ST:7

Question 1

According to the NRC, survey meters must be calibrated _____ and following any repairs.
(a)semiannually (twice a year)

(b) biannually (every other year)
(c) monthly (once a month)
(d) yearly (once a year)
(e) quarterly (four times a year)

Answer 1

(d) Survey meters are calibrated annually to make sure that the instrument is performing within NRC regulation guidelines.

Question 2

The difference between a direct radiation survey and a wipe check radiation survey is that:
(a)There is none.

(b) One is qualitative and one is not.
(c) One is quantitative and one is not.
(d) One breaks bonds and the other does not.
(e) One gives an instant reading and one does not.

Answer 2

(e) The direct radiation survey will give an instant reading, while the wipe check does not give an instant reading.

Question 3

For an occupational worker who has received 14,000 mRem of exposure to the eyes in 1 year on his/her eye dose dosimeter, which course of action would be appropriate?
(a)Recommend eye chelation therapy.

(b) Review ALARA standards to reduce exposure because because s/he is close to exceeding their annual eye dose limit.
(c) Review ALARA standards to reduce exposure because s/he has exceeded his/her annual eye dose limit.
(d) Recommend s/he use leaded eyeglasses to reduce exposure.
(e) Recommend s/he use thyroid shields.

Answer 3

(b) An occupational radiation worker is allowed up to 15,000 mRem/yr dose to the eye. Since this worker is close to but not exceeding the yearly dose, a review of the ALARA concept and a dedicated reduction in eye exposure in the future is recommended.

Question 4

A nuclear medicine department has an action level of 500 mRem per month whole-body exposure. If you were the NRC inspector, what would you recommend to this site?
(a)Reduce their action level to at least 410 mRem per month to be compliant with annual possible levels of exposure.

(b) Reduce their action level to at least 450 mRem per month to be in compliance with annual possible levels of exposure.
(c) Increase their action level to 5000 mRem per month
(d) Nothing, everything is fine
(e) Reduce their action level to at least 430 mRem per month to be compliant with annual possible levels of exposure.

Answer 4

(a) It is recommended that a radiation occupational worker who is using radiation stay under 410 mRem per month. This limit will keep the worker’s radiation levels within the NRC regulations of 5,000 mRem per year whole-body dose.

Question 5

The allowed dose of ionizing radiation to a declared pregnant woman’s embryo/fetus is:
(a)10% of the standard occupational workers whole-body dose per year

(b) 1% of the standard occupational workers whole-body dose per year
(c) 20% of the standard yearly occupational dose for the gestation period
(d) 1% of the standard yearly occupational dose for the gestation period
(e) 10% of the standard yearly occupational dose for the gestation period

Answer 5

(e) It is recommended that women who are pregnant stay within or lower than 10% (500 mRem) of the regular occupational limit of 5,000 mRem/yr for the duration of the gestational period.

Question 6

In doing a room survey, you discover that a therapy patient’s room has removable contamination above acceptable levels. What is the acceptable level?
(a)<367 Bq/100 cm^2

(b) <200 MBq/100 cm^2
(c) <12,000 Bq/100 cm^2
(d) <200 Bq/100 cm^2
(e) <15,000 Bq/100 cm^2

Answer 6

(a) To stay in compliance with NRC regulations, the room radiation levels must be below this level of removable contamination: <367 Bq/100cm^2 or 22,000 dpm/100cm^2

Question 7

In calibrating your survey meter for your nuclear medicine department, you discover that is has a 12% error. What is your next course of action to remain in compliance with NRC regulations?
(a)Recommend that it be serviced.

(b) Throw it away.
(c) Replace the batteries.
(d) Use the survey meter as you normally would.
(e) Check the high-voltage power supply.

Answer 7

(d) It is all right to use a survey as long as it does not exceed +-20% of expected readings according to the NRC.

Question 8

You suspect that a low-level B emitter has been spilled on a countertop. Which of the following survey techniques would be best?
(a)wipe-check with a SCA/MCA-type meter

(b) scintillation probe-type meter
(c) wipe-check with a G-M-type meter
(d) pancake probe G-M-type meter
(e) wipe-check with a pocket dosimeter

Answer 8

(a) Performing a wipe check with a SCA/MCA would be the best method because it is able to detect the low energies form the beta emitter.

Question 9

An unrestricted nuclear medicine waiting room is on the other side of the wall from a hot lab. G-M meter readings in the hot lab read 50 mRem/hr. Readings on the other side of the wall in the waiting room read 25 mRem/hr. What is the minimum number HVLs of Pb required in the wall to bring the waiting room reading down into compliance with NRC regulations?
(a)4

(b) 2
(c) 5
(d) 1
(e) 3

Answer 9

(a) For unrestricted areas, it is recommended that the radiation level stay below 2 mRem/hr. Therefore, if the waiting room reads 25 mRem/hr, then 4 HVLs of Pb is needed to decrease the radiation to the acceptable level of 2 mRem/hr.

Question 10

If a G-M meter has a scale of 1-5 mR/hr. If a deflection on the meter reads 4.5 and the meter is set on the X0.1 setting, what is the reading?
(a)40.5 mR/hr

(b) 4.5 mR/hr
(c) 0.45 mR/hr
(d) 0.045 mR/hr
(e) 45 mR/hr

Answer 10

(c) The reading determined by using the G-M meter was 4.5 mR/hr. However, it was measured on the X0.1 setting. Therefore, the initial reading of 4.5 mR/hr has to be multiplied by X0.1 to get the reading form the meter correctly.

Question 11

In operating a G-M meter on a daily basis, what is the first thing you should always do?
(a)Use a check source to make sure the meter is working correctly.

(b) Set it to the most-sensitive scale/setting.
(c) Insert the batteries.
(d) Check the batteries.
(e) Set it to the least-sensitive scale/setting.

Answer 11

(d) It is always important to verify that the battery in the survey meter is working correctly to ensure proper detector response.

Question 12

Form X or NRC Form 3 includes all of the following EXCEPT:
(a)The employer must abide by the state and federal regulations.

(b) The worker is required to become familiar with the regulations and operating procedures for the work engaged in.
(c) The worker must abide by the state and federal regulations.
(d) The employer will make available to the worker a copy of all applicable state and federal regulations, licenses, and operating procedures pertaining to the work.
(e) The employer is not required to post any notices of violations of the regulations involving radiological working conditions.

