American Board ofNuclear Radiology Practice Exam

I. Nuclear Medicine Basics and Instrumentation • Basic Principles of Nuclear Medicine o Introduction to nuclear medicine: history, scope, and clinical applications o Basic concepts of radiation physics: radiation types (alpha, beta, gamma), decay, half-life, and units of measurement (Curie, Becquerel) o Interaction of radiation with matter: attenuation, scattering, absorption o Concepts of radionuclide decay: spontaneous decay, radioisotopes, and kinetics o Production of radionuclides: cyclotrons, reactors, and generators • Instrumentation and Equipment o Gamma cameras: types, components (crystals, photomultiplier tubes, collimators), and functioning o PET scanners: basic design, operational principles, and advantages over conventional imaging o SPECT imaging technology and protocols o Quality assurance in nuclear medicine: calibration, routine maintenance, and troubleshooting o Radiation detectors: scintillation counters, ionization chambers, and dosimeters o Computerized tomography (CT) integration with nuclear medicine (PET/CT, SPECT/CT) • Radiation Safety and Quality Control o Radiation protection principles: time, distance, shielding o Radiation safety protocols for patients, healthcare workers, and the public o Dosimetry: measurement of patient and occupational radiation exposure o Preventive maintenance procedures for imaging equipment o Compliance with regulatory guidelines (NRC, FDA, ACR, etc.) ________________________________________ II. Radiopharmaceuticals and Pharmacology • Radiopharmaceuticals: Overview and Classification o Properties of radiopharmaceuticals: radionuclides, chemical form, biological behavior o Radiopharmaceutical production and preparation techniques o Radiopharmaceuticals used in diagnostic imaging: indications, pharmacokinetics, and dosimetry o Radiopharmaceuticals for therapy: therapy for thyroid disease, bone metastases, and other clinical applications o Special considerations for pediatric and geriatric patients in radiopharmaceutical administration • Mechanisms of Action o Pharmacodynamics and pharmacokinetics of nuclear medicine agents o Mechanisms by which radiopharmaceuticals accumulate in tissues: receptor binding, enzyme activity, and cellular uptake o Impact of organ function (renal, hepatic) on drug clearance and imaging results • Preparation, Dosage, and Administration o Procedures for radiopharmaceutical handling: dispensing, dilution, storage, and administration o Dosage calculations based on patient weight, age, and clinical condition o Quality control for radiopharmaceutical purity, sterility, and radiochemical integrity o Guidelines for intravenous, oral, and inhaled administration of radiopharmaceuticals o Adverse reactions and management of complications related to radiopharmaceutical use ________________________________________ III. Clinical Applications of Nuclear Medicine • Diagnostic Imaging Applications o Cardiovascular Imaging  Myocardial perfusion imaging: indications, radiopharmaceuticals (Tc-99m, Thallium-201)  Quantitative imaging: ejection fraction, stress testing, and blood flow analysis  Cardiac viability studies and risk assessment in coronary artery disease  Evaluation of heart failure and arrhythmias o Oncology Imaging  Tumor localization and metastasis detection using PET and SPECT  Specific radiopharmaceuticals: FDG, Ga-68, and other agents  PET imaging for monitoring response to cancer therapy o Neurological Imaging  Brain perfusion and functional imaging with radiotracers (Tc-99m, F-18 FDG)  Neurodegenerative diseases: Alzheimer's, Parkinson’s disease, and Huntington’s disease  SPECT and PET imaging in epilepsy and brain tumors o Endocrinology and Thyroid Imaging  Thyroid scan using I-131 and Tc-99m pertechnetate  Radioactive iodine therapy for hyperthyroidism and thyroid cancer  Evaluation of parathyroid disease o Pulmonary Imaging  Ventilation/perfusion (V/Q) scans for pulmonary embolism diagnosis  Assessment of lung function in pulmonary diseases (COPD, asthma) o Renal Imaging  Renal scan with Tc-99m MAG3 for renal function and morphology assessment  Evaluation of renal transplant function  Renal obstruction and perfusion studies • Therapeutic Applications o Targeted Radiotherapy  Radioactive iodine therapy for thyroid cancer  Bone pain palliation using Strontium-89 and Samarium-153  Radiolabeled monoclonal antibodies for cancer therapy o Pain Management and Palliation  Radiopharmaceuticals in managing bone metastases and pain relief  Techniques for patient comfort during treatment and follow-up ________________________________________ IV. Imaging Techniques and Methodology • Single Photon Emission Computed Tomography (SPECT) o Principles of SPECT imaging: tracer injection, acquisition, and reconstruction o Image quality control: resolution, sensitivity, and artifact recognition o Image interpretation: identifying normal and abnormal patterns of uptake • Positron Emission Tomography (PET) o PET technology: principles, equipment, and isotope production o PET tracers: F-18 FDG, other oncology-related tracers, and emerging radiotracers o Quantification in PET: Standardized Uptake Value (SUV), kinetic modeling o PET/CT and PET/MRI: applications, advantages, and image fusion techniques • Hybrid Imaging o Advantages of combining SPECT/CT and PET/CT in clinical practice o Image registration and fusion technology o Clinical applications: oncology, cardiology, and neurology ________________________________________ V. Image Interpretation and Reporting • Basic Image Interpretation o Understanding normal and abnormal patterns of radiopharmaceutical uptake o Identifying common artifacts in nuclear medicine imaging o Analyzing the biological distribution of tracers in various organs o SPECT/PET scan interpretation and correlation with clinical symptoms • Advanced Image Analysis o Functional imaging: assessing regional blood flow, metabolism, and organ function o Identifying physiological vs. pathological uptake patterns in oncology, cardiology, and neurology o Quantitative analysis: calculating lesion size, metabolic activity, and physiological processes • Reporting and Documentation o Writing clear, concise, and accurate nuclear medicine reports o Communicating findings to referring physicians and medical teams o Legal and ethical considerations in reporting: confidentiality and informed consent ________________________________________ VI. Pathophysiology and Disease Processes • Oncology o Mechanisms of cancer spread and metastasis o Role of nuclear medicine in staging and monitoring treatment o Imaging of common cancers: breast, lung, prostate, and gastrointestinal cancers • Cardiology o Pathophysiology of ischemic heart disease, myocardial infarction, and heart failure o Imaging for coronary artery disease, arrhythmias, and myocardial viability o Evaluation of cardiac perfusion, function, and tissue viability • Neurology o Pathogenesis of Alzheimer’s disease, Parkinson’s disease, and epilepsy o Imaging markers of neurodegeneration o Functional imaging for brain tumor detection and monitoring • Endocrine Disorders o Pathophysiology of thyroid diseases (hyperthyroidism, hypothyroidism, thyroid cancer) o Imaging techniques for parathyroid gland and adrenal disorders o Radiopharmaceutical therapy for endocrine-related cancers ________________________________________ VII. Advanced Topics in Nuclear Radiology • Emerging Technologies in Nuclear Medicine o Development of novel radiotracers and imaging agents o Advances in PET/MRI hybrid imaging o Artificial intelligence and machine learning in image analysis • Regulatory, Ethical, and Legal Issues o Regulatory bodies overseeing nuclear medicine practice (NRC, FDA, ACR) o Ethical considerations in radiology, patient consent, and confidentiality o Legal issues in imaging, radiation safety, and reporting