Procedure

Question 1

Radionuclides and Radiopharmaceutical’s

Answer 1

Production of Radionuclides

Question 2

Procedure: Methods: Reactor:

Answer 2

An apparatus or structure in which fissile material ( 235U or 239 PU) can be made to undergo a controlled,self- sustaining nuclear reaction( fission) with the consequent release of energy. Fission is the breakup a heavy nucleus into two fragments of approximately equal mass, accompanied by the emission of 2 to 3 neurons. There is an energy release that appears as head and is usually removed by heat exchangers to produce release that appears as head and is usually removed by heat exchangers to produce electricity. ( I-131, Mo- 99 , Xe-133, Cs- 137) .

Question 3

Methods: Accelerator:

Answer 3

A machine that uses electromagnetic fields to propel charged particles to nearly light speed and to contain them in well- defined beams.

Question 4

Methods: Cyclotron:

Answer 4

An apparatus in which charged atomic and subatomic particles are accelerated by an alternating by an alternating electric field which following an outward spiral or circular path in a magnetic field. Cyclotron produced radionuclides are usually neutron deficient and therefore decay by B+ emission or electron capture. ( Ga-67,
I123, In 111, TI-201, C-11, N-13, O-15,F-18)

Question 5

Methods Generator:

Answer 5

They provide a convenient source of short-lived radionuclides. In a generator, a longer- lived radionuclide, called the parent, decays to a shorter- lived radionuclide, called the daughter. The daughter can be removed periodically as it is replenished by decay of the parent. (Ga-68, Sr-82,Rb-82, and Mo-99/Tc-99). Some of these systems have been developed commercially and are supplied as sterile shielded, automatically operated devices.

Question 6

Purity Radionuclide:

Answer 6

Defined as the fraction/ratio of total radioactivity present in its desired chemical form. If radiochemical impurities exceed certain limits in a given preparation, the distribution of the radio -pharmaceutical in the patient will be altered. Free pertechnetate can be visualized on images as increased tracer concentration in the stomach, thyroid and salivary glands.

Question 7

Purity Chemical:

Answer 7

Tc-99 is present in 3 different chemical forms-bound Tc-99, unbound Tc-99 (free) and hydrolyzed reduced(HR) Tc-99. Because the bound Tc-99
Is the desired form, the others should be present on in very small quantities. Tc-99m pertechnetate and HR Tc-99 are radiochemical impurities.
Math for Purity:
% Radiochemical Impurity = CPM in part A /CPM in part +CPM in part B X 100%
% Labeling Ef ficiency = 100% radiochemical impurity.

Question 8

Purity: Physical form:

Answer 8

Ex: Gas , Solution,Capsule

Question 9

Radiopharmaceutical Characteristics: Method of Localization: Capillary Blockage:

Answer 9

Mechanical obstruction, physical trapping, of capillaries or pre-capillary arterioles in the lungs. Ex: Tc-99 MAA.

Question 10

Radiopharmaceutical Characteristics: Method of Localization: Active Transport:

Answer 10

Another type of carrier-mediated transport across membranes. It unlike diffusion, it requires energy (ATP) for the transporters to function. Hence, it can go through of as a a motorized revolving door or pump. Ex: I-123,I-131, Thyroid-function/ imaging, Na/K pump in the heart muscle with Ti-201.

Question 11

Radiopharmaceutical Characteristics: Method of Localization: Phagocytosis:

Answer 11

The process whereby the cell engulfs a particle and internalizes it. A prime example involves reticuloendothelial system(RES) cells, such as kupffer cells in the liver, phagocytizing colloid particles. EX: Sulfur colloid.

Question 12

Radiopharmaceutical Characteristics: Method of Localization: Diffusion:

Answer 12

A type of carrier- medicated transport across membranes, can be thought of as a revolving door. Accordingly, it can be competitively inhibited by the presence of similar molecules that also fit into the carrier. Because there are a limited number of carriers, it is possible to achieve saturation. EX. Glucose FDG.

Question 13

Radiopharmaceutical Characteristics: Method of Localization: Compartmentalization:

Answer 13

Introduction of (Rph) into well- defined body compartment, where it remains for an extended period. Ex. Tc-99m DTPA aerosol, Xe- 133.

Question 14

Radiopharmaceutical Characteristics: Method of Localization: Chemisorption:

Answer 14

The binding of phosphate- type compounds onto the surface of bone. The strength of this binding is intermediate between chemical covalent bonding and hydrogen bonding l(absorption), hence the coined tern chemi-sorption. Ex: MDP and HDP.

Question 15

Radiopharmaceutical Characteristics: Method of Localization: Receptor binding:

Answer 15

Refers to the “lock and Key” binding of a molecules to a specific General characteristics include, selectively, competitive inhibition by similar molecules and the possibility of being over saturated. Ex: In-111 capromab pendetide/a monoclonal murine lgG anitbody for prostate specific membrane antigen (PSMA), I-131 tositumomab and Y-90 ibritumomab/receptors no B-cells and non- Hodgkin’s cells.

Question 16

Radiopharmaceutical Characteristics: Method of Localization: Antigen antibody:

Answer 16

Radiolabeled antibody binds to tumor- associated antigen. Ex. Using tumor- specific labeled to detect cancer or stage therapy.

Question 17

Filtration:

Answer 17

A special case of diffusion involving transit of molecules through pores, or channels driven by a hydroelectric or osmosis pressure gradient. Ex: GFR by the kidney, DTPA.

Question 18

Metabolism:

Answer 18

Used to describe all chemical reactions involved in maintaining the living state of the cells and organism. Can be divided into 2 categories- Catabolism: the breakdown of molecules to obtain energy, Anabolism: the synthesis of all compounds needed by the cells.

Question 19

Sequestration:

Answer 19

The process whereby old or damaged RBC are removed from the circulation of the spleen, uptake of WBC’s in infection sties. Ex: Ultra Tag RBC’s taken up by spleen,In-111 WBC’s site of infections.

Question 20

Half-Life: Physical(t1/2)

Answer 20

Defined as the period of time required to reduce the radioactivity level of a source to exactly one half its original value due solely to radioactive decay.

Question 21

Half-life: Biological (Tb):

Answer 21

Defined as the period of time required to reduce the amount of a drug in an organ or the body to exactly one half its original value due solely to biological elimination.

Question 22

Half-Life: Effective (Te):

Answer 22

Defined as the period of time required to reduce the radioactivity level of an internal organ or of the whole body to exactly one half its original value due to both elimination and decay.

Math: Te=T1/2+Tb

Question 23

Biodistribution: Pharmacokinetics:

Answer 23

Described as what the body does to a drug, refers to the movement of drug into, through and out of the body; the time course of its absorption, bioavailability,distribution,metabolism and excretion..

Question 24

Biodistribution: Critical Organs:

Answer 24

Refers to the part of the body most vulnerable to a given isotopes. For iodine, the critical organ is the thyroid gland.

Question 25

Biodistribution: Target Organs:

Answer 25

A specific organ on which a hormone, drug, or the other substance acts upon it. Ex: Bone scan= Bone, Bladder.

Question 26

Preparation and administration:

Answer 26

1: kit preparation 2: Labeling Process 3: Principles

Question 27

Oxidation/reduction( redox):

Answer 27

A redox reaction is a type of chemical reaction that involves a transfer of electrons between two chemical species.

Question 28

Oxidation:

Answer 28

Used to describe reactions in which an element combines with oxygen. Ex: reaction between magnesium and oxygen to from magnesium oxide involves the oxidation of magnesium. Technetium can exist in various oxidation states form 1-to 7+. The Tc5+ is the most common in 99m complexes.

Question 29

Reduction:

Answer 29

From the Latin meaning “ To lead back” Anything that leads back to magnesium therefore involves reduction.

Question 30

PH:

Answer 30

A figure expressing the acidity or alkalinity of a solution on a logarithmic scale on which 7 is neutral, lower values are more acid, and higher values more alkaline. 1: Time for reaction 2: Temperature

Question 31

Compounding Techniques:

Answer 31

The creation of a particular pharmaceutical product to fit the unique need of a patient by combining or process appropriate ingredients using various tools. ( Solid pill to a liquid, avoid a non- essential ingredient that the patient is allergic to, or obtain the exact dose needed or deemed best of particular active pharmaceutical ingredients.)

Question 32

Compounding techniques:

Answer 32

1: Venting 2: Heating 3: Mixing

Question 33

USP 797 Regulations:

Answer 33

The objective of this document is to describe conditions and practices to prevent harm including death, to patients that could result from the following: 1) microbial contamination/ nonsterility. 2) excessive bacterial endotoxins. 3) Variability in the intended strength of correct ingredients that exceeds either monography limits for official articles or 10% for no official articles. 4) unintended chemical and physical contamination and 5.) incorrect types and qualities of ingredients in compounded sterile preparations (CSPs).

Question 34

Factors that affect labeling quality:

Answer 34

B: She’ll life and storage C: Quality Control

Question 35

Radiochemical Purity:

Answer 35

The total amount or fraction of the desired radioactive compound.

Question 36

Particles Size:

Answer 36

Radiopharmaceutical | MAA, Sulfur Colloid

Question 37

Specific Activity:

Answer 37

Ex: (Millicuries per mas)

Question 38

Color and clarity:

Answer 38

Of the kit and Labeling process.

Question 39

Calculation of radiopharmaceutical and pharmaceutical dosage. A: Units

Answer 39

1: Conversions 2: Calculation

Question 40

Math guide: Volume determination:

Answer 40

1: formula 2: Decay Tables 3: Concentration 4: Activity

Question 41

Pharmaceutical and radiopharmaceutical administration preparation:

Answer 41

1: Syringe dose level 2: Needle selection 20g 18g 3: Shielding for use to help us with limit of radiopharmaceutical use..

Question 42

Radiopharmaceutical label: Pertinent information:

Answer 42

1: Name of the radiopharmaceutical 2: Assay date and time 3: Lot number and expiration date 4: Concentration 5: Volume 6: Activity

Question 43

Administration techniques: Routes:

Answer 43

The main ways of delivery are inhalation and Iv, while some applications for orally, IM,and via the spinal cord (intrathecal).

Question 44

Administration techniques: Aseptic:

Answer 44

Technique involves maintaining the sterility of the needle hub as it is attached to the syringe and the needle itself and sanitizing the top of the radiopharmaceutical vial with alcohol.

Question 45

Administration techniques: Uniform distribution ( Ex: mixing, agitation). :

Answer 45

Depends on the particular Radiopharmaceutical.

Question 46

Administration techniques: Complication and reactions( Adverse Reaction):

Answer 46

A harmful and unintended response to a human medicine, occurring at doses normally used for the diagnosis or treatment of a disease. Adverse events in the administration of radiopharmaceutical products might continue to occur. The important thing is that the relevant staff should immediately document such reactions as soon as it occurs. Regular documentation and recording of such reactions as well as evaluation of the results will make a great contribution to the development of better radiopharmaceutical with less adverse effects.

Question 47

Administration techniques: Documentation:

Answer 47

Pertinent information, such as the name of the radiopharmaceutical, lot number, activity and volume administered, time, date, person administering the dose, route of administration, and patient’s name, should be entered into the appropriate records.

Question 48

Cardiac Procedure: Anatomy and Physiology:

Answer 48

Deoxygenated blood enters the right atrium from the superior and inferior vena Cava. During Ventricular diastole( relaxation/ filling phase) the tricuspid value opens allowing blood to flow into the right ventricle. Blood exits the right ventricle during Ventricular Systole(Contraction Phase) and travel through the pulmonary value into the pulmonary artery that leads into lungs. Newly oxygenated blood enters the left atrium by pulmonary veins. Blood passes across mitral valves into left ventricle during Ventricular diastole. Oxygenated blood is introduced to systematic circulation during ventricular systole by passing through aortic valve into aorta.

Question 49

Coronary and Systemic Circulation:

Answer 49

Perfusion of blood into heart muscle is through Coronary Circulation. Begins at base of aorta where the right and left coronary arteries (RCA and LCA) originate. RCA exits aorta, follows right posterior sulcus and branches posteriorly ( posterior descending artery/PDA) toward apex. The RCA supplies the posterior and inferior areas of the myocardium. The LCA exits aorta at level of the left coronary sinus. It branches into the left descending artery (LAD) and left circumflex artery (LCX).LAD usually traverses down anterior heart surface to provide septal and anterior walls of myocardium with blood. Also, provides blood to apex, LCX services the lateral free wall. Perfusion of oxygenated blood to rest of body return of deoxygenated to the heart is (Systemic Circulation).

Question 50

Conduction system:

Answer 50

Conduction (systole) and Relaxation (diastole)

Question 51

SA node (Sinoatrial):

Answer 51

Electrical impulse that initiates contraction, pacemaker for the heart (60-100 beats).

Question 52

Av node (atrioventricular)

Answer 52

Serves as ventricles “gate Keeper” allows only 40-60 impulses per min.

Question 53

Bundle of His (Av bundle)

Answer 53

Collection of heart muscles specialized for electrical conduction; transmits impulses from Av node to right and left bundle branches.

Question 54

Purkinie fibers:

Answer 54

Thermal branches for both bundle branches. They carry impulses to myocardial cells causing ventricular contraction.

Question 55

Electrocardiogram (ECG) Graphics electrical heart activity: P Wave:

Answer 55

Atrial depolarization(activation), slowing of impulse is indicated by interval between P and QRS=PR interval.

Question 56

Electrocardiogram (RCG) Graphic electrical heart activity: QRS Complex:

Answer 56

Indicates depolarization of ventilation Q waves is 1- deflection, R wave, is 1+ deflection, S wave is the rest.

Question 57

Electrocardiogram (ECG) Graphic electrical heart activity: ST segment:

Answer 57

Rest period between de and depolarization ( relaxation).

Question 58

Electrocardiogram (ECG) Graphic electrical heart activity: T wave:

Answer 58

Repolarization of Ventricles.

Question 59

Coronary Artery Disease (CAD): Myocardial Ischemia:

Answer 59

Decreases blood flow to the myocardium causing narrowing or occlusion of the coronary artery. Angina pectoris(chest pain) is major symptom and ST depression on ECG.

Question 60

Coronary Artery Disease (CAD):Myocardial Infarction (MI):

Answer 60

Results from total occurrence of the narrowing coronary artery by a blood clot. Injured and ischemic areas are viable from therapeutic intervention such as coronary artery bypass graft (CABG) surgery or percutaneous transluminal coronary angioplasty (PTCA).

Question 61

Coronary Artery disease (CAD): Hibernating myocardium:

Answer 61

Chronic ischemic tissue that is viable yet appears to be nonfunctioning.

Question 62

Coronary Artery Disease (CAD): Myocardial stunning:

Answer 62

A phenomenon that may occur after a patient experiences an acute episode of severe ischemia or an MI that is terminated by thrombolysis or revascularization.

Question 63

Akinesis:

Answer 63

Absence of motion

Question 64

Hypokinesis:

Answer 64

Decreased motion

Question 65

Dyskinesis:

Answer 65

Segment of ventricle bulges out as remainder of ventricle contracts.

Question 66

Stroke Volume (SV) :

Answer 66

Volume of blood ejected by either ventricle during Ventricular systole, SV=ED-ES

Question 67

Cardiac Output (CO):

Answer 67

Volume of blood that the heart pumps per minute., CO=SV x HR

Question 68

End Diastolic Volume (ED):

Answer 68

Capital of the Ventricle after it is completely filled with blood; largest volume reached during cycle.

Question 69

End Systolic Volume(ES);

Answer 69

Residual capacity of the ventricle at the end of concentration; smallest volume reached during cycle.

Question 70

Ejection Fraction (EF):

Answer 70

Percentage of blood ejected from the ventricle during each concentration EF=(ED-ES)/EDx100.

Question 71

Good Blood Pool (MUGA): Selection:

Answer 71

Tagged red blood cells( RBC’s) by pyrophosphate(PYP) in combination with Tc-99m pertechnetate or a stannous chlorine kit(Ultra Tag).

Question 72

Gated Blood Pool (MUGA): Dosage:

Answer 72

15-30mCi

Question 73

Gated Blood Pool(MUGA): Administration:

Answer 73

Intravenous(IV), 3 methods to label RBC’s. In Vivo: Make cold pyp kit; 2-3ml normal saline into pyp vial. Mix then let sit for 5 mins. Next, inject 1-3 ml pyp. Wait/circulate for 20 mins. Next, inject 20-30mCi of pertechnetate into opposite arm ( 90% efficiency).

Question 74

Gated Blood Pool( MUGA): Modified in Vivo/InVitro:

Answer 74

Make cold pyp kit, 2-3ml normal saline into pyp vial. Mix then let sit for 5 mins. Next inject patient with pyp; straight stick. 1.5ml for small patient or not no blood thinners, 3 ml of blood into a 5-10mins and reinject.

Question 75

Gated Blood pool(MUGA): Biodistribution:

Answer 75

Compartmental, tagged, to and circulating with blood.

Question 76

Gated Blood Pool(MUGA): patient preparation, Monitoring and Education. Indicators:

Answer 76

Evaluation of left/sometimes right wall motion( CHF), calculation of ejection fraction (EF),ventricular volume, cardiac output and diastolic function, assessment of CHF to ischemic or non ischemic causes,detection and evaluation of CAD,evaluation of patient’s heart before/ after surgery, chemotherapy or radiation. Contraindications: chest pain, unstable condition, severe arrhythmia and allergic to pyrophosphate or phosphate.

Question 77

Gated Blood Pool(MUGA): Pregnancy and Nursing:

Answer 77

Must ask if pregnant or nursing if under 40 / 50years old.

Question 78

Gated Blood Pool(MUGA): Dietary restrictions:

Answer 78

NPO 4-8 hrs before study.

Question 79

Gated Blood Pool(MUGA): Adverse reactions/artifacts:

Answer 79

Arrhythmias, cold pyp oxidized if not used soon after mixing B-blockers, Ca2+ blockers may cause false negatives, Do not use chest ports as will show in pictures, should be done before any contrast type of exam, check clothing for articles, ECG in the way or pacemakers.

Question 80

Gated Blood Pool(MUGA): Medications:

Answer 80

Discontinue any cardiac meds and caffeine 4hrs prior.

Question 81

Gated Blood Pool(MUGA): Age specific/other considerations:

Answer 81

N/A

Question 82

Gated Blood Pool(MUGA): Lab Values:

Answer 82

N/A

Question 83

Gated Blood Pool(MUGA): Imaging Techniques: Anatomical Landmarks

Answer 83

Once the camera is positioned correctly (LAO,40*), there should be a nice separation between ventricles nearly straight up and down.

Question 84

Gated Blood Pool(MUGA): Views:

Answer 84

Position camera anterior,LAO(35-60* looking for best septal wall separation for EF calculation, slightly tilt(5-10%) to camera can help), LLAT and sometimes RLAT or RAO displaying anterior and inferior wall moniton/apex..

Question 85

Gated Blood Pool(MUGA); Patient Detector Orientation;

Answer 85

Supine.

Question 86

Gated Blood pool(MUGA) Fusion Imaging

Answer 86

N/A

Question 87

Gated Blood Pool(MUGA): Instrumentation: Detector System:

Answer 87

Low energy/ all-purpose or high res parallel hole collimator.

Question 88

Gated Blood Pool (MUGA): Instrumentation: Data acquisition:

Answer 88

Collect for 300-600 beats: image or go by preset time(5-10min/image).

Question 89

Gated Blood Pool (MUGA): Instrumentation: Data analysis:

Answer 89

Draw regions of interest, calculate EF(ED-ES/EDx100), calculate SV ( ED-ES), calculate CO(SVxHR).

Question 90

Gated Blood Pool(MUGA): Instrumentation: Data analysis: Normal:

Answer 90

Good tag with blood,circulation in major vessels and heart should present clearly, septal image should show easily definable separation between right/left ventricles. Dynamic shows fair amount of motion in all (septal, anterior, lateral inferior, apex) walls no defects. Left Vent EF= 50-70% or better. Right vent EF, 35-45% or less. Below 30% indicates servers impairment. Regional wall abnormalities indicates CAD.

Question 91

Gated Blood Pool (MUGA): instrumentation: Data analysis: Abnormal:

Answer 91

Dynamic shows one or more walls with abnormal movements (dyskinesia), decreased wall motion ( hypokinesis) or no movement (akinesia). Low EF,35-45% or less. Below 30% indicates several impairment. Regional wall abnormalities indicates CAD.

Question 92

Gated Blood pool (MUGA): Ancillary Equipment:

Answer 92

3 to 5 lead ECG. Check R-R wave,adjust acquisition parameters accordingly. Make sure there is a good HR for gate.

Question 93

Myocardial Perfusion (MPI) (Stress): Selection:

Answer 93

Tc- 99m Sestamibi, Tc-99m Tetrofosmin and TI-201 Thallous Chloride.

Question 94

Myocardial Perfusion (MPI)(Stress): Dosage:

Answer 94

Sestamibi and Tetrofosmin, 20-30mCi; Thallous Chloride 3-5mCi

Question 95

Myocardial Perfusion (MPI)(Stress): Administration:

Answer 95

Intravenous (IV) or butterfly setup.

Question 96

Myocardial Perfusion (MPI)(Stress): Biodistribution:

Answer 96

Sestamibi-passive transport into myocardial mitochondrial in proportion to blood flow. Tetrofosmin-same; binds to myocytes. Thallous Chloride-distributes with Na/K pump within 20 mins of injection, then seeps out myocardium and redistributes.

Question 97

Myocardial Perfusion (MIP)(Stress): patient preparation,monitoring and Education: Indicators:

Answer 97

Detection and evaluation of coronary artery disease(CAD), suspected or known coronary artery stenosis, evaluation of possible candidates for coronary bypass surgery or angiogram, evaluation of physical indicators( acute myocardial infection,chest pain, SOB, history or family history of heart disease) and determination of prognosis after a myocardial infection.

Question 98

Myocardial Perfusion (MPI)(Stress): Indicators. Contraindications:

Answer 98

Chest-pain, documented acute MI within 2-4 days prior, has no discontinued chemical stressors( caffeine theophylline,viagra)24 to 48 prior, on heart medications, extremely high BP, arrhythmias, CHF, etc.

Question 99

Myocardial Perfusion (MPI)(Stress): pregnant and nursing:

Answer 99

N/A however is patient is under 40/50 years old must ask.

