Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CD III > Lecture 10- Nuclear Medicine > Flashcards

Lecture 10- Nuclear Medicine Flashcards

1
Q

nuclear med technologist vs nuclear med advanced associates

A
  • tech: bachelor degree; (CNMT) NMTCB or (RT (N)) ARRT accredited
  • assoc: midlevel provider for NMAA; masters degree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

principles of nuclear medicine

A
  • physiologic vs structural imaging
  • radiopharmaceuticals (radiotracers; energy spectrum; half-life)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe radiotracers

A

radioactive element bound to pharmaceutical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe the energy spectrum

A
  • gamma radiation (diagnostic)
  • beta/alpha (therapeutic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

contraindications for radiopharmaceuticals

A
  • allergy
  • hx of adverse rxns (rare, but include erythema, edema, fever)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

isotopes used

A
  • 99m TeO4 (most common)
  • Xe133 (xenon gas)
  • T1201 (thalium)
  • I131, I123 (iodine)
  • Ga67 (gallium)
  • In111 (indium)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

radiation exposure with nuclear imaging

A
  • similar to CXR
  • one dose for as many films as needed
  • gamma rays emitted in all direction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

safety components for techs

A
  • time
  • distance
  • shielding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Image Acquisition

A
  • planar imaging
  • SPECT 3D imaging
  • Pb (lead) collimator (parallel apertures allows gamma rays) (NOT NEEDED IN NEWER TECH)
  • gamma rays hit scintillation crystal
  • crystal converts gamma energy to electronic signal (or light)
  • cumulative “photo”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Image Resolution

A
  • ability to distinguish 2 different points as such
  • high resolution scans require high res collimator, longer acquisition time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

sensitivity of images

A
  • ability to pick up gama signal
  • high sens scans (low res/high sens collimator; shorter acquisition time)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

artifact sources

A
  • affecting apparent distribution (uptake)
  • Attenuation: decrease in intensity gamma ray energy
  • Scatter: gamma ray changes its path
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Image processing/manipulations

A
  • regions of interest: placed by technologist
  • reconstruction: SPECT requires; time required to reconstruct
  • manipulations can introduce artifact
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

quality control

A
  • cameras: daily flood field testing
  • isotope generators
  • radiopharmaceuticals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

image interpretation

A
  • read by physician
  • hot (increased) or cold (decreased) uptake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ordering studies

A
  • chronological order is important as isotopes need time to decay
  • ex: barium, IV contrast will introduce artifacts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how to indicate emergent scan needed?

A

asteriks ( * )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

common studies

A
  • bone scans
  • nuclear cardiology (MUGA-ECG gate, exercise MUGA, stress thallium/cardiolite)
  • liver/spleen (replaced by US, not common anymore)
  • hepatobiliary
  • thyroid scan/uptake
  • SPECT brain
  • V/P or V/Q scans
  • VCUG
  • renal
  • blood flow images (testicular scans, GI bleeds)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Bone Scans

A
  • Planar or SPECT bone
  • used to r/o mets, Paget’s (hot spots), avascular necrosis (e.g. femoral neck; cold)
  • isotope: 99mTc MDP IV with imaging 4 hours later; inject L wrist; renal clearance of isotope
  • look for symmetry; darker spots are increased upate (thick bone, closer to camera, hypermetabolic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Bone scan film orientation

A
  • Right Anterior Left
  • Left Posterior Right
  • Cephalad is top of film
  • Caudal is bottom
21
Q

peds bone scan tips

A
  • growth plates darker
  • need to give med to block thyroid
  • increased uptake in L fibula is most likely a tumor!
22
Q

why bone scan over XR?

A
  • Catch stress fx earlier than X ray
  • Similar concepts for osteomyelitis
  • Function changes earlier detected over Xray structural changes
23
Q

3 phases of a bone scan

A
  • 1: blood flow
  • 2: blood pool
  • 3: bone imaging
24
Q

during which phases are following things visible:
* cellulitis
* acute fx/osteomyelitis/loose prosthetic joints
* chronic fx

A
  • cellulitis: phase 1/2
  • acute fx/osteomyelitis/loose prosthetic: phase 1/2/3
  • chronic fx: none
25
Q

FUO/Infection

A

Method 1
* Gallium 67 via IV to r/o osteomyelitis
* image at 24, 48, 72 hrs (96) post infusion

Method 2
* 111 labeled WBCs via collecting pt’s blood, WBCs isolated, radiolabeled, reinjected
* image at 24, 48, 72 hrs

Method 3
* Ceretec HMPAO for same day imaging

26
Q

Nuclear Cardiology

A
  • echos have replaced but:

MUGA- LV study
* Multi gated acquisition (EKG gated)
* Images Blood Pool; typically 3 view; can view Cardiac wall motion (hypokinesia, akinesia, dyskinesia) and Ejection Fraction (normal is 45-65%)