Answer 12

(e) According to the NRC, the employer is required to post any notices or violations of the regulations to employees.

Question 13

The triblade radiation symbol must be which of the following colors on a yellow background?
(a)green

(b) red
(c) purple
(d) brown
(e) gray

Answer 13

(c) Radiation warning signs consist of a purple, magenta, or black tri-blade symbol on a yellow background.

Question 14

Which of the following radiation signs would be required if a survey meter reading were 40 mRem/hr at 60 cm from a source in the room?
(a)”Caution: Radioactive Material”

(b) “Caution: High Radiation Area”
(c) “Caution: Radiation Area”
(d) “Grave Danger: Very High Radiation Area”
(e) “Caution: Very High Radiation Area”

Answer 14

(b) Different radiation caution signs are used depending on the amount of radiation an individual is likely to receive in that area in the course of 1 hr while 30 cm from a radioactive source or surface. Using the Inverse Square Law and the information given, it can be determined that an individual in this circumstance would receive 160 mRem/hr at a distance of 30 cm. For an area where an individual is exposed to radiation levels in excess of 100 mRem/hr, the correct sign to post is the “Caution: High Radiation Area” sign.

Question 15

When a DOT II radioactive label on a package reads 9 mR/hr at 1 m, what is the appropriate action to take?
(a)Log in the package as you normally would.

(b) Contact the regional office of the NRC.
(c) Inform the vendor that the wrong label was on the container.
(d) Notify the DOT that a “shipment event” has occurred.
(e) Notify the DOT that a “medical event” has occurred.

Answer 15

(c) If a package reads 9 mRem/hr at 1 meter, it should have a DOT yellow III shipping label. A DOT Yellow II shipping label is limited to a reading of 1 mRem/hr at 1 m. When a package arrives with the wrong label, the vendor should be contacted.
DOT I (white)
At contact, not more than 0.5 mR/hr
At 3 feet (1 m), no detectible radiation (NDR)
DOT II (yellow)
At contact, not more than 50 mR/hr
At 3 feet (1 m), not more than 1 mR/hr
DOT III (yellow)
At contact, not more than 200 mR/hr
At 3 feet (1 m), not more than 10 mR/hr

Question 16

The average energy required to create an ion pair in air is _____.
(a)60 eV

(b) 34 eV
(c) 5 eV
(d) 30 keV
(e) 50 eV

Answer 16

(b) The average amount of energy required to cause an ionization depends on the type of gas used in teh chamber, but it is generally between 20 and 45 eV per ion pair. 34 eV per ion pair is a commonly accepted value.

Question 17

The ionization of the ENTIRE fixed volume of a gas due to secondary ionization is known as the _____:
(a)Geiger effect

(b) Townsend avalanche
(c) proportional effect
(d) internal amplification
(e) inverse gain

Answer 17

(a) Region V of gaseous detectors is the Geiger-Mueller region. Within this region, a charged particle, x-ray, or gamma ray will initiate an avalanche of ionization reactions (Townsend avalanche). When one initial ionization event triggers an Townsend avalanche of secondary ions that extends throughout the entire volume of the detector, this is called the Geiger effect.

Question 18

How do the sizes of the pulses produced by the collection of ions in the proportional region compare to those produced by an instrument that operates in the ionization region of the gas curve for radiation detectors?
(a)The pulses are in resonance.

(b) The pulses are smaller.
(c) The pulses are the same size.
(d) The pulses are larger.
(e) The pulses are affected by pulse pile-up.

Answer 18

(d) The sizes of the pulses are determined by the amount of ions created in the gas chamber. More ions are created when there is a greater charge between the cathode and anode. On the characteristic voltage curve for gas detectors, the proportional region operates at a higher current than the ionization region. Because the proportional region operates at a higher current, it produces more ions and has a larger pulse.

Question 19

Gas amplification is a phenomenon associated with instruments that operate in which region of the gas curve for radiation detectors?
(a)recombination

(b) ionization
(c) proportional
(d) continuous discharge
(e) G-M

Answer 19

(c) Within the proportional region of the characteristic voltage curve for gaseous detectors, charged particles collide with gas molecules to produce additional ionization events. This additional ionization results in an amplified current that is proportional to the number of original ion pairs created by the incident radiation. Because ions collide with gas to create an amplified current, this occurrence is called gas amplification.

Question 20

The output pulse height of a gaseous detector is, in most cases, dependent upon what?
(a)the quantity of radiation that passes through the gas

(b) numbers of ions produced in the gas
(c) volume of gas in the detector
(d) pressure of the gas in the tube
(e) type of gas in the tube

Answer 20

(b) The pulse height represents the amount of radiation detected in the gas chamber. The amount of radioactivity is based upon the number of ions produced by the interactions between the gas and radiation.

Question 21

Which of the following is used for SPECT system performance?
(a)high count flood

(b) COR offset measurement
(c) PLES phantom
(d) Jaszczak phantom
(e) 3D or 4D operation

Answer 21

(d) A Jaszczak phantom consists of a 20-cm-diameter plexiglass cylinder with rod and spheres inserted. The Jaszczak phantom provides excellent information about SPECT performance.

Question 22

Which of the following operations would help in improving the image contrast AFTER display?
(a)use a smoothing filter

(b) use an edge enhancement filter
(c) use windowing
(d) use a formatter
(e) use a PHA

Answer 22

(c) Neither smoothing nor edge enhancement filters will improve image contrast after display . A formatter is no longer widely used in most facilities because it is for a gamma camera using film.

Question 23

Which SPECT cardiac slice is used to generate a polar plot?
(a)transverse

(b) HLA
(c) VLA
(d) SA
(e) sagittal

Answer 23

(d) Polar plots are circular profiles of the heart created by placing the most-apical short axis slice in the center, surrounded by each successive short axis slice. The most-basal slice becomes the outermost ring of the plot.

Question 24

For the majority of physiologic studies, “cold” spots are areas on the image display that indicate:
(a)necrotic tissue

(b) mistuned PMTs
(c) increased activity
(d) nonlinearity
(e) a cracked crystal

Answer 24

(a) Any area that uptakes the radiotracer will display as “hotter” than the background. This means that there is more uptake in these locations. Radiotracer will uptake in active cells and overactive cells. Cold spots are indicative of areas in which the cells are not active, such as dead or necrotic tissue.

