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NUKES Flashcards

1
Q

Tc-99m

A

“low” 140 keV; 6 hours

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2
Q

Iodine - 123

A

“low” 159 keV; 13 hours

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3
Q

Xenon - 133

A

“low” keV 81; 125 hours or 5.3 days (biologic 1/2 life of 30 seconds)

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4
Q

Thallium - 201

A

Potassium analogue; “low” x-rays from daughter Hg 201 at 68-82 keV (71 or 77 keV), 135 keV (2%), 167 keV; half life 73 hours

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5
Q

Indium - 111

A

“medium” 173 keV, 247 keV; 67 hours

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6
Q

Gallium - 67

A

Iron analogue; 93 keV (40%), 184 keV (20%), 300 keV (20%), 393 (5%); half life 78 hours

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7
Q

Iodine - 131

A

“high” 365 keV, 8 days

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8
Q

Fluorine - 18

A

“high” 511 keV, 110 mins

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9
Q

Strontium 89 half life

A

50.5 days (14 days in bone)

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10
Q

Samarium 153 half lif

A

46 hours

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11
Q

Radium half life

A

11 days

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12
Q

Yttrium 90 half life

A

64 hours

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13
Q

Rubidium 82 half life

A

75 seconds

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14
Q

Nitrogen 13 half life

A

10 mins

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15
Q

Critical organ Tc-MDP

A

Bladder (some say bone)

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16
Q

Critical organ Tc - sulfur colloid (IV)

A

Liver

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17
Q

Critical organ Tc - sulfur colloid (oral)

A

proximal colon

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18
Q

Critical organ Tc - pertechnetate

A

stomach > thyroid (some sources say colon)

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19
Q

Critical organ Tc - sestamibi

A

proximal colon

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20
Q

Critical organ Tc - heat treated RBC

A

Spleen > heart

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21
Q

Critical organ Tagged RBC - MUGA

A

Heart

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22
Q

Critical organ Tc - MAA

A

Lung

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23
Q

Critical organ Tc- DMSA

A

Renal cortex

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24
Q

Critical organ Tc - MAG 3

A

Bladder

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25
Q

Critical organ DTPA

A

Bladder

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26
Q

Critical organ I-123 MIBG

A

Bladder (some say adrenal medulla)

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27
Q

Critical organ I-131 MIBG

A

Liver (some say adrenal medulla)

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28
Q

Critical organ I-131, I-123

A

Thyroid

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29
Q

Critical organ In-111 WBC

A

spleen

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30
Q

Critical organ In-111 ProstaScint

A

Liver

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31
Q

Critical organ In-111 Octreoscan

A

Spleen

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32
Q

Critical organ Thallium 201

A

renal cortex

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33
Q

Critical organ F18 FDG

A

Bladder

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34
Q

Critical organ Gallium-67

A

Distal colon

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35
Q

HIDA

36
Q

Mechanism of localization: Tc - sestamibi

A

passive diffusion (lipophilic diffusion)

37
Q

Mechanism of localization: Tc - tetrofosmin

A

passive diffusion (lipophilic diffusion)

38
Q

Mechanism of localization: Tc - HMPAO

A

passive diffusion (delivery flow related - then diffuse into brain)

39
Q

Mechanism of localization: Tc - ECD

A

passive diffusion (delivery flow related - then diffuse into brain)

40
Q

Mechanism of localization: DTPA

A

Filtration

41
Q

Mechanism of localization: F18 - FDG

A

Facilitated diffusion (Carrier mediated transport across membrane via GLUT)

42
Q

Mechanism of localization: I-123, I-131

A

Active transport (AtP to move against concentration gradient)

43
Q

Mechanism of localization: Thallium

A

Active transport (Na/K Pump)

44
Q

Mechanism of localization: Rubidium

A

Active transport (Na/K Pump)

45
Q

Mechanism of localization: MIBG

A

Active Transport (Na facilitated norepinephrine uptake system)

46
Q

Mechanism of localization: DMSA

A

active transport

47
Q

Mechanism of localization: Pertechnatate

A

Secretion (Active transport OUT of gland or tissue)

48
Q

Mechanism of localization: MAG - 3

A

secretion (secreted by peritubular capillaries)

