Test Bank For Nuclear Medicine and Pet/CT: Technology and
Techniques 8th Edition By Kristen M. Waterstram-Rich, MS,
CNMT, NCT, FSNMTS and David Gilmore 9780323356220
Chapter 1-24 Complete Guide .
1. What is the basic principle of nuclear medicine?
A. A radiopharmaceutical is administered to the patient and it accumulates in the organ of interest.
B. Gamma rays emitted in all directions, those which headed in the direction of gamma camera will
enter
the crystal and undergo Scintillations.
C. An image of radiopharmaceutical is formed.
D. Can be 2D/ series of slices.
E. Fusion of 2 images can be obtained by PET/CT, PET/MRI and SPECT/CT.
F. We can combine the radiopharmaceutical with a compound that suits our purpose (glucose,
diphosphonates) and use this for visualization.
G. Nuclear medicine is a FUNCTIONAL imaging used for both diagnostics and therapeutic
purposes. - ANSWER: G. Nuclear medicine is a FUNCTIONAL imaging used for both diagnostics and
therapeutic
purposes.
What is the principle and procedure of an indirect vesico-ureteral reflux study? - ANSWER: For direct
radionuclide cystography, 99m Tc pertechnetate, 99m Tc-DTPA, or 99m Tc sulphur colloid is instilled
through an indwelling bladder catheter, in a volume of normal saline sufficient to fill the bladder. In
normal patients, no radiopharmaceutical reflux from the bladder into the ureters or the kidneys is
seen.
The indirect radionuclide cystogram (IRC) offers the possibility of detecting VUR without a bladder
catheter, and allows micturition to be studied under physiological conditions. imaging low urinary
tract while patient voids.
Single choice- After administration during stress, which radiopharmaceutical can you expect
redistribution?
(check all that apply) (all 3 radiopharmaceuticals are for MPI= Myocardial Perfusion Imaging).
A. Tc-99m MIBI.
B. TI-201 chloride.
C. Tetrofosmin. - ANSWER: B. TI-201 chloride.
List at least 3 clinical indication of static renal scintigraphy. - ANSWER: A. Urinary tract infection.
B. Function- evaluation of parenchymal mass (below 15%-non functioning).
C. Congenital kidney malformation (dystrophic kidney, sigmoid horseshoe kidney).
We administer a higher therapeutic dose than in diffuse Graves-Basedow disease in:
A. Nodular G-B disease.
B. Autonomous adenoma.
C. Both.
D. Neither of them. - ANSWER: C. Both.
What is the purpose of crystal in a gamma camera? - ANSWER: A. Gamma- rays are emitted in all
directions from the organ and those heading in the direction of the
gamma camera enter the crystal and produce scintillations (light produced in a transparent material
by
passage of a particle).
B. The crystal converts gamma ray into photon which can then be measured.
,Single Choice- The patient should fast for 6 hours before (check all apply):
A. Bone scintigraphy.
B. FDG PET. - ANSWER: B. FDG PET.
(Quantification is by max SUV- Standardized Uptake Value).
Which tumors commonly metastasize to bone? (please list at least 3). - ANSWER: A. Breast.
B. Lung. (Pulmonary)
C. Prostate.
Bone scintigraphy indication - ANSWER: OPRA FN
osteomyelitis, prothesis joint pain, Renal origin- osteodystrophy / Rheumatic d., Aseptic bone
necrosis, Fracture, Neoplasm (1- osteosarcoma, Ewing's sarcoma)
Complete: What do you expect to see in case of hemangioma in the liver?
A. On liver scintigram with labelled colloid:____________
B. With labelled red blood cells:____________ - ANSWER: A. On liver scintigram with labelled colloid:
Deceased uptake (photopenic area).
B. With labelled red blood cells: Perfusion- decreased; Blood pool- increased uptake.
(Tc-99 RBC labelled SPECT demonstrates decreased activity on initial dynamic images followed by
increased activity on delayed blood pool images)
Hepatic lesions with Tc-99m Colloid scans.