Question 25

Correction tables are used for: (a)uniformity correction (b) detector misalignment correction (c) COR correction (d) linearity correction (e) spatial linearity correction

Answer 25

(a) Sometimes camera non-uniformity can be attributed to regional variations of insensitivity. Count subtraction/addition would be most appropriate at this point. Most gamma cameras achieve this by using an isotope- or collimator-specific uniformity correction map to generate an image of final non-uniformity within a +-1-3% range.

Question 26

Total combined energy of the TWO annihilation photons originating from an annihilation reaction is: (a)500 keV (b) 1.02 MeV (c) 1 MeV (d) 511 keV (e) 2.04 MeV

Answer 26

(b) A good event in PET is determined by the coincident detection of two 511-keV photons for a total of 1.02 MeV. These two 511-keV annihilation photons originate from the combination of a positron and an electron during the annihilation reaction.

Question 27

The path between the two detectors in PET is referred to as the: (a)line of origination (b) line of action (c) line of flight (d) line of response (e) line of correction

Answer 27

(d) In PET imaging, during coincidence detection, each crystal acts as a separate detector. Each scintillation crystal is allowed to be in coincidence with other scintillation crystals. Each pair of crystals for which coincidence is allowed is designated as an individual line of response.

Question 28

The chance detection of photons from UNRELATED annihilation events within the coincidence timing window is called the _____ coincidence: (a)true (b) scatter (c) prompt (d) random (e) delayed

Answer 28

(d) Random coincidence occurs when two photons from two separate annihilations are detected within the coincidence timing window. The system naturally assumes that both photons come form one annihilation event and that the interaction occurred within the line of response for both detectors.

Question 29

A "blank scan" is performed in PET: (a)hourly (b) monthly (c) weekly (d) with every patient study (e) daily

Answer 29

(e) A "blank scan" is a short-timed acquisition that is done at the beginning of each day to verify that the PET's tomography feature is operating correctly for the day.

Question 30

Upon performing a blank scan, your final image looks like this. (diagonal line artifact across the image) What is the likely explanation? (a)perfect blank scan (b) high voltage fluctuation (c) detector malfunction (d) unexplained phenomenon (e) artifact in the field of view

Answer 30

(c) In PET tomography, since each block has a small number of photomultiplier tubes and uses only one set of electronic devices, a malfunction will oftentimes affect the entire sinogram. Therefore, since blocks typically appear as diagonal lines on the sinogram, a malfunction also appears along a diagonal line.

Question 31

In nuclear medicine, "windowing" (choosing a linear scale with threshold) is used primarily for: (a)background subtraction (b) image normalization (c) background normalization (d) image reconstruction (e) background addition

Answer 31

(c) The purpose of the window in reconstruction techniques is to limit the reconstruction to data within a range, much like a pulse height analyzer on a gamma camera. Thus, it is used primarily for background subtraction.

Question 32

Which of the following is the correct method to calculate gall bladder (GB) ejection fraction? (a)(net min GB cts - net max GB cts) / net min GB cts (b) (net max GB cts - net min GB cts) x 100 / net min GB cts (c) (net max GB cts - net min GB cts) / net max GB cts (d) (net max GB cts) x 100 / (net max GB cts - net min GB cts) (e) (net max GB cts - net min GB cts) x 100 / net max GB cts

Answer 32

(e) This is the only equation given that accurately represents the true total net value of counts from the gallbladder by using the percent difference equation. This equation can also be represented as: (pre-CCK cts - lowest post - CCK cts) x 100 / pre-CCK cts

Question 33

For SPECT acquisition, a reasonable choice for pixel size would be: (a)5.25 mm^2 (b) 1/3 FWHM of detector resolution or smaller (c) equal to 3 FWHM (d) equal to 2 FWHM (e) 3.12 mm^2

Answer 33

(e) If a test image of two point sources is acquired in a 128 x 128 image matrix, the approximate pixel size would be 3.133 mm in one plane. Both the x and y planes are needed.

Question 34

The star artifact during SPECT reconstruction can be reduced by: (a)increasing the time per projection (b) increasing the number of projections (c) applying a 4 D mode acquisition (d) decreasing the number of projections (e) decreasing the time per projection

Answer 34

(b) Unfiltered backprojection (UBP) is a method of reconstruction used in SPECT imaging. One disadvantage of unfiltered backprojection is that the area of increased count density is greater than the area of increased activity in the object. As more projections are added to the object, the image begins to form a star artifact, and the object's size increases. The more projections are added, the larger and blurrier the star artifact becomes. This is why filtered backprojection is commonly used. With regular or filtered backprojection, since it is used clinically, the more projections you have, the better the resolution.

Question 35

Which one of the following WILL NOT give information on left ventricular function? (a)gated equilibrium radionuclide angiography (b) gated myocardial perfusion imaging (c) ungated first-pass study (d) gated myocardial PET (e) ungated myocardial SPECT

Answer 35

(e) The purpose of the first-pass study is to evaluate the ejection fraction of the right and/or left ventricle and determine the overall functioning capabilities of the heart. When calculating left ventricular ejection fraction, a multiple-gated acquisition is normally used. Gating slows heart motion and contraction to be resolved better by dividing the projections into discrete time intervals throughout an entire cardiac cycle. This provides more-precise and specific information related to a specific portion of the heart. this method includes gated equilibrium radionuclide angiography and gated tomographic myocardial perfusion imaging. A first-pass study occurs too quickly to get any reliable gating, but one does get ventricular function information. Therefore, ungated myocardial SPECT would not provide the information on ventricular function that all the other options here do.

Question 36

When performing a thyroid uptake, the non-thyroidal body background measurement is obtained over the: (a)stomach (b) skull (c) sternum (d) thigh (e) lumbar spine

Answer 36

(d) The thigh area is used to obtain non-thyroidal body background because it provides a more-accurate approximation of the soft tissue uptake throughout the entire body. The camera is positioned over the patient's thigh at the same distance as it is positioned from the thyroid organ.