27
Q

MUGA for Cardiology

A
  • 99mTc PYP labeled RBCs
  • 20 mCi
  • IV injection of PYP (pyrophosphate) tags to RBCs
  • IV injection 20 min later of 99mTcO4- tags to PYP
  • Or ultratag kit - 1 bottle with all reagents
28
Q

MUGA interpretation

A
  • Septum appears “cold”
  • Anterior
  • “Best septal” or LAO (left anterior oblique)
  • Used to calculate EF
  • L lateral images
  • Series of 3 different orientation “cine” pictures
  • Additive collection of radioactive particles over and over again to make pictures for movie
29
Q

Abnormal MUGA

A
  • “Flatter” graph
  • Decreased EF
  • End Diastole and End Systole pictures
  • Not much change in size
  • This is LAO or best septal view
30
Q

First pass MUGA

A
  • One chance only for Right Ventricle study
  • Left heart will “cover” right heart after “first pass” in circulation
  • RV: Normal RVEF=45-55% (10% less ish than LV)
  • Utilizes butterfly or other IV access (pertechnetate bolus w pt under camera and Blood flow imaged)
31
Q

Exercise MUGA

A
  • Modified bicycle table or other device
  • Increase work load (can be done w Echo)
  • Normally see LVEF increase with exercise
  • Wall motion changes
  • (Similar to stress echo)
  • Can be done with pharmaceuticals to mimic “stress”- EG persantine
32
Q

Nuclear cardiology stress test

A
  • r/o CAD w SPECT
  • Stress Component: Image after exercise protocol completed, LV seen
  • Rest Component: Either several hours after exercise (using Thallium- a K+ analog) or first with Cardiolite (pertechnetate derivative); May see RV faintly (Tl)
33
Q

use ot Tl (or TCO4 agents)

A
  • Same views as MUGA
  • Anterior
  • LAO (see donut w/o “bite”)
  • L Lateral
34
Q

Liver/Spleen Scan

A
  • Less common due to US
  • 99mTc Sulfur Colloid 4 mCi
  • Taken up by macrophage Kuppfer Cells of RES thus, does NOT image hepatocytes!
  • Homogenous uptake normal
35
Q

Hepatobiliary Scanning

A
  • r/o biliary obstruction
  • Aka HIDA or PIPIDA, DISIDA
  • Choletch/mebrofenin: excreted through biliary system
  • 99mTc HIDA 4-8 mCi dose: can be adjusted for abnormal LFTs
  • should visualize GB by 45-60 min; should visualized SI by 2 hrs
  • EF of GB can be calculated after dose of med
36
Q

GI bleed/Meckel’s Diverticulum

A
  • Labeled RBCs
  • Figure of bleed distal descending colon
37
Q

Gastric Emptying

A
  • Sulfur colloid scrambled eggs for solid
  • Sulfur colloid in liquid
  • Can follow GI transit time
  • Gastroparesis
  • E.g. Diabetic
38
Q

Thyroid Scans

A
  • Pertechnetate
  • Iodine isotopes
  • Thyroid uptake
  • HOT vs COLD nodules
  • Cold may be malignant or a cyst; US can help
39
Q

SPECT Brain uses

A
  • Cerebrovascular Disease
  • Ischemia CVA identified earlier than CT
  • Brain death
  • Dementia evaluation
  • PET brain scans “higher tech”
40
Q

SPECT brain investigations

A
  • DAT (Dementia of Alzheimer’s Type)
  • Epilepsy
  • Schizophrenia
41
Q

Brain SPECT views

A
  • Transverse (superior to inferior)
  • Coronal (ant to post)
  • Sagittal (L to R)
42
Q

V/P or V/Q scans

A
  • R/o PE (pulmonary embolism)
  • Ventilation phase: Xe 133 gas, Tc99m DTPA aerosol (captures inspiration, equilibrium, washout)
  • Perfusion phase: Tc 99m MAA which blocks small capillaries
  • Ventilation Perfusion “mismatch” for PE: Ventilation normal –> Perfusion absent area(s)
  • If perfusion normal, vent not performed w perfusion first technique
43
Q

V/P COPD findings

A
  • COPD (loner ventilation washout phase; air trapping)
  • Area could be infarcted (no ventilation or perfusion)
44
Q

Voiding Cystourethrogram

A
  • TcO4 saline via bladder (Filling phase, Voiding phase)
  • Measures bladder volume
  • Looks for reflux
45
Q

Testicular Scan uses

A
  • US w doppler has largely replaced
  • Acute scrotal pain
  • Chronic scrotal pain
  • Injury
  • Mass
  • Torsion
  • Note: US usually used
  • IV Tc blood flow, pool studies
46
Q

Thyroid Ablation

A

high dose oral radioactive iodine

47
Q

Nuclear Oncology

A
  • Theranostics- molecular imaging/treatment
  • (aka theragnostic) alpha or beta emitters
  • Palliative or curative therapy goals
  • E.g. mets, but not cure primary site
48
Q

bone met radiotherapy

A
  • palliative
  • IV strontium 89

CD III (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions