumed for the standard person
  • cellular level micro-dosimetry is not modeled
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25
Q

What is the effective radiation dose per examination:

  • Tc99m Sestamibi
  • Tl201
  • Cardiac cath
  • CT angio
  • CXR
A
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26
Q

What is the dose limit:

  • non-occupational dose limits from occupational sources (shielding of rooms, breastfeeding)
A

1 mSv (100 mRem)

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27
Q

What is the dose limit:

  • infrequent exposure from other’s medical procedures (family member, release to public)
A

5 mSv (500 mRem)

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28
Q

What is the dose limit:

  • occupational dose limits
A
  • models determining the equivalent chance of developing major cancer = as that of a major work related event
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29
Q

What are the Quarterly ALARA Investigational Levels?

A
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30
Q

What steps should be taken if you reach a Quarterly ALARA investigational level?

A
  • Level I –> Notify and action taken at RSO discretion
  • Level II –> Investigate and take action
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31
Q

What is the natural background received by a person living the US each year?

A

300 mRem/year

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32
Q

What is the annual whole-body dose limit for an occupational worker?

A

5 Rem or 0.05 Sv

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33
Q

What is the dose limit:

  • Pregnant workers
A

500 mRem (5 mSv) over gestation period

  • < 50 mRem / month
  • fetus is a non-occupational worker
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34
Q

What are the regulations for breastfeeding?

A

reduce the dose to a newborn infant to < 1 mSv (actual regulation is < 5 mSv)

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35
Q

What is the unit equivalent:

  • 1 Rem –> mSv
A

1 Rem –> 10 mSv

36
Q

What are the requirements for personnel monitoring?

A
  • any occupational woker likely to exceed 500 mRem/year

and/or

  • those who handle millicurie amounts of radioactive material (license requirement)
37
Q

What are the main types of devices used for personnel monitoring?

A
  • Film badges
  • Thermo Luminscent Devices (TLD)
  • Optically Stimulated Luminescence (OSL)
  • Pocket Ion Chamber
38
Q

What is ALARA?

A

As Low as Reasonably Achievable

  • 10% of occupational dose limits
  • 10% of limit (5 Rem/yr) = 500 mRem/year
39
Q

What are the components of ALARA?

A
  • Time
  • Distance
  • Shielding
40
Q

Define Inverse Square Law

A

maintain a distance from a known radiation source

  • Intensity = 1 / d2
  • increase distance –> reduce by a squared factor
41
Q

What is the unit equivalent:

  • 1 mRem –> μSv
A

1 mRem –> 10 μSv

42
Q

What is the unit equivalent:

  • 100 Rem –> Sv
A

100 Rem –> 1 Sv

43
Q

What are the principles of shielding:

  • Alpha particles
  • Beta particles
  • Gamma rays
A
44
Q

Define Half-Value Layer

A

amount of material needed to reduce the intensity by half

  • synonymous with half-life
45
Q

What are the HVL’s (in Pb):

  • Tc99m
  • F18
  • Cs137
A
46
Q

Describe deterministic effects

A
  • Threshold dose below which no effect is observed
  • Severity increases with dose (commonly from cell death)
  • Examples: skin erythema, dermatitis, cataracts, sterility, hematopoietic syndrome
47
Q

Describe Stochastic Effects

A
  • Incidence (probability) increases with dose - not severity
  • No dose threshold
  • Basis for ALARA principle of radiation protection
  • Example: Late induced malignant neoplasm
  • “Linear No-threshold” theory
48
Q

What are the ways to handle waste management?

A
  • Decay in storage
  • Transfer to authorized recipient
  • Sewage
  • Atmosphere
49
Q

What are the rules for Decay In Storage?

A
  • Waste with half-life of < 120 days
  • Store in shielded container
  • Label with date and longest lived isotope
  • Survey to ensure indistinguishable from background
  • Remove all radioactive labels prior to final disposal
  • Maintain record of disposal for a minimum of 3 years
50
Q

What are the rules for receiving radioactive material?

