NMTCB study guide latest update graded A

NMTCB study guide latest update graded A Patient Release (therapy) TEDE < 0.5rem (5mSv) TEDE to other individual < 0.1 rem (1mSv) with written instructions Palliative therapy: Sr-89 Chloride Ca+ analog that rapidly clears out of blood and localizes in areas of osteogenesis repeated every 12 weeks Palliative therapy: Sm-153 Lexidronam BONE CANCER phosphate compound repeat t(x) every 12 weeks Palliative therapy: P-32 Sodium Phosphate BONE CANCER accumulation in hydroxiapatite crytal of bone and non-osseous tissue Repeat every 12 weeks Palliative Therapy: Y-90 Zevalin Monoclonal antibody Radioimmunotherapy for Non-Hodgkin's lymphoma Rituximab infusion Zevalin 10 min infusion Dose < 32mCi Palliative Therapy: Y-90 Microspheres LIVER CANCER glass microspheres (20-30um) MAA shunting prior to therapy Palliative Therapy: Ra-223 Dichloride (Xofigo) Prostate cancer administration every 4 weeks for 6 weeks (6 injections) Wipe test trigger level 22,000dpm/100cm^2 RSO must be notified Restricted area Radiation limit > 2mrem in any one hour Unrestricted area Rad limit < 2mRem in any one hour Caution: Radiation Area (sign) -Where individual can receive more than .05 msv (5mRem) in 1 hour @ 30cm -Seen in entrances to nuc med labs Caution: High Radiation Area (sign) -Individual can receive more than 100mRem in 1 hour (1mSv) @ 30 cm -Commonly where radiation therapy is performed Grave Danger: Very High Radiation Area (sign) Where individual can receive more than 500 rad (5Gy) in 1hr at 1m from source TYPE A DOT I label (color and regulation specifics) White -no Transport Index - 0.5mRem/hr @ surface -0.0mRem/hr @ 1 meter TYPE A DOT II label (color and specifics) Yellow II <50mR/hr @ surface <1mR/hr @ 1m TYPE A DOT III label (color and specifics) Yellow III <200mR/hr @ surface <10mR/hr @ 1 meter Decay in storage requirements half life < 120 days Labeled: date and identity of radionuclide Items separated by half-lives decay to background (10 half lives) How long is too long to use the Tc eluate and why? >12 hours due to Tc-99 build up WHat unit are wipe tests reported? DPM activity disintegrations/minute By doubling distance from a radioactive source, how much does this cut down the exposure rate? 1/4 Record-able event -wrong radiopharmaceutical -wrong patient -wrong route -wrong dose (+/-20%) Reportable event (medical event) Effective dose equivalent > 5rem Oragn/tissue dose > 50rem SDE > 50 rem Z# of an atom # of protons A# of atom # of protons + neutrons = mass of atom Alpha decay: Z#? A#? Z# decrease by 2 (loss of 2 protons) A# decrease by 4 (loss of 2 protons and 2 neutrons) Alpha decay scheme Daughter decay to the left with a loss of protons (2) and neutrons (2) Beta Decay Z# and A # Z# increase by 1 (n-->p) A# unchanged (NEUTRON RICH) Gamma Decay Z# and A#? unchanged -- excess energy release by photons that have no mass Beta + Decay (positron) competes with Electron Capture because must reach 1.022MeV to emit positron (B+) Z# decrease by 1 (p-->n) PROTON RICH A# unchanged BRAIN IMAGING AGENTS Tc99m HMPAO/exametasine/ceretec Tc99m Bicisate/Neurolite In111 Tl201 Ga67 C11 F18 Tc99m HMPAO (ceretec) properties Slow brain clearance to allow for delayed imaging 10-20mCi dose crosses BBB and becomes trapped in the brain proportional to perfusion In-111 DTPA Cisternogram Cerebrospinal fluid shunt dose and tracer Tc99m DTPA 1mCI in 0.2ml with preservative free Saline or 0.5mCi In-111 DTPA (for delayed images) Diamox (Acetazolamide) Vasodilator to compare perfusion in Brain imaging Endocrine system organs of internal secretion (hormones) Growth, TSH, Prolactin, parathyroid glands, etc. Thyroid Nodule could be normal, malignant, hyperthyroidism Hyperthyroidism thryoidtoxidosis- T4 elevated but 24hr uptake low decreased TSH increased Iodine uptake "hot" appearance on imaging Grave's disease Hypothyroidism increased TSH (overactive) decreased Iodine uptake Thyroid Cancer: LOW RISK PROTOCOL I-123 scan treat with I-131 50-75mCi (low dose) WB scan 1 week