Question 100

Myocardial Perfusion (MPI)(Stress): Dietary restrictions:

Answer 100

NPO for 4-12hrs. Clear liquids and crackers for Sestamibi and Tetrofosmin, noting at all for Thallium. Orange juice allowed for diabetics; may need to monitor blood sugar and adjust. Ingest no caffeine, dairy products, or sugar.

Question 101

Myocardial Perfusion (MPI)(Stress): Adverse Reactions/artifacts:

Answer 101

Most common attenuation:(men) left hemidiaphragm affecting inferior wall,(women) left breast affecting anterior wall. Bier activity close to heart can mask inferior wall defects, patient not able to reach 85% of max HR, left arm down to the side instead of above the head, Test should be discontinued of patients experiences angina, severe SOB, fall in BP, ischemic ECG changes, arrhythmias etc:

Question 102

Myocardial Perfusion (MPI)(Stress): Medications:

Answer 102

Some doctors prefer to hold heart medications until after test( check with cardiologist)

Question 103

Myocardial Perfusion (MPI)(stress): Age Specific/other considerations:

Answer 103

Be well rested and avoid strenuous exercise the day of test and before exam.

Question 104

Myocardial Perfusion (MPI)(Stress): lab values:

Answer 104

N/A not need for this test.

Question 105

Myocardial Perfusion (MPI)(Stress): Imaging Techniques:Anatomical Iandmarks

Answer 105

N/A

Question 106

Myocardial Perfusion (MPI)(Stress): Views:

Answer 106

SPECT imaging so RAO to LPO

Question 107

Myocardial Perfusion (MPI)(Stress): Patient Detector Orientation:

Answer 107

Supine with heart in the center FOV .

Question 108

Myocardial Perfusion (MPI)(Stress): Fusion Imaging

Answer 108

N/A not for this tests.

Question 109

Myocardial Perfusion (MPI)(Stress): Instrumentation: Detector System:

Answer 109

Low/Energy/all purpose or low energy/ high res parallel hole.

Question 110

Myocardial Perfusion (MPI)(Stress): Instrumentation: Data acquisition:

Answer 110

Tc-99 window at 140kev, TI-201 at 167kev at 20% (static) Timed for 300 secs. (SPECT)- 180*, 32 or 64 projections at 20-40sec/frames,8frames/cycle of gated, matrix at 64x64.

Question 111

Myocardial Perfusion (MPI)(Stress): Data analysis:

Answer 111

Imaging processed to show myocardium of left ventricle in vertical, horizontal and shot axis views; bulls eye pilot and EF information.

Question 112

Myocardial Perfusion (MPI)(Stress): Instrumentation: Data analysis: Normal:

Answer 112

Heterogeneous uptake throughout the myocardium of the left ventricle. Normal left ventricular end diastolic volume is 70ml, end-systolic volume is 2ml. Normal heart 80%, RVEF: 40-60%. No deviations in full contraction of heart, all walks contracting in a coordinated measure.

Question 113

Myocardial Perfusion (MPI)(Stress): Instrumentation:Data analysis: Abnormal:

Answer 113

Defect(area of little to no uptake in localized area) in stress but not rest;the myocardium is ischemic and reversible. Defect in both stress and rest in the same area; most likely infracted and considered a fixed defect. Enlarged right ventricle possible pulmonary hypertension. Bone uptake on images; possible multiple myeloma.

Question 114

Myocardial Perfusion (MPI)(Stress): Instrumentation: Ancillary equipment:

Answer 114

Prep patient with a 10-12leads ECG; run standing, lying or sitting test sheets: Treadmill: Monitor Hr, BP, ECG changes and patient closely. Inject and flush on physician order( when target HR is obtained or about 1min before patient gives out). Maintain exercise for 60/90second after infection.

Question 115

Myocardial Perfusion (MPI)(Rest): Selection:

Answer 115

Tc-99 Sestamibi, TC-99m Tetrofosmin and TI-201Thallous Chloride.

Question 116

Myocardial Perfusion (MPI)(Rest): Dosage:

Answer 116

Sestamibi and Tetrofosmin,8-30Mci; Thallous Chloride 2-5mci.

Question 117

Myocardial Perfusion (MPI)(Rest): Administration:

Answer 117

Intravenous (IV) or butterfly setup.

Question 118

Myocardial Perfusion (MPI)(Rest): Biodistribution:

Answer 118

Sestamibi-passive transport into myocardial mitochondria in proportion to blood flow. Tetrofosmin- same; binds to myocytes. Thallous chloride distribution with Ma/K pump within 20 minutes of injection, then seeps out of myocardium and redistributes.

Question 119

Myocardial Perfusion (MPI)(Rest): Indicators:

Answer 119

Detection and evaluation of coronary artery disease (CAD), suspected or known coronary artery stenosis, evaluation of possible candidates for coronary bypass surgery or angioplasty, evaluation of physical indicators ( acute myocardial infarction, chest pain, SOB, history or family history of heart disease) and determination of prognosis after a myocardial infection. Contraindications: On chemical (caffeine, theophylline, Viagra)24 to 48 prior, taking heart medications until after test, NPO for 4- 12 hrs and severe arrhythmias.

Question 120

Myocardial Perfusion (MPI)(Rest): pregnancy and nursing:

Answer 120

N/A | Might have to ask if under 40/50 year old.. depends on the test..

Question 121

Myocardial Perfusion (MPI)(Rest): Dietary Restrictions:

Answer 121

NPO 4-12hrs (No caffeine, dairy products or sugar).

Question 122

Myocardial Perfusion (MPI)(Rest): Adverse Reactions/artifacts:

Answer 122

Not being NPO for 4+hrs articles in pockets, medallions, necklaces, heart monitors, pacemakers, or metal buttons cause artifacts. If patient has left arm down to side, it may cause unwanted attention. Possible shield gall bladder b/c of uptake with Sestamibi.

Question 123

Myocardial Perfusion (MPI)(Rest):Medications:

Answer 123

Some doctors prefer to hold heart medications until after test (check with cardiologist).

Question 124

Myocardial Perfusion (MPI)(Rest): Age Specific/other Considerations:

Answer 124

Be well rested and avoid strenuous exercise the day of test and before exam.

Question 125

Myocardial Perfusion (MPI)(Rest): Lab Values:

Answer 125

N/A not need.. | will be done before surgery if need after test.

Question 126

Imaging Techniques: Anatomical Landmarks:

Answer 126

N/A

Question 127

Imaging Techniques: Views:

Answer 127

SPECT imaging so RAO to LPO

Question 128

Imaging Techniques: Patients Detector Orientation:

Answer 128

Supine with heart in the center FOV and left arm over head if possible. If arm is down at side because of problems with shoulder or recent surgery, both images(stress/rest) should be taken the same way.

Question 129

Imaging Techniques: Fusion Imaging

Answer 129

N/A

Question 130

Imaging Techniques: Procedure: Thallium:

Answer 130

Rest only; patient waits 5-20 after injection before image.

Question 131

Imaging Techniques: Procedure: Sestamibi

Answer 131

Patient waits 45-60 mins after injection before image. Give patient a cold glass of water to clear Thyroid, live and bowel.

Question 132

Imaging Techniques: procedure: Tetrofosmin:

Answer 132

Patient waits 5-30 minutes after injection before imagine (give water). Images may include a static ANT Picture first, (300seconds). Start SPECT images with camera RAO to LPO.

Question 133

Imaging Techniques: Procedure: Other Protocols: Thallium (Only):

Answer 133

Stress is done first, imaged as soon as possible, then imaged again 3-4hrs later(sometimes with a small reinjection of 1 mCi). Rest study is completed using its ability to redistribute. Some perform a 24 hr delay study with a 1MCi reinjection (wait 5-20 mins to image), looking for hibernating tissue.

Question 134

Imaging Techniques: procedures: Thallium-Thallium:

Answer 134

Both tests are done with Thallium but on different days.. This is a two day tests..

Question 135

Imaging Techniques procedure: Thallium- Sestamibi (dual energy/ dual isotopes):

Answer 135

Thallium rest study (3Mci) is done first ( inject,wait 20 mins, image) followed quickly ( within the hour) by the stress test using Mibi.

Question 136

Imaging Techniques procedure: Sestamibi-Sestamibi:

Answer 136

Both tests are done with Mibi but on different days. The stress can be done first but If no defects are observed, so choose to not do rest study.

Question 137

Imaging Techniques procedure: MIBI MIBI

Answer 137

Both tests are done on the same day. Either rest or stress can be done; however, most prefer to do resting first then stress. The first study is done with a low dose (8mCi) and the second(an hr or more later) with a high dose (25-30 mCi).

Question 138

Instrumentation: Detector System:

Answer 138

Low energy/ all-purpose or low energy/ high res parallel- hole.

Question 139

Instrumentation: Data acquisition:

Answer 139

Tc-99m window at 140 keV, TI-201 at 167 KeV at 20%. (static)-Timed for 300secs. (SPECT)- 180*,32 or 64 projections at 20-40sec/frame, 8 frames/cycle if gated,matrix at 64x64.

Question 140

Instrumentation: Data analysis:

Answer 140

Computer analysis of left ventricle showing the vertical long, horizontal long and shot axis. Usually done at the same time as stress images; the results of the two are compared.

Question 141

Instrumentation: Data analysis: Normal:

Answer 141

Heterogeneous uptake of the left ventricular myocardium or right ventricle myocardium if requested.

Question 142

Instrumentation: Data analysis: Abnormal:

Answer 142

Areas of little to no uptake exhibiting a cold spot. If the lack of uptake matches the stress results in the same area , it may be infarcted myocardium or severe ischemic tissue.

Question 143

Instrumentation:Data analysis: Ancillary equipment:

Answer 143

N/A

Question 144

Endocrine: Thyroid Imaging: Selection:

Answer 144

I-123 and I-131 as capsules, Tc-99m pertechnetate.

Question 145

Endocrine: Thyroid Imaging: Dosages:

Answer 145

I-131: 1uCi-10mCi depending on the patient and reason for scan. Usually 5-30uCi for uptake and scan,2-5mCi for whole imaging and/or treatment of the patients, I-123: 100-450uCi Tc-99m: 2-10mCi.

Question 146

Endocrine: Thyroid Imaging: Administration:

Answer 146

I-123 and I-131 capsule Oral(PO), Tc-99m by intravenous (IV).

Question 147

Endocrine: Thyroid Imaging: Biodistribution:

Answer 147

Active transport; Tc-99 trapped but not organified. iodine organified by the thyroid and held in cells or follicular Lumen. T=3-5days.

Question 148

Endocrine: Thyroid Imaging: Patient Preparation: Indicates:

Answer 148

Evaluations of thyroid anatomy(Ex: position, goiter,surgery,cold or hot nodules.): Detection, localization and evaluation of hyperthyroidism and hypothyroidism metastases from thyroid cancer. Differentiation of benign from malignant nodules, independent functioning nodules, benign ectopic tissue. Evaluations of abnormal thyroid serum lab results, sub clinical and subacute disease processes. Abnormal finding on other diagnostic tests.

Question 149

Endocrine: Thyroid Imaging: Indicates: Contraindications:

Answer 149

Pregnant or nursing females, interfering recent contrast studies or patient has no discontinued thyroid or interfering medication, vitamins, or iodinated food products.

Question 150

Endocrine Thyroid Imaging: Pregnancy and nursing:

Answer 150

N/A | Must asks if patient is under 40/50 years old.

Question 151

Endocrine Thyroid Imaging: Dietary Restrictions:

Answer 151

Refrain from eating foods that containing iodine such as cabbage, turnips, greens seafood, Kelp or large amounts of table salt.

Question 152

Endocrine: Thyroid Imaging: Adverse reactions/artifacts:

Answer 152

Compton scatter and down scatter from contaminated may contribute, Tc-99m not as accurate because of low uptake, high neck bkg, concentrations in extra-thyroid tissues and trapping without organification. Improper collimator and computer changes. Careless marker placement. Patient movement.

Question 153

Endocrine Thyroid Imaging: Medications:

Answer 153

Physician to instruct patient to discontinue thyroid meds, contrast material, Butadiene or amiodarone( antiarrhythmics).

Question 154

Endocrine Thyroid Imaging: Age specific/ other considerations:

Answer 154

N/A

Question 155

Endocrine Thyroid Imaging: Lab Values:

Answer 155

N/A

Question 156

Endocrine Thyroid Imaging: Imaging Techniques: Anatomical Landmarks:

Answer 156

Thyroid cartilage, | Supranational notch

Question 157

Endocrine Thyroid Imaging: imaging Techniques: Views:

Answer 157

RAO and LAO

Question 158

Endocrine: Thyroid: Imaging Techniques: Patient- Detector orientation:

Answer 158

Supine with pillow under shoulders and chin up.

Question 159

Endocrine Thyroid: Fusion Imaging:

Answer 159

N/A

Question 160

Endocrine: Thyroid: Procedure:

Answer 160

Tc-99: Administrator injection to patient; wait 15-20 mins before imaging. Give patient water. place patient supine with pillow under shoulders and chin up. Using the LEHR collimator, obtain ANT views(300 secs or 100,000) depending on protocol) with or without markers as per protocol( thyroid cartilage and superasternal, maker strip, right side,ets.)RAO and LAO and perhaps a “pull-back” image(more distant) for ectopic thyroid tissue are optional images of a pinhole not available. Using a pinhole collimator if available, take all.

Question 161

Endocrine:Thyroid: Procedure: I-123:

Answer 161

Same as procedure above without injection. Image 50,000 to 100,000 counts or 8- 10 mins per image. Images can be taken from 3-36 hrs after admin of capsules(usually 4- 6 hours or 24 hours). peak camera for radio-tracer.

Question 162

Endocrine Thyroid: I-131:

Answer 162

Same as procedure above without injection. Usually used to locate residual and recurrent cancers. 24,48,72 hr pictures may be the most useful. Collect 100,000 counts over thyroid and whole body of cancer is suspected. Check peak and collimators.

Question 163

Endocrine Thyroid: Instrumentation: Detector System:

Answer 163

Low energy, high res or LEAP and pinhole for Tc-99m and I-123. High energy, parallel hole for I-131.

Question 164

Endocrine: Thyroid: Data acquisition:

Answer 164

30% window at 364 keV for I-131,20%. Window at 159 KeV for I-123, 20% window at 140keV for Tc-99m; 50,000 to 100,000counts.

Question 165

Endocrine Thyroid: Data analysis: Normal:

Answer 165

(Euthyroid) Homogeneous uptake of radio-tracer. Left lobe smaller then right lobe or having pyramidal lobe. Straight or convex outer margins. Uptake equal or greater then that of salivary( water or lemon given to reduce salivary uptake)Tc-99m shows on soft tissue, brain stomach mucosa,nasopharynx, bladder. I-123 and I-131 shows in nasopharynx, salivary glands, stomach, colon, bladder and lactating breasting breasts.

Question 166

Endocrine Thyroid: Instrumentation: Data Analysis: Abnormal:

Answer 166

Plummer’s disease: autonomous multi modular goiter, nodules,solitary or multiple, cold or hot(solitary: adenoma, thyroiditis; multiple: goiter). non visual of thyroid gland caused by(Ex: subacute thyroiditis; patient on contraindicated meds.) Graves, disease: Enlarged gland, high uptake( LATS- long acting thyroid stimulator). Cold nodules on iodine scan can be clarified by, pertechnetate. Cold means non-vascular and can be malignant. Hot means vascularized and more likely to be benign.

Question 167

Endocrine Thyroid: Instrumentation:

Answer 167

Ancillary equipment

Question 168

Endocrine Thyroid Uptake: selection:

Answer 168

I-123 and I-131 as capsules, Tc-99m Pertechnetate.

Question 169

Endocrine Thyroid Uptake: Dosage:

Answer 169

I-131: 1uCi- 10mCi depending on the patient and reason for scan. Usually 5-30uCi for uptake and scan, 2-5 mCi for whole imaging and/ or treatment of patients. I-123: 100-450uCi. Tc-99m: 2-10mCi.

Question 170

Endocrine Thyroid Uptake: Administration:

Answer 170

I-123 and I-131 Caupsule(PO), Tc-99m by Intravenous (IV).

Question 171

Endocrine Thyroid Uptake: Biodistribution:

Answer 171

Active transport, Tc-99m trapped but not organified. Iodine organified by thyroid and held in cells or follicular lumen. T=3-5 days.

Question 172

Endocrine Thyroid Uptake: Patient Preparation: Indicators:

Answer 172

Evaluation of thyroidal radioactive iodine uptake( This provides an index of thyroid trapping and iodine organification as a % radioactive tracer into thyroid tissue over a period of time; dependent on thyroid function.) evaluation of(before hypothyroidism and independently functioning nodules, evaluation of( before appearance of typical symptoms) subacute disease processes (toxic goiter,thyroiditis etc.) When used with Thyroid scan: Detection and localization of metastasis from cancer, differentiation of benign/ malignant nodules, evaluation of function diversity within a hyperthyroid gland, detect and localization of benign ectopic tissue.

Question 173

Endocrine Thyroid Uptake: Contraindications:

Answer 173

Allergic to iodine, has not discontinued thyroid or other interfering meds, discontinue thyroid med for too long, radiologic studies with iodine contrast performed within 6-8weeks of study.

Question 174

Endocrine Thyroid Uptake: Pregnancy and Nursing:

Answer 174

N/A | Must ask if patient under 40/50 years old.

Question 175

Endocrine Thyroid Uptake: Dietary Restrictions:

Answer 175

Refrain from eating iodine- containing foods such as cabbage, turnips,greens, soybeans,shellfish,Kelp or large amounts of table salt. Some require this as a 3to 10days protocol before administration of the capsules.

Question 176

Endocrine Thyroid Uptake: Adverse reactions/artifacts:

Answer 176

Capsule not assayed in dose calibrator for activity/counted before administration. Tc-99m not as accurate because of low uptake, high neck bkg, concentrations in extra- thyroid tissues and trapping without organification. Placement of probe must be consistent with department protocol or reading can be false positive or negative. Patient on interfering food or medications .

Question 177

Endocrine Thyroid Uptake: Medications:

Answer 177

Physician to instruct patient to discontinue thyroid meds, contract material, betadine or amiodarone(antiarrhythmics). Thyroid stimulator: Thyroid Antagonists.

Question 178

Endocrine Thyroid Uptake: Age specific/ other considerations:

Answer 178

N/A

Question 179

Endocrine Thyroid Uptake: Lab Value:

Answer 179

Calcitonin (400ng/L) High= Medullary carcinoma of the thyroid, some non- thyroid tumors. T4 Thyroxine (4.5-11.5mg/dL) High= Hyperthyroidism, thyroiditis, Low= Hypothyroidism,hypoproteinemia. T3 triiodothyronine (25-35%) High= Hyperthyroidism, TBG deficiency low= Hypothyroidism, pregnancy, TBG excess. TSH Thyroid stimulating hormone(3-5m/IU/L) High= primary hypothyroidism Low=Hyperthyroidism.

Question 180

Endocrine Thyroid Uptake: Imaging Techniques: Anatomical Landmarks:

Answer 180

Probe for thyroid- facing thyroid 25-30 cm from patients neck, probe for bkg- facing thigh 25-30 cm.

Question 181

Endocrine Thyroid Uptake: Imaging Techniques: Views:

Answer 181

Camera for thyroid: ANT and Close.

Question 182

Endocrine Thyroid Uptake: Patient - Detector orientation:

Answer 182

Supine

Question 183

Endocrine Thyroid Uptake: Fusion Imaging:

Answer 183

N/A

Question 184

Endocrine Thyroid Uptake: Procedure:

Answer 184

Assay capsules in dose calibrator or syringe with Tc-99m. Then, Tc-99m count in neck phantom for “standard” inject and wait 20 mins. Calculate 20 min decay(Tc-99m is rarely used for uptake). Count capsules in neck photon with probe or camera; can serve as the “standard “. Count room bkg and record counts.

Question 185

Endocrine Thyroid Uptake: Imaging Techniques: Probe for Thyroid:

Answer 185

Facing thyroid gland(Usually 25-30cm from patient’s neck), 1 minute; can be counted twice then averaged. Record counts.

Question 186

Endocrine Thyroid Uptake: Imaging Techniques: Camera for Thyroid:

Answer 186

Place patient in supine position, pillow under shoulders to extend neck with camera ANT and close( EX: 10cm (record position to use for 24 hrs uptake)), thyroid centered; start count or camera(1 min count, can be twice then averaged) then record counts.

Question 187

Endocrine Thyroid Uptake: Probe for patient bkg:

Answer 187

Position probe usually facing thigh, (25-30cm), start counts, one minute can be twice than average, record counts/applies to 24 hour uptake too.

Question 188

Endocrine Thyroid Uptake: Camera for patient bkg:

Answer 188

Position camera over patient size . Use same distance as from thyroid (10 cm). Start counting or camera(1minute counts, can be twice than average). Then record counts.

Question 189

Endocrine Thyroid Uptake: Camera/probe for standard:

Answer 189

Count Standard in neck phantom at same distance as patient. If there is no capsule, use original of capsule and apply, to Decay factors.

Question 190

Endocrine Thyroid Uptake: Camera/ Probe for room bkg:

Answer 190

Ensure no patient under camera or probe not facing any source of activity. Start cutting or camera, (1 minute count, can be twice than average, then record counts. Must Calculate uptake:

Question 191

Endocrine Thyroid Uptake: Instrumentation: Detector System:

Answer 191

Flat–field scintillation probe with pulse - height analyzer, LEAP or Low energy/ high res.

Question 192

Endocrine Thyroid Uptake: Data Acquisition:

Answer 192

30% window at 364keV for I-131, 20% window at 159keV for I-123, 20% window at 140keV for Tc-99m.

Question 193

Endocrine Thyroid Uptake: Data analysis: Normal:

Answer 193

4-6hour= 5to 20%, 24hrs = 7 to 35%, Tc99m: 20 mins=4%.

Question 194

Endocrine Thyroid Uptake: Instrumentation: Abnormal:

Answer 194

At 24hrs, less then 7% indicates hypothyroidism especially with concordant history. More then 35% indicates hyperthyroidism with concordant history.

