2026 NCT Study Guide: Nuclear Cardiology
Technologist —Questions with Answer
Explanations Myocardial Perfusion Imaging |
Radiopharmaceuticals | Stress Testing |
Cardiac Procedures Review
Section 1: Myocardial Perfusion Imaging (MPI) & Procedures
1. Which myocardial perfusion pattern is most indicative of stress-induced
ischemia?
A. Normal resting Tc-99m MIBI, abnormal stress Tc-99m MIBI
B. Abnormal resting Tc-99m MIBI, normal stress Tl-201
C. Normal resting Tc-99m MIBI, normal stress Tl-201
D. Abnormal resting Tl-201, abnormal stress Tc-99m MIBI
Answer: A
Rationale: Myocardial ischemia is characterized by a reversible perfusion defect—
the myocardium appears normal at rest but shows reduced uptake during stress
due to inadequate blood flow.
2. What is the primary cause of a false-positive inferior wall defect in male
patients?
A. Breast attenuation
B. Diaphragmatic attenuation
C. Patient motion
D. Extracardiac activity
Answer: B
Rationale: The diaphragm can attenuate photons from the inferior wall, creating
an apparent perfusion defect that is not real. This is more common in men and
can be corrected with prone imaging or attenuation correction.
,3. In a 180° SPECT acquisition for MPI, where does the detector begin and end?
A. Anterior to posterior
B. Right anterior oblique to left posterior oblique
C. Left anterior oblique to right posterior oblique
D. Lateral to medial
Answer: B
Rationale: The standard 180° acquisition begins at the right anterior oblique
(RAO) and ends at the left posterior oblique (LPO) to optimize resolution and
contrast for the left ventricle.
4. What does a Summed Difference Score (SDS) of 0 indicate?
A. No reversible ischemia
B. Severe reversible ischemia
C. Fixed infarction only
D. Normal perfusion
Answer: A
Rationale: SDS is calculated as SSS minus SRS. A score of 0 means there is no
difference between stress and rest scores, indicating no reversible ischemia
(though it does not exclude a fixed defect).
5. Which acquisition parameter is essential for gated SPECT MPI to assess wall
motion and ejection fraction?
A. Continuous acquisition
B. ECG gating
C. 360° rotation
D. High-energy collimator
Answer: B
Rationale: ECG gating divides the cardiac cycle into multiple frames (typically 8 or
16), allowing assessment of ventricular function (LVEF, wall motion) alongside
perfusion.
6. A patient has a known history of breast cancer and underwent a left
mastectomy. What type of artifact might you expect on the MPI study?
,A. Inferior wall attenuation
B. Anterior wall attenuation
C. Septal wall attenuation
D. Lateral wall attenuation
Answer: B
Rationale: Breast tissue attenuates photons from the anterior wall. In a patient
who has had a mastectomy, the attenuation pattern may be different (less
attenuation on the affected side), potentially creating a relative "hot" appearance
or altering the expected attenuation pattern.
7. What is the primary purpose of administering a "fatty meal" or milk after a Tc-
99m sestamibi injection?
A. Increase myocardial uptake
B. Accelerate hepatobiliary clearance
C. Reduce radiation dose to the bladder
D. Improve ECG gating
Answer: B
Rationale: Tc-99m sestamibi has significant hepatobiliary clearance. A fatty meal
or milk stimulates gallbladder contraction, helping to clear activity from the liver
and gallbladder, reducing extracardiac interference in the inferior wall.
8. Which SPECT filter has no selectable parameters?
A. Butterworth
B. Ramp
C. Parzen
D. Hanning
Answer: B
Rationale: The ramp filter is a high-pass filter with no adjustable parameters. It
sharpens edges but amplifies noise. Other filters like Butterworth and Hanning
have adjustable cutoff frequencies.
9. A "bull's-eye" or polar map display represents what?
A. A 3D reconstruction of coronary arteries
, B. A polar projection of LV perfusion data onto a circular diagram
C. The CT attenuation map overlaid on SPECT
D. A time-activity curve of tracer clearance
Answer: B
Rationale: The polar map (bull's-eye) plots the 3D left ventricular perfusion data
onto a 2D circular display, with the apex at the center and the base at the
periphery.
10. What is the "upward creep" artifact in SPECT MPI, and how can it be
prevented?
A. Patient motion; use sedation
B. Heart position shifting due to breathing; allow bed rest before acquisition
C. Detector drift; recalibrate camera
D. Liver uptake; administer fatty meal
Answer: B
Rationale: Upward creep refers to the heart's position shifting during acquisition
due to changes in respiratory pattern (often after exercise). Allowing the patient to
rest before acquisition helps stabilize breathing patterns.
11. Which of the following is a characteristic of a "fixed" perfusion defect that is
NOT infarction?
A. Reversible on rest imaging
B. Hibernating myocardium
C. Normal wall motion on gated SPECT
D. High FDG uptake on PET
Answer: B
Rationale: Hibernating myocardium is chronically ischemic but viable tissue that
appears as a fixed defect on perfusion imaging. It can be distinguished from scar
by preserved FDG uptake on PET (perfusion-metabolism mismatch).