Question 37

To prepare a patient for a thyroid uptake, the technologist performs a baseline thyroid count and measures radioactivity in the neck that is twice the background counts. Which of these actions is the most-appropriate for the technologist to follow? (a)Cancel the exam: This is a contraindication for performing it in this patient. (b) Administer [131I]sodium iodide instead of [123I]sodium iodide for the uptake. (c) Put the patient on a low iodide diet. (d) Subtract the baseline counts from the thyroid counts collected at a later time. (e) Calculate a thyroid uptake using only the baseline counts.

Answer 37

(d) When preparing a patient for thyroid uptake using a thyroid probe, take counts from the thigh and neck (at thyroid level). The thigh counts represent background or baseline counts, Subtract the baseline counts from the actual thyroid counts as part of the calculation for uptake percentage.

Question 38

The therapeutic effectiveness of 131I in treating hyperthyroidism results from the delivery of energy to thyroid tissue from: (a)alpha particles (b) neutron radiation (c) y rays (d) x-rays (e) B particles

Answer 38

(e) X-ray alpha particles are not emitted from 131I. 131I is both a gamma and beta emitter; however, the beta particles are what is responsible for the effectiveness of the therapy.

Question 39

Fever, dehydration, and slightly elevated white cell count are all symptoms of: (a)nontoxic goiter (b) euthyroid (c) hypothyroidism (d) benign thyroid goiter (e) hyperthyroidism

Answer 39

(e) Some of the symptoms of hyperthyroidism include fever, sweating, dehydration, palpitations, increased heart rate, and elevated white blood cell counts.

Question 40

In a normally functioning system, an increase in circulating thyroid hormone will cause TSH secretion to: (a)remain the same (b) increase (c) decrease (d) vary unpredictably (e) cause a goiter formation

Answer 40

(c) An increase in thyroid hormone causes a decrease in the stimulation of TSH. Suppressed TSH is indicative of hyperthyroidism.

Question 41

Which of the following would NOT normally appear as an area of increased activity on the bone image of an adult? (a)anterior iliac crests (b) epiphyseal plates (c) sacroiliac joints (d) nasopharyngeal area (e) kidneys

Answer 41

(b) Iliac crests, sacroiliac joints, and the nasopharyngeal areas are typical "hot spots" in adult bone imaging. Typically there is symmetrical, increased uptake in all joints, junctions, and scapulas. Epiphyseal plates, also known as "growth plates," are bright hot spots in pediatric images. Children are steadily growing, which causes increased uptake in those areas.

Question 42

For which of the following clinical indications would limited bone imaging ("spot" views) be most appropriate? (a)rule out avascular necrosis of the right femoral head (b) rule out metastatic prostate cancer (c) determine extent of Paget's disease (d) history of child abuse; rule out occult fractures (e) rule out metastatic breast cancer

Answer 42

(a) Spot views are individual images of certain areas after the initial whole-body image has been performed. They provide detailed images of areas not clearly visualized on the whole-body images. The right femoral head is a specific area that has to be images, which makes limited imaging the appropriate choice.

Question 43

It is safe to block a portion of the pulmonary circulation with MAA particles in patients with symptoms of pulmonary emboli because: (a)the particles pass through the lungs (b) the particles are made from albumin isolated from human serum (c) the particles are rapidly phagocytized by lung macrophages (d) The number of injected particles is very small compared to the number of available precapillary arterioles (e) the albumin is denatured before it is made into particles

Answer 43

(d) MAA causes micro emboli in approximately 100,000 capillaries of the 350 million arterioles and 280 billion small capillaries of the lungs. The particles are typically 10-90 um in size, therefore the number injected does not compromise the patient. In general, 0.1% of the capillaries are blocked after an injection.

Question 44

If tracer concentration is visualized in the stomach, thyroid, and salivary glands on a bone image, the most likely explanation is that: (a)The tracer contained unbound [99mTc]pertechnetate. (b) The patient did not drink sufficient fluids. (c) There is pathology in those areas. (d) The patient was imaged too soon to allow adequate blood clearance of the tracer. (e) The patient ate dairy products between the injection time and post imaging.

Answer 44

(a) Radiotracer tag, like 99mTc, may break down or be delivered to the body with an insufficient tag. This means that the tracer did not properly attach itself to the pharmaceutical used for the study. It results in unbound pertechnetate or "free Tc" that localizes in the stomach, thyroid, salivary glands, gastrointestinal tract, and some other systems.

Question 45

Which of the following phrases describes the sensitivity and specificity of bone imaging? (a)sensitive and specific (b) more specific than sensitive (c) sensitive but not specific (d) neither sensitive or specific (e) not sensitive but specific

Answer 45

(c) Bone imaging is sensitive but not specific. It may be used to determine whether there is an abnormality within the bones. It is also capable of localizing the problem area; however, there is no way to determine the exact location and cause of the problem. Typically other studies are ordered, such as CT or MRI, which are more specific.

Question 46

Ischemia means: (a)necrotic tissue (b) infarction (c) decreased blood flow (d) the superior portion of the pelvis (e) scar tissue

Answer 46

(c) Necrotic tissue is that which has undergone premature cell death. An infarction is localized necrosis caused by a lack of blood supply. Ischemia is the term used to describe inadequate or decreased blood flow to an area caused by a blockage.

Question 47

To confirm a referring physician's request for a nuclear medicine therapeutic procedure, the technologist should: (a)Confer with the nuclear medicine physician. (b) Ask the patient why s/he came to nuclear medicine. (c) Locate the written directive for the therapy in the patient's medical record. (d) Text the physician. (e) Telephone the referring physician for confirmation.

Answer 47

(c) For a therapeutic procedure, there should always be a written directive in the patient's record. It is mandatory that a nuclear medicine technologist have the written directive and that he/she verifies it before administering any therapeutic radiopharmaceuticals. The referring physician or nuclear medicine physicians may not always be readily available for questions, and the patient may not always be certain about the procedures s/he is scheduled for.

Question 48

All of the following statements about three- or four-phase bone imaging are true EXCEPT: (a)This study has dynamic imaging. (b) The last phase is performed 24 hr post-tracer administration. (c) The patient is positioned under the camera before tracer administration. (d) This study has static imaging. (e) Special instructions are given to the patient before the injection.

