NUCLEAR MEDICINE UPDATED EXAMS TEST PAPER
QUESTIONS AND SOLUTIONS GUARANTEE A+
✔✔What are key points to a thalium-201 cardiac imaging protocol? - ✔✔pt should fast
for 4h 111-120 MBq IV image 10 min after injection
✔✔What are the key in the cardiac imaging protocol for Tc99- sestemibi or tetrafosmin -
✔✔fast 4h 370-1110 MBq IV 1-day rest protoco: rest - 370 MBq, image at 30-90min
stress: 1110 MBq imaging at 15-30 2 day protocol rest/stress or stress/rest imaging
*1110 MBq
✔✔What agents can you use for a pharmacologic stress test - ✔✔adenosine
dipyridamole (persantine) dobutamine dypyrimadole and adenosine - cornoay
vasodialators (adenosine is direct action, dipyrimadole prevents reuptake of adenosine)
unlike exercise these test for coronary flow reserve dobutamine 0 used as alternative.
Synthetic catecholamine. Frequently Pt will have side effects.
✔✔What must be discontinued for 24 hours prior to adenosine and dipyrimadole testing
- ✔✔Methylxanthines - theophylline and caffeine These agents also cause
bronchospasm - should not be used if there is a history of bronchospastic disease
✔✔What are the antidotes for dipyridamole and adenosine? - ✔✔Dipyridamole -
aminophylline Adenosine - none half life really shory 10sec so just stop the infusion
✔✔What are the gender specific attenuation patterns one can see in cardiac imaging? -
✔✔Male- decreased activity in the infectior wall - diaphragmatic attenuation Females -
may also see diaphragmatic attenuation, however decreased activity in the anterior wall,
apex or lateral portion of the heart secondary to breast attenuation dominates.
✔✔What extracardiac regions of uptake can you see? - ✔✔Any metabolically active
tissue other than brain. Thyroid, salivary, skeletal muscle, kidneys, gb, intestinal Benign
and malignant tumors also uptake Tl and Tc-sestamibi
✔✔What is the definition and scan appearance of: Ischemia Infarction Hybernating
myocardium Stunned Myocardium - ✔✔Ischemia - oxygen supply below metabolic
requirements due to inadequate blood flow due to stenosis. Photon deficient defecton
stress perfusion scintograms Infarction - necrosis of myocardial tissue due to occlusion.
Photon deficient on rest and stress perfusion and metabolic imaging studies
Hybernating myocardium - chronically ischemic myocardium with decreased blood flow
and down regulation of contractility, reversible with restoration of blood flow no
perfusion on rest images, poor contraction, improved perfusion on rest/rest or
reinjection of Tl. Increased uptake by FDG metabolic imaging compared to perfusion
scan Stunned - persistant contractile dysfunction despite restoration of perfusion after a
,period of ischemia Normal by perfusion imaging, poor contraction, Uptake by FDG
metabolic imaging.
✔✔Normal flow and extraction but delayed excretion and cortical retention can be seen
in which scenarios during renal scaning? - ✔✔ATN obstruction medical renal disease
(GN, diabetic nephropathy) ATN- caused by ischemia, sepsis, renal toxic drugs and IV
contrast. Rejection would show delated flow/extraction where as it will be normal in
ATN.
✔✔What probability of PE would a triple match abnormality be? - ✔✔Intermediate
(merate or large segmental)
✔✔Which neoplastic processes may not be significantly FDG avid - ✔✔mucinous
cancers low grade lymphoma (MALT) leukemia papillary thyroid -lung,colon, renal, low
grade prostate, ovarian, neuroendocrine tumors
✔✔What are 4 differences between Tc-HMPAO WBC and In-WBC imaging? - ✔✔1) Tc-
HMPAO can perorm early imaging (20min), and has shorter imaging times. In usualy at
24hours. 2)Tc- excretion into bowel can be seen as early as 1h (a disadvantage when
compared to In111) - In111 not usually excreted into bowel or bladder 3) HMPAO
excreted into bladder, In-111 is not 4) HMPAO has lower radiation exposure 5) HMPAO
needs smalled blood sample
✔✔What drug and at what dose do you use to pretreat infants with suspected biliary
atresia? what does the drug do? - ✔✔Phenobarbital - 5mg/kg PO 2 divided doses daily
for minimum of 3-5days proir to study. Enhances biliary excretion
✔✔How is gallium uptake graded? - ✔✔1- less than bone but above background 2-
equal to bone 3- equal to liver 4- greater than liver