49
Q

Mechanism of localization: Tc-99m IDA

A

secretion (secreted by hepatocytes)

50
Q

Mechanism of localization: Sulfur colloid

A

phagocytosis (RES eats teh colloid particles)

51
Q

Mechanism of localization: Heat treated RBCs

A

sequestration

52
Q

Mechanism of localization: MAA

A

Capillary blockade (lung perfusion)

53
Q

Mechanism of localization: MDP

A

Chemisorption to calcium hydroxyapatite

54
Q

Mechanism of localization: SM - 153

A

Chemisorption

55
Q

Mechanism of localization: Indium WBC

A

Cellular migration

56
Q

Mechanism of localization: Octreotide

A

receptor binding

57
Q

DAT Scan (I-123 Isoflupane)

A

receptor binding

58
Q

Tumors that are PET COLD (6)

A

1) BAC (adeno in situ) - lung cancer
2) Carcinoid
3) RCC
4) Peritoneal bowel/liver implants
5) anything mucinous
6) prostate

59
Q

PET HOT - NOT CANCER (6)

A

1) Infection
2) Inflammation
3) Ovaries in follicular phase
4) Muscles
5) Brown fat
6) Thymus

60
Q

Indium is better than gallium for evaluating (1)

A

abdomino-pelvic abscess due to lack of normal bowel excretory pathway

61
Q

Gallium is better than indium for evaluating (3)

A

1) Spine
2) diffuse pulmonary process (gallium is probably the agent of choice for the evaluation of pulmonary inflammatory abnormalities)
3) Lymphocytic mediated infection

62
Q

Tc - HMPAO is better than In WBC (3)

A

1) children (lower dose)
2) IBD (image early 30-60 minutes)
3) Osteomyelitis in extremity

63
Q

In WBC is better than Tc - HMPAO (1)

A

Fever of unknown origin

64
Q

tumors that take up octreoscan

A

Somatostatin analog

Taken up by:

1) carcinoid tumor
2) paraganglioma (glomus jugulare tumor, glomus jugulotympanicum, glomus vagale, glomus tympanicum, carotid body tumor)
3) phaeochromocytoma
4) small cell lung cancer
5) pituitary adenoma
6) neuroblastoma
7) medullary thyroid carcinoma
8) pancreatic islet cell tumor

Variable taken up by: meningioma, astrocytoma, breast carcinoma, lymphoma, Merkel cell carcinoma

65
Q

Excessive aluminum from generator elution on Tc study results in accumulation of radiotracer where?

A

Causes colloid formation and accumulation in the liver

66
Q

How frequently is field uniformity checked for nuclear medicine?

A

Extrinsically (with a collimator) is done daily and checks the collimator and cyrstals

Intrinsically (without a collimator) is done weekly (can use either Na99TcO4 or Co57

If bulls eyes are seen then that is a PMT problem.

Need to compare if defect is seen on intrinsic or extrinsic alone or on both to determine where problem is. If only on extrinsic then the collimator may be cracked!

67
Q

How frequently are linearity and spatial resolution checked in nuclear medicine?

What about Energy Window?

Center or rotation?

A

Linearity and SR should be sheck weekely with bar phantom and flood source (Co57)

Energy window should be checked daily (Tc center at 140 keV with 20% window)

Center of Rotation is done with 5 small Tc point sources along the axis of rotation and should be performed monthly.

68
Q

Radionuclide purity test

1) What are you testing for?
2) How is it performed?
3) What is the NRC allowance?

A

Testing for Molybdenum in Tc-99m eluate (breakthrough).

Mo (740 keV) is assayed first by shielding lower Tc.

0.15 micro Ci of Mo per 1 milli Ci of Tc, AT THE TIME OF ADMINISTRATION

Ratio less than 0.038 at the time of elution will be suitable for injection at least 12 hours.

69
Q

Chemical purity test

1) What are you testing for?
2) How is it performed?
3) What is the NRC allowance?
4) What artifact is caused?

A

Testing for aluminum with pH paper. Must be < 10 mg of Al per 1 mL.

Can show up as liver activity on Tc scan due to clumping (bone study for example)

Can show up in lungs on liver/spleen scan with Sulfur Colloid

70
Q

Radiochemical purity test

1) What are you testing for?
2) How is it performed?
3) What is seen on the scan?

