review game Flashcards
What is the preferred technique for labeling RBC’s? - (it has the highest labeling efficiency)
in vitro
What imaging artifact could potentially occur if a patient with a LBBB or a pacemaker undergoes a nuclear exercise stress test?
false positive septal wall defect
Name the cellular receptor activated by Regadenoson
a2a adenosine receptor
Name the part of the cardiac cycle that involves relaxation of the cardiac muscle (when ventricles are full)
diastole (end diastole)
Name two items that we can use to help assess for patient motion on a MPI study?
sineogram, cine
Can the cine be used to asses for motion if the scan was done on the CZT530?
no
What is this the equation for?
SV/EDV x100%
ejection fraction
What does delayed (4hr/24hr) Tl-201 imaging represent?
redistribution (viable myocardium)
An ischemic event will cause the heart to switch to which type of substrate for its energy needs?
glucose
MPI SPECT imaging on conventional gamma cameras covers _____ degrees and goes from
_______ to _________
180 degrees and 45 RAO and 45 LPO
What is the dose (mg) for all patients receiving Lexiscan?
0.4 mg/5 mL
Which of the following drugs would prevent a patient from undergoing a LST?
Theophylline, Aspirin, Persantine, Caffeine, Heparin
theophylline, caffeine, persantine
What does Myovation Evolution enable us to decrease while still maintaining image quality?
dose or acquisition time or combo of both
Tc99m-Myoview and Tc99m-Sestamibi bind to what in the myocyte?
mitochondrial membrane
Which one (QGS or QPS) enables us to evaluate wall motion?
QGS (g cuz g goes like the wall goes in motion)
Polar maps and SSS would be considered what kind of analysis?
(Qualitative, quantitative, technical, retrospective)
quanitative
What is being quantified by calculating the LVEF on an ERNA study?
percentage of blood ejected from left ventricle per beat
What is being quantified by calculating the LVEF on an ERNA study?
Tc99MAA
What % of Tc99m-MAA would need to be deposited outside of the lungs for a RtLt shunt to be present?
> 10%
Name the reconstruction method that divides the projection images into subsets.
OSEM
Is noise in an image considered low or high frequency?
high
To eliminate noise should a low-pass or high-pass filter be used?
low pass so only low pass get through
Which reconstruction method is associated with the star artifact?
filtered back projection
What is the term that describes the condition when blood supply to the heart does not meet demand?
ischemia
If an area of the myocardium is completely deprived of blood supply and the tissue dies, an __________ has occurred.
infarction
The uptake method for Tl-201 is primarily __________ and for Tc99m-Myoview it is primarily ___________.
active; passive
What is the chelating agent used in the Ultratag Kit for RBC labeling?
tin (stannous ion)
What is the main purpose of syringe I and II in the Ultratag kit?
sequester any residual extracellular tin
Name the two cardiac conditions that we can use Tc99m-PYP to evaluate in Nuclear Cardiac imaging?
Myocardial Infarct
Cardiac Amyloidosis
I-123 MIBG is an analogue of _____________
norepinephrine
In women undergoing MPI, what artifact is most commonly seen?
anterior wall perfusion defect
In men undergoing MPI, diagnosing CAD in which artery might be compromised due to diaphragmatic attenuation?
RCA
Which of the positron emitters have the lowest spatial resolution?
Rb-82 because its MeV travels further = less res
How does prone imaging improve the diagnostic accuracy of SPECT MPI?
shifting the location of any attenuation
I-123 MIBG can be used in the detection of _________________
heart failure
One reason for early termination of a treadmill stress test is if the systolic BP drops by greater than _____ mm Hg
10
The main goal of filtering in nuclear medicine is to reduce ____________ while preserving _________________
noise; resolution
Perfusion on an MPI study can be graded semi-quantitatively using models with either ___ or ____ segments
17 or 20
Perfusion on the 17 or 20 segment models can then be graded on a 5 point scale from 0-4. Which number represents normal perfusion?
0=normal tracer uptake
1=mild reduction of uptake
2=moderate reduction of uptake
3=severe reduction of uptake
4=no uptake of tracer
In a fasting state the heart primarily uses _________ to meet its energy needs
fatty acid
In a fed-state the heart primarily uses _________ to meet its energy needs
glucose
Sarcoidosis is an inflammatory disease in which ______________ gets deposited in tissue.
WBCs (specifically non-caseating granulomas)
How long is the fasting period according to Froedtert’s protocol for F-18 FDG Sarcoid?
What dietary recommendations does the standard protocol give?
