Physics/Radiopharm Flashcards

1
Q

What are: a) isotope b) isotone c) isobar d) isomer

A
Nuclides with same:
o isotopes – proton number
o isobars – mass number
o isomers – proton and neutron number, but different energy state
o isotones – neutron number
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2
Q

What is KLL Auger electron? How do you calculate its energy

A

K-shell vacancy filled by L-shell electron, energy difference absorbed by another L-shell electron which is emitted from the atom
energy = KB – 2LBe

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3
Q

What are differences between Auger and Characteristic electrons? (They probably mean conversion electrons. No such thing as characteristic electrons.)

A

Property
Internal conversion
Auger

Source of energy
Excited/metastable nucleus
Orbital electron transition

Origin shell
Inner
Outer

Kinetic energy
Discrete (Eγ – BE)
Discrete (BEhole – BEtransition – BEAuger )

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4
Q

Name 2 methods of radionuclide production in a reactor.

A

Fission(1) & Neutron activation (2)

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5
Q

For the reaction (n,γ): what are the requirements for this reaction? What type of reaction occurs? What is the relationship between the target and product? Under what circumstances could high specific activity be obtained?

A

a. Need a neutron source (reactors)
b. Neutron activation (gains a neutron, and a gamma is emitted)
c. Same Z, so same chemical, but higher mass, which may be less stable.
d. Could be obtained if product underwent beta- decay to a different chemical (Z+1) or fission into multiple separable fission products.

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6
Q

What is the ‘effective positron range’?

A

In words: distance from nucleus to the line of annihilation photons (perpendicular), which is always shorter than the actual distance the positron travels

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7
Q

Start with 100MBq. T1/2 = 10 days. What is activity after 50 days?

A

Show calculation.
T1/2 = ln2 / λ
λ = ln 2 /10 = 0.0693147181

A(t) = A(o)e-λt = 100e-0.0693147181(50)

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8
Q

Describe in one or two sentences the Bateman equation. List two types of equilibrium as they relate to the Bateman equation. What is the ratio of 99Mo:99mTc at equilibrium? (exact wording, not sure activity ratio or molar ratio)
B2015-1: What is Bateman equation used for?
C2016-6. a)What is Bateman’s equation – give equation or describe

A

Differential equations describing nuclide quantities in a decay chain
· For 1-nuclide decay chain (parent-daughter), with branching ratio, BR, solution is:

< GET EQUATION>

Used for samples containing radionuclides having parent-daughter relationships. Equation for the activity of the daughter at time (t) which accounts for the fact that the daughter product is being formed (by decay of the parent) at the same time it is decaying.

1st part of the equation: activities of the parent Ap (t) and the daughter Ad (t) at the time t with their respective decay constants (λ) and branching ratio for the decay producing the daughter of interest when several decay modes are possible.
2nd part of the equation: residual activity of daughter that was present at time 0
Sorenson Chapter 4 page 39

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9
Q

List 2 equilibriums

A

Secular, Transient

Secular Equilibrium (Tp > 100x Td)
At secular equilibrium, the Bateman equation dictates that the daughter will be produced at approximately the same rate that it decays, so a plateau of activity is reached.

Transient Equilibrium
Where BR = branching ratio which is 0.876 for Mo/Tc
At transient equilibrium, the Bateman equation dictates that the rate of decay of the daughter exceeds the rate of production, and so daughter activity will reach a peak after which it declines.

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10
Q

What is 99Mo:99mTc ratio?

A

Branching ratio = proportion of decay events resulting in a particular decay scheme: for 99Mo to 99mTc = 0.88

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11
Q

Calculate ratio of Mo99:Tc99m at equilibrium

A

< See notes>

Is the fraction of nuclei decaying by a specific decay mode

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12
Q

What is definition of transient and secular equil? What type of equil is Mo and Tc

A

a. Transient Equilibrium: when the daughter activity decays at the same rate as a parent whose half-life is 10-50x that of the daughter.
b. Secular Equilibrium: when the daughter activity decays at the same rate as a parent whose half-life is 100-1000x that of the daughter.
c. transient

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13
Q

How do you calculate decay constant.

A

THE DECAY CONSTANT = 0.693/T1/2

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14
Q

What are the physical half life and photon energy of I-123?

A

13.2 hours, 159keV

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15
Q

Aside from fission production of 223Ra, what is Health Canada’s approved production method

A

Actinium 227 generator

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16
Q

Name 3 alpha radionuclides with therapeutic potential. You are given a table to fill in with the headings of “Radionuclide,” “T1/2,” “Number of alpha particles,” “Total energy”

A

SEE NOTES

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17
Q

How do you image 223Ra? Or, how do you measure 223Ra in dose calibrator?

A

<2% of energy emitted is from photons – these can be imaged with gamma camera
Dose calibrator must be properly calibrated for RA223

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18
Q

Of F18-FDG, Rb82, and N13 ammonia, which has the best range, first pass extraction. Give their half-lives and positron ranges.

A

Shortest range: F18 FDG (t1/2 110 min, max range 2.3 mm)
Highest first pass extraction: N13 ammonia (t1/2 10 min, max range 5.1 mm)

First pass extraction: O-15 water > N-13 ammonia > Rb-82 > F-18 FDG
Range: Rb-82 (16 mm) > O-15 water (8 mm)> N-13 ammonia (5 mm) > F-18 FDG (2 mm)

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19
Q

Compare dose, time to imaging, urinary excretion, protein binding of NaF and MDP.

A

SEE NOTES

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20
Q

Calculate effective T1/2 for 99mTc. Biologic excretion (11% fecal, 35% renal, 4% etc.) Show formula and calculation. 11% cleared by feces, 4% by sweat, 35% by urine at 5 hours for 99mTc radiopharmaceutical. What is effective half life?

A

Effective 1/2 life: incorporates both the physical and biologic 1/2 lives. Effective 1/2 life is always shorter than the physical and biological 1/2 life.
Effective 1/2 Life = (physical 1/2 life X Biologic 1/2 Life) / (Physical + Biologic)
Biologic 1/2 Life: Refers to the time it takes an organism to eliminate half of an administered compound or chemical on a strictly biologic basis.
Physical 1/2 life of 99m Tc = 6 hrs
Biologic 1/2 life = 5 hours (given above) 648
Effective = 6 x 5 / 6 + 5 = 30/11 = approx 2.7 hours

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21
Q

90Y

a) Parent
b) T1/2
c) Mode of decay

A

Strontium-90
Half-life of 64.1 hours and a decay energy of 2.28 MeV
B- decay

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22
Q

Know generator daughter products (Table with the parent given, and asking for the corresponding daughter radionuc)

A

a. Mo99-Tc99m
b. Sr82-Rb82
c. Ge68-Ga68
d. Sr90-Y90
e. Rb81-Kr81m
f. Ac227-Ra223

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23
Q

Name 5 mechanisms of localization of radiopharmaceuticals in an organ.

A

PACRIM
P = passive diffusion
A = active transport or antbody/antigen complex
C = chemotaxis, compartmental localisation, cell sequestration, capillary blockage)
R = receptor binding
I = ionic exchange
M = metabolism

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24
Q

Describe how a generator works.

A

Consists of a parent-daughter radionuclide pair contained in an apparatus that permits separation and extraction of the daughter from the parent. The daughter product activity is replenished continuously by decay of the parent and may be extracted repeatedly.
Most important is the 99Mo-99mTc generator. Can be wet or dry:

  • Wet Generator: A large reservoir of saline 500ml is connected to the generator. The generator is continuously bathed in saline. Techentium is eluted by attaching a sterile 30 ml evacuated vial to the elution port.
  • Dry Generator: A 5 ml saline vial is attached before attaching the 30 ml evacuated vial. The 30 ml evacuated vial then draws 5 ml of saline through the generator to remove the Tc-99m activity followed by 25 ml of air to “dry” the column. Drying cuts down on radiolysis product formation. The air promotes oxidation to the pertechnetate state.
    In both systems the evacuated vial contains sodium pertechnetate in normal saline.
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25
Q

Parts of cyclotron

A

Ion source, dees, gap, magnets, vacuum, stripping foil, target

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26
Q

Shielding method for MO QC from eluate

A

Mo99 breakthrough: Assessed with each elution by placing sample in a 10HVL lead shield (2mm for Tc99m; to attenuate 140keV gammas), and detecting 740 & 780keV photopeaks in dose calibrator. The upper limit is 0.15 kBq/MBq at the time of injection (may be exceeded in emergency situations). Because Mo99 decays slower, the ratio of Mo99 to Tc99m increases with time.

i. Can also perform with phenylhydrazine solution: Mo-Ph complex causes a color change, which can be quantified by colorimetric test.

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27
Q

How does AL QC work

A

Al breakthrough: excess Al3+ induces flocculation (aggregation) of Tc99m-SC and agglutination of Tc99m-labeled RBCs, potentially resulting in liver and/or lung embolization, as well as image degradation. Al3+ is therefore limited to 10ug/mL by colorimetric spot test using aurin tricarboxylic acid or methyl orange, which is performed on each eluate.

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28
Q

How does AL in eluate affect radiopharm

A

Leads to flocculation of SC, agglutination of RBCs, and lung uptake in bone scan

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29
Q

4 drugs that can interfere with in vivo RBC labeling

A

Heparin, penicillin, iodinated contrast media, dextran, doxorubicin, hydralazine (can oxidize stannous ion)

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30
Q

With respect to Tc-SC – what is use of thiosulfate, gelatin, EDTA

A

a. Thiosulfate is the source of sulfur for SC formation in acid.
b. Gelatin is a protective colloid (a “stabilizer”) which coats the negatively-charged sulfur particles with a charged protein sheath, causing them to repel one another.
c. EDTA is added to the kit to chelate excess Al from Tc elution (Al flocculates SC).