Question 195

Endocrine Thyroid Uptake: Factors that increase uptake:

Answer 195

Hyperthyroidism, early Hashimoto’s recovery from subacute thyroiditis, rebound from anti-thyroid drugs, enzyme defects, starvation, iodine deficiency, TSH, tumor-secreted stimulators, pregnancy.

Question 196

Endocrine Thyroid Uptake:Factors that decreases uptake:

Answer 196

Hypothyroidism, iodine overload(radiographic contrast),subacute or autoimmune thyroiditis, thyroid hormone therapy, ectopic secretion of thyroid hormone, renal failure.

Question 197

Endocrine Thyroid Uptake: Instrumentation:

Answer 197

Ancillary equipment…

Question 198

Parathyroid: Selection:

Answer 198

Tc-99m/Tc04 Pertechnetate,TI-201 Thallous Chloride, Tc-99m Sestamibi,Tc-99m Tetrofosmin, I-123 Sodium Iodide.

Question 199

Parathyroid: Dosage:

Answer 199

Tc04: 5-12mCi, TI-201: 2-3mCi, Tc-99m: 16-30mCi,I-123: 200-300uCi.

Question 200

Parathyroid: Administration:

Answer 200

Intravenous (IV),I-123: month(PO).

Question 201

Parathyroid: Biodistribution:

Answer 201

Tc04: Active transport into normal thyroid. TI-201: Distributes with Na/K pump,enters thyroid and parathyroid tissue with blood flow. Tc-99m: Passive transport in proportion to blood flow, prolonged Mibi retention within parathyroid. I-123: Organified in cells or follicular lumen.

Question 202

Parathyroid: Patient Preparation: Indicates:

Answer 202

Detection/localization of primary and secondary cancer. Identification of single/ multiple adenomas or glandular hyperplasia in patients with newly diagnosed hypercalcemia and elevated(PTH) levels. Localization of cancer for surgery candidate or tissue after surgery for persistent or recurrent hyperparathyroidism ( elevated serum calcium and PTH).

Question 203

Parathyroid: Patient Preparation: Indicates : Contraindications:

Answer 203

Patients on calcium meds, thyroid meds or received recent iodine contrast studies, patients should be off of thyroid meds for five days, contra study; 7 to 10 days. Patient is prone to movement’s or claustrophobia.

Question 204

Parathyroid: Pregnancy and Nursing:

Answer 204

N/A

Question 205

Parathyroid: Dietary restrictions:

Answer 205

N/A

Question 206

Parathyroid: Adverse reactions/artifacts:

Answer 206

No patient movement is critical in subtraction method and with use of pinhole collimator. May not visualize ectopic tissue or abnormal tissue<300mg in size. Adenomas can wash out quickly in two-phase or fail to present.

Question 207

Parathyroid: Adverse reactions/ artifacts: Flase-positive:

Answer 207

Patient motion, thyroid disease, multi modular goiter(MNG),uptake in cervical lymph node, extravasation causing ancillary lymph node uptake and carcinomas. Images should be corrected with an ultrasound.

Question 208

Parathyroid: Adverse reactions/artifacts: False -negatives:

Answer 208

Parathyroid hyperplasia. Interference from medications,rad, contact studies. Depending on camera, for severe claustrophobic patients, points camera outward and seat patient with chin on camera/ ROI in view and secure with tape ensuring no movement.

Question 209

Parathyroid: Medications:

Answer 209

Patient should be off thyroid meds for 5 days.

Question 210

Parathyroid: Age | Specific/other considerations:

Answer 210

N/A

Question 211

Parathyroid: Lab Values:

Answer 211

N/A

Question 212

Parathyroid: imaging Techniques: Anatomical Landmarks:

Answer 212

Position camera anterior over extended neck mediastinum.

Question 213

Parathyroid: Imaging Techniques: Views

Answer 213

ANT, RAO, LAO.

Question 214

Parathyroid: patient Detector Orientation:

Answer 214

Supine, pillow under shoulders, head back,neck extended.

Question 215

Parathyroid: Fusion imaging

Answer 215

N/A

Question 216

Parathyroid: Imaging Techniques: procedure: Dual- Isotopes Subtraction Technique:

Answer 216

Place patient supine, pillow under shoulders, head back, neck extended. position camera ANT over neck and mediastinum. Remove any attenuation items, immobilize head if necessary. Instruct patient to remain motionless during acquisition. Inject TI-201. procedure A: within 2-3 mins of injection, obtain a 300 sec image with pinhole looking for uptake between heart and thyroid. Immediately follow with a 900 sec image of thyroid centered in FOV. Follow with injection of 5-10mCi of Tc04, obtain 900 second image. Run subtraction program, if necessary, to separate TI-201 from Tc04.

Question 217

Parathyroid: Imaging Techniques: Dual-Isotopes with I-123 or Tc04 and Sestamibi/Tetrofosmin:

Answer 217

I-123: Patient given 200-300uCi PO. At 3-4hrs after admin, take a single image with 300,000- 500,000 counts or 300 sec using 10% window for I-123( image used for digital subtraction or visual comparison). Patient is then injected with Mibi or Tetrofosmin. After 15 mins, patient is imaged with two 600 secs ANT pictures; one using 10% window for Tc-99 and the other for I-123. Imaging can also include RAO and LAO angles. 3hrs after injection, image using the same parameters again. Normalize I-123 images to the Tc-99m images, subtract the I-123 from the Tc-99m images. TcO4 inject 1-2 mCi pertechnetate. At 15mins,take 300 sec using 10% window at 140keV; this is used for subtraction. Patient is then injected with Mibi or Tetrofosmin. Imaging and processing as above.

Question 218

Parathyroid: Imaging Techniques: Procedure: Single-Isotopes Two-Phase:

Answer 218

Injected patient with either Mibi or Tetrofosmin. Wait 15 mins to obtain image. Remove any intuition materials, please patient as instructed above. Position camera ANT over extended neck and Mediastinum. Using LEAP/LEHR collimator,acquire 300-600 sec ANT,RAP,LAO 30*images. Obtain marker image:Thyroid cartilage and supranational notch(SNN) if protocol.( Be sure to include salivary glands to mediastinum with ANT images!) Repeat images at 1.5-hrs after injection. Repeat images at 4-6hrs after injection if there are questionable images. SPECT may also be a consideration; acquire at 3 mins after injection and delay at 2hrs.

Question 219

Parathyroid:Instrumentation: Detector System:

Answer 219

Pinhole, LEAP or Low energy, high res:

Question 220

Parathyroid: Instrumentation: Data Acquisition Planar:

Answer 220

128x128 or 64x64 matrix, 1 million counts or 300-900sec/image SPECT-360, 128 x128 matrix,64stops, 20-25sec/stop.

Question 221

Parathyroid: Instrumentation: Data analysis: Normal: Dual- Isotopes subtraction Technique:

Answer 221

No increased TI-201 activity within or outside normal thyroid tissue. Normal parathyroid does not accumulate TI-201 or Tc-99m activity. Mibi and Tetrofosmin initially hetero uptake by thyroid, salivary, heart, gut. Delays; hetero washout, no focal points of uptake. I-123 uptake in thyroid tissue as in a normal thyroid study as normal para tissue does not accumulate I-123.

Question 222

Parathyroid: Instrumentation: Data analysis: Normal:Single-Istope Two Phase:

Answer 222

Initially, hetero uptake by thyroid, salivary, heart and gut. Delays; hetero washout, no focal points of lingering uptake.

Question 223

Parathyroid: Instrumentation: Data analysis: Abnormal: Dual-Isotopes Subtraction Technique:

Answer 223

Areas of increased TI-201 within and out normal thyroid tissue. Increased focal areas of Mibi/Tetrofosmin uptake after subtraction of I-123 especially on delays.

Question 224

Parathyroid: Instrumentation: Data analysis: Abnormal: Single Isotopes Two phase:

Answer 224

Washout of thyroid tissue with focal areas of increased activity on delayed images anywhere from salivary glands to mediastinum. Obliques help define position of abnormalities in neck area. Surgery- Focal areas are usually located by small hand- held gamma probe. Once resected, the tissue should at least 20% to50% higher then bkg tissue.

Question 225

Parathyroid: Instrumentation: Data analysis:

Answer 225

Ancillary equipment

Question 226

Neuroendocine/OctreoScan: Selection:

Answer 226

In-111 Pentetreotide, long acting analog of the hormone somatostatin receptors, concentrating in tumors cells with a density of receptors.

Question 227

Neuroendorcine/OctreoScan: Dosage:

Answer 227

6 mCi

Question 228

Neuroendocine/OctreoScan: Administration:

Answer 228

Intravenous (IV) and 10 ml of flush.

Question 229

Neuroendocine/OctreoScan: Biodistribution:

Answer 229

Extravasation and chemical bonding to somatostatin receptors, concentrating on tumors cells with a density of receptors.

Question 230

Neuroendocrine/OctreoScan/ Patient Preparation: Indicators:

Answer 230

Detection and localization of somatostatin receptors on primary and metastatic neuroendocrine tumors(EX: carcinoid, pituitary, small cell carcinoma of the lung, pheochromocytoma,ets.) Detection and localization of endocrine pancreatic tumors,paragangliomas and neuroblastoma. Evaluation of elevated tumor markers, patients with history of cancer or known somatostatin receptors type cancer, pre or post surgery and receptors status(therapy)

Question 231

Neuroendocrine/OctreoScan: Contraindications:

Answer 231

Patients with severely impaired renal function. Do not inject through total parenteral nutrient(TPN) admixtures or TPN IV catheters B/C the sugars may cause a glycolysis- In-111 Pentetreotide conjugate to form.

Question 232

Neuroendocrine/OctreoScan: Pregnancy and Nursing:

Answer 232

N/A

Question 233

Neuroendocrine/ OctreoScan: Dietary Restrictions:

Answer 233

Instruct patient to hydrate well before/after injection. Physician to order mild laxatives evening before infection and continued with light meals and clear liquids until all images completed.

Question 234

Neuroendocrine/ OctreoScan: Adverse reactions/ artifacts:

Answer 234

Patients with impaired renal function,pediatrics or have insulinoma( can become severely hypoglycemic/should have IV glucose infusion available. Do NOT administer in TPN mixtures or inject in TPN catheters. Glaze-positive results(especially in lungs) can occur as a result of inflammatory reactions,radiation therapy,etc. Flase-negative may be possible from poor somatostatin tag, poor affinity to tumor.

Question 235

Neuroendocrine/OctreoScan: Medications:

Answer 235

Octreotide therapy patients should suspend the medications for 72hours before injection of radiopharmaceutical.

Question 236

Neuroendocrine/OctreoScan: Age Specific/other considerations: Study prep-Day1:

Answer 236

Purchase 4 bottles of magnesium citrate. Eat a light breakfast on morning of infection and be well hydrated. After injection, drink a bottle and drink plenty of clear liquids until scan is completed. Eat a light dinner followed by 2nd bottle and plenty of clear liquids until after the 24hr scan.

Question 237

Neuroendocrine/Octreoscan: Study Prep- Day 2:

Answer 237

After 24 hours scan, eat light lunch and dinner. After evening meal, drink 3nd bottle and plenty of liquids until the 48hrs scan.

Question 238

Neuroendocrine/OctreoScan: Study Prep-Day3:

Answer 238

After 48hour scan, eat lunch and dinner after the dinner, evening meal,drink 4th bottle and plenty of liquids until the 72hr scan.

Question 239

Neuroendocrine/OctreoScan: patient preparation: Lab Values:

Answer 239

N/A

Question 240

Neuroendocrine/OctreoScan: Imaging Techniques: Anatomical Landmarks:

Answer 240

N/A

Question 241

Neuroendocrine/OctreoScan: Imaging techniques: Views:

Answer 241

Whole body

Question 242

Neuroendocrine/ OctreoScan: Imaging techniques: Patient Detector Orientation:

Answer 242

Supine

Question 243

Neuroendocrine/OctreoScan: Imaging Techniques:Fusion Imaging:

Answer 243

N/A

Question 244

Neuroendocrine/ OctreoScan: imaging Techniques: Procedure:

Answer 244

Instruct patient to void before scan begins and between multiple procedures. Place patient in supine position on table,check for attenuating items. Images: Obtain at 4hours( Whole body, static and/or planar of abdomen),24hour ( whole body, planer, and /or SPECT with liver,spleen and kidney in FOV; some require SPECT chest, abdomen and pelvis),48hours(same)and 72hours(same).

Question 245

Neuroendocrine/OctreoScan: Instrumentation: Detector System:

Answer 245

Medium energy, general purpose or medium energy,all purpose.

Question 246

Neuroendocrine/OctreoScan: Instrumentation: Data acquisition: Statics:

Answer 246

Abdomen-500,000 counts or 15min/image. Whole body: 512x1024 matrix,10cm/min or longer(minimum 30 mins),head to pelvis. SPECT: 360*,64 stop, 45-60sec/stop, 64x64 matrix.

Question 247

Neuroendocrine/OctreoScan: Instrumentation: Data analysis: Normal:

Answer 247

Excretion is almost exclusively renal;50% at 6hrs,85% at 24hrs, and 90% at 48hrs( hence the need for hydration). Uptake seen in blood pool, pituitary, liver, GB,spleen,kidneys and bladder. Planar images at 4 and 24hrs can differentiate bowel contents from true uptake or fecal contamination; clarity at 48 hrs. Pituitary and normal thyroid present at 24 hrs.

Question 248

Neuroendocrine/ OctreoScan: Instrumentation: Abnormal:

Answer 248

Focal areas of uptake; particularly visible as time and biologic activity diminishes bkg distribution.

Question 249

Neuroendocrine/OctreoScan: Instrumentation:

Answer 249

Ancillary equipment

Question 250

Adrenal Imaging: Selections:

Answer 250

I-123 or I-131 mIBG,I-123 iobenguane and I-131 iobenguane.

Question 251

Adrenal Imaging: Dosage:

Answer 251

I-131 500uGi(1mCi for suspected metastasis pheochromocytoma). I-123 3-15 mCi.

Question 252

Adrenal Imaging: Administration:

Answer 252

Intravenous (IV) slowly over 5 mins

Question 253

Adrenal Imaging: Biodistribution:

Answer 253

Blood flow, guanethidine along absorbed the same as norepinephrine into the chromaffin cells of the adrenergic tissue and stored in granules.

Question 254

Adrenal Imaging: Patient Preparation: indicates:

Answer 254

Detection and localization of benign or malignant intravenous-adrenal and extra-adrenal pheochromocytoma(usually benign chromaffin cells tumors of the sympathoadrenal system that secrete catecholamines: EX: (noroehhrine and epinephrine), sites of hormonal overproduction, neuroectodermal(nerve tissue) tumors, neroblastomas and other Neuroendocrine tumors. Differentiating Neuroendocrine and no Neuroendocrine tumors,previously diagnosed pheochromocytoma, staging,evaluating chemotherapy and surgery.

Question 255

Adrenal Imaging: Patient Preparation: Contraindications:

Answer 255

Allergy to iodine may be a consideration and taking medications.

Question 256

Adrenal Imaging: Patient Preparation:,Pregnancy and Nursing:

Answer 256

N/A

Question 257

Adrenal Imaging: Patient Preparation: Dietary Restrictions:

Answer 257

N/A

Question 258

Adrenal Imaging: patient preparation: Adverse Reactions/artifacts:

Answer 258

Attenuating articles in clothing, images not taken for enough counts, aggressive chemotherapy may hinder visual of some Mets. FALSE-POSITIVE: Caused by recent surgical sites, X-ray therapy to lungs, bleomycin-induced pulmonary changes. FLASE-NEGATIVE: due to lesions too close to a large primary, metastatic mass, or tissue with high normal uptake. No or low tumor uptake, lack of granules and loss of tumor capacity to absorb tracer. Focal areas usually linger over time and grow in intensity; limit false P’s with delays.

Question 259

Adrenal Imaging: patient preparation: Medications:

Answer 259

Ideally, no medications 2-3 weeks before the examination.

Question 260

Adrenal Imaging: Patient Preparation: Age Specific/ other considerations: Before Day of Injection:

Answer 260

Physician instructs patient to take saturated solution potassium iodide (SKKI) or lugol’s solution to block free iodine uptake in thyroid. Admin 1drop,beginning the day before radiopharmaceutical administration,continuing for 6 days after injection. If allergic to iodine, perchlorate may be used. Physician instructs patient to take prescribed laxative days before imaging to reduce bowel activity: patient with atopic history(hypersensitivity or allergy to meds like iodine or steroids) to be treating with oral antihistamines 1hour before infection.

Question 261

Adrenal Imaging: Patient Preparation: LAB Values:

Answer 261

N/A

Question 262

Adrenal Imaging: Imaging Techniques: Anatomical Landmarks:

Answer 262

N/A

Question 263

Adrenal Imaging: Imaging Techniques: VIEWS:

Answer 263

ANT/POST

Question 264

Adrenal Imaging : Imaging Techniques: Patient Detector Orientation:

Answer 264

Supine.

Question 265

Adrenal Imaging: Imaging Techniques: Fusion Imaging:

Answer 265

N/A

Question 266

Adrenal Imaging: Imaging Techniques: Procedure:

Answer 266

Ensure patient is off meds and has taken thyroid blocker night before. instruct to empty bladder and lay supine.

Question 267

Adrenal Imaging : Imaging Techniques: I-131 MIBG at 24,48 and possibly 72hrs.

Answer 267

Acquire ANT/POST images of head/neck, thorax abdomen and pelvis. Set whole body sweep slow (10cm/min or less). Static images of areas of interest of preferred or protocol:should run at least 100,000 counts or 5-20mins. Acquire lateral views of abnormal uptake to aid in localization. Acquire marker images. If protocol (on axillae,lower ribs and iliac crests). Use 5uci I-131 capsules for markers. Acquire SPECT if protocol or requested.

Question 268

Adrenal Imaging:Imaging Techniques: I-123 MIBGat24,48and possibly 72hours.

Answer 268

Same imaging procedures as above. Acquire static (chest, posterior mid thorax,Kidneys centered and lumbar) of at least 500k counts or 15 mins each.

Question 269

Adrenal Imaging: Imaging Techniques: Instrumentation: Detector System:

Answer 269

I-131: Medium energy/general purpose or medium energy/high resolution. I-123: LEAP or low energy/high resolution:

Question 270

Adrenal Imaging: Imaging Techniques: Instrumentation: Data Acquisition: Statics:

Answer 270

I-13:=100 K counts up to 20 min/images= I-123=500K or 15 min. Whole body: 5-10 cm/min,head to pelvis. SPECT: 360*,64 stops at 20/sec/stop.

Question 271

Adrenal Imaging: Imaging Techniques: Data analysis: Normal:

Answer 271

Uptake occurs in pituitary,salivary glands,thyroid,liver,spleen. GB will be visualized in patients with renal failure. Kidney and bladder will visualize due to excretion, heart with normal catecholamine levels. Heart and adrenal medulla are seen more clearly with I-123. No skeletal uptake that normal uptake areas diminish over time.

Question 272

Adrenal Imaging: Imaging Techniques: Abnormal:

Answer 272

Focal areas of increased activity that increase over,time; sporadic,unilateral tumors show intense focal uptake. Mets disease is visualized in axial skeleton, heart, lung, mediastinum, lymph nodes and liver. Images at 72 hrs provide maximal contrast between foci of activity and bkg.

Question 273

Adrenal Imaging: Imaging Techniques: Ancillary Equipment:

Answer 273

N/A

Question 274

Tumors: Whole Body/PET/CT: Selection:

Answer 274

FDG/F-18,a glucose analogue.

Question 275

Tumor: Whole Body/PET-CT: Dosage:

Answer 275

4-20 mCi, adjust by weight or body surface for peds.

Question 276

Tumor: Whole Body/PET-CT: Administration:

Answer 276

Intravenous (IV) butterfly or indwelling catheter. Should be admin in a site contralateral to the area of interest. Steps: Assay dose,record amounts and time. Administer injection, flush with 10cc saline, remove catheter, record time. Assay the syringe after injection, record amount and time.

Question 277

Tumor: Whole Body/PET/CT: Biodistribution:

Answer 277

Trapped in the tissue as a phosphate with distribution mapped as glucose metabolism. FDG does not undergo tubular reabsorption in the kidneys and thus, is excreted in the urine.

Question 278

Tumor: Whole Body/PET-CT: patient Preparation: indicators:

Answer 278

Detection, localization and staging of primary, metastatic and/or recurrent tumors. Differentiation between benign and malignant tumors,recurrent malignant disease form therapy induced changes, staging of patients with known malignant tumors, localization of lesions for biopsy or radiation therapy and evaluation of oncologic therapies of known or residual malignancies.

Question 279

Tumor Whole body/PET-CT: patient preparation: Contraindications:

Answer 279

High glucose levels will hinder tumor uptake(>200mg:dl). FDG does present well In all kinds of tumors. Patient too agitated,uncooperative or claustrophobic to remain still. Drug and/ or food ingestion bears specific consideration for each study; either could be contamination. Too much muscle activity before exam.

Question 280

Tumor:Whole Body: Patient preparation: Pregnancy and nursing:

Answer 280

N/A

Question 281

Tumors: Whole Body: Patient Preparation: Dietary Restrictions:

Answer 281

NPO at least 6 hrs except water before test. This reduces insulin levels to base levels and uptake in certain organs (EX: heart). This includes no gum, candy, soda, or anything that contains sugar. Patient is to hydrated before(Two 8 ounce cups).

Question 282

Tumor: Whole Body: Patient Preparation: Adverse reactions/artifacts:

Answer 282

N/A

Question 283

Tumor: Whole Body: Patient Preparation: Medications:

Answer 283

No Caffeine, alcohol,or nicotine products with 24hours of exams.

Question 284

Tumor: Whole Body: Patient preparation: Age specific/ other considerations:

Answer 284

Blood sugar level should be 200 MG/DL, before injection allies for better FDG uptake. Patients, with blood sugar problems not taking, insulin in the morning and be scheduled for the earliest exam time. Patient is to avoid vigorous exercising within 24 hours of exam. After injection, patient should be kept warm, comfortable and resting during uptake phase until imaging time. Remind patient not to move or speak during this time. Patient to remove all metal articles from person.

