ST:4 Flashcards
A [99mTc]medronate image of the region shown (POSTERIOR PELVIS) would best demonstrate which of the following structures?
I. iliac crest
II. distal femur
III. ischium
IV. thoracic vertebrae 10-12
(a) III and IV only
(b) I and III only
(c) III only
(d) I, III, and IV only
(e) I, II, III, and IV
(c) The diagram depicts a posterior view of the lower lumber spine, the pelvis, and the proximal femurs. The iliac crests would be demonstrated on an anterior view of the pelvis. The distal femurs and the tenth through twelfth thoracic vertebrae are inferior and superior, respectively, to the structures shown in the diagram.
In performing a bone image, which of the following views would best demonstrate an abnormality in the calcaneous?
(a)lateral views of the patella
(b) post-void image of the pelvis
(c) posterior view of the distal humerus and radius
(d) anterior view of the distal humerus and radius
(e) plantar view of the feet
(e) The calcaneus-the heal of the foot-would be best imaged by placing the sole of the patient’s foot on the detector. Both feet may be imaged at the same time.
All of the following statements about 4-phase bone imaging are TRUE, EXCEPT:
(a)The study may be performed with any blood pool agent.
(b) This study includes both dynamic and static imaging.
(c) The patient is positioned under the camera before tracer administration.
(d) The third phase is performed 5-6 hr after tracer administration.
(e) The fourth phase is performed the next day.
(a) Because the second through fourth phases are performed to determine the presence of increased, persistent tracer uptake in the bone, the study must be performed with a bone agent.
Which of the following patients should receive fewer particles than typically administered for lung perfusion imaging?
(a)80-year-old woman with suspected pulmonary embolism
(b) 65-year-old man with chronic obstructive pulmonary disease
(c) 25-year-old woman with asthma
(d) 45-year-old man with right-to-left cardiac shunt
(e) 19-year-old women who is pregnant
(d) Patients with right-to-left cardiac shunts should be given a reduced number of particles because the particles pass through to the left side of the heart and into the systemic circulation, where they block capillaries and occlude blood flow in the brain, kidneys, heart, and other organs.
Which of the following statements about the wash-in/wash-out method for performing xenon ventilation studies is TRUE?
(a)The patient rebreathes a mixture of xenon and oxygen during the wash-in phase.
(b) The patient can be disconnected from the gas-trapping apparatus after the wash-in phase.
(c) This method is not recommended for comatose patients.
(d) It is not necessary to introduce oxygen or air into the xenon delivery system.
(e) The xenon system is a self-contained generator of xenon.
(a) In the wash-in/wash-out method, the patient breathes a mixture of xenon and oxygen for several minutes while a wash-in image is acquired. Air is then added to the system, and the xenon that is exhaled is trapped. Serial images are acquired as the xenon clears from the lungs. This method requires little cooperation from the patient; no breath-holding or deep breaths are required. therefore, the method is well-suited for comatose patients as well as for those on ventilators.
After the administration of [99mTc]pentetate aerosol with a face mask, radioactive contamination is likely to be found in all of the following areas EXCEPT:
(a)on the technologist’s hands
(b) around the patient’s mouth
(c) on the patient’s chest
(d) on the floor between the patient and nebulizer
(e) on the patient’s face
(a) there is aerosol leakage at the exhaust of the delivery system. the filter is unable to trap the exhausted aerosol sufficiently to prevent the escape of airborne tracer from the delivery system. The area around the patient’s mouth becomes contaminated when a face mask is used. Some of the airborne tracer is not inhaled and is deposited on the patient’s face.
Thyroid imaging may be performed with which of the following radiopharmaceuticals?
(a)[99mTc]pertechnetate
(b) [99mTc]sestamibi
(c) [99mTc]medronate
(d) [99mTc]pyrophosphate
(e) [99mTc]sulfur colloid
(a) For routine thyroid imaging, either [99mTc]pertechnetate or [123I]sodium iodide may be used. [99mTc]pertechnetate is trapped by the follicular cells of the thyroid. [123I]sodium iodide is trapped and organified (incorporated into the manufacture of thyroid hormones).