✔✔What pharmaceutical can estimate GFR? - ✔✔Tc99-DTPA May also use I-125
✔✔What is the dose limit to the pregnant worker fetus? - ✔✔0.5 rem (5mSv)
✔✔What is a disadvantage of Ga-67 for abdominal abscesses - ✔✔Normal excretion
within bowel Decrease effect by early (5h ) Or delayed imaging In-111 WBC has no
bowel or renal excretion
✔✔What's the mechanism of localization of Tc99-SC - ✔✔Phagocytized by
reticuloendothelial cells
✔✔What's the normal distribution of Ga-67 citrate - ✔✔Liver Spleen Bone Bowel
Salivary and lacrimal glands Breast uptake Kidney a bladder in first 24 hours
, ✔✔What examination may you consider for pancreatic neuro endocrine tumor -
✔✔Octreoscan
✔✔Name 3 cardiac perfusion agents? - ✔✔Rb-82 Tc-99m tetrofosmin N-13 ammonia
✔✔What tracer is best for cardiac viability - ✔✔F-18
✔✔What effect does glucagon have on peristalsis and vessels? - ✔✔Decreases
peristalsis Vasodilation
✔✔What would you give to reverse the effects of pharmacological coronary
vasodilation? - ✔✔Aminophylline (non selective adenosine receptor antagonist)
✔✔What are factors that may give you a false positive for reversible ischemia in the
septum - ✔✔Left bundle branch block High heart rate
✔✔What cardiac agents do you use for viability ? - ✔✔Fdg-PET Th-201
✔✔What's the difference between stunned and hibernating myocardium? -
✔✔Hibernation- reduced blood flow and contractility. But viable Stunned- will have
contractile function that may be blunted or delayed. Normal perfusion.
✔✔What is REM - ✔✔Based on bilogical damage caused by ionization in tissue Term
for dose equivalence- equals the damage caused by 1 RAD of dose =dose in RADs x
quality factor (different type of radiation)
✔✔What's the keV for Tc99m - ✔✔140 keV
✔✔What's the energy of I-123 - ✔✔159 keV
✔✔What's the energy of I-131 - ✔✔364 keV
✔✔What's the half life of F-18 FDG - ✔✔110 min
✔✔What is Rb-82 used for? What's the half life? - ✔✔Cardiac perfusion 75sec
✔✔Above what dose of I131 do you need a written directive - ✔✔Anything above 30uCi
(1.11 MBq)
✔✔What is a restricted area in a nuclear medicine department? - ✔✔Any place that
receives >2 mrem/h
QUESTIONS AND SOLUTIONS GUARANTEE A+
✔✔What are key points to a thalium-201 cardiac imaging protocol? - ✔✔pt should fast
for 4h 111-120 MBq IV image 10 min after injection
✔✔What are the key in the cardiac imaging protocol for Tc99- sestemibi or tetrafosmin -
✔✔fast 4h 370-1110 MBq IV 1-day rest protoco: rest - 370 MBq, image at 30-90min
stress: 1110 MBq imaging at 15-30 2 day protocol rest/stress or stress/rest imaging
*1110 MBq
✔✔What agents can you use for a pharmacologic stress test - ✔✔adenosine
dipyridamole (persantine) dobutamine dypyrimadole and adenosine - cornoay
vasodialators (adenosine is direct action, dipyrimadole prevents reuptake of adenosine)
unlike exercise these test for coronary flow reserve dobutamine 0 used as alternative.
Synthetic catecholamine. Frequently Pt will have side effects.
✔✔What must be discontinued for 24 hours prior to adenosine and dipyrimadole testing
- ✔✔Methylxanthines - theophylline and caffeine These agents also cause
bronchospasm - should not be used if there is a history of bronchospastic disease
✔✔What are the antidotes for dipyridamole and adenosine? - ✔✔Dipyridamole -
aminophylline Adenosine - none half life really shory 10sec so just stop the infusion
✔✔What are the gender specific attenuation patterns one can see in cardiac imaging? -
✔✔Male- decreased activity in the infectior wall - diaphragmatic attenuation Females -
may also see diaphragmatic attenuation, however decreased activity in the anterior wall,
apex or lateral portion of the heart secondary to breast attenuation dominates.
✔✔What extracardiac regions of uptake can you see? - ✔✔Any metabolically active
tissue other than brain. Thyroid, salivary, skeletal muscle, kidneys, gb, intestinal Benign
and malignant tumors also uptake Tl and Tc-sestamibi
✔✔What is the definition and scan appearance of: Ischemia Infarction Hybernating
myocardium Stunned Myocardium - ✔✔Ischemia - oxygen supply below metabolic
requirements due to inadequate blood flow due to stenosis. Photon deficient defecton
stress perfusion scintograms Infarction - necrosis of myocardial tissue due to occlusion.
