NUKES Flashcards
1
Q
Tc-99m
A
“low” 140 keV; 6 hours
2
Q
Iodine - 123
A
“low” 159 keV; 13 hours
3
Q
Xenon - 133
A
“low” keV 81; 125 hours or 5.3 days (biologic 1/2 life of 30 seconds)
4
Q
Thallium - 201
A
Potassium analogue; “low” x-rays from daughter Hg 201 at 68-82 keV (71 or 77 keV), 135 keV (2%), 167 keV; half life 73 hours
5
Q
Indium - 111
A
“medium” 173 keV, 247 keV; 67 hours
6
Q
Gallium - 67
A
Iron analogue; 93 keV (40%), 184 keV (20%), 300 keV (20%), 393 (5%); half life 78 hours
7
Q
Iodine - 131
A
“high” 365 keV, 8 days
8
Q
Fluorine - 18
A
“high” 511 keV, 110 mins
9
Q
Strontium 89 half life
A
50.5 days (14 days in bone)
10
Q
Samarium 153 half lif
A
46 hours
11
Q
Radium half life
A
11 days
12
Q
Yttrium 90 half life
A
64 hours
13
Q
Rubidium 82 half life
A
75 seconds
14
Q
Nitrogen 13 half life
A
10 mins
15
Q
Critical organ Tc-MDP
A
Bladder (some say bone)
16
Q
Critical organ Tc - sulfur colloid (IV)
A
Liver
17
Q
Critical organ Tc - sulfur colloid (oral)
A
proximal colon
18
Q
Critical organ Tc - pertechnetate
A
stomach > thyroid (some sources say colon)
19
Q
Critical organ Tc - sestamibi
A
proximal colon
20
Q
Critical organ Tc - heat treated RBC
A
Spleen > heart
21
Q
Critical organ Tagged RBC - MUGA
A
Heart
22
Q
Critical organ Tc - MAA
A
Lung
23
Q
Critical organ Tc- DMSA
A
Renal cortex
24
Q
Critical organ Tc - MAG 3
A
Bladder
25
Critical organ DTPA
Bladder
26
Critical organ I-123 MIBG
Bladder (some say adrenal medulla)
27
Critical organ I-131 MIBG
Liver (some say adrenal medulla)
28
Critical organ I-131, I-123
Thyroid
29
Critical organ In-111 WBC
spleen
30
Critical organ In-111 ProstaScint
Liver
31
Critical organ In-111 Octreoscan
Spleen
32
Critical organ Thallium 201
renal cortex
33
Critical organ F18 FDG
Bladder
34
Critical organ Gallium-67
Distal colon
35
HIDA
GB wall
36
Mechanism of localization: Tc - sestamibi
passive diffusion (lipophilic diffusion)
37
Mechanism of localization: Tc - tetrofosmin
passive diffusion (lipophilic diffusion)
38
Mechanism of localization: Tc - HMPAO
passive diffusion (delivery flow related - then diffuse into brain)
39
Mechanism of localization: Tc - ECD
passive diffusion (delivery flow related - then diffuse into brain)
40
Mechanism of localization: DTPA
Filtration
41
Mechanism of localization: F18 - FDG
Facilitated diffusion (Carrier mediated transport across membrane via GLUT)
42
Mechanism of localization: I-123, I-131
Active transport (AtP to move against concentration gradient)
43
Mechanism of localization: Thallium
Active transport (Na/K Pump)
44
Mechanism of localization: Rubidium
Active transport (Na/K Pump)
45
Mechanism of localization: MIBG
Active Transport (Na facilitated norepinephrine uptake system)
46
Mechanism of localization: DMSA
active transport
47
Mechanism of localization: Pertechnatate
Secretion (Active transport OUT of gland or tissue)
48
Mechanism of localization: MAG - 3
secretion (secreted by peritubular capillaries)
49
Mechanism of localization: Tc-99m IDA
secretion (secreted by hepatocytes)
50
Mechanism of localization: Sulfur colloid
phagocytosis (RES eats teh colloid particles)
51
Mechanism of localization: Heat treated RBCs
sequestration
52
Mechanism of localization: MAA
Capillary blockade (lung perfusion)
53
Mechanism of localization: MDP
Chemisorption to calcium hydroxyapatite
54
Mechanism of localization: SM - 153
