Nucs

Question 1

Whole body scan with bones and liver hotter then spleen. What are possible tracers?

Answer 1

More photons -> Tc99m Sulfur colloid

Less photons -> gallium

Question 2

Whole body scan showing bones and spleen hotter than liver what is the tracer?

Answer 2

Indium 111-wbc

Question 3

Whole body scan, no bones, no liver, no spleen. What are you options?

Answer 3

I-123 or I-131

Question 4

Whole body scan, no bones, liver and spleen are lighting up. What is the tracer if the liver > spleen? What is the tracer if spleen > liver and renal uptake?

Answer 4

Liver > spleen I-131 MIBG

Spleen > liver + kidney I-131 MIBG

Question 5

If there are bones and lacrimal gland uptake what are your options?

Answer 5

Free Tc if the bones are faint

Gallium but only if there is no spleen uptake

Question 6

Hot spleen what should you think of?

Answer 6

Octreotide and WBC (sullfur colloid will have liver = spleen)

Question 7

What does MIBG often look for?

Answer 7

Neuroblastoma

Question 8

No bones + no liver + dark kidneys and spleen = ?

Answer 8

Octreotide. Higer count study the images should be cleaner

Question 9

When do you image for Tc wbc scan?

Answer 9

4 adn 24 hours

Question 10

How long can you see lung uptake in a Tc WBC scan?

Answer 10

4 hours

Question 11

in WBC or Tc WBC which has no renal or GI take?

Answer 11

Indinum

Question 12

What organ gets the highest dose of radiation with MDP? With F-18?

Answer 12

Bone for MDP

Bladder for F-18

Question 13

What is normal distribution for Tc-MDP?

Answer 13

Bone
Kidney (If not seen or faint = super scan)
bladder
breasts (in young females)
soft tissues - low levels
epiphyses in kids

Question 14

If there is more then faint uptake in the skull what should you think of? ( Tc-MDP)

Answer 14

Renal osteodystrophy

Question 15

If the renal cortex is hotter then lumbar spine ( Tc-MDP)

Answer 15

Hemochromatosis

Question 16

If there is diffuse renal uptake ( Tc-MDP)

Answer 16

Seen in chemotherapy and urinary obstruction

Question 17

What could abnormal liver uptake indicate? ( Tc-MDP)

Answer 17

Too much Al+3 contamination
Cancer mets or hepatoma
Amyloidosis
Liver Necrosis

Question 18

Lung uptake in ( Tc-MDP) can be from what?

Answer 18

Heteroptic calcification (dystrophic or mets)
Osteosarcoma
Fibrothroax
primary lung tumors
radiation changes
sarcoid
berylliosis
alveolar microlithiasis
wegeners (etc)

Question 19

What is flair phenomenon for ( Tc-MDP)?

Answer 19

Increase in activity 2 weeks to 3 months post treatment. X-rays should show lesions getting more sclerotic

Question 20

Prostate ca mets are uncommon with a PSA below?

Answer 20

10

Question 21

Prostate mets where?

Answer 21

Bone!

Question 22

Lung cancer bone mets tend to be where?

Answer 22

appendicular skeleton

Question 23

What bone related condition is assoicated with lung cancer?

Answer 23

Hypertrophic osteoarthropathy

Question 24

Solitary sternal lesion on bone scan is concering for what?

Answer 24

Breast CA

Question 25

Where does neuroblastoma frequently met?

Answer 25

Metaphysis of long bones

Question 26

I-123 and 131 MIBG are superior for detection of bone mets in what condition?

Answer 26

neuroblastoma

Question 27

How does osteopoikilosis look on bone scan?

Answer 27

Cold

Question 28

What is hypertrophic osteoarthopathy assoicated with?

Answer 28

Chronic hypoxia (CF< Cyanotic heart disease, mesothelioma, pneumoconiosis) and LUNG CANCER!

Question 29

Tram tracking on bone scan?

Answer 29

HPOA

Question 30

What does AVN look like on bone scan?

Answer 30

Early and Late is cold, middle is hot from repair

Question 31

What are HOT benign bone lesions on bone scan?

Answer 31

``` Fibrous dysplasia Giant cell tumor ABC Osteoblastoma OO ```

Question 32

What is a benign COLD lesion on bone scan?

Answer 32

Bone cyst without fracture

Question 33

What is variable on bone scan but benign?

Answer 33

Hemangioma | Multiple hereditary exostosis

Question 34

How can RSD look on bone scan?

Answer 34

Hot on flow and pool with periarticular uptake on delayed phase

Question 35

When do you use Tc HMPAO WBC over In-WBC?

Answer 35

Kids - Tc99 will have lower absorbed dose and shorter imaging times Small parts - Tc99m does better in hands and feet

Question 36

What cells are labeled by In-WBC?

Answer 36

Neutrophils

Question 37

Normally what is the critical organ for In-WBC?

Answer 37

Spleen

Question 38

In In-Wbc what happens to the distribution if the cells get fragmented?

Answer 38

Indium binds with transferrin and increased liver and bone marrow uptake

Question 39

What is the dose used for ablating a thyroid remenent

Answer 39

30-75

Question 40

What dose is used for treatment of recurrent diseasein the thyroid bed?

Answer 40

150

Question 41

What dose is used for bone or distant thyroid mets?

Answer 41

200-250