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Nuc. Med. Boards > Procedures > Flashcards

Procedures Flashcards

1
Q

Bone Scan- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-MDP (Methylene-Diphosphonate)
99mTc- HDP (Hydroxymethylene Diphosphonate)

T1/2- 6hrs, E- 140keV, Camera- LFOV; LEHR or LEAP

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2
Q

Bone Scan- Dose & Administration

A

20-30mCi (740-1110MBq)

intravenous, Straight Stick

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3
Q

Bone Scan- Patient Prep

A

Hydrate (2x 8oz water) & Void Frequently

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4
Q

Bone Scan- Imaging Parameters

A

2hr Delay After Admin, Void Bladdder Immediately Prior, Patient Supine

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5
Q

Bone Scan- Views/Images

A 
Spot &/or Whole Body:
Phase 1- Vascular (60sec) Dynamic
Phase 2- Soft Tissue (Blood Pool) @ 5min
Phase 3- Delayed (Bone); 2-3hrs post
Phase 4- 24-72hr Delay
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6
Q

Bone Scan- Image/Views Counts

A

Dyanmic- 2-4sec for 60sec w/ immediate blood pool (500,000cts)
Static- Extremities = 200,000-300,000cts; Appendicular= 150,000-300,000cts; Axial= 500,000-800,000cts; Foot= 75,000cts; Whole Body = 10-14cm/min (body Contour), 2.5million cts.
SPECT: LEHR; Pt. supine, knees bent; Body Contour; 64x64 or 128x128; 120-128 views, 360deg.; High cts. = High Res.; 64 steps, 20-25sec/stop

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7
Q

Bone Scan- Indications

A

Evaluate and Detect: Metastatic Disease, Neoplasm/Lesions, Osteomyelitis & Prosthesis Loosening, Occult Fractures & Pain & Pagets, Viability for Bone Graph & Surgery, Response to Therapy, Abnormal Findings X-ray/Labs

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8
Q

Bone Scan- Contraindications

A

Barium Contrast; Tc based scan recently

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9
Q

Bone Scan- Results

A

Normal: Symmetric Uptake, Kidneys light and bladder bright, Epiphyseal Plates, 3-5days post injury = Fracture, Nasopharynx Uptake

Abnormal: Asymmetric Uptake, “SuperScan”, Metabolic Disease (Axial Skeleton), Cold Lesions= Cancer, Osteomyelitis = ‘Hot’ increase uptake, Cellulitis = ‘Hot’ increased uptake, Prosthesis= ‘Hot’ increased uptake, Arthritis - joints light

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10
Q

Lung Perfusion (Q)- Radiopharmaceutical, t1/2, E, Camera

A

99mTc- MAA (MacroAggregated Albumin)
99mTc- HAM (Human Albumin Mesospheres)

T1/2- 6hrs, E- 140keV, Camera- LFOV; LEHR or LEAP

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11
Q

Lung Perfusion (Q)- Dose & Administration

A

2-6mCi (74-222MBq)
Particles- 10-90micrometers, 75,000-700,000 (total)
*Infant: <50,000 (less for R-L Shunts)

Intravenous, Lift Arm to Circualte, No Re-Blush

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12
Q

Lung Perfusion (Q)- Patient Preparation

A

Chest X-Ray w/in 24hrs

If in conjunction w/ Ventilation (V), V FIRST

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13
Q

Lung Perfusion (Q)- Imaging Parameters

A

Patient Supine, Start Computer prior to injection

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14
Q

Lung Perfusion (Q)- Views/Images

A

Static: RAO, RLAT, RPO, LPO, LLAT, LAO, Ant

R-L Shunt: Ant, Post, RLAT, LLAT, Whole Body Sweep

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15
Q

Lung Perfusion (Q)- Counts

A

Dyamic Flow - Immediate, 1-3sec/frae, 60-120sec
Static- (post flow) 500,000-1million cts.
R-L Shunt- immediate, whole body sweep

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16
Q

Lung Perfusion (Q)- Indications

A

Evaluate & Detect: Pulmonary Embolism, Deep Vein Thrombosis, Chest Pain, Dyspnea (low SpO2), Right-to-Left Shunt, & Chronic Lung Disease
Evaluate Lungs for surgy &/or Transplant

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17
Q

Lung Perfusion (Q)- Contraindications

A

Pulmonary Hypertenson, Active Pneumonia, R-L shunt, Hypersentivity to human Serum Albumin

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18
Q

Lung Perfusion (Q)- Results

A

Normal: Homogenous Uptake of skeleton, breasts, heart, apical activty < base (patient upright)
Abnormal: Segmental/Wedge shaped decrease in activity, high Mismatch w/ Vent. = PE, Stripes = COPD, Matching Defects w/ Vent. = COPD, Large lungs = Emphysema, Lack of Activity in Base = Pleural Effusion, 1 Lung = Problem, Decrease V/Q = Pneumonia

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19
Q

Lung Ventilation (V)- Radiopharmaceutical GAS (t1/2, E, Camera)

A

133Xenon
t1/2: 5.3d
E: 81 keV
LFOV, LEHS

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20
Q

Lung Ventilation (V)- GAS Dose & Administration

A

10-20mCi Xenon133

Inhalation

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21
Q

Lung Ventilation (V)- GAS Patient Preparation

A

Chest X-ray w/in 24hours

If in conjunction with Perfusion (Q), Vent. first

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22
Q

Lung Ventilation (V)- GAS Imaging Parameters

A 
Seated Upright (camera Posterior)
Negative Pressure room, Inject/Pump gas as patient breathes in, Start Computer Simultaneously acquire Dynamics, Mask on for 60sec or 4 frames
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23
Q

Lung Ventilation (V)- GAS Views/Images

A

Dynamic flow 20-60sec/frame
Static: RAO, RLAT, RPO, Post, LPO, LLAT, LAO

Wash-In (hold); full deep breath & hold
Equilibrium; breath normal 3-5min
Wash-Out; breath normal 2-3min

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24
Q

Lung Ventilation (V)- GAS Indications

A

Evaluate & Detect: Pulmonary Embolism, Chronic Obstructive Pulmonary Disease, Dyspnea (obstructed//constricted airway), Chest Pain, Low SpO2, ARDS, Carcinoma

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25
Q

Lung Ventilation (V)- GAS Contraindications

A

Active Pneumonia, Other Disease

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26
Q

Lung Ventilation (V)- GAS Results

A

Normal- Uniform Washes, Cardiac Notch

Abnroml- Decreased activity, Mismatch V//Q, Patchy Equilibrium= COPD/ Emphysema, Decreased V & slight decreased Q = Bacterial Pneumonia, Liver = Alcoholism

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27
Q

Lung Ventilation (V)- AEROSOL Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- DTPA (Diethylenetriamine Pentaacetate)
6hrs, 140keV
LFOV, LEHR

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28
Q

Lung Ventilation (V)- AEROSOL Dose & Administration

A

25-40mCi

PO

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29
Q

Lung Ventilation (V)- AEROSOL Patient Preparation

A

Chest X-ray w/in 24hrs

If in conjunction w/ Perfusion (Q), Vent. First

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30
Q

Lung Ventilation (V)- AEROSOL Imaging Parameters

A 
Seated Upright (camera Posterior)
Inject in Nebulizer, clamp nose, ~10mL/min of air, 1mCi inhalaed, breathe normal for 5min
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31
Q

Lung Ventilation (V)- AEROSOL Views/Images

A

Dynamic Flow 20-60sec/frame

Static: RAO, RLAT, RPO, Post, LPO, LLAT, LAO; 150,000cts

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32
Q

Lung Ventilation (V)- AEROSOL Indications

A

Evaluate & Detect: Pulmonary Embolism, Chronic Obstructive Pulmonary Disease, Dyspnea (obstructed/constricted airway), Chest Pain, Low SpO2, ARDS, Carcinoma

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33
Q

Lung Ventilation (V)- AEROSOL Contraindications

A

Active Pneumonia, Other Disease

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34
Q

Lung Ventilation (V)- AEROSOL Results

A

Normal: Pharynx bright, Swallowed saliva = stomach, facial from mask, Trachea & Bronchi easily visualized

Abnormal: Decreased Activity, Accelerated Clearance, Only1 Lung; Mismatch V/Q, Decreased V & Slight Decreased Q = Bacterial Pneumonia

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35
Q

Hepatobiliary (HIDA) Scan- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-IDA (Iminodiacetic Acids - Mebrofenin)
6hrs
140keV
LFOV; LEHR

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36
Q

Hepatobiliary (HIDA) Scan- Dose & Administration

A

3-15mCi (~10mCi - based on Serum Bilirubin levels)

Intravenous

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37
Q

Hepatobiliary (HIDA) Scan- Patient Preparation

A

NPO 2-4hrs (no >24hrs), D/C Opiates 6-12hrs

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38
Q

Hepatobiliary (HIDA) Scan- Imaging Parameters

A

Patient Supine

Liver in Upper LEft Corner FOV

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39
Q

Heptobiliary (HIDA) Scan- Views/Images

A

Flow/Dynamic - immediate
Sequential Statics every 5min for 45-60min
Ant, RAO, RLAT, LAO

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40
Q

Hepatobiliary (HIDA) Scan- Views/Images Counts

A

Flow- 2sec/frame for 60sec & immediate post injection
Dyn- 60sec/frame for 60-90min; Pausse @ 30-45minif GB & Bowel
Static- Immediate, every 5min up to 30min, Every 110-15min; 90-180sec

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41
Q

Hepatobiliary (HIDA) Scan- No Gallbladder?

A

W/in 40-60min
Morphine Sulfate (Astramorph/Duramorph)
-Contracts Sphincter of Oddi
-Dose: 0.04-1mg/kg Intravenous over 2-3min
-Contraindication: neonate, decrease respi., allergy, pancreatitis
-Adverse: decrease respir, sweating, constipation
-Reversal: Naloxone

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42
Q

Hepatobiliary (HIDA) Scan- No Intestines?

A

Sincalide (Kinevac) - Cholecystokinin (CCK)
-Contracts Pyloric Sphincter/ Relax Oddi
-Dose: 0./01-0.02ug/kg Intravenous over 3-5min, before tracer (30-60min) not given before Morphine; Dilute in 10mL Saline & infuse 30-40min
—Imaging 60min post CCK
—-Contraindications: hypersensitivty, obstrution
—-Adverse: nausea, pain, dizziness, flushing

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43
Q

Hepatobiliary (HIDA) Scan- Infant/Neonate- Pharmaceutical & Dose

A

Phenobarbital (Lumina) pre-treatment for assessment of Biliary Atresia
5mg/kg/day for 3-5days prior

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44
Q

Hepatobiliary (HIDA) Scan- Infant/Neonate- Indications

A

Differentation b/w biliary Atresia (block of ducts from Liver to GB) from other causes of jaundice

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45
Q

Hepatobiliary (HIDA) Scan- Infant/Neonate- Contraindications

A

Allergy to Barbituates and/or Decrese in Respiration

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46
Q

Hepatobiliary (HIDA) Scan- Infant/Neonate- Results

A

Normal: enhanced excretion of tracer w/ Patent Bile Ducts, excretion w/in 24hrs

Abnormal: not excreted into Bowel = Biliary Atresia

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47
Q

Hepatobiliary (HIDA) Scan- Indications

A

Evaluate Right Upper Quadrant Pain, Cholecystitis, Biliarycoli, Biliary Diyskinesia, Gallbladder Function, GB Surgery/Perforation, Hepatic Function, Liver Anatomy

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48
Q

Hepatobiliary (HIDA) Scan- Contraindications

A

Recent food, No CCK//Morphine, Known Obstruction

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49
Q

Hepatobiliary (HIDA) Scan- Results

A

Normal Liver in 5-15sec, Ducts & GB in 5-10m, Cardiac Blood Pool in 5-10m, Intestines in 10-60m, Hepatic Artery, Liver Diminishes & GB fills, GBEF >35%

GBEF (%) = {[(max GB cts - bkg)-(min GB cts- bkg)] / (maxGB cts- bkg)} x 100

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50
Q

Hepatobiliary (HIDA) Scan- Abnormal

A

No GB in 60min, No GB but bladder in 60m, No Bowel w/ good Hepati in 60m, No Liver, Cardiac Blood Pool longer than 5-10m, No Bowel w/in 24hr = Biliary Dyskinesia (Infant), GBEF <35%

GBEF(%) = {[(max GB cts - bkg) - (min GB cts - bkg)] / (max GB cts - bkg)} x 100

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51
Q

Gastric Emptying- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- Sulfur Colloid (SC)
6hrs
140keV
LFOV, LEHR

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52
Q

Gastric Emptying- Dose & Administration

A

0.5-1mCi (18.5-37MBq)

Injected & Mixed in ~118mL (4oz) Egg Whites (Scrambled), w/ 2 slices toasted White Bread, 120mL Water, 30g Jam/Jelly

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53
Q

Gastric Emptying- Patient Preparation

A

NPO 4-12hrs

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54
Q

Gastric Emptying- Imaging Parameters

A

Immediate (w/in 10min of finishing meal)

Patient Supine

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55
Q

Gastric Emptying- Views/Images

A

Statics & Dynamic: Ant, Post, LAO
Dynamic- immediate, 60s/image for 60-90m (hourly intervals up to 4hrs)
Static- immediate, 60-120s for 50,000cts; if no Dyn. Image every 15min

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56
Q

Gastric Emptying- Data Processing

A

ROI around entire stomach, Ant & Post, avoid activity from small bl. Iliac Crest Marker. Time-Activity curve from geometric mean of gastric cts

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57
Q

Gastric Emptying- Adjunct

A

Reglan (contract stomach)

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58
Q

Gastric Emptying- Indications

A

Determine delayed emtying quatity & rate

Evaluate: tumors/surgery, Nausea/Vomiting, Weight Loss, Gastric therapy, Gastroparesis, Abdmonial Distension/fullness

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59
Q

Gastric Emptying- Contraindications

A

Allergy to Eggs (use Oatmeal/Chicken Liver)

