2026 NCT Study Guide: Nuclear Cardiology
Technologist —Questions with Answer Explanations
Myocardial Perfusion Imaging |
Radiopharmaceuticals | Stress Testing | Cardiac
Procedures Review
SECTION 1: CARDIOVASCULAR ANATOMY, PHYSIOLOGY &
PATHOPHYSIOLOGY (Questions 1–18)
Question 1. Which coronary artery supplies the majority of the anterior wall and
anterior septum of the left ventricle?
A) Right coronary artery
B) Left circumflex artery
C) Left anterior descending artery
D) Posterior descending artery
Rationale: The left anterior descending (LAD) artery runs in the anterior
interventricular groove and perfuses the anterior septum and anterior free wall of
the left ventricle. It supplies the greatest proportion of myocardium and is
sometimes called the "widow maker" when significantly stenosed.
Question 2. During which phase of the cardiac cycle does the mitral valve close?
A) Isovolumetric contraction
B) Rapid ejection
C) Isovolumetric relaxation
D) Rapid filling
Rationale: The mitral valve closes at the onset of systole, initiating the
isovolumetric contraction period when ventricular pressure rises but volume
remains constant.
Question 3. The ejection fraction (EF) is calculated as:
,A) Stroke volume ÷ End-diastolic volume × 100%
B) Cardiac output ÷ Heart rate × 100%
C) End-systolic volume ÷ End-diastolic volume × 100%
D) Stroke volume ÷ Cardiac output × 100%
Rationale: EF = (SV / EDV) × 100%, reflecting the proportion of blood ejected
from the ventricle each beat. The formula can also be expressed as (EDV − ESV) /
EDV × 100%.
Question 4. Which of the following best describes hibernating myocardium?
A) Irreversibly scarred tissue
B) Viable tissue with reduced function due to chronic low flow
C) Tissue with normal perfusion but abnormal metabolism
D) Tissue stunned after acute ischemia and now normal
Rationale: Hibernating myocardium remains viable but exhibits sustained
contractile dysfunction because of chronic suboptimal perfusion; it can improve
after revascularization.
Question 5. The most common cause of restrictive cardiomyopathy is:
A) Amyloidosis
B) Hypertrophic cardiomyopathy
C) Dilated cardiomyopathy
D) Ischemic heart disease
Rationale: Amyloid deposition in the myocardium leads to stiff ventricles and a
restrictive filling pattern, making amyloidosis the leading cause.
Question 6. Which of the following best describes the perfusion–metabolism
mismatch pattern on PET imaging?
A) Hibernating myocardium
B) Normal myocardium
C) Scarred myocardium
D) Stunned myocardium
,Rationale: The perfusion–metabolism mismatch pattern — reduced perfusion with
preserved FDG metabolism — is the hallmark of hibernating myocardium and
indicates viability.
Question 7. The normal range for left ventricular ejection fraction (LVEF) is:
A) 30–45%
B) 40–55%
C) 55–70%
D) 70–85%
Rationale: The normal LVEF is 55–70%. An LVEF below 55% is generally
considered reduced and may indicate systolic dysfunction.
Question 8. Which of the following is a measure of the work load of the heart,
equal to systolic blood pressure multiplied by heart rate?
A) The double product
B) The heart rate recovery
C) The metabolic equivalent
D) The predicted heart rate
Rationale: The double product (rate-pressure product) is calculated as systolic
blood pressure × heart rate and serves as an index of myocardial oxygen demand.
Question 9. The typical stroke volume (SV) of the left ventricle is approximately:
A) 35 ml
B) 70 ml
C) 140 ml
D) 280 ml
Rationale: The typical stroke volume of the left ventricle is approximately 70 ml
per beat.
, Question 10. What is the correct order of injections when a pharmacological stress
test with regadenoson (Lexiscan) is performed?
A) Saline flash, Lexiscan, radiotracer, saline flash
B) Lexiscan, saline flash, radiotracer, saline flash
C) Radiotracer, saline flash, Lexiscan, saline flash
D) Radiotracer, saline flash, Lexiscan, saline flash
Rationale: The correct sequence is: Lexiscan bolus, saline flash, radiotracer
injection, followed by another saline flash. Regadenoson is administered as a
fixed-dose intravenous bolus, unlike adenosine or dipyridamole which are given as
constant infusions.
Question 11. Which of the following statements describing extracardiac incidental
findings (ECFs) on nuclear SPECT MPI is FALSE?
A) ECFs on nuclear SPECT MPI are rare and difficult to identify
B) ECFs can be small or large and they can be single or multiple
C) Patients with ECFs may have symptoms that can often mimic cardiac symptoms
D) There is a significant variability in the incidence of reported ECFs, depending
on the reader's skill
Rationale: ECFs on nuclear SPECT MPI are actually common and can be easily
identified. The other statements are true.
Question 12. Which of the following PET agents is classified as a freely diffusible
tracer?
A) F-18 fluorodeoxyglucose
B) N-13 ammonia
C) O-15 water
D) Rb-82
Rationale: O-15 water is a freely diffusible tracer that crosses cell membranes by
passive diffusion and is used for quantitative myocardial blood flow measurement.