When performing a radioiodine thyroid uptake, nonthyroidal (body) background measurements may be taken over the:
(a) lateral skull
(b) mediastinum
(c) thigh
(d) abdomen
(e) substernal notch
(c) Nonthyroidal background measurements may be collected over the thigh. The uptake probe should be positioned vertically just above the patient’s knee to exclude bladder activity.
Pulse rates may be determined by all of the following methods EXCEPT:
(a)listening to the heart with a stethoscope
(b) using a pulse oximeter
(c) multiplying the respiration rate by 4
(d) analyzing the electrocardiogram
(e) using a 3-lead EKG
(c) In addition to the routine finger method of determining the radial pulse, pulse rates can be determined from the ECG or pulse oximeter. Listening to the heart with a stethoscope will give a pulse rate known as the apical pulse.
Which of the following statements regarding the administration of oxygen is FALSE?
(a) Oxygen is classified as a drug.
(b) With the consent of a physician or nurse, an oxygen appliance may be removed from the patient if it interferes with the imaging procedure.
(c) Oxygen therapy may be ordered by a physician, nurse, athletic trainer, or respiratory therapist.
(d) Orders for oxygen therapy must include the amount to be delivered, and the type of oxygen appliance to be used.
(e) Orders for oxygen therapy must include whether administration is to be continuous or intermittent.
(c) Because oxygen is a drug, it must be prescribed by a physician who specifies the amount to be received, the device to be used, and the time interval (continuous vs. intermittent). Cessation of oxygen therapy can be done only with the consent or supervision of a physician or attending nurse.
Treatment of the adverse effects induced by dipyridamole involves the administration of:
(a)aminophylline
(b) adenosine
(c) acetazolamide
(d) nitroglycerin
(e) aspirin
(a) Adverse effects of dipyridamole-a vasodilator-include hypotension, headache, and nausea. these effects may be reversed by administering aminophylline intravenously.
Which of the following must be discontinued for at least 24-36 hr before the administration of dipyridamole?
(a)water
(b) theophylline
(c) insulin
(d) Lasix
(e) aspirin
(b) When adenosine or dipyridamole is used for stress testing, the patient should be instructed to discontinue the use of certain substances that interfere with the action of these drugs. Caffeine and medications containing caffeine should not be consumed for at least 12 hr before testing. the use of xanthine derivatives (theophylline, aminophylline) should be discontinued for 24-36 hr before the nuclear medicine procedure. In a normal hepatobiliary study, the duodenum and proximal jejunum are visualized by 30 min after tracer administration.
In a normal hepatobiliary study, excretion of the tracer into the intestine should occur a maximum of how long after tracer administration?
(a)20-30 min
(b) 35-40 min
(c) 45-60 min
(d) 1-2 hr
(e) 2-3 hr
(a) In a normal hepatobiliary study, the duodenum and proximal jejunum are visualized by 30 min after tracer administration.
Which of the following agents would be used to perform a gallbladder ejection fraction?
(a)morphine and [99mTc]lidofenin
(b) sincalide and [99mTc]sulfur colloid
(c) sincalide and [99mTc]disofenin
(d) morphine and [99mTc]mertiatide
(e) sincalide and [99mTc]medronate
(c) A gallbladder ejection fraction is useful in assessing gallbladder dysfunction. In cases of delayed gallbladder visualization, sincalide is administered when the gallbladder is full. Pre- and postcontraction images are used to calculate an ejection fraction.
For which of the following procedures is the radiopharmaceutical administered orally?
(a)vesicoureteral reflux imaging
(b) gastrointestinal bleeding
(c) salivary gland imaging
(d) gastric emptying
(e) gallbladder ejection fraction determination
(d) For the determination of gastric emptying, the patient ingests the radiopharmaceutical. tracers to detect gastrointestinal bleeding and to image the salivary glands are administered intravenously. Depending on the method used, tracers to detect vesicoureteral reflux are instilled into the urinary bladder via a catheter (direct method) or injected intravenously (indirect method).
Patient preparation for functional renal imaging should include which of the following?