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31
Q

Name 5 methods of radiolabelling.

A
B  I  E  B  E  R :
B= bifunctional chelating agents
I= Introduction foreign label
E= exchange of isotope
B= Biosynthesis
E= excitation labeling
R= recoil labeling
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32
Q

What is most common method for producing I123. What is its half life and photon energy?

A

Indirect method:

Xe-124 (p,2n) Cs-123 -> Xe-123 -> I-123 This will be I-124 carrier free.

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33
Q

Direct method for producing I123

A

Proton bombardment of enriched Te-124 can yield I-123 but not ideal because can be contaminated by I-124 and I-125.

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34
Q

2 ways of making F-18? 1 adv and 1 disadv of each

A

a. O18(p,n) gives fluoride ion in aqueous solution, higher specific radioactivity and better for FDG production, but O18 water is expensive.
b. Ne20(d,α) gives elemental fluorine gas, cheap and better for F-dopa production, but lower specific radioactivity.

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35
Q

What is no carrier added. What are 2 advantages with MIBG?

A

No carrier added - A preparation of a radioactive isotope which is essentially free from stable isotopes of the element in question.

Advantages:

  • Permits more efficient and high specific activity labeling with the therapeutically active 131-Iodine isotope which could result in maximum delivery of the therapeutic potential of I 131 MIBG
  • Minimizes the amount of non-radioactive MIBG molecules administered to the patient, potentially reducing pharmacologic toxicities, especially cardiovascular events or toxicity, and possibly enabling better tolerated and effective treatment
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36
Q

Define Carrier. Define Specific activity. Calculate the carrier-free specific activity for I-131

A

a. Carrier: non-desirable contaminant radioactive or non-radioactive species in solution with the desired species.
b. Specific activity: proportion of a sample that contains only the radioactive form of the atom, expressed in Bq/g.
c. CFSA (Bq/g) = lambda*N = ln2/T1/2 * 6.022x1023/atomic weight (remember to convert T1/2 to sec)

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37
Q

Name 3 causes of radiochemical impurity.

A

Radiochemical purity is the fraction of total radioactivity in the desired chemical form in the radiopharmaceutical. Impurities include free and hydrolyzed Tc-99m TcO4-

Causes:
o Decomposition of the radiopharmaceutical due to the action of a solvent
o Changes in temperature or pH
o Light
o Presence of oxidizing or reducing agents
o Incomplete reaction
o Radiolysis

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38
Q

Name 5 ways to detect radiochemical impurities.

A
  • solvent extraction
  • ion exchange
  • paper, gel, thin-layer or high performance liquid chromatography
  • gel electrophoresis
  • precipitation
  • distillation
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39
Q

Define the following and give an example of each:

a) RN purity
b) RC purity
c) Chemical purity
d) Biological purity

A

A) fraction of total radioactivity in the desired radionuclide form. (Mo99 breakthrough)

B) fraction of total radioactivity in the desired chemical form. (HR and free tech.)

C) Presence or absence of contaminating chemicals (e.g. solvents in FDG synthesis).

D) Biologic purity: sterility and apyrogenecity.

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40
Q

Patient had 82Rb 4 days ago. Sets off radiation detector. What do you expect happened?

A

Sr–82 and Sr-85 breakthrough

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41
Q

What is the maximum quantity of Mo99 in Tc99m. How is it measured? When is it measured?

A

Limit is 0.15 uCi 99Mo/mCi 99mTc (0.15 kBq/MBq) at the time of administration. Saha, page 77

The 99Mo contamination is measured by detecting 740-keV and 780-keV photons of 99Mo in a dose calibrator or a NaI(Tl)detector coupled to a pulse height analyzer. The eluate vial is placed in a lead pot (about 6-mm thick) to stop all 140-keV photons from 99mTc and to count only 740-keV and 780-keV photons from 99Mo. The shielded vial is then assayed in the dose calibrator using the 99Mo setting. Molybdenum-99 along with 98Mo (from the molybdenum target) can also be detected by adding phenylhydrazine to the eluate and observing the color change due to the Mo-phenylhydrazine complex by the use of a colorimeter.

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42
Q

2 ways of 99mTc production

A

Using Fission MOLY in generator
99Mo → 99mTc + β− + νe
Cyclotron produced
100Mo(p,2n)99mTc

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43
Q

Tc eluate should be ___, ___, and be free of visible ___. It should have less than ___ kBq/MBq Mo-99 and ___ per mL of Al3+ ion. As the Tc-99m generator eluate does not contain bactericidal activity, how long can you keep it before it expires? A Mo/Tc generator expires ___ after manufacture.

A

The solution should be clear, colourless, and free of visible foreign material.
0.15 kBq/MBq, 0.10 ug/mL
12 hours
2 weeks

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44
Q

You elute a dry generator with 20 ml of saline, but only obtain 10 ml in the eluting vial. What would be the consequence if the remaining volume were left in the generator? What can you do to correct this?

A

It will cause oxidation and radiolysis. The Tc99m still in the generator will also decay, leaving more Tc99 and decreasing the specific activity of your next elution. Also, possibility of pseudo-channeling is created by leaving the column wet. You can try to elute remaining fluid with another vacuum-vial.

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45
Q

2 radiotracers produced by biosynthesis.

A

Co-57 cyanocobalamin (Vitamin B12)

C-14 Xylose

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46
Q

What are essential and tagged Tc99m tracers?

A

Tc-essential – Tc is integral part and for which the molecule would not be delivered to target in the absence of the Tc (prepared by integrated approach). Biodistribution depends of their physico-chemical properties (charge, size, lipophilicity) E.G. MAG-3, ECD, HMPAO, Sestamibi.

Tc tagged - non-substrate specific localization mechanisms. Technetium is labeled or “tagged” to a variety of molecular species that delivered technetium to organs of interest by simple diffusion, phagocytosis, entrapment, or cell sequestration mechanisms. Technetium is a passenger atom not essential for localization. include complexing agents (e.g. DTPA), particles (e.g. sulfur colloid), blood cellular elements (e.g. leukocytes), and proteins (e.g. human serum albumin).

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47
Q

Tc labeled radiopharmaceuticals can be “Tc-essential” or “Tc-tagged”. Define each, and give 4 examples for each.

A

Tc-essential is integral part of the molecule and without it, it will not have desired in vivo effect. Examples: HMPAO, ECD, MIBI, TETRAFOSMIN, HIDA, MAG3.

Tc-tagged does not need Tc atom to carry function. Tc is added to side-branch with no effect on receptor site or is attached to bifunctional chelate. MAA, SC, DTPA, RBC.

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48
Q

What is the oxidation state of MIBI?

A

1+

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49
Q

Tc oxidation states – Tc – Sc, DTPA, mibi and I think one more?

A

See notes

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50
Q

What are the possible oxidation states for Tc, and which is most stable? Describe the mechanism behind erythrocyte labeling with Tc?

A

+7 to -1 oxidation states are possible. +7 is the most stable (+4, +5, and +7 are the most common; +4 if I had to pick one, but not sure).
Add pyrophosphate-Sn to carry tin inside and reduce Hgb. Pertechnetate then added and goes inside cell and get reduced by Sn. The Tc then binds B-hemoglobin and heme.

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51
Q

What is the minimal number of MAA particles?

A

60 000 vs. 100000 (debated)

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52
Q
  1. What is a pyrogen? Which is best method to detect? Give 3 reasons?
A

Pyrogenicity: ability of substance to induce fever
- Rabbit test and limulus amebocyte lysate test
BEST IS Limulus amebocyte lysate test
- o No live animal testing
- o Rapid result (1 hour)
- o Less radiopharmaceutical needed

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53
Q

Current standard for testing pyrogenicity? 3 reasons this is better than rabbit testing

A

LAL/ BET test derived from horseshoe crab blood cells (amebocytes): Gram-negative endotoxin activates proenzyme to coagulase, which in turn activates coagulogen to coagulin. The gel-clot method and the chromogenic method are comparable.
b. More sensitive than rabbit testing; cheaper; faster; easier; more ethical (?)

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54
Q

Name 2 conditions that require reducing the number of MAA particles

A

Pulmonary Hypertension
Pediatric
Known R to L Shunt

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55
Q

2014-1. RBC labelling , which is most efficient method and what is the labeling efficiency..what reduces Tc in RBC

A

a. In vitro is most at >97%, modified in vivo >95%, in vivo ~85%.
b. Sn2+

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56
Q

3 types of QC you would do on eluate? (specifically said eluate..radionuc purity, biologic, etc - not sure if radiochemic would count, as that’s more after prep)

A

a. Mo99 breakthrough (radionuclide purity)
b. Al breakthrough and pH (chemical purity)
c. HR tech (radiochemical purity)

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57
Q

Cyclotron production of radionuclides: What is the typical charge of the bombarding particle? What is the change in the nuclear charge? Where are products in relation to line of stability? What types of decay occur in the product? What is the isotopic purity? Radionuclidic yield? Cost of produced radionuclides?

A
  • Bombarding particle typically has +1 (proton) or +2 (deuteron) charge (though most cyclotrons now are negative-ion cyclotrons)
  • In a (p,n) reaction, presumably you’re gaining a charge.
  • They are shifted to the proton-heavy side
  • They decay by positron or EC.
  • Isotopic purity is high.
  • Radionuclidic yield is low.
  • Cost is high.
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58
Q

. 4 advantages of a negative ion cyclotron

A

a. stripping foil is near 100% efficient, so get less radioactivity in the housing.
b. Better beam optics.
c. The foil can also split a beam, so you can create 2 different products at once.
d. Smaller than positive ion cyclotrons
e. Disadvantage: need a lower-pressure vacuum.