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60
Q

Gastric Emptying- Results

A

Normal- 50% w/in 32-120min (90min), 63% w/in 1hr, End study before 60min if >95%; Infants 50% 25-48m (formula) or 60-90m (milk)

Abnormal- Little/No movement, Rapid Emptying ‘Dumping Syndrome’, or Delayed ‘Gastroparesis’

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61
Q

Meckel’s Diverticulum- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- Pertechnetate (Tc-O4)
6hrs
140keV
LFOV, LEHR

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62
Q

Meckel’s Diverticulum- Dose & Administration

A

10-15mCi, Intravenous

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63
Q

Meckel’s Diverticulum- Patient Preparation

A

NPO 2-12hrs
No Barium Contrast or Laxatives
Adjunct Meds

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64
Q

Meckel’s Diverticulum- Patient Prep. W/ Adjunct Meds

A

Pentagastrin (Peptavlon), Sub-Cutaneous: NPO 8hrs, Admin 15-20m prior, 6ug/kg
Cimetidine (Tagamet), Intravenous or PO: 2d prior, 300mg 4x/d; Children 20mg/kg/d & Neonate 10-20mg/kg/d
Glucagon, 50ug/kg IV, 10m after TcO4

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65
Q

Meckel’s Diverticulum- Imaging Parameters

A

Patient Supine
Enhance Visualization w/ Pentagastrin - Stims Gastric Secretion
Enhance Visualization w/ cimetidine - Retains TcO4
Enhance Visualization w/ Glucagon - Relaxes/Slows Peristalsis = Increased Tc-O4 uptake

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66
Q

Meckel’s Diverticulum- Views/Images

A

Ant, Post, RLAT, LLAT, RAO, LAO
Statics: immediate, every 30-60s for 30-60m
Flow/Dynamic: 1image every 5m up to 30m

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67
Q

Meckel’s Diverticulum - Images/Frames/Counts

A

Flow- 1-5sec/frame for 1min
Dynamic- 15s/frame for 239m or 1m/frame for 15m
Statics- ~500,000-1million cts/image

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68
Q

Meckel’s Diverticulum- Indications

A

Localization of Meckel’s
Detection of GI Bleed
Evaluate positive Guaiac Test, Abdominal Pain, Bleed, Twisting Bowel

More prevalent in Males; 25% have rectal bleeds

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69
Q

Meckel’s Diverticulum- “Rules of Two”

A

Occurs in 2% of population, w/in 2ft of ileocecal valve, ~2” long, symptomatic by age 2

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70
Q

Meckel’s Diverticulum- Results

A

Normal: Increased GI uptake & Renal in 10-20m decreasing as study progresses, Bladder increases w/ time

Abnormal: Meckel’ w/ functioning Gastric Mucosa in 10-15m & stomach activity at sane time (in Right Lower Quadrant), remains in same position despite peristalsis

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71
Q

Gastrointestinal Bleeding- Active Bleed- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- Sulfur Colloid (SC), leaves blood pool rapidly (RUG blocked by increased Liver uptake)
6hrs
140keV
LFOV, LEHR

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72
Q

Gastrointestinal Bleeding- Active Bleed- Dose & Administration

A

99mTc-SC 10-20mCi Intravenous (while under camera)

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73
Q

Gastrointestinal Bleeding- Active Bleed- Patient Preparation

A

None

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74
Q

Gastrointestinal Bleeding- Active Bleed- Imaging Parameters

A

Patient Supine

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75
Q

Gastrointestinal Bleeding- Active Bleed- Views/Images

A

Anterior from bottom of heart to lower Bowel, RAO & LAO
Rapid sequental images as tracer admin. (Dynamic)
Short Static images every 5min up to 60-90m

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76
Q

Gastrointestinal Bleeding- Active Bleed- Counts/Frame

A

Flow- 2-5sec/frame, 60-180sec
Dynamic- post Flow, 60sec/frame, 1hr
Statics- 500,000-1mill cts

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77
Q

Gastrointestinal Bleeding- Active Bleed- Indications

A

Detect and Locate Bleeding Sites (active or intermittent)

Detect and Locate Secondary Blood Loss (Blood Pool)

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78
Q

Gastrointestinal Bleeding- Intermittent Bleed- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Perchlorate RBCs (In-Vivo- Phosphate= lesser option) (In-Vitro- UltraTag) - remains in blood pool for delays
6hrs
140keV
LFOV, LEHR

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79
Q

Gastrointestinal Bleeding- Intermittent Bleed- Dose & Administration

A

20-50mCi, Intravenous while under the Camera

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80
Q

Gastrointestinal Bleeding- Intermittent Bleed- Patient Preparation

A

None; Collect blood w/Heparin Syringe

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81
Q

Gastrointestinal Bleeding- Intermittent Bleed- Imaging Parameters

A

Patient Supine

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82
Q

Gastrointestinal Bleeding- Intermittent Bleed- Views/Images

A

Anterior from bottom of heat to Lower Bowel, RAO & LAO
Rapid Sequental images as tracer admin (Dynamic)
Short Static images every 5min up to 60-90m
Delayed 4 & 24hr if nothing seen

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83
Q

Gastrointestinal Bleeding- Intermittent Bleed- Counts/Image

A

Flow- 2-5sec/frame, 60-180s
Dynamic- post Flow, 60s/frame, 1hr
Statics- 500,000-1million counts

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84
Q

Gastrointestinal Bleeding - Intermittent Bleed- Indications

A

Detect & Locate Bleeding Sites (active or intermittent)

Detect & Locate Secondary Blood Loss (Blood Pool)

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85
Q

Gastrointestinal Bleeding- Results

A

Liver/Spleen Uptake = Clears blood ~12-15m
Normal: w/RBCs, Liver Spleen, Abdominal Vessels, kidneys, Bladder, Gential Organs & Stomach, high bkg activity, site localization impaired

Abnormal: progressive tracer accumulation = bleed, increased focal uptake (blood pool), Focal uptake moves thru Bowel Loop; w/Tc-SC area with active bleeding increases within first 5m and increased intensity as bkg decreases

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86
Q

Liver/Spleen Scan- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- Sulfur Colloid (1um)
6hrs
140keV
LFOV, LEHR

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87
Q

Liver/Spleen Scan- Dose & Administration

A

5-10mCi (185-370MBq)

Intravenous (under camera for Flow)

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88
Q

Liver/Spleen Scan - Patient Preparation

A

None; no Barium Contrast prior

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89
Q

Liver/Spleen Scan- Imaging Parameters

A

Patient Supine

85% Liver, 10% Spleen, 5% Bone Marrow

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90
Q

Liver/Spleen Scan- View/Images:

A

Ant., Post., RLAT, LLAT, RAO, LAO, RPO, LPO
Flow w/ injection if needed, allow sufficient time before begining Statics (10-15m)
Reference Marker Right Coastal Margin
Breath-holding View in Ant to assess motility of Liver
SPECT = abnorms/artifacts visible

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91
Q

Liver/Spleen Scan- Images/Counts

A

Flow- 1-3sec/frame for 1min

Statics - 350k-700k counts

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92
Q

Liver/Spleen Scan - Indications

A

Determine size, configuration & position
(Hepatomegaly/Splenomegaly)
Detection of Tumors, Hematomas, Cysts, Abscesses, Trauma
Evaluation of functional liver diseases (cirrhosis & hepatitis)

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93
Q

Liver/Spleen Scan- Contraindications

A

Colloidal Reaction, Pulmonary Hypertension

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94
Q

Liver/Spleen Scan- Results

A

Normal: ( Liver= above right costal margin, R. Lobe> L. Lobe; Spleen= retroperitoneally in LUQ (viewed Posterior) Flow- ~6sec delay from Aorta to Liver, Dual Blood Supply, Statics- Liver & Spleen equa heterogenous dstribution w/ no Bone Marrow; L 85%, S10%, BM5%
Heart, R. Kidney, Porta Hepatis & Gallbladder may distort. Do SPECT

Abnormal: Fast uptake = tumor, Increased Uptake = Hemangioma, Slow uptake = Heart Failure/Cirrhosis

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95
Q

Liver SPECT- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- RBCs OR 99mTc-SC
6hrs
140keV
LFOV, LEHR

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96
Q

Liver SPECT- Dose & Administration

A

Tc-RBCs: 20-50mCi Intravenous

Tc-SC: 3-5mCi

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97
Q

Liver SPECT- Preparation

A

InVitro- Ultra Tag ~2-2.5mL
InVivo- Cold PYP 20min - inject tracer
For Flow = Hemangioma or RBC Liver Study

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98
Q

Liver SPECT- Imaging Parameters

A

Invitro/Vivo inject under camera; for flow image 1-2hrs post

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99
Q

Liver SPECT- Views

A 
Determined by Physician post MRI/CT/US
Flow- immdiate, 1frame/sec fr 60sec
Dynamic- immediate blood pool
Delayed- 45-180m
Statics- 500k-1million counts
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100
Q

Liver SPECT- Results

A 
Hemangioma = Decreased/Normal Perfusion on flow ut Increased Uptake on delayed
Tumor = RBCs early but is not retained
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101
Q

Gastroesophageal Reflux- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Sulfur Colloid
6hrs
140keV
LFOV, LEHR

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102
Q

Gastroesophageal Reflux- Dose & Administration

A

300uCi-2mCi (<1um)
PO, 150mL Orange Juice &150mL Dilute Hydrochoric Acid
Infants: PO, tracer mixed w// formula (NJ or Bottle)

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103
Q

Gastroesophageal Reflux- Patient Preparation

A

NPO 6hrs

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104
Q

Gastroesophageal Reflux- Imaging Parameters

A

Patient Supine, Seated Upright
Can use abdominal binder
Outline ROis to calc GEReflux%
Stomach in Lower FOV, Focus on Esophagus & Lungs

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105
Q

Gastroesophageal Reflux- Views/Images

A

Ant., Serial Images
-Statics - 30sec after admin, 30s/imae, 300k-500k cts
—30s, 60s, 15m - outline ROIs - w/ Binder 30s image as increse pressure
-Delayed - 24hrs check lungs

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106
Q

Gastroesophageal Reflux- Indications

A

Detect & Quantify Reflux, Diaphragmatic Hernia, Heartburn, Vomiting, children w/ Asthma, COPD, Aspiration, Pnemonia

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107
Q

Gastroesophageal Reflux- Results

A

Normal: <3% refluxed, bright stomach w/ no esophagus & stays in stomach, clear lungs
Abnormal: >4-5% refluxed, visible refluxing toward mouth, Lungs = esophagus reflux 0-25%, activity in lungs

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108
Q

Salivagram- Radiopharmaceutical

A

99mTc-O4

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109
Q

Salivagram- Dose & Administration

A

<1uL; 250-300uCi

PO, rinse mouth w/ lemon

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110
Q

Salivagram- Patient Preparation

A

None

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111
Q

Salivagram- Imaging Parameters

A

Patient Seated, FOV Mouth the Stomach, Rapid Sequence

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112
Q

Salivagram- Views

A

Ant., RLAT., LLAT.

-Dynamic- 1-2s for 15-20s

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113
Q

Salivagram- Indications

A

More sensitive for Aspiration than Reflux

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114
Q

Salivagram-Results

A

Normal: Oral Activity, thr Esoophagus to Stomach

Abnormal: Oral cavity into Tracheal-Broncheal Tree

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115
Q

Esophageal Motility- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Sulfur Colloid
6hrs
140keV

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116
Q

Esophageal Motility- Dose & Administration

A

150-300uCi

PO in 15mL water; 1 bolus swallow or 1.35mCi in 50mL Apple Sauce

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117
Q

Esophageal Motility- Patient Preparation

A

NPO >8hrs, Cooperate w/ swallowing

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118
Q

Esophageal Motility- Imaging Parameters

A

Supine, sip thru straw, hold bolus in mouth, start Camera, patient dry swallow

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119
Q

Esophageal Motility- Views

A

Ant.
Flow- 0.25s/15s for 1 min (4x) or 1-2s/frame for 1min
Post Flow- 15s/frame for 9

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120
Q

Esophageal Motility- Indications

A

Evaluate Sphincter Dyfunction, Dysphagia, Dysmotility or Ranaud’s Phenomenon

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121
Q

Esophageal Motility- Results

A

Normal: Low ct. rates or None Detectable (5-10s after 1st swallow), Transit rates >90% after 1-8swallows, <4% of max activity in Esophagus by 10m

Abnormal: Tansit rates 5-40% after 8swallows, Diffuse Esophagus spasm as signiffcantly reduced transit rate for 1st half of study, then no rm after 20swallows

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122
Q

Thyroid Scan- Radiopharmaceutical (t1/2, E, Camera)

A

123Iodine
13.2hrs
159keV
LFOV, Pinhole

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123
Q

Thyroid Scan- Dose & Administration

A

0.2-0.6mCi

PO, Capsule (rince mouth w/ water/lemon)

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124
Q

Thyroid Scan- Patient Preparation

A

Discontinue Meds, low iodine Diet 3-10days prior

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125
Q

Thyroid Scans- Imaging Parameters

A

Supine, pillow under shoulders, chin up (Water’s)
Camera /w/in 10cm of Neck
Marker on Suprasternal Notch

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126
Q

Thyroid Scans- Views/Images

A 
Ant., RAO, LAO, ‘Pull-Back’
Ant. Mediastinum to view Ectopic Thyroid
-Statics- 2 parts: 3-4 or 16-24hr post admin
  6-24hr post admin
-50k-100k counts or 8-10min per image
*In conjunction with Thyroid Uptake*
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127
Q

Thyroid Scan- Tc- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Pertechnetate (Tc-O4)
6hrs
140keV
LFOV, Pinhole

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128
Q

Thyroid Scans- Tc- Dose & Administration

A 
2-10mCi
Intravenous Injection (water/lemon clear salivary)
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129
Q

Thyroid Scans- Tc- Patient Preparation

A

None

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130
Q

Thyroid Scans- Tc- Imaging Parameters

A

Supine, Pillow under shoulders, Chin Up (Water’s); Camera w/in 10cm, Marker on Suprasternal Notch

