ST:3 Flashcards
Static bone imaging is performed several hours after tracer administration to permit:
(a)maximum tracer uptake in the skeleton
(b) tracer clearance from normal bone tissue
(c) tracer clearance from sites of infiltration
(d) blood clearance of excess tracer
(e) tracer clearance from the kidneys
(d) Maximum skeletal uptake of [99mTc]medronate and [99mTc]oxidronate occurs within 45 min after tracer administration, and imaging is to allow the excess circulating tracer to be cleared from the blood by the kidneys. Such clearance is necessary to increase the target (bone) : non-target (soft tissue) ratio for an optimal image.
For which of the following clinical indications would limited bone imaging (“spot” views) be most appropriate?
(a)Rule out skeletal metastases.
(b) Evaluate Paget’s disease.
(c) Evaluate temporomandibular joint pain.
(d) With history of child abuse, rule out occult fractures.
(e) Rule out kidney stones.
(c) Paget’s disease, skeletal metastases, and occult fractures resulting from child abuse all have the potential to be widespread throughout the skeleton. For these conditions, because their extent is unknown before imaging, total-body bone imaging is indicated. Temporomandibular join (TMJ) pain is localized; therefore, “spot” view imaging of the skull, face (especially in the area of the TMJs), and cervical spine is indicated.
Three- or four-phase bone imaging is particularly useful when which of the following conditions is suspected?
(a)osteomyelitis
(b) osteoporosis
(c) skeletal metastases
(d) stress fracture
(e) compound fracture
(a) Early images are important in diagnosing inflammatory conditions such as osteomyelitis. The flow study, the first phase of a multiphase bone image, is important in demonstrating increased blood flow to the affected area. In osteomyelitis, tracer concentration remains increased throughout the other phases.
The standard views performed in a lung perfusion study are:
(a)anterior and posterior only
(b) posterior and obliques only
(c) anterior, posterior, and lateral of the affected lung
(d) laterals and obliques only
(e) anterior, posterior, laterals, and obliques
(e) At least six views should be performed in a lung perfusion study: anterior, posterior, right and left laterals, and right and left posterior obliques. Some authors recommend eight standard views; these plus right and left anterior obliques.
Upon completion of an imaging procedure, the patient sits up quickly and complains of dizziness and feeling faint. The most appropriate action for the technologist would be to:
(a)Have the patient stand and walk around the room.
(b) Check vital signs.
(c) Have the patient lie down again.
(d) talk with the patient and have the patient breathe slowly and deeply.
(e) Ask the patient if they have a family history of syncope.
(d) Initial feelings of dizziness and faintness when going from a recumbent to an upright position may be the result of a slight drop in blood pressure that occurs when the patient moves too quickly. To help minimize the severity of this orthostatic hypotension, the patient should be encouraged to talk and breathe slowly and deeply. Symptoms should subside within a few minutes. If they do not, the technologist should seek medical help for the patient.
All of the following statements about performing a lung ventilation study with [99mTc]pentetate aerosol are true, EXCEPT:
(a)Multiple projections may be obtained with one dose of tracer.
(b) The patient is disconnected from the nebulizer after inhalation of the aerosol.
(c) The patient is imaged while inhaling particles from the nebulizer.
(d) The face mask, tubing, and nebulizer must be disposed of as radioactive waste.
(e) Some residual tracer may be present in the esophagus.
(c) To perform a ventilation study with [99mTc]pentetate aerosol, the liquid tracer is placed into the nebulizer, where it is broken up into small airborne particles that are inhaled by the patient. The patient is connected to the nebulizer with tubing and a face mask or mouthpiece. After inhalation of the tracer, the patient is disconnected from the delivery apparatus. Then, the patient is imaged. Because the particles remain where they have been deposited for a period of time, the same views that are acquired for the perfusion images may be acquired for the ventilation images. The nebulizer, tubing, and face mask or mouthpiece all are contaminated with [99mTc]pentetate and must be handled as radioactive waste.