Question 285

Tumor Whole Body: patient;preparation: Lab Values:

Answer 285

N/A

Question 286

Tumors: Whole Body: patient; Preparation: Imaging Techniques: Anatomical Landmarks

Answer 286

Base of skull to mid-thigh, “Eyes to thighs”

Question 287

Tumors: Whole Body: Imaging Techniques: VIEWS:

Answer 287

Whole Body

Question 288

Tumors: Whole Body: Imaging Techniques: Patient Detector orientation:

Answer 288

Supine, arms up( arms down of head/ neck neoplasms), use head holder.

Question 289

Tumors: Whole Body: Imaging Techniques: Fusion Imaging:

Answer 289

Yes

Question 290

Tumors: Whole Body: Imaging Techniques:Procedure:

Answer 290

Image at 45 minutes, range of (30–90) after injection for Malibu Alek Uptake. Some wait longer for target to backgrounds; ratio to improve. Patient to avoid before, Lay supine, supine, align with laser to landmark, arms up, use head holder.

Question 291

Tumor: Whole Body: Imaging Techniques: Procedure: For dedicated PET cameras:

Answer 291

Limited field tomographic images: Acquire transmission image(some require 125 million counts over15-20mins). On some systems, this can be done before or after emission imaging. Emission image: 6 to 15 mins per bed position,collecting 5-15 million counts,depending on area of interest.

Question 292

Tumor:Whole Body: Imaging Techniques: procedure: PET/CT:

Answer 292

Some scans require ingesting oral contrast arrival. Studies that do not are (cardiac,brain,head and neck cancer studies). Scout ( topogram)image at 120 kV, 10mA.CT (attenuation correction) imaging at 140keV,auto for (100-200lbs) normal size patient or (200-400IBs) large patient). PET imaging at 3 mins FOV 100-200lbs) normal or 5 min FOV 200-400Ib for large patient.

Question 293

Tumor Whole Body: Instrumentation: Detector System:

Answer 293

2D-3D dedicated PET imaging.

Question 294

Tumor:Whole Body: Instrumentation: Data acquisition:

Answer 294

Dedicated PET: photopeak 300-650keV for BGO, 435-665KeV for Nal( CPET). Bed acquisition times per bed ( usually 6-8beds).

Question 295

Tumors: whole Body: Instrumentation: Data analysis:

Answer 295

Images filtered/reconstructed in transverse, coronal, and Sagittal planes. PET studies can be fused with CT. There may be four groups of images in each study(EX: scout 2D,AC,2D NAC, and CTAC.Erase scout then save and send images.

Question 296

Tumors: Whole Body: PET/CT: Instrumentation: Data analysis: Normal:

Answer 296

Uptake pretty much everywhere, only going to focus on main areas. Brain, high in gray, low and white, cortex and basal ganglia. Thyroid Camby high with Graves’ disease or thyroiditis),Myocardium (even despite fasting), aorta( bandlike in thoracic aorta),liver,spleen,stomach,bowel( ascending colon appearing tubular) esophagus,kidneys, bladder,and bone marrow(can be high after stimulating agents). Brown fat( females and cold environment). Low uptake in lung, breast, testes and penis. Increased uptake in surgical wounds( up to 6 months after surgery). No activity in pancreas, prostate,lymph nodes or breast implants. After cancer therapy, uptake common in axial skeletal, brown fat(posterior neck/shoulders) and costovertebral joints.

Question 297

Tumor: Whole Body: Instrumentation:Data analysis: Abnormal:

Answer 297

High uptake in the larynx, esophagus, colorectal, melanoma. Moderate uptake in thyroid,lung, breast. Low uptake in brain, renal/ bladder and prostate. Variable uptake in head/neck,skeletal,uterine,cervical and testicular. Increased uptake in infections and inflammatory tissue(pneumonia,cellulite and osteomyelitis). Increased uptake in trauma(recent surgery,fracture,graft,radiation therapy). An SUV of 2.5 is suggestive of malignancy.

Question 298

Tumor:Whole Body: Instrumentation:

Answer 298

Ancillary equipment:

Question 299

Lymphoscintigrapy: Radiopharmaceutical: Selection:

Answer 299

Tc-99m Sulfur Colloid (Filtered).

Question 300

Lymphoscintigraphy: Radiopharmaceutical: Dosage:

Answer 300

200uCi to 2mCi,450uCi to 1mCi is typical for 2 to 6 injections. Up to 7mCi total.

Question 301

Lymphoscinigraphy: Administration: For Melanoma:

Answer 301

2 to 6 subcutaneous or intravenous injections producing a wheal around the cancer, surgery site or ROI (within 5mm). Volume should not exceed 0:25ml per injection site.

Question 302

Lymphoscintigraphy: For breast lesions:

Answer 302

I tra glandular injection,4 to 6, placed in tissue surrounding the lesion(within 1-3mm) found by palpation. 3,6,9,and 12 o’clock position.

Question 303

Lymphoscintigraphy: Administration: Intradermmal Injections:

Answer 303

Because of the nature of the lymphatic system in the breast, injections can only be intradermal and not deep at the position of the lesion or site. Peri- Aurelia can be done at 3,6,9 and 12 o’clock positions.

Question 304

Lymphoscintigraphy: Administration: for Lymphedema:

Answer 304

Subcutaneous injections, 2sites per limb.

Question 305

Lymphoscintigraghy: Administration:Biodistribution:

Answer 305

Compartmental,phagocytosis. Particles cleared by lymphatic system.

Question 306

Lymphoscintigraphy : patient preparation: Indicates:

Answer 306

Evaluation of staging( spread) cancers.(Ex: Lymphatic leukemia,Hodgkins disease, melanomas). Into the lymph system. Detection of metastatic invasion of lymph nodes. Evaluation of node reaction as an alternative to removing an entire bed of lymph nodes which can cause edema or other complications to that area. Evaluation of pelvic or peri aortic lymphatic drainage for blockage by trauma or tumor. Differentiation of primary and secondary lymphedema.

Question 307

Lymphoscintigraphy: patient preparation: Contraindications:

Answer 307

N/A

Question 308

Lymphoscintigraphy: patient Preparation: pregnancy and nursing:

Answer 308

N/A

Question 309

Lymphoscintigraphy: patient preparation: Dietary Restrictions:

Answer 309

N/A

Question 310

Lymphoscintigraphy: patient preparation: Adverse reactions: artifacts:

Answer 310

A star artifact can be caused from intensity of injection sites. Injection sites that are too distant from ROI may obscure primary bodes close to lesions. One view of the presenting nodes may not be enough to properly locate; multiple views may be needed. Care must be taken when marking affected nodes for pre surgery candidates as that’s were the surgeon will make the excisions.

Question 311

Lymphoscitigraphy: patient preparation: Medications:

Answer 311

N/A

Question 312

Lympho-Scintigraphy: patient preparation: Age Specific/other considerations:

Answer 312

Wipe area with alcohol pad, shave if necessary, clean area with Betadine or sterilizing solution. For breast study, patient is to bring mammograms and any related studies with her, oh patient, or make previous related studies available, inpatient. Patient is instructed to massage area of injection after injections, stimulation blood flow equals tracer distribution). For lymphedema, physician to instruct patient to wear elastic stocking; should be removed 3-4 hours before study.

Question 313

Lympho-Scintigraphy: patient preparation: Lab Values:

Answer 313

N/A

Question 314

Lympho-scintigraphy: Imaging Techniques:

Answer 314

Anatomical Landmarks

Question 315

Lymph- scintigraphy: Imaging Techniques: Views:

Answer 315

ANT,POST,LAT,OBL

Question 316

Lymph-Scintigraphy:imaging Techniques: Patient Detector Orientation:

Answer 316

Positioning depends On location of site to best obtain Imaging.

Question 317

Lymph-scintigraphy: Imaging Techniques: Fusion Imaging:

Answer 317

N/A

Question 318

Lymph-Scintigraphy: Imaging Techniques: Procedure:

Answer 318

Prepare the area of interest ( shave, alcohol,betadine). Melanoma: injected around ROI with 2 to 6 doses subacute or intraderm. Breast: injected 4 to 6 round lesion. Lymphedema: injected subacute in weds for feet or hands as indicated,2 to 6 per limb. Place patient in prone, supine or sitting position to best obtain images. FLOW: position ROI under camera, image dynamic flow for 5-15 mins. Statics: immediate,5-10 mins, with or without markers. Markers Images: use a point source outlining the body or a transmission image using CO 57 flood source, cookie sheet, placed behind the patient to help define the position of the nodes Presurgical: position patient as he or she will be in surgery. When all related nodes are believed to be exposed, mark locations with indelible ink. Use point source/monitor or gamma probe to locate. Delays: 1–4 hours after injection.

Question 319

Lymph-scintigraphy: Instrumentation: Detector analysis:

Answer 319

LEAP or low energy, high resolution

Question 320

Lymph-scintigraphy: Instrumentation: Data acquisition:

Answer 320

Peak for Tc-99m at 140 keV and Co57 at 122keV of cookie sheet is used. FLOW: 30-60sec/frame, 10-15 mins. IMMEDIATE STATIC: Collect for 5 mins(300 secs) every 5 mins up to 30 mins. 256x256x16 matrix, try 10% window to reduce scatter. DECAY: 400,000-200,000 counts or 5 mins each. WHOLE BODY: Set for 10-15 cm/min.

Question 321

Lymph-scintigraphy: Instrumentation: Data analysis: Normal:

Answer 321

Radiotracer enters the lymphatic system through normal channels and into the major lymphatic beds, EX retroperitoneal, axillaries,inguinal,parastatal and cervical. Visual info the sentinel node or nodes within the 1st half hour. After 4 hours a chain of activity should visualize in the inguinal, iliac and peri-aortic regions; Liver should also be present. A biopsy of the bones will yield the results. If the dissect node contains no cancer cells, the patient may be spared removal of entire lymph bed.

Question 322

Lymph-Scintigraphy: Instrumentation: Data analysis: Abnormal:

Answer 322

None or only some expect nodes visualizing; can indicate malignant disease or blockage. Continuity of a chain interrupted, or abnormal pathway created by tumor replace of node. Enlargement of chain width, unexpected intensity difference or displacement of expected location. Missing liver activity may indicate insufficient movement of extremities or lymph blockage. Malignant melanoma can Mets through the lymph system to liver,lung,brain and bones. Primary (congenital) lymphedema visualized with an unobstructed few lymphatic channels. Secondary (obstructive)lymphedema present with lack of migration of radiotracer from injection site. Diffuse dermal activity or multiple torturous collateral pathways.

Question 323

Lymph-scintigraphy: Instrumentation: Ancillary Equipment:

Answer 323

Gamma Probe.

Question 324

Therapy: Palliative Bone: Radiopharmaceutical: Selection:

Answer 324

Sr-89 Chloride

Question 325

Therapy: Palliative Bone: Radiopharmaceutical: Dosage:

Answer 325

4mCi or 40-60uCi per Kg:

Question 326

Therapy: Palliative Bone: Radiopharmaceutical: Administration:

Answer 326

Suggested that the syringe be shielded with a syringe shield rather then plastic even though Sr-89 is a pure B emitter. 21- Gauge butterfly,3way stopcock. 10 milliners of flush or more as should flush several times to ensure the entire dose is administered. Performed by nuclear physician or radiologist.

Question 327

Therapy Palliative Bone: Radiopharmaceutical: Biodistribution:

Answer 327

Uptake at sites of osteopathic skeletal metastases remaining in same concentration for 100 days after injection. Sr-89 behaves like calcium analogs,localizing in areas of active osteogenesis.

Question 328

Therapy Palliative Bone: Patient preparation: Indicators:

Answer 328

Palliation of intractable bone pain for patients with 2 or more Osseous metastases(osteoblastic bone lesions) documented by bone scan. Candidates should have multiple bone met sites. Bone pain, WBC count of >2400 and platelet count of >60,000. Assessment of painful bone Mets for the use of palliation In conjunction with or instead of radiotherapy.

Question 329

Therapy: Palliative Bone: Patient Preparation: Contraindications:

Answer 329

Patients with no bone pain, multiple sites of metastases,WBC count of >2400, platelet count of >60,000 or Doing well with other methods of pain palliation. A solitary metastases site. Pregnancy, patients with compromised bone marrow from previous therapy or disease infiltration. No contraindications are indicated for the following: Previous failure of Sr-89 therapy, not yet been used or being used and have not yet failed.

Question 330

Therapy: Palliative Bone: patient preparation: pregnancy and nursing

Answer 330

N/A

Question 331

Therapy: Palliative Bone: patient preparation: Dietary Restrictions:

Answer 331

Instruct patient to ingest 500 ml of fluid before infection and to void often before and after.

Question 332

Therapy: Palliative Bone: patient preparation: Adverse Reactions/artifacts:

Answer 332

Non-patient IV sites leading to leakage or extravasation of rph causing injury and less then desired or no amount delivered to patients. Myelosuppression(bone marrow toxicity) is one of the major concerns with therapy; patient should be monitored for any signs during this and other types of therapy. In cases with spinal cord compression or fractures form vertebral metastases my occur, therapy should only be used in conjunction with other management forms that address this.

Question 333

Therapy: Palliative Bone: patient preparation: Medications:

Answer 333

N/A

Question 334

Therapy Palliative Bone: patient preparation: Age Specific/other considerations:

Answer 334

Obtain signed informed consent from patient.Patient to bring results of latest lab tests,images and results of latest bone scan(6weeks). Patients with incontinence to catheterize 2 days before injection.

Question 335

Therapy:Palliative Bone: patient preparation: Lab Values:

Answer 335

N/A

Question 336

Therapy: Palliative Bone: Imaging Techniques: Anatomical Landmarks

Answer 336

N/A

Question 337

Therapy: Palliative Bone: Imaging Techniques: Views:

Answer 337

N/A

Question 338

Therapy: Palliative Bones: Imaging Techniques: Patient-Detector Orientation:

Answer 338

N/A

Question 339

Therapy: Palliative Bone: Imaging Techniques: Fusion Imaging:

Answer 339

N/A

Question 340

Therapy:Palliative Bone: Imaging Techniques: Procedure:

Answer 340

Place patient in supine position on table or sitting upright in chair. The following is in prep for the injection: Place a butterfly needle in the antecubital, secured. Attach port. Ensure that the needle is properly in the vein by withdrawing and reinfecting small amounts of blood. Clover area with absorbent material in case of spill/leak. Injection (performed by an authorized user,Ex: nuclear physician). Attach the syringe containing the radiopharmaceutical to the side port. Turn the stopcock to connect the radiopharmaceutical syringe to the patient and inject for 30-60 secs. Turn the stopcock to connect saline syringe and flush 3 times to ensure the entire dose has been pushed; observed injection site for extravasation. The Iv catheter (removed), saline syringe, tubing and radiopharmaceutical syringe can be counted before proper disposal to ensure there is not an abundance of residue.

Question 341

Therapy: Palliative Bone: Instrumentation: Detector System:

Answer 341

LEAP or low energy high resolution.

Question 342

Therapy: Palliative Bone: Data Acquisition Statics:

Answer 342

500,000- 750,0000 counts. Whole Body: 10cm/min,head to toes.

Question 343

Therapy:Palliative Bone: Instrumentation: Data: analysis: Normal:

Answer 343

Decreased bone pain beginning in 7-20 days and lasting 10-24 weeks or more. Increased quality of life, decreased dependency on opiates. Patient can treated again as early as 10 weeks if symptoms reappear.

Question 344

Therapy: Palliative Bone: Instrumentation: Abnormal:

Answer 344

No change or short-term change in pain levels and/or deteriorating conditions. Platelet count should be monitored as 80% of patients experience a 20-30% decrease by 6 weeks.

Question 345

Therapy: Palliative Bone: Instrumentation:

Answer 345

Ancillary equipment n/A

Question 346

Thyroid Ablation: Radiopharmaceutical: Selections:

Answer 346

I-131 as sodium iodide capsule or liquid.

Question 347

Thyroid Ablation: Radiopharmaceutical: Dosage:

Answer 347

30 to 300 mCi

Question 348

Thyroid Ablation: Radiopharmaceutical Administration:

Answer 348

Oral (PO) capsule: may require the RSO, nuclear physician or resident nuclear physicist to be present.

Question 349

Thyroid Ablation: Radiopharmaceutical: Biodistribution:

Answer 349

Active Transport, organified by thyroid and held in cells or follicular luman(3-5days)

Question 350

Thyroid Ablation: patient preparation: Indicators:

Answer 350

Ablation of residual functioning thyroid carcinoma. Ablation of residual functionality normal thyroid tissue after total or partial thyroidectomy.

Question 351

Thyroid Ablation: Patient Preparation: Indicators: Contraindication:

Answer 351

Pregnancy or nursing, allergy to iodine. Iodinated studies under way or performed recently. Patient taking thyroid meds or vitamins, or not on low- iodine diet. Patient extremely likely to regurgitate dose.

Question 352

Thyroid Ablation: Patient Preparation: Pregnancy and nursing:

Answer 352

Females patients cannot be pregnant, or nursing nor should they have plans to be until therapy/ follow- up studies are completed.

Question 353

Thyroid Ablation: Patient preparation: Dietary restrictions:

Answer 353

Low-iodine diet 1 week before therapy.

Question 354

Thyroid Ablation: patient preparation: Adverse reactions/artifacts:

Answer 354

Patient may vomit dose immediately or soon after dosing. Prepare for that type of rad spill(gloves absorbent cloths ets:) Distances from patient must be consistent when recording readings. Patient must force hydration and empty bladder often.

Question 355

Thyroid Ablation: Patient Preparation: Medication:

Answer 355

Patient should discontinue thyroid medication for 2-4 weeks before therapy.

Question 356

Thyroid Ablation: patient preparation: age specific/other considerations:

Answer 356

No iodinated radiography Studies 3 weeks before therapy.

Question 357

Thyroid Ablation: patient preparation: Lab Values:

Answer 357

N/A

Question 358

Thyroid Ablation: imaging Techniques: Anatomical Landmarks:

Answer 358

N/A

Question 359

Thyroid: Ablation: Imaging Techniques: Views:

Answer 359

Whole Body

Question 360

Thyroid Ablation: Imaging Techniques: Patient Detector Acquisition:

Answer 360

N/A

Question 361

Thyroid Ablation: Data Analysis:Normal:

Answer 361

Residual thyroid tissue and carcinoma tissue ablated: Patient treated with thyroid medication. No naturally occurring elevated levels of thyroid hormones.

Question 362

Thyroid Ablation:Instrumentation: Abnormal:

Answer 362

On re- eval, elevated levels of thyroid hormones in lab tests. Whole body scan reveals areas of uptake in neck, thorax, perhaps other places as well suggesting insufficient ablation, Mets or recurrence.

Question 363

Thyroid Ablation: Instrumentation: Ancillary Equipment:

Answer 363

N/A

Question 364

Hyperthyroidism:Radiopharmaceutical: Selection:

Answer 364

I-131 Sodium iodide capsule or liquid

Question 365

Hyperthyroidism: Radiopharmaceutical: Dosage

Answer 365

1-33 mCi,dosages can be more then 33mCi but require an amendment to the department license.

Question 366

Hyperthyroidism: Radiopharmaceutical: Administration:

Answer 366

Oral(PO), usually admin by physician or tech under supervision,

Question 367

Hyperthyroidism: Radiopharmaceutical: Biodistribution:

Answer 367

Active transport, organified by thyroid and held in cells or follicular lumen(3-5days).

Question 368

Hyperthyroidism: Patient Preparation: Indicators:

Answer 368

Treatment of hypothyroidism, of Graves’ disease (thyrotoxicosis, diffuse toxic goiter), of toxic (multiple) noduler goiter, of Plummer’s disease ( true autonomous toxic nodular goiter), of toxic nodule(toxic adenoma),of recurrent hypothyroidism, sub clinical hypothyroidism. Low dose ablation of residual thyroid tissue after surgery.

Question 369

Hypothyroidism: patient preparation: Contraindication:

Answer 369

Pregnancy or allergic to iodine. Interfering with allergic meds vitamins, food sources or radiographic test ongoing or recently performed

Question 370

Hyperthyroidism: patient preparation: pregnancy and Nursing:

Answer 370

Female patients cannot be pregnant, or nursing nor should they have plans to be until therapy/follow up studies are completed.

Question 371

Hyperthyroidism: patients Preparation: Dietary restrictions:

Answer 371

Instruct patient to consume no food or vitamins contain a large amount of iodine. After Ingestion,patient is not allowed to share food or utensils.

Question 372

Hyperthyroidism patients preparation advised Restrictions/Artifacts:

Answer 372

Are you sure the patient has signed all consent forms for treatment. Patient’s regurgitates dose shortly after dosing and/or is reluctant to inform department of loss. Patient does not discontinue thyroid meds. Effectiveness of therapy can be affected by: nodular thyroids that are usually more resistant and require larger doses, large thyroid glands that will result in less response, previous anti-thyroid drugs increase resistance and severely hyper thyroid patients will have less response due to rapid turnover of iodine in the gland. Approximately half of patients experience hyperthyroidism 10 years after treatment and thyroid storm occurs in< .1% of patients.

Question 373

Hyperthyroidism. Patient preparation. Medications:

Answer 373

Physician to instruct patient to discontinue all thyroid meds for at least 2 days.

Question 374

Hyperthyroidism’s patient preparations .Age specific/ other considerations: Before ingestion:

Answer 374

Ensure that there has been no iodinated radiographic studies for 3weeks before test,for patients who presented with an extremely high percent on the uptake/scan and who might be candidates for thyroid storm, there is a suggestion that the patient take a beta- blocker for 1 week before dosing. AFTER INGESTION: Patient is not to have close contact with anyone for 48 hrs, flush toilet twice,wash clothes and linen throughly, might feel a scratchy throat, there is no immediate benefit to therapy, takes a week or more to feel effect, if dose is vomited, contact department immediately.

