ST:5 Flashcards
A [99mTc]oxidronate image of the region shown (ANTERIOR THORAX/PROXIMAL UPPER EXTREMITIES) would demonstrate all of the following structures EXCEPT the:
(a)costochondral junctions
(b) acromion processes
(c) clavicles
(d) sternum
(e) humerus
(b) The diagram depicts an anterior view for the rib cage and proximal upper extremities. The acromion processes would be demonstrated on a posterior view of the upper thorax that includes the scapulae.
For a patient undergoing bone imaging, which of the following information from the medical history is relevant to the interpretation of the bone image?
(a)splenectomy 5 years ago
(b) abdominal surgery 10 days ago
(c) radiation therapy to the breast 6 months ago
(d) gallbladder surgery a year ago
(e) results of previous bone imaging procedures
(e) Results of previous bone imaging procedures performed with nuclear medicine or another imaging modality may provide additional information not demonstrated on the current image or indications that the condition has improved or worsened. Healing soft tissue, such as that resulting from recent abdominal surgery, will concentrate bone tracer in an unexpected area. External beam radiation therapy can cause photopenic areas-areas of decreased tracer activity- on the bone image in the area where the therapy was delivered. All of this information will help the physician explain the findings on a bone image.
If a patient is injected with [99mTc]MAA while in an upright position, which of the following is most likely to be seen on the perfusion lung images?
(a)increased tracer activity in the lung apices
(b) decreased tracer activity in the lung bases
(c) decreased tracer activity in the lung apices
(d) decreased tracer activity throughout both lungs
(e) the heart
(c) If the patient is in the upright position, the apices of the lung receive very little blood flow, Consequently, more MAA particles will be distributed in the bases of the lungs than in the apices. In the supine position, although there is a blood flow gradient from anterior to posterior, there is a more homogeneous distribution of particles from apex to base.
If the usual adult dosage of [99mTc]MAA is 4 mCi, a patient who has had a right pneumonectomy should receive what dosage?
(a)1 mCi
(b) 3 mCi
(c) 2 mCi
(d) 5 mCi
(e) 4 mCi
(c) For an adult patient who has only one lung and, therefore, half the lung vasculature, half the usual dosage is recommended. This reduces the number of particles to approximately half of what is administered in a full dosage.
Which one of the following steps would be appropriate during a standby-assist wheelchair transfer?
(a)The wheelchair should be perpendicular to the imaging table.
(b) The wheelchair footrests should be out of the way.
(c) The wheelchair should be placed parallel to the imaging table.
(d) The wheelchair should be unlocked.
(e) The transfer should take place in the presence of a physician.
(b) The footrests should always be moved out of the way. The wheelchair must be properly aligned to the imaging table (depending on patient condition) and locked.
Patient preparation for infection imaging using tagged white blood cells includes:
(a)fasting for at least 4 hr with a blood glucose level below 120 mg/dL
(b) lab work and information concerning recent blood transfusions
(c) discontinuation of certain medications
(d) smoking cessation for at least 24 hr
(e) fasting for at least 4 hr with a blood glucose level below 200 mg/dL
(b) No special preparation is needed for a white blood cell infection imaging other than a possible interference if the patient has had a recent blood transfusion.
Thyroid imaging may be performed with which of the following collimators?
(a)flat field
(b) pinhole
(c) parallel hole
(d) pinhole or parallel hole
(e) slant hole
(d) A pinhole collimator provides an image with better resolution and offers the ability to obtain oblique views. A parallel-hole collimator used with electronic zoom can provide a magnified image with good resolution.
In performing a thyroid uptake, a technologist collects the thyroid counts 5 cm from the surface of the patient’s neck and the standard counts 20 cm from the surface of the neck phantom. What is the effect on the thyroid uptake value calculated from this data?
(a)The uptake value will be falsely increased.
(b) The uptake value will be falsely decreased.
(c) The uptake value will be accurate.
(d) The results are unpredictable.
(e) There is no effect.
