©THESTAR 2025 ALL RIGHTS RESERVED 12:35 PM A+
Nuclear Medicine boards Exam Questions
And Answers |Latest 2025 | Guaranteed Pass
Differentiate whole body scans (see flip side) - Answer✔Key points:
Gallium has light spleen uptake
Octreotide has intense kidney uptake
MIBG has no kidneys (remember we use it to look at adrenals)
Indium vs. Tc99m WBC scan appearance - Answer✔Tc WBC
-renal and GI activity
-lung uptake if imaged at 4 hours
In WBC
-no renal or GI activity
mechanism of MDP bone scans - Answer✔chemisorption
-phosphate binds to bone
-distribution based on flow and osteoblastic activity
how is MDP tagged to Tc99m - Answer✔add free pertechnetate to stannous ion (to reduce it)
1
, ©THESTAR 2025 ALL RIGHTS RESERVED 12:35 PM A+
it will then bind to MDP
what causes free Tc when preparing MDP scans - Answer✔air in the syringe (oxidation)
OR
not enough stannous ion
highest dose organ with MDP and F-18 bone scans - Answer✔MDP: bones
F-18: bladder
marked bone scan uptake along cranial sutures - Answer✔hyperPTH
focal breast uptake on bone scan - Answer✔breast cancer
marked renal cortex uptake on MDP bone scan - Answer✔hemochromatosis
liver uptake on bone scan - Answer✔cancer, amyloid, liver necrosis
spleen uptake on bone scan - Answer✔infarcted spleen (sickle cell)
sacral insufficiency fracture on bone scan - Answer✔Honda sign
muscle uptake on bone scan - Answer✔rhabdomyolysis
2
, ©THESTAR 2025 ALL RIGHTS RESERVED 12:35 PM A+
preferred test for bones mets from neuroblastoma - Answer✔MIBG with I-123/131
hypertrophic osteoarthropathy on bone scan
next step? - Answer✔"tram line uptake" along periosteum
next step? chest CT for lung cancer
Pagets on bone scan - Answer✔enlarged hot long bone or hemipelvis
"mickey mouse" vertebrae (body and post elements)
early and late AVN on bone scan - Answer✔Early and late are cold
middle may be hot (from repair)
osteoid osteoma on bone scan - Answer✔double density
BENIGN BONE LESIONS ON BONE SCAN
HOT or COLD?
fibrous dysplasia
bone cyst without fracture
giant cell tumor
ABC
osteoblastoma
3
, ©THESTAR 2025 ALL RIGHTS RESERVED 12:35 PM A+
osteoid osteoma - Answer✔all hot except bone cyst without fracture
decreased soft tissue uptake vs. increased soft tissue uptake on bone scan - Answer✔decreased
-metastatic superscan
increased soft tissues
-metabolic superscan (kidney disease)
skull hot on metabolic (from PTH)
causes of triple phase positive bone scan - Answer✔osteomyelitis
fracture
tumor
osteoid osteoma
charcot joints
RSD or CRPS
preferred nucs agent for spine osteomyelitis - Answer✔Gallium (In-WBC can be false negative)
which patients sometimes require a 4th phase bone scan (24 hours)? - Answer✔diabetics
give time for soft tissue tracer to clear
critical organ of In-WBC - Answer✔spleen
agent for V/Q perfusion portion?
4
Nuclear Medicine boards Exam Questions
And Answers |Latest 2025 | Guaranteed Pass
Differentiate whole body scans (see flip side) - Answer✔Key points:
Gallium has light spleen uptake
Octreotide has intense kidney uptake
MIBG has no kidneys (remember we use it to look at adrenals)
Indium vs. Tc99m WBC scan appearance - Answer✔Tc WBC
-renal and GI activity
-lung uptake if imaged at 4 hours
In WBC
-no renal or GI activity
mechanism of MDP bone scans - Answer✔chemisorption
-phosphate binds to bone
-distribution based on flow and osteoblastic activity
how is MDP tagged to Tc99m - Answer✔add free pertechnetate to stannous ion (to reduce it)
1
, ©THESTAR 2025 ALL RIGHTS RESERVED 12:35 PM A+
it will then bind to MDP
what causes free Tc when preparing MDP scans - Answer✔air in the syringe (oxidation)
OR
not enough stannous ion
highest dose organ with MDP and F-18 bone scans - Answer✔MDP: bones
F-18: bladder
marked bone scan uptake along cranial sutures - Answer✔hyperPTH
focal breast uptake on bone scan - Answer✔breast cancer
marked renal cortex uptake on MDP bone scan - Answer✔hemochromatosis
liver uptake on bone scan - Answer✔cancer, amyloid, liver necrosis
spleen uptake on bone scan - Answer✔infarcted spleen (sickle cell)
sacral insufficiency fracture on bone scan - Answer✔Honda sign
muscle uptake on bone scan - Answer✔rhabdomyolysis
2
, ©THESTAR 2025 ALL RIGHTS RESERVED 12:35 PM A+
preferred test for bones mets from neuroblastoma - Answer✔MIBG with I-123/131
hypertrophic osteoarthropathy on bone scan
next step? - Answer✔"tram line uptake" along periosteum
next step? chest CT for lung cancer
Pagets on bone scan - Answer✔enlarged hot long bone or hemipelvis
"mickey mouse" vertebrae (body and post elements)
early and late AVN on bone scan - Answer✔Early and late are cold
middle may be hot (from repair)
osteoid osteoma on bone scan - Answer✔double density
BENIGN BONE LESIONS ON BONE SCAN
HOT or COLD?
fibrous dysplasia
bone cyst without fracture
giant cell tumor
ABC
osteoblastoma
3
, ©THESTAR 2025 ALL RIGHTS RESERVED 12:35 PM A+
osteoid osteoma - Answer✔all hot except bone cyst without fracture
decreased soft tissue uptake vs. increased soft tissue uptake on bone scan - Answer✔decreased
-metastatic superscan
increased soft tissues
-metabolic superscan (kidney disease)
skull hot on metabolic (from PTH)
causes of triple phase positive bone scan - Answer✔osteomyelitis
fracture
tumor
osteoid osteoma
charcot joints
RSD or CRPS
preferred nucs agent for spine osteomyelitis - Answer✔Gallium (In-WBC can be false negative)
which patients sometimes require a 4th phase bone scan (24 hours)? - Answer✔diabetics
give time for soft tissue tracer to clear
critical organ of In-WBC - Answer✔spleen
agent for V/Q perfusion portion?
4