A. Decreased uptake:
B. Increased uptake: - ANSWER: A. Decreased uptake:
1. Metastasis (colon!)
2. Cyst
3. Cirrhosis-Pseudo-tumor.
4. Hepatoma (Cirrhosis!)
5. Adenoma
6. Hematoma
7. Hemangioma (Cavernous Hemangioma- Photopenic defect Tc-99m RBC's: perfusion decreased,
blood pool increased).
8. Abscess
B. Increased uptake-
1. FNH- Focal Nodular Hyperplasia.
2. Cirrhosis with regenerating nodule.
3. Budd-Chiari syndrome (caudate lobe).
4. SVN (superior vena cava) obstruction
Single Choice- The localization of Tc-99m HMPAO is related to:
A. A breakdown of the blood brain barrier.
B. Cerebral blood flow.
C. Glucose metabolism.
D. Infection/ inflammation.
E. Receptor studies.
F. Tumor detection. - ANSWER: B. Cerebral blood flow.
What is the difference between how the thyroid handles iodine and how it handles pertechnetate? -
ANSWER: A. The thyroid can do organification of iodine but not pertechnetate.
1. Tc-99 perthechnetate (IV or PO) "Trapping" only- active transport to the thyroid acinar cells.
Imaging 15-30 min post injection.
2. I-131 or I-123 sodium iodine (PO) "Trapping" and then organification (incorporation of iodine into
thyroglobulin for the production of thyroid hormone) Imaging 24h.
, Which of the following disorders are usually associated with an enhanced
blood pool on a labelled RBC study of the liver?
A. Single choice:
1. Hemangioma.
2. Hepatoma.
3. Metastases disease.
4. FNH- Focal Nodular Hyperplasia.
5. (A) and (C).
6. All of the above. - ANSWER: 1. Hemangioma.
Please provide the meaning of the following abbreviations:
A. PET
B. ROI
C. Tc-99m
D. SPECT - ANSWER: A. PET: Positron Emitting Tomography.
B. ROI: Regions-Of-Interest
C. Tc-99m: Technetium-99 metastable.
D. SPECT: Single Photon Emittion computered Tomography.
Single Choice- A perfusion lung scan shows a segmental cold defect in the right base if the ventilation
study
for the same patient is normal, what is the most probable explanation for the defect? (ventilation
study
normal, perfusion right base segmental cold defect)
A. COPD.
B. Pulmonary embolism.
C. Attenuation of the heart.
D. Pacemaker. - ANSWER: B. Pulmonary embolism.
Acute pulmonary embolism: Ventilation-Normal, Perfusion-(multi)segmental defect (decrease).
Ventilation-Perfusion mismatch.
In jaundiced patients, there is enhanced renal excretion of HIDA (Hydroxy Imino-Diacetic Acid) (HIDA
Scancholescintigraphy
using hepatobiliary iminodiacetic acid). True\ False? Please explain. - ANSWER: A. True.
B. HIDA pharmaceutical would accumulate in polygonal calls and eventually cleared through the bile
circulation.
In hepatitis the bile excretion of the liver is impaired, as is the number of hepatocytes, which means
that more of the pharmaceutical would be cleared by the kidneys.
A. In case of liver damage there is no uptake of the radiopharmaceuticals by the Kupffer-cells of the
liver and there will be more excretion by kidney. If the liver is healthy- the Kupffer-cells will uptake the
radiopharmaceuticals and there will be less excretion by the kidney.
In case of what results obtained with myocardial perfusion SPECT would you propose a PET study of
glucose
metabolism?
A. Single Choice-
1. No perfusion defect.
2. Defect during stress only.
3. Fixed (stress+ rest) defect. - ANSWER: 3. Fixed (stress+ rest) defect.
Explanation: Abnormal pump function>need to decide if and what can we do (2 options: nothing/
coronarography revascularization).>First: Stress-Rest MPI (Myocardial Perfusion Imaging) 3 optional
results:
1. Normal> normal perfusion> nothing to do.
2. Stress Defect, Rest Normal (or better than stress)> active ischemia> coronarography
Techniques 8th Edition By Kristen M. Waterstram-Rich, MS,
CNMT, NCT, FSNMTS and David Gilmore 9780323356220
Chapter 1-24 Complete Guide .