(a) Recall that, as a point source is moved closer to the face of a flat-field collimator, more counts are collected. If the standard represents the total amount of activity administered to the patient, the counts collected from the patient’s neck represent a portion of the total amount of activity that concentrated in the thyroid gland. It is important, therefore, based on the response of the detector at a given distance, to count both the standard and the patient at the same distance. For example, suppose the standard and the patient were both counted at 20 cm, and 20,000 net cpm and 5,000 net cpm were obtained, respectively. The patient’s uptake is:
neck counts x 100 / standard counts = 5000 cpm x 100 / 20,000 cpm = 25%
If the patient were counted at 5 cm instead of 20 cm, more counts would be collected (i.e., 10,000 cpm). Then, the patient’s uptake is falsely increased:
neck counts x 100 / standard counts = 10000 cpm x 100 / 20,000 cpm = 50%
The percentage left ventricular ejection fraction calculated from the net counts per minute shown here: End diastole: 2875 End systole: 2162 is approximately: (a)25%
(b) 13%
(c) 33%
(d) 100%
(e) 75%
(a) The counts per minute are obtained from the regions of interest drawn around the end-diastolic and end-systolic images. The counts in each region are then corrected for background. The formula for calculating the left ventricular ejection fraction is:
LVEF = (net end-diastolic counts - net end-systolic counts) x 100 / net end-diastolic counts
= (2875 cpm - 2162 cpm) x 100 / 2875 cpm = 25%
When a technologist cares for a patient who is not known to have a communicable disease, all of the following infection control measures should be implemented EXCEPT:
(a)wearing gloves when collecting a blood sample
(b) decontaminating imaging equipment with an antiseptic
(c) handwashing before and after the nuclear medicine examination
(d) using a needle recapping device
(e) maintaining aseptic technique when administering the radiopharmaceutical
(b) Standard precautions should be used routinely with all patients. These precautions include activities such as hand washing, wearing gloves, and recapping needles using a safety device. Decontaminating imaging equipment would be performed only if it came in contact with biological fluids from a patient or with a patient known to be infected with a communicable disease.
Normal sinus rhythm is characterized by which of the following? I. 60-100 beats/min II. R wave occurs at constant intervals III. PR interval 0.12-0.20 sec long (a)I and II only
(b) I and III only
(c) II and III only
(d) I, II, and III
(e) III only
(d) the characteristics of normal sinus rhythm as they appear on an ECG tracing are: (1) heart rate of 60-100 beats per minute, (2) R waves at regular intervals (variance of less than 0.12 sec), (3) P waves present and precede QRS complex, (4) PR interval between 0.12 and 0.20 sec long, and (5) QRS complex less than 0.12 sec.
After stress myocardial imaging with [201Tl]thallous chloride, 1-1.5 mCi of [201Tl]thallous chloride may be administered before rest myocardial imaging to:
(a)improve patient throughput
(b) demonstrate reversible ischemia more readily
(c) demonstrate infarct size more precisely
(d) minimize visualization of attenuation artifacts
(e) maximize visualization of attenuation artifacts
(b) Defects visualized on stress images are interpreted as myocardial ischemia if the defects fill in on the resting images. However, the rate of redistribution varies, and ischemic areas may not appear to have re-perfused by 4 hr. Administering a second, smaller dose of 201Tl before rest imaging provides additional tracer in the circulation that can be extracted into there areas, improving the image quality and identifying reversible ischemia.
If the gallbladder is not visualized within 60 min during hepatobiliary imaging, which of the following may be administered?
(a)cimetidine
(b) morphine
(c) dobutamine
(d) furosemide
(e) adenosine
(b) If the gallbladder is not visualized after 1 hr but tracer is seen in the common bile duct and small intestine, morphine may be administered. Morphine acts on the sphincter of Oddi, causing it to contract, thus increasing pressure in the common bile duct and causing tracer to flow into the gallbladder.
Preparation of the patient for Meckel’s diverticulum localization includes:
(a)administration of laxatives
(b) oral or intravenous hydration
(c) an enema immediately before imaging
(d) fasting for at least 2 hr before imaging.
(e) an enema immediately after imaging
(d) Bowel preparations are contraindicated before Meckel’s diverticulum imaging because they irritate the intestinal mucosa, possibly causing a false-positive finding. It is recommended that patients fast for at least 2 hr before imaging to reduce stomach secretions that cause migration of [99mTc]pertechnetate from the stomach into the bowel.
Which of the following 99mTc-labeled agents is the preferred tracer for demonstrating intermittent gastrointestinal bleeding?