Technologist —Questions with Answer Explanations
Myocardial Perfusion Imaging |
Radiopharmaceuticals | Stress Testing | Cardiac
Procedures Review
SECTION 1: CARDIOVASCULAR ANATOMY, PHYSIOLOGY &
PATHOPHYSIOLOGY (Questions 1–18)
Question 1. Which coronary artery supplies the majority of the anterior wall and
anterior septum of the left ventricle?
A) Right coronary artery
B) Left circumflex artery
C) Left anterior descending artery
D) Posterior descending artery
Rationale: The left anterior descending (LAD) artery runs in the anterior
interventricular groove and perfuses the anterior septum and anterior free wall of
the left ventricle. It supplies the greatest proportion of myocardium and is
sometimes called the "widow maker" when significantly stenosed.
Question 2. During which phase of the cardiac cycle does the mitral valve close?
A) Isovolumetric contraction
B) Rapid ejection
C) Isovolumetric relaxation
D) Rapid filling
Rationale: The mitral valve closes at the onset of systole, initiating the
isovolumetric contraction period when ventricular pressure rises but volume
remains constant.
Question 3. The ejection fraction (EF) is calculated as:
,A) Stroke volume ÷ End-diastolic volume × 100%
B) Cardiac output ÷ Heart rate × 100%
C) End-systolic volume ÷ End-diastolic volume × 100%
D) Stroke volume ÷ Cardiac output × 100%
Rationale: EF = (SV / EDV) × 100%, reflecting the proportion of blood ejected
from the ventricle each beat. The formula can also be expressed as (EDV − ESV) /
EDV × 100%.
Question 4. Which of the following best describes hibernating myocardium?
A) Irreversibly scarred tissue
B) Viable tissue with reduced function due to chronic low flow
C) Tissue with normal perfusion but abnormal metabolism
D) Tissue stunned after acute ischemia and now normal
Rationale: Hibernating myocardium remains viable but exhibits sustained
contractile dysfunction because of chronic suboptimal perfusion; it can improve
after revascularization.
Question 5. The most common cause of restrictive cardiomyopathy is:
A) Amyloidosis
B) Hypertrophic cardiomyopathy
C) Dilated cardiomyopathy
D) Ischemic heart disease
Rationale: Amyloid deposition in the myocardium leads to stiff ventricles and a
restrictive filling pattern, making amyloidosis the leading cause.
Question 6. Which of the following best describes the perfusion–metabolism
mismatch pattern on PET imaging?
A) Hibernating myocardium
B) Normal myocardium
C) Scarred myocardium
D) Stunned myocardium
,Rationale: The perfusion–metabolism mismatch pattern — reduced perfusion with
preserved FDG metabolism — is the hallmark of hibernating myocardium and
indicates viability.
Question 7. The normal range for left ventricular ejection fraction (LVEF) is:
A) 30–45%
B) 40–55%
C) 55–70%
D) 70–85%
Rationale: The normal LVEF is 55–70%. An LVEF below 55% is generally
considered reduced and may indicate systolic dysfunction.
Question 8. Which of the following is a measure of the work load of the heart,
equal to systolic blood pressure multiplied by heart rate?
A) The double product
B) The heart rate recovery
C) The metabolic equivalent
D) The predicted heart rate
Rationale: The double product (rate-pressure product) is calculated as systolic
blood pressure × heart rate and serves as an index of myocardial oxygen demand.
Question 9. The typical stroke volume (SV) of the left ventricle is approximately:
A) 35 ml
B) 70 ml
C) 140 ml
D) 280 ml
Rationale: The typical stroke volume of the left ventricle is approximately 70 ml
per beat.
, Question 10. What is the correct order of injections when a pharmacological stress
test with regadenoson (Lexiscan) is performed?
A) Saline flash, Lexiscan, radiotracer, saline flash
B) Lexiscan, saline flash, radiotracer, saline flash
C) Radiotracer, saline flash, Lexiscan, saline flash
D) Radiotracer, saline flash, Lexiscan, saline flash
Rationale: The correct sequence is: Lexiscan bolus, saline flash, radiotracer
injection, followed by another saline flash. Regadenoson is administered as a
fixed-dose intravenous bolus, unlike adenosine or dipyridamole which are given as
constant infusions.
Question 11. Which of the following statements describing extracardiac incidental
findings (ECFs) on nuclear SPECT MPI is FALSE?
A) ECFs on nuclear SPECT MPI are rare and difficult to identify
B) ECFs can be small or large and they can be single or multiple
C) Patients with ECFs may have symptoms that can often mimic cardiac symptoms
D) There is a significant variability in the incidence of reported ECFs, depending
on the reader's skill
Rationale: ECFs on nuclear SPECT MPI are actually common and can be easily
identified. The other statements are true.
Question 12. Which of the following PET agents is classified as a freely diffusible
tracer?
A) F-18 fluorodeoxyglucose
B) N-13 ammonia
C) O-15 water
D) Rb-82
Rationale: O-15 water is a freely diffusible tracer that crosses cell membranes by
passive diffusion and is used for quantitative myocardial blood flow measurement.
