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NM By Myself > Ped NM > Flashcards

Ped NM Flashcards

1
Q

PET

A

Radiation burden reduce 50%
2.5 MBq/kg
0.2 mg/kg fusid to increase urine extraction

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2
Q

CT

A

Dose length product converted into effective dose values
Pitch >1
Slice increment = slice thickness, no overlap
Activate dose modulation system

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3
Q

SPECT/CT

A

Reduce scan length
Can rule out malignant bone lesions
Evaluate soft tissue involvement

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4
Q

Bone scan radiation dose

A

<3 mSv

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5
Q

F-fluoride PET

A

Better spatial resolution
Shorter duration of study (max 90 min)

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6
Q

Condylar hyperplasia

A

Asymmetric growth of mandibular condylar metaphysis
Time for surgery at the end of developing age growth, before arising of degenerative alteration
Bone scan reveal when metabolic activity of metaphysis is declining compared to reference bone

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7
Q

Dynamic renal scan

A

Tc-MAG3 and Tc-EC
Greater renal extraction - - better visualisation
15-20s/frame for 30-45 min posterior
Static after upright position

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8
Q

Congenital Hydronephrosis

A

Self-limiting condition without obstruction
Kidney damage - - pyeloureteroplasty

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9
Q

Static renal scan

A

Pinhole collimator
Postinfection scar - cold defect, triangular
At least 6 months after UTI
Negative scan - - absent or very low reflux - - no need for MCUG
Confirm/Exclude acute pyelonephritis

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10
Q

Cystography

A

Intravesical administration of Tc
Most sensitive for VUR
Recurrent UTI - - detect and quantify VUR
MCUG is better for first evaluation
#6 French no balloon catheter warm saline mixed with Tc-pert or Tc-SC 15-30 MBq - - bladder max capacity - - remove catheter - - void
Follow up VUR or first exam when bladder dysfunction and urethral anomalies excluded

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11
Q

Cystography protocol

A

10s/frame filling phase
2-5s/frame voiding phase
Tracer in ureter and renal pelvis - - VUR

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12
Q

Thyroid

A

Tc-pert or I123-iodide
I131-high radiation burden
Uptake 0.4 MBq
4-6-24-96 h

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13
Q

Thyroid cancer

A

Secondary after radiotherapy of HL, neuroblastoma - DTC
Primary cancer infiltrates capsule more often than adult - - T3
I131 cumulative activity <18.5 GBq to avoid sialoadenitis
After surgery – radioiodide ablation

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14
Q

Neuroblastoma

A

Most common extracranial solid tumor of childhood
Adrenal or retroperitoneum
Diagnosed after 1 year - - advanced disease and worse prognosis

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15
Q

I123-MIBG

A

Diagnostic
Better image quality and lower radiation
159 keV, no beta
T1/2 13h

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16
Q

I131-MIBG

A

Target therapy
364 keV, beta
T1/2 8 days
Theragnostic

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17
Q

MIBG protocol

A

Image 24h after IV
Medium energy parallel hole collimator
Reduce septal penetration by 3% photons with high energy photons 400 keV
Prevent blurring
Ant/post WBS, lateral skull, high count spot in abdomen

18
Q

SIOPEN

A

Standardized scoring system
Evaluate MIBG uptake
Extension of skeletal disease

19
Q

Negative MIBG

A

FDG - - uptake in Waldeyers ring, diffuse thymic uptake, brown fat tissue
FDOPA - higher accuracy and sensitivity than MIBG

20
Q

FDG indication

A

Hodgkins lymphoma
Ewing sarcoma
Soft tissue sarcoma
Osteosarcoma

21
Q

I131-MIBG therapy indication

A

Inoperable pheo, Paraganglioma, Carcinoid
Stage III or IV neuroblastoma
Metastatic or recurrent MTC
Reserved for patients with uptake