(a)human serum albumin
(b) lidofenin
(c) red blood cells
(d) sulfur colloid
(e) macro aggregated albumin
(c) Because [99mTc]sulfur colloid is cleared from the blood within 10-15 min after administration, it is preferred when the patient exhibits active gastrointestinal (GI) bleeding. In cases where the GI bleeding is intermittent and unpredictable, 99mTc-labeled red blood cells are preferred, because this tracer remains in the blood pool for an extended period that permits imaging up to 24 hr.
Furosemide is sometimes administered during renal imaging to:
(a)Rule out transplant rejection.
(b) Increase blood flow to the kidneys.
(c) Enhance tracer uptake in an abnormal kidney.
(d) Rule out ureteropelvis obstruction.
(e) Decrease blood flow to the kidneys.
(d) Furosemide is a diuretic that increases the production. Activity retained in the collecting system or renal pelvis may indicate an obstruction in that area. Furosemide is used to wash out the activity with an increased production of urine. If the activity clears after the administration of furosemide, there is no obstruction.
Which of the following events is a normal response when furosemide is administered near the end of a renal function study?
(a)The peak transit time of the radiopharmaceutical is elongated.
(b) Radioactivity is taken up into the renal cortex.
(c) Mechanical blockages in the renal collecting system are cleared.
(d) The peak transit time of the radiopharmaceutical is shortened.
(e) Radioactivity is cleared from the renal pelvis into the bladder.
(e) Furosemide is a diuretic that increase the production of urine. Activity retained in the collecting system or renal pelvis may indicate an obstruction in that area. Furosemide is used to wash out the activity with an increased production of urine. If the activity clears after the administration of furosemide, there is no obstruction. Clearance of the activity is the normal response.
Early (6 hr after injection) 67Ga imaging should be performed if which of the following conditions is suspected?
(a)sarcoma
(b) osteomyelitis
(c) lymphoma
(d) bronchogenic carcinoma
(e) chrondrosarcoma
(b) 67Ga imaging can be performed form 6 hr to 3 days or longer after tracer administration. When the examination is being performed for evaluation of an inflammatory process, early imaging (6 hr after injection) is indicated.
The most effective way of controlling the spread of infectious disease in a hospital setting is for the technologist to:
(a)Wash hands both before and after patient contact.
(b) Wear gloves, mask, and hospital gown at all times.
(c) Stay home when ill.
(d) Maintain distance from each patient.
(e) Always wear a face mask.
(a) It is widely accepted that hand washing is considered to be the single most-effective way of preventing the spread of infection in a medical care facility.
[111In]Pentetreotide normally localizes in all of the following sites EXCEPT:
(a)pituitary gland
(b) salivary glands
(c) spleen
(d) thyroid gland
(e) liver
(b) [111In]pentetreotide normally localizes in the pituitary gland, thyroid gland, liver, spleen, bladder, and bowel.
SPECT brain imaging may begin how soon after the administration of [99mTc]exametazime?
(a)immediately
(b) 1-2 hr
(c) 15-20 min
(d) 24 hr
(e) 48 hr
(b) For the best image quality, brain imaging with [99mTc]exametazime should begin no sooner than 90 min after the administration of the tracer.
Radioactivity is visualized in all of the following areas during a normal cisternographic study EXCEPT the:
(a)cerebral convexities
(b) basal cisterns
(c) central canal
(d) lateral ventricles
(e) subarachnoid space
(d) Normally, cerebral spinal fluid flows out of the lateral ventricles. Reversal of this flow (or reflux) and visualization of tracer in the lateral ventricles is an abnormal finding.
Patient preparation for instilling colloidal [32P]chromic phosphate into the peritoneal cavity includes which of the following?
(a)surgical placement of a LeVeen shunt to remove excess peritoneal fluid
(b) fasting for 8-12 hr before radiopharmaceutical administration
(c) instructing the patient about isolation requirements
(d) introducing [99mTc]sulfur colloid into the cavity to confirm that the 32P will disperse evenly
(e) administering an antacid 2-4 hours before the procedure
(d) Before instilling 32P into the peritoneal space, [99mTc]sulfur colloid is introduced to demonstrate that the agent will disperse throughout the cavity, thereby uniformly irradiating the peritoneal space.