Question 375

Hypothyroidism: patient preparation: Lab values:

Answer 375

N/A

Question 376

Hyperthyroidism: | Imaging Techniques: Anatomical Landmarks:

Answer 376

N/A

Question 377

Hyperthyroidism:Imaging Techniques: | Patient-Detector Orientation:

Answer 377

N/A

Question 378

Hyperthyroidism: imaging Techniques: Fusion Imaging:

Answer 378

N/A

Question 379

Hyperthyroidism: Imaging Techniques: Procedure:

Answer 379

Ensure procedure is preceded by uptake and scan procedures within 2 weeks. Obtain signed consent forms and written preparation prepared and signed by ordering physician before ordering dose. Ensure that the patient receives an explanation of the benefits/disadvantages of the therapy and has a clear understanding of the of the instructions to follow after admin of the capsule. Provide a glass of water to the patient and assay the to be administered. I sure the dose is administered by physician, or tack under the supervision of the physician who is authorized. Some instructions will allow the technician to administer dose after patient has had a consultation with the radiologist or Nucla physician. Inform the patient that they will be reevaluated in 2 to 3 months with lab results, nuclear med Uptake/scan and other imaging modalities.

Question 380

Hypothyroidism: Instrumentation: Detector system:

Answer 380

N/A

Question 381

Hyperthyroidism: Instrumentation: Data Acquisition:

Answer 381

N/A

Question 382

Hyperthyroidism: Instrumentation: Data analysis: Normal:

Answer 382

Goiter shrinks and symptoms decrease with earliest effect 2 to 6 weeks after injection. Patient becomes euthyroid after 2 to 6 months( follow- up lab tests and /or uptake and scan).

Question 383

Hyperthyroidism: Instrumentation: Abnormal:

Answer 383

In three months to a year, patient doses not become euthyroid as confirmed by following- up tests; retreatment may be ordered. Hypothyroidism that is rectified by thyroid meds.

Question 384

Hyperthyroidism: Instrumentation: Ancillary Equipment:

Answer 384

N/a

Question 385

B-Cell non-Hodgkin Lymphoma (NHL) Bexxar: Radiopharmaceutical: Selection:

Answer 385

I-131 Tositumonab

Question 386

B-Cell Non-Hodgkin Lymphoma (NHL) Bexxar: Radiopharmaceutical: Dosage:

Answer 386

Dosimetric:=5mCi,Therapy =30-200mCi

Question 387

B-Cell Non-Hodgkin Lymphoma (NHL) Bexxar: Administration:

Answer 387

Intravenous (IV) butterfly, large bore, 18 Dash 22, over 20 minutes with micropore filter on syringe. 20 ML saline flush. Physician or nurses available for possible allergic reaction, (1mg epinephrine). Follow Vital Signs: Baseline, 5 mins post injection, 15, 30 and 60. Some observe patient for 15 mins of looking for redness at injection site or nausea/vomiting signs.

Question 388

B-cells Non- Hodgkin Lymphoma(NHL) Bexxar. Radiopharmaceutical: Biodistribution:

Answer 388

Compartmental,blood flow; dose department, antibody binding. Targets CD20 antigen located on the Normal and malignant B- lymphocytes of NHL.

Question 389

B-Cell Non- Hodgkin Lymphoma(NHL) Bexxar. Patient preparation: Indicates:

Answer 389

Confirm Biodistribution of 1-131 tositumomab I-131 tositumomab for I-131 tositumomab therapy. Treatment of patients with CD20 antigen-expressed relapsed or refractory low grade, follicular or transformed B-Cell NHL. Treatment of patient with Rituximab-refractory non-Hodgkin’s lymphoma, chemotherapy- refractory disease and nonmyeloablative and (higher dose) myeloblative therapies.

Question 390

B-Cell Non-Hodgkin Lymphoma (NHL) Bexxar: patient Preparation: Indicates: Contraindication:

Answer 390

Patients with known type one hypersensitivity or anaphylactic reactions to murine proteins or any component of this product. Patients with >25% lymphoma marrow involvement and/ or impaired bone marrow reserve caused by myeloablative surgery, low platelet counts or neutrophils count<1500 cells. Patients having impaired renal function (>1.5 times upper normal creatinine level, pregnant, unable to tolerate thyroid blocking agents, who has not received thyroid-blocking agent at least 24 hours before dosimetric dose.

Question 391

B-Cell Non-Hodgkin Lymphoma (NHL) Bexxar: patient Preparation: pregnancy and Nursing:

Answer 391

Female patients of childbearing age should be advised to void becoming pregnant during therapy, pregnant females should be consoled as to the potential hazard to the fetus.

Question 392

B-cell Non- Hodgkin Lymphoma (NHL) Bexxar: patient Preparations : Dietary Restrictions:

Answer 392

Patient should be well hydrated before I – 131 dosing.

Question 393

B- Cell Non- Hodgkin Lymphoma (NHL) Bexxar: patient preparation: Adverse reactions/ artifacts:

Answer 393

Observe patient for allergic reactions(Ex: anaphylactic shock, nausea, redness, or rash at injection). Typical occurs with the 1st Rituximab injection. Should do HAMA titer if patient has had previous MOAB test. Impaired renal function may be a consideration. Myelodysplastic syndrome(MDS),secondary leukemia, and solid tumors have been ovoid patients receiving. Patient motion may distort or obscure possible sites. Dose infiltration; immediately stop infusion and start a new site in opposite arm. Used same IV tubing set and filter for either dosimetric or Patient may respond with hypothyroidism; free iodine may present in normal tissue.

Question 394

B-cells Non- Hodgkin Lymphoma (NHL) Bexxar: Patient preparation: Medications:

Answer 394

Patient to receive thyroid- blocking medication at least 24 hours before receiving the dosimetric dose and continuing until 14 days after therapeutic dose. Patient to be medicated with 650 Mg acetaminophen and 50mg diphenhydramine PO before receiving cold tositumomab (Bexxar).

Question 395

B-cells Non- Hodgkin Lymphoma (NHL) Bexxer: patient preparation : Age specific/other considerations: as

Answer 395

Obtain signed consent forms and appropriate written directive for iodine dosages. Ensure patient supplies list of history or allergy and prior exams.

Question 396

B-Cells Non- Hodgkin Lymphoma (NHL) Bexxer: patient preparation: Lab Values:

Answer 396

Patient should have>50,000/mm platelet count and ANC> 800/mm. Platelet counts should be taken before regimen and continued for 10 weeks or longer; TSH levels and serum creatinine should be monitored as well.

Question 397

B- cells non-Hodgkin’s lymphoma(NHL) Bexxer: imaging Techniques: Anatomical Landmarks:

Answer 397

N/A

Question 398

B-Cell non-Hodgkin’s lymphoma(NHL) : imaging Techniques: Views:

Answer 398

Whole body.

Question 399

B-Cell Non-Hodgkin lymphoma (NHL) Bexxer: Imaging techniques: Patient-Detector Orientation:

Answer 399

Supine, arm to sides, remind patient of no movement during imaging.

Question 400

B-Cell Non-Hodgkin lymphoma(NHL) Bexxar: imaging Techniques: Fusion imaging:

Answer 400

N/A

Question 401

B-Cell Non-Hodgkin lymphoma (NHL) Bexxer: imaging Techniques: Procedure:

Answer 401

Patient is injected with dosimetric I-131 tositumomab on day”0; record time. Scan day: instructed to void before imaging, check clothing for possible artifacts. Statics: 10 minutes, 60 seconds, preview, ANT/POST, thorax, abdomen, pelvis extremities if protocol. Whole Body: (preferred method) 30 mins, ANT/POST. Patient infused with I-131tositumomab therapy approx. 7-10 days after injection. This takes about 30 mins and is done by radiation oncologist or Nuclear med tech in department under supervision. (Same camera sensitivity each acquisition, same field of view, calibration source and bkg). Calibrate camera sensitivity each day of use by placing a sealed vial containing 200-250 uCi I-131 in 200 ml saline on table. Acquire a digital image with no vial (BKg) using the same parameters. Calculate the sensitivity of the gamma camera: Counts per uCi= bkg corrected source counts/calibrated I-131 activity. At 1 hr post injection, acquire whole body ANT/POST at 20 cm/min. Repeat images on day 2,3 or 4 and then again on day 6 or 7 using same parameters.

Question 402

B cell Non- Hodgkin Lymphoma: (NHL) Bexxer: Instrumentation: Detector System:

Answer 402

Medium or high energy/ general purpose or medium energy or high energy/ all purpose.

Question 403

B-cell Non- Hodgkin Lymphoma (NHL) Bexxer: Instrumentation: Data acquisition: Statics:

Answer 403

``` Indium peaks (364 keV), 15-20% window, 128x 128 or 256 x256 matrix,600 secs or more per view. Whole Body: 10cm/min or slower, check patient for length. ```

Question 404

B-cells Non-Hodgkin Lymphoma(NHL) Bexxer: Instrumentation: Data analysis: Normal:

Answer 404

1st day imaging=activity in blood pool. Focal areas for tumor uptake may visualize in soft tissue. Tumor- bearing areas in normal organs by visualizing as increased and/or decreased areas of intensity.

Question 405

B-cell Non- Hodgkin Lymphoma(NHL) Bexxer: Instrumentation: Abnormal:

Answer 405

Altered Biodistribution of I-131 include =(1 st day) blood pool not visualized, diffuse uptake in liver and / or spleen, evidence obstruction and diffuse lung uptake.

Question 406

B-cell Non-Hodgkin Lymphoma(NHL) Bexxer: Instrumentation:

Answer 406

Ancillary equipment: N/A

Question 407

B-Cell Non- Hodgkin Lymphoma (NHL) Zevalin. Radiopharmaceutical: Selection:

Answer 407

In-111 Chloride (Ibritumomab) and Y-90 Chloride ( zevalin).

Question 408

B cell- Non- Hodgkin Lymphoma (NHL) Zevalin: Radiopharmaceutical: Dosage:

Answer 408

111=5 mCi,Y- 90= 4mCi, not exceed 33mCi.

Question 409

B-cell Non Hodgkin Lymphoma (NHL)Zevalin: Radiopharmaceutical: Administration:

Answer 409

Intravenous (IV) butterfly (large bore, 18-22) over 10 mins with microphore filter on syringe. 10 ml saline flush. Physician or nurse available for possible allergic reactions (1 mg epinephrine). Follow vital signs: Baseline, 5 mins post injection, 15,30 and 60. Some observe patient for 15mins of looking for redness’s at infection site or nausea/vomiting signs.

Question 410

B-Cell- Hodgkin Lymphoma (NHL) Zevalin. Radiopharmaceutical: Biodistribution:

Answer 410

Compartmental, blood flow; dose dependent, antibody binding. Targets CD20 antigen located on the normal and malignant B- lymphocytes of NHL.

Question 411

B-cell -Non-Hodgkin Lymphoma(NHL) Zevalin: patient preparation: Indicators:

Answer 411

Confirm Biodistribution of In-111 Zevalin for Y-90 Zevalin therapy. Treatment of patients with relapsed or refractory low grade,follicular or transformed B-Cell NHL.

Question 412

B-Cell Non-Hodgkin Lymphoma (NHL) Zevalin: patient preparation: Contraindications:

Answer 412

Patients with no one type one hypersensitivity or Anaphylactic reactions to murine proteins or any component of this product. Patients with>25% lymphoma marrow involvement and/ or impaired bone marrow reserve caused by myeloablative surgery, low platelet counts or neutrophil count<1500 cells. Patients having bone marrow transplantation or radio immunotherapy, leukemia, HIV or AIDS.

Question 413

B-Cell -Non-Hodgkin Lymphoma (NHL) Zevalin: Patient Preparation: Pregnancy and Nursing:

Answer 413

Female patients of childbearing age should be advised to avoid becoming pregnant during therapy; pregnant females should be counseled as to the potential hazard to the fetus.

Question 414

B-Cell Non-Hodgkin Lymphoma (NHL) Zevalin: patient preparation: Dietary Restrictions:

Answer 414

Patient should be well hydrated before In-111 and Y-90 dosing.

Question 415

B-cell Non-Lymphoma (NHL) Zevalin: Adverse reactions/artifacts:

Answer 415

Observe patient for allergic reaction (Ex:anaphylactic shock,nausea, redness or rash at injection). Typical occurs with the 1st Rituximab injection. Should do HAMA titer if patient has had previous Moah test. Patient motion or acrylic syringe shield should be used on Y-90 dose. Lead shielding, as used with In-111, causes more penetrating bremsstrahlung radiation from Yttrium.

Question 416

B-Cell Non- Hodgkin Lymphoma: Patient preparation: Lab Values:

Answer 416

Verify patient’s platelet count; not less then 100,000 for Y-90.

Question 417

B-cell Non- Hodgkin Lymphoma: patient preparation: Imaging Techniques: Anatomical Landmarks:

Answer 417

N/A

Question 418

B Cell Non-Hodgkin Lymphoma (NHL) Zevalin: imaging Techniques: Views:

Answer 418

Whole body

Question 419

B cell Non- Hodgkin Lymphoma: imaging Techniques: Patient Detector Orientation:

Answer 419

Supine

Question 420

B Cell Non- Hodgkin Lymphoma: imaging Techniques: Imaging Preparation: Fusion Imaging:

Answer 420

N/A

Question 421

B Cell- Non-Hodgkin lymphoma (NHL)Zevalin: Procedure:

Answer 421

Instruct patient to void before imaging, check clothing for possible artifacts. Remind patient of no movement during imaging. Image at 2 to 24 hours, 48 to 72 hours, and possibly 96 to 120 post- injection ( per protocol). Statics: 10 mins (600 secs) per view= ANT/POST, thorax,abdomen, pelvis, extremities(per protocol). Whole Body: Preferred method= 30 mins(1800 secs) ANT/POST. patient infused with Y-90 Zevalin approximately 7-10 days after In-111 injection.

Question 422

B cell Non-Hodgkin Lymphoma(NHL) Zevalin: Instrumentation: Detector system:

Answer 422

Medium energy, general purpose or medium energy all purpose.

Question 423

B Cell-Non Hodgkin-Lymphomas: Instrumentation: Data Acquisition: Statics:

Answer 423

``` Indium peaks( 127 and 247 keV), 15% to 20% windows, 128x128 or 256x 256 matrix, 600 secs or more per view. Whole body: 10 cm/min or slower,check patient for length: at least 30 min image. ```

Question 424

B cell-Non Hodgkin-Lymphomas: Instrumentation: Data analysis: Normal:

Answer 424

Activity in heart, Vascular areas of head,lungs pelvis, and abdomen blood vessels on 1st images (Day 1): less blood poor activity thereafter. Moderately to high uptake in liver and spleen all images. Moderately to very low uptake in kidneys, bladder and bowel on 1st and 2nd days. Focal areas of tumor uptake may visualize in soft tissue. Tumor-bearing areas in normal organs by visualizing as increased or decreased areas of intensity, this is normal in the sense that the test is attempting to confirm Biodistribution to tumors.

Question 425

B cell Non- Hodgkin-Lymphoma: Instrumentation: Abnormal:

Answer 425

Altered Biodistribution of In-111 include = diffuse uptake in lung space is more intense than cardiac blood pool on 1st day or more intense then liver on subsequent days; Kidneys present with greater intensity then liver in posterior view on 2nd or 3rd day, increased uptake in normal bowel compared to liver on 2nd and 3rd day.

Question 426

B cell- Non- Hodgkin-Lymphoma: Instrumentation:

Answer 426

Ancillary equipment: N/A

Question 427

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study(HAPS): Radiopharmaceutical:Selection:

Answer 427

Y-90 (Yttrium)

Question 428

Selective Internal radiation therapy (SIRT) with hepatic artery personal study (HAPS): Radiopharmaceutical: Dosage:

Answer 428

80-150 GY (8000,to 15,000 rad)

Question 429

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (HAPS): Radiopharmaceutical: Administration:

Answer 429

Interventional surgery; an angiographic catheter is inserted and placed in the proper hepatic artery. The SIR sphere are infused from a micro- catheter with the angiographic catheter to treat the entire liver.

Question 430

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study(HAPS): Radiopharmaceutical: Biodistribution:

Answer 430

Compartmental blood flow.

Question 431

Selective Internal radiation therapy(SIRT) with hepatic artery perfusion study(HAPS): patient preparation: Indicators:

Answer 431

SIRT is considered to be a third line option for patients with colorectal metastatic disease that is confined to the liver or with minimal extra- hepatic involvement, they have exhausted other treatment options and no respond to chemotherapy. Stable labs, imaging assessment of portal vein patency,liver involvement <60% and successful arterial mapping(arteriography and MAA lung shunt study).

Question 432

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (haps): Radiopharmaceutical: Indicators: Contraindication:

Answer 432

Decomposition liver function, Elevated bilirubin (>2mg/dl), poor performance status (ECOG>2), Greater then 20% lung,shunting of the hepatic artery blood flow(determined in pre=procedure mapping),Abnormal vascular anatomy that would result in significant reflux of hepatic arterial blood to the stomach, pancreas or bowel and portal vein thrombosis.

Question 433

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (haps): Patient preparation: pregnancy and nursing:

Answer 433

N/A

Question 434

Selective Internal radiation therapy (SIRT)with hepatic artery perfusion study (HAPs): Patient preparation: Dietary Restrictions:

Answer 434

Patient are not allowed to eat or drink anything for 6 hours prior to the procedure.

Question 435

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (Haps): Adverse reactions/artifacts:

Answer 435

Low-grade fever, loose of appetite,lethargy,and fatigue are common for 6 weeks after procedure. Acute abdominal/epigastric pain and or nausea has been reported to occur in 30% . Gastric ulcers were reported in 5% of patients; radiation indicated ulcers do not heal well. Radiation induced liver disease or pancreatic is very rare.

Question 436

Selective Internal radiation therapy (SIRT):with hepatic artery perfusion study (haps): patient preparation: Age specific/ other considerations:

Answer 436

A PET/CT Scan: is performed to evaluate the extent of metastases as well as to provide a baseline measure of metabolic activity of tumors which will be used to asses response to SIRT. If the PET confirms that the metastases are confined to the liver or, angiography will be used to assess the patient’s hepatic artery and celiac axis. Then MAA are infused into the proper hepatic artery for perfusion scintigraphy. If less then>10% of the radioactivity reaches the lungs, the standard procedure can be considered. If 10-20%, it’s possible to perform with a reduced dose of Y-90. If more then 20%, it is contraindicated die to risk of radiation pneumonitis.

Question 437

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (haps): patient preparation: Indicators: Lab Values:

Answer 437

Must have adequate liver functions (bilirubin <2mg/dl), good function (eGRF>30ml/min).

Question 438

Selective Internal radiation therapy (SIRT) with hepatic perfusion study (haps): Imaging Techniques: Detector System:

Answer 438

N/A

Question 439

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (haps):Imaging Techniques: Data acquisition:

Answer 439

N/A

Question 440

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (haps): Imaging Techniques: Data Analysis:

Answer 440

PET/CT together with lab test for tumor markers are used to assess response six weeks after initial treatment and at subsequent 3-month intervals for the 1st year and every six months to detect recurrence or spread of disease.

Question 441

Selective Internal radiation therapy (SIRT) with hepatic artery perfusion study (haps): Imaging Techniques:

Answer 441

Ancillary equipment: N/A

Question 442

Gastric Emptying: Radiopharmaceutical: Selection:

Answer 442

(Solid) Tc-99 sulfur colloid and Tc-99m albumin colloid. (Liquid) Tc-99m DTPA and In-111 DTPA.

Question 443

Gastric Emptying: Radiopharmaceutical: Dosage:

Answer 443

Tc-99= 100uCi to 1mCi, In-111=125uCi.

Question 444

Gastric Emptying: Radiopharmaceuticals: Administration:

Answer 444

(Solid) Radio-tracer usually mixed with 1 or 2 whole eggs or egg whites, oatmeal, beef stew,liver some use a whole sandwich with or without toast. (Liquids) Radio-tracer mixed into 120 cc water or other (orange juice, milk) and ingested PO. In-111 DTPA in 300 ml of for simultaneous study. Pediatrics: milk, scan, mix in milk or formula.

Question 445

Gastric emptying: Radiopharmaceuticals: Biodistribution:

Answer 445

Compartmental; moved along with food through GI tract.

Question 446

Gastric emptying: patient preparation: Indicators:

Answer 446

Determination of decayed gastric emptying rate. Evolution of mechanical obstruction, anatomic obstruction( Pyloric, post-surgical, post-radiotherapy), altered function (gastroparesis, scleroderma, amyloidosis,anorexia,nervous), suspected tumors,nausea, vomiting,early satiety,upper abd discomfort, bloating, gastrointestinal reflux, weight loss or gastric therapy.

Question 447

Gastric emptying: patient preparation: Concentrations:

Answer 447

Allergies to eggs, use oatmeal baby food, sweet potatoes, chicken or beef liver or beef stew. Hypoallergenic patients.

Question 448

Gastric emptying: patient preparation: Pregnancy and nursing

Answer 448

N/A

Question 449

Gotcha Emptying Patient Preparation: Dietary restrictions:

Answer 449

Ensure patient to be NPO 4-12 hours before exam.

Question 450

Gastric Emptying: patient preparation: Adverse reactions/ artifacts:

Answer 450

Burn eggs; non- uniform mixing of rph and eggs. Too little or too much food/water. Inconsistent amounts of food will yield inconsistent data. Allergies or intolerance to eggs or food; unable to eat or may vomit/aspirate food and dose. Camera or position changes; patient must placed exactly in same position for each patient. To do so, place camera as close as possible and use a maker at a specific point on patient.

Question 451

Gastric emptying: patient preparation: Lab Values:

Answer 451

N/A

Question 452

Gastric Emptying: imaging Techniques: Anatomical Landmarks:

Answer 452

N/A

Question 453

Gastric Emptying: imaging Techniques: Veiws:

Answer 453

ANT

Question 454

Gastric Emptying: imaging Techniques: Patient detector orientation:

Answer 454

Standing or supine.

Question 455

Gastric Emptying: imaging Techniques: Fusion imaging:

Answer 455

N/A

Question 456

Gastric Emptying: imaging Techniques:,Procedure: Baseline Solid Study:

Answer 456

Prepare 1to 2eggs and mix in radio-tracer, stir and scramble, administer to patient PO following by 30-120 mL of water. Encourage patient to eat quickly (within 10 mins). Supine: Acquisition should be started as quickly as possible after ingestion of food. Position camera ANT or LAO to help separate a known posterior loop of bowel from stomach. Obtain static images every 5 mins up to 30 mins, then every 15 min thereafter, allowing patient to ambulate between images. Dynamic supine images. Dynamic supine images = 60-90 mins, good for checking esophagus reflux. STANDING: Facing camera (back towards camera is optional). Use patient realignment and obtain immediate image(s),then every 10 mins. Baseline Liquid Study: Add 500 uCi of TC-99m DTPA to 120mL of water or orange juice. Administered PO and encourage patients to drink quickly. Liquid Study: Peak camera for both Tc-99m and In-111, 20 % windows. Patient fasting for at least 8 hours. Solid portion is 500 uCi sulfur colloid in eggs or meal usually given. Liquid portion is 125uCi In-111 DTPA in 300 mL of water. Patient is instructed to eat eggs within 5 mins and then wash down with Liquid portion of meal. Begin imaging immediately using protocol of choice. If computer has correct software, both can run at the same time; 60 to 20 mins.

