Nuclear Medicine – NMTCB Practice Exam
This study guide covers the five major NMTCB content domains: Radiation Physics and
Detection, Radiation Safety and Regulations, Pharmaceutical and Radiopharmaceutical Agents,
Instrumentation Operation and Quality Control, and Clinical Procedures. Candidates will review
radionuclide characteristics, radiopharmacy calculations, imaging instrumentation, quality
assurance procedures, SPECT/PET imaging principles, patient care, and diagnostic nuclear
medicine protocols commonly encountered in clinical practice. The material is designed to
strengthen technical knowledge, reinforce clinical decision-making skills, and support
comprehensive preparation for the Certified Nuclear Medicine Technologist (CNMT)
certification examination
Question 1
Which of the following radiopharmaceuticals is used for imaging of infection and
inflammation using labeled white blood cells?
A) Tc-99m HMPAO
B) Tc-99m Exametazime
C) In-111 Oxine
D) All of the above
Answer: D) All of the above
Rationale: Tc-99m HMPAO (Exametazime) and In-111 Oxine are both used to label white
blood cells (WBCs) for infection imaging. Tc-99m HMPAO provides higher count rates and
better image quality, while In-111 Oxine allows delayed imaging (up to 24 hours) due to
its longer half-life (67 hours).
Question 2
The normal biodistribution of Tc-99m MDP in bone includes highest uptake in
which of the following areas?
A) Axial skeleton (spine, pelvis)
B) Appendicular skeleton (extremities)
,C) Skull
D) All areas equally
Answer: A) Axial skeleton (spine, pelvis)
Rationale: Tc-99m MDP uptake is highest in areas of high bone turnover, including the
axial skeleton (spine, pelvis, ribs) and the proximal appendicular skeleton (proximal
femurs, humeri). The skull and distal extremities show relatively lower uptake.
Question 3
Which of the following is a "superscan" appearance on a bone scan?
A) Intense, uniform skeletal uptake with absent renal activity
B) Patchy, asymmetric uptake
C) Focal hot spots
D) Diffuse decreased uptake
Answer: A) Intense, uniform skeletal uptake with absent renal activity
Rationale: A superscan is characterized by intense, uniform skeletal uptake (especially in
the axial skeleton) with absent or faint renal activity. It is seen in conditions with
widespread increased bone turnover, such as metastatic prostate cancer, metabolic bone
disease (e.g., hyperparathyroidism), and multiple myeloma.
Question 4
Which of the following conditions can cause a "superscan" appearance on a bone
scan?
A) Metastatic prostate cancer
B) Hyperparathyroidism
C) Paget's disease (diffuse)
D) All of the above
Answer: D) All of the above
Rationale: A superscan can be caused by widespread metastatic disease (especially
,prostate and breast cancer), metabolic bone disease (hyperparathyroidism, renal
osteodystrophy), and diffuse Paget's disease. The common feature is diffuse, increased
bone turnover.
Question 5
The "renal excretion" of Tc-99m MDP is important because:
A) Renal activity is normally visible and helps assess renal function
B) Renal activity indicates abnormal bone uptake
C) Renal activity should be absent for diagnostic quality
D) Renal activity interferes with bone imaging
Answer: A) Renal activity is normally visible and helps assess renal function
Rationale: Tc-99m MDP is excreted by the kidneys, so normal renal activity is seen on
bone scans (kidneys and bladder). Reduced or absent renal activity may indicate poor
renal function or, in a superscan, suggests intense bone uptake overwhelming renal
excretion.
Question 6
Which of the following is a common cause of a "photopenic" (cold) defect on a
bone scan?
A) Bone metastasis
B) Bone infarct
C) Osteomyelitis
D) Paget's disease
Answer: B) Bone infarct
Rationale: A photopenic (cold) defect on a bone scan indicates decreased tracer uptake,
which can be caused by bone infarcts (avascular necrosis), multiple myeloma (lytic
lesions), radiation therapy, and certain tumors. Bone metastases, osteomyelitis, and
Paget's disease typically show increased uptake (hot).
, Question 7
Which of the following is a typical "myocardial perfusion" protocol for Tc-99m
Sestamibi?
A) Stress imaging, then rest imaging on separate days
B) Rest imaging, then stress imaging on same day
C) Stress only
D) Rest only
Answer: A) Stress imaging, then rest imaging on separate days
Rationale: Tc-99m sestamibi protocols include either a 1-day or 2-day rest-stress or stress-
rest protocol. A common 2-day protocol involves stress imaging on day 1 (with stress and
injection), then rest imaging on day 2 (with rest injection). The 1-day protocol uses a low-
dose rest injection followed by a higher-dose stress injection with imaging at both time
points.
Question 8
What is the "dose reduction" principle in pediatric nuclear medicine?
A) Reducing the radiopharmaceutical dose based on patient weight or body surface
area
B) Eliminating all pediatric procedures
C) Increasing the dose for better image quality
D) Using only non-ionizing imaging
Answer: A) Reducing the radiopharmaceutical dose based on patient weight or
body surface area
Rationale: In pediatric nuclear medicine, doses are adjusted (reduced) based on patient
weight or body surface area (BSA) to minimize radiation exposure while maintaining
adequate image quality. This is done according to established guidelines (e.g., EANM,
SNMMI).