Patient preparation for post-thyroidectomy 131I whole-body imaging for metastases may include all of the following EXCEPT:
(a)administration of 600-1000 mg of potassium perchlorate 2 hr before imaging
(b) administration of exogenous TSH
(c) discontinuation of replacement thyroid hormone
(d) following a low-iodine diet for 1-2 weeks before imaging
(e) no IV CT contrast 6 weeks before
(a) After a thyroidectomy, the purpose of 131I whole-body imaging is to detect the presence of residual thyroid tissue and/or distant metastases. To enhance the visualization of any metastases, the patient may be instructed to limit dietary iodine. The patient may also discontinue replacement thyroid hormone therapy to permit the metastases to function as thyroid tissue. Exogenous TSH may also be prescribed to stimulate the metastases to concentrate iodine.
The administration technique for [99mTc]bicisate includes which of the following?
(a)direct venous stick
(b) infusion at peak cardiac stress
(c) bolus injection technique
(d) infusion over 3 hours
(e) minimize environmental stimuli
(e) It is desirable to image the brain in as close to a “resting” state as possible. Because uptake of [99mTc]bicisate can be affected by sensory input, distractions (bright lights, noise, pain) should be kept to a minimum.
Which of the following instructions should be given to patients after administration of [18F]FDG for PET imaging?
(a)The patient may leave the imaging area and return in approximately 90 min.
(b) The patient should rest quietly in a designated waiting area until imaging begins.
(c) The patient may read or watch television until imaging begins.
(d) The patient should consume a fatty meal to clear excess tracer from the hepatobiliary system.
(e) The patient should exercise in place for 15 minutes before the start of imaging.
(b) Patients who receive [18F]FDG for PET imaging must remain quiet during the interval between tracer administration and imaging. Small changes in tissue metabolism can cause uptake in skeletal muscle that may obscure or be mistaken for disease or can decrease the amount of tracer taken up into the tumor.
In performing a gastric-emptying study, imaging should begin:
(a)15 min after meal consumption, then every 15 min for 1 hr
(b) immediately after meal consumption, then every 15 min for at least 2 hr
(c) immediately after meal consumption, then every 5 min for at least 1 hr
(d) 1 hr after meal consumption, then every 15 min for the next hour
(e) 2 hr after meal consumption, then every 15 min for at least 2 hrs
(b) With the patient upright, imaging should begin immediately after meal consumption for 1 min, then every 15 min for at least 2 hr. Imaging may need to be extended beyond 2 hr if it appears that the stomach is not emptying.
A patient with a chest tube arrives in the nuclear medicine department for an imaging study. The technologist should:
(a)Place the chest tube’s external apparatus on a level lower than the patient’s chest.
(b) Cancel the procedure because chest tube apparatus will interfere with the study.
(c) Place the chest tube’s external apparatus on the imaging table next to the patient.
(d) Hang the chest tube’s external apparatus from an IV pole and raise it above the patient’s chest.
(e) Drain the chest tube while holding in place during the imaging procedure.
(a) For proper drainage, the chest tube apparatus must always remain lower than the patient’s chest.
Where is the x-ray generator located in a CT scanner?
(a)under the patient imaging table
(b) inside the operator’s console
(c) inside the gantry
(d) inside the electronics cabinet
(e) inside the computer workstation
(c) The gantry houses the key components of the scanner: the x-ray tube, the detector array, the power generator, and the data acquisition system.
To help clear the thyroid, liver, and bowel when performing a cardiac perfusion study with sestimibi, a technologist should give what before imaging?
(a)a fatty meal
(b) dobutamine
(c) dextrose intravenously
(d) adenosine
(e) a glass of cold water
(e) The sestamibi pharmaceutical for cardiac imaging concentrates in multiple organs and can affect the image. In an effort to clear activity out of the thyroid, liver, and lower, cold water can be given to the patient prior to imaging to increase the target:non-target ratio for imaging the heart.
A contraindication for performing a myocardial perfusion resting study is:
(a)fasting for 4-12 hr before the study
(b) drinking cold water before the study
(c) having a normal sinus rhythm
(d) being NPO for 4-12 hr before study
(e) having a nitroglycerin drip
(e) A nitroglycerin drip will interferer with determining if, at rest, the cardiac arteries are partially occluded. (Patients suffering from angina could be on nitroglycerin therapy.)