The purpose of wrapping the legs with elastic bandages before performing a radionuclide venogram with [99mTc]MAA is to:
(a)distend the veins in the feet
(b) prevent blood clots from traveling to the lung
(c) suppress superficial circulation
(d) trap the tracer in the lower extremities
(e) increase low blood pressure in the patient
(c) The purpose of radionuclide venography is to demonstrate the presence of thrombi in the deep veins of the legs and pelvis (internal iliacs). Therefore, elastic bandages are used to wrap the legs between the ankles and knees to divert blood flow from the superficial circulation to the deep venous system.
When the radiation level coming from a radioiodine therapy patient in isolation is measured, it should be measured:
(a)every day
(b) every day at the same time
(c) at the same distance from the patient each time
(d) every day and at the same distance from the patient each time
(e) at different distances from the patient each time
(d) It is important to monitor a radioiodine therapy patient daily to determine the earliest possible release from isolation. The measurement should be performed using the same instrument and counting geometry each time the radiation level is monitored to permit comparison of measurements.
The function of a draw sheet is to provide:
(a)support for the patient during a stretcher to bed transfer
(b) warmth to the patient during the procedure
(c) protection from infectious disease
(d) patient privacy during an imaging procedure
(e) an activity for the patient during transfer
(a) The draw sheet is the one on which the patient is lying and is used for transferring the patient from stretcher to imaging table.
A gated equilibrium ventricular function study can be performed with which of the following 99mTc-labeled tracers?
(a)pentetate
(b) medronate
(c) human serum albumin
(d) pyrophosphate
(e) macro aggregated albumin
(c) An equilibrium ventricular function study requires a radiopharmaceutical that remains in the blood pool. Many departments label the patient’s red blood cells with [99mTc]pertechnetate, but other facilities prefer the immediate availability of [99mTc]albumin. Currently, [99mTc]albumin is available only outside the United States.
Which of the following diagrams is a correctly labeled representative slice of the horizontal long axis of the left ventricular myocardium?
(a) _\
(b) O
(c) ^
(d) >
(c) All of the diagrams are correctly labeled cross-sectional slices of the heart: (1) transaxial, (b) short axis, (c) horizontal long axis, and (d) vertical long axis.
Stress-rest myocardial imaging performed with [99mTc]sestamibi requires two administrations of tracer, because the tracer:
(a)does not redistribute once it has been taken up by the myocardium
(b) rapidly washes out of the myocardium after administration
(c) has too short a half-life to permit delayed imaging
(d) must be administered immediately after its preparation
(e) has a fast biological half-life
(a) [99mTc]sestamibi is taken up into the myocardium in proportion to blood flow. It is taken into the myocardial cells, bound, and retained in the myocardium. Therefore, it does not redistribute the way [201Tl]thallous chloride does, making it necessary to administer tracer for both the stress and rest portions of the examination.
In a normal hepatobiliary study, which of the following structures will NOT be visualized?
(a)liver
(b) common bile duct
(c) spleen
(d) gallbladder
(e) intestines
(c) Hepatobiliary agents are cleared from the blood by the hepatocytes in the liver. The tracer is cleared from the hepatocytes into the common bile duct and gallbladder, and from there into the small intestine.
In preparation for hepatobiliary imaging, patients are required to fast to:
(a)prevent renal uptake of the tracer
(b) enhance liver uptake of the tracer
(c) minimize the risk of radioactive emesis
(d) avoid stimulating the gallbladder
(e) avoid gastric interference
(d) Ingestion of food may cause the gallbladder to contract, potentially causing a false-positive result; that is, the gallbladder is not visualized. While the gallbladder is contracting, tracer will not be able to flow into it.
To determine the patency of a LeVeen shunt, the radiopharmaceutical is administered into:
(a)a vein
(b) the circle of Willis
(c) the intrathecal space
(d) the shunt tubing
(e) the peritoneal cavity
(e) The physician performs an intraperitoneal injection of the tracer.
Which of the following is the correct patient/camera positioning for imaging a transplanted kidney?
Patient position - Camera placement
(a)Supine - Anterior
(b) Upright - Posterior
(c) Upright - Anterior
(d) Supine - Posterior
(e) Supine - Oblique
(a) A transplanted kidney is placed in the iliac fossa. Therefore, a transplanted kidney should be imaged with the patient supine and the camera placed anteriorly over the pelvis.