Chemisorption
55
Mechanism of localization: Indium WBC
Cellular migration
56
Mechanism of localization: Octreotide
receptor binding
57
DAT Scan (I-123 Isoflupane)
receptor binding
58
Tumors that are PET COLD (6)
1) BAC (adeno in situ) - lung cancer
2) Carcinoid
3) RCC
4) Peritoneal bowel/liver implants
5) anything mucinous
6) prostate
59
PET HOT - NOT CANCER (6)
1) Infection
2) Inflammation
3) Ovaries in follicular phase
4) Muscles
5) Brown fat
6) Thymus
60
Indium is better than gallium for evaluating (1)
abdomino-pelvic abscess due to lack of normal bowel excretory pathway
61
Gallium is better than indium for evaluating (3)
1) Spine
2) diffuse pulmonary process (gallium is probably the agent of choice for the evaluation of pulmonary inflammatory abnormalities)
3) Lymphocytic mediated infection
62
Tc - HMPAO is better than In WBC (3)
1) children (lower dose)
2) IBD (image early 30-60 minutes)
3) Osteomyelitis in extremity
63
In WBC is better than Tc - HMPAO (1)
Fever of unknown origin
64
tumors that take up octreoscan
Somatostatin analog
Taken up by:
1) carcinoid tumor
2) paraganglioma (glomus jugulare tumor, glomus jugulotympanicum, glomus vagale, glomus tympanicum, carotid body tumor)
3) phaeochromocytoma
4) small cell lung cancer
5) pituitary adenoma
6) neuroblastoma
7) medullary thyroid carcinoma
8) pancreatic islet cell tumor
Variable taken up by: meningioma, astrocytoma, breast carcinoma, lymphoma, Merkel cell carcinoma
65
Excessive aluminum from generator elution on Tc study results in accumulation of radiotracer where?
Causes colloid formation and accumulation in the liver
66
How frequently is field uniformity checked for nuclear medicine?
Extrinsically (with a collimator) is done daily and checks the collimator and cyrstals
Intrinsically (without a collimator) is done weekly (can use either Na99TcO4 or Co57
If bulls eyes are seen then that is a PMT problem.
Need to compare if defect is seen on intrinsic or extrinsic alone or on both to determine where problem is. If only on extrinsic then the collimator may be cracked!
67
How frequently are linearity and spatial resolution checked in nuclear medicine?
What about Energy Window?
Center or rotation?
Linearity and SR should be sheck weekely with bar phantom and flood source (Co57)
Energy window should be checked daily (Tc center at 140 keV with 20% window)
Center of Rotation is done with 5 small Tc point sources along the axis of rotation and should be performed monthly.
68
Radionuclide purity test
1) What are you testing for?
2) How is it performed?
3) What is the NRC allowance?
Testing for Molybdenum in Tc-99m eluate (breakthrough).
Mo (740 keV) is assayed first by shielding lower Tc.
0.15 micro Ci of Mo per 1 milli Ci of Tc, AT THE TIME OF ADMINISTRATION
Ratio less than 0.038 at the time of elution will be suitable for injection at least 12 hours.
69
Chemical purity test
1) What are you testing for?
2) How is it performed?
3) What is the NRC allowance?
4) What artifact is caused?
Testing for aluminum with pH paper. Must be < 10 mg of Al per 1 mL.
Can show up as liver activity on Tc scan due to clumping (bone study for example)
Can show up in lungs on liver/spleen scan with Sulfur Colloid
70
Radiochemical purity test
1) What are you testing for?
2) How is it performed?
3) What is seen on the scan?