A
  • Package must be monitored within 3 hours (start of buisness, if before hours)
  • Wear gloves
  • Visually inspect for problems
  • Measure 1 meter exposure (report if problem; > 10 mR/hr report to DOH)
  • Wipe test if contamination is suspected
51
Q

Describe the meaning of the package:

A

Type III - Yellow

  • Surface exposure < 200 mRem/hr
  • 1 meter exposure < 10 mRem/hr
  • Surface wipe test < 6600 dpm/300 cm2
52
Q

Describe the meaning of the package:

A
  • Surface exposure < 50 mRem/hr
  • 1 meter exposure < 1 mRem/hr
  • Surface wipe test < 6600 dpm / 300 cm2
53
Q

Describe the meaning of the package:

A
  • Surface exposure < 0.5 mRem/hr
  • 1 meter exposure - not detectable
  • Surface wipe test < 6600 dpm / 300 cm2
54
Q

What is the package label required for limited quantities of radioactive material?

A

Excepted Package, Limited Quantity

55
Q

What are the Excepted Package, Limited Quantities of the following:

  • Tc99m
  • Co57
  • Tl201
  • F18
A
  • Tc99m –> 11 mCi
  • Co57 –> 27 mCi
  • Tl201 –> 11 mCi
  • F18 –> 1.6 mCi
56
Q

What if a package has more than one isotope, how is the amount quantified?

A

max quantity defaults to the lower limit

57
Q

When are medical misadministrations reportable to NRC?

A
  • > 5 Rem (0.05 Sv) to the whole body
  • > 50 Rem (0.5 Sv) to any individual organ
58
Q

Describe the meaning of the sign

A

Radioactive material

  • areas where material are used / stored
59
Q

Describe the meaning of the sign

A

Radiation area

  • Individuals could exceed a dose of > 5 mRem in an hour
  • 30 cm from a source or any surface where radiation penetrates
60
Q

Describe the meaning of the sign

A

High Radiation Area

  • Individuals could exceed a dose of > 100 mRem in an hour
  • 30 cm from a source or any surface where radiation penetrates
61
Q

What are the half-lives of the following radionuclides?

  • F18
  • Tc99m
  • Tl201
  • Co57
A
  • F18 –> 110 minutes
  • Tc99m –> 6 hours
  • Tl201 –> 73 hours / 3 days
  • Co57 –> 271.7 days
62
Q

Describe the relationship between:

  • physical half-life
  • biologic half-life
A

(1/Te) = (1/Tp) + (1/Tb)

  • Tp = physical half life
  • Tb = biologic half life
  • Te = effective half-life
63
Q

What is an example of a radionuclide useful for quality assurance and calibration of PET scanners?

A

Germanium-68

64
Q

What are required regulations under the Nuclear Regulatory Commission (NRC) for the possession of radiaoctive material?

A
  • Limits of radioactive material possessed at any given time
  • Disposal of radioactive material
  • Use of radioactive material

*** Cost of radioactive material not required

65
Q

What is the radiation cut-off that does not require posting of a sign?

A

areas where a person receives < 2 mrem / hr

66
Q

Caution: Very High Radiation Area sign should be posted in an area where radiation exceeds this amount?

A

500 rads / hr at 1m from the source

67
Q

What does the transportation index found on a radioactive shipment package measure?

A

Exposure measurement at 1m from the surface of the package

​

68
Q

What instrument is used to measure removable contamination on a radioactive package?

A

well counter

  • most sensitive and practical for measuring the swipes that are used to test packages delivered to a nuclear laboratory
69
Q

A 65 year old male presents with A-fib. He was started on a Heparin drip. A multigated (MUGA) acquisition scan was ordered to evaluate the LVEF.

What is the most appropriate choice for labeling the RBC for this patient?

A

Ultratag

  • composed of stannous citrate along with acid citrate dextrose and sodium hypochlorite
  • labeling RBCs by this pharmaceutical is by in “in vitro” method
  • labeling efficiency > 97%
70
Q

What RBC labeling agent is contraindicated with Heparin use?