Answer 48

(e) Three- and four-phase bone imaging studies include dynamic images for the flow and blood pool. Static images are also included for images of the extremities and torso. To capture blood pooling and flow as they occur, the patient should be positioned under the camera before tracer administration

Question 49

Which of the following structures normally appear as areas of increased activity on the bone images of a child vs. an adult? (a)ribs (b) femur (c) humerus (d) sternoclavicular joints (e) costochondral junctions

Answer 49

(e) Normal uptake in children and adults includes the ribs, femur, and joints (sterno-clavicle joints included). However, in children, the growth plates show increased activity during bone imaging and do not in adults.

Question 50

Non-reactivity toward a particular antigen is called: (a)tolerance (b) immunity (c) immunogenicity (d) anaphylaxis (e) autoimmunity

Answer 50

(a) Tolerance refers to non-reactivity toward a particular antigen.

Question 51

The ability of an antibody to react with one and ONLY ONE antigen is known as its: (a)affinity (b) sensitivity (c) avidity (d) specificity (e) tolerance

Answer 51

(d) Specificity refers to the ability of an antibody to react with one, and only one, antigen.

Question 52

The property where an antibody reacts with two or more antigens of similar structure is know as: (a)sensitivity (b) cross-reactivity (c) tolerance (d) immunoreactivity (e) avidity

Answer 52

(b) The property where an antibody reacts with two or more antigens of similar structure is called cross-reactivity.