22
Q

I131 - MIBG therapy dose

A

100-300 mCi

23
Q

Lung scan

A

Tc-MAA or Tc-microspheres
Reduce injected activity and number of particles
Further reduce if right-to-left shunt
Tc-MAA - - reduce to 10000 particles - - reduce risk of systemic embolism

24
Q

Bronchopulmonary infection

A

Patchy distribution
Difficult interpretation
Postpone scan if wheezing
Slow injection in peripheral vein
Central line - - hot spot artifact

25
Q

Cavo-pulmonary anastomosis

A

Split the dose
Inject multiple sites (upper and lower limbs)

26
Q

Infant

A

Avoid anterior view lung

27
Q

Evaluate shunt

A

Compare total lung counts with counts from ROI of whole brain
Brain activity should be <1% of lung activity

28
Q

Main pulmonary trunk stenosis

A

Scan not sensitive
Combi with echo
Detailed evaluation of central pulmonary bed

29
Q

Congenital heart disease

A

Diffuse hypoperfusion
Possible to observe focal perfusion defects - - most frequent cause - peripheral vascular abnormality or surgery (Blalock-Taussig shunt)

30
Q

Cardio scan

A

Tc-Sestamibi or Tc-tetrofosmin
Sedation in children <6 y - - fasting
Adenosine 0.14 mg/kg
High resolution collimator with zoom
Indication - anomaly of coronary arteries
ALCAPA - anomalous origin of left coronary artery from pulmonary artery
Post-op follow up

31
Q

Meckel

A

Fast 4-6h
Premedication with gastric secretion inhibitor 12-24h before - - reduce release from gastric mucosa
Dynamic anterior 128*128 1min/frame 60 min
Focal spot of uptake simultaneously with stomach
Up to 40-50 min in children
Additional view to avoid urinary activity

32
Q

GER

A

Common in infants (incomplete maturation of lower sphincter)
Disappear at 18-24 m
Complications - regurgitation, vomit, dysphagia, wheezing, recurrent pneumonia

33
Q

Milk scan

A

Detect GER
Fast 4-6 h
Study when normal feeding time
No sedation (alter motility)
Regular volume of milk
Insufficient volume - - decrease sensitivity for reflux and gastric emptying

34
Q

Milk scan protocol

A

1/3 contain tracer
2/3 to wash down activity
Meal should not last >10-15 min - - avoid spillage - - absorbent sheets on lung
Tc-SC 0.5 mCi in children <5y
Can withstand low pH (also DTPA)

35
Q

Milk scan image

A

Dynamic 30s/frame over 60 min posterior mouth and upper abdomen + zoom
Fast dynamic study after first swallowing act with child sitting - - 2-3 frames/s for 1 min - - esophageal transit
Late image 2-4h - - gastric emptying and pulmonary aspiration
24h - - pulmonary aspiration during sleep
Cine loop - - activity in esophagus - - GER - - report number of episodes, level and duration

36
Q

Gastric emptying in older children

A

Tc-SC added to egg
Fast 4-6h
Meal <10 min. 30s/frame for 60 min
2-3-4h

37
Q

Salivagram

A

Aspiration of saliva
Single drop 0.1 ml Tc-SC or DTPA 10 MBq under tongue
Dynamic posterior 128*128 10-30 s/frame 60 min
Oropharynx and thorax
Static with marker on xiphoid, supra sternal notch, axillae
Cine loop
Appear in trachea/bronchi - - note the level
Distal aspiration more relevant

38
Q

Child abuse finding on bone scan

A

Scapula fracture

39
Q

Shin splints

A

Posteromedial cortex

40
Q

Lower back pain in young adults

A

Spondylolysis
Repetitive trauma - - disruption of pars interarticularis
L5

41
Q

Hyperthyroidism

A

Graves
6-12 m antithyroid drugs
More radical approach for: severe side effects, non responders, relapse
More common in children

42
Q

Ectopic thyroid

A

Lifelong hypothyroidism
Higher dose of L-thyroxine

NM By Myself (25 decks)

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