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131
Q

Thyroid Scans- Tc- Views

A

Ant., RAO, LAO, ‘Pull-Back’, Whole Body

-Statics- 2parts: 15-30m post Admin., 300sec or 50,000-100k counts

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132
Q

Thyroid Scan- Tc- Indications

A

Evaluate Thyroid, posiiton/goieter, Detect & Evaluate Hyper/Hypo., Metastases, Functioning Nodule, Heterogenity of Function, Ectopic Tissue

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133
Q

Thyroid Scan- Tc- Contraindications

A

Allergy to Iodine, Meds, Contrast

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134
Q

Thyroid Scan- Tc- Results

A

Normal: Euthyroid, L. Lobe smaller than R, Straight/Convex Margins, Equal uptake of Salivary Glands & Stomach, Colon, Bladder, Nasopharynx, & soft tissue, Brain (TcO4), Butterfly Shape

Abnormal: Plummer’s Disease, Non-Visualization, Grave’s Disease, Hashimotos, Carcinoma, Cold Nodule (Non-Functioning-Benign cyst, Adenoma, Inflammatory), Increased Blood Pool; Hot=benign

In conjuction w/ Uptake

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135
Q

Thyroid Uptake- Radiopharmaceutical (t1/2, E, Camera)

A

123 Iodine
13.1hrs
159keV
LFOV/Thyroid Probe; Flat field w// PHA or LEHR

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136
Q

Thyroid Uptake- Dose & Administration

A

0.1-0.2mCi, PO Capsules

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137
Q

Thyroid Uptake- Patient Preparation

A

Discontinue Meds, low Iodine Diet (3-10d prior)

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138
Q

Thyroid Uptake- Imaging Parameters

A

Patient Seated, Probe 25-30cm away or Camera ~10cm

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139
Q

Thyroid Uptake- Views/Images

A 
Ant.
Thyroid Centered: 1 min count x2
Patient Bkg/Thigh: 1min count x2
Neck Phantom: 1min count x2
-Static- 4-6hrs post & 24hr Delay
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140
Q

Thyroid Uptake- Calculations

A

Uptake w/ Probe: [(pt thyroid cpm - thigh cpm)/{(std. ct or capsule cpm x DF)-Bkg room}] x 100

Uptake w/ Camera: [2 60sec pt count x2 / 2 60sec std. cts added up] x100

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141
Q

Thyroid Uptake- Indications

A 
Evaluate Uptake (trapping/organification?), Hyper/Hypo, Function of Nodules
Evaluate Abnormal findings
W/ Camera- Detect & Localize Cancer, Benign vs. Malignant, Hertero or Hypo function, Detect & Localize Ectopic Tissue
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142
Q

Thyroid Uptake- Results

A

Normal: 4-6hrs = 5-20%, 24hrs = 7-35%, TcO4= 20min= ~4%

Abnormal: @ 24hrs <7% indicates Hypothyroid; >35%indicates Hyperthyroidism, Early Hashimotos; TSH (factors that increase uptake); Hypothyrois, Iodine Overload, Autoimmune Thyroiditis, Ectopic Secretion, Renal failure

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143
Q

131Iodine Scan/Uptake/Therapy- t1/2, E, Camera

A

8.1days; E= 364keV Gamma & 606keV Beta

LFOV/Thyroid Probe; High E Parallel Hole, Flat Field

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144
Q

131Iodine Scan/Uptake/Therapy- Dose & Administration

A

Uptake - 0.004-0.01mCi (5-30uCi)
Imaging - 0.05-0.2mCi (WB 2-5mCi)
“Stuns” Thyroid follicular (Therapy) - 1-10mCi

PO, Capsule

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145
Q

131Iodine Scan/Uptake/Therapy- Patient Preparation

A

Discontinue Meds, Low Iodine Diet (3-10d prior), NPO 4-6hrs

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146
Q

131Iodine Scan/Uptake/Therapy- Imaging Parameters

A

Patient Supine, Pillow under shoulders, Chin up (water’s)

Probe 25-30cm, Camera 10cm Away from neck

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147
Q

131Iodine Scan/Uptake/Therapy- Views/Images

A

Ant., RAO, LAO, ‘pull-back’

  • Statics - 24, 48, 72hrs; >100,000cts. Thyroid & Whole Body
  • 4-6hrs if w Uptake +Scan*
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148
Q

131Iodine Scan/Uptake/Therapy- Indications

A

Same as 123I, Locate Residual & Recurrent cancers

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149
Q

131Iodine Scan/Uptake/Therapy- Results

A

Normal: Euthyroid, L. Lobe smaller than R., Butterfly shaped, Equal uptake, Equal Uptake of salivary glands, stomach, colon, bladder, nasophayrnx

Abnormal: Non-Visulization, Increased Blood Pool, Nonfunctioning Nodules ‘Cold’ = benign Adenoma, Cystm Hematoma & Inflammatory, “Hot” nodules = benign

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150
Q

Parathyroid Dual Isotope- Radiopharmaceuticals (t1/2, E, Camera)

A

99mTc-Perchlorate (Tc-O4); 201 Thallium Chloride
6hrs, 140keV ; 73hrs, 167keV
LFOV, Pinhole or LEHR; LFOV, Pinhole or LEHR

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151
Q

Parathyroid Dual Isotope- Dose & Administration

A

Intravenous
Tc-Perchlorate: 5-12mCi
201Tl: 2-3mCi

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152
Q

Parathyroid Dual Isotope- Patient Preparation

A

None

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153
Q

Parathyroid Dual Isotope- Imaging Parameters

A 
Patient Supine w// Neck Hyperextended
Neck & Mediastinumin FOV
Static & SPECT
99mTcO4- Normal Thyroid
201Tl-Ch- Normal Thyroid & Abnormal Para
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154
Q

Parathyroid Dual Isotope- Views/Images

A

Ant.
Planar- 128x128 or 64x64, 1mill cts. Or 300-900s/image
SPECT- Circ. Or Non-Circ. , 128x128, 64 stops, 20-25sec/stop

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155
Q

Parathyroid Dual Isotope- Procedure

A

Inject Tl201, w/in 2-3min, obtain 300sec image (Pinhole looking for focal uptake b/w Heart & Thyroid). Follow image w/ 900sec centered on Thyroid. Follow image w/ injection of TcO4, wait 5min, ensure no movement. Obtain 900sec. Run subtraction if needed to separate Tl201 accumulation from 99mTc trapping

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156
Q

Parathyroid Dual Isotope- Indications

A

Detect & Locate Primary & Secondary Parathyroid Cancer, ID of single Adenomas/Glandular hyperplasia in newly diagnosed hypercalcemia & elevated PTH
Localize cancer for pre-op, parathyroid after surgery for hyper-parathyroidism (increased Calcium + increased PTH)

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157
Q

Parathyroid Dual Isotope- Contraindications

A

Patient on Ca meds/thyroid meds, Patient agitate or prone to move/claustraphobia

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158
Q

Parathyroid Dual Isotope- Results

A

Normal: No increased Tl201 activity w/in or outside normal thyroid tissue, Normal parathyroid tissue does not accumulate Tl201

Abnormal: Areas of increased Tl201 w/in and outside normal thyroid tissue

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159
Q

Parathyroid Dual Phases- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- Sestamibi
6hrs, 140keV
LFOV; Pinhole or LEHR

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160
Q

Parathyroid Dual Phase- Dose & Administration

A

16-30mCi, Intravenous

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161
Q

Parathyroid Dual Phase- Patient Preparation

A

None

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162
Q

Parathyroid Dual Phase- Imaging Parameters

A

Seated or Supine in Water’s
Neck & Mediastinum in FOV
Static or SPECT
Transports via Blood Flow, Removes in Adenomatous & Hyperplastic

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163
Q

Parathyroid Dual Phase- Views/Images

A

Ant., LAO

  • Planar- 128x128 or 64x64, 1mill cts. Or 300-900sec/image
  • SPECT- Circ. Or Non-Circ., 128x128, 64steps, 20-25sec/stop
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164
Q

Parathyroid Dual Phase- Procedure

A

Inject, wait 15min, Water’s position, Camera Anterior over extended Neck & Mediastinum, use LEAP/LEHR, 300-600sec (> or equal to 1million cts.), repeat after 15min, use lemon if needed to clear salivary

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165
Q

Parathyroid Dual Phase- Indications

A

Detect & Locate Primary & Secondary Parathyroid CA, ID single Adenomas/Glandular hyperplasia in newly diagnosed hypercalcemia & elevated PTH
Localize Cancer for pre-op, post-op for hyper-para

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166
Q

Parthyroid Dual Phase- Contraindications

A

Patient on Ca meds/thyroid meds, Patient agitated or prone to move/claustraphobic

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167
Q

Parathyroid Dual Phase- Results

A

Normal: Initial- Hetero uptake by thyroid, Salivary, Heart & gut; Delays- Hetero washout, no focal points of lingering uptake

Abnormal: Washt of Thyroid w/ focal increases on delay images from salivary to mediastinum; obliques hlp define position of abnormal uptake

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168
Q

Renal Perfusion- Radiopharmaceuticals (t1/2, E, Camera)

A

99mTc-Mertiatide (Tc-MAG3)
99mTc-Succimer (Tc-DMSA)
99mTc-Pentetate (Tc-DTPA)

6hrs, 140keV, LFOV; LEAP/LEHR

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169
Q

Renal Perfusion- Dose & Administration

A

10-15mCi, Intravenous Bolus

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170
Q

Renal Perfusion- Patient Preparation

A

Hydrate & Void

Check Blood Pressure for Renovascular Hypertension

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171
Q

Renal Perfusion- Imaging Parameters

A 
Patient Supine (Camera Posterior)
Kidneys centered (Iliac crest in lower 1/3 FOV)
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172
Q

Renal Perfusion- Views/Images

A

Posterior (Anterior if needed)

  • Sequential images- every 2sec for 30-60sec
  • Blood Pool- immediately post Flow
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173
Q

Renal Perfusion- Indications

A

Localization & Detection of Tumors, Malformations, Cysts

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174
Q

Renal Perfusion- Results

A

Renal Tubular Binding, 2-3hr total; Everythign else~30min total*
Normal: soon after arrival in the aorta, bolus perfuses each kidney in a vascular blush. Activity in renal area at same time & equal intensity. (Concentration levels depend on agent used). Gradual increase of concentration of Pentetate as a result of Glomerlar Filtration. Activity will then be seen in renal collecting system, ureters & bladder. Mertiatide is taken up promptly in kidneys, followed by excretion into the collecting system & bladder. With Succimer, activity accumulates gradually, outlining tubular cells. A minute amount of agent is excreted in the urine, so the collecting system will no concentrate the radiopharma.

Abnormal: Vascular tumors & Arteriovenous Malformations (AVMs)= areas of increased activity during the flow sequence. Cysts or Avascular tumors = areas of Decreased activity during the flow sequence

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175
Q

Renal Function: Renogram- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Pentetate (DTPA)
99mTc-Mertiatide (Tc-MAG3)

6hrs, 140keV
LFOV; LEHR, LEAP

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176
Q

Renal Function: Renogram- Dose & Administration

A

10-15mCi, Intravenous

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177
Q

Renal Function: Renogram- Patietn Preparation

A

Hydrate & Void

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178
Q

Renal Function: Renogram- Imaging Parameters

A

Patient prone or Supine (camera posterior)

  • Dynamic Flow Study- Sequential images every 2sec for 30-60sec for 20-30m
  • Time-Activity Curve (Renogram)
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179
Q

Renal Function: Renogram- Adjunct

A

Administer Furosemide (Lsix) if needed to rule out uretral obstruction if tracer activity does not clear from renal pelvis or ureteropelvic junction after the initial acquisition is completed

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180
Q

Renal Function: Renogram- Indications

A

Evaluate for Renal Artery Stenosis/Obstruction, Renal Tubular Function, Evaluat Renal Fow, Evaluate for Nephropathy or Hydronephrosis, Detect Necrosis, Evaluate Kidney translant

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181
Q

Renal Function: Renogram- Contraindications

A

Iodine IV same day, patient dehydrated (dehydration = may exhibit delayed transit time)

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182
Q

Renal Function: Renogram- Results

A

Normal: show prompt tracer uptake in kidneys w/ peak uptake at 3-5min. Kidney activity then gradually decreases as the tracer is excreted. Renal pelvis & Bladder activity usually seen by 3-6min.
Time-Activity Curve: 3 Phases- Vascular, Secretory & Excretory
-Vascular: arrival of the bolus of activity in renal area
-Secretory: tracer is concentrated in kidneys
-Peak:3-5min after injection, timw @ which tracer reaches its maximum concentration in the kidneys
-Excretory: rapid drop in Activity Curve as tracer is excreted from kidney into the bladder

Abnormal: reflected in Second & Third Phase of Curve. Adequate UpSlope but No subsequent Fall in activity = obstruction & renal tubules take up the material but cannot excrete the activity. A below-normal level of activity throughout the Renogram = poor renal function. Serial images corresponding to curve = additional visual demonstration of the abnormalities

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183
Q

Diuresis Renography- Indication

A

If tracer retained in Renal Pelvis or Calyces, admin diuretic to rule out urinarytract obstruction

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184
Q

Diuresis Renography- Patient Preparation

A

Hydrate & Void (cath if needed)

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185
Q

Diuresis Renography- Pharmaceutical

A

Furosemide (Lasix)

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186
Q

Diuresis Renography- Dose & Administration

A

Intravenous, slow over 1-2min
Adult: 20-40mg
Child: 0.5-1mg/kg

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187
Q

Diuresis Renography- Imaging

A

Flow
-Images begin during injection
—should see effect w//in 30-60sec
-Imaging continued for 20min

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188
Q

Renal Imaging w/ ACE Inhibitor- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Pentetate (DTPA)
6hrs, 140keV
LFOV; LEHR/LEAP

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189
Q

Renal Imaging w/ ACE Inhibitor- Dose & Administration

A

5-15mCi, Intravenous

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190
Q

Renal Imaging w/ ACE Inhibitor- Patient Preparation

A

Hydrate & Void
Discontinue ACE Inhibitor Terapy 3-7d prior
Baseline Sitting & Standing BP & HR