A

Sn-Pyrophate

  • heparin is one of the drugs that inhibit the diffusion of stannous ion to the RBC with the use of Sn-Pyrophate
  • labeling is compromised –> some of Tc99m-pertechnetate is reduced
71
Q

Why should BB and nitrates be held prior to stress testing?

How long should they be held prior to testing?

A
  • they may decrease the detection of ischemia
  • should be held 12-24 hours prior to testing
72
Q

What is the most appropriate monitoring device for measurement of occupational dose for a radiation worker?

A

Photographic film badge

73
Q

How long should one abstain from breastfeeding following a stress Tl201 study?

A

at least 2 weeks following the study

  • T 1/2 = 73 hours
74
Q

What is the NRC annual body radiation exposure limit for radiation?

A
  • 1.25 Rem/quarter year
  • 5 Rem / year
75
Q

What survey frequency is mandated by the NRC for radioactive materials areas?

A

Daily

  • in accordance with ALARA principles, the NRC requires that daily surveys be performed with a survey instrument at the end of each day
76
Q

What is the appropriate DOT label for package shipping:

  • Surface radiation exposure - 5 mR/h
  • 1 m from surface - 0.2 mR/h
A

Yellow II

77
Q

For a Tc99m, 1 day, rest/stress sequence, How long after the resting injection should the acquisition be performed?

A

30 minutes (ideally 30-60 minutes)

  • time delay after injection is to allow clearance from the liver and maximize the myocardial uptake
    • at 15 minutes –> too much liver activity –> contaminates inferior wall
    • > 2 hours –> liver clearance but increased probability of bowel loop uptake
78
Q

What is the optimum “rest” dose range for a 1-day rest/stress Tc99m SPECT MPI study?

A

8-12 mCi

  • rest dose should be approximately 1/3 of the stress dose
  • with some variation introduced by the length of time between the 2 studies
79
Q

Describe 1-day rest/stress Tc99m SPECT MPI study rest/stress doses

  • Why?
  • What are the effect on intervals?
A
  • 1:3 ratio (rest/stress)
  • stress dose overcomes the smaller rest dose so that the stress images have less residual activity form the rest study
  • Interval between studies
    • Short –> higher stress dose
    • Longer –> lower stress dose (1:3 may not be needed)
80
Q

1-day rest/stress Tc99m SPECT MPI study

  • What is the effect if a lower stress dose is used without enough time between injections?
A
  • there will be residual activity from the rest study
  • this can underestimate the amount of ischemia present
81
Q

When can rest/stress imaging be started in a 1-day rest/stress Tc99m SPECT MPI study:

  • Rest images
  • Stress images
A
  • Rest images –> 30-60 minutes post-injection
  • Stress images –>
    • 10-20 minutes after exercise
    • 30-60 minutes after pharmacologic
82
Q

Tc99m labeled perfusion tracers have improved SPECT perfusion imaging relative to Tl201 due to this characteristic?

A

Higher photon energy resulting in less tissue attenuation

  • also has shorter half-life allowing administration of a much higher dose but less total body radiation
83
Q

Describe the interaction between Quantitative analysis and AC in SPECT imaging?

  • gender differences
  • normalcy
  • specificity
A
  • AC gender maps are not different between males and females
  • AC improves normalcy > Quantitative analysis
  • Specificity of a positive finding is higher in images interprested with AC
84
Q

What is the maximum permissible activity concentration of molybdenum-99 to Tc99m as stipulated by NRC?

A

0.15 μCi / mCi at the time of administration to the patient

85
Q

What are regulations related to Aluminum ion concentrations?

Who regulates these concentrations?

A
  • Limts are 10 μg/mL of eluate
  • US Pharmacopeia (USP-XXIII)
86
Q

What is the average ionizing radiation received annually?

A

620 mRem (6.2 mSv) per year

87
Q

How should Tc99m radioactive waste generated in a nuclear medicine department be disposed?

A

Store in-house for decay to background radiation level before disposal

Medical (69 decks)

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