(a) hydration of the patient
(b) discontinuation of all medications
(c) fasting for at least 2 hr before imaging
(d) administration of furosemide 1 hr before imaging
(e) fasting for at least 4-6 hrs before imaging
(a) Renal function imaging should be performed with the patient in a normal state of hydration. To ensure hydration, the patient should drink 0.5 L of water 30-60 min before the study. False abnormal results may be obtained if the patient is not hydrated.
Static renal imaging is performed about how long after the administration of [99mTc]succimer?
(a)immediately
(b) 2 hr
(c) 4 hr
(d) 8 hr
(e) 6 hr
(b) [99mTc]succimer (DMSA) is used for static renal cortical imaging. Imaging is performed about 2 hr after tracer administration.
Patient preparation for [67Ga]citrate imaging may include administration of which of the following?
(a)diuretics
(b) potassium perchlorate
(c) Lugol’s solution
(d) adenosine
(e) laxatives
(e) [67Ga]citrate is excreted in the feces. The activity in the bowel may interfere with the interpretation of the study. Therefore, a bowel preparation may be prescribed at the time the tracer is administered.
A normal biodistribution of 111In-labeled leukocytes will demonstrate the greatest tracer uptake at 24 hr after injection in which of the following sites?
(a) bone marrow
(b) liver
(c) lung
(d) heart
(e) spleen
(e) At 24 hr after injection, a normal biodistribution of 111In-labeled leukocytes demonstrates tracer uptake only in the spleen, liver, and bone marrow. The greatest uptake is in the spleen, followed by the liver and the bone marrow.
A patient with diabetes who becomes hypoglycemic may exhibit all of the following signs and symptoms EXCEPT:
(a) weakness and shakiness
(b) confusion
(c) irritability
(d) nausea and vomiting
(e) low blood sugar
(d) Hypoglycemic patients may exhibit an intense hunger; might be weak and shaky; and may sweat excessively. They may become confused and irritable. Most patients will recognize symptoms before they become severe.
Which of the following tracers may be used to confirm brain death?
(a)[99mTc]oxidronate
(b) [99mTc]exametazime
(c) [99mTc]mertiatide
(d) [201Tl]thallous chloride
(e) [99mTc]medronate
(b) [99mTc]gluceptate, [99mTc]pertechnetate, or [99mTc]pentetate have been used to demonstrate brain death with a cerebral blood flow study followed by immediate static imaging. [99mTc]exametazime more recently has been used for this purpose. Because this tracer is normally concentrated in brain tissue in proportion to blood flow, it can visualized the degree of perfusion in the brain.
Counting cotton gauze that has been placed in a patient’s nose after intrathecal tracer administration is most useful when which of the following conditions is suspected?
(a)rhinorrhea
(b) hydrocephalus
(c) CSF shunt patency
(d) blockage of CSF flow
(e) pump patecy
(a) In the case of cerebral spinal fluid leaks through the nose (rhinorrhea) or ears (otorrhea), placing cotton gauze in the patient’s nose or ears is helpful in diagnosing such leaks. This technique is particularly useful with small leaks that may not be visualized on images.
Collodial [32P]chromic phosphate is administered by which of the following routes?
(a)intravenous
(b) intraperitoneal
(c) subcutaneous
(d) inhalation
(e) intrathecal
(b) Colloidal [32P]chromic phosphate is used to treat pleural or peritoneal effusions resulting from a malignancy. The agent is introduced directly into the pleural or peritoneal cavity. It should not be administered intravenously because it will be taken up in the liver, causing localized radiation damage.
Which of the following radiation safety measures should be used when performing 89Sr therapy?
(a)use of lead vial and syringe shields
(b) monitoring patient radiation levels daily
(c) use of absorbent paper in isolation room
(d) monitoring patient radiation levels weekly
(e) urinary catheterization for incontinent patients
(e) It is recommended that incontinent patients receiving [89Sr]chloride be catheterized to minimize the spread of contamination. Because 89Sr is primarily a beta emitter (less than 1% gamma emission), it is not necessary to place patients in isolation or monitor them with a survey meter. Lead shielding should not be used with this beta emitter because bremsstrahlung radiation will be produced in the shielding.
On the basis of blood flow, which of the following is visualized as an area of high tracer concentration on a brain image performed with [99mTc]exametazime?