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191
Q

Renal Imaging w/ ACE Inhibitor- Imaging Parameters

A

Captopril (Capoten), PO 25-50mg (can be crushed in water), Admin. 60min prior to RP, NPO 4hrs,monitor BP every 15m
OR
Enalaprilat, Intravenous slow push 40ug/kg in 10mL Saline over 3-5min, RP 15min post, monitor BP (drops in first 10-15min)

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192
Q

Renal Imaging w/ ACE Inhibitor- Views/Images

A

Posterior (Anterior if needed)

  • Flow- 1-5sec/frame for 1min
  • Dynamic- 20-30sec/frame for 19min
  • Baseline- count syringe before & after, wait for activity blush in abdomen before starting camera
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193
Q

Renal Imaging w/ ACE Inhibitor- Proedure

A

Captopril: 1 or 2 day study;

    1. Initial 45min MAG3 - - 1hr Cap - - 1.5hrs - 3hrs total (Renin Levels Pre & Post);
    1. Baseline - - 1hr - - next day Cap. 2hrs
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194
Q

Renal Imaging w/ ACE Inhibitor- Indications

A

Decrease in kidney’s perfusion pressure, results in adecrease in the afferent arterioles pressure. Declined Filtration pressure & Decreased GFR, Renal ArteryStenosis (RAS)

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195
Q

Renal Imaging w/ ACE Inhibitor- Adverse Effects

A

Captopril: Orthostatic hypotension, Dizziness, Tachycardia, Chest Pain, Rash & Loss of Taste
Enalaprilat: Orthostatic hypotension, Dizziness, Chest Pain, Headache, Dry Cough, electrolyte Disturbances, Fatigue, Abdominal Pai, Vomiting & Diarrhea

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196
Q

Static Renal Imaging- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Succimer (DMSA)
6hrs, 140keV
LFOV; LEHR/LEAP

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197
Q

Static Renal Imaging- Dose & Administration

A

1-6mCi, Intravenous

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198
Q

Static Renal Imaging- Patient Preparation

A

Hydrate & Void

D/C ACE &/or ARBs

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199
Q

Static Renal Imaging- Imaging Parameters

A

Patient supine

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200
Q

Static Renal Imaging- Views/Images

A

Left & Right Posterior Obliques (Ant. If needed)

  • Statics- 2-3hrs post Flow
  • Delay- Severe Renal Failure: 24hr & Ant.
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201
Q

Static Renal Imaging- Results

A

Normal: smooth renal contour, Equal & Uniform Tracer Distribution

Abnormal: Congential Abnormalities- Horseshoe kidneys, ectopic kidney, & absence of a kidney; Congenital Malformations- fetal lobulations & horseshoe kidneys = areas of activity outside the normal renal outline. Areas of increased or decreased activity = cysts, neoplasms, infants or renal tumors

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202
Q

Renal Cystography (VCUG)- InDirect- Radiopharmaceuticals (t1/2, E, Camera)

A

99mTc-Pentetate (DTPA)
99mTc- Mertiatide (MAG3)

6hrs, 140keV
LFOV; LEHR//LEAP

203
Q

Renal Cystography (VCUG)- InDirect- Dose & Administration

A

3-10mCi, Intravenous

204
Q

Renal Cystography (VCUG)- InDirect- Patient Preparation

A

Hydrate, NO VOID 2hrs prior

205
Q

Renal Cystography (VCUG)- InDirect- Imaging Parameters

A

Patient Supine, No Catheter

206
Q

Renal Cystography (VCUG)- InDirect- Views/Images

A 
Posterior (Anterior if needed)
-Dynamic- Renal Functional
—Inject & No Void 2hrs
-Dynamic- 2sec/frame for 120frames as VOIDING
-Static- 120sec Post: SKIP if not needed
207
Q

Renal Cystography (VCUG)- Direct- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Pertechnetate (TcO4)
6hrs, 140keV
LFOV; LEHR/LEAP

208
Q

Renal Cystography (VCUG)- Direct- Dose & Administration

A

1mCi, Intravenous w/ 50-150mL Saline mixed

209
Q

Renal Cystography (VCUG)- Direct- Patient Preparation

A

Catheterize Patient

210
Q

Renal Cystography (VCUG)- Direct- Imaging Parameters

A

Patient Supine, Upper Portion bladder in lower FOV; Connect Cath to Bottle w/ saline-RP

211
Q

Renal Cystography (VCUG)- Direct- View/Images

A

Posterior (Anterior)
-Dynamic Flow - Sequential iages as bladder fills, 60sec/frame for 30min
—D/c Saline when bladder reached
—-Posterior Pre-Void Images
-Emptying Phase- Voiding images - Patient in seated position camera against bacl; 120frames, 2sec/frame
-Remove Cath & encourage patient to void in a bad pan
-Obtain Post Void image

212
Q

Renal Cystography (VCUG)- Direct- Results

A

Normal: increasing activity in the bladder w/out reflux into ureters.

Abnormal: reflux increases as study progresses, altough transient reflux may occur

*Prep area w/ absorbent paper; ensure bladder can fill w/o leak; if quantitative, note any loss of urine = inaccurate calc.

213
Q

Blood-Brain Barrier- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Pentetate (DTPA)
6hrs, 140keV
LFOV; LEHR

214
Q

Blood-Brain Barrier- Dose & Administration

A

15-30mCi, Intravenous bolus

215
Q

Blood-Brain Barrier- Patient Preparation

A

Verify Patient ID

216
Q

Blood-Brain Barrier- Imagign Parameters

A 
Patient Supine (or Upright), Tape to Secure head,
FOV Top of head to Anterior Neck
217
Q

Blood-Brain Barrier- Views/Images

A

Anterior, Posterior, R & L LAT (& Vertex psitions)

  • Image as tracer injected—Flow: 1-3sec intervals 30-60sec
  • Blood Pool: 60sec w/in 5-10min; post Flow Study
  • Anterior Projection- 500,000-1million counts
218
Q

Blood-Brain Barrier- Procedure notes

A

For Vertex: a lead cape draped over shlders
For Lateral: a lead shield - reduce counts from facial activity
Immediate & Delayed Static in same projections if any suspicion of a lesion/abnormality on initial iages

219
Q

Blood-Brain Barrier- Indications

A

Primary (Glioma, Meningioma) or Metastatic Disease, Intracranial inflammatory disease (abscess, encephalitis), Cerebrvascular Disease (cerebral hemorrhage, vascualr occlusion, hemangiomas, arteriovenous malformation), Complications of Head Trauma (subdural hematoma, brain death)

220
Q

Blood-Brain Barrier- Results

A

Normal: ~6sec = symmetric distribution in Right & Left coratid arteries & visualization of anterior cerebral artery. Visualiation of superior sagital sinus after 16sec indicates that arterial blood has begun to flow into venous system. Normal delayed static shows symmetric ativity around entire skull border. Increased activity observed around face and base of skull in Sagittal, Transverse & Sigmoid sinuses as a result of blood pool activity

Abnormal: Increased Localization in area of dsruption of the BBB from a lesion. In case of Brain Death, the flow study will demonstrate tracer distribution in the carotids & a cmoplete absence of perfusion in the middle anterior cerebral arteries due to increased intra-cranial pressure

in case of Brain Death- Planar

221
Q

Brain Perfusion- Radiopharmaceuticals (t1/2, E, Camera)

A

99mTc-Exametazime (HMPAO) - Ceretec
99mTc- Bicisate (ECD) - Neurolite
6hrs, 140keV
LFOV; Ultra High Res.

222
Q

Brain Perfusion- Dose & Administration

A

10-20mCi

butterfly Intravenous, Floow w/ Saline Flush

223
Q

Brain Perfusion- Patient Preparation

A

Patient Supine in Quiet, Dim Room prior

Insert Butterfly 5-10min prior

224
Q

Brain Perfusion- Imaging Parameters

A

Admin. Tracer & saline flush, remove Butterfly, patient remain quiet and unstimulted for 10-15min (ECD = 15-20m, 45 is best) & (HMPAO = no earlier than 1hr) - there is very white redistribution so Delays are okay

225
Q

Brain Perfusion- Views/Images

A

SPECT; Detector perpendicular to floor @ side of head, cam. Rotate under head first = 180degree = in case panic/agitation

  • total: 20-40min (transaxial, sagittal, Coronal slices)
  • 64 view 40sec per view, 360degree rotation
226
Q

Brain Perfusion- Indications

A

Cerebrovascular Disease (Acute stroke, transient ischemic attacks), Dementia (Alzheimer’s, Multi-Infarcted Dementia), Psychiatric Disorders (affectve disorders = depression/schizophrenia), Seizure Disorders (ID & Locate sites of focal epilepsy), Head Trauma (cerebral brain death)

227
Q

Brain Perfusion- Results

A

Normal: symmetric in both cerebral hemispheres, b/c blood flow to Gray matter structures is much greater than to white matter (Basal Ganglia & Thalamus = greater intensity of increased uptake), white matter = areas of decreased or no uptake

Abnormal: Site of Acute Cerbral Infarct = Phoopenic Defect = cerebral artery affected by stroke. Alzehimer’s = decreased perfusion in parietal, temporal &frontal lobes of both hemispheres. This contrasts w/ Multi-Infarct Dementia = random areas of decreased or absent uptake b/c of multiple areas of infarction. Schizophrenia = decreased perfsion in frontl lobes. Increased activity in area of basal ganglia and temporal lobes. Depressed patients = decreased uptake over entire cerebral cortex and, Manic = increased activity perfusion overall. during active seizure activity, area of intense focal uptake

228
Q

Cerebral Brain Death- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Exametazime (HMPAO) - Ceretec
6hrs, 140keV
LFOV; Ultra High Res.; Converging (Peds.)

229
Q

Cerebral Brain Death- Dose & Administration

A

10-20mCi, Intravenous

230
Q

Cerebral Brain Death- Patient Preparation

A

Signed Consent from Surrogate

231
Q

Cerebral Brain Death- Imaging Parameters

A

Static Planar, ~30min total

Often repeated 1-2days later

232
Q

Cerebral Brain Death- Views/Image

A

Anterior & Laterals

  • 50,000-1million cts. Each view
  • Imaging begins 1-3hrs post injection
233
Q

Cerebral Brain Death- Results

A

Normal: intense symmetric uptake throuhgout both Cerebral Hemispheres & Cerebellum ( not very detailed, if needed = SPECT)

Abnormal: total absence of tracer uptake in brain = Brain Dead; any uptake = ‘negative’ for brain death. Maysee perfusion defects = cerebral blood flow is compromised in specifc areas, more severe the defects the greater probability of eventual brain death

234
Q

PET Brain Imaging- Radiopharmaceutical (t1/2, E, Camera)

A

18Fluorine-Fluorodeoxyglucose (FDG)
110min, 511keV
Transmission scan (CT) prior

235
Q

PET Brain Imaging- Dose & Adminsitration

A

10-20mCi, Intravenous/ (in a Quiet & Dim room, rest at least 40 min)

236
Q

PET Brain Imaging- Patient Preparation

A

Blood Glucose ~120mg/dL (void prior)

NPO 4hrs

237
Q

PET Brain Imaging- Imaging Parameters

A

Patient Supine, head stablized

Laying in Quiet & Dim room inject and remain resting 40min

238
Q

PET Brain Imaging- Views/Images

A

3D

  • Emission scan for 30min
  • Transmission scan for Attenuation Correction
239
Q

PET Brain Imaging- Indications

A

Evaluation of Primary Brain Tumors, Epilepsy, Dementa & Alzheimer’s & Parkinson’s Disease

240
Q

PET Brain Imaging- Normal Results

A

Normal: uptake in gray matter normally; Active brain tissue will demonstrate intense uptake, (inactive tissue = lesser degrees of uptake)

241
Q

PET Brain Imaging- Abnormal Results

A

Primary Brain Tumors = positive correlation b/w FDG uptake on PET & tumor or grade of malignancy. High-grade tumor = intense FDG uptake; Necrosis = no uptake
Epilepsy = seizures that cannot be controlled; effective in locating the seizure focus. FDG injected during Inter-Ictal /Phase = significant reduction of uptake in area of seizure focus. Injected during Ictal Phase = focal ‘hot’ areas at focus
Dementia = FDG demonstrates unique pattern for Alzheimers, typicall show decreased uptake in parietal, temporal & frontal cortex but the sensorimotor & visual regions = normal. Non-Alzheimers Dementia = Pick’s Disease (frontotemporal dementia) = decreased uptake in frontal lobes; Creutzfeldt-Jakob Disease (Bovine Spongiform Encephaly ‘mad cow’) = generalized poor uptake thru-out brain

242
Q

Cisternography- Radiopharmaceutical (t1/2, E, Camera)

A

111Indium-Pentetate
2.8days
173keV & 247keV
LFOV; Medium Energy

243
Q

Cisternography- Dose & Administration

A

0.5-1.5mCi

Intrathecal b/w 3rd & 4th vertebrae

244
Q

Cisternography- Patient Preparation

A

Pledgets placed in Nose & Ears in case of a leak

245
Q

Cisternography- Imaging Parameters

A

Patient Supine during injection & several hours post
Count pledgets every 2hrs (in Well Counter)
Entire Skull & Spinal Tract in FOV

246
Q

Cisternography- Views/Images

A

Anterior, Posterior & Laterals

  • Imaging begins 4-6hrs post admin., 300sec/view
  • Additional Images @ 24, 48 & 72hrs if needed
247
Q

Cisternography- Indications

A

Diagnosis of normal pressure hydrocephalus, Detection of CSF leaks & Evaluation of Ventricular Shunt Patency

248
Q

Cisternography- Normal Results

A

@4-6hrs tracer completed its ascent, 1-4hr =Basal Cisterns (2hrs @ abdomen= ~200,000cts), @24hrs = uptake in subarachnoid spaces surrounding cerebral hemispheres as well as in interhemispheric cisterns & visualized in superior sagittal region (where reabsorpation of CSF occurs). Tracer clearance from Basal Cisterns @24hrs