1. What is the basic principle of nuclear medicine?
A. A radiopharmaceutical is administered to the patient and it accumulates in the organ of interest.
B. Gamma rays emitted in all directions, those which headed in the direction of gamma camera will
enter
the crystal and undergo Scintillations.
C. An image of radiopharmaceutical is formed.
D. Can be 2D/ series of slices.
E. Fusion of 2 images can be obtained by PET/CT, PET/MRI and SPECT/CT.
F. We can combine the radiopharmaceutical with a compound that suits our purpose (glucose,
diphosphonates) and use this for visualization.
G. Nuclear medicine is a FUNCTIONAL imaging used for both diagnostics and therapeutic
purposes. - ANSWER: G. Nuclear medicine is a FUNCTIONAL imaging used for both diagnostics and
therapeutic
purposes.
What is the principle and procedure of an indirect vesico-ureteral reflux study? - ANSWER: For direct
radionuclide cystography, 99m Tc pertechnetate, 99m Tc-DTPA, or 99m Tc sulphur colloid is instilled
through an indwelling bladder catheter, in a volume of normal saline sufficient to fill the bladder. In
normal patients, no radiopharmaceutical reflux from the bladder into the ureters or the kidneys is
seen.
The indirect radionuclide cystogram (IRC) offers the possibility of detecting VUR without a bladder
catheter, and allows micturition to be studied under physiological conditions. imaging low urinary
tract while patient voids.
Single choice- After administration during stress, which radiopharmaceutical can you expect
redistribution?
(check all that apply) (all 3 radiopharmaceuticals are for MPI= Myocardial Perfusion Imaging).
A. Tc-99m MIBI.
B. TI-201 chloride.
C. Tetrofosmin. - ANSWER: B. TI-201 chloride.
List at least 3 clinical indication of static renal scintigraphy. - ANSWER: A. Urinary tract infection.
B. Function- evaluation of parenchymal mass (below 15%-non functioning).
C. Congenital kidney malformation (dystrophic kidney, sigmoid horseshoe kidney).
We administer a higher therapeutic dose than in diffuse Graves-Basedow disease in:
A. Nodular G-B disease.
B. Autonomous adenoma.
C. Both.
D. Neither of them. - ANSWER: C. Both.
What is the purpose of crystal in a gamma camera? - ANSWER: A. Gamma- rays are emitted in all
directions from the organ and those heading in the direction of the
gamma camera enter the crystal and produce scintillations (light produced in a transparent material
by
passage of a particle).
B. The crystal converts gamma ray into photon which can then be measured.
,Single Choice- The patient should fast for 6 hours before (check all apply):
A. Bone scintigraphy.
B. FDG PET. - ANSWER: B. FDG PET.
(Quantification is by max SUV- Standardized Uptake Value).
Which tumors commonly metastasize to bone? (please list at least 3). - ANSWER: A. Breast.
B. Lung. (Pulmonary)
C. Prostate.
Bone scintigraphy indication - ANSWER: OPRA FN
osteomyelitis, prothesis joint pain, Renal origin- osteodystrophy / Rheumatic d., Aseptic bone
necrosis, Fracture, Neoplasm (1- osteosarcoma, Ewing's sarcoma)
Complete: What do you expect to see in case of hemangioma in the liver?
A. On liver scintigram with labelled colloid:____________
B. With labelled red blood cells:____________ - ANSWER: A. On liver scintigram with labelled colloid:
Deceased uptake (photopenic area).
B. With labelled red blood cells: Perfusion- decreased; Blood pool- increased uptake.
(Tc-99 RBC labelled SPECT demonstrates decreased activity on initial dynamic images followed by
increased activity on delayed blood pool images)
Hepatic lesions with Tc-99m Colloid scans.