(a)pineal body
(b) white matter
(c) gray matter
(d) medulla oblongata
(e) pituitary gland
(c) Uptake of SPECT brain agents is primarily in the gray matter of the cerebrum, which has a higher blood flow than white matter. These agents are localized in proportion to blood flow.
A technologist is performing a lung image on a patient known to have active tuberculosis. The most appropriate personal protective device the technologist should use it:
(a)latex gloves
(b) gown
(c) lab coat
(d) mask
(e) booties
(d) The mask is the most appropriate for airborne respiratory diseases.
The patency of a LeVeen shunt may be demonstrated with which of the following radiopharmaceuticals?
(a)[99mTc]disofenin or [99mTc]sulfur colloid
(b) [99mTc]albumin or 99mTc-labeled red blood cells
(c) [99mTc]pentetate or [99mTc]pertechnetate
(d) [99mTc]MAA or [99mTc]sulfur colloid
(e) [99mTc]medronate or [99mTc]sulfur colloid
(d) A LeVeen shunt is used to treat ascites by draining the excess fluid that accumulates in the peritoneal cavity into the superior vena cava. Sometimes the shunt tube becomes blocked. Radionuclide imaging is used to differentiate mechanical blockage of the tube from other reasons for increasing ascetic fluid. Imaging may be performed with either [99mTc]MAA or [99mTc]sulfur colloid. After the introduction of one of these tracers into the peritoneal cavity, images of the anterior abdomen (and chest if MAA is used) will demonstrate activity in the liver or lungs, confirming that the shunt is functioning. If the liver or lungs are not visualized, then the tubing is blocked.
Which of the following is common to imaging gastroesophageal reflux in both adults and children?
(a) [99mTc]macro aggregated albumin is the tracer of choice.
(b) The patient must fast starting at midnight before the test.
(c) An abdominal binder is used to increase pressure over the abdomen.
(d) The patient ingests dilute hydrochloric acid with the tracer.
(e) [99mTc]Sulfur colloid is the tracer of choice.
(e) [99mTc]sulfur colloid is the radiopharmaceutical used to image gastroesophageal reflux in both adults and children. However, adults are administered a mixture of dilute hydrochloric acid, orange juice, and tracer after fasting from midnight. In infants and toddlers, the procedure is performed at the time of a scheduled feeding, so they may fast as little as 2 hr before receiving the tracer. In adults, an abdominal binder is used to increase external abdominal pressure to demonstrate more subtle instances of reflux. Because the abdominal muscles are important in pediatric respiration, the binder is typically not used with children, particularly infants.
The following studies are ordered for a patient:
I. ERPF determination
II. total-body bone imaging
III. [111In]pentetreotide imaging
In which order should the studies be performed so they do not interfere with one another and they can be accomplished in the shortest amount of time?
(a) I, II, III
(b) I, III, II
(c) II, I, III
(d) III, II, I
(e) II, III, I
(a) In general, a quantitative study-any study whose results are a number-should be performed first, so radioactivity from another study does not interfere with or have to be accounted for when calculating the results of a quantitative study. An ERPF is performed with [99mTc]mertiatide. This radiopharmaceutical clears the kidneys quickly. Its 6-hr half-life is short enough to permit bone imaging the next day. [111In]pentetreotide imaging should be performed last. 111In has a three-day half-life, and the tracer may remain in the body for an extended period.
Which of the following is the common term for the artifact created by the presence of metals in the patient in CT imaging?
(a) ringing
(b) partial volume
(c) arcing
(d) biasing
(e) streaking
(e) Patient-generated artifacts commonly come from patient motion, beam hardening, or metallic artifacts (commonly causing streak artifacts).
The region(s) of interest for detection of a left-to-right cardiac shunt is (are) drawn around which of the following structures?
(a) superior vena cava
(b) one or both lungs
(c) left ventricle
(d) right ventricle and great vessels
(e) aorta
(b) The region(s) of interest for detection of a left-to-right cardiac shunt is (are) drawn around one or both lungs to generate a pulmonary time-activity curve. The curve demonstrates the first pass of tracer through the lungs, as well as any tracer that has returned to the lungs and bypassed the systemic circulation.
Which of the following sets of vital sign measurements represent normal values for an adult?