249
Q

Cisternography- Abnormal Results

A

Normal Pressure Hydrocephalus: older adults, develops slowly over time = chronic disease. Drainage CSF is blocked gradually & excess fluis builds uo slowly over time. Slow enlargement of ventricles = fluid pressure. Enlarged ventricles press on brain = Persistant visualization of lateral ventricles & w/ abnormal delay of tracer in reaching the superior sagittal region
CSF: Pledgets measure abnormal activity in nose/ears = leak, imaging the site of suspected leak while radiopharmaceutical is passing thru the suspected area (1-3hrs post injection);leaks may be intermittent
Evaluation of Ventricular Shunts: usedto treat Hydrocephalus. Injection of 111In or 99mTc-O4 directly into shunt resevoir will cleary demonstrate shunt patency. Persistent radiopharmaceutical uptae in the shunt can indicated partial or complete obstruction of shunt

250
Q

Dopamine Transporter Imaging (DaT)- Radiopharmaceutical (t1/2, E, Camera)

A

123Iodine-Ioflupane
13.22hrs
159keV
LFOV; High Res. SPECT

251
Q

Dopamine Transporter Imaging (DaT)- Dose & Administration

A

3-5mCi, Intravenous (Slow, ~20sec push)

252
Q

Dopamine Transporter Imaging (DaT)- Patient Preparation

A

Check Med List, D/C Cocaine, Amphetamines, Fentanyl

Pre-Treat w/ 400mg f Potassium Perchlorate OR Lugol’s

253
Q

Dopamine Transporter Imaging (DaT)- Imaging Parameteres

A

SPECT
Void Prior
Patient Supine w/ Head Restraint
FOV w/ Entire Brain & as close as possible to detector heads

254
Q

Dopamine Transporter Imaging (DaT)- Views/Images

A 
360degree
Anterior, Posterior, & Laterals
-Imaiging begins 3-6hrs post admin, minimum 1000k cts.
-3-head detector- 120-20sec slices
-2-head detector- 120-30sec slices
-1-head detector- 120-20sec slices
255
Q

Dopamine Transporter Imaging (DaT)- Indications

A

Detecting Degenerative Dopaminergic Nigrostriatal pathway; Tremor vs. Post-Synaptic Parkinson’s. differentiate Parkinsonism; Normal = w/out presynaptic dopaminergic loss. Dementia w/ lewy bodies vs. Alzheimer’s (A = normal)

256
Q

Dopamine Transporter Imaging (DaT)- Results

A

Normal: Classic Comma Sign, showing head of the caudate nucleus & putamen in the transverse slice

Abnormal: Incomplete Comma Sign appearance of the caudate nucleus & putamen in the transerse slice

257
Q

Gallium Imaging (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)

A

67Gallium-Citrate
78hrs
93, 184, 296, 388keV
LFOV; Medium or High Energy Parallel-Hole

258
Q

Gallium Imaging (Infection/Inflammation)- Dose & Administration

A

4-6mCi (148-222MBq)

Intravenous

259
Q

Gallium Imaging (Infection/Inflammation)- Patient Preparation

A

None

260
Q

Gallium Imaging (Infection/Inflammation)- Imaging Parameters

A

Patient supine
Planar or SPECT
Imaging can begin 6hrs-1wk post

261
Q

Gallium Imaging (Infection/Inflammation)- Views/Images

A

Ant/Post, Whole-Body

  • Planar/Tomographic/SPECT
  • WB Images (A&P) begins 6hrs-1wk post injection for 1-2million cts.
  • 64x64 or 128x128, 360degree w// 3-6degree sampling for 40-50sec
  • Statics- 800,000-1million cts.
262
Q

Gallium Imaging (Infection/Inflammation)- Indications

A

Localization of sources of fever of uknown origin (FUO), Suspected Osteomyelitis, Pulmonary & Mediastinal Inflammation/Infection, Evaluation & Monitoring of Inflmmatory Processors (Sarcoidosis), Acute or Chronic Inflammation or Infection

263
Q

Gallium Imaging (Infection/Inflammation)- Contraindications

A

Recent laxatives/enema (these cause inflammation = increased uptake = mistaken for disease)/Bowel Prep for patients who are acutely ill/unable to eat soli food, Recent Barium Contrast (barium scan after 67Ga is ok)

264
Q

Gallium Imaging (Infection/Inflammation)- Normal Results

A

Tracer uptake in Nasopharynx, Lacrimal glands, Salivary glands, Bony thorax (ribs, sternum, clavicle, scapule), Extnal genitalia, Liver, Kidney (up to 48hrs after), Colon contents, & Pelvis (lumbar spine, sacrum, ileum, ischium) & Epiphyses; Liver is INTENSE.
Excreted 20-30% from kidneys during first 24hrs = Renal activity up to 48hrs

1) Skeleton & Liver are Well-Vsualized, faint activity in Colon
2) Skeleton & Hepatic Uptake is less intense, while intense activity is present in proximal colon
3) Skeleton is well defined, Hepatic Activity intense & Colonic activity confined to proximal ascending colon is faint
4) Nasopharyngeal activity is prominent & pancolonic activty is intense

GALLIUM = GUT ACTIVITY

265
Q

Indium-Labeled Leukocytes (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)

A

111Indium-Oxine ( labeled white cells)
67.4hrs
247kev (94%) & 171keV (90%)
LFOV; Medium or High Energy Parallel-Hole

266
Q

Indium-Labeled Leukocytes (Infection/Inflammation)- Dose & Administration

A

500-600uCi

Lare Bore, Intravenous (Slow Push)

267
Q

Indium-Labeled Leukocytes (Infection/Inflammation)- Patient Preparation

A

Void Bladder

Withdraw ~50mL Blood (check WBC count)

268
Q

Indium-Labeled Leukocyte (Infection/Inflammation)- Imaging Parameters

A 
Patient Supine
-Whole Body SPECT (& or static)
—imaging begins 1-4hrs or 16-30hrs after labeling
—no delays past 24hrs
—lower counting statistics than 67Ga
269
Q

Indium-Labeled Leukocytes (Infection/Inflammation)- Labeling Procedure

A

White cells ae isolated, 1111In diffusses into cells & binds (total~2hrs). ~70-90% efficient, important WBC & RBCs separated (& Platelets), requires Centrifuge @ correct speed. If platelets are tagged = False-Positives

270
Q

Indium-Labeled Leukocytes (Infection/Inflammation)-Views/Images

A

Ant, Post of Head, Abdomen, Pelvis, Chest & Extremities

271
Q

Indium-Labeled Leukocytes (Infection/Inflammation)- Indications

A

Detection of sources of fever of Unknown Origin (FUO), Detection of sites of Inlammatory Bowel Disease, Detection of Osteomyelitis

272
Q

Indium-Labeled Leukoctes (Infection/Inflammation)- Results

A

Normal: Spleen, Liver, Bone Marrow, (most Intense. SPLEEN < in Liver & < in BM)

Abnormal: Damaged luekocytes, Extravasation of labeled cells compromises image quality = False-Negative (also if insufficient leukocytes adminsitered)

273
Q

Indium-Labeled Leukocytes (Infection/Inflammation)- Radiation Dosimetry

A

WB: 0.50-0.53rad/mCi
Liver: 1-5rad/mCi
Spleen: 18-20.4rad/mCi

274
Q

Technetium-Labeled Leukocytes (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-Exametazime (HMPAO-Ceretec)
6hrs, 140keV
LFOV; LEHR/LEAP Parallel or Pinhole

275
Q

Technetium-Labeled Leukocytes (Infection/Inflammation)- Dose & Administration

A

7-25mCi,

Large Bore, Intravenous (Slow push)

276
Q

Technetium-Labeled Leukocytes (Infection/Inflammation)- Patient Preparation

A

Void Bladder

Withdraw 40-50mL Blood for labeling (check WBC ct)

277
Q

Technetium-Labeled Leukocytes (Infection/Inflammation)- Imaging Parameters

A

Patient Supine

278
Q

Technetium-Labeled Leukocytes (Infection/Inflammation)- Exametazime Radiopharmaceutical Kit

A

Re-constituted w/ 99mtc-O4, added to white cells suspended in plasma (stabilizer, Methylene blue NOT added)

279
Q

Technetium-Labeled Leukocyte (Infection/Inflammation)- Views/Images

A

Ant, Post Head,Pelvis & Abdomen Critical, Chest & Extremities

  • 4 & 24hr Delay, 30min = Max Sensitvity
  • 15-30min & Delays = FUO
280
Q

Technetium-Labeled Leukocyte (Infection/Inflammation)- Indications

A

Fever of Unown Orign (FUO), Abdominal Pain, Detection of Inflammation or Ischemia in Small Bowel & Detection of Acute OM

281
Q

Technetium-Labeled Leukocytes (Infection/Inflammation)- Results

A

Normal: Slow Blood Clearance = Activity in Heart, Lungs & Great Vessels (on Delayed image), Bowel activity increases over time, Spleen/Liver/Bone Marrow/Kidneys/Bowel/Bladder & Major Blood Vessels

Abnormal: can be seenin bowel very early (15-30min after injection) & increases over time. lung persisting longer than 4hrs

282
Q

Bone Marrow Imaging (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)
Tc-SC

A

99mTechnetium-Sulfur Colloid
6hrs, 140keV
LFOV, LEHR/LEAP

283
Q

Bone Marrow Imaging (Infection/Inflammation)- Dose & Administration Tc-SC

A

10mCi, Large-Bore Intravenous, Slow push

284
Q

Bone Marrow Imaging (Infection/Inflammation)- Patient Preparation

A

Void Bladder

Withdraw 40-50mL Blood (check WBC counts)

285
Q

Bone Marrow Imaging (Infection/Inflammation)- Imaging Parameters

A

Patient Supine

286
Q

Bone Marrow Imaging (Infection/Inflammation)- Procedure Tc-SC

A

1st inject fresh Tc-SC (>2hrs old = blood pool & bladder), image 30min post injection (maximizes clearance from circ.)
-10min images of ROI w// LFOV, 128x128

287
Q

Bone Marrow Imaging (Infection/Inflammation)- Views/Images

Tc-SC

A

Ant, Post, WB
*Om vs. Bone Marrow
Tc-SC: image 30min post injection

288
Q

Bone Marrow Imaging (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)
111In

A

111Indium-Oxine (WBC)
67.4hrs
247kev & 171keV

289
Q

Bone Marrow Imaging (Infection/Inflammation)- Dose & Administration
111In

A

0.3-1mCi

Large Bore Intravenous, slow push

290
Q

Bone Marrow Imaging (Infection/Inflammation)- Procedure

111In

A

2-Day, 111In procedure, cells labeled & re-injected on 1st day & image 24hrs later 9image Marrow prior to injection)
- After injection, 10% window, 10min/view, 128x128

291
Q

Bone Marrow Imaging (Infection/Inflammation)- Views/Images

A

Ant, Post WB

111In-WBC: image 24hrs post injection

292
Q

Prostate Cancer- Radiopharmaceutical (t1/2, E, Camera)

A

111Indium-Capromab Pendetide (Prostascint)
67.4hrs; 247keV & 171kev
LFOV; Medium-Energy

ProstaScint is a Monoclonal Antibody, directed at PSMA (an antigen secreted by Malignant Prostate Cells)

293
Q

Prostate Cancer- Dose & Administration

A

5mCi

Intravenous, infuse over 3-5min

294
Q

Prostate Cancer- Patient Preparation

A

Hydrate, Laxatives, Void Frequently
Catheter if needed
Check PSA #d & HAMA Titer

295
Q

Prostate Cancer- Imaging Parameters

A

Patient Supine

SPECt

296
Q

Prostate Cancer- Views//Images

A

Abdomen & Pelvis, Ant. Post Spont View/WB

  • early Blood Pool @ 30min-4hrs
  • 4-5day delay
  • 96-120hr post injection = optimal target &
297
Q

Prostate Cancer- Indications

A

Diagnose & Assess Prostate Cancer, at risk or Lymphnode metastases

298
Q

Prostate Cancer- Contraindications

A

HAMA response/ Allergy

299
Q

Prostate Cancer- Results

A

Normal: activity in blood pool & blood-filled structures (Liver, Spleen, Penis), Bone Marrow & Large Bowel

300
Q

Neuroendocrine Cancer- Radiopharmaceutical (t1/2, E, Camera)

A

111Indium-Pentetreotide (OctreoScan)
67.4hrs
247keV & 171keV
LFOV; Medium Energy

301
Q

Neuroendocrine Cancer- Dose & Administration

A

Adult: 6mCi
Child: 0.14mCi/kg

Intravenous

302
Q

Neuroendocrine Cancer- Patient Preparation

A

Hydrte Prior & 24hrs Post
Mild Laxative evening prior & post
Insulinoma - IV solution w/ Glucose prior to avoid hypoglycemia

303
Q

Neuroendocrine Cancer- Imaging Parameters

A

Patient Supine, Void Prior

SPECT/ WB/ Planar

304
Q

Neuroendocrine Cancer- Views/Images

A

WB, Ant & Post, Pelvis
-Aqcuire images at 4, 24, 48hrs
-WB/ 800,000-1million, A&P Planar @ 4hrs
-SPECT- 24 &48hrs images (differentiate bowel activity & disease)
—-128x128, 360degree, 3degree sampling, 30-45sec time/stop

305
Q

Neuroendocrine Cancer- Indications

A

Localize Primary & Metastatic Tumors Originating from neuroendocrine cell, cells that contain Somatotatin Receptor Sites(Pituitary & Endocrine tumors, Paranglioma, Medullary Thyroid Carcinoma, Carcinoids & Small-cell lung cancer

306
Q

Neuroendocrine Cancer- Results & Adverse Effect %

A

Normal: Pituitary, Thyroid, Liver, Spleen, Kidneys, Bowel, Gallbladder, Ureters, Bladder & Stimulated Adrenal Glands;s ~4hrs = GI, Intestinal activity = 24hr