Question 457

Gastric Emptying:Instrumentation: Detector System:

Answer 457

LEHR or LEAP

Question 458

Gastric Emptying: Instrumentation: Data acquisition: Statics=

Answer 458

Preset for 60-120 secs or 50,000 counts. Dynamic = Preset for 60/sec/image, 60-90mins.

Question 459

Gastric Emptying: Instrumentation: Data analysis:

Answer 459

Generate ROIs around stomach. Use counts taken in ROI and divide counts by decay factor to obtain corrected counts, performed on each frame, plotted on as semilogarithmic graph and compared with normal curve. Obtain the t1/2 emptying time from the graph.

Question 460

Gastric Emptying: Instrumentation: Data analysis: Normal:

Answer 460

(Liquid) 50% at 10-65 mins or 80% in 1 hours with a mean of 40 mins. (Solid,type and size of meals varies) 50% movement out of the stomach within a lower limit of 32 mins to an upper limit of 120 mins with a mean of 90 mins. At 4 hours, less then or equal to 10%. Terminate study before 60 mins if gastric emptying becomes > 95%. 50% for infants give. breast milk at 25-48 mins or formula at 60-90 mins.

Question 461

Gastric Emptying: Instrumentation: Abnormal:

Answer 461

Very little or no movement from stomach after 60 minutes. Rapid at the end may occur in cases of. “dumping syndrome”

Question 462

Gastric emptying: instrumentation: Ancillary Equipment:

Answer 462

N/A

Question 463

Gastroesophageal Reflux: Radiopharmaceutical’s: Selection:

Answer 463

Tc-99m Sulfur Colloid

Question 464

Gastroesophageal Reflux: Radiopharmaceuticals: Dosages:

Answer 464

300uCi to 2 mCi; 1 mCi or more if acidified orange juice is used.

Question 465

Gastroesophageal Reflux: Radiopharmaceuticals: Administration:

Answer 465

Oral(PO) in water,orange juice, milk, wet oatmeal or saline, total of 300 mL. PO with acidified orange juice (150 mL orange juice and 150mL of 0.1 normal HCL) to delay gastric emptying time and predispose the patient to reflux. Ingested through a nasogastric tube if patient has a history of esophagus motility dysfunction or children.

Question 466

Gastroesophageal Reflux: Radiopharmaceuticals: Biodistribution:

Answer 466

Compartmental, esophagus to GI tract.

Question 467

Gastroesophageal Reflux: Patient preparation: Indicators:

Answer 467

Detection and quantitation of Gastroesophageal reflux m. Evaluation of patients with diaphragmatic hernia,heartburn, regurgitation, bilious vomiting, children with asthma, chronic lung disease or aspiration pneumonia.

Question 468

Gastroesphageal Reflux: patient preparation: Indicators: Contraindications:

Answer 468

None.

Question 469

Gastroesophageal Reflux: patient preparation: pregnancy and Nursing

Answer 469

N/A

Question 470

Gastroesophageal Reflux: patient preparation: Dietary Restrictions: 

Answer 470

Ensure patient has fasted for 6 hours or overnight.

Question 471

Gastricroesphagreal Reflux: Patient preparation: Adverse Reactions/ artifacts:

Answer 471

Inability to swallow or aspirate dose. Regurgitation with or without aspiration. Attenuating articles or clothing. Patient with known esophageal varies; perhaps not enough for a concentration may be given to this condition.

Question 472

Gastricroesophageal Reflux: Patient preparation: Medications:

Answer 472

N/A

Question 473

Gastricoesphageal Reflux; patient preparation: Age specific/ other considerations:

Answer 473

N/A

Question 474

Gastroesophageal Reflux: patient preparation: LAB VALUES:

Answer 474

N/A

Question 475

Gastricroesophageal Reflux: Imaging Techniques: Anatomical Landmarks:

Answer 475

N/A

Question 476

Gastricroesophageal Relax: Imaging Techniques: Views:

Answer 476

ANT

Question 477

Gastricroesophageal Relax: Imaging Techniques: Patient Detector orientation:

Answer 477

Sitting or standing in front of camera.

Question 478

Gastricroesophageal Relax: imaging Techniques: Imaging Techniques: procedure:

Answer 478

At 30 secs after ingestion, patient is in sitting position, camera ANT, and a 30- 60 sec. Image is acquired to ensure passage to stomach. If there’s residual activity in the esophagus, an additional 30 ml of water may be given to flush. At 15 minutes after injection, position patient sitting or standing in front of camera acquire 30 secs,image. (From this baseline marker before a abdominal finding, a ROI around will be drawn to use as esophageal background subtraction). From this image, the ROI around the stomach is also drawn to obtain total counts of dose ingested for quantitation for reflux. If there are significant counts remaining in the esophagus, administered more fluid and image again. If counts remain,consider rescheduling the test at a later date using a NG tube).

Question 479

Gastricroesophageal Relax: Imaging Techniques: procedure: Abdominal binder:

Answer 479

Place patient supine on table, binder around lower abdomen below the rib cage. (Do not place on infants and / or children) Attach a sphygmomanometer anterior under the binder. Acquire 30 secs images with pressures in the abdominal binder at 0,20,40,60,80, and 100 mm hg.

Question 480

Gastrointestinal Reflex: Instrumentation: Detector system:

Answer 480

LEAP/LEHR

Question 481

Gastrointestinal Relax: Instrumentation: Data Acquisition:

Answer 481

30sec/image; some go for 300,000-500,000 counts.

Question 482

Gastrointestinal Reflex: Instrumentation: Data analysis:

Answer 482

Draw ROIs around lower esophagus, stomach, and lower left lung( for background). Calculate reflux at each pressure with the following equation using counts from each ROI% Gastroesphageal reflux= A-B/C x<100 where A is esophageal counts(minus prebinder esophageal ROI counts), B is background counts(lung ROI) and C is gastric counts from prebinder gastric imaging. Normal: <3% refluxed radiotracer at any pressure level. Dose should present brightly in stomach with very little or no residual activity in esophagus. The activity should remain in the stomach with no reflux at any pressure level. For pulmonary aspiration there should be no activity in the lungs are pathways to the lungs. Abnormal:>4-5% refluxed radiotracer. Activity will appear to be refluxing up this esophagus toward the mouth. For pulmonary aspiration, activity in the lungs. Direct of aspiration during a esophageal reflux is 0-25%

Question 483

Gastroesphageal Reflux: Instrumentation: Ancillary Equipment:

Answer 483

N/A

Question 484

Meckel-Diverticulum: Radiopharmaceutical’s: Selection:

Answer 484

Tc-99m: Tc04 Pharmaceuticals.

Question 485

Meckel- Diverticulum: Radiopharmaceuticals: Dosage:

Answer 485

10-15mCi, 200-300 uCi peds.

Question 486

Meckel- Diverticulum: Administration:

Answer 486

Intravenous (IV)

Question 487

Meckel- Diverticulum: Radiopharmaceuticals Biodistribution:

Answer 487

Active-,transport, concentrated and rapidly secreted by the epithelial tissue of the gastric mucosa.

Question 488

Meckel-Diverticulum: patient preparation: Indicator:

Answer 488

Location of a Meckel-diverticulum, with functioning gastric mucosa. Direction of gastrointestinal bleeding. Evaluation of positive guaiac test (blood in feces), abdominal pain(especially in children), bleeding, diverticulitis, intestinal obstruction and volvulus(twisting of bowel). Meckel is formed from incomplete closure of yolk duct and usually within 18 inches of the ileocecal value; usually early age onset from abnormal development of fetal intestine from yolk sac. It may contain ileal,duodenal, colonic, pancreatic or gastric tissue.

Question 489

Meckel- Diverticulum: Radiopharmaceuticals: Indictors: Contraindications:

Answer 489

Patients with barium or contrast studies underway.

Question 490

Meckel- Diverticulum: Radiopharmaceuticals: Pregnancy and nursing:

Answer 490

N/A

Question 491

Meckel- Diverticulum: patient preparation: Dietary restrictions:

Answer 491

Patient to be NPO 4-12 hours. Infants-NPO equal to normal feeding time minus study time.

Question 492

Meckel-Diverticulum: patient Preparation: Adverse restrictions/artifacts:

Answer 492

Any radiographic study before scan for Meckel’s may mask activity. Flase- Positive: Barium/ proctoscopy,early renal activity. Unassociated ectopic- gastric mucosa, blood pooling from inflammation, bladder, laxatives,endoscopy causing bowel irritation,tumors and normal gastric activity,once transported to the bowel can be mistaken for Meckel. Radio-tracer may present in renal pelvis and duodenum are different to separate,thurs,need lateral views. False-Negative: small Meckel’s no gastric mucosa, (no activity), ischemic,necrosis, rapid radio-tracer washout, barium enema, upper GI exam, recent NM bleeding study,or obscured by normal activity.

Question 493

Meckel- Diverticulum: patient Preparation: Medications:

Answer 493

Physician to discontinue thyroid blocker agents( Perchlorate or saturated solution of potassium iodide 48 hours before). Drug interventions may be included in study. Pentagastrin 6ug/kg, stimulates ectopic mucosal uptake of pertechnetate by 30-60% while decreasing emptying time into small bowel and decreased bkg. Administered intramuscularly in children; sub Q in adult. 15 mins before perrechnetate injection. GLUCAGON: 50ug/Kg, decreases peristalsis and increases persistence of activity in the ectopic mucosa. Administer IV 10 mins post injection of Pertechnetate. CIMETIDINE: 300mg Qi’s( 4 times a day) adjusted for age for 24 to72 hours before exam. 20mg/Kg/day for peds 2 days before study. This inhibits the release of pertechnetate from the ectopic mucosa into the bowel lumen and increase gastric uptake. Pentagastrin and cimetidine should not be given together. POTASSIUM PERCHLORATE: Blocks uptake of perrechnetate by thyroid and salivary glands.

Question 494

Meckel’s-Diverticulum: patient Preparation: Age specific/other considerations:

Answer 494

Ensure patient has no radiographic barium studies on same day or 48 hours before study. If Pentagastrin is to be used, ensure patient to be NPO for 8 hours. It must be order from pharmacy 24 hours in advance; inject 15 mins before perrechnetate. Cimetidine suggested in difficulty cases; this H2 blocker inhibits the release of the tracer from the gastric mucosa.

Question 495

Meckel’s-Diverticulum: patient Preparation: Lab Values:

Answer 495

N/A

Question 496

Meckel’s- Diverticulum: Imaging Techniques: Anatomical Landmarks:

Answer 496

Camera covering xiphold to pubis.

Question 497

Meckel’s-Diverticulum: imaging Techniques: Views:

Answer 497

ANT,POST,LATS,OBL

Question 498

Meckel’s-Diverticulum: Imaging Techniques: Patient-Detector Orientation:

Answer 498

Supine

Question 499

Meckel’s- Diverticulum: Imaging Techniques: Fusion Imaging:

Answer 499

N/A

Question 500

Meckel’s-Diverticulum: Imaging Techniques: Imaging Techniques: Procedure:

Answer 500

Instruct the patient to void before procedure. Place patient supine with camera ANT covering xiphold to pubis. Inject and star camera for flow and dymamic study. STATICS: Obtain immediate image(s) and depending on length of dynamic; one image every 5 mins up to 60 mins after injection. Imaging ANT,POST, LATS, OBL per protocol if possible area is visualized. if delays are required, instruct patient to void between imaging sessions.

Question 501

Meckel’s Diverticulum: instrumentation: Detector System:

Answer 501

LEAP/LEHR

Question 502

Meckel’s Diverticulum: Instrumentation: Data-Acquisition: Flow

Answer 502

1-5 sec/frame for 1 min.

Question 503

Meckels Diverticulum: Instrumentation: Data Acquisition: Dynamic:

Answer 503

5sec/frame for 29 mins or 1min:frame for 15 mins.

Question 504

Meckel’s Divericuium: Instrumentation Data Acquisition: Statics:

Answer 504

Acquire 500,000-1 million counts per image. Consider magnifying all types and views for pets patients.

Question 505

Meckels-Diverticulum’s: Instrumentation: Data analysis: Normal:

Answer 505

Increased gastric uptake and activity in 1st 10-20 mins. Decreasing as study prophetesses. Bladder uptake increases with time.

Question 506

Meckel’s - Diverticulum: Instrumentation: Data Acquisition: Abnormal:

Answer 506

O ally increased activity not associated with normal situations. Particularly in RLQ or mid- abd. Activity will appear ANT on a LAT view proving no relation to any ureteral activity. Activity in Meckel’s will appear at the same time normal gastric mucosa presents and remains in same position despite peristalsis. Usually appears within 30 mins but may take up to 60 mins depending on amount of gastric mucosa present. Other reasons for activity in a Meckel’s scan= other cysts with gastric mucosa, ectopic kidney, ureteral stenosis, very active bleeding sites,tumor and inflammatory bowel disease.

Question 507

Meckel’s Diverticulum: Instrumentation: Ancillary Equipment:

Answer 507

N/A

Question 508

GI Bleed: Radiopharmaceuticals: Selection:

Answer 508

Tagged red blood cells (RBC’s) by pyrophosphate or stannous Chloride to Tc04 ( Pertechnetate) by in Vivo, in Vitro or kit(Ultra Tag). For active bleeding. Tc-Sc( Sulfur colloid).

Question 509

GI Bleed: Radiopharmaceuticals: Dosage:

Answer 509

Tc04 20-30 mCi and Tc-SC 10- 20 mCi.

Question 510

GI Bleed: Radiopharmaceuticals: Administration:

Answer 510

Intravenous injection (IV) drawing tagging and rein-Injection of tagged RBC’s.

Question 511

GI Bleed: Radiopharmaceuticals: Biodistribution:

Answer 511

Compartmental tagged to and circulating with blood.

Question 512

GI Bleed: Radiopharmaceuticals: Patient Preparation: Indicators:

Answer 512

Detection and localization of bleeding sites in patients with active or intermittent GI bleeding; usually presents as low red blood cell counts in labs and/or blood in stool( hematochezia) or Melina ( dark stool). Dark red blood may be small bowel or old bleed, bright red blood may be large bowel or anal. Could be caused by aspirin, ulcers, perforation, cancers, inflammation,diverticula, hemorrhoids, of angiodysplasia. Detection and localization of secondary blood loss as in blood pooling in peritoneal cavity or ruptured and localization of secondary blood loss as in blood pooling in peritoneal cavity or ruptured arterial or venous supplies. TC-SC=Detection and localization of activity bleeding flow through the liver) and hypertension to abdominal collateral vessels.

Question 513

GI Bleed: Radiopharmaceuticals: Indicators: Contraindications:

Answer 513

Patients with contrast studies under way or medically unstable (Ex: uncontrolled hypertension).

Question 514

GI Bleed: Radiopharmaceuticals: Pregnancy-and Nursing:

Answer 514

N/A

Question 515

GI Bleed: patient preparation: Dietary Restrictions:

Answer 515

Instruct patient to empty bowel and bladder before beginning procedure.

Question 516

GI Bleed: patient preparation: Adverse reactions/Artifacts:

Answer 516

Bad radio-tracer tag could lead to poor results. Do a thyroid image to confirm a bad tag; free tech will go to thyroid salivary glands, kidneys and gastric mucosa. Causes of a poor tag= drug interactions, cold pyrophosphate not injected soon enough after mixing, antibodies ( transfusions transplantation), Chemotherapy, shot incubation time, too much/ too little stannous ion. Any attenuating articles in clothing. A full bladder may mask bleeding area. Intermittence of bleeding compounds the problem of detection. Tc-SC: May be indicated if there is known active bleeding. The drawback is the relatively quick removal by the RES when intermittence is indicated. Do a flow at 1 sec/frame for 60 sec to catch the bleed site. If positive, take full series of immediate ( OBL,LAT,POST) to localize followed by timed images.

Question 517

GI Bleed: patient preparation: Medications:

Answer 517

N/A

Question 518

GI Bleed: Age specific/Other Considerations:

Answer 518

Obtain a signed consent for blood work. Check patient’s current vital signs ( BP and HR) and asses for orthostatic hypertension. If possible, have patient or nurse look for signs of active bleed.

Question 519

GI Bleed: Imaging Techniques:,Lab Values:

Answer 519

Obtain lab work and info concerning recent blood transfusions.

Question 520

GI Bleed: Imaging Techniques: Anatomical Landmarks:

Answer 520

The ligament of Treitz ( the dispensary ligament of the duodenum) is the tissue that connects the duodenum of the small intestines to the diaphragm; divides the upper and lower GI tract. GI bleeding is either upper ( proximal to the ligament of Treitz) or lower ( distal to the ligament of Treitz).

Question 521

GI Bleed: patient preparation: Views:

Answer 521

ANT,RAO, LAO

Question 522

GI Bleed: Imaging Techniques: Patient-Detector Oientation:

Answer 522

Supine

Question 523

GI Bleed: Imaging Techniques: Fusion imaging:

Answer 523

N/A

Question 524

G I Bleed: imaging Techniques: Procedure:

Answer 524

Patient must sign consent form to take/ return blood if these methods are employed; must be signed by technologist and witness. In Vitro: Extract 2-2.5ml of blood into heparinized syringe from patient and tagged with Ultra Tag . In ViVO: inject cold and pyrophosphate, then 20 mins later, inject radio-tracer under camera for flow. Modified In Vivo: inject colder pyrophosphate and wait 20 mins, 2-2.5mL of blood into a heparinized shielded syringe containing 30 mCi of TC04. Mix for 5-10mins. Place patient supine, camera ANT and from bottom of heart to lower in view. If patient is tall, upper and lower pictures taken. Inject under camera for initial flow if protocol. Acquire flow if active bleeding is suggested; sulfur colloid is best used to present the active bleeding site. Acquire statics ANT; immediately and at 5,10,30,45,and 60 mins with RAO and LAO indicated if positive. Or acquire dynamic for 60 mins after flow study. Delayed images as necessary; patients with Melena are candidates for prolonged studies with delays. 4 and 24 hours delays.If a patient has bowel movement after tagging, some hardy souls bag the bedpan and image for activity. if bleeding is found on delay, another delay should be taken to establish the direction of flow from initial site.

Question 525

GO Bleed: Instrumentation: Detector System:

Answer 525

LEAP/LEHR

Question 526

GI Bleed: Data Acquisition:

Answer 526

Flow: 2-5 sec/Frame, 60-180sec, Dynamic: 60 sec/ frame for 60mins. Statics: 500,000-2 million counts.

Question 527

GI Bleed:instrumentation: Data analysis: Normal:

Answer 527

Heart, vascular space of liver and spleen and great vessels prominent. Soft tissue uptake is light and homogeneous. Bladder, bowel and penile activity not unlikely.