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59
Q

Define chelation.

A

a. Chelation: The formation of attractive interactions between two or more separate binding sites within the same ligand and a single central atom (usually a metal).
b. BFCA: reagents containing a strong metal-chelating group and a chemically reactive functional group

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60
Q

110 particles in 1x1 mm square on hemocytometer, how many particles / ml of MAA?

A

1x1x0.1mm = 0.1mm3 = 0.0001mL, so 110/0.0001mL = 1,100,000/1mL

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61
Q

Pittsburgh protein B (PiB) has been investigated for binding to what substance? What radionuclide has been used to label PiB?

A

B-amyloid plaques, labeled with 11C.

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62
Q

What is ionization? What is delta ray?

A

a. In an ionization event, an electron (delta ray) is ejected from its atomic orbit by an incident charged particle, and has enough energy to cause secondary ionizations on its own.

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63
Q

2 types of interactions a photon greater than 511 Kev would have

A

a. Compton scatter

b. Photoelectric absorption

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64
Q
  1. What is iodine escape peak
A

Iodine escape peak: photoelectric absorption of an incident photon by iodine in the crystal emits a 30keV characteristic x-ray. When this x-ray is not absorbed, the resultant energy deposited is 30keV less than the photopeak. This happens more commonly for low-energy photons (<100keV).

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65
Q

What is the photoelectric effect. Describe its relationship to Z and E
What is photoelectric effect. Relationship to Z and photon energy for photoelectric effect

A

It is one of the possible interactions between photons and matter, where the atom absorbs all energy of incident photon and an orbital electron is ejected.
It is the dominating effect in heavy elements at low photon energies.
Probability of photoelectric effect α Z3/E3.

The photoelectric component increases abruptly at energies corresponding to orbital electron binding energies of the absorber elements (K absorption edges)

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66
Q

Compton scatter:

a) How does this affect image quality
b) What does it do?
c) How does Compton scatter affect camera performance?

Can reduce intrinsic spatial resolution. Intrinsic spatial resolution is the limit of spatial resolution achievable by the detector and electronics, ignoring additional blurring due to the collimator. It is limited primarily by 2 factors:

A

Detection of compton scattered events reduces image quality

Compton scatter: photon interaction with outer shell electron resulting in deflection of photon and ejection of electron

Can reduce intrinsic spatial resolution. Intrinsic spatial resolution is the limit of spatial resolution achievable by the detector and electronics, ignoring additional blurring due to the collimator. It is limited primarily by 2 factors:

Multiple scattering of photons within the detector: if a photon undergoes Compton scattering within the detector crystal and the residual scattered photon is also detected, but at some distance away, the two events are recorded as a single event occurring at a location along the line joining the two interaction sites. For photon energies less than 300 keV this is not significant.

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67
Q

What is HVL? What type of photon beam geometry?

A

HVL is the half value layer or the amount of a material necessary to attenuate half of the incident radiation

*Dependent on type/density of material and energy/type of incident radiation
*Assumes narrow beam geometry
Examples in lead:
99mTc: 0.03 cm
67Ga: 0.07 cm
60Co: 1.6 cm

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68
Q

What is HVT? What factors affect/influence its value

A

a. Half-value thickness (thickness of a material that absorb 50% of an incident beam)
b. Z and density of material, and energy and type of incident beam

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69
Q

When is constancy of dose calibrator performed

A

at installation, daily, after servicing. Use Cs-137 (long-lived) +/- 10%

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70
Q

List 4 things to perform for dose calibrator quality control. Which of these does the shielding method test for?

A

Accuracy, linearity, constancy, geometry. Shielding is used for linearity.

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71
Q

QC for survey meters

A

a. Battery check – display on screen
b. Background – performed in an area remote from radioactive sources (to ensure meter is not contaminated)
c. Constancy – using long lived source, should be within +/- 10%

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72
Q

List 3 daily quality control tests for ionization survey meter?

A

Battery check
Background
Constancy?
Physical inspection (EANM)

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73
Q

How does a Geiger Mueller counter work?

A

· High sensitivity counting-type ionizing radiation detector
· Ionizations in gas chamber (argon + quenching gas) result in avalanches due to high voltage operation (accelerated electrons -> excited gas molecules -> UV photons -> more ionizations)

GM counter is a gas-filled (argon + quenching gas) detector designed with high voltage across the chamber.
· when ionization occurs, the accelerating electrons in addition to ionizing gas molecules, also cause excitation of gas molecules which in turn release UV photons. The UV photons undergo photoelectric absorption and more electrons are emitted, causing an avalanche ionization. The Geiger discharge continues until a band of slow-moving positive charges around the anode reduce the effective electric field, dropping it below the level needed for gas amplification.
· GM counter CANNOT distinguish different energies

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74
Q

What are characteristics of a quenching gas?

A
  1. Give up electrons easily
  2. When they are neutralized by electrons entering higher energy orbits, they deenergize themselves by dissociating into molecular fragments rather than by emitting UV photons
  3. Strong absorbers of UV radiation
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75
Q

Well counter - Name 2 reasons why the volume and geometry must be kept constant (2 marks)

A
  1. To be able to compare counting rates between two samples, because sample volume/geometry has a significant effect on counting rates.
  2. To maintain constant geometric efficiency.

The fraction of gamma rays escaping the well (and the geometric efficiency) depends on the position of the source in well. Differences in volume and geometry affect the position of the source in the well and will therefore affect counting rates.
Sorenson p. 197

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76
Q

Name QC tests for dose calibrators and well counters and give their frequency.

A

Well Counter:
DAILY Q/C: background adjustment, constancy (with long-lived reference source)
QUARTERLY Q/C: Energy resolution (FWHM)
ANNUAL Q/C: Efficiency (cpm/Bq) ref source +/- 5%

Dose Calibrator: says +/-10 % in Saha??
DAILY Q/C: Constancy (reference source +/- 5%)
QUARTERLY Q/C: Linearity (shielding or decay method +/- 5%), Accuracy (2 radionuclides +/- 5%)
After repair/recalibration: Geometry (+/- 5%)

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77
Q

What is the range of activity measured in a well counter. What are the primary factors that determine maximum and minimum detectable activity?

A

Bq-kBq up to 37 kBq. Crystal thickness and dead time are the primary factors determining minimum and maximum detectable activity

The detection efficiency D (see Chapter 11, Section A) of the NaI(Tl) well counter for most γ-ray emitters is quite high, primarily because of their near 100% geometric efficiency g. The combination of high detection efficiency and low background counting levels makes the well counter highly suitable for counting samples containing very small quantities (Bq–kBq) of γ-ray-emitting activity. The geometric efficiency for small (environ 1-mL) samples in the standard well counter is approximately 93% (see Fig. 11-3).

Because of their high intrinsic and geometric efficiencies (resulting from the use of a thick crystal and a well-type counting geometry, respectively), well counters are extremely sensitive and, in fact, can reliably be used only for counting activities up to approximately 37 kBq; at higher activities, dead-time counting losses become prohibitive and the measured counts inaccurate.

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78
Q

Why measure background before and after counting in a well counter.

A
  • Measure background before and after to have more reliable (mean) background?
  • Identify spills( “ Further, even trace contamination of the counting well will produce inaccurately high counting-rate values. Accordingly, a blank (i.e., an empty counting tube or vial) should always be included to determine the current background count.”)
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79
Q

What is detector efficiency and give a formula?

A

D = ratio of detector counting rate to emission rate of a source = g x ε x f x F
o g = geometric efficiency
o For point source far away ~ Α/(4π r2)
§ A = area of detector
§ r = distance from point source
o For point source close ~ ½ (1 – cos θ)
o ε = intrinsic efficiency
o f = fraction of output signals within PHA window
o F = factor for absorption/scatter occurring within source or between source and detector

Detector Efficiency: D = g x e x f x F Explain each term.
g: geometric efficiency of the detector – efficiency with which detector intercepts radiation emitted from the source, determined mostly by detector size and distance from source.
e: intrinsic efficiency with which detector absorbs incident photons and converts them to potentially usable detector output signal
f: fraction of output signals produced by the detector recorded by the counting system, an important factor in energy-selective counting, when a pulse-height analyzer is used to select signals in a desired amplitude (energy) range
F: Absorption and scatter within the source itself, or by material between source and detector

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80
Q

Define intrinsic efficiency. What factors affect it?

A

Intrinsic efficiency (ε) – efficiency with which detector absorbs incident radiation events and converts them into potentially usable detector output signal; determined by detector thickness and composition/density and by type and E of radiation – with increased E need increased crystal thickness
o Decreases with increasing E
o Increases with increasing thickness of detector
o Increases as detector density and Z increase (stopping power)

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81
Q

How does geometric efficiency change in relation to volume and position?

A
Geometric efficiency decreases at a rate equivalent to the square of the distance
            	o g = geometric efficiency
o For point source far away ~ Α/(4π r2)
§ A = area of detector
§ r = distance from point source
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82
Q

Uncertain about volume component…if they meant area then it increases in proportion to the area of the detector

A

“The coaxial Ge(Li) detector was developed in order to increase overall detector volume, and thus detection efficiency”

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83
Q

What is the purpose of Tl in the NaI crystal?

A

Tl doping (0.1-0.4 mol %) adds activation centres that makes NaI crystal an efficient scintillator at room temperature (vs. liquid nitrogen temperatures)

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84
Q

Name 4 components of a liquid scintillation camera.