A. Decreased uptake:
B. Increased uptake: - ANSWER: A. Decreased uptake:
1. Metastasis (colon!)
2. Cyst
3. Cirrhosis-Pseudo-tumor.
4. Hepatoma (Cirrhosis!)
5. Adenoma
6. Hematoma
7. Hemangioma (Cavernous Hemangioma- Photopenic defect Tc-99m RBC's: perfusion decreased,
blood pool increased).
8. Abscess
B. Increased uptake-
1. FNH- Focal Nodular Hyperplasia.
2. Cirrhosis with regenerating nodule.
3. Budd-Chiari syndrome (caudate lobe).
4. SVN (superior vena cava) obstruction
Single Choice- The localization of Tc-99m HMPAO is related to:
A. A breakdown of the blood brain barrier.
B. Cerebral blood flow.
C. Glucose metabolism.
D. Infection/ inflammation.
E. Receptor studies.
F. Tumor detection. - ANSWER: B. Cerebral blood flow.
What is the difference between how the thyroid handles iodine and how it handles pertechnetate? -
ANSWER: A. The thyroid can do organification of iodine but not pertechnetate.
1. Tc-99 perthechnetate (IV or PO) "Trapping" only- active transport to the thyroid acinar cells.
Imaging 15-30 min post injection.
2. I-131 or I-123 sodium iodine (PO) "Trapping" and then organification (incorporation of iodine into
thyroglobulin for the production of thyroid hormone) Imaging 24h.
, Which of the following disorders are usually associated with an enhanced
blood pool on a labelled RBC study of the liver?
A. Single choice:
1. Hemangioma.
2. Hepatoma.
3. Metastases disease.
4. FNH- Focal Nodular Hyperplasia.
5. (A) and (C).
6. All of the above. - ANSWER: 1. Hemangioma.
Please provide the meaning of the following abbreviations:
A. PET
B. ROI
C. Tc-99m
D. SPECT - ANSWER: A. PET: Positron Emitting Tomography.
B. ROI: Regions-Of-Interest
C. Tc-99m: Technetium-99 metastable.
D. SPECT: Single Photon Emittion computered Tomography.
Single Choice- A perfusion lung scan shows a segmental cold defect in the right base if the ventilation
study
for the same patient is normal, what is the most probable explanation for the defect? (ventilation
study
normal, perfusion right base segmental cold defect)
A. COPD.
B. Pulmonary embolism.
C. Attenuation of the heart.
D. Pacemaker. - ANSWER: B. Pulmonary embolism.
Acute pulmonary embolism: Ventilation-Normal, Perfusion-(multi)segmental defect (decrease).
Ventilation-Perfusion mismatch.
In jaundiced patients, there is enhanced renal excretion of HIDA (Hydroxy Imino-Diacetic Acid) (HIDA
Scancholescintigraphy
using hepatobiliary iminodiacetic acid). True\ False? Please explain. - ANSWER: A. True.
B. HIDA pharmaceutical would accumulate in polygonal calls and eventually cleared through the bile
circulation.
In hepatitis the bile excretion of the liver is impaired, as is the number of hepatocytes, which means
that more of the pharmaceutical would be cleared by the kidneys.
A. In case of liver damage there is no uptake of the radiopharmaceuticals by the Kupffer-cells of the
liver and there will be more excretion by kidney. If the liver is healthy- the Kupffer-cells will uptake the
radiopharmaceuticals and there will be less excretion by the kidney.
In case of what results obtained with myocardial perfusion SPECT would you propose a PET study of
glucose
metabolism?
A. Single Choice-
1. No perfusion defect.
2. Defect during stress only.
3. Fixed (stress+ rest) defect. - ANSWER: 3. Fixed (stress+ rest) defect.
Explanation: Abnormal pump function>need to decide if and what can we do (2 options: nothing/
coronarography revascularization).>First: Stress-Rest MPI (Myocardial Perfusion Imaging) 3 optional
results:
1. Normal> normal perfusion> nothing to do.
2. Stress Defect, Rest Normal (or better than stress)> active ischemia> coronarography