Question 53

``` The major antibody class found in normal human serum is: (a)IgG ``` (b) IgM (c) IgA (d) IgD (e) IgE

Answer 53

(a) IgG is the major antibody found in normal human serum. It is also the smallest and most-common antibody. IgM is the primary antibody against A & B antigen on red blood cells. IgA is primarily an aid in mucosal immunity, and IgD makes up 1% of proteins in plasma membranes of mature B-lymphocytes.

Question 54

All of the following PET radionuclides must be produced very close to the site where they are administered EXCEPT: (a)82Rb (b) 11C (c) 15O (d) 18F (e) 13N

Answer 54

(d) 18F has the longest half-life of these PET radionuclides. Therefore, it is not necessary for 18F to be produced close to the site where it is administered. 18F has a half-life of 110 min; 11C, of 20 min; 15O 2 min; and 13N, 10 min.

Question 55

For what reason is a patient's blood glucose level checked before [18F]FDG administration? (a)FDG tends to increase blood glucose levels that may already be elevated. (b) The blood glucose level may have to be increased to ensure good tracer uptake. (c) Hypoglycemia reduces tumor uptake of the tracer. (d) FDG administration is contraindicated in diabetic patients. (e) Hyperglycemia reduces tumor uptake of the tracer.

Answer 55

(e) Hyperglycemia reduces tumor uptake of the tracer; therefore, the patient's blood glucose level is checked prior to [18F]FDG administration. FDG does not increase glucose levels and is not a contraindication in diabetic patients. High blood glucose levels do not ensure good tracer uptake; they actually reduce uptake in the tumor.

Question 56

Preparation of patients undergoing PET imaging for an oncologic clinical indication includes all of the following EXCEPT: (a)checking blood glucose levels (b) installation of IV line (c) 12-lead ECG monitoring (d) fasting (e) hydration

Answer 56

(c) For PET oncologic studies, the patient should hydrate right before the test and fast for at least 6 hr before test to reduce insulin levels and uptake in certain organs. An IV should be installed in the patient so the injection can be flushed with saline. A 12-lead ECG monitoring is not required.

Question 57

[90Y]ibritumomab tiuxetan is used for therapy of which type of cancer? (a)breast (b) prostate (c) liver (d) non-Hodgkin's lymphoma (e) thyroid

Answer 57

(d) Yttrium ibritumomab tiuxetan therapy is used for non-Hodgkin's lymphoma. This therapy is not used for breast, prostate, or liver cancers.

Question 58

[90Y]ibritumomab tiuxetan is used in conjunction with which chemotherapeutic agent? (a)interferon (b) ribavirin (c) cyclosporine (d) methotrexate (e) rituximab

Answer 58

(e) Yttrium-90 ibritumomba tiuxetan is used in conjunction with rituximab chemotherapeutic agent. Y-90 is not used in conjunction with interferon, cyclosporine, or methotrexate.

Question 59

The size of the spleen can best be determined using what view of a [99mTc]sulfur colloid image? (a)anterior (b) posterior (c) right lateral (d) left lateral (e) anterior oblique

Answer 59

(b) The spleen is located posterior-laterally in the left upper abdomen, so a right lateral will not show the size of the spleen well. A left lateral view will show the liver and spleen, making it hard to view the size of the spleen. The best view to determine the size of the spleen, therefore, is the posterior view.

Question 60

If 4 mCi of [99mTc]sulfur colloid is administered intravenously, approximately how much activity will be concentrated in the spleen of a normal subject (biodistribution is 80, 15, and 5% to different parts of the body)? (a)0.6 mCi (b) 3.2 mCi (c) 4 mCi (d) 0.2 mCi (e) 2.3 mCi

Answer 60

(a) [99mTc]sulfur colloid once injected will biodistribute 80% in the liver, 15% in the spleen, and 5% in the bone marrow. If 4 mCi is injected, 0.6 mCi will be concentrated in the spleen. 4 mCi x 0.15 = 0.6 mCi of activity

Question 61

Significant visualization of bone marrow uptake on a [99mTc]sulfur colloid liver/spleen image is most likely due to which of the following? (a)liver dysfunction (b) insufficient circulation time of the radiopharmaceutical (c) multiple myeloma (d) overactive bone marrow (e) improper colloid particles that are too large

Answer 61

(a) Colloid shifting presents in the bone marrow due to severe liver dysfunction, especially due to cirrhosis, hepatitis, leukemia, infection, or a tumor.

Question 62

Which of the following diagnostic test should NOT be performed immediately before liver/spleen imaging with [99mTc]sulfur colloid? (a)gallbladder examination with ultrasound (b) chest radiograph (c) radiographic upper GI series (d) echocardiogram (e) thyroid uptake with [123I]sodium iodide

Answer 62

(c) A barium study of the colon could cause artifacts or show presumed defects with the liver and spleen.

Question 63

In a normal hepatobiliary study, excretion of the tracer into the instestine should occur by no longer than how many minutes after tracer administration? (a)30 min (b) 15 min (c) 5 min (d) 60 min (e) 90 min

Answer 63

(a) In the normal individual, radioactivity is identified in the gastrointestinal tract by 30 min post-injection.

Question 64

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) adeosine

Answer 64

(b) Morphine is usually given to the patient after 60 min because morphine contracts the sphincter of Oddi and increased the pressure in the common bile duct and cystic duct. This causes the gallbladder to fill up with the radiopharmaceutical if the gallbladder is functioning.

Question 65

Very increased serum bilirubin levels will most likely cause which of the following to be visualized on hepatobiliary images? (a)colon (b) lungs (c) kidneys (d) spleen (e) heart

Answer 65

(c) Elevated serum bilirubin levels indicating severely jaundiced patients can result in increased renal excretion of the radiopharmaceutical, which can be confused with gallbladder activity.

Question 66

Which of the following framing rates would be most-appropriate for a renal function study? (a)0.1 sec/frame for 260 frames (b) 20 sec/frame for 78 frames (c) 2 min/frame for 13 frames (d) 5 min/frame for 15 frames (e) Framing rate is not a relevant consideration for this study.

Answer 66

(e) The computer setup for the procedure is usually 20-60 sec/frame for 1800 sec, which is a dynamic study but not a gating study.

Question 67

For the detection of liver hemangioma, all of the following imaging is routinely performed EXCEPT: (a)blood flow images (b) 24 hr delayed imaging (c) delayed imaging as late as 3 hr after tracer administration (d) anterior images (e) immediate blood pool images

Answer 67

(b) In liver hemangioma imaging, a blood flow image, an immediate blood pooling image, and a delayed image 2-3 hr after injection are required as a normal imaging protocol. The 24-hr delayed image is not required for a liver hemangioma study.

Question 68

Advantages of using [99mTc]sestamibi for myocardial perfusion imaging include all of the following EXCEPT: (a)no redistribution of tracer (b) acquisition of ventricular function information (c) completion of stress and rest imaging on the same day (d) flexibility in the time of imaging following tracer administration (e) acquisition of stress and rest images with one tracer dose

Answer 68

(e) If using [99mTc]sestamibi, you will have to use more than one tracer dose for the acquisitions of stress and rest iamges. The sestamibi will have been partially decayed by the time it is ready for both images to be taken.

Question 69

Which of the following agents used for pharmacologic stress testing has the longest plasma half-life? (a)adenosine (b) dipyridamole (c) dobutamine (d) nitroglycerin (e) atropine

Answer 69

(b) Dipyridamole has a half-life of up to 30 min and can last several hours. Adenosine's half-life is only 10 sec, and dobutamine and nitroglycerin only have half-lives of a couple of min.

Question 70

Which of the following pharmacologic stress agents should NOT be administered to patients with asthma or bronchospastic disease? (a)both adenosine and dipyridamole (b) both atropine and adenosine (c) dobutamine (d) adenosine (e) atropine

Answer 70

(a) Adenosine and dipyridamole both have side effects of a feeling of breathlessness and heaviness in the chest. Dobutamine just increases the heart rate and blood pressure by increasing the myocardial work of the heart.

Question 71

Dobutamine is contraindicated for stress testing in patients with all of the following conditions EXCEPT? (a)severe aortic stenosis (b) blood glucose about 200 mg/dL (c) ejection fraction below 15% (d) unstable angina (e) severe hypertension

Answer 71

(b) A patient who has severe aortic stenosis, unstable angina, or an ejection fraction below 15% is a contraindication for using dobutamine as a stress test. Dobutamine raises the heart rate and blood pressure, hence it could be dangerous for such a patient to undergo this stress test.

Question 72

Which of the following is cited as an advantage of [99mTc]tetrofosmin over [99mTc]sestamibi for myocardial imaging? (a)it redistributes (b) one-day stress-rest protocol can be used (c) faster tracer clearance from the GI system (d) stress and rest images can be obtained with one tracer dose (e) higher activities may be administered

Answer 72

(c) When given [99mTc]tetrofosmin, the patient only has to wait 5-30 min for clearance of the GI system. When given [99mTc]sestamibi, the patient has to wait 45-60 min for clearance of GI system. Therefore, tetrofosmin has a faster GI clearance.

Question 73

Treatment of the adverse effects induced by dipyridamole involves the administration of: (a)aminophylline (b) adenosine (c) antihistamines (d) nitroglycerin (e) dobutamine

Answer 73

(a) Some physicians administer aminophylline and/or caffeine to all patients as a precautionary measure before releasing them, regardless of symptoms after dipyridamole. Some physicians do this selectively.

Question 74

When the heart rate if 90 beats/min, how many beats are there per sec? (a)0.011 beat (b) 1.5 beat (c) 0.67 beat (d) 0.006 beat (e) 0.016 beat

Answer 74

(b) By using dimensional analysis, we know that there are 60 seconds in 1 minute. 90 beats / 1 min = 1.5 beats 90 beats / 60 sec = 1.5 beats/second

Question 75

Which agent is preferred for acute myocardial infarction imaging? (a)[201Tl]Cl (b) [99mTc]pyrophosphate (c) [99mTc]sestamibi (d) [99mTc]tetrofosmin (e) [99mTc]sulfur colloid

Answer 75

(b) [99mTc]pyrophosphate is a bone agent that flows with the bloodstream. Pyrophosphate deposition accumulates with calcium in the mitochondria and within the cytoplasm of necrotic myocardial tissue, so it is preferred for acute myocardial infarction imaging.

Question 76

Which of the following pharmacologic stress agents indirectly affects adenosine receptor sites on cell membranes? (a)dobutamine (b) adenosine (c) atropine (d) esmolol (e) dipyidamole

Answer 76

(e) Dipyridamole produces coronary vasodilation and reactive hyperemia by increasing endogenous plasma adenosine levels. Because dipyridamole inhibits the clearance pathway of adenosine across the cell membrane, it indirectly affects adenosine receptor sites.

Question 77

Which of the following pharmacologic stress agents would be a contraindication for severe aortic stenosis? (a)dobutamine (b) adenosine (c) dipyidamole (d) esmolol (e) atropine

Answer 77

(a) Dobutamine injection is contraindicated in patients with idiopathic hypertrophic subaortic stenosis (severe aortic stenosis) and in patients who have shown previous manifestations of hypersensitivity to dobutamine.

Question 78

89Sr and 153Sm are used for which of the following indications? (a)cardiac imaging (b) bone palliation therapy (c) bone scan to assess metastasis (d) liver/spleen metastatic disease (e) brain imaging

Answer 78

(b) 89Sr and 153Sm are used in bone palliation therapy due to their high beta emissions.

Question 79

It is best NOT to administer 89Sr and 153Sm directly via straight stick injection because: (a)The syringe cannot be adequately shielded. (b) There is an increased possibility of local irradiation of soft tissue due to infiltration. (c) There is no means of controlling the rate of radiopharmaceutical administration. (d) The radiation dose to the technologist's hands from the B- emissions is great. (e) The radiation dose to the technologist's hands from the alpha emissions is great.

Answer 79

(b) It is best to administer 89Sr or 153Sm via IV catheter, rather than syringe, due to possible infiltration and local irradiation of the patient since it is a high beta emitter.

Question 80

A patient scheduled for PET imaging with [18F]FDG should avoid which of the following foods in the last meal before fasting? (a)steak and mushrooms (b) blackened fish and spinach salad (c) grilled chicken and broccoli (d) spaghetti and garlic bread (e) eggs and bacon

Answer 80

(d) There is more emphasis on medications and food in terms of glucose intake (meaning a high protein and low carbohydrate diet) and physical activity before PET imaging with [18F]FDG.

Question 81

When reporting a medical event to the NRC, which of the following information should NOT be included? (a)identity of the patient (b) licensee's name (c) description of the event (d) remedial action (e) facility name

Answer 81

(a) Due to confidentiality rules, the patient identity should not be disclosed in the report to the NRC.

Question 82

If a physician prescribes a radiopharmaceutical according to the patient's body weight, approximately how much activity should a 185 lb patient receive if 55 uCi/kg is prescribed? (a)1.6 mCi (b) 6.4 mCi (c) 9.6 mCi (d) 46.0 mCi (e) 4.6 mCi

Answer 82

