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mrso 2 > Gadolinium and or Pregnancy > Flashcards

Gadolinium and or Pregnancy Flashcards

1
Q

Linear structure gadolinium based contrast agents (GBCA’s):

should not ever be used

are the only GBCA’s associated with gadolinium retention

have one bond between the gadolinium and ligand molecules

are named this way because the gadolinium molecules line up in a straight line

A

have one bond between the gadolinium and ligand molecules

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2
Q

The physician providing “direct supervision” does not need to be in the MRI room during contrast administration. True or False?

True

False

A

True

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3
Q

Gadolinium is considered to be:

magnetic

ferromagnetic

paramagnetic

unmagnetic

A

paramagnetic

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4
Q

All extracellular GBCA’s have the same concentration of Gadolinium except _____. This agent has twice the concentration of Gadolinium and can be administered at half the volume as the others.

Magnevist

Omniscan

Ablavar

Gadavist

A

Gadavist

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5
Q

Which of the following suggests a high likelihood of a reaction to gadolinium?:

Prior gadolinium-based contrast reactions

Prior iodine-based contrast reactions

Asthma

Anxiety

A

Prior gadolinium-based contrast reactions

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6
Q

All of these are non-allergic reactions to gadolinium based contrast agents (GBCA’s) except:

Nausea

Emesis

Hives

Headache

A

Hives

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7
Q

Allergic reactions to GBCA are common. True or False?

True

False

A

False

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8
Q

Gadolinium deposition has been reported to happen within what structures within the human body?

bone marrow, internal capsule, dentate nucleus

dentate nucleus, putamen, internal capsule

bone marrow, dentate nucleus, globus pallidus, and orbital globes

putamen, internal capsule, globus pallidus

A

bone marrow, dentate nucleus, globus pallidus, and orbital globes

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9
Q

According to the ACR, pregnant healthcare workers in the MR environment:

Must not work in MRI for the duration of the pregnancy

Are able to work in and around the MR environment, with the exception of Zone IV during scanning

Are OK to work in MRI after the first trimester

Have no restrictions because there is no ionizing radiation

A

Are able to work in and around the MR environment, with the exception of Zone IV during scanning

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10
Q

NSF has occurred most frequently with:

Group 1 agents, patients with decreased renal function

Group 1 agents, patients with normal renal function

Group 2 agents, patients with decreased renal function

Group 2 agents, patients with acute renal function deficits

A

Group 1 agents, patients with decreased renal function

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11
Q

Macrocyclic GBCA’s have four bonds between the gadolinium ion and the ligand molecule. Disassociation can occur if just one of these bonds break before the contrast is excreted by the patient. True or False?

True

False

A

False

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12
Q

Guidelines suggest that MRI during pregnancy:

Should wait until after the first trimester

Should be avoided

Can be performed at any stage of the pregnancy after risk benefit assessment

Is entirely up to what the patient wants

A

Can be performed at any stage of the pregnancy after risk benefit assessment

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13
Q

Concentrations of anthropogenic (caused by human activity) gadolinium in ground and drinking water are greater in developed, urban areas when compared to less populated, rural areas. True or False?

True

False

A

True

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14
Q

The occurrence of anthropogenic (originating from human activity) gadolinium is increasing and has been reported in:

waste water

reservoirs

tap (drinking) water

internationally and in the U.S.

all of the above

A

waste water

reservoirs

tap (drinking) water

internationally and in the U.S.

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15
Q

Macrocyclic structure gadolinium based contrast agents (GBCA’s):

are always a better choice than linear structure

are safe for all patients regardless of renal function

have four bonds between the gadolinium and ligand molecule

can be administered in any dose regardless of patient weight

A

have four bonds between the gadolinium and ligand molecule

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16
Q

Which gadolinium agent sub classification is thought to be more stable than the other?

Non-Ionic

Ionic

A

Ionic

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17
Q

According to the Centers for Medicare and Medicaid Services (CMS), _________ supervision is required when injecting gadolinium based contrast agents.

General

Direct

Personal

Indirect

A

Direct

18
Q

What differentiates one gadolinium based contrast agent from another?

Cost

Type of gadolinium

Ligand molecule as well as ionic and non-ionic sub classifications.

Nothing, they’re all the same

A

Ligand molecule as well as ionic and non-ionic sub classifications.

19
Q

Gadolinium is considered paramagnetic because it:

becomes permanently magnetic when exposed to the magnetic field

repels the magnetic field

becomes temporarily magnetized when exposed to the magnetic field

A

becomes temporarily magnetized when exposed to the magnetic field

20
Q

Direct supervision during contrast administration means:

another level 1 MR staff member must be in Zone 3 while contrast is being administered

a radiologist must be in the MRI suite while contrast is being administered

a physician must be available and interruptible to provide assistance if needed

another staff member must watch the contrast injection

A

a physician must be available and interruptible to provide assistance if needed

21
Q

All the following are examples of Group 1 GBCA agents (and therefore, have a known relationship to nephrogenic systemic fibrosis) EXCEPT:

Magnevist

Omniscan

Optimark

Prohance

A

Prohance

22
Q

Anxiety can have an effect on allergic-type reactions to GBCA. True or False?