A post-surgery patient is in the nuclear medicine department for a study. The technologist notices that the patient’s surgical dressing shows signs of drainage. The most appropriate action for the technologist is to:
(a)Reinforce the dressing with additional gauze and notify the appropriate medical personnel.
(b) Remove the old dressing and replace it with a fresh one.
(c) Terminate the study and transport the patient back to his/her room.
(d) Complete the nuclear medicine procedure and ignore the dressing.
(e) Remove the dressing and drain the wound.
(a) The technologist should report the drainage and reinforce the original dressing with additional dressing until appropriate medical personnel are available to address the patient’s needs.
If the hematocrit is 40% and a plasma-volume determination, performed with [125I]-human serum albumin, is 3,900 mL, what are the derived red cell and whole blood volumes, in milliliters?
Red cell volume (mL) - Whole blood volume (mL)
(a)1,560 - 2,340
(b) 2,340 - 6,240
(c) 5,850 - 9750
(d) 2,600 - 6,500
(e) 6,500 - 2,340
(d) The red cell and whole blood volumes can be calculated from the measured plasma volume (PV) using the following formulas:
total blood volume (TBV) = PV (mL) x 100 / (1 - HCT)
TBV = 3900 mL x 100 / (1 - 0.40)
red cell volume = TBV - PV
= 6500 mL - 3900 mL
= 2600 mL
During a red blood cell survival study, the first blood sample is taken 24 hr after the injection of the labeled cells. This 24 hr time period is needed to allow:
(a)the radiochromium to decay to a level compatible with the scintillation detector
(b) patient recovery from the radiopharmaceutical injection
(c) removal of any cells damaged during the labeling process
(d) uniform mixing of the labeled cells throughout the vascular system
(e) a better non-target ratio
(c) The time span between injection and blood sampling allows the body to remove cells damaged during the labeling process and allows free chromic ions to be removed for the plasma.
If an anticoagulant is added to a blood sample, the fluid portion of the blood sample is know as:
(a)serum
(b) plasma
(c) antiserum
(d) blood complement
(e) clotting factor
(b) Preventing clot formation with the addition of an anticoagulant will result in the fluid portion remaining as plasma. The fluid portion of a blood sample that has been allowed to clot is serum.
In a hospital setting, CPR CANNOT legally be administered to a patient in cardiac arrest when the:
(a)patient has an infectious disease
(b) patient’s spouse or significant other indicates their wishes
(c) patient is hallucinating
(d) patient’s chart indicates a terminal illness
(e) patient’s chart indicates DNR
(e) CPR should always be administered to a patient in cardiac arrest unless the patient, patient’s family, or patient’s physician has specifically requested that it not be done. In these cases, DNR (Do Not Resuscitate) or “allow natural death” should be clearly indicated on the patient’s chart.
Pentagastrin is commonly used in which of the following scans:
(a)gastric emptying
(b) deep vein thrombosis
(c) Meckel’s diverticulum
(d) LeVeen shunt patency
(e) myocardial perfusion imaging
(c) Pentagastrin stimulates ectopic gastric mucosal uptake of pertechnetate by 30%-60& while decreasing emptying time into small bowel and decreasing background.
Data collected from a red cell survival procedure are plotted on what type of graph paper?
(a)semilog
(b) linear
(c) log-log
(d) logit-log
(e) logit-logit
(a) Red cell survival half-time is obtained from a graph of the net counts per minute of each blood sample plotted on the log scale and time plotted on the linear scale of semi-log paper.
Which of the following is NOT recommended DURING HMPAO/ECD administration?
(a)Dim the lights.
(b) Inject using an IV line.
(c) Talk calmingly to the patient while injecting.
(d) Ask the patient to keep eyes and ears open.
(e) Let the patient rest for 10 minutes before injection.
(c) Place patient in quiet environment before injection.
If a 1:50 dilution of a solution with a tracer concentration of 50 uCi/mL is prepared, followed by a 1:200 dilution of the 1:50 dilution, what is the final dilution?
(a)1:20
(b) 1:50
(c) 1:1,000
(d) 1:10
(e) 1:10,000
(e) When multiple dilutions are performed, the final dilution is the product of the individual dilutions. Thus:
(1/50) x (1/200) = 1/10000