Adverse Effects %: <1%

307
Q

Neuroendocrine Cancer- Octreotide Analog & Function

A

Octreotide is an analod of the hormone Somatostatin. binds to somatostatin receptors on surface of cells, concentrating in Tumors w/ high density of receptor sites.
Somatostatin is concentrated in hypothalamus, cerebral cortex, brains tem, GI tract & pancreas

Fuctions: Neurotransmission & inhibition of the release of growth hormone, insulin, glucagon, & gastrin & hormone production by certain tumors

308
Q

Neuroendocrine Cancer- Receptor sites for Octreotide (Somatostatin)

A

Receptor sites for somatostatin are located in the Anterior Pituitary Gand, Pancreatic Islet, Lymphocytes & certain type of tumors (Brain, Breast, lung Cancer & Lymphoma)

309
Q

Adrenal Tumors- Radiopharmaceuticals (t1/2, E, Camera)

A 
131Iodine-Meta-Iodobenzylguanine (MIBG)
-8.02days; 606keV (364keV/peak)
-High Energy
123Iodine-Iobenguane (MIBG) Sulfate (AdreView)
-13.2hours; 159keV
-LEHR/LEAP
310
Q

Adrenal Tumors- Dose & Administration

A

Intravenous
Adult:
131I-MIBG: 0.5-1mCi
123I-MIBG: 10mCi

Child:
131I-MIBG: 0.135mCi
123I-MIBG:avg. weight- 13.7-162uSv/MBq

311
Q

Adrenal Tumors- Patient Preparation

A

Lugol’s (Potassium Iodide) 1day prior & 6-7days post

312
Q

Adrenal Tumors- Imaging Parameters

A

Patient Supine

Void Prior

313
Q

Adrenal Tumors- Views/ Images

A

Ant & Post, Top of Skull to Pelvis FOV
-Ant/Post Planar of EHad, Chest, Abdomen & Pelvis
—Acquired on days 1 & 3 for 131I
—Acquired at 6 &24hrs for 123I (24hr= SPECT)
-SPECT- 64x64, 360degree, 3-6degree sampling, 3-45sec/stop

314
Q

Adrenal Tumors- Indications

A

Detection, Localization, Staging & follow-up of Neuroendocine Tumores & their Metastases: Neuroblastomas, Pheochromcytomas, Ganglioneuroblastomas, Carcinoid Tumors, Ganglioneuromas, Parangliomas, Medullary Thyroid Carcinomas & Meckel Cell Tumors

315
Q

Adrenal Tumors- Results

A

Normal: Uptake in Liver, Spleen & Heart, Salivary Glands, Nasopharynx & Urinary Bladder

Abnormal: persist over time, Pheochromocytomas may occur in Adrenal Bed or other places in Thorax & abdomen, Metastases may be visualized in Liver,Bone, Lymph Nodes, Heart, Lungs

316
Q

Adrenal Tumors- Pheochromocytomas

A

Catecholamine-Secreting Tumors from Adrenal Medulla. Hypertension is primary symptom

317
Q

Adrenal Tumors- Neuroblastoma

A

Malignant Tumors of symptomatic Nervous syste & most often in children (<10yr olds). Most originate in Adrenal Glands or Sympathetic Nervous System Ganglia of the abdomen (1/3 found in chest, neck, pelvis or spinal cord)

318
Q

Adrenal Tumors- Catecholamines & Adrenal Gland location

A

Epinephrine & Norepinephrine

*Adrenal glans located at superior poles of kidneys

319
Q

Scintimamography- Radionpharmaceutical (t1/2, E, Camera)

A

99mTechnetium-Sestamibi
6hrs, 140kev
Specialized tube; LEHR//LEAP

320
Q

Scitimammography- Dose & Administration

A

20-30mCi, Intravenous (contralateral arm)

321
Q

Scintimammography- Patient Preparation

A

No needle aspiration 2wks piror

No biopsy w/in 4-6wks prior

322
Q

Scintimammography- Imaging Parameters

A

Patient Upright/Supine/Prone
If bilateral - inject in Foot vein
SPECT

323
Q

Scintimammography- Views//Images

A

Planar Ant. Chest & axillae, Lat. each breast (arms extended above head), Prone /Lateral Axillae
-Planar Ant & Lat 10min images
Imaging begins 5-10min post injection
—place markers near palpated abnormalities
—Ant- Upright or Supine
—Lats - Prone, Breast suspended

324
Q

Scintimammography- Indications

A

Indeterminate x-ray mammogram, Dense breast tissue, Suspected recurrence of breast CA after surgery/radiation

325
Q

Scintimammography- Results

A

Normal: Uptake in the Salivary & Thyroid Glands, Myocardium, Liver, Gallbladder, Intestines, Skeletal Muscles, Kidneys & Bladder

326
Q

Lymphoscintigraphy- Radiopharmaceutical (t1/2, E, Camera)

A

99mTechnetium- Sulfur Colloid
6hrs, 140keV
LFOV; LEHR
Filter Colloid thru 0.2um filter; <0.10um

327
Q

Lymphoscintigraphy- Doe & Administration

A

~200uCi (in 4-5syringes) (~1mCi total)

Subcutaneous (4-6syringes) Intradermal

328
Q

Lymphoscintigraphy- Patient Preparation

A

Wipe/Betadine Area (shave if needed)

Lymphedema - stockings removed 3-4hrs prior

329
Q

Lymphoscintigraphy- Imaging Parameters

A

One Day: 0.1mCi in 0.05mL, intradermal injection, iamge @ 30min, surgery @ 2-4hrs
Two Day: 0.5mCi in 0.05mL, intradermal injection, image @ 0min & 2hrs, surgery next morning
OR Mapping: longer delay b/w injection & surgery the better

330
Q

Lymphoscintigraphy- Views/Images

A

Post injection, Dynamic/statics, Whole body/ Ant/ Post/ Lats/ Obl., SPECT (best to visualize draining)
-immediate, 45min-1hr& 30-45min

331
Q

Lymphoscintigraphy- Injection Sites

A

Surface Lesions: 2-6injections around area of Cancerous tissue or ROI (shield injection site)
Retroperitoneal Lymph Nodes: Injection into medial 2 interdigital webs of feet. Image @ 4hrs w/ part of Liver in FOV w/ lumbar nodes
Axillary & Apical Lymph Nodes: Injection into Medial 2 interdigital webs of the hands. Image @ 2-4hrs
Cervical Ndoes: Inject into the dorsum of mastoid process
Internal Mammary change: inject into the posterior rectus sheet below the rib cage
Iliopelvic Lymph Nodes: Injection into perianal justlatera to anal margin @ 3’ & 9’o’clock positions

332
Q

Lymphoscintigraphy- Methods: Melanoma

A

2-6 subcutaneous &/or intradermal producing a wheal, places around the cancer site, surgery, or ROI (w/in 5mm). Other routes, Intradermal into we of hand/foot, <0.25mL/injection site.
FILTERED Sulfur Colloid

333
Q

Lymphoscintigraphy- Methods: Breast Cancer

A

4injections in tissue surrounding the lestion (2-3mm), 4mL/syringe @ 3, 6, 9, 12 positions around site, lidocaine to reduce pain
UN-FILTERED Sulfur Colloid

334
Q

Lymphoscintigraphy- Methods: Lymphodema

A

IV injection, 2 sites/limb, placed into web of fingers or toes depending on ROI

335
Q

Lymphoscintigraphy- Methods: Non-Palpable Tumors

A

Wire localization done via US prior to sending patient to OR, radionuclide injected after wire has been placed (injection around periphery of tumor/biopsy cavity w/ 800-1000mCi)
FILTERED Sulfur Colloid, divided into 4doses & injected @ 12, 3, 6, 9 o’clock positions w/in 1cm of cavity edge

336
Q

Lymphoscintigraphy w/ Lymphoseek- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc- Tilmanocept
6hrs, 140keV
LFOV; LEHR or LEAP

337
Q

Lymphoscintigraphy w/ Lymphoseek- Dose & Administration

A

0.5mCi, Subcutaneous (Intradermal)

338
Q

Lymphoscintigraphy / Lymphoseek- Patient Preparation

A

None

339
Q

Lymphoscintigraphy w/ Lymphoseek- Kit Preparation

A

Sterile Syringe, draw ~92.5MBq (2.5mCi) 99mTc Sodium injection solution in either 0.35mL volume (for 0.5mL reconsituted vial volume) or 0.7mL volume (for 2.5mL or 5mL reconstituted vial volume), Assay syringe for 99mTc in Dose Calibrator. Record amount, date, time, etc. Add 99mTc injection solution to the Tilmanocept Powder Vial. Remove needle, gently shake to mix, let stand @ rm. temp for 15min

340
Q

Lymphoscintigraphy w/ Lymphoseek- Imaging Parameters

A

Site of Lesion = PAtient position, SPECT (CT) if extremity or unknown
-Admin 15min before intitating intraoperative lymphatic mapping sentinel node biopsy (complete w/in 15min)

341
Q

Lymphoscintigraphy w/ Lymphoseek- Views/Images

A

3 Ant, 1 Lat, w & w/o 57Co, WB sweep

  • planar (90-120sec)/ Dynamic (Immediate, 30sec/frame for 20-30min)
  • or sequential static (Immediate, 30-60min, every 5min for 60min)

VISIBLE in 10-15min & up to 15-30hrs

342
Q

Lymphoscintigraphy w/ Lymphoseek- Methods

A

4 intradermal injections @ 12, 3, 6, 9 o’clock positions (0.25mL/syringe)
1-8 intradermal peritumoral inejctions around cavity, 100uCi in a volume of 0.1mL

343
Q

Lymphoscintigraphy w/ Lymphoseek- Notes/How it works

A

A 1st class Mannose Receptor (CD206) binding radiopharmaceutical agent developed for use in external lymphnode imaging, intraoperative lymphatic mapping & Sentinel Node Biopsy

  • Allows rapid transit from injection site, accumulates in tumor
  • Transits thru lymphatic vessels & accumulates in lymph nodes draining from primary tumor

VISIBLE in 10-15min & up to 15-30hrs

344
Q

Parathyroid Cancer- Radiopharmaceutical (t1/2, E, Camera)

A

201 Thallous-Chloride
73.1hrs, 69-81keV (~71keV)
LFOV; LEHR/LEAP

345
Q

Parathyroid Cancer- Dose & Administration

A

3-4mCi 201Tl, Intravenous

346
Q

Parathyroid Cancer- Patient Preparation

A

None

347
Q

Parathyroid Cancer- Imaging Parameters

A

Dual-Phase/Dual-Isotope

348
Q

Parathyroid Cancer- Views/ Images

A

Ant, Neck/Mediastinum (SPECT)

-Image 20-60m post injection, immediate @20m (CNS neoplasm) Delay 3hrs

349
Q

Parathyroid Cancer- 201Tl Note

A

Accumulation is < in connective tissue w/ inflammatory cells - Localizes in ATPas System
Tl does not cross intact BBB; Karposi’s Tl+ &Ga-; Lymphoma + w/ both; Infection = Ga avid but Tl-; Lung CA seen w// Tl if >2cm, delays also helpful (inflammation is washed out)

350
Q

Parathyroid Cancer- Method w/ 201Tl

A

201Tl inject - - - 20min - - - image (1hr)

351
Q

Parathyroid Cancer w/ MIBI- Radiopharmaceutical (t1/2, E, Camera)

A

99mTechnetium-Sestamibi
6hrs, 140keV
LFOV; LEHR/ Pinhole/ Parallel-hole

352
Q

Parathyroid Cancer w/ MIBI - Dose & Administration

A

20mCi, Intravenous

353
Q

Parathyroid Cancer w/ MIBI- Patient Preparation

A

None

354
Q

Parathyroid Cancer w/ MIBI- Imaging Parameters

A

Dual-Phase / Dual Isotope

355
Q

Parathyroid Cancer w/ MIBI - Views/Images

A

Ant, Neck-Mediastinum (SPECT)

  • Flow- immediate, 1st phase begins 15-20min post injection, (Thy), 2nd phase begins 2hrs post injection (parathy)
  • Not w/ PArathyroid= decreases in Thyroid faster & longer*
356
Q

Parathyroid Cancer w/ MIBI- Method

A

99mTc-MIBI - - - Inject, initial pic - - -2hr delay - - - 1.5hr/image

357
Q

Lung Cancer- Radiopharmaceutical (t1/2, E, Camera)

A

99mTechnetium-Depreotide (NeoTect)
6hrs, 140keV
LFOV; LEHR/LEAP

358
Q

Lung Cancer- Dose & Administration

A

15-20mCi, Intravenous (must be a new line)

359
Q

Lung Cancer- Patient Preparation

A

Hydrate & Void

360
Q

Lung Cancer- Imaging Parameters

A

SPECT w/ entire Lung fields

361
Q

Lung Cancer- Views/Images

A

Arms above head, Anteroposterior

  • Imaging begins 2-4hrs post injection
  • 128x128, 360degree, 3degree sampling & 30-40min acquistion time per stop
  • optional: 800,000-1million planar images
362
Q

Lung Cancer- Results

A

Normal: Kidneys, Liver, Spleen & Bone Marrow

363
Q

Lung Cancer- Depreotide Function

A

A 10-amino acid synthetc peptide tht contains a somatostatin receptor (SSTR) binding domain that demonstrates a high affinity for SSTR-expressing tumor. Increased SSTR = most neuroendocrine tumors including small cell lung carcinoma

364
Q

Non-Hodgkin’s Lymphoma- Radiopharmaceutical (t1/2, E, Camera)

A

90Yttrium-Ibritumomab Tiuxetan (Zevalin)

  1. 1hrs
  2. 28MeV Betas (penetrates ~5mm)
365
Q

Non-Hogdkin’s Lymphoma- Dose & Rad. Dose & Critical Organ

A

0.3mCi/kg for 100,000-149,000 platelet count
0.4mCi/kg for >150,000 platelet count
~Radiation Dose, 23-79cGy (60cGy)
*Critical Organ: Liver, 532cGy