A

organic solvent – dissolves scintillator material (the primary solute) and radioactive sample; absorbs most radiation from sample and transfer energy to scintillator molecules

primary solute (aka scintillator or fluor) – absorbs energy from solvent and emits light

secondary solute (waveshifter) – absorb emissions from primary solute and re-emit photons of different wavelength which are better matched to PMT response

additives – improve some aspect of LS performance, eg energy transfer efficiency from solvent to primary solute

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85
Q

What are benefit of semiconductor with multiple pinholes as you ask for admin to pay for this equipment

A

a. Faster scan time (more scans performed in a day)
b. Lower dose administered to the patient
c. Better spatial resolution (improved images for more accurate diagnosis)
d. Patient comfort (some scanners pt in sitting position and scan faster to acquire)
e. Smaller size of the scanner – needs less room in hospital

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86
Q

What is Z pulse

A

The summed signal from all PMTs from a single scintillation event, which is then fed to the pulse-height analyzer for analysis.

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87
Q

List three advantages of semiconductor detectors over NaI detectors. List 3 disadvantages of semiconductor detectors. What is the energy resolution in FWHM of a semiconductor detector vs. a NaI detector?

A
Semiconductor 
High energy resolution
Direct conversion to current
Higher efficiency than gas-filled detectors
Expensive
Requires supercooling
Poor stopping power

CZT
Room temperature operation
High Z, good stopping power

NaI
Good stopping power 50-250 keV
High light output
Transparent to own scintillations
Inexpensive
Scintillation wavelength well matched to PMT
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88
Q

For each CT situation, fill in the blank for radiation dose and manner. Decribe “increase” or “decrease” for radiation dose and in a “non-linear” or “linear” manner

A

a) When kVP is increased from 120 to 140 – Increase, Non-linear
b) When mAs is increased - Increase, Linear
c) When pitch is increased from 1.0 to 1.5 – Decrease, Linear
d) When collimation is increased from 1 to 5mm – Decrease, Linear

89
Q

Radiation weighting factors, for photons, electrons, alpha, neutrons (with neutrons, they were specifically looking for the factors in terms of ranges of their energies like factor for 10-100Kev etc

A

Photons = 1
Protons > 2 MeV = 5
Alpha/fission fragments = 20

Neutrons:

i. <10keV = 5
ii. 10-100 keV = 10
iii. 100keV-2MeV = 20
iv. 2MeV-20MeV = 10
v. >20MeV = 5

90
Q

Define: absorbed dose, equivalent dose, effective dose, and give SI units for these.

A

● Absorbed dose D (Gy): energy absorbed per unit mass
● Equivalent dose (H, Sv): average absorbed dose of an organ that takes into account type and energy of radiation, according to weighting factor (wR).
● Effective dose (E, measured in Sv): a weighted total-body dose, considering the radiation type, organ sensitivity, and relative distribution of activity in vivo. Used in assessing potential for stochastic effects (Gy for deterministic effects).

91
Q

What is the committed dose?

A

Committed dose is a measure of the stochastic health risk (probability of cancer induction and genetic damage) due to an intake of radioactive material into human body. SI unit of measure is the sievert.

Definition from Hall: Effective dose integrated over 50 years following intake of a radiopharmaceutical.

92
Q

2015 71. What is the effective dose for commonly performed nuclear medicine studies?

A

See notes

93
Q

Name 2 critical organs of MIBI, tetrofosmin and thallium.

A

MIBI: Colon, Gallbladder
Tetrofosmin: Gallbladder, Colon
Thallium: Kidneys, Thyroid

Isn’t there technically only 1 critical organ for a given radiopharmaceutical? The critical organ for Thallium are variable depending on where you look (ICRP, Requisites, Essentials, Kowalsky…)

94
Q

What is A (ie cumulative activity) and S in MIRD calculation

A

a. Cumulated activity (Ã, Bq·s) = (amount of activity in a source organ) x (time the activity is present)

b. Mean dose per cumulated activity (S; a.k.a. S-value, or dose factor, Gy/Bq·s): approximated constants for each organ pair, multiplied with cumulated activity to give an organ dose. It’s an approximation:
i. D(rk ⃪ rh) = Ã x S(rk ⃪ rh)

95
Q

List in order from lowest to highest effective dose the following exams: Rb-82 PET, 1-day stress-rest MIBI, dual isotope, stress-only MIBI

A

In increasing dose: O15, N13, Rb82, Stress-only MIBI, One-day Stress-Rest MIBI, dual-isotope.

96
Q

In radiation protection, effective dose equivalent: how does it change with age? In a 15 year old, list order of highest to lowest dose, Ga-67, Tc-99m-WBC, and In-111-WBC. In a 1 year old, would a Ga-67 or F-18-FDG study have higher effective dose?

A

a. Effective dose and the tissue weighting factors are age- and sex-averaged, and do not actually change with patient age. Obviously, younger patients are more prone to negative effects of radiation, but this is not reflected in effective dose measurements; “radiation dose equivalent,” on the other hand, is an outdated term that provides tables of mSv/MBq for children of different ages, and of course younger patients have higher radiation dose equivalents.
b. In111-WBCs, then Ga67, then Tc-WBCs (http://orise.orau.gov/files/reacts/pedose.pdf)
c. Gotta be Ga67, considering its 78day halflife.

97
Q

Define LET

A

Linear energy transfer: the density of energy deposition along the particle’s path-length.

98
Q

Define DDREF

A

Dose and Dose-Rate Effectiveness Factor, which is the ratio between the radiation detriment from high doses/rates and that from low doses/rates.

99
Q

How does low dose rate and high dose rate differ in terms of damage it causes

A

a. Low dose rate causes less damage for most tissues (longer linear portion of the cell survival curve at lower doses)

100
Q

. What action does high LET radiation cause?

A

a. Lots of double strand breaks, as well as SSBs, dicentric ring formations

101
Q

2015 59. In what 2 ways does SH act as a radioprotector?

B2016-21: List 2 cytoprotective mechanisms of sulfylhydryl compounds (2 marks)

A

Mechanisms:
Scavenging of Free Radicals
The sulfhydryl group may act by chemically reacting with free radicals generated by indirectly ionising radiation and preventing their interaction with DNA

Improvement of DNA Repair
The sulhydryl group may donate a hydrogen atom to assist in DNA repair pathways.

102
Q

B2016-Rpt 3: Radiobiology. Explain a) radiation hormesis

B2003-32: What is hormesis? It happens at what level of absorbed dose?

A

Hormesis: paradoxical, beneficial effect of low dose ionizing radiation in biological systems
Data controversial, but typical effects <100 mSv
Radiation hormesis is a theory that states that low level radiation (1-20 cGy acute dose of low LET radiation) can actually have a beneficial effect on health by stimulating the immune system.

103
Q

(B2005-78: Define radiation hormesis, and three proposed methods of cellular adaptation to hormesis.)

A

Hormesis: paradoxical, beneficial effect of low dose ionizing radiation in biological systems

There are three proposed mechanisms;
o 1.DNA repair
o 2.free radical detoxification
o 3.stimulation of the immune system

104
Q

B2015-24: Name 5 radiobiologic effects in radiotherapy.

A
Repair
Redistribution (called reassortment in Hall)
Reoxygenation
Repopulation
Radiosensitivity
105
Q

B2016-5. Radiobiology - define
a) adaptive response

b) genomic instability
c) doubling dose

A

Exposure to very low levels of radiation induces mechanisms whereby cells are better able to cope with subsequent higher levels of radiation exposure

High frequency of mutations with the genome of a cellular lineage

Dose to whole population required to double spontaneous mutation rate in population

106
Q

2016 11.Effects of radiation on DNA (3 marks)

A
  • Direct action: radiation (typically high LET) interaction with DNA
  • Indirect action: radiation (typically low LET) interaction with other molecules (primarily H20), producing free radicals (H2O2 and OH), that cause DNA damage
    Indirect generally easier to repair, as usually constitutes single strand breaks (can lead to frameshifts and substitutions), while direct is more likely to cause double strand breaks (can lead to direct death from cytoxic effect of exposed dbl strands)
107
Q

Name 2 main categories of biologic effects of radiation and define.

A

Stochastic effect: radiobiologic effect where probability of occurrence ↑ with radiation dose, but severity independent of dose; no threshold dose
a. Example: cancer and heritable mutations

Deterministic effect: radiobiologic effect with a threshold dose; severity ↑ with radiation dose
b. Example: cataract and skin erythema

108
Q

List 3 characteristics of stochastic effects?

A

Stochastic effect: radiobiologic effect where

  1. Probability of occurrence ↑ with radiation dose
  2. Severity independent of dose
  3. No threshold dose
109
Q

2016 30. What is the ‘law’ that radiation causes increased cancer risk in rapidly dividing, undifferentiated cells?

A

Law of Bergonie-Tribondeau
1906: X-rays are more effective on cells which have a greater reproductive activity:
o Therefore, cells that are rapidly dividing, undifferentiated and have long mitotic futures are most radiosensitive

110
Q

What is BEIR? What type of radiation, what is considered low dose?

A

Biological Effects of Ionizing Radiation
Low LET radiation (x-rays, gammas), <100 mSv
Most recent report involves “The primary objective of the study is to develop the best possible risk estimate for exposure to low-dose, low linear energy transfer (LET) radiation in human subjects.”
Low dose = For this report, the committee has defined low dose as doses in the range of near zero up to about 100 mSv (0.1 Sv) of low-LET radiation.

111
Q

What is the population studied by BEIR?

A

Several including Japanese atomic bomb survivors (primary), Medical radiation studies, Occupational radiation studies, Environmental radiation studies

112
Q

What do following stand for – MIRD, BEIR, DDREF

A

a. Medical Internal Radiation Dosimetry
b. Biological Effects of Ionizing Radiations
c. Dose and Dose-Rate Effectiveness Factor

113
Q

Know Bier 7 well. Purpose and how you define Low LET radiation in the study

A

a. Purpose: “BEIR VII develops the most up-to-date and comprehensive risk estimates for cancer and other health effects from exposure to low-level ionizing radiation.”

b. Low-LET: “x-rays and gamma rays.”
i. “low-LET radiation deposits less energy in the cell along the radiation path and is considered less destructive per radiation track.”
ii. “The BEIR VII report defines low doses as those in the range of near zero up to about 100 mSv (0.1 Sv) of low-LET radiation.”

114
Q

Why was Hiroshima and Nagasaki data used by BIER (

A

a. ”The most thoroughly studied individuals for the evaluation of health effects of ionizing radiation are the survivors of the Hiroshima and Nagasaki atomic bombings, a large population that includes all ages and both sexes. The Radiation Effects Research Foundation (RERF) in Japan has conducted followup studies on these survivors for more than 50 years.”
b. “More than 60% of exposed survivors received a dose of radiation of less than 100 mSv (the definition of low dose used by the BEIR VII report).”

115
Q

Name effects of radiation during gestation. What is the most radiosensitive phase?

A

The principal effects of radiation on the developing embryo and fetus, aside from cancer, are embryonic, fetal, or neonatal death; congenital malformations; growth retardation; and functional impairment, such as mental retardation.
Pre-Implantation (0 through 9 days), Organogenesis(10 days through 6 weeks), Fetal(6 weeks through term)

116
Q

Define the bystander effect.

A

The radiation-induced bystander effect (bystander effect) is the phenomenon in which unirradiated cells exhibit irradiated effects as a result of signals received from nearby irradiated cells.

117
Q

Define OER.

A

Oxygen enhancement ratio (OER) = ratio of dose under hypoxic to aerated conditions needed to achieve the same biological effect

118
Q

What are 3 radiation syndromes and give the doses required?

A
  • Hematopoietic 2.5-5 Gy (some symptoms may occur at 0.3 Gy)
  • Gastrointestinal ~ 10 Gy (some symptoms may occur at 6 Gy)
  • Cerebrovascular > 50 Gy (some symptoms may occur at 20 Gy)
119
Q

List 3 defining characteristics for non-stochastic effects. List 3 examples of non-stochastic effects.

A

Deterministic effect have a threshold; increasing dose leads to increased severity of effect; and the timing is within hours or days.

Examples would include: radiation induced cataracts, skin radiation injury following fluoroscopy, cerebrovascular syndrome, sterility, etc.

120
Q

For each of the following: Cerebrovascular syndrome, gastrointestinal, and hematopoietic syndrome: What is the dose threshold? When does it usually become fatal (in days)? What is the LD50 dose?

A

LD50 /60 total body radiation
~ 3-4 Gy (with antibiotics and nursing this increases to 7 Gy, 100% lethality 10Gy)

Hematopoeitic syndrome
~ 2.5 to 5 Gy
       	Death at 1-2 months
GI syndrome
> 10 Gy
Death at 3-10 days
Cerebrovascular syndrome
50-100 Gy
Death at 24-48 hours
121
Q

What does IAEA stand for?

A

International Atomic Energy Agency

The International Atomic Energy Agency is the world’s central intergovernmental forum for scientific and technical co-operation in the nuclear field. It works for the safe, secure and peaceful uses of nuclear science and technology, contributing to international peace and security and the United Nations’ Sustainable Development Goals.

122
Q

Why should you not wear a lead apron to protect from a beta particle?

A

It will produce Bremsstrahlung radiation, which is more penetrating in soft tissues
A 0.5 lead apron will attenuate less than 15% of radiation for photon energies above 350 keV

123
Q

How long should you stop breastfeeding with MAG3, I123 and FDG?

A

MAG3 – Dont I-123 >3 weeks FDG – Dont

124
Q

: ICRP 106 Breastfeeding interruptions. Match each radionuclide (MIBG, 67Ga, 201Tl, DMSA, MAA, Octreoscan, 99mTc-HMPAO WBC, pertechnetate, 111In-WBC) with

A

a) no interruption (DMSA, 111In-WBC)
b) 12 hour interruption (MAA, 99mTc-HMPAO WBC, pertechnetate)
c) 48 hour interruption (201 Tl)
d) 3 week interruption (MIBG, 67-Ga)

ALSO SEE NOTES

125
Q

How long does CNSC adopt IAEA recommendations after they are published?

A

2 years
Packaging and Transport of Nuclear Substances Regulations, 2015 (SOR/2015-145)
Incorporation by reference of IAEA Regulations: For the purposes of these Regulations, the incorporation by reference of any particular amendment of the IAEA Regulations is effective two years after the day on which the amendment is initially published by the IAEA or six months after the day on which the amendment is available in both of the official languages of Canada, whichever is later.

126
Q

What is an action level? What 3 things should be done if the action level is reached?
(B2010-39: define action level)

A

Action level = specific dose of radiation or other parameters, if reached, may indicate a loss of control of part of licensee’s radiation protection program and triggers a requirement for specific actions to be taken

A specific dose of radiation or other parameter that, if reached, may indicate a loss of control of part of a Permit Holder’s radiation protection program, and triggers a requirement for specific action to be taken”.

The primary goal of the action to be taken is to prevent a re-occurrence of the events.

127
Q

(B2010-40: what 3 things to do according to CSNC when an action level is reached?)

A
  1. Conduct an investigation and determine a cause
  2. Identify and take action to restore the effectiveness of the radiation safety program
  3. Notify the CNSC within the time specified on the licence.
128
Q

what is an action level? Who do you inform? What steps do you need to take?

A

a. “action level” means a specific dose of radiation or other parameter that, if reached, may indicate a loss of control of part of a licensee’s radiation protection program and triggers a requirement for specific action to be taken.
b. When a licensee becomes aware that an action level referred to in the license has been reached, the licensee shall:
i. conduct an investigation to establish the cause for reaching the action level;
ii. identify and take action to restore the effectiveness of the radiation protection program
iii. notify the CNSC within the period specified in the license

129
Q

List 3 characteristics of a major spill.

A

Minor Spill
● <100 exemption quantities

Major Spill

  1. > 100 Exemption quantities
  2. contamination of personnel
  3. release of volatile substance
130
Q

Who do you report to after a spill? Name 4 roles this person needs to do.

A

RSO
Roles

Annual review of the radiation safety program for adherence to ALARA

Quarterly review of occupational exposures.

Quarterly review of records of radiation level surveys.

The RSO will schedule briefings and educational sessions to inform workers of ALARA programs.
The RSO will ensure that authorized users, workers, and ancillary personnel who may be exposed to radiation will be instructed in the ALARA.
An institution must establish Investigational Levels for occupational external radiation exposure which, when exceeded, will initiate review or an investigation into the over exposure of the worker or authorized user.

131
Q

35 year old Graves for radioiodine treatment. Has husband and 2 young kids. Name 8 radiation safety issues or adverse effects to discuss

A

Side effects:

  • Thyroid storm
  • Sialoadenitis
  • Exacerbation of ophthalmopathy
  • Hypothyroidism (long term)
  • Neck tenderness

Safety Issues

  • Separate bathroom
  • Flush immediately
  • Not primary child caregiver
  • Drive home separate from children if possible
  • Teratogenic (no pregnancy)
  • No breastfeeding
132
Q
  1. a) Name the Canadian federal agency looking after nuclear use
    b) What is the federal act that gives the said agency power to enforce regulations?
A

CNSC (Canadian Nuclear Safety Commission) – Nuclear Safety and Control Act (May 31, 2000)

133
Q

14: Allowable dose for a pregnant worker and NEW?

A

The effective dose limits for a nuclear energy worker is set at 50 mSv in any one year and 100 mSv in five consecutive years.
The dose limit for pregnant workers is 4 mSv from the time the pregnancy is declared to the end of the term.

134
Q

2013-37 and 2014-2. Effective dose limits – NEW per year and per 5 years, Pregnant, public

A

A NEW is any person who in the routine performance of their profession, business or employment will expect to be exposed to more than the prescribed limit of ionizing radiation for the general public (>1 mSv)
100 mSv over 5 years with a maximum of 50 mSv in any one year
1 mSv per year
I think they are getting at that this is an action level. NEW probably requested to avoid further work while, the following take place:

135
Q

As per CNSC:

A

a) What is the dose from natural radiation (for Canada)?
Approx. 1.8 mSv (this is total natural background radiation)
b) What is the dose from internal radiation (for Canada)?
Approx. 1.2 mSv (ingestion + inhalation)

136
Q

According to 2008 paper (don’t remember the name..some Canadian paper), what is the effective dose of natural background? And internal radionuclide?

A

a. Natural background = 1.8mSv in Canada, 2.4mSv worldwide
b. Ingestion = 0.3mSv
c. Cosmic = 0.3mSv
d. Terrestrial BG = 0.2mSv
e. Inhalation = 0.9mSv

137
Q

Radioactive waste. List 3 steps to take in the hospital to decrease chance of having to go to the landfill to check for radioactive waste. 3 things to prevent alarms at waste disposal facility?

A
  • Decay in storage
  • Release into sewer system (needs to be authorized explicitly in license)
  • Transfer to authorized recipient (e.g., landfill)
  • Incineration/atmospheric release
138
Q

What is the maximum dose at the door of an inpatient treated with I131? What is the maximum dose a neighboring patient could receive?

A

Dose rates in areas surrounding the room (therefore at the door) <2.5 μSv/h
dose to other patients cannot exceed 0.5 mSv for their hospital stay
can release when dose is < 7 mRem/h (<70 μSv/h) at 1 meter.

139
Q

When should a bioassay be performed after handling I131?