``` (e) 2.2 lbs = 1 kg 1 mCi = 1000 uCi 185 lbs x 1 kg / 2.2 lbs = 84.09 kg (55 uCi / 1 kg) x 84.09 kg = 4625 uCi 4625 uCi x 1 mCi / 1000 uCi = 4.6 mCi ```

Question 83

Which of the following is/are medical event(s) according to the NRC? (a)A second dose of [99mTc]MAA is administered after the first is inadvertently infiltrated. (b) [99mTc]DTPA for renal function imaging is requested by the referring physician, but [99mTc]mertiatide is prescribed by the nuclear medicine physician. (c) A [131I]sodium iodide (15 mCi) is prescribed for therapy, but 19 mCi are administered. (d) A myocardial perfusion dose is given to a therapy patient by mistake. (e) A second dose of [99mTc]medronate is administered after the first is inadvertently infiltrated.

Answer 83

(c) Since this is a therapy dose, it must be within +-20% of the prescribed dose. 20% of 15 mCi is 3 mCi, and 3 + 15 = 18 mCi. 18 mCi is thus the maximum that can be given, so 19 mCi would be considered a medical event in this case.

Question 84

A syringe that contains 50 mCi of a 99mTc-labeled compound at 0600 will contain how much radioactivity at 1000? (a)1.17 GBq (b) 116.0 MBq (c) 1169 kBq (d) 11.7 GBq (e) 17 Bq