Question 528

GI Bleed: instrumentation: Data analysis: Abnormal:

Answer 528

``` Flow= focal area of increased activity, blood pooling abdominal cavity may also be present. Dynamic= focal area that may or may not move with time; can be most helpful to verify movement of focal area. Statics= focal area peristalses with time, blood pool may persist in abdominal cavity and may or may not move. Typical areas of active bleeding include ascending, transverse, descending and sigmoid colon, right hepatic flexure, left colonic flexure and small bowel. Uptake with no change over time may be inflammatory disease or bad tag. Bleeding in small or large bowel can be differentiated by rapid movement. ```

Question 529

GI Bleed: instrumentation:

Answer 529

Ancillary equipment:

Question 530

Hepatobiliary or Gallbladder Scan(HIDA): Radiopharmaceuticals: Selection:

Answer 530

Tc-99m IDA agent. Disofenin (DISDA, Hepatolite) and Mebrofenin ( BRIDA, Choletec).

Question 531

Hepatobiliary or Gallbladder Scan(HIDA). Dosage:

Answer 531

3-15 mCi, higher doses for patients with elevated bilirubin levels. 0.05-0.07 mCi for children.

Question 532

Hepatobiliary or Gallbladder Scan (HIDA): Administration:

Answer 532

Intravenous injection (IV), direct or butterfly catheter if using cholecystokinin (CCK) for pre- emptying or gallbladder EF. IV injection under camera if flow is required or immediate image at injection is taken.

Question 533

Hepatobiliary or Gallbladder Scan: (HIDA): Radiopharmaceuticals: Biodistribution:

Answer 533

Polygonal cell uptake and excretion, follows bile path. IDA agents are removed from the blood stream by hepatocytes using active transport and are exerted into the bile unconjugated.

Question 534

Hepatobiliary or Gallbladder Scan: (HIDA): Patient preparation: Indicators:

Answer 534

Evaluation of abdominal ( especially RUQ) pain. Evaluation of cholecystitis; acute(calculous or a acalcuous), obstruction. Acute is caused by cystic duct obstruction (usually by stones) chronic is recurring gallstones and many other types of obstruction ( EX: stenosis,tumor,lack of ability to react to CKK or sphincter failure. Evaluation of biliary colic (spasm in bile ducts) or biliary dyskinesia ( incomplete emptying of the GB due to obstruction or kinking, sphincter of Oddi spasm( SOS), sphincter of oddi disease (SOD) and biliary atresia. Evaluation of EF or GB function ( EX: stasis allowing “ sludge to accumulate). Evaluation of post GB surgery for suspected leakage and detection of perforation of GB. Liver anatomy and function/biliary tract disorders; hepatobiliary function die to abnormal results on related studies.

Question 535

Hepatobiliary or Gallbladder Scan (HIDA): patient preparation: Indicators: Contraindications:

Answer 535

Recent food intake; NPO 4 hours prior to exam but having a meal within 24hours of exam. No CKK if recently diagnosed positive for gallstones. No morphine sulfate (MS) if the patient is allergic or elevated amylase (hyperamylasemia) or other pancreatic enzymes indicating pancreatitis, respiratory compromise or opiate addiction. Known common bile duct ( CBD) obstruction or intestinal obstruction regarding use of interventions.

Question 536

Hepatobiliary or Gallbladder Scan (HIDA) Patient Preparation: Pregnancy and nursing:

Answer 536

N/A

Question 537

Hepatobiliary or Gallbladder Scan (HIDA): Patient Preparation: Dietary Restrictions:

Answer 537

Ensure patient NPO 2-14 hours before exam( usually 4-6hour, 2 hours for infants). Clear liquids may be sued only if necessary.

Question 538

Hepatobiliary or Gallbladder Scan (HIDA): Patient Preparation: Adverse reactions/artifacts:

Answer 538

Previous undisclosed cholecystectomy, breast attenuation, a meal too soon before study will deleteriously affect result, not eating for 24 or more hours may cause stasis in contractions or sludge formation in the GB. Other false positives: TPN,etc. In jaundiced patients, there may be increased renal excretion of radio-tracer causing the right extrarenal pelvis to be confused will GB uptake. Elevated serum bilirubin levels may not allow uptake by hepatocytes causing radio-tracer excretion quickly. Morphine sulfate false-positive: chronic cholecystitis caused by fluid or stone in GB prevent adequate filling. Morphine sulfate false- negative: GB perforation and acute gangrenous cholecystitis.

Question 539

Hepatobiliary or Gallbladder Scan (HIDA): patient preparation: Age specific/ other considerations:

Answer 539

Explain the procedure; usually runs 1hours but baseline studies can go as long as 4 hours with up to 24 hours delays required in some instances.

Question 540

Hepatobiliary or Gallbladder Scan (HIDA): Patient Preparation: Lab Values:

Answer 540

Physician might do lab work before or other tests.

Question 541

Hepatobiliary or Gallbladder Scan (HIDA): Imaging Techniques: Anatomical Landmarks:

Answer 541

Liver in upper left quadrant of FOV.

Question 542

Hepatobiliary or Gallbladder Scan (HIDA): Imaging Techniques: Views:

Answer 542

ANT or 15-40 degrees LAO.

Question 543

Hepatobiliary or Gallbladder Scan: (HIDA): Patient Detector Orientation:

Answer 543

Supine.

Question 544

Hepatobiliary or Gallbladder Scan:(HIDA) : Fusion imaging:

Answer 544

N/A

Question 545

Hepatobiliary or Gallbladder Scan(HIDA): imaging Techniques: Procedure:

Answer 545

Place patient, camera, FOV, ets. Position liver in middle FOV if taking immediate heart shadow image. Then move camera to position liver in ULQ for remaining images. ROIs can be drawn around heart and liver to ascertain radio-tracer clearance from blood pool. Static: immediate then every 5 mins up to 30 mins and then every 20-15 mins after 30 mins has past. Dynamic: If patient can hold still for 60 mins. Stop at 30-45 mins if GB and bowel present. Acquire to 90 mins if not. Acquire a right LAT static if GB presents. Other useful images may be taken from OBL, LAT, POST or using pinhole collimators and magnified views for children. Neonatal hepatitis/biliary atresia: Place on phenobarbital regimen, image very 10 mins for 1 hour. Delays up to 24 hours.

Question 546

Hepatobiliary or Gallbladder Scan(HIDA): imaging Techniques: Procedure: GB and bowel visual:

Answer 546

Imaging RLAT, some require RAO and LAO. Study is complete. Dynamic: ingestion of water (100 ml) may assist in distinguishing duodenal loop tracer from true GB visual. No visual of GB and/or bowel: radiologist ( EX: patient returns for 2-6 hr delays). No visual with non pharmacological interaction: No visual of GB and/or bowel by 30-45 mins and patient is supine =turn patient to right decubitus position for 5-10 mins. Return patient supine and image. No visual of GB and/ or 30-45 mins and patient is ambulatory= let patient walk for few mins, reposition and image. GB but no bowel: if talking dynamic and patient is alert, try encouraging the patient to think about their favorite food as it might stimulate the GB to contract. DELAYED IMAGES: 3-24 after initial injection. May require a small rein-injection of rph; check with radiologist. No Visual with pharmacological Interventions: GB but no bowel=CCK( suggested over a 3 min injection minimum) or fatty meal. Bowel but no GB= MS (check for contraindications then obtain order). Per-injection CCK or per-morphine injection image, then post injection images by protocol, usually every 5 min for 30 mins; check again with radiologist for continuance or delay.

Question 547

Hepatobiliary or Gallbladder Scan: (HIDA): Instrumentation: Detector System:

Answer 547

LEAP/LEHR

Question 548

Hepatobiliary or Gallbladder Scan (HIDA):instrumentation: Data- Acquisition:

Answer 548

Statics: 90-180 sec for 500,000-1 million counts. Flow: 2sec/frame for 60 sec then immediate blood pool image. Dynamic: 60 sec/frame for 60-90 mins.

Question 549

Hepatobiliary or Gallbladder Scan (HIDA): instrumentation: Data analysis: Normal:

Answer 549

Visual of liver 5-15 sec after injection; hepatic,common bile duct and GB 5-20 mins up 60 mins. Cardiac blood pool should no longer be seen after 5-20mins. Intestinal activity should be visualized and move within 10-60 mins. A flow study will show the liver immediately but dimly from activity entering through the hepatic artery, then brightly with portal vein flow. The liver diminishes in activity as the GB visualizes in its “bed” and grows bright as bowel activity visualizes and moves with time. For post- GB surgery, there should be no activity pooling around the liver or in the abdomen. The GB can visualize nearly anywhere in or under the liver and in most any orientation. If questionable location, compare image to other related scans/ask radiologist.

Question 550

Hepatobiliary or Gallbladder Scan (HIDA): instrumentation: Data analysis: Abnormal:

Answer 550

``` Non visualization(no visual) of GB within 1 hour of visualization(visual) of common bile duct and bowel): Indicating acute cholecystitis,contracted GB. GB filled with stones, bile/sludge or poor hepatic fiction. Non- Visual of GB within 1 hour of vis of bowel but having a “rim sign” (faint outline GB) indicating gangrenous acute cholecystitis. Non-visual of bowel within 1hour with good hepatic uptake, vis of GB and common bile duct: Indicating sphincter of Oddi dysfunction or obstruction. Non-visual of GB or bowel within 1 hour with good hepatic uptake but no draining: indicating complete/near-complete obstruction of hepatic ducts. Partial or Non-visual of Liver: servers hepatocellular disease, space-occupying vascular or non- vascular ,hepatoma or surgery. Non-vis of GB 30 mins after MS is administered: Indicating cystic duct obstruction or acute cholecystitis. Vis of GB after MS is administered: indicates chronic cholecystitis. Drug Interaction: Delayed biliary to bowel transit time= narcotics, phenobarbital. Poor extraction and elimination of tracer from liver=high dose of nicotinic acid. No or delayed vis of GB=TPN. Non-visual of GB= hepatic artery infusion of chemotherapy. Low EF= everything,Gallbladder EF: 35% is normal. <35% is abnormal. 35-50 % is considered borderline and >50% is unequivocally normal. The mean is 75% to 35%. ```

Question 551

Hepatobiliary or Gallbladder Scan (HIDA): Instrumentation:

Answer 551

Ancillary equipment

Question 552

RBC Hemangioma (Hepatic): Radiopharmaceuticals:Selection:

Answer 552

Tagged RBC’s by pyp or stannous chloride to Tc04 Pertechnetate by in Vivo, In Vitro, or kit( Ultra Tag).

Question 553

RBC Hemangioma (Hepatic): Radiopharmaceuticals: Dosage:

Answer 553

20-30 mCi

Question 554

RBC Hemangioma (Hepatic): Radiopharmaceuticals: Administration:

Answer 554

IV injections or drawing, tagging and rein-injection of tagged RBCs using IV catheter or butterfly.

Question 555

RBC Hemangioma (Hepatic): Radiopharmaceuticals: Biodistribution:

Answer 555

Compartmental, tagged to and circulating with blood.

Question 556

RBC Hemangioma ( Hepatic): Patient preparation: Indicators:

Answer 556

Detection/localization of hepatic hemangiomas, vascularized primary and metastases tumors,cysts,space occupying lesions,necrosis and abnormal focal areas(increased or decreased activity). Evaluation of liver with contrast studies underway and receiving blood products.

Question 557

RBC Hemangiomas (Hepatic ): patient preparation: pregnancy and nursing:

Answer 557

N/A

Question 558

RBC Hemangiomas (Hepatic): patient preparation: Dietary Restrictions:

Answer 558

N/A

Question 559

RBC Hemangiomas ( Hepatic): Adverse reactions/artifacts:

Answer 559

Bad tag could lead to poor results. Do a thyroid image to confirm as free Tc-99 will go to the thyroid, salivary glands and gastric mucosa: Causes of poor tag: Drug interactions, cold pyp not injected soon enough after mixing, antibodies though transfusions and transplantation, shot incubation, too much/little stannous ion. Articles in clothing, different slice orientations of SPECT may allow vessels to appear hot or cold spots. Detection depends on lesion size.

Question 560

RBC Hemangiomas: (HEPATIC): Medications:

Answer 560

N/A

Question 561

RBC’s Hemangiomas (Hepatic): Age specific/other considerations:

Answer 561

Obtain signed consent from for blood return if required; must also be signed by tech and witness.

Question 562

RBCs Hemangiomas (Hepatic): patient preparation: Lab Values:

Answer 562

N/A | Or the physician might do blood work before scan.

Question 563

RBCS Hemangiomas ( Hepatic): Imaging Techniques: Anatomical Landmarks:

Answer 563

Liver and spleen centered in the FOV.

Question 564

RBCs Hemangiomas (Hepatic): Imaging Techniques: Views:

Answer 564

ANT, RAO,RL,POST and more as protocol.

Question 565

RBCS Hemangiomas (Hepatic): Imaging Techniques: Patient-Detector orientation.

Answer 565

Supine

Question 566

RBCS Hemangiomas (Hepatic) : Imaging Techniques: Fusion Imaging

Answer 566

N/A

Question 567

RBCS Hemangiomas ( Hepatic) : Imaging Techniques: Procedure:

Answer 567

In-Vitro method: 2-2.5 mL of blood is extracted into heparinized syringe from patient and tagged with Ultra Tag. In-Vivo Method: inject cold pyp, wait 20 mins, inject radio-tracer under camera for flow of required. Place patient supine, camera anterior for flow,liver and spleen center in FOV or preload SPECT. Camera posterior if that is what is determined for best view from other imaging Techniques( EX. Lesion POST in is what is liver). FLOW: Obtain images of early blood supply from hepatic artery to primary and metastatic tumors/hemangiomas. A flow may help determine a non-vascularized and fill in overtime becoming “hot”. STATICS: Obtain immediate ANT with marker, regular ANT, RAO,RL,POST and more as to protocol. SPECT: Obtain images 1-2 hours after injection. Set proper patient orientation,set camera with ROI liver and spleen area.

Question 568

RBCS Hemangiomas (Hepatic): Instrumentation: Detector System:

Answer 568

LEAP/LEHR

Question 569

RBCS Hemangiomas (Hepatic): Instrumentation: Data Acquisition:

Answer 569

FLOW: 1-5 sec/frame,60-120seconds. STATICS: 500,000-2million counts. SPECT: 1.5 magnification,64x64 or 128x128 matrix, 64stops,20-30sec/stop.

Question 570

RBCS Hemangiomas (Hepatic): Instrumentation: Data Analysis: Normal:

Answer 570

Heart, great vessels, spleen and spleen and kidneys prominent. Heterogeneous light uptake of liver within secs of injection from hepatic artery; bright uptake from portal system. SPECT: Heterogeneous uptake of liver parenchyma.

Question 571

RBCS Hemangiomas (Hepatic): Instrumentation: Data analysis: Abnormal:

Answer 571

Typically, hemangiomas are initial hypo-vascular(filling with time). They become hyper-vascular with delays. A differential diagnosis is a solitary hepatoma that is typically hyper-vascular. FlOW: Focal areas of increased or decreased activity. STATICS: Focal areas persist in relative positions from different views. SPECT: Focal areas of over-abundance of vascularity present as hot spots; focal areas of less then normal or unsuspected sites that were hidden. Cold spots can be cysts, tumors, necrosis lesions from trauma, surgery or poorly vascularized hemangiomas.

Question 572

RBCS Hemangiomas (Hepatic) Instrumentation:

Answer 572

Ancillary equipment: gamma camera

Question 573

Liver/Spleen: Radiopharmaceuticals: Selection:

Answer 573

Tc-99m Sulfur Colloid:

Question 574

Liver/Spleen: Radiopharmaceuticals: Dosages:

Answer 574

2-7 mCi

Question 575

Liver/Spleen: Radiopharmaceuticals: Administration:

Answer 575

Intravenous (IV) injection or IV catheter and flush; invert syringe before administering the dose to mix particles.

Question 576

Liver/Spleen: Radiopharmaceuticals: Biodistribution:

Answer 576

Phagocytosis by reticular cells of liver, spleen, bone marrow, and lungs. Administering the dose to mix particles.

Question 577

Liver/Spleen: patient preparation: Indicators:

Answer 577

Assessment of anatomy, size relative position of liver and spleen. Assessment of hepatomegaly, splenomegaly,splenic infarcts, chronic liver or spleen disease including primary liver tumors and metastasis, jaundice, cirrhosis, hepatitis, etc. Detection and assessment of hepatic or splenic trauma. Evaluation for live disease, leukemia, thrombocytopenia,WBC sequestration, tumors,abscesses,cysts and trauma.

Question 578

Liver/Spleen: patient preparation: Indicators: Contraindications:

Answer 578

Study should be perform before any iodinated or barium containing contract agents; particularly barium in the colon may result in artifactual defects with the Liver/spleen.

Question 579

Liver/Spleen: patient preparation: Pregnancy and nursing:

Answer 579

N/A

Question 580

Liver/Spleen: patient preparation: Dietary Restrictions:

Answer 580

N/A

Question 581

Liver/Spleen: Patient preparation: Adverse reactions/artifacts:

Answer 581

Tape marker to clothes or camera to prevent movement. Breast may cause attenuation for females; patient can hold them out of FOV or can be taped. Obese skin folds may also cause attenuation; standing in-front of camera can eliminate them. Lung uptake caused by large colloid size may indicate colloid clumping in rph. Deep lesions may be missed and deep respirations may blur images. Surgery using anesthesia within 1 month can contribute to decreased hepatic uptake of rph. Chemotherapy may cause irregular distribution, g Hepatomegaly and/ or shift from spleen and bone marrow. Amount of damaged RBCs will affect outcome of splenic images.

Question 582

Liver/Spleen: patient preparation: Medications:

Answer 582

N/A

Question 583

Liver/Spleen: patient preparation: Age specific/other considerations:

Answer 583

N/A

Question 584

Liver/Spleen: patient preparation: Lab Values:

Answer 584

If available, write considerations of alanine amino transferase (ALT), aspirate amino transferase (AST,) lactate dehydrogenase (LDH) and total bilirubin on history.

Question 585

Liver/Spleen: patient: imaging Techniques: Anatomical Landmarks:

Answer 585

Position using point source on xiphold process at top of camera FOV. Camera ANT over lower thorax-abdomen; marker over last costal margin.

Question 586

Liver/ Spleen: Imaging Techniques: Views:

Answer 586

ANT, RAO,RLAT,POST,LLAT,LAO.

Question 587

Liver/Spleen: Imaging Techniques: Patient-Detector Orientation:

Answer 587

Supine.

Question 588

Liver/Spleen: Imaging Techniques: Fusion Imaging:

Answer 588

N/A

Question 589

Liver/Spleen: Imaging Techniques: Procedure: Liver:

Answer 589

Place patient in supine position, camera ANT over lower thorax- abdomen. FLOW: Position using point source on xiphold process at top of farmers FOV. Inject, wait a couple seconds, then start camera. Take immediate blood pool image when flow is complete. STATICS without FLOW: inject, wait 15 mins( patients with liver dysfunction or portal hypertension may require 20-30 min before imaging). ANT with marker over last costal margin for liver( and spleen if splenomegaly indicated), ANT, RAO,RLAT,POST,LLAT,LAO. SPECT: center ROI in FOV, set parameters and start cam. Hepatic Artery Study: 1-3 mCi Tc-99 MAA. Inject slowly through hepatic artery catheter or infusion pump 1 ml/min. Immediate images ANT, POST,RL of liver, 500,000-1 million counts. Image lungs to identify intra-hepatic arteriovenous fistulas. Splenic study and imaging: 1-3 mCi Tc-99m head- damaged RBCs. This is accomplished by heating tagged RBCS for 20 minutes and warm water at 50 Celsius image 30-120 minutes after injection. ANT, POST, POST oblique. 300,000-750,000 counts. Image abdomen if ectopic splenic tissue is suspected. Image chest in cases of diaphragmatic rupture due to trauma. SPECT: imaging may be requested.

Question 590

Liver/Spleen: Instrumentation: Detector System:

Answer 590

LEAP/LEHR

Question 591

Liver/Spleen: Instrumentation: Data analysis: Normal:

Answer 591

FLOW: 1-3 sec/frame for 1 min followed by immediate static blood pool ( 60sec or 500,00 counts) STATICS: liver and spleen should have equal heterogeneous distribution. A large patient may present with hepatomegaly and slightly decreased uptake. Liver uptake is homogeneous, dominant right and small left lobe; variants are normal (Riedel’s lobe long, thin right lobe). Right lobe size is about 18 cm (ANT) highest point to inferior tip. Splenic uptake is homogeneous and equal or less then the liver. Normal size is 10 cm not to exceed 13cm posterior view. Relative rph uptake: 85% liver, 10% spleen and 5% bone marrow. Hepatic artery Study: Hepatic uptake; small amount of lung uptake may be visible with a properly placed catheter due to arteriovenous fistulas in the liver. Splenic images: uptake of tagged head- damaged RBC’s in spleen.

Question 592

Liver/Spleen: Data analysis: Abnormal:

Answer 592

FLOW: fast uptake= tumors or hepatitis. Increased uptake= hepatomas, hemangiomas. Slow uptake = CHF, servers cirrhosis. STATICS: Hepatomegaly = Fatty infiltration, chronic passive congestion, hepatitis metastasis, diabetes etc. Splenomegaly: Leukemia, myelofibrosis, malaria splenic dominance: compromised liver function. Splenic Absence: Sickle cell. Colloid shifting presents in marrow, spleen, lungs and kidneys. Hot Spots: Tumors, superior vena cava obstruction, hepatic vein thrombosis,etc. Cold Spots: Metastatic tumors, hepatomas, adenomas, cysts, trauma, pseu-tumor caused by cirrhosis, etc. Accumulation in renal transplant indicates rejection of organ. Hepatic artery study: Extrahepatic: uptake (stomach,spleen, lung) This indicates improper position of catheter. Spleen Imaging: Little or no uptake of heart- damaged cells in spleen.

Question 593

Liver/Spleen: Instrumentation: Ancillary Equipment:

Answer 593

Gamma Camera.

Question 594

Renal Function ( ERPF and GFR): Radiopharmaceuticals Selection:

Answer 594

Tc-99m DTPA or Tc-99m MAG3

Question 595

Renal Function (ERPF and GFR) : Radiopharmaceutical’s: Dosage:

Answer 595

3-20 mCi, generally 10 mCi for most studies.

Question 596

Renal Function (ERPF and GFR): Radiopharmaceutical’s: Administration:

Answer 596

Bolus IV injection, if study includes a Dino, use butter IV catheter. ACE inhibitor study: Captopril, 50 mg, is given PO 1hour before exam. Enalapril 0.4mg/Kg, intravenous over 3-5mins.

Question 597

Renal Function (ERPF and GFR): Radiopharmaceutical’s: Biodistribution:

Answer 597

Compartmental, blood flow.

Question 598

Renal function ( ERPF and GFR): patient preparation: Indicators:

Answer 598

Evaluation for renal artery stenosis, obstruction and / or trauma, renal tubular function and perfusion ( glomerular filtration for blood, parenchyma, excretion),renal vascular flow( effective renal plasma flow), renal obstructive nephropathy and/or hypdronephrosis ( study with furosemide), renal “ Reno-vascular hypertension ( captoprill study) and kidney transplant.

Question 599

Renal Function (ERPF and GFR): Indicates: Contraindications:

Answer 599

Iodine contrast on same day, Patient still on ACE ( angiotensin-converting enzyme) inhibitors or angiotensin receptors blocker(ARB). If the test is ordered as a captoprill study and patient has taken ACE or ARB hours before, take patients BP. If it’s normal or high, give captoprill and continue with exam; check with radiologist if okay. If the BP is too low, it may be rescheduled. Food intake too close to a captoprill/enalapriat challenge studies should be used advisedly, especially in cases of severe stenosis. Beta blockers may affect production of renin.

Question 600

Renal Function ( ERPF and GFR); Pregnancy and nursing

Answer 600

N/A

Question 601

Renal function ( ERPF and GFR): Dietary restrictions:

Answer 601

Instruct patient to hydrate well (water,up to 10mL/Kg) and void just before test. If is a 1 day-two-study test, hydration should continue between studies. Patient to be NPO for at least 4 hour on morning before captoprill study.

Question 602

Renal Function(ERPF and GFR): Adverse reactions/ artifacts:

Answer 602

Some patients do not have both kidneys, injection can alter renography curves,food within 4 hours of study, pelvis retention, dehydration, hypertension or full bladder at start, misalignment on positioning, infiltration at injection site hypotension or full bladder at start. Spleen may overlie left kidney giving increased left kidney perfusion or phantom kidney in patients with left nephrectomy. False positive of mechanical obstruction, poor hydration/poor underlying renal function, eliciting poor diuretic response, non compliant or rigid renal pelvis, high filling pressure of bladder, over compliant or patulous (open) renal pelvis allowing pelvis to phil and not washout.

Question 603

Renal function (ERPF and GFR): medication‘s:

Answer 603

Physician is to instruct patient to discontinue a CE inhibitors for several days(3–7)before examination depending on half/life of drug, (EX: Captoprill =48 hours enalapril and lisinopril= 1 week). There are cases were the patient cannot discontinue meds. Physician May also choose to discontinue ARBs diuretics, beta blockers and Calcium channel blockers.