A
  • After handling open-source radioiodine >2MBq, >200MBq in a fumehood, or >20,000 MBq in a glovebox (see table)
  • If exposed to a spill >2MBq
  • If externally contaminated
  • If working within 2m of a person whose screening results were >1kBq, within 1 hr of the suspected exposure

CNSC reporting level is >=10kBq

Screening must be performed 1-5 days from exposure

140
Q

Thyroid Screening for RadioiodineWorkers

A

Other persons who regularly work close to a worker handling more than 2 MBq of volatile I-125 or I-131 on an open bench or in an open area should be screened for the relevant radioiodine.
Workers and other persons who have been exposed to one of the following situations should be screened for the relevant radioiodine:
1. Exposed to a volatile I-125 or I-131 spill greater than 2 MBq;
2. Externally contaminated by I-125 or I-131; or
3. Worked within two meters of a person whose screening measurement results are equal to or greater than 1 kBq, if they were working within one hour after the time of the suspected exposure.

141
Q

2 instances when a transport good is considered excepted (exact wording ‘excepted’..not exempted like EQ)..

A

a. Limited quantity of radioactive material (below EQ threshold) (e.g. UN2910)
b. Packaging that previously contained radioactive material. (e.g. UN2908)

142
Q

Define transport index. What is the maximum threshold for the following types of packages: White I, Yellow II & Yellow III.

A

TI = dose rate measurement at 1 meter in uSv/hr divided by 10
White I - maximum TI <0.05
Yellow II - 1.0
Yellow III - 10

SEE NOTES for exempted

143
Q

. When do you put up radiation safety sign? What is written on this sign?

A

a. at entry/access points to areas where there is an amount of radioactive substance > 100 EQs, or where there is a reasonable chance someone will be exposed to an effective dose rate >25 uSv/hr. Sign says “Rayonnement – Danger – Radiation”

144
Q

BRCA gene 1 and 2…what does it produce in the cell and how does it act at the cellular level? Why is lung scint and CT pulm angio important in this setting?

A

BRCA 1 and 2 are tumor suppressor genes.

BRCA1 protein is part of a complex that directly repairs DSBs by HRR; BRCA2 protein binds ssDNA (in DSBs) and initiates repair by HRR.

VQ and CTPA important due to effects of radiation;
patient with BRCA mutation less able to repair DSBs.

145
Q

Types of events in SPECT gamma camera (valid event etc..4 of them..right off sorenson)

A

a. Valid
b. Detector scatter
c. Object scatter
d. Septal penetration

146
Q

Name 5 collimators for 140keV

A

Parallel hole, Pinhole, Converging, Diverging, Fan Beam

147
Q

. How can MTF be used to choose a collimator? Given MTF function plotted vs. spatial frequency (cm-1) for 3 collimators, A, B and C. Describe, qualitatively, how an MTF can be generated from a LSF.

A

Better MTF is closer to 1.0 for all spatial frequencies.

It is a measurement of the degradation produced by an imaging device as a function of various spatial frequencies.

When M = 1 for A PARTICULAR SPATIAL FREQUENCY, this means no degradation of contrast for that frequency. Ideal imaging device has M=1 for all spatial frequencies.

When M = 0 for a particular spatial frequency, the imaging device is unable to reproduce this particular spatial frequency. Therefore value of 0 = maximum degradation of spatial frequency.

Calculated by FOURIER TRANSFORM of LSF or PSF.

148
Q

If MTF of collimator is MTFc, and intrinsic MTF of the detector is MTFi, what is system MTF, MTFs? Describe qualitatively how the MTF relates to the line spread function (LSF)?

A

MTFsystem = MTFintrinsic x MTFcollimator

MTF is the FT of the LSF

149
Q

Other than the pre-amplifier, name 3 components of a PMT.

A

Entrance window, photocathode, anode, dynodes, focusing grid, etc.

150
Q

What are characteristics of the sodium iodide crystal. Why is it a good crystal?

A

a. Relative dense with high atomic number, therefore good stopping power for 50-250 keV photons (photoelectric absorption)
b. Efficient scintillator (1 visible photon/30 eV absorbed)
c. Transparent to own scintillations
d. Relatively inexpensive
e. Scintillation light wavelength is well matched to PM tubes

151
Q

Name 3 disadvantages of a NaI crystal.

A

a. Fragile
b. Hygroscopic
c. At higher γ energies Compton interaction dominates, requiring thicker crystal

152
Q

Advantages and disadvantges of Sodium Iodide crystals

A

a. Advantages:
i. 1. Relatively dense (3.67 g/cc) with a high-Z atom (I, Z=53). Therefore, good absorber and very efficient detector of penetrating radiation in the 50 – 250 keV range. Predominant mode is photoelectric absorption
ii. 2. Efficient, yielding 1 photon per 30 eV of energy absorbed
iii. 3. Transparent to its own scintillations (approx 415 nm), even in large crystals
iv. 4. Can be grown cheaply and in large size
v. 5. Scintillation light well matched to peak response of PM tube cathode
b. Disadvantages
i. 1. Crystal fragile and easily fractured by mechanical or thermal stress (rapid temp changes). These create opacifications which reduce the amount of scintillation light reaching the photocathode.
ii. 2. Hygroscopic. Exposure to moisture leads to yellow discoloration which impairs light transmission to the PM tube. Hermetic sealing required.
iii. 3. At higher energies (> 250 keV), predominant interaction becomes Compton scattering, and larger volumes of NaI(Tl) are required for adequate detection efficiency.

153
Q

Define dead time. What is the consequence of dead time for imaging? For a NaI gamma camera, what happens to events that occur during the dead time?

A

“the period of time that a counter remains insensitive to count the next event after an event.” (Saha). Dead time reduces sensitivity, which reduces S/N ratio. Images are noisier due to dead time, but the spatial resolution is unchanged. Events that occur in the dead time are lost, and in paralyzable systems, extend the dead time even further.

154
Q

How do you evaluate dead time losses. Give 2 methods and how each works.

A

Two-source method – This method is based on observing the count rate from two sources individually and then in combination. Because the losses are non linear, the observed rate due to the combined sources will be less than the sum of the rates from the individual measurements and the dead time can be obtained from this discrepancy.

Fixed-rate pulser method – Fixed rate pulser connected to the preamplifier of the radiation detector. The pulser injects pulses of fixed amplitude (usually larger than the photopeak pulses of interest) into the circuitry, and the counting rate for these events is monitored using a separate single-channel analyzer window. The fractional loss of pulser events is equal to the fractional loss of radiation events because both are subject to same loss mechanisms

155
Q

How far away should the source be for daily uniformity scan? What is the number of counts for daily uniformity scan on gamma camera?

A

Extrinsic uniformity performed daily with sheet source directly on collimated detector. 10-15 million counts is acquired (Note: at my hospital 8 million counts for extrinsic and 15 million counts for intrinsic)
g-Camera uniformity may be evaluated either intrinsically (i.e., without collimation) or extrinsically (i.e., with collimation).

Intrinsically, a point source 0.1 mL in volume and containing 18.5 MBq of 99mTc is placed 5 crystal dimensions from and centered over the uncollimated detector to provide a near-uniform photon flux impinging on the detector; if necessary, the activity should be adjusted to yield a measured counting rate of no greater than 25,000 cycles per second (cps), to avoid dead-time counting losses and counting-rate–related image degradation.

Extrinsically, a uniform flood, or sheet source (typically 185–555 MBq) of 57Co is placed directly on the collimated detector. A total of 10–15 million counts is acquired and uniformity quantitated for the integral and differential uniformities, which actually express the deviation from uniformity of the flood image

156
Q

Give 4 factors that affect intrinsic spatial resolution. List 2 ways to improve spatial resolution for a parallel hole collimator.

A

● Intrinsic spatial resolution increases with:
o Smaller crystal thickness
o Higher photon yield
o Higher energy photons (penetrate deeper into the crystal)
o Decreased statistical variation in PMT response to scintillation light.
● Collimator resolution improve with: increasing septal depth, narrower holes, and putting the source closer to the collimator.

157
Q

Separate question: what are 4 characteristics that affect the performance of a parallel hole collimator?

A

Septal depth, septal thickness, size of holes, material used (lead vs tungsten, vs ?), distance to object

158
Q

What is the number of counts required for a 5% error?

A

Percent uncertainty = 100%/(square root N)
0.05=1/(square root N)
N = 400 counts

159
Q

Calculate the minimal detectable activity (MDA). Values given for: background count rate, confidence interval required (95%) and counting efficiency (mCi/cps).)

A
MDA = 3√(R/t)
Sorenson P138 (see Example 9-6)
-        MDA = activity of radionuclide that increases the counts recorded by an amount that is “statistically significant” compared to random variation.
-        MDA = 3 σ = 3 square root (Rb / t); Rb = background counting rate (cpm), t = counting time
-        First calculate in cpm, then divide by sensitivity (cpm/Bq) to get MDA in Bq
160
Q

MDA dose calculating question

A

Use formula and then divide by the sensitivity of the counting device for the radionuclide question

161
Q

List 4 methods for reducing respiratory motion artifacts used for PET imaging. What is the easiest and most common method used today in Nuclear medicine departments?

A

Respiratory gating (4D PET)
Low level free breathing
Multiple breath holds (deep inspiration breath-holding technique (DIBH))
Post-processing algorithm: post-reconstruction registration and motion-compensated image reconstruction

162
Q

What is simplest and most common method to decrease respiratory motion artifact?

A

Low level free breathing

163
Q

4 devices used in respiratory gating.