Photon deficient on rest and stress perfusion and metabolic imaging studies
Hybernating myocardium - chronically ischemic myocardium with decreased blood flow
and down regulation of contractility, reversible with restoration of blood flow no
perfusion on rest images, poor contraction, improved perfusion on rest/rest or
reinjection of Tl. Increased uptake by FDG metabolic imaging compared to perfusion
scan Stunned - persistant contractile dysfunction despite restoration of perfusion after a
,period of ischemia Normal by perfusion imaging, poor contraction, Uptake by FDG
metabolic imaging.
✔✔Normal flow and extraction but delayed excretion and cortical retention can be seen
in which scenarios during renal scaning? - ✔✔ATN obstruction medical renal disease
(GN, diabetic nephropathy) ATN- caused by ischemia, sepsis, renal toxic drugs and IV
contrast. Rejection would show delated flow/extraction where as it will be normal in
ATN.
✔✔What probability of PE would a triple match abnormality be? - ✔✔Intermediate
(merate or large segmental)
✔✔Which neoplastic processes may not be significantly FDG avid - ✔✔mucinous
cancers low grade lymphoma (MALT) leukemia papillary thyroid -lung,colon, renal, low
grade prostate, ovarian, neuroendocrine tumors
✔✔What are 4 differences between Tc-HMPAO WBC and In-WBC imaging? - ✔✔1) Tc-
HMPAO can perorm early imaging (20min), and has shorter imaging times. In usualy at
24hours. 2)Tc- excretion into bowel can be seen as early as 1h (a disadvantage when
compared to In111) - In111 not usually excreted into bowel or bladder 3) HMPAO
excreted into bladder, In-111 is not 4) HMPAO has lower radiation exposure 5) HMPAO
needs smalled blood sample
✔✔What drug and at what dose do you use to pretreat infants with suspected biliary
atresia? what does the drug do? - ✔✔Phenobarbital - 5mg/kg PO 2 divided doses daily
for minimum of 3-5days proir to study. Enhances biliary excretion
✔✔How is gallium uptake graded? - ✔✔1- less than bone but above background 2-
equal to bone 3- equal to liver 4- greater than liver
✔✔What pharmaceutical can estimate GFR? - ✔✔Tc99-DTPA May also use I-125
✔✔What is the dose limit to the pregnant worker fetus? - ✔✔0.5 rem (5mSv)
✔✔What is a disadvantage of Ga-67 for abdominal abscesses - ✔✔Normal excretion
within bowel Decrease effect by early (5h ) Or delayed imaging In-111 WBC has no
bowel or renal excretion
✔✔What's the mechanism of localization of Tc99-SC - ✔✔Phagocytized by
reticuloendothelial cells
✔✔What's the normal distribution of Ga-67 citrate - ✔✔Liver Spleen Bone Bowel
Salivary and lacrimal glands Breast uptake Kidney a bladder in first 24 hours
, ✔✔What examination may you consider for pancreatic neuro endocrine tumor -
✔✔Octreoscan
✔✔Name 3 cardiac perfusion agents? - ✔✔Rb-82 Tc-99m tetrofosmin N-13 ammonia
✔✔What tracer is best for cardiac viability - ✔✔F-18
✔✔What effect does glucagon have on peristalsis and vessels? - ✔✔Decreases
peristalsis Vasodilation
✔✔What would you give to reverse the effects of pharmacological coronary
vasodilation? - ✔✔Aminophylline (non selective adenosine receptor antagonist)
✔✔What are factors that may give you a false positive for reversible ischemia in the
septum - ✔✔Left bundle branch block High heart rate
✔✔What cardiac agents do you use for viability ? - ✔✔Fdg-PET Th-201
✔✔What's the difference between stunned and hibernating myocardium? -
✔✔Hibernation- reduced blood flow and contractility. But viable Stunned- will have
contractile function that may be blunted or delayed. Normal perfusion.
✔✔What is REM - ✔✔Based on bilogical damage caused by ionization in tissue Term
for dose equivalence- equals the damage caused by 1 RAD of dose =dose in RADs x
quality factor (different type of radiation)
✔✔What's the keV for Tc99m - ✔✔140 keV
✔✔What's the energy of I-123 - ✔✔159 keV
✔✔What's the energy of I-131 - ✔✔364 keV
✔✔What's the half life of F-18 FDG - ✔✔110 min
✔✔What is Rb-82 used for? What's the half life? - ✔✔Cardiac perfusion 75sec
✔✔Above what dose of I131 do you need a written directive - ✔✔Anything above 30uCi
(1.11 MBq)
✔✔What is a restricted area in a nuclear medicine department? - ✔✔Any place that
receives >2 mrem/h
