Nuclear Imaging

Question 1

T or F. Nuclear Imaging utilizes Safe, Painless and Cost – effective techniques

Answer 1

T

Question 2

T or F. Procedures in nuclear imaging are primarily physiologic showing function and anatomic details of the organs.

Answer 2

F. It shows function but DOES NOT provide anatomic details

Question 3

This is a specialized equipment that detects, records and process radioactivity emanating from the patient who has been injected with radioactive material

Answer 3

Gamma Camera

Question 4

An ideal radionuclide , used in >70% of nuclear imaging procedures which rapidly concentrates in salivary glands, choroid plexus, thyroid gland, gastric mucosa, functioning breast tissue and placenta

Answer 4

Technetium – 99 (TC99M)

Question 5

Use for treatment of thyroid cancer and hyperthyroidism

Answer 5

Iodine – 131

Question 6

Type radiation that is undesirable in diagnostic applications due to high radiation to patient (helium nuclei)

Answer 6

Alpha Particles

Question 7

Scopes of Nuclear Medicine

Answer 7

Nuclear Imaging, Radioimmunoassay, Radioactive iodine Therapy, Bone Palliation, Bone Densitometry, PET

Question 8

Highest bone density can be possibly achieved at what age?

Answer 8

30

Question 9

Use in assessing the patency of nasolacrimal glands

Answer 9

Dacryoscintigraphy

Question 10

Radioactive Iodine (RAI) therapy is used in these conditions

Answer 10

Grave’s Disease, Toxic Nodular Goiter, Thyroid Carcinoma (Papillary and Follicular)

Question 11

Used in Bone Pain Palliation. Delivers a High Local radiation dose directly to the sites of bony metastasis through a single IV administration. Toxic effect is Platelet Depression

Answer 11

Strontium – 89

Samarium – 153

Question 12

This is a functional renal examination which provides information on infrarenal kinetics of the intravenously administered radiopharm. This is done to know how the kidney is functioning, to monitor the flow of urine in ml/min, the degree of any blockage, to assess the effect of recurrent urinary tract infection, to know how the transplanted kidney is functioning.

Answer 12

Dynamic Renal Scintigraphy

Question 13

This renal scan is used to assess renal function and urodynamics of native or transplanted kidneys

Answer 13

Basic Renal Scan

Question 14

This renal scan is used to diagnose or exclude urinary tract obstruction

Answer 14

Diuretic Renal Scan

Question 15

Renal scan used to diagnose or exclude renovascular hypertension

Answer 15

Captopril – augmented Renal Scan

Question 16

Renal Scan used to detect changes/abnormalities in renal morphology, also to work – up for infection and in the diagnosis of pyelonephritis

Answer 16

Renal Cortex Scan – DMSA

Question 17

Amount of blood completely cleared of material in 1 minute

Answer 17

125 ml/min

Question 18

. T or F. In the proximal convoluted tubule, water is reabsorbed as well as Na+, Cl and HCO3 while glucose and amino acids are resorbed.

Answer 18

T

Question 19

T or F. In the Loop of Henle, electrolytes and water are resorbed

Answer 19

F. Electrolytes are resorbed but not water

Question 20

20. Resorption of Na under the control of ADH or angiotensin system occurs in the distal convoluted tubule

Answer 20

T.

Question 21

Kidney lies in what level of vertebrae

Answer 21

Retroperitoneally between T11 and L3

Question 22

A glomerular filtration agent which is completely eliminated by filtration and no tubular secretion occurs. It is used in the local setting for quantitation of GFR, evaluation of urinary drainage, VUR, bladder function and urinary patency

Answer 22

99m Tc – DTPA (Technetium 99m diethylenetriamine pentaacetic acid

Question 23

These agents are ideal for measuring effective renal plasma flow (ERPF)

Answer 23

Tubular Agents

Question 24

This tubular agent is the gold standard for measurement of ERPF

Answer 24

paraaminohippuric acid (PAH)

Question 25

Most commonly used tubular agent because of improved image quality and lack of particulate emission

Answer 25

99m TcMAG3 (Technetium 99m mercaptoacetyltriglycine)

Question 26

This parenchymal agent is used for cortical imaging and in patients with recurrent UTI to check for scarring

Answer 26

Tc – 99m DMSA (Technetium – 99m dimercaptosuccinic acid)

Question 27

. T or F. In doing renal scan for functional studies first thing to be assessed is the renal blood flow and following 25 – 30 minutes uptake and clearance are assessed.

Answer 27

T.