A
  1. Pressure Sensor – Belt around abdomen or thorax that detects pressure changes with respiration
  2. Spirometry gating – measures airflow to and from lungs
  3. Temperature sensor – similar to spirometer except detects temperature difference between air coming in and air leaving lungs.
  4. Real-time position management respiratory gating - The RPM includes a video camera that measures respiratory motion by tracking the vertical displacement of 2 infrared reflective markers rigidly mounted on a plastic block placed on the patient’s thorax.
164
Q

define septal penetration and what % is acceptable?

A

a. gamma is not parallel to the collimator and is not completely absorbed therein. Some of these gammas may still have enough energy to stay within the acceptance window. Increasingly important with high-energy emitters and thinner septa.
b. 5%

165
Q

What is the percentage septal penetration that is acceptable?

A

· Septal penetration = proportion of the off-angle photons passing through lead septae of collimator and detected in adjacent portion of scintillator
<5%

166
Q

What is the relationship of LSF to MTF?

A

MTF is the modulus of the discrete Fourier transform of the measured line spread function
Explanation from PDF
In essence, both convey the same information: quantification of a system’s performance in capturing/transferring a signal/image. The MTF conveys this information as a frequency response to signals of varying frequencies. The LSF conveys this as the extent to which a single (sharp) line source is “blurred”.

167
Q

Typical energy resolution of gamma camera (don’t remember specifying more details ..just typical for NaI should suffice)

A

9-10%

168
Q

What is a reconstruction filter?

A

Term used for any operation that is applied to pixels in an image. It is a mathematical process by which images are suppressed in noise and also includes smoothing, edge enhancement and resolution recovery.
The quality of SPECT images are degraded by several factors such as noise because of the limited number of counts, attenuation, or scatter of photons. Image filtering is necessary to compensate these effects and, therefore, to improve image quality. The goal of filtering in tomographic images is to suppress statistical noise and simultaneously to preserve spatial resolution and contrast.

169
Q

Name 4 commonly used filter

A

Ramp filter – high pass filter that does not permit low frequencies that cause blurring to appear in the image. Eliminates the star artifact resulting from simple backprojection.

Butterworth filter – low pass filter that smoothes noise while maintaining image resolution

Metz filter – resolution recovery filter that is a function of the MTF of the gamma camera system

Wiener filter – resolution recovery filter based on the signal to noise ratio of the specific image

Hanning filter – relatively simple low pass filter that is very effective at reducing image noise but does not preserve edges

Hamming filter – low pass filter that presents high degree of smoothing

Parzen filter – low pass filter that is the most smoothing filter
Shepp-Logan filter – low pass filter that is the least smoothing and has highest resolution

170
Q

2 methods to reconstruct SPECT images

A

iteratively or filtered backprojection. The iterative reconstruction methods include algebraic methods like the algebraic reconstruction technique (ART) and statistical algorithms like maximum likelihood expectation maximization (MLEM) or ordered-subsets expectation maximization (OSEM) [1].

Filtered back-projection is used for image reconstruction. Back-projection alone (without filtering) results in undesirable image smoothing and the presence of star-like artifacts. The degree to which back-projection artifacts can be removed must be balanced by the degree to which image noise can be tolerated. Frequency refers to the change in number of counts from pixel to pixel. True image signal falls off rapidly with increasing frequency, while the noise content remains constant. Background (noise) is considered to be high frequency because there is marked variability in the number of counts from pixel to pixel. Image sharpness (edge detection, small objects, and fine detail) are also high frequency, while the target (a large object) is low frequency.

171
Q

Ramp filter (high-pass filter):

A

passive

  • named for its shape in the frequency domain
  • designed to reduce the star artifact resulting from backprojection
  • removes more data at the low end of the spectrum (a type of high-pass filter)
  • Accentuate edges and retain finer details but create a “grainy” appearance because of high-frequency noise that makes the images difficult to interpret
  • High pass filters are limited to the ramp filter in nuclear medicine
172
Q

Low-pass filters

A
  • used to reduce the contribution of high-frequency noise and smoothes the image
  • results in an image with indistinct edges and loss of detail
  • Examples: Hann, Hanning, Butterworth, Parzen
173
Q

Recovery Filters:

A

active

  • Composed of two parts: inverse MTF, roll-off for high frequencies
  • Take into account system characteristics, statistics of the image, statistical noise in the data
  • Provides both amplification and attenuation of frequencies in selected ranges…. So ideally, tries to reduce noise without unduly penalizing resolution
  • Examples: Metz, Wiener
174
Q
  • Combination filter:
A
  • the prefilter (eg. Butterworth, hann, hamming, parzen, etc) and ramp filter are applied in a single step.
  • Example: Ramp-Parzen
175
Q

What does FBP proj stand for? What does OSEM stand for? 3 adv of OSEM (did not say if adv was compared to FBP or other IR methods)

A

a. Filtered Backprojection, Ordered Subsets Expectation-Maximization
b. OSEM is faster than MLEM; IR produces less streak artifact than FBP and FT; IR creates more accurate reconstructions than FBP/FT.

OSEM vs MLEM
Smaller # of projections 
Faster Processing time 
Less noise
Smoother solution 

MLEM vs. MAP
MLEM at high iterations emphasizes noise, but there is guaranteed convergence
MAP produces smoother solution, converges faster, but computationally difficult

MLEM = maximum likelihood expectation maximization
- uses Poisson statistics to compute the most likely source distribution that would have created the observed projection data. It biases heavily towards the high count data, as well as the high spatial frequency data, therefore an increased number of iterations lead to increased noise.

OSEM = Ordered-Subsets Expectation Maximization
- considers only a subset of project data in each iteration, speeding up the reconstruction

MAP = maximum a posteriori
- uses knowledge based on the prior iteration to enforce smoothing, hence reducing noise

OSEM better than MLEM:
-       reconstruction is faster
MLEM disadvantage:
-       slow to converge
-       as the number of iteration ↑, noise tends ↑ too (compared to MAP), biasing the image heavily towards the higher spatial frequencies.
176
Q

Minimum allowable integral uniformity for SPECT

A

Integral uniformity is based on the maximum and minimum pixel counts in the image. This is calculated for the UFOV and CFOV. Integral uniformity values are typically 2% to 4% for planar images, and need to be ~1% for SPECT to be artifact-free.

177
Q

2 extra QC you do for spect

A

a. Center of rotation testing.
b. Tomographic uniformity.
c. Multihead cameras need to be aligned together.

178
Q

Timing of doing QC for resolution, uniformity, photopeak,

A

a. Photopeak and uniformity (for Tc99m) daily.
b. Spatial resolution and COR alignment weekly.
c. Uniformity (for other nuclides), tomographic uniformity, overall SPECT performance monthly or quarterly.

179
Q

Factors affecting SPECT spatial resolution

A

a. In-plane resolution (a.k.a. transaxial resolution): determined by collimator resolution (dominant factor), intrinsic resolution of the camera, angular and linear sampling intervals, and properties of the reconstruction filter.
b. Axial resolution (a.k.a. slice thickness): determined by collimator resolution (dominant factor), intrinsic resolution of the camera, and the interval along the Z-axis.

180
Q

How do you qualitatively assess spatial resolution

A

a. Qualitatively in planar: look at bar phantom, and spatial resolution is equivalent to the smallest quadrant you can still visually distinguish the lines from one another. Not sure how this is done in SPECT.

b. Quantitatively for SPECT: Scan a tiny point source (<25% the FWHM of the camera) or line sources at multiple locations through the UFOV. FWHM of the PSF (or LSF for line sources) is obtained at each location. Transaxial spatial resolution is the average x- and y-plane FWHMs, and axial resolution is the average z-axis FWHM. MTF is a better measure because it accounts for the shape of the PSF (PSFs of different shapes can have the same FWHM), and can be acquired as the FT of the PSF.
c. Quantitatively for planar, use the bar phantom method.

181
Q

List and describe 2 ways to determine count rate performance of SPECT.

A

Decay Method
exposing an uncollimated detector to a radioactive source (typically Tc-99m) and sampling the count rate at intervals over a period of time sufficient such that radioactive decay results in low observed count rates where losses are negligible.

Dual Source Method
making count rate measurements using two sources of similar activity, with the detector exposed to each source individually and then concurrently
these measurements must be corrected for background. Once these measurements are made, τmay be estimated based on the following equation:

182
Q

SPECT AC - list 3 errors (3 marks)

A

improper patient positioning, respiratory motion, other voluntary patient movement, or mechanical misalignment of the SPECT/CT device

183
Q

b)How many pixels required to affect AC?

A

A more recent study, by Fricke et al. (3), suggested that a misalignment of 1 pixel can lead to artifacts in the anterior, apical, and septal segments.

184
Q

A) Name 3 SPECT artifacts other than misregistration.

A

CT truncation artifact
Beam hardening
Partial volume averaging

185
Q

Names 3 causes of SPECT CT misregistation.

A

· Respiratory motion
· Sag of emission table
· Patient motion between acquisitions

186
Q

What is beam hardening effect in CT? what is its effect on image quality? What do manufacturers do to correct for it?

A

Absorption of low-energy x-rays from a polyenergetic beam, results in streak artifact at high-density high-Z areas. Corrected by using adaptive tube current modulation, which varies the kvp and mas in different areas of the patient.

187
Q

What is the formula for calculating SUV? What are 4 things that affect SUV?

A
·        SUV = mean activity in ROI (MBq/ml) / [injected dose (MBq) / body weight (g)]
·        Factors:
o   Size of ROI
o   Injected dose
o   Body weight
o   Serum insulin
o   Uptake time
188
Q

Name 3 factors that determine SUV in a pulmonary nodule.

A

Size
Metabolic activity of the nodule
Respiratory motion

189
Q

List 5 technical or physical factors for inaccurate SUVs. Exclude biological factors or patient-related factors. 5 technical causes for decreased SUV.