NPO after 5 PM
Avoid carbs ( eat high fat/high protein) day before test
Name the method of action for Adenosine and Regadenoson
direct vasodilation
Name the method of action for Persantine
indirect vasodilation
Dobutamine is a positive __________and _____________
inotrope and chronotrope
To determine peak filling and emptying rates on a MUGA (highly quantitative measurements) you need more _________ than the standard 16. This would also require a ___________ acquisition time to achieve adequate count density.
bins (frames), longer
Name two methods of attenuation correction for PET scan
CT Cs-137 rods or Ge-68 rods
What main camera component does our NAI cameras have that the CZT 530 does not?
PMT
We do prone imaging on the CZT 530 to try and eliminate what type of artifact?
diaphragmatic (affects inferior wall of heart)
Name two possible benefits of having a patient do low-level exercise during a pharmacologic stress test
less gi uptake, reduced symptoms
Tl-201 has gamma emissions at two different energy levels. It also has abundant low energy x-rays. What is the energy range of these three emissions?
69-80keV x-rays (90%)
135keV gamma ray (8%)
167keV gamma ray (2%)
What % drop in LVEF would be considered statistically significant on a resting ERNA study?
> 5-7%
The advantage of Tc99m-PYP in the diagnosis of cardiac Amyloidosis is help differentiate which two types of Amyloid?
ATTR and AL
Tc99m-PYP 3hr images are graded on a scale of 0-3. Which number represents uptake equal to that of the ribs?
2
Name a common artifact seen when using filtered back projection (FBP) as a reconstruction method? What filter is used in FBP?
star artifcat; ramp
Could you image a rest MPI scan on the 670 and the stress portion on the CZT530 and compare the two image sets? Why or why not?
no bc CZT 4mm slices vs. 670 6.8mm slices
F-18 FDG viability vs. F-18 FDG Sarcoid
Which exam requires glucose loading and which doesn’t. Why?
viability
Name the three views used to acquire an ERNA study.
45° LAO
ANT
70° LAO
Name the two tracers available to evaluate myocardial viability
F-18 FDG
Tl-201
If the technologist places a portion of the myocardium from the NM emission data in the lung field on CTAC, what is the potential outcome?
false positive
If a patient is unable to reach their target HR on a nuclear exercise stress test, what number of METS should be achieved so the test could still be considered to be diagnostic?
greater than or equal to 10 mets
In general does a high or low Duke treadmill score indicate a low risk for the patient?
higher duke score= lower the ris
In general, if you were performing a 2-Day protocol for a stress test, would you do the rest or stress portion first?
stress
What is the infusion rate for Adenosine?
140ug/kg/min
T1/2 Adenosine?
approx 10 sec
The CZT 530 directly converts photons into what?
electrical signal
Is Lexiscan a high or low-affinity A2A adenosine receptor agonist?
low affinity bc not long term affect
How many half-lives does Lexiscan have?
3
2-4 minutes (initial phase)
30 minutes (intermediate phase)
2 hours (terminal phase
Describe the timing of Lexiscan administration (including tracer)
Lexiscan over 10-20sec
Immediate 5cc saline flush
Inject tracer 10-20sec after flush
What NM study could be used to evaluate for the presence of a LtRt shunt?
First Pass Angiography
Region drawn around lungs
Other than shunt assessment, what other use does First Pass angiography have?
left or right ventricular function
How long after symptoms/MI is the optimal time to inject a patient with Tc99m-PYP to evaluate for infarction?
48-72 hrs
A TID ratio greater than the normal value could indicate what?
extensive CAD (triple vessel disease)
One of the problems with Adenosine is that it is an agonist for A2B and A3 receptors. Activation of these receptors can lead to what undesired side effect?
bronchoconstriction
What are the two key pieces of information derived from I-123 mIBG imaging for heart failure?
HMR (<1.6 = abnormal)
WR (higher washout rate = poorer prognosis)
What is referred to as the “ischemic memory tracer” ?
I-123 BMIPP
What are the three types of coincidence events detected in PET imaging?
true, random, scatter
What are two important quantitative measurements that can be obtained in PET myocardial imaging (that SPECT imaging can’t provide?)
MBF, MFR
Absolute Myocardial Blood Flow (MBF)
MBF uses dynamic acquisition from time of injection (binning data with time)
blood flow in mL/min/g tissue
Normal MBF 0.99 +/- 0.23 mL/min/g
SPECT MPI only relative differences in blood flow
Myocardial Flow Reserve (MFR)
Ratio of hyperemic flow : resting flow
Dynamic acquisition
ROIs around LV myocardium and LV blood pool
time activity curves generated
MFR >2.3 = favorable prognosis
MFR <1.5= significantly diminished , associated with elevated cardiac risk
Which of the PET radiopharmaceuticals we discussed is produced by a generator?
Rb-82
Which PET radiopharmaceutical for cardiology has the best spatial resolution?
F-18 FDG
Which PET tracer is showing promise in evaluating sarcoidosis?
DOTA peptides