A

This is done using thin layer chromatography to essentially check labeling efficiency.

You are testing for free pertechnatate (TcO4)

Due to incomplete reduction by stannous ions or by accidental air injection

Shows up on the scan with gastric, salivary gland and thyroid uptake

71
Q

Allowable dose exposure limits (NRC) for occupational, public, family of patient and pregnant categories? Lens dose?

A

Occupational total body dose limit: 50 mSv (5 rem)
Dose to the ocular lens: 150 mSv (15 rem)
Total equivalent organ dose per year: 500 mSv (50 rem)
Embryo/fetus dose over 9 months: 5 mSv (0.5 rem)
Annual dose to the public: 1 mSv (0.1 rem or 100 mrem)
No greater than 2 mrem/hr in an “unrestricted area”

72
Q

Hot sink limit

A

1 Ci per year

73
Q

Package labels and limits

A

White I: < 0.5 mrem/hr (surface); N/a @ 1 m
Yellow II: < 50 mrem/hr (surface) AND < 1 mrem/hr @ 1 m
Yellow III: 50 < x < 200 mrem/hr (surface) OR 1 < x < 10 mrem/hr @ 1 m

74
Q

When does a Mo/Tc generator have the max Tc-99m amount? How frequently should generator undergo elution?

A

Max build up of Tc-99m occurs after about 4 half lives or 23 hrs

Should be eluted daily to prevent accumulation of Tc-99 (notice the not metastable form)

75
Q

What can cause diffuse muscle uptake on MIBG?

A

Medications (TCA, antihypertensives, sympathomimetics, cocaine)

76
Q

How frequently should PET QA “Blank Scan” be done?

What about a normalization scan?

A

This should be done daily. Can be done with a positron source and no patient in the scanner either Ge 68 or Cs 137 or a uniform source phantom.

Normalization scan should be done monthly or annually? Expose to uniform source, looking for variations in detector elements (variations in crystal thickness, etc?)

Note Ge(68)/Ga(68) system is similar to Mo/Tc, Ga 68 (not 67) is a positron emitter with half life of only 68 minutes.

77
Q

Name beta minus decay radiotracers

A 
Tc - 99m
Xe - 133
I - 131
Strontium - 89
Samarium 153
Y - 90
78
Q

Name electron capture radiotracers

A 
I - 123 (goes to Te-123m)
Thallium -201 (goes to Hg)
Indium - 111 (goes to Cadmium)
Gallium - 67 (goes to Zn)
Cobalt 57 - (goes to Fe)

*** GIIT and Cobalt

79
Q

Name the beta plus (positron) radiotracers

A

F-18 (Yields oxygen 18)
Rubidium - 82
N - 13

80
Q

Low, medium and high energy radiotracers

A

Low: Tc, I-123, X-133, TI-201 (1-200 keV)
Med: Ga-67 and In-111 (200 - 400 keV)
High: I - 131 (>400 keV)

81
Q

Qc for Ionizing Chamber or Dose Calibrator

A

Consistency w/i 5% checked daily
Linearity (quarterly)
Accuracy (annually)
Geometry (installation and anytime it is moved)

82
Q

10 CFR part 19
10 CFR part 20
10 CFR part 35

A

19: Notices, instructions and reports to workers
20: Standards for protection against radiation
35: Medical use of by-product material

83
Q

Major spill thresholds

A

100 mCi Tc-99m and TI-201
10 mCi In-111, I-123, Ga-67
1 mCi I-131

84
Q

Recordable event versus Reportable event

A

Recordable: less than 5 rem whole body dose or single organ dose < 50 rem with error (wrong drug, route, patient or dose >20%) *** Must be kept for 5 years (most other things for only 3 years)

Reportable: mistake causing harm to patient with whole body dose greter than 5 rem or single organ dose > 50 rem

Reporting

  • Call NRC w/i 24 hours
  • write NRC letter w/i 15 days
  • Notify referring doc w/i 24 hours
  • Notify patient
85
Q

Tolerated wipe dose or survey on packages

A

> 6600 dpm/300 cm^2 is not allowed

Must check within 3 hours of receipt

CORE Radiology (12 decks)

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