A
  • Dose of FDG
  • Interstitial injection
  • Uptake period
  • Reconstruction matrix size, algorithm and filtering
  • Size of ROI
  • Attenuation correction
    ALSO SEE NOTES
190
Q

a)Daily quality control for PET

A

Blank scans - performed daily by uniformly irradiating the detector elements using either the 68Ge or 137Cs transmission source (if applicable) of the scanner without any source or other attenuating object in the field of view (FOV) or with a uniform source of 511-keV annihilation photons (most commonly a 20-cm-diameter 68Ge cylinder) centered in the FOV.

The term blank scan, derived from the first of these 2 approaches, reflects the absence of any material in the FOV; the term is still often applied to the latter approach, even though it involves placing an object (i.e., the 68Ge source) in the FOV. For PET systems that use 68Ge or 137Cs transmission data to derive attenuation corrections, the blank scan also provides the reference (i.e., unattenuated) transmission data for calculating such corrections. In some respects, the blank scanner is analogous to the daily uniformity flood image acquired for g-cameras, providing an overall assessment of detector response.

191
Q

b)What do you expect to see if detector malfunction?

A

Blank or hypointense diagonal line or band on a sinogram indicate that a detector element or detector block is malfunctioning.

192
Q

List 2 quality controls for PET done less frequently (monthly or weekly)

A

Tomographic uniformity - for PET is essentially the same as that for SPECT and may be evaluated with either a 18F-filled cylinder phantom or a 68Ge cylinder source. In practice, the use of a long-lived 68Ge cylinder is preferred because constant refilling of a cylinder with shortlived 18F is avoided. Tomographic uniformity should be evaluated daily or at least weekly

Normalization scan - Nonuniform response can be corrected by acquiring data for a uniform flux of annihilation g-rays ). Such a scan is known as a normalization scan and the uniformity correction thus derived (analogous to the uniformity correction table of a g-camera) is known as a normalization.

SEE NOTES

193
Q

What is recovery coefficient and why is it used.

A

RC = Measured peak activity concentration / true activity concentration
Used to correct for partial volume effect in PET/CT
Linear sampling interval sets voxel size
Too small voxel - low counting statistics/voxel and ↑ noise
Too large voxel - partial volume averaging

194
Q

TOF a) What is TOF PET?

A

Accurate measurement of arrival times of annihilation photons theoretically allows localization of annihilation event along line of response, but in practice, insufficiently precise to improve spatial resolution, but improves SNR

195
Q

PET TOF crystals?

A

BaF2 used in the past; LSO/LYSO used in existing scanners; LaBr3 being tested

196
Q

What do you want for TOF PET crystals?

A

Short rise and decay time
High light output
Good stopping power for 511 keV photons

197
Q

What is TOF, and how does it improve PET.

A

a. by determining the time difference between photons, we can calculate the relative distance between the 2 detectors from which the annihilation event occurred.
b. Improves PET by increasing image quality, allowing for shorter scan times and/or lower dose, higher spatial resolution, lower sensitivity to inconsistent data, and the opportunity for new architectures with missing angles.

198
Q

List formula for PET resolution given the terms “Rrange,” “Rdetector” and “Rnon-colinear”

A

Resolution = √((Rrange)2 + (Rdetector)2 + (Rnon-colinear)2

199
Q

What is non-colinearity

A

Annihilation photons are not exactly 180 degrees apart because of the residual kinetic energies of the positron and negative electron. Results in 2 – 3 mm loss of resolution. Loss of resolution is a function of distance between the detectors.

200
Q

Given PET diameter of 80cm, calculate blurring

A

Non-colinearity: R180° = 0.0022 x D = 0.176 cm = 1.76 mm

201
Q

Three events in PET and their relationship to activity.

A

True coincidence, linearly proportional to activity
Scatter coincidence, linearly proportional to activity
Random coincidence, proportional to activity squared

202
Q

Name 3 methods to correct for randoms.

A

I wonder if they asked for 2 and not 3… In the past they have asked for 2, and Sorenson only describes 2.
o Delayed window method
o Singles method

To correct random coincidence:
Delayed window method – create a delayed timing window with a time offset from coincidence timing window (CTW). Events recorded in the delayed window provides a measure of random event rate and is subtracted from the total number of coincidence events since random coincidence rate is the same in delayed and undelayed windows

Singles method - If the rate at which single (not coincidence) events occur in each detector is measured, and the coincidence timing window ΔT is known, then the rate of random coincidences for any pair of detectors can be computed

203
Q

Out of the following (NaI, BGO, LSO, GSO), which are the best and worst for: density, light output, photon yield (photons/MeV), decay constant, and which is (are) hygroscopic?
2014-1. PET detector questions (highest and lowest for density, energy resol, decay time, light output? Know table well.. these were the types asked - NaI, BGO, LSO, GSO),

A

SEE NOTES

204
Q

What form is 13-N NH3 usually in circulation?, how does it get into cell? How is it trapped?

A

a. In blood, it’s in equilibrium between NH3 and NH4+.
b. Gets into cell by passive diffusion (as NH3)
c. Converted to N13-glutamine by enzyme glutamine synthetase, and trapped in there as an amino acid

205
Q

4 adv of Oxygen-15 as PET cardiac tracer

A

a. H2O is freely diffusible,
b. 100% extraction by myocardium
c. Not affected by metabolic factors
d. Unlike other agents, extraction is linear even at high flow rates
e. Can perform quantitative regional blood flow measurements of myocardium.
f. Disadvantages:
i. Image quality is inferior (high blood pool activity)
ii. Short half-life, etc.

206
Q

2D and 3D PET differ in that 2D PET utilizes septa. What is the purpose of the septae in 2D PET? What is the sensitivity of 2D vs. 3D PET?

A

The purpose is to reduce amount of scatter that is accepted. The sensitivity is higher for 3D than for 2D.

207
Q

List three types of coincidence events by a PET system, and how are they related to activity? List 3 methods for reducing the number of random (non-true?) events.

A

True, scatter, random.
True and Scatter events increase linearly with activity; random events increase with the square of activity.
To decrease random events: use 2D imaging with septa, reduce dose, scatter correction (delayed window method or singles method), reduce coincidence acceptance window.

208
Q

Define mode, median, mean

A
  • Mean: sum of values divided by number of values
  • Median: middle value in ordered set, if odd number; mean of middle two in ordered set if even
  • Mode: most commonly occurring value (may have multimodal sets, if more than 2 modes)
209
Q

Define prevalence and incidence.

A

Prevalence: number of cases of a disease existing in a population at a certain moment in time

Incidence: number of new cases of a disease occurring in a population within a specified period of time

210
Q

What is duration of disease, given prevalence and incidence?

A

Prevalence = incidence x length of disease

211
Q

incidence of disease 30/100000 a year, prevalence 1/100, how long does the disease last?

A

a. Prevalence = incidence x length of disease, so length of disease = Prevalence/incidence = (1/100)/(30/100,000) = 0.01/0.0003 = 33.3 years

212
Q

Give 2 examples of continuous distribution regarding statistics and epidemiology

A

· Continuous data can have any value within a certain range
o Weight
o Height

213
Q

ROC curve

a) What is it?
b) What is on x- and y-axis?
A

a) A way to analyze the accuracy of a test and to determine the best threshold value for distinguishing between positive and negative test results. The area under the curve is the accuracy of the test. Accuracy is measured by the area under the ROC curve.
o 1 – excellent
o 0.5 – worthless

b) TP fraction (Sn) (y axis) vs. FP fraction (1-Sp) (x axis)

214
Q

3 principles of Belmont

A

Respect for Persons
● In practice, this means that individuals have a right to decide for themselves whether to participate in research. You may not use information about people without first getting their informed consent. Special care must be taken with people who are unable to understand or who are particularly susceptible to coercion.

Beneficence
● This means that it is not OK to use people for research unless the research is likely to have some benefit. Furthermore, this benefit must outweigh the risks.

Justice
● Justice requires that people be treated fairly. Researchers should not take from research participants without giving back:

215
Q

Define, preferably using a formula, “incremental cost effectiveness ratio (ICER)”.

A

ICER is the ratio of the change in costs to incremental benefits of a therapeutic intervention or treatment. The equation for ICER is:
ICER = (C1 – C2) / (E1 – E2)
where C1 and E1 are the cost and effect in the intervention or treatment group and where C2 and E2 are the cost and effect in the control care group. Costs are usually described in monetary units while benefits/effect in health status is measured in terms of quality-adjusted life years (QALYs) gained or lost.

216
Q

Define in a couple of sentences Bayes’ theorem.

A

the probability of event A (e.g., having breast cancer) given event B (having a positive mammogram) depends not only on the relationship between A and B (i.e., the accuracy of mammograms) but on the absolute probability (occurrence) of A not concerning B (i.e., the incidence of breast cancer in general), and the absolute probability of B not concerning A (i.e. the probability of a positive mammogram).

crucial point to remember from Bayes’ theorem is that the prior probability (or pretest clinical assessment) is as important as the sensitivity and specificity of the diagnostic test in the determination of the post-test probability (the probability that the patient with a positive test truly has the disease).

217
Q

Definition of a p value? If the confidence interval for a study constitutes a wide range, is the sample number too high or too low?

A

a. The probability of falsely rejecting the null hypothesis (due to inadvertently sampling outliers, for example), when the null hypothesis is in fact true.
b. Too low

218
Q

What does a positive likelihood ratio mean for a test (describe with a formula or in sentence form)?

A

In sentence form, positive likelihood ratio is “the probability of a person who has the disease testing positive divided by the probability of a person who does not have the disease testing positive.”

LR+ = Sn / (1-Sp)