True

False

A

True

23
Q

The decision to scan a pregnant patient should be made by the ____________ after performing a risk vs benefit assessment.

Technologist

Supervising radiologist

MRSO

Referring physician

Department manager

A

Supervising radiologist

24
Q

Which bond is more stable in regards to GBCA’s?

Ionic

Nonionic

Neither

It doesn’t matter, the only concern is linear or macrocyclic

A

Ionic

25
Q

All of the following gadolinium agents are examples of Group 2 agents (and therefore are associated with few, if any unconfounded cases of nephrogenic systemic fibrosis) EXCEPT:

Dotarem

Gadovist

Multihance

Optimark

A

Optimark

26
Q

Which is NOT an example of an acute gadolinium reaction?

anaphylaxis

hives (urticaria)

nausea/vomiting

deposition

A

deposition

27
Q

The ligand molecule is what differentiates one GBCA from another.

True

False

A

True

28
Q

GBCAs are different than other prescription medications in terms of dose and delivery. True or False?

True

False

A

False

29
Q

Since 2007, GBCA practice world-wide has been modified by three major changes. These include all of the following EXCEPT:

Pre-screening (at the minimum higher risk) patients for renal disease

Not administering GBCA or administering a lower dose of GBCA if renal disease is present

Talking patients out of GBCA when we feel it is not indicated

Selecting specific agents to be used or specifically not to be used in patients with renal disease

A

Talking patients out of GBCA when we feel it is not indicated

30
Q

The ACR has determined that pregnant patients can be accepted to undergo MR scans at any stage of pregnancy if the risk–benefit assessment of the patient warrants that the study be performed. True or False?

True

False

A

True

31
Q

Magnevist is associated with noncounfounded reports of gadolinium retention. What does that mean?

It means that these reports have not been verified

It means that Magnevist is a linear structure contrast agent

It means that the FDA does not agree with the reports

It means that Magnevist was the only gadolinium based contrast agent these patients received

A

It means that Magnevist was the only gadolinium based contrast agent these patients received

32
Q

Which is NOT an example of a chronic gadolinium reaction?

urticaria

nephrogenic systemic fibrosis

bone marrow retention

dentate nucleus retention

A

urticaria

33
Q

All linear structure GBCA’s behave similarly and are similar in their number of reported cases of NSF. True or False?

True

False

A

False

34
Q

Patients with unrelated allergies may be at an increased risk to have an allergic-like reaction to intravenous contrast, so they should be premedicated. True or False?

True

False

A

False

35
Q

According to the ACR, giving GBCA to a breastfeeding mother is _________ because the of the _______ amount of __________ contrast in the breast milk.

unsafe / high / non-chelated

safe / low / non-chelated

unsafe / low / chelated

safe / low / chelated

A

safe / low / chelated

36
Q

Your radiologist has approved a contrast enhanced MR study for a patient who is 22 weeks pregnant and comes to you, the MRSO, for advice on the type of GBCA to be used. You have access to all contrast agents on the market. Which would you suggest based on stability/least likely to disassociate?

linear ionic agents like Magnevist, MultiHance

linear non-ionic agents like Omniscan, Optimark

macrocyclic ionic agents like Dotarem

macrocyclic non-ionic agents like Gadavist, ProHance

A

macrocyclic ionic agents like Dotarem

37
Q

Gadolinium is not directly seen on post contrast imaging. True or False?

True

False

A

True

38
Q

There is no known cure for NSF. True or False?

True

False

A

True

39
Q

Define “Direct Supervision.”

The physician or NPP must be immediately available and interruptible to furnish assistance and direction throughout the performance of the procedure.

The physician or NPP must be in the magnet room during the examination.

The physician or NPP must be in the building throughout the performance of the procedure.

The physician or NPP must be reachable to give emergency instructions in an emergency situation

A

The physician or NPP must be immediately available and interruptible to furnish assistance and direction throughout the performance of the procedure.

40
Q

Macrocyclic structure GBCA’s are more stable than linear structure because:

Macrocyclic are more expensive than linear

Macrocyclic GBCA’s have four bonds with their ligand which must be broken simultaneously for disassociation to occur

They aren’t. Linear structure GBCA’s are more stable.

Macrocyclic structure GBCA’s use larger gadolinium molecules.

A

Macrocyclic GBCA’s have four bonds with their ligand which must be broken simultaneously for disassociation to occur

41
Q

Confounded reports of gadolinium retention means:

The reports are more believable

The gadolinium retention is not observable

Patients reporting gadolinium retention received different brands of GBCA over time

Nothing. Gadolinium retention does not happen.

A

Patients reporting gadolinium retention received different brands of GBCA over time

42
Q

Anthropogenic (caused by human activity) gadolinium is removed by municipal waste water treatment facilities. True or False?

True

False

A

False

mrso 2 (17 decks)

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