Pulse(bpm) - Blood pressure(mm Hg) - Respirations(resp/min) - Temperature(oral,F)
(a)75 - 120/80 - 17 - 98.6
(b) 60 - 100/50 - 12 - 98.6
(c) 45 - 120/80 - 10 - 97
(d) 100 - 150/100 - 25 - 102
(e) 110 - 100/200 - 30 - 105
(a) The normal ranges of vital signs for adults are: Vital sign - Range Pulse - 60-100 beats per minute Blood pressure Diastolic 60-90 mm Hg Systolic 95-140 mm Hg Respirations 12-20 breaths/min Temperature 97.7-99.5F (36.5-37.5C)
A common antecubital vein used for intravenous administration of a radiopharmaceutical is the:
(a)radial
(b) cephalic
(c) brachial
(d) ulnar
(e) plantar
(b) A variety of antecubital veins can be used for drug administration, but the two most commonly used are the basilica and cephalic veins.
The 51Cr red cell sequestration study is performed to identify abnormal destruction of red blood cells by the:
(a) bone marrow
(b) spleen
(c) liver
(d) heart
(e) gallbladder
(b) The red cell sequestration study is performed to determine if the patient’s anemia is the result of active splenic sequestration of normal red cells.
The difference in hematocrit values between the average whole-body hematocrit and the venous hematocrit is the result of:
(a)variation in red blood cell diameter
(b) difference in vessel size
(c) increased amount of blood in the extremities
(d) plasma leakage
(e) difference in size of white blood cells
(b) Hematocrits vary with vessel size. Smaller vessels yield a lower hematocrit value than larger vessels.
On the basis of these counts per minute obtained from a thyroid uptake test: Thyroid: 2876 Patient background: 563 Standard: 10,111 Room background: 124 the percentage radioiodine uptake is: (a)3.5%
(b) 4.3%
(c) 28%
(d) 23%
(e) 50%
(d) The formula for calculating thyroid radioiodine uptake is:
% uptake = net thyroid cpm x 100 / net standard cpm
Using the data, the percent uptake is:
(2876 - 563 cpm) x 100 / (10,111 - 124 cpm) = 23%
A technologist is asked to check the flow rate on a drip infusion on a patient in the department. An acceptable flow rate is how many drops per minute?
(a)1-5
(b) 75-100
(c) 40-60
(d) 10-20
(e) 100-125
(d) An acceptable flow rate for a drip infusion is 10-20 drops per minute. This rate may be adjusted by physician order.
The total blood volume may be calculated by dividing the measured red cell volume by the:
(a)hematocrit
(b) plasmacrit
(c) number of red blood cells determined from a hemocytometer
(d) corrected plasmacrit
(e) corrected hematocrit
(e) The formula for calculating the total blood volume (TBV), based on the red cell volume, uses the corrected hematocrit (HCT) in the denominator. Correction is needed to account for trapped plasma and to adjust the venous hematocrit to an average whole body hematocrit. the formula is:
TBV = red cell volume / (HCT x 0.91 x 0.97)
The following data were collected for a plasma volume determination:
Net standard counts: 839,621 cpm
Standard dilution factor: 15
Net plasma counts: 2,528 cpm/mL
The calculated plasma volume in milliliters is:
(a)2,214
(b) 3,321
(c) 4,516
(d) 4,982
(e) 5,280
(d) The formula for calculating plasma volume is:
PV = (net standard cpm)(dilution factor) / (net plasma cpm/mL)
From the data supplied:
PV = (839,621 cpm)(15) / (2528) = 4982 mL
If the concentration of a 1:2,000 dilution is 0.05 uCi/mL, what is the tracer concentration of the original solution?
(a)0.00025 uCi/mL
(b) 10 uCi/mL
(c) 25 uCi/mL
(d) 100 uCi/mL
(e) 125 uCi/mL
(d) A 1:2,000 dilution means that the concentration in the diluted solution is one 2,000th of the original concentration. In this problem, the concentration of the original solution is unknown. thus:
(? uCi/mL) x 1/2000 = 0.05 uCi/mL
1/2000 = 0.05 uci/mL / x
x = 2000(0.05 uCi/mL) = 100 uCi/mL