In performing an effective renal plasma flow determination, the injection site should be imaged to:
(a)quantitate the amount of tracer deposited at the injection site
(b) calculate the amount of injected activity
(c) rule out tracer infiltration
(d) correct the kidney transit time of the tracer
(e) correct the urinary output graph
(c) Because an ERPF is a quantitative study, any tracer infiltration will invalidate the calculated ERPF values. Therefore, it is essential to confirm that the entire amount of activity was injected into the circulatory system.
Radionuclide cystography performed by the direct method requires which of the following?
(a)intravenous injection of the tracer
(b) use of a renal agent
(c) administration of furosemide
(d) catheterization of the patient
(e) calculation of the ERPF
(d) Direct radionuclide cystography requires that the patient be catheterized and the bladder drained. The tracer is then instilled into the bladder with saline. Although [99mTc]pentetate, a renal agent, may be used, it is not required. [99mTc]sulfur colloid or [99mTc]pertechnetate may be used.
All of the following conditions may demonstrate uptake of 111In-labeled leukocytes EXCEPT:
(a)osteomyelitis
(b) pulmonary embolism
(c) dental abscess
(d) ostomy site
(e) fever of unknown origin
(b) Leukocytes accumulate in areas of infection or inflammation. Thus, they would accumulate at ostomy sites, in osteomyelitis, and in dental abscesses.
Signs/symptoms that a patient is going into anaphylactic shock include all of the following EXCEPT:
(a)skin splotches
(b) pallor
(c) restlessness
(d) tachycardia
(e) hot, dry skin
(e) Pale, cold, clammy skin is characteristic of shock. The patient may also exhibit restlessness and tachycardia.
Which of the following radiopharmaceuticals crosses the intact blood-brain barrier?
(a)[99mTc]pertechnetate
(b) [99mTc]gluceptate
(c) [99mTc]pentetate
(d) [99mTc]bicisate
(e) [99mTc]sulfur colloid
(d) [99mTc]gluceptate, [99mTc]pentetate, and [99mTc]pertechnetate cross the blood-brain barrier only if disease has caused a disruption in the barrier. Therefore, these agents remain in the blood pool unless there is a disruption in the blood-brain barrier. [99mTc]bicisate and [99mTc]exametazime normally cross the blood-brain barrier and are taken up in brain tissue in proportion to blood flow.
The patency of ventriculoperitoneal shunts may be assessed with which of the following tracers?
(a)[111In]chloride
(b) [99mTc]MAA
(c) [99mTc]bicisate
(d) [99mTc]pertechnetate
(e) [99mTc]pentetate
(d) A ventriculoperitoneal shunt is designed to treat hydrocephalus by directing excess cerebral spinal fluid into the peritoneal cavity, where it is absorbed into the circulation. The patency of the shunt can be ascertained by injecting a tracer, typically [99mTc]pertechnetate, into the shunt tubing and imaging the movement of the tracer down the tube into the peritoneum. Because of the short duration of this examination, 99mTc may be used.
According to the FDA, written informed consent must be obtained to administer which of the following radiopharmaceuticals?
(a)[123I]sodium iodide
(b) [99mTc]sestamibi
(c) [131I]sodium iodide
(d) [99mTc]bicisate
(e) [125I]sodium iodide
(c) Written consent must be obtained for any radiopharmaceutical that is investigational. These drugs are referred to as investigational new drugs (INDs). All of the radiopharmaceuticals cited in this publication have been approved by the FDA for clinical use. That is, their new drug authorization (NDA) has been approved, and they are referred to as NDA drugs.
Patient preparation for [89Sr]chloride therapy includes all of the following EXCEPT:
(a)nuclear medicine bone imaging
(b) complete blood count
(c) discontinuation of pain medication
(d) renal function studies
(e) correlated physical exam
(c) Patient preparation for [89Sr]chloride therapy includes total-body bone imaging to demonstrate increased tracer uptake in painful metastatic sites, a complete blood count to confirm adequate platelet and white blood cell counts, and renal function studies because the major route of tracer excretion is through the kidneys.
Patient preparation for 131I therapy for thyroid cancer includes all of the following EXCEPT:
(a)ruling out pregnancy
(b) diet restrictions
(c) reviewing isolation requirements
(d) discontinuing breast-feeding
(e) administering oral potassium iodide
(e) In preparation for 131I therapy for thyroid cancer, the patient will have to be instructed about the requirements and limitations associated with being in isolation. If the patient is female, a pregnancy test MUST BE PERFORMED IMMEDIATELY BEFORE THE RADIOIODINE IS ADMINISTERED. PREGNANCY IS AN ABSOLUTE CONTRAINDICATION to 131I therapy. If the woman is breast-feeding, she must discontinue this activity. Oral potassium iodide may be administered to personnel who are exposed to airborne radioiodine as a means of preventing tracer uptake in the thyroid gland.
One verification method used to ensure that the correct radiopharmaceutical is being administered is to check the label found on the vial. The best times to check this label would include all of the following EXCEPT:
(a)before the vial is removed from the shelf
(b) before the radiopharmaceuticals is dispensed
(c) after the vial is placed back on the shelf
(d) after the radiopharmaceutical is administered to the patient
(e) after the syringe shield is added
(d) Verification should be done before injection, and the label should be checked when the radiopharmaceutical is removed from the shelf, when it is dispensed, and when it is returned to the shelf.
When dual-radionuclide myocardial perfusion imaging is performed, which of the following tracers are used for stress and which for rest?
Stress - Rest
(a)[99mTc]Sestamibi - [99mTc]Teboroxime
(b) [201Tl]Thallous chloride - [99mTc]Sestamibi
(c) [99mTc]Sestamibi - [201Tl]Thallous chloride
(d) [99mTc]Sestamibi - [99mTc]labeled red blood cells
(e) [99mTc]Sestamibi - [99mTc]sulfur colloid
(c) The dual-radionuclide myocardial perfusion imaging protocol used [99mTc]sestamibi for stress imaging and [201Tl]thallous chloride for rest imaging. [99mTc]tetrofosmin may be used in place of [99mTc]sestamibi. The dual-radionuclide protocol shortens the time that patients spend in the imaging department and is useful for evaluating myocardial ischemia and viability.
If [99mTc]sulfur colloid is administered to demonstrate gastrointestinal bleeding, the bleeding can be best visualized how long after the radiopharmaceutical is administered?
(a)20-30 min
(b) 10-15 min
(c) 45 min - 1 hr
(d) Anytime up to 24 hr
(e) Anytime up to 48 hr
(b) [99mTc]sulfur colloid is cleared from the blood and localized in the liver and spleen within 15 min of administration. Therefore, to demonstrate gastrointestinal bleeding with this tracer, it will have to occur while the tracer is still circulating.
Which of the following areas is the recommended injection site for a cardiac first-pass study?
(a)axillary vein
(b) cephalic vein
(c) median basilica vein
(d) dorsal vein
(e) carotid vein
(c) A cardiac first-pass study requires a bolus injection technique to demonstrate each of the cardiac chambers separately. Therefore, a large peripheral vein, such as the median antecubital or external jugular, is needed.
Patient preparation for a 131I therapy includes:
(a)a low-iodine diet for 1 week before the therapy
(b) a high-iodine diet for 1 week before the therapy
(c) a low-carbohydrate diet fro 3 days before the therapy
(d) not consuming any salt for 1 week before the therapy
(e) not consuming potassium for 1 week before the therapy
(a) Patient preparation for 131I therapy includes a low iodine diet for 1 week prior to therapy to help increase the ability of the thyroid gland or metastatic cancer as a whole to uptake the radioactive 131I versus stable iodine. This will allow for a better uptake of the 131I.
For a 67Ga infection imaging, the proper route of administration of the radiopharmaceutical is what?
(a)by inhalation
(b) intramuscularly
(c) orally
(d) intravenously
(e) intrathecal
(d) The proper route of administration for 67Ga infection imaging is intravenously.
Which of the following statements best describes the preferred injection and blood sampling site(s) when performing a plasma volume?
(a)Place a butterfly needle in an antecubital vein for injection of the radiopharmaceutical and subsequent blood sampling.
(b) Intravenous injection should be performed in an antecubital vein, and subsequent blood samples should be obtained from the same vein.
(c) Intravenous injection should be performed in an antecubital vein in one arm, and subsequent blood samples should be obtained from an antecubital vein in the opposite arm.
(d) Intravenous injection should be performed in an antecubital vein, and subsequent blood samples should be obtained from a different antecubital vein in the same arm.
(e) An angiocath should be placed in an antecubital vein for injection of the radiopharmaceutical and subsequent blood sampling.
(c) Because radioiodinated serum albumin is “sticky,” it has a tendency to adhere to substances, including tissue. Tracer administration and blood sampling should be performed, if possible, in contralateral arms.
When administering an intravenous injection, the needle should be inserted into the view at an angle of:
(a)90
(b) 45
(c) 5
(d) 15
(e) 1
(d) An intravenous injection should be done with the needle at about a 15-degree angle to the vein it is being inserted into.
When counting 51Cr red blood cell samples in scintillation well counter, the window should be set around the photopeak at:
(a)320 keV
(b) 159 keV
(c) 81 keV
(d) 511 keV
(e) 664 keV
(a) The gamma energy of 51Cr is 320 keV. Therefore, the scintillation detector should be set to accommodate this photopeak.
Which tomographic plane of the heart displays all walls of the left ventricle?
(a)horizontal long axis
(b) short axis
(c) transaxial
(d) vertical long axis
(e) sagittal
(b) The short-axis slice displays all walls of the left ventricle.
When performing a radioiodine thyroid uptake with an uptake probe, the most appropriate collimator to use is a:
(a)low-energy, high-sensitivity parallel-hole collimator
(b) converging collimator
(c) flat-field collimator
(d) straight-bore collimator
(e) diverging collimator
(c) A scintillation probe with a flat-field-of-view collimator is used for a radioiodine uptake test. The flat-field collimator allows for small variations in organ depth without affecting statistical accuracy.
Which of the following would NOT be in accordance with electrical safety guidelines?
(a)use of three-pronged plugs and outlets
(b) keeping walk areas free from electrical cords
(c) disconnecting an electrical plug from the wall by pulling on the cord
(d) not using frayed or kinked cords
(e) using a 25 amp appliance in a 30 amp outlet
(c) Cords should be disconnected from the wall by grasping and pulling on the plug, NOT on the cord.
Which of the following statements about the image of a left ventricle slice shown here is correct?
_____apex
septum ^ lateral wall
_____base
(a)It is an incorrectly labeled image of a vertical long axis slice.
(b) It is an incorrectly labeled image of a horizontal long axis slice.
(c) It is a correctly labeled image of a vertical long axis slice.
(d) It is a correctly labeled image of a horizontal long axis slice.
(e) It is a correctly labeled image of a short axis slice.
(d) It is a correctly labeled image of a horizontal long-axis slice of the left ventricle.
When using [18F]FDG for PET imaging, which of the following should be considered as a contraindication for performing the study?
(a)low-carb diet
(b) blood glucose level of 120 mg/dL
(c) high-iodine diet within past week
(d) low-iodine diet within past week
(e) blood glucose level of 200 mg/dL
(e) Ideally, the blood glucose should be less than 120 mg/dL when imaging with [18F]FDG. The [18F]FDG competes for glucose receptors, and a high blood glucose level reduced potential uptake of the [18F]FDG.
A 1:25 dilution of a solution with a concentration of 10 uCi/mL is prepared. What is the tracer concentration in the dilution?
(a)0.04 uCi/mL
(b) 0.25 uCi/mL
(c) 2.5 uCi/mL
(d) 0.4 uCi/mL
(e) 4.5 uCi/mL
(d) A 1:25 dilution means that the concentration in the diluted solution is 1/25 of the original concentration. Thus:
1/25 x 10 uCi/mL = 0.4 uCi/mL