366
Q

Non-Hodgkin’s Lymphoma- Administration & Pre-Admins

A

250mg/m^2 Rituximab (Rituxan infusino ~2-6hrs)
Zevalin Dose (in 4-8mL) over 10min
Flush w/ 0.9% NaCl

367
Q

Non-Hodgkin’s Lymphoma- Patient Preparation

A

Recent Bone Marrow Biopsy, Lymphoma in BM <25%;
Recent Blood Count, platelet >100,000uL;
WB scan / 111In 2-24hrs & 48072hrs to confirm treatment;
Intravenous Line Established

368
Q

Non-Hodgkin’s Lymphoma- Patient Discharge & Radiation Safety

A

For 3DAYS: Wash Hands Carefully, Avoid Transfer of Bodily Fluids, Clean Up Spilled Urine/Blood Contamination
For 1WEEK: Use condom
For 1YEAR: Use effective contraception

369
Q

Non-Hodgkin’s Lymphoma- Zevalin Function

A

A Murine IgG, monoclonal antibody that targets CD20 Antigen; a targeted dose @ tumor (binds to tumor), rad. Dose is minimal to surrounding tissue

370
Q

Liver Cancer- Radiopharmaceutical (t1/2, E)

“Selective Internal Radiation Therapy (SIRT)”

A

99Yttrium-Glass Microspheres (Therasphere)

  1. 2hrs
  2. 7keV
371
Q

Liver Cancer- Dose & Administration

“Selective Internal Radiation Therapy (SIRT)”

A

Y90
Activity: 80-150Gy (max 18.4mCi)
Diameter: 20-30um (22,000-73,000microspheres/mg)

Catheter via Groin; Dose adminstered in multiple small increment infusions during Therapeutic Hepatic Angiogram. Vascular status is mapped w/ contrast b/w each infusion. Full dose is administered or until stasis is reached

372
Q

Liver Cancer- Patient Preparation

“Selective Internal Radiation Therapy (SIRT)”

A

Transfemoral 99mTc-MAA (2-4mCi) injection to assess Liver arterial perfusion, lung & intra-abdominal shunting (Ant & Post Planar Head to Thighs & SPECT//CT Abdomen; ROI around Liver & each Lung)

373
Q

Liver Cancer- Y90 Facts

A

Blood flow plays large effect on Norm. Liver rad & tumor

374
Q

Liver Cancer- Exposure

“Selective Internal Radiation Therapy (SIRT)”

A

Bremsstrahlung 15uSv per GBq @ 15cm

375
Q

Liver Cancer- Y90 Therapsheres vs/. Y90 SIR Spheres

A

Y90 Theraspheres: Glass/Resin Beads & Fewer Beads

Y90 SIR Spheres: Plastic, Larger # Beads, Colorectal Carcinoma

376
Q

MidGut Neuroendocrine Cancer - Radiopharmaceutical (t1/2, E)

A

177Lutetium-Dotatate (Lutathera)

  1. 647days
  2. 498MeV
377
Q

MidGut Neuroendocrine Cancer- Dose & Administration

A

200mCi (every 8WEEKS, 4 DOSES TOTAL)
Intravenous (20gauge) 500mL NaCl 5-10min
4x w/ 2MONTH BREAK

378
Q

MidGut Neuroendocrine Cancer- Patient Preparation

A

No Somatostatin Analog Drugs (SSA)
Kidney function measured 1st & end (6mos from 1st dose)
Kidney protecting AminoAci Infusion (long lasting Octreotide) 30min PRIOR

379
Q

MidGut Neuroendocrine Cancer- Side Effects

A 
Hormonal Crisis (Hypotensino, Bronchoconstriction, Flusing, Arrhythmia)
Low Blood Counts
380
Q

MidGut Neuroendocrine Cancer- Radiation Safety

A

Avoid close contact, 3feet from others for 2-3DAYS

Can be detected in Urine for 30DAYS

381
Q

MidGut Neuroendocrine Cancer- Location & Lutathera Localization

A

MidGut, Jejunum - Ascending Colon; Carcinoid Tumors; Peptide Receptor Radionuclide Therapy (binds to CA)

382
Q

Hyperthyroidism/Thyroid Carcinoma- Radiopharmaceutical (t1/2, E)

A

131Iodine-Sodium Iodide
8days
606keV (gamma 364keV)

383
Q

Hyperthyroidism/Thyroid Carcinoma- Dose & Administration

A

1uCi or 5uCi, >30mCi
PO, Pill
Inpatient, until <30mCi or <5mrem/hr @1m

384
Q

Hyperthyroidism/Thyroid Carcinoma- Preparation

A

Private Room & Bath, Labeled, Patietn Secretion Absorbed (w/ paper, own phone, bedrails, floor, mattress, remote. Spray Cold Iodine on Porcelain. All Disposable

385
Q

Hyperthyroidism/Thyroid Carcinoma- Monitoring/ Area Surveys

A

Surveyed @ bedside, 3feet, Door, Next Door Room, Outside Room below 2mrem, <100mrem/y, 2mrem/hr

386
Q

Hyperthyroidism/Thyroid Carcinoma- Discharge

A

<33mCi or <7mrem @ 1m

200mCi —-> 33mCi = 72hrs, Force Fluids

387
Q

Hyperthyroidism/Thyroid Carcinoma- Post D/C

A

RSO checks everything, store till BKG (~80-120days)

388
Q

Hyperthyroidism/Thyroid Carcinoma- Side Effects

A

Sialoadenitis (Salivary Gland Swelling) 10-33%

Hypothyroid

389
Q

Hyperthyroidism/Thyroid Carcinoma- Notes on images & dpm

A

METS post Thyroid removed = Liver Shadow = BAD

If Thyroid dpm reaches 2.22x10^6 = evaaute for why, if 1.11x10^7dpm = investigate

390
Q

Bone Pain Therapy- Radiopharmaceutical (t1/2, E)

A

89Strontium-Chloide (Metastron)
50.5days,
1463keV, 583.keV Betas penetrate 8mm

391
Q

Bone Pain Therapy- Dose & Administration

A

4mCi (40-60uCi/kg)

Intravenous w/ Saline 100mL

392
Q

Bone Pain Therapy- Preparation & Retention

A

Pb (lead) syringe shield; IV running w/ saline = clears rapidly from blood, 50-70% retained in Skeleton (14days) in bone METs (>50days)

Rentention in METS longer than Bone

393
Q

Bone Pain Therapy- Results

A

30-50% decrease in WBC & Platelets
Excretion is Renal/Urinary (2/3) greatest up to 2 days
Normal: Decrease in pain for 10-16weks, Increases quality of life

394
Q

Bone Pain Therapy- Crtical Organ & Behavior/Function of 89Sr

A

Bone Surface & Red Bone Marrow

Behaves like Calcium Analog; areas of active osteogenesis (incorporated into Hydroxyapatite molecule)

395
Q

Bone Pain Therapy w/ Quadramet- Radiopharmaceutical (t1/2,E)

A

153Samarium-Lexidronam (Quadramet)

  1. 7hrs
  2. 81MeV (103keV photopeak)
396
Q

Bone Pain Therapy w/ Quadramet- Dose & Administration

A

~4mCi (1mCi/kg), Intravenous

153Sm-Lexidronam

397
Q

Bone Pain Therapy w/ Quadramet- Uptake & Excretion

A

Rapid uptake by skeleton in osteoblastic Bone METS - 45-90% localizes to skeleton thru chemisorption on surface of hydroxyapatite molecule
2-13% to Liver
Rapid Renal Excretion w/in 6hrs

Complexed w// EDTMP
Rapidly cleared from blood w/in 1hr, b/c shorter t1/2 a higher dose can be administered vs. 89Sr

398
Q

Bone Pain Therapy- 89Sr vs. 153Sm

A

Sm greater dose (faster acting)
Lower t1/2 (Sm)
Hematopoietic response immediate & resolves faster than Sr

399
Q

PET Tumor Imaging: Metabolic Cancers- Radiopharmaceutical (t1/2, E)

A

18Fluorine-Flurodeoxyglucose (FDG)

110min; 2x 511keV

400
Q

PET Tumor Imaging: Metabolic Cancers- Dose & Administration

A

5-20mCi(~10mCi), Intravenous

401
Q

PET Tumor Imaging: Metabolic Cancers- Patient Preparation

A

NPO 4hrs (heart = laxative prior)

402
Q

PET Tumor Imaging: Metabolic Cancers- Imaging Parameters

A

Blood Glucose Level <200mg/dL

Post injection, Relax in Dim Rm before imaging

403
Q

PET Tumor Imaging: Metabolic Cancers- Views/Images

A

Whole-Body

-Imaging begins 30-60min prior

404
Q

PET Tumor Imaging: Metabolic Cancers- Quality Control

A

Visual Inspection (clear//colorless), ID Testing w/ Dose Calibrator, pH (4.5-7.5), Radiochemical & Chemical Purity (99.5%), Residual Solvent analysis, Sterility Testing & Bacterial Endotoxin Test (<175u/mL)

405
Q

PET Tumor Imaging: Metabolic Cancers- Normal Distribution

A

Brain, Myocardium, Liver, Spleen, Stomach, Intestines, Kidneys & Bladder
(Organs w/ increased glucose metabolism, Bone Marrow, Skeletal Msucle, GI tract, Accumulates in Liver)

406
Q

PET Tumor Imaging: Metabolic Cancers- Excretion

A

In Renal System (unlike Glucose)

407
Q

PET Tumor Imaging: Metabolic Cancers- Head/Neck/Brain

A

Cortex intense uptake (6%), WB @ 1-2hrs post = Brain. Can be interpreted as synaptic Activity. Cancer cells metabolize glucose @ high rate; phosphorlization process ends instead trapped in cells, high sensitivity to disease. FDG cannot be broken down or re-cross the cell membrane once transformed into FDG-6-P, accumulation w/in cellular crystal

408
Q

PET Tumor Imaging: Metabolic Cancers- Skeletal Uptake

A

Neck & Paaspinal Musculature; Cause = tension, talking, movement; Scalene or Supraclavicular

409
Q

PET Tumor Imaging: Metabolic Cancers- Retroperitoneal

A

Excreted thru kidneys, accumulation in colon, not filtered by Glomerulus & not re-absorbed, frequent hydrate & void

410
Q

PET Tumor Imaging: Metabolic Cancers- Renal Uptake

A

Poorly reabsorbed by kidneys allowing filtered FDG to be excreted in urine, results can sow intense concentrated activity in renal collecting symptoms, can be influenced by level of renal function, hydration, patient position, activity extendeds Craino-Caudal

411
Q

PET Tumor Imaging: Metabolic Cancers- Liver Uptake

A

Faint, Heterogeous activity

412
Q

PET Tumor Imaging: Metabolic Cancers- Gastrointestinal Tract

A

Large bowel activity can be focal/segmental or diffuse, Focal in colon = further inspection to rule out neoplasm, Segmental Colong = inflamamtion vs. diffuse, Cecum & Right Colon = Increased b//c abundant lymphoid tissue, Stomach = normal LowLevel Activity

413
Q

PET Tumor Imaging: Metabolic Cancers- Thymus

A

“V” shaped (bi-lobed)

414
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Radiopharmaceutical (t1/2, E, Camera)

A

99mTechnetium-Pertechnetate labeled Red Blood Cells
6hrs, 140keV
LEAP or LEHR, Parallel-Hole

415
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Dose & Administration

A

15-30mCi (555-1110MBq) 99mTc -RBCs

Intravenous

416
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - In-Vitro Kit Prep

A

Withdraw 2 10mL blood, centrifuge & wash cells, combine with a reducing agent (Stannous Phosphate) & Anticoagulent./ Add 99mTc-O4 & incubate @ room temp. For 20-30min. Re-inject, image 4hrs later; ULTRATAG (no centrifuge) 95%

417
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - In-Vivo

A

IV inject 2-3mg of stannous pyrophosphate, allow to circulate 15-20min, IV inject 99mTc-O4; 60-90%

418
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Patient Preparation

A

None

419
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Imaging Parameters

A

Patient Supine
3 Electrode standard lead II ECG
Patient lay on R. Side for LAO

420
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Views/Images

A

LAO, ANT, LLAT

  • each view 3-7million counts
  • R. Ventricular function —> Gated 1st Pass in list mode while RBCs injected & 10-15degree RAO position
421
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Frames

A

Divide Cardiac Cycle into 16, 24, or 32 frames. The time that an individual frame wil accumulate counts during a single cardiac cycl depends on the average length pf R-R. 20-30% acceptance window placed around average R-R. Counts begin to be depositied in 1st frame @ first R-R etc. End Diastolic & End Systlic frames can be seen

422
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Indications

A

Detect/Assess CAD, MI, Congestive Heart Failure
Assess Cardiac function in chemo patients
LVEF, SV, CO, Peak Filling Rate

423
Q

Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Results

A

Normal: 5% increase in LVEF in Stress, Homogenous Uptake, Normal Wall Motion, acceptable R-R wave

Abnormal: Akinesis (absence of motion), Hypokinesis (decreased motion) & Dyskinesis (segment of ventricle bulges out), Paradoxical Motion, Abnormal R-R

424
Q

First-Pass- Radiopharmaceutical (t1/2, E, Camera)

A

Any Technetium:
99mTc-DTPA or 99mTc-O4

6rs, 140keV
LFOV; High-Sensitivity Collimator

425
Q

First-Pass- Dose & Administration

A

15-30mCi in <1mL
Rapid Antecubital Intravenous Bolus
Large Bore (>18guage)
Rapid 10mL Saline Flush

426
Q

First-Pass- Patient Preparation

A

Baseline ECG

427
Q

First-Pass- Imaging Parameters

A

Patient Supine or Upright
Camera Anterior or 10-15degree RAO
1mCi source, mark sternal notch & xiphoid
Camera on & Positioned Prior

428
Q

First-Pass- Views/Images

A

ANT, RAO
-ROI drawn over RV, Lungs & LV or Non-Pulmonary BKG
—Applied to Dynamic
-200,000counts/sec; acquisition started before injection,then the bolus & acquisition temrinated once tracer travels thru the right side of the heart, lungs & left side of heart