Question 28

Phases of Normal Renogram

Answer 28

. Initial Blood flow (Perfusion Phase) (30 -60 seconds) 2. Cortical Uptake phase (normally 1 – 3 minutes) 3. Clearance phase representing cortical excretion and collecting stem clearance

Question 29

. T or F. in the perfusion phase, peak of renal perfusion should occur no more than 3 seconds later than aortic peak.

Answer 29

T

Question 30

In a normal renal scan, urine should already be seen in the urinary bladder in three minutes to say that the kidney has normal excretion

Answer 30

T

Question 31

Normal value for GFR

Answer 31

80 – 125 ml/min

Question 32

Normal value for Effective Renal Plasma Flow (ERPF)

Answer 32

500 – 600 ml/min

Question 33

Normal Filtration Index

Answer 33

0.2

Question 34

Normal Excretory Index

Answer 34

1

Question 35

. In doing Diuretic Renal Scan to diagnose hydronephrosis, furosemide is used to induce urine flow and if the kidney is obstructed there is no wash out but if it is just dilated but not obstructed there will be wash out

Answer 35

T

Question 36

Captopril – augmented Renal Scan is used to exclude these Renovascular Diseases

Answer 36

Renal Artery Stenosis (RAS) Ischemic Nephropathy Renovascular Hypertension (RVH)

Question 37

A normal Tc-99m DMSA scan should show a homogeneous distribution throughout the renal cortex. The upper poles may often appear less intense due to splenic impression on the cortex, fetal lobulation, and attenuation from liver and spleen.

Answer 37

T

Question 38

The most common indication to do bone scan or scintigraphy

Answer 38

Search for Metastases

Question 39

Contraindications of Bone Scan

Answer 39

Pregnancy and Brest – feeding

Question 40

Used to accurately identify and locate cancerous tissue in the breasts.

Answer 40

Scintimammography

Question 41

Agent used to define breast cancer in scintimammography

Answer 41

Sestamibi labelled with 99mTc

Question 42

This imaging modality demonstrate leaks from the biliary tree after surgery, using 99m Tc – HIDA (bilirubin analogue)

Answer 42

Hepatobiliary scan

Question 43

A necroinflammatory disease characterized by development of cholecystitis in a gallbladder either without gallstones or with gallstones

Answer 43

Acute acalculous cholecystitis

Question 44

This imaging modality is done to identify source of bleeding in a patient with melena and hematochezia. Otherwise known as RBC tagging

Answer 44

Bleeding Scan

Question 45

Meckel’s diverticulum is a remnant of this structure

Answer 45

Omphalomesenterial cap

Question 46

. What is the rule of 2 for Meckel’s Diverticulum

Answer 46

At least 2% of the population, occurs in children 2 years and below, within 2 feet of the ileocecal valve, 2 inches in length, 2 types of heterotropic mucosa

Question 47

Meckel’s diverticulum has the propensity to bleed without producing pain. This tendency to bleed is due to the presence of

Answer 47

Ectopic Gastric Mucosa

Question 48

T or F. In perfusion scan the radiotracer is injected via IV while in the ventilation scan the radiotracer is inhaled by the patient.

Answer 48

T

Question 49

. Most common isotope used in Thyroid Scan

Answer 49

99mTc as pertechnetate; administered dose 80 MBq

Question 50

. T or F. Hot’ nodules need further investigation since there is a high incidence of malignancy.

Answer 50

F. Hot nodules usually does not need further investigation while cold nodules need to be further investigated due to risk of carcinoma (5%)

Question 51

What is the normal RAI uptake

Answer 51

2 hour: 5-15% of thyroid should be seen. | At 24hours: 20-45% should be intense.

Question 52

. T or F. When the thyroid is inflamed it appears almost invisible in the scan

Answer 52

T

Question 53

. Tor F. In toxic goiter the thyroid is very active and takes a lot of tracers

Answer 53

T

Question 54

T or F. In thyroiditis the presence of the virus disrupts the thyroid cells allowing escape of hormones into the bloodstream and the thyroid compensates by increasing its glandular activity appearing dense in scan

Answer 54

F. In thyroiditis although the patient is toxic due to thyrotoxicosis there is no glandular activity and the thyroid does not appear as dense like in toxic goiter

Question 55

Testicular torsion will reveal this pattern in testicular scan

Answer 55

Halo sign

Question 56

Most commonly used agent in parathyroid adenoma scan

Answer 56

99mTc Sestamibi, administered dose 900 MBq

Question 57

. T. or F. The parathyroid scan can differentiate parathyroid adenoma from carcinoma

Answer 57

F. Cannot Differentiate

Question 58

This scan is done to patients with thyroid carcinoma, who has undergone thyroidectomy and underwent iodine treatment for ablating thyroid carcinoma

Answer 58

Total Body Scan