Answer 84

``` (a) A = Ao(0.5)^(n(t/T1/2) Ao = 50 mCi T1/2 = 6 hr half-life for 99mTc t = 10:00 - 6:00 = 4 3.7 GBq = 100 mCi A = 50 mCi(0.5)^(4/6) A = 31.,5 mCi 31.5 mCi x 3.7 GBq / 100 mCi = 1.17 GBq ```

Question 85

According to the NRC, departmental records of "medical events" must include all of the following of information, EXCEPT? (a)identity of the patient (b) referring physician's name (c) nuclear medicine staff involved in the medical event (d) estimated dose to personnel involved (e) actions take, if any

Answer 85

(d) A written report to the appropriate NRC regional office must be submitted within 15 days and must include the licensee's name; prescribing physician; description of event; why event occurred; effect, if any, on the individual(s) who received the dose; actions taken, if any, to prevent recurrence; and certification that licensee notified the individual and, if not, why not. A separate section for occupationally overexposed individuals must also be included in the report and must include employee's name, Social Security number, and date of birth.

Question 86

Methods to decrease personal radiation exposure when preparing patient doses for injection include all of the following EXCEPT: (a)working as quickly as possible (b) preparing all necessary materials in advance (c) holding the radiopharmaceutical as close to the eye as possible (d) using syringe shields (e) working behind an L-block

Answer 86

(c) Exposure to ionizing radiation can be reduced by three basic principles: (1) decrease the amount of time spent in the area of the radiation source; (2) increase the amount of distance between the radiation source and the person to be protected; and (3) use a shielding material that will attenuate radiation coming from the source. Working as quickly as possible and preparing all necessary materials in advance will decrease the amount of time spent near the radiation source, and using syringe shields will attenuate radiation coming form the source. Holding the radiopharmaceutical as close to the eye as possible does not follow the three basic tenets of radiation safety and will increase radiation exposure. The less time a person is around a radiation source, the lower the exposure; and the more shielding between a person and a radiation source, the lower the exposure.

Question 87

During the IV injection of unit doses, all of the following practices are standard aseptic technique EXCEPT: (a)assembling the syringe and needle aseptically (b) using disposable equipment before its expiration date (c) aseptically cleaning the venipuncture site before injection with an alcohol swab (d) uncapping the needle immediately before the injection (e) wearing sterile gloves

Answer 87

(e) Using disposable equipment before its expiration date, aseptically cleaning the venipuncture site before injection with an alcohol swab, and uncapping the needle immediately before injection are all standard aseptic technique practice. Wearing sterile gloves is not part of standard aseptic technique. Disposable gloves are used during venipuncture.

Question 88

The prescribed unit dose range for a radiopharmaceutical is 5-8 mCi. The unit dose is assayed in a dose calibrator is 19.2 mCi. Which of these actions is the best for the technologist to pursue? (a)Squirt excess dose into a waste bucket. (b) Do not use the dose and call and radiopharmacy for a replacement dose. (c) Question whether the right radiopharmaceutical has been prepared. (d) Delay the radiopharmaceutical administration until the unit dose has decayed. (e) Administer the unit dose to the patient.

Answer 88

(b) Unless otherwise directed by the authorized user (AU), a licensee may not use a dosage if it does not fall within the prescribed range or if it differs from the prescribed dosage by greater than 20%.

Question 89

How many microcuries must be placed in each [123I]sodium iodide capsule to provide approximately 220 uCi at the time of calibration 29 hr after preparation (DF for 1 hr = 0.9488) (a)264 uCi (b) 704 uCi (c) 1009 uCi (d) 800 uCi (e) 234 uCi

Answer 89

(c) The decay time is t = 29 hr. The decay factor (DF) for 1 hr is 0.9488. Thus, the pre-calibration factor which is 1/DF = 1/(0.9488^29) = 4.59. The activity that must be placed in each [123I]sodium iodide capsule is 4.59 x 220 uCi = 1009 uCi.

Question 90

Which of the following is not one of the factors that affect daily planning needs for a nuclear medicine department? (a)types of nuclear medicine procedures (b) unit dosages or dosage ranges for each procedure (c) time interval between radiopharmaceutical preparation and administration (d) percentage of "no shows" a department expects (e) number of each nuclear medicine procedure

Answer 90

(d) Part of planning in a nuclear medicine facility includes the activities and forethought needed to maintain the appropriate amount of supplies and doses to accomplish the type and number of procedures done for the day. The time interval between radiopharmaceutical preparation and administration is also part of the forethought needed. The percentage of no-shows a department expects is not part of the daily planning because all the patients may come, and a facility has to be prepared.

Question 91

The following studies are ordered for the next day: total-body bone image, Meckel's diverticulum localization, renal and a hepatobiliary study. Which of the following radiopharmaceuticals is NOT needed? (a)[99mTc]mebrofenin (b) [99mTc]macroaggregated albumin (c) [99mTc]medronate (d) [99mTc]pertechnetate (e) [99mTc]mertitide

Answer 91

(b) [99mTc]medronate is used for total body bone imaging, [99mTc]TcO4- (pertechnetate) is used to image Meckel's diverticulum localization, and [99mTc]mebrofenin is used for a hepatobiliary study. [99mTc]macroaggregated albumin (MAA) is used for lung perfusion scans and it not needed for the studies that will be performed.

Question 92

Bioavailability refers to what, concerning pharmacology? (a)fraction of a drug that is delivered to body based on weight (b) fraction of a drug that is excreted from the body (c) fraction of a drug that reaches systemic circulation after a particular route of administration (d) fraction of a drug that reaches the heart (e) fraction of a drug that reaches the kidney

Answer 92

(c) Bioavailability refers to the rate and extent of the strength to which an active drug or substance enters the general circulation.

Question 93

All IV contrast agents have a greater osmolality than plasma. The osmolality of plasma is _____ mOsm/kg: (a)75 (b) 435 (c) 285 (d) 525 (e) 755

Answer 93

(c) The osmolality of plasma has a narrow range of 275-295 mOsm/kg.

Question 94

Which of the following is NOT a route of administration of a radiopharmaceutical? (a)inhalation (b) intravenous (IV) (c) intrathecal (d) oral (e) intramuscular

Answer 94

(e) The route of administration for a lung ventilation study is through inhalation. Many nuclear medicine studies require an intravenous (IV) route of administration. Some examples include bone imaging, HIDA scans, and lung perfusion studies. Cisternography utilizes an intrathecal route of administration. Intraarterial is not a route of administration for a radiopharmaceutical.

Question 95

If a concentration equals 25 mCi/mL at 0700 but a dose of 30 mCi has to be drawn at 0200, what volume has to be drawn if the DF equals 1 hr = 0.985? (a)~1.11 mL (b) ~1.52 mL (c) ~0.77 mL (d) ~0.52 mL (e) ~0.75 mL

Answer 95

(a) The decay factor for 1 hr is 0.985. The time is t = 5 hr. The concentration of activity in teh vial is 1/(0.985^5) x 25 mCi/mL = 26.962 mL. The volume required for 30 mCi is 30 mCi divided by 26.962 mCi/mL = 1.11 mL

Question 96

Which of the following is most characteristic of a neutron activation product produced from an (n,p) reaction? (a)decay by electron capture (b) can be made nearly carrier free (c) relatively low specific activity (d) more expensive than cyclotron products (e) cannot be added to preservative-free saline

Answer 96

(b) In an (n,p) reaction, the product nuclide is an isotope of a different element, which allows for the production of high-specific activity, carrier-free (no stable isotope of the same element) radioisotopes.

Question 97

Which of the following statements about the determination of aluminum contamination in 99mTc eluate is TRUE? (a)The eluate sample is compared to a standard solution with an aluminum concentration of zero. (b) The test for aluminum breakthrough needs to be performed only after the generator has been eluted 10-12 times. (c) The USP states that the aluminum concentration in 99mTc eluate is not to exceed 15 ug/mL of eluate. (d) An excessively increased aluminum concentration indicates that the elution volume exceeds the capacity of the generator. (e) The USP states that the aluminum concentration in 99mTc eluate is not to exceed 10 ug/L of eluate.

Answer 97

(e) The USP 26 limit states that the limit for aluminum concentration in a 99mTc eluate is 10 ug/mL for fission-produced 99Mo.

Question 98

In practice, carrier-free specific activity means that: (a)No stable forms of the radioisotope are in the sample. (b) The sample contains no chemical contaminants. (c) All nuclei in the sample will always remain radioactive. (d) Only stable forms of an isotope are present. (e) It creates metal hydrogen.

Answer 98

(a) Carrier-free specific activity is when no stable forms of the radioisotope are in the sample. This is because no stable form of the radioisotope is expected to be in a sample.

Question 99

If no eluate appears in the collection vial during generator elution, the technologist should first: (a)attempt to eluate the generator with a different (new) collection vial (b) contact the manufacturer for advice (c) change the generator tubing (d) add more elution solvent to the column (e) inspect the column

Answer 99

(a) Attempt to elute the generator with a different (new) collection vial first to see if the evacuated vial was compromised.

Question 100

A(n) _____ contrast material may be described as one that does not dissociate or divide into charged particles in solution. (a)non-ionic (b) ionic (c) oral (d) osmolar (e) intravenous

Answer 100

(a) A non-ionic contrast material may be described as one that does not dissociate or divide into charged particles in solution.