429
Q

First-Pass- Indications

A

Evaluate R.Ventricular dysfunction, Interventricular shunts, Myocardial Ischemia/Infarction

430
Q

First-Pass- Results

A

Normal: Tracer in the venous blood being shunted into left ventricle & systemic circulation; Paks representing the bolus of activity are observed by graphing each region over time. LV EF calc. After LV ROI, 2-3peaks = contraction, Apices=Diastole & Low Points = Systole

Abnormal: Poor perfusion = mix of oxygen-rich & oxygen-poor blood is ejected into systemic circulation as a result of blood shunting from RV into LV

431
Q

Right-to-Left Shunt Quantification- Radiopharmaceutical

A

99mTc-Macroaggregated Albumin (Tc-MAA)
6hrs, 140keV
LFOV; LEHR

432
Q

Right-to-Left Shunt Quantification- Dose & Administration

A

(Less than Lung Perfusion)
<2-5mmCi, <200,000-700,000particles (20-40um)
Intravenous

433
Q

Right-to-Left Shunt Quantification- Patient Preparation

A

NPO

434
Q

Right-to-Left Shunt Quantification- Results

A

Normal: Cerebral Cortex, bolus in Left Heart, bolus in Lungs, >10%, ROI on Lungs & Total Body

(4-6% in Lungs = Normal)

*Kidneys = Bad Tage/ Free Tc-O4**

435
Q

Myocardial Infarct Amyloid Imaging- Radiopharmaceutical

A

99mTechnetium- Pyrophophate (Tc-PYP)
6hrs, 140keV
LFOV; LEHR

436
Q

Myocardial Infarct Amyloid Imaging- Dose & Administration

A

20mCi, Intravenous

437
Q

Myocardial Infarct Amyloid Imaging- Patient Preparation

A

None, Void Frequently

438
Q

Myocardial Infarct Amyloid Imaging- Imaging Parameters

A

Patient Supine, L. Arm Raised

Image 1hr post Injection (SPECT/PLANAR)

439
Q

Myocardial Infarct Amyloid Imaging- Views/Images

A

Ant, L. Lat., LAO

  • 750,000counts, 90degree
  • 180degee, Non-Gated, 40views///detector, 20sec/stop
440
Q

Myocardial Infarct Amyloid Imaging- Results

A

Normal: 1-2hrs post injection. ~40-50% of dose is taken up by skeleton; localization in heart muscle is 0.01%-0.02% per gram of Acutely Infarcted Myocardium

441
Q

Myocardial Infarct Amyloid Imaging- Critical Organs

A

Bone Surface & Bladder

442
Q

Myocardial Imaging w/ MIBG- Radiopharmaceutical

A

123Iodine-Metaiodobenzylguanine (AdreView Iobenguane I-123)
13.1hrs, 159keV
LFOV; LEHR

443
Q

Myocardial Imaging w/ MIBG- Dose & Administration

A

10mCi, Intravenous

444
Q

Myocardial Imaging w/ MIBG- Patient Preparation

A

~500mg Potassium Perchlorate (PO) or Lugol’s

445
Q

Myocardial Imaging w/ MIBG- Imaging Parameters

A

Planar & SPECT

Heart to Mediastinum Ratio

446
Q

Myocardial Imaging w/ MIBG- Views/Images

A

Ant, L.Lat, LAO

  • imaging begins at 15-20m & Again at 4hrs
  • ROIs over LV myocardium & Non-Cardiac portion of medistinum & Heart-to-Mediastinum Ratio is calc.
447
Q

Myocardial Imaging w//MIBG- Results

A

Normal: washout at 4hrs - 35%

Abnormal: increased washout & decreasing HMRatio = Heart Failure; Decreased uptake w/ increased washout that corresponds to sympathetic denervation = MI (post) & higher risk of vent. Arrhythmias

Increased uptake = dense sympathetic innervation (good)

448
Q

Myocardial Imaging w/ MIBG- Indication

A

Asessing Neuronal Status of heart

449
Q

Myocardial Imaging w/ MIBG- MIBG Function

A

Guanethidine Derivative- a potent Neuron-Blocking acts on sympathetic nerve endings
Molecular structure similar to Noradrenaline

450
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Radiopharmaceuticals (t/1/2, E, Camera)

A 
99mTechnetium-Sestamibi (CardioLite)
OR
99mTechnetium-Tetrofosmin (MyoView)
6hrs, 140kkeV
LFOV;LEHR
451
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Dose & Administration

A

24-36mCi, Intravenous

99mTc-Sestamibi OR 99mTc-Tetrofosmin

452
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Patient Preparation

A

NPO 2-4hrs, D/C Caffiene 12hrs

Comfortable Clothes & Med. List

453
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Imaging Parameters (Stress):

A 
Bruce Protocol (increase Speed & elevation every 3min), monitor Hr/BP @ 85% MAX HR Inject & wit 15-60min to begin imaging. 
Patient Supine, SPECT, L. Arm Raised; Rest - - wait 1hr Repeat
454
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Views/Images

A

Usually 180degrees, Ant, LAO, LLAT

  • 64 projections, 64x64, 20sec/stop
  • Gating, 8 or 16 frames
455
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Indications

A

Detection of CAD, Risk Stratification

Evaluate efficacy of theraputic interventions Drugs//Surgery

456
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Contraindications

A

Nitroglycerin w//in 4-6hrs, Cannot Exercise, Pulmonary Hypertension

457
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Results (Stunned Myocardium)

A

If Stress is Normal, Testing is Done
Stunned Myocardium- Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischemia, length of time stunned = severity) (no myocardial necrosis), rest EF >5% higher than stress EF

458
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Results (Hibernating Myocardium)

A

Prolonged Ischemia, adaptive response in which viable but dysfunctionnal myocardium arises from prolonged myocardial hypoperfusion at rest in the absence of clincially evident ischemia

459
Q

Myocardial Perfusion: 2-Day Technetium Protocol- When to Stop

A

ST Depression = STOP test & Inject

If Stress Normal = Test Done

460
Q

Myocardial Perfusion: 2-Day Technetium Protocol- Adjunct

A

Nitroglycerin

461
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Radiopharmaceuticals

A

99mTechnetium- Sestamibi (CardioLite)
OR
99mTechnetium- Tetrofosmin (MyoView)

6hrs, 140keV
LFOV; LEHR

462
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Dose & Administration

A

Rest: 8-12mCi (99mTc-MIBI or 99mTc-Tetrofosmin)
Stress: 24-36mCi

Intravenous

463
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Patient Preparation

A

NPO 2-4hrs, D/C Caffiene 12hrs (4-6hrs Nitro), Comfortable Clothes, Meds List

464
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Imaging Parameters

A

Rest 1st, inject dose & wait 30m-1hr, Image (15-3m/i). Wait 2-3hrs, Stress w/ Bruce protocol (increase Speed & Elevaion every 3m) monitor HR//BP until 85% MAX HR reached, Inject (w/in 5-10min)Dose & wait 30m-1hr, Image (15-30m/Imge)
Image w/ Gating
Patient Supine w/ L. Arm Raised

465
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Views/Images

A

180degree;Ant, LAO, LLAT

  • 64 projections, 64x64, 20sec/stop (low dose 25sec/stop)
  • Gating, 8 or 16 frames
466
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Adjunct

A

Nitrogen

467
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Indications

A

Detection of CAD, Risk Stratifications,

Evaluate efficacy of therapeutic interventions Drugs/Surgery

468
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Containdications

A

Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension

469
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Results (Stunned Myocardium)

A

Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischema, length of time stunned = severity) (no myocardial necross), Rest EF >5% higher than stress EF

470
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- Results (Hibernating Myocardium)

A

Prolonged Ischemia, adaptive response, in which viable but dysfuncitonal myocardium arise from prolonged myocardial hypoperfusion at rest in the absence of clinically evident ischemia

471
Q

Myocardial Perfusion: 1-Day Rest/Stress Protocol- When to Stop

A

ST Depression = Stop Test & Inject

472
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Radiopharmaceuticals

A

99mTechnetium-Sestamibi (CardioLite)
OR
99mTechnetium-Tetrofosmin (MyoView)

6hrs, 140keV
LFOV; LEHR

473
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Dose & Administration

A

Stress: 8-12mCi; 99mTc-MIBI or 99mTc-Tetrofosmin

Rest: 24-36mCi
Intravenous

474
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Patient Preparation

A

NPO 2-4hrs, D/C Caffiene 12hrs (4-6hr Nitro)

Comfortable Clothes, Med. List

475
Q

Myocardial Perfusion: 1-Day Stress/Rest Perfusion- Procedure

A

Stress w// Bruce Protocol (increase Speed & Elevation every 3min), Inject Dose w/in 5-10min & wait 30min-1hr, Image (15-30min/image), Delay 2-4hr/
‘Rest’, Inject Dose & Wate 30min-1hr, Image (15-30min/I)
If Stress is Normal —Done!

476
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Imaging Parameters

A

Image w/ Gating

Patient Supine, w/ L. Arm Raised

477
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Views/Images

A

180degree; Ant, LAO, LLAT

  • 64 projection, 64x64, 20sec//stop
  • Gating, 8 or 16 frames
478
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Indications

A

Detection of CAD, Risk Stratifications,

Evaluate efficacy of theraputic interventions Drugs/Surgery

479
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Contraindications

A

Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension

480
Q

Myocardial Perfusion: 1-Days Stress/Rest Protocol- Results (Stunned Myocardium)

A

Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischemia, length of time stunned = severity) (no myocardial necrosis), Rest EF >5% higher than stress EF

481
Q

Myocardial Perfusion: 1-Day Stress/Rest Protocol- Results (Hibernating Myocardium)

A

Prolonged Ischemia, adaptice response, in which viable but dysfuncitnoal mycardium arises from prolonged myocardial hypoperfusion at rest in the absence of clinically evident ischemia

482
Q

Myocardial Perfusion: Dual Isotope Protocol- Radiopharmaceuticals

A

201Thallous-Chloride
-73.1hrs; 69-81keV

99mTechnetium- Sestamibi (CardioLite) OR Tetrofosmin (MyoView)
-6hrs; 140keV

483
Q

Myocardial Perfusion: Dual Isotope Protocol- Dose & Administration

A

Rest: 201Tl- 2.5-4mCi
Stress: Tc- 24-36mCi
Intravenous

484
Q

Myocardial Perfusion: Dual Isotope Protocol- Patient Preparation

A

NPO 2-4hrs, Caffiene 12hrs (4-6hr Nitro)

Comfortable Clothes, Med. List

485
Q

Myocardial Perfusion: Dual Isotope Protocol- Protocol

A

Rest, Image within 20min (Inject 201Tl), Image (15-30min//image), NO Delay, Stress / Bruce Protocol (increase Speed & Elevation every 3min) monitor BP/HR until 85% MAX HR achieved, Inject 99mTc @ PEAK, Image w/in 5-10min, Image (15-30min/image)My

486
Q

Myocardial Perfusion: Dual Isotope Protocol- Imaging Parameters

A

Image w/ Gating

Patient Supine w/ L. Arm raised

487
Q

Myocardial Perfusion: Dual Isotope Protocol- Views/Images

A

180degree; Ant, LAO, LLAT

  • 32 projection, 40sec/stop (201Tl)
  • 64 projection, 20sec/stop (high dose) (Tc)
488
Q

Myocardial Perfusion: Dual Isotope Protocol- Adjunct

A

Nitroglycerin

489
Q

Myocardial Perfusion: Dual Isotope Protocol-Indications

A

Detection of CAD, Risk Stratifications
Evaluate efficacy of therapeutic interventions Drugs/Surgery
Need a Rapid Test, Despite High Radiation Dose

490
Q

Myocardial Perfusion: Dual-Isotope Protocol- Contraindications

A

Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension

491
Q

Myocardial Perfusion: Dual-Isotope Protocol- Results (Stunned Myocardium)

A

Delayed Recovery of regional LV dysfunction after a transient period of ischmia, followed by re-perfusion (severe ischemia, legth of time stunned = severity) (no myocardial necrosis), Rest EF >5% higher than Stress EF

492
Q

Myocardial Perfusion: Dual-Isotope Protocol- Result (Hibernating Myocardium)

A

Prolonged Ischemia, adaptive response, in which viable but dysfunctional myocardium arises from prolonged myocardial hypoperfusion at rest in the absence of clinically evident ischemia

493
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Radiopharmaceutical

A

201Thallous-Chloride
73.1hrs, 69-81keV
LFOV; LEAP

494
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Dose & Administration

A

Stess: 2.5-4mCi (201Tl)
Re-inject@ Rest: 1-2mCi (if needed)

Intravenous

495
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Patient Preparation

A

NPO 2-4hrs, D/C Caffiene 12hrs (4-6hrs Nitro)

Comfortable Clothes, Med. List

496
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Procedure

A

Stress w/ Bruce Protocol (increase Speed & Elevation) monitor HR/BP until 85% MAX HR reached, Inject Dose w/in 5-10min & wait 10-15min, Image (15-30min/image). ”Bumper Dose” re-inject. Image Delayes 3-4hrs later. Rest, Inject Dose & wait 10-15min, Image (15-30min/image). Delays at 4 & 24hrs

497
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Imaging Parameters

A

Image w/ Gating

Patient Supine w/ L.Arm raised

498
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Views/Images

A

180degrees; Ant, LAO, LLAT

-32 projections, 40sec//stop

499
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Adjunct

A

Nitroglycerin

500
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Indications

A

Detection of CAD, Risk Stratification
Evaluate efficacy of therapeutic interventions Drugs/Surgery
(Higher extraction rate = good perfusion image)

501
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Contraindications

A

Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension

502
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Results (Stunned Myocardium)

A

Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischemia, length of time stunned = severity)(no myocardial necrosis), Rest >5% higher than Stress EF

503
Q

Myocardial Perfusion: 201Thallous-Chloride Protocol- Results (Hibernating Myocardium)

A

Prolonged Ischemia, adaptive response, in which viable but dysfunctional myocardum arises from prolonged myocardial hypoperfusion at rest in the absence of clincially evident ischemia

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