12. What is the standard energy window for Tc-99m imaging?
A. 70 keV ± 10%
B. 140 keV ± 10%
Technologist —Questions with Answer
Explanations Myocardial Perfusion Imaging |
Radiopharmaceuticals | Stress Testing |
Cardiac Procedures Review
Section 1: Myocardial Perfusion Imaging (MPI) & Procedures
1. Which myocardial perfusion pattern is most indicative of stress-induced
ischemia?
A. Normal resting Tc-99m MIBI, abnormal stress Tc-99m MIBI
B. Abnormal resting Tc-99m MIBI, normal stress Tl-201
C. Normal resting Tc-99m MIBI, normal stress Tl-201
D. Abnormal resting Tl-201, abnormal stress Tc-99m MIBI
Answer: A
Rationale: Myocardial ischemia is characterized by a reversible perfusion defect—
the myocardium appears normal at rest but shows reduced uptake during stress
due to inadequate blood flow.
2. What is the primary cause of a false-positive inferior wall defect in male
patients?
A. Breast attenuation
B. Diaphragmatic attenuation
C. Patient motion
D. Extracardiac activity
Answer: B
Rationale: The diaphragm can attenuate photons from the inferior wall, creating
an apparent perfusion defect that is not real. This is more common in men and
can be corrected with prone imaging or attenuation correction.
,3. In a 180° SPECT acquisition for MPI, where does the detector begin and end?
A. Anterior to posterior
B. Right anterior oblique to left posterior oblique
C. Left anterior oblique to right posterior oblique
D. Lateral to medial
Answer: B
Rationale: The standard 180° acquisition begins at the right anterior oblique
(RAO) and ends at the left posterior oblique (LPO) to optimize resolution and
contrast for the left ventricle.
4. What does a Summed Difference Score (SDS) of 0 indicate?
A. No reversible ischemia
B. Severe reversible ischemia
C. Fixed infarction only
D. Normal perfusion
Answer: A
Rationale: SDS is calculated as SSS minus SRS. A score of 0 means there is no
difference between stress and rest scores, indicating no reversible ischemia
(though it does not exclude a fixed defect).
5. Which acquisition parameter is essential for gated SPECT MPI to assess wall
motion and ejection fraction?
A. Continuous acquisition
B. ECG gating
C. 360° rotation
D. High-energy collimator
Answer: B
Rationale: ECG gating divides the cardiac cycle into multiple frames (typically 8 or
16), allowing assessment of ventricular function (LVEF, wall motion) alongside
perfusion.
6. A patient has a known history of breast cancer and underwent a left
mastectomy. What type of artifact might you expect on the MPI study?
,A. Inferior wall attenuation
B. Anterior wall attenuation
C. Septal wall attenuation
D. Lateral wall attenuation
Answer: B
Rationale: Breast tissue attenuates photons from the anterior wall. In a patient
who has had a mastectomy, the attenuation pattern may be different (less
attenuation on the affected side), potentially creating a relative "hot" appearance
or altering the expected attenuation pattern.
7. What is the primary purpose of administering a "fatty meal" or milk after a Tc-
99m sestamibi injection?
A. Increase myocardial uptake
B. Accelerate hepatobiliary clearance
C. Reduce radiation dose to the bladder
D. Improve ECG gating
Answer: B
Rationale: Tc-99m sestamibi has significant hepatobiliary clearance. A fatty meal
or milk stimulates gallbladder contraction, helping to clear activity from the liver
and gallbladder, reducing extracardiac interference in the inferior wall.
8. Which SPECT filter has no selectable parameters?
A. Butterworth
B. Ramp
C. Parzen
D. Hanning
Answer: B
Rationale: The ramp filter is a high-pass filter with no adjustable parameters. It
sharpens edges but amplifies noise. Other filters like Butterworth and Hanning
have adjustable cutoff frequencies.
9. A "bull's-eye" or polar map display represents what?
A. A 3D reconstruction of coronary arteries
, B. A polar projection of LV perfusion data onto a circular diagram
C. The CT attenuation map overlaid on SPECT
D. A time-activity curve of tracer clearance
Answer: B
Rationale: The polar map (bull's-eye) plots the 3D left ventricular perfusion data
onto a 2D circular display, with the apex at the center and the base at the
periphery.
10. What is the "upward creep" artifact in SPECT MPI, and how can it be
prevented?
A. Patient motion; use sedation
B. Heart position shifting due to breathing; allow bed rest before acquisition
C. Detector drift; recalibrate camera
D. Liver uptake; administer fatty meal
Answer: B
Rationale: Upward creep refers to the heart's position shifting during acquisition
due to changes in respiratory pattern (often after exercise). Allowing the patient to
rest before acquisition helps stabilize breathing patterns.
11. Which of the following is a characteristic of a "fixed" perfusion defect that is
NOT infarction?
A. Reversible on rest imaging
B. Hibernating myocardium
C. Normal wall motion on gated SPECT
D. High FDG uptake on PET
Answer: B
Rationale: Hibernating myocardium is chronically ischemic but viable tissue that
appears as a fixed defect on perfusion imaging. It can be distinguished from scar
by preserved FDG uptake on PET (perfusion-metabolism mismatch).
12. What is the standard energy window for Tc-99m imaging?
A. 70 keV ± 10%
B. 140 keV ± 10%