This study guide covers the five major NMTCB content domains: Radiation Physics and
Detection, Radiation Safety and Regulations, Pharmaceutical and Radiopharmaceutical Agents,
Instrumentation Operation and Quality Control, and Clinical Procedures. Candidates will review
radionuclide characteristics, radiopharmacy calculations, imaging instrumentation, quality
assurance procedures, SPECT/PET imaging principles, patient care, and diagnostic nuclear
medicine protocols commonly encountered in clinical practice. The material is designed to
strengthen technical knowledge, reinforce clinical decision-making skills, and support
comprehensive preparation for the Certified Nuclear Medicine Technologist (CNMT)
certification examination
Question 1
Which of the following radiopharmaceuticals is used for imaging of infection and
inflammation using labeled white blood cells?
A) Tc-99m HMPAO
B) Tc-99m Exametazime
C) In-111 Oxine
D) All of the above
Answer: D) All of the above
Rationale: Tc-99m HMPAO (Exametazime) and In-111 Oxine are both used to label white
blood cells (WBCs) for infection imaging. Tc-99m HMPAO provides higher count rates and
better image quality, while In-111 Oxine allows delayed imaging (up to 24 hours) due to
its longer half-life (67 hours).
Question 2
The normal biodistribution of Tc-99m MDP in bone includes highest uptake in
which of the following areas?
A) Axial skeleton (spine, pelvis)
B) Appendicular skeleton (extremities)
,C) Skull
D) All areas equally
Answer: A) Axial skeleton (spine, pelvis)
Rationale: Tc-99m MDP uptake is highest in areas of high bone turnover, including the
axial skeleton (spine, pelvis, ribs) and the proximal appendicular skeleton (proximal
femurs, humeri). The skull and distal extremities show relatively lower uptake.
Question 3
Which of the following is a "superscan" appearance on a bone scan?
A) Intense, uniform skeletal uptake with absent renal activity
B) Patchy, asymmetric uptake
C) Focal hot spots
D) Diffuse decreased uptake
Answer: A) Intense, uniform skeletal uptake with absent renal activity
Rationale: A superscan is characterized by intense, uniform skeletal uptake (especially in
the axial skeleton) with absent or faint renal activity. It is seen in conditions with
widespread increased bone turnover, such as metastatic prostate cancer, metabolic bone
disease (e.g., hyperparathyroidism), and multiple myeloma.
Question 4
Which of the following conditions can cause a "superscan" appearance on a bone
scan?
A) Metastatic prostate cancer
B) Hyperparathyroidism
C) Paget's disease (diffuse)
D) All of the above
Answer: D) All of the above
Rationale: A superscan can be caused by widespread metastatic disease (especially
,prostate and breast cancer), metabolic bone disease (hyperparathyroidism, renal
osteodystrophy), and diffuse Paget's disease. The common feature is diffuse, increased
bone turnover.
Question 5
The "renal excretion" of Tc-99m MDP is important because:
A) Renal activity is normally visible and helps assess renal function
B) Renal activity indicates abnormal bone uptake
C) Renal activity should be absent for diagnostic quality
D) Renal activity interferes with bone imaging
Answer: A) Renal activity is normally visible and helps assess renal function
Rationale: Tc-99m MDP is excreted by the kidneys, so normal renal activity is seen on
bone scans (kidneys and bladder). Reduced or absent renal activity may indicate poor
renal function or, in a superscan, suggests intense bone uptake overwhelming renal
excretion.
Question 6
Which of the following is a common cause of a "photopenic" (cold) defect on a
bone scan?
A) Bone metastasis
B) Bone infarct
C) Osteomyelitis
D) Paget's disease
Answer: B) Bone infarct
Rationale: A photopenic (cold) defect on a bone scan indicates decreased tracer uptake,
which can be caused by bone infarcts (avascular necrosis), multiple myeloma (lytic
lesions), radiation therapy, and certain tumors. Bone metastases, osteomyelitis, and
Paget's disease typically show increased uptake (hot).
, Question 7
Which of the following is a typical "myocardial perfusion" protocol for Tc-99m
Sestamibi?
A) Stress imaging, then rest imaging on separate days
B) Rest imaging, then stress imaging on same day
C) Stress only
D) Rest only
Answer: A) Stress imaging, then rest imaging on separate days
Rationale: Tc-99m sestamibi protocols include either a 1-day or 2-day rest-stress or stress-
rest protocol. A common 2-day protocol involves stress imaging on day 1 (with stress and
injection), then rest imaging on day 2 (with rest injection). The 1-day protocol uses a low-
dose rest injection followed by a higher-dose stress injection with imaging at both time
points.
Question 8
What is the "dose reduction" principle in pediatric nuclear medicine?
A) Reducing the radiopharmaceutical dose based on patient weight or body surface
area
B) Eliminating all pediatric procedures
C) Increasing the dose for better image quality
D) Using only non-ionizing imaging
Answer: A) Reducing the radiopharmaceutical dose based on patient weight or
body surface area
Rationale: In pediatric nuclear medicine, doses are adjusted (reduced) based on patient
weight or body surface area (BSA) to minimize radiation exposure while maintaining
adequate image quality. This is done according to established guidelines (e.g., EANM,
SNMMI).