This is done using thin layer chromatography to essentially check labeling efficiency.
You are testing for free pertechnatate (TcO4)
Due to incomplete reduction by stannous ions or by accidental air injection
Shows up on the scan with gastric, salivary gland and thyroid uptake
71
Allowable dose exposure limits (NRC) for occupational, public, family of patient and pregnant categories? Lens dose?
Occupational total body dose limit: 50 mSv (5 rem)
Dose to the ocular lens: 150 mSv (15 rem)
Total equivalent organ dose per year: 500 mSv (50 rem)
Embryo/fetus dose over 9 months: 5 mSv (0.5 rem)
Annual dose to the public: 1 mSv (0.1 rem or 100 mrem)
No greater than 2 mrem/hr in an "unrestricted area"
72
Hot sink limit
1 Ci per year
73
Package labels and limits
White I: < 0.5 mrem/hr (surface); N/a @ 1 m
Yellow II: < 50 mrem/hr (surface) AND < 1 mrem/hr @ 1 m
Yellow III: 50 < x < 200 mrem/hr (surface) OR 1 < x < 10 mrem/hr @ 1 m
74
When does a Mo/Tc generator have the max Tc-99m amount? How frequently should generator undergo elution?
Max build up of Tc-99m occurs after about 4 half lives or 23 hrs
Should be eluted daily to prevent accumulation of Tc-99 (notice the not metastable form)
75
What can cause diffuse muscle uptake on MIBG?
Medications (TCA, antihypertensives, sympathomimetics, cocaine)
76
How frequently should PET QA "Blank Scan" be done?
| What about a normalization scan?
This should be done daily. Can be done with a positron source and no patient in the scanner either Ge 68 or Cs 137 or a uniform source phantom.
Normalization scan should be done monthly or annually? Expose to uniform source, looking for variations in detector elements (variations in crystal thickness, etc?)
Note Ge(68)/Ga(68) system is similar to Mo/Tc, Ga 68 (not 67) is a positron emitter with half life of only 68 minutes.
77
Name beta minus decay radiotracers
```
Tc - 99m
Xe - 133
I - 131
Strontium - 89
Samarium 153
Y - 90
```
78
Name electron capture radiotracers
```
I - 123 (goes to Te-123m)
Thallium -201 (goes to Hg)
Indium - 111 (goes to Cadmium)
Gallium - 67 (goes to Zn)
Cobalt 57 - (goes to Fe)
```
*** GIIT and Cobalt
79
Name the beta plus (positron) radiotracers
F-18 (Yields oxygen 18)
Rubidium - 82
N - 13
80
Low, medium and high energy radiotracers
Low: Tc, I-123, X-133, TI-201 (1-200 keV)
Med: Ga-67 and In-111 (200 - 400 keV)
High: I - 131 (>400 keV)
81
Qc for Ionizing Chamber or Dose Calibrator
Consistency w/i 5% checked daily
Linearity (quarterly)
Accuracy (annually)
Geometry (installation and anytime it is moved)
82
10 CFR part 19
10 CFR part 20
10 CFR part 35
19: Notices, instructions and reports to workers
20: Standards for protection against radiation
35: Medical use of by-product material
83
Major spill thresholds
100 mCi Tc-99m and TI-201
10 mCi In-111, I-123, Ga-67
1 mCi I-131
84
Recordable event versus Reportable event
Recordable: less than 5 rem whole body dose or single organ dose < 50 rem with error (wrong drug, route, patient or dose >20%) *** Must be kept for 5 years (most other things for only 3 years)
Reportable: mistake causing harm to patient with whole body dose greter than 5 rem or single organ dose > 50 rem
Reporting
- Call NRC w/i 24 hours
- write NRC letter w/i 15 days
- Notify referring doc w/i 24 hours
- Notify patient
85
Tolerated wipe dose or survey on packages
> 6600 dpm/300 cm^2 is not allowed
Must check within 3 hours of receipt