Question 604

Renal function (ERPF and GFR): Age specific/Other considerations:

Answer 604

Post study voiding is recommended to lessen bladder exposure.

Question 605

Renal function (ERPF and GFR): LAB Values:

Answer 605

Done by Physician before test or tests.

Question 606

Renal function (ERPF and GFR): Imaging Techniques: Anatomical Landmarks

Answer 606

Position camera by pointing source over xiphold, Umbilicus, public symphysis and sides in view.

Question 607

Renal function ( ERPF and GFR): VIEWS:

Answer 607

ANT,POST

Question 608

Renal function (ERPF and GFR): Imaging Techniques:Patient-Detector Orientation:

Answer 608

Supine.

Question 609

Rental Function (ERPF and GFR): Imaging Techniques: Fusion imaging :

Answer 609

N/A

Question 610

Renal function (ERPF and GFR):Imaging Techniques: Procedure:

Answer 610

Baseline: GFR is to be included, count the syringe before/after injection for 1 min at 20-30cm from camera (same distance each time). Place patient supine, camera under table, except for kidney replacement patients as camera is placed ANT over abdomen including lower abdomen. Some injection 100 -200 UCI of MAG3 before starting camera to visualize kidney placement. Bolus IV injection, set flow for 120 seconds and start camera just before injection.

Question 611

Renal function (ERPF and GFR): Procedure: Diuretic (furosemide) study, use following options:

Answer 611

1: Insert Ivy butterfly with three-way stop cock, inject furosemide, flush and inject bolus of tracer. 2: One minute flow equals inject bolus, start camera, and inject furosemide and flush. 3: acquire Statics 2-5 minutes interval for 30 mins or dynamic 1 min images for 3 mins. Always note the time when diuretic was given. 

Question 612

Renal function (ERPF and GFR): Procedure: Captoprill:

Answer 612

Patient’s BP is measured and recorded. Administrator 50 MG tablets PO with water, as much as one L,. An option is to crush the tablet and dissolve in 150-250 ML‘s of water, it may enchance absorption. Patient is monitored closely, take BP every 15 minutes, for one hour at which time patient is to void. Position and repeat baseline procedure from start, including diuretic if ordered. take delays as Pre- physician’s Order. Their account be done as same or separate day procedures. Captoprill Study can be performed first, if normal, it negates need for baseline study.

Question 613

Renal function (ERPF and GFR): Enalaprilat:

Answer 613

Start IV or butterfly intake BP. Used .04 MG/KG, divide that number by 1.25 MG/ML to give the total amount of fluid to infuse using normal Celine. The patient should not receive more than 2.5 MG’s part two ML’s. Infuse slowly over five minutes while watching BP. Beginning Imaging 15-20 after infusion complete.

Question 614

Renal function (ERPF and GFR): pre and post 1 Day Studies:

Answer 614

Position Patient for Baseline, medication restrictions and hydration still applies. The combination study is usually accomplished using a low/high dose combo, EX: One–3mCi DTPA or MAG3 for baseline, 8–10 MCi DTPA or MAG3 for captoprill study). Follow baseline instructions. When completing, allow patient to void and continue with hydration. Take baseline BP, FBP is suitable/described above, give 50 MG Captoprill tablet or injection of enalaprilat. Follow either instructions above.

Question 615

Renal function (ERPF and GFR): Instrumentation: Detector System

Answer 615

LEAP/LEHR

Question 616

Renal function (ERPF and GFR): Data acquisition:

Answer 616

Flow: 1–5 seconds/frame for one minute. Dynamic: 20-62nd/frame for 30 minutes. Statics: 500,000– 1 million counts at 1,3,5,10,15,20,25, and 30 minutes out of 60 depending on protocol. 

Question 617

Renal function (ERPF and GFR): Instrumentation: Data analysis: Normal:

Answer 617

Assuming to kidneys, both visualizing about the same size and intensities. Both graphs peaking with parallel up Dash slope and within three seconds of aortic Peak and dropping off, (excretion) add the same rate. Static imaging should yield a smooth Renal contour. Time – two time peak consideration is 3–5 minutes. Clearance time half is 12–15 minutes. A normal vapor enalaprilat, renograph obviates the need for baseline study. GFR= 125ml/ minute. ERPF = 500– 600 ML/minutes. Filtration fraction, GFR / ERPF),= .2.

Question 618

Renal function(ERPF and GFR): Instrumentation: Data analysis Abnormal:

Answer 618

One of both kidneys not visualizing. Enlarged, decreased activity= pyelonephritis. asymmetrical activity = renal artery stenosis, hyroureternephrosis. Graphs not having parallel in out and excretion drop rates. Correction slopes after captoprill May mean renal artery stenosis, uncorrected slope after captoprill May mean an obstruction or nephrosis of tissue. Increased spleen and liver activity indicates renal failure. Relative renal uptake ratio at 2–3 minutes of 40% or less. Lasix(furosemide): Distinguishes begin dilated systems form mechanical obstruction. Struggled abnormal half time washout time is 20 minutes or greater for injection. With dilated non-obstruction studies (curves rise)after diuretic injection the system releases urine (curves decline). In mechanical obstruction, the curves raise and continue to do after diuretic is administered. Captoprill: Renal uptake at 2–3 minutes by one kidney> 405 F total, retained cortical activity at 20 minutes differing from contralateral kidney>20% or increase from baseline of 0.15 time to peak activity end of affected kidney>2 mins compared to baseline or non affected kidney. Bilateral changes after captoprill are more likely associated with hypotension, salt depletion, calcium Channels blocker and / or low urine flow. Acute rejection of transplanted kidney = delayed DTPA. Sulfur colloid can be used to confirm rejection b/c the agent localizes in fibrin thrombi of rejecting transplant.

Question 619

Renal function (ERPF and GFR): Instrumentation: Ancillary Equipment:

Answer 619

BP Cuff/ Stethoscope.

Question 620

Renal Cortical: Radiopharmaceuticals: Selection:

Answer 620

Tc-99m DMSA.

Question 621

Renal Cortical: Radiopharmaceuticals::Dosages:

Answer 621

1-6 mCi

Question 622

Renal Cortical: Radiopharmaceuticals: Administration:

Answer 622

Direct intravenous Injection or IV catheter with saline Flush.

Question 623

Renal Cortical: Radiopharmaceuticals: Biodistribution:

Answer 623

Compartmental,blood steam. 90% binds to plasma proteins, preventing any significant glomerular filtration, hence slow clearance from renal cortex ( proximal convoluted tubules). Only 10% excreted through the urine in the first several hours.

Question 624

Renal Cortical: patient preparation: Indicators:

Answer 624

Evaluation of renal cortex, quantitation of regional relative function, differential function, detection and localization of renal mass, acute, chronic pyelonephritis, evaluation for renal blood supply obstruction l/ trauma and renal transplant.

Question 625

Renal Cortical: Patient Preparation: contraindication:

Answer 625

N/A

Question 626

Renal Cortical: patient preparation: Pregnancy and nursing

Answer 626

N/A

Question 627

Renal Cortical: patient preparation: dietary restrictions.

Answer 627

Patient is to be well hydrated and should avoid before exam begins.

Question 628

Renal Cortical: patient preparation: Adverse reactions/ artifacts:

Answer 628

Increased liver uptake with decreased renal uptake may be caused by breaking down of radiopharmaceutical, acidic urine may produce same results. Some patients don’t have both kidneys. Patient still on a ACE inhibitors or a or ARBS. With dehydration decrees kidney/liver ratio. Misalignment on positioning.

Question 629

Renal Cortical: patient preparation: medications:

Answer 629

Patient is to discontinue angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blocker (ARB).

Question 630

Renal Cortical: patient preparation: Age specific/ other considerations:

Answer 630

Explain the procedure, especially the delay between injection and imaging.

Question 631

Renal Cortical: patient preparation: Lab Values:

Answer 631

N/A

Question 632

Renal Cortical: imaging Techniques: Anatomical Landmarks:

Answer 632

Kidneys in FOV,position camera with upper abdomen centered in FOV.

Question 633

Renal Cortical: Imaging Techniques: Views:

Answer 633

POST, RPO, LPO,RLATs,LLATs, ANT.

Question 634

Renal Cortical: Imaging Techniques: Patient-Detector orientation::

Answer 634

Supine

Question 635

Renal Cortical: Imaging Techniques: Fusion Imaging:

Answer 635

N/A

Question 636

Renal Cortical: Imaging Techniques: Procedure:

Answer 636

Place patient in supine position,camera under table, except for kidney transplant patients for whom camera is placed above the abdomen. Prone for pinhole, kidneys in FOV; upper abdomen centered in FOV. 50% of injected DMSA dose is in kidneys within 1 hour. Wide variation in protocols for imaging: some may require a flow study as in renograms. 1: inject take immediate statics ( 500,000-800,000 counts), then delays at 1 hour, using this 1 hour POST view for processing. Also 4-6 delays and 24 hour delays. If requested to. In Jack, patient returns in 2–6 hours for delay Imaging out again for 24 hour delays if request. Select imaging techniques by checking with radiologist. Optional imaging, 500,000-800,000 counts, RPO and LPO, RLAT & LLAT and a NTF horseshoe kidneys are suspected or kidney transplant.

Question 637

Renal Cortical: Instrumentation: Detector System:

Answer 637

LEAP/LEHR

Question 638

Renal Cortical: Data Acquisition:

Answer 638

FLOW: 1-5 sec/frame for 1 minute. Dynamic: 20-60 sec/frame for 30 mins. Statics: 500,000-1 million counts at 1,3,5,10,15,20,25, and 30 minutes out 60 depending on protocol.

Question 639

Renal Cortical: instrumentation: Data analysis: Normal:

Answer 639

Assuming two kidneys, both kidneys visual about the same size and intensities if flow is performed. Static Imaging should yield bilateral smooth renal contour. Hepatic uptake visualized, varies with degree for renal function. Because of extremely slow rate of clearance of DMSA, collecting system may not visualize.

Question 640

Renal Cortical: instrumentation: Abnormal:

Answer 640

One or both kidneys not visualized. Either enlarged or decreased activity indicates pyelonephritis. Asymmetric activity indicates renal artery stenosis or hydroureteronephrosis. GB and gut are visualized in renal failure. Decreased DMSA uptake in HRN or RAS patients= ACE inhibitors ( EX: Captoprill).

Question 641

Renal Cortical: instrumentation: Ancillary Equipment:

Answer 641

BP/stethoscope/ gamma camera.

Question 642

Radionuclides Cystography (Direct and Indirect): Radiopharmaceuticals: Selection:

Answer 642

Tc04 Pertechnetate, Tc-SC Sulfur Colloid, Tc- DTPA, TC-MAG3.

Question 643

Radionuclides Cystography (Direct and indirect): Radiopharmaceuticals: Dosage:

Answer 643

(Direct) 0.5 mCi (Indirect) 3-10mCi. Child dose should be adjusted using weight or body surface area using as low as practical for image quality.

Question 644

Radionuclides Cystography (Direct and indirect): Radiopharmaceuticals: Administration:

Answer 644

(Direct): injection into Foley catheter by injection port or needle puncture. (Indirect): IV Injection,butterfly or catheter.

Question 645

Radionuclides Cystography (Direct and indirect): Radiopharmaceuticals: Biodistribution:

Answer 645

Direct: Compartmental, flows with saline and urine. Indirect: Compartmental, blood ( bound to protein and some RBCs).

Question 646

Radionuclides Cystography: ( Direct and indirect): Patient Preparation: Indicators:

Answer 646

Evaluation and detection of vesicoureteral reflux, quantification of post-void bladder residual,evaluation of management and continuing assessment of patients with reflux surgery intervention or other to prevent subsequent impairment of function.

Question 647

Radionuclides Cystography (Direct and indirect): Patient Preparation: Contraindications:

Answer 647

Indirect: method not recommended in patient with known significant renal dysfunction.

Question 648

Radionuclides Cystography (Direct and indirect): pregnancy and nursing:

Answer 648

N/A

Question 649

Radionuclides Cystography (Direct and indirect): Dietary restrictions:

Answer 649

N/A

Question 650

Radionuclides Cystography (Direct and indirect): Adverse reactions/artifacts:

Answer 650

Recent contrast radiographic studies may interfere with results. Contamination of area by infusion leakage, etc. indirect method= Reflux may be missed during filling phase, which is not imaged; kidneys may retain radio-tracer. Patient may not be able to hold contents of bladder for 2 hours until imaging or void on command .

Question 651

Radionuclides Cystography(Direct and indirect): patient preparation: Medications:

Answer 651

N/A

Question 652

Radionuclides Cystography (Direct and indirect): patient preparation: Age specific/ other considerations:

Answer 652

Patients are usually pediatric and require special attention to relieve apprehension. Instruct patient to void completely just before exam. Catheterize patient for direct. Hydrate and void after exam as well to reduce exposure to bladder.

Question 653

Radionuclide Cystography (Direct and indirect): Radiopharmaceuticals: Lab Values:

Answer 653

N/A

Question 654

Radionuclides Cystography (Direct and indirect): Imaging Techniques: Anatomical Landmarks:

Answer 654

Kidneys in FOV, position camera with upper of Domino centering in FOV.

Question 655

Radionuclides Cystography (Direct and indirect): views:

Answer 655

POST, RPOs, LPOs.

Question 656

Radionuclides Cystography (Direct and indirect): Patient preparation: patient-Detector Oientation:

Answer 656

Supine or Patient sitting with back and pelvis against the camera.

Question 657

Radionuclides Cystography (Direct and indirect): Patient preparation: Fusion imaging:

Answer 657

N/A

Question 658

Radionuclides Cystography (Direct and indirect): Procedure:

Answer 658

Direct: usually with TC04, TC- SC or TC-DTPA. Cover camera and table area with disposable pads, chocks, to absorb leakage and/or contamination. Hang 50-1000 and 500 mL, depends on size of patient, normal Celine for gravity- feed infusion(no more than 100cm above table). For PEDS, 250 ML‘s= normal. Note amount at start and finish. Position catheterized patient supine with camera POST, or patient sitting with back and pelvis against the camera, the dome of the bladder and lower FOV, kidneys in upper. This can be done before imaging if radiopharmaceutical is injected into calf before filling start or eyeball position if radiopharmaceutical is to be injected after patency is established/while filming. For infants/children, radiopharmaceutical is injected into calf following by the appropriate amount of saline. For adults radiopharmaceutical may be added to an appropriate shielded 500 ml bag of normal saline and infused slowly. Start camera for flow, full bladder completely with radio-tracer/saline mixture ( usually verified by patient’s urgency to micturate, leakage around the catheter, or cessation of flow into bladder. Monitor P-scope closely for signs of reflux, F reflux, activity just above the bladder, is visible, Records amount of ceiling infused at time. When bladder is full stop flow image and take 122nd stats of post and left/right post oblique images record the amount of ceiling used to fill bladder and the CPM during posterior views. Do not. Position patient sitting or lateral decubitus, camera behind. Start second flow Study, Instruct patient to void into empty urinal or bedpan, some take only a static determine volume voided by patient ML. Indirect, usually with TC- DTPA or TC- M a G3. Patient is injected and most not void for two hours. Add two hours after injection, when the radiopharmaceutical has cleared the kidneys and filtered the bladder, the patient is positioned sitting with back and pelvis to Camera, Bladder/Kidneys in FOV and is told to void. Obtain dynamic imaging as patient voids. Obtain statics ( 120 secs) when completely voided. Carefully monitor P scope when patient is voiding for signs of reflux.

Question 659

Radionuclides Cystography(Direct and indirect): Instrumentation: Detector System:

Answer 659

LEAP/LEHR

Question 660

Radionuclides Cystography (Direct and indirect): instrumentation: Data acquisition:

Answer 660

Direct: Flow: = 1 to 2 sec/frame for 30 sec to 1 min during filling and voiding segment: 120x128 matrix. STATICS:= 120 sec images, bladder at full capacity and post- void. Indirect: flow and static images during void and post void.

Question 661

Radionuclides Cystography (Direct and indirect): Instrumentation: Data analysis: Normal:

Answer 661

No visualization of reflux of solution and tracer past bladder during filling and/ or voiding. All or nearly all solutions is voided from bladder.

Question 662

Radionuclides Cystography (Direct and indirect): Instrumentation: Data analysis; Abnormal:

Answer 662

 significant activity in activity in upper urinary tracts during filling, at full capacity, and /or while voiding. This will visualize as a spot or in elongated activity in one or both of your ureter‘s just above the bladder. Reflux is associated with causing UTI’s particularly in peds patients. Reflex usually resolves itself however, it is potential damaging to kidneys. Reflex nephropathy usually develops in infants or early childhood, low grade reflux more likely to resolve than higher grade. Bacterial infections of the kidneys may present with a fever, leukocytosis and bacteremia. Bacterial nephritis may present with only fever and leukocytosis. This test could help distinguish between lower and the more serious upper tract infections.

Question 663

Radionuclides Cystography (Direct and indirect):

Answer 663

Ancillary equipment: gamma camera.

Question 664

Abscess/ infection procedure: Gallium Scan: Radiopharmaceuticals: Selection:

Answer 664

Gallium citrate (Ga-67):

Question 665

Abscesses/infection procedures gallium scan. Radiopharmaceuticals. Dosage

Answer 665

3-6 mCi for inflammation, 8-10 mCi for tumors.

Question 666

Abscesses/infection procedures gallium scan. Radiopharmaceutical. Administration.

Answer 666

Iv straight stick or because of the amount, a butterfly and three way stop cough with flash.

Question 667

Abscesses/infections procedures gallium scan radiopharmaceutical.Biodistribution:

Answer 667

Avidly binds to iron- binding proteins; competes for iron sites in transference and is absorbed by lysosomes and endopladasmic reticulum of WBC’s.

Question 668

Abscess/infection procedure gallium; patient preparation: Indicators:

Answer 668

Evaluation of fever of unknown origin, chronic inflammations (abscesses), pulmonary disorder, lymphocytic or granulomatoys inflammation ( sarcoidosis, tuberculosis) immunodeficiency disorder (AIDS), detection of myocardial or pericardial inflammation, follow-up of retroperitoneal fibrosis, localization of osteomyelitis and/ or disk space infection, tumors and abnormal results on related studies.

Question 669

Abscess/infection procedures: gallium scan. Patient preparation.contraindications:

Answer 669

Patients having other nuclear medicine studies during the same time period. Patient cannot have contrast, x-ray, CT, MRI with gadolinium) during the same period.

Question 670

Hofsess/infections procedures gallium scan. Patient preparation. Pregnancy and nursing.

Answer 670

N/A

Question 671

Abscesses/infections procedures gallium scan. Patient preparation: Dietary Restrictions:

Answer 671

N/A

Question 672

Abscesses/infection procedures gallium scan. Patient preparation: Adverse reactions/artifacts:

Answer 672

MRI gadolinium admin within 24 hours of gallium injection may decrease location, recent blood transfusions will saturate iron- binding transferrin sites, patient motion, article in clothing and prostheses may cause attenuation, patient not void before scan; activity could mask ROI. False positive possible from bowel. (also false-negatives),spleen, spine or bladder activity, bone repair activity around orthopedic hardware/prosthetics.

Question 673

Abscesses/infection procedures gallium scan. Patient preparation medications:

Answer 673

N/A

Question 674

Abscesses/infection procedures gallium scan. Patient preparation :Age specific/other considerations:

Answer 674

Study should be done prior to chemotherapy or after 3 weeks past last course.

Question 675

Obsess/infection procedures gallium scan. Patient preparation lab values.

Answer 675

Physician Well do labs before test.

Question 676

Abscesses/infection procedures gallium scan: imaging Techniques: Anatomical Landmarks:

Answer 676

Whole body:

Question 677

Abscesses/infection procedures gallium scan. Imaging Techniques: views

Answer 677

ANT / POST Head, thorax, abdomen,pelvis,mid-femur; Also ANT . OBL, ROI, Also ROIs.

Question 678

Abscess/infection procedures gallium scan: imaging Techniques: patient Director orientation.

Answer 678

Supine

Question 679

Obsess/infection procedures gallium scan. Imaging Techniques:

Answer 679

Supine

Question 680

Abscess/infection procedures gallium scan. Imaging Techniques: Fusion Imaging:

Answer 680

N/A

Question 681

Abscess/infection procedures gallium scan. Imaging Techniques: procedures.

Answer 681

Administer injection to patient. Instruct them to return for imaging at designed hours from injection (EX: 6, 24, 48, 72, 96, 120 hours) in accordance with purpose of diagnose age, patient to return home or sent back to hospital room to weight imaging. Struggled return infections six hours, inflammation, abdominal abscess, AIDS patients with fever) 24 hour and occasionally 48 hr. Tumors= 48hr, occasionally 72 and beyond. Instruct patient to void before, lay supine and check for any attenuating materials. Obtain. STATICS: ( ANT/POST of head, thorax, abdomen, pelvis, mid-femur; ANT of extremities, OBL of ROI, axillae for history of lymphoma). Collect 600,000 to 1,000,000 counts according to protocol. Whole-Body sweep: Head to at least mid-femur. SPECT: center ROI(s).

Question 682

Abscess/infection procedures gallium scan imaging Techniques: instrumentation: Detector System:

Answer 682

Medium to high energy; parallel hole.

Question 683

Obsess/infection for seizures gallium scan.Instrumentation: Data Acquisition:

Answer 683

STATICS: peak for gallium, windows at 25%, 1,000,000 counts/image. Whole Body: 10 cm/min. SPECT: 360,64 stops, 20-25 sec/stop; ROI centered.

Question 684

Abscess /infection; procedures: gallium scan: Instrumentation: Data analysis: Normal:

Answer 684

20-25% administered dose via a kidneys in first 12 -24 hours. After which, the major route is intestinal mucus. This amounts ;of approximately 1/3 of the injected dose, the remaining 2/3’s is retained for a prolonged. Soft tissue activity at six in 24 hours, renal activity at 24 hours. Bull activity will move over time. Lactoferrin content visualizes lacrimal glands, salivary glands( prominent after rad therapy), external genitalia, breast, nasopharynx, bone marrow, spleen and liver ( most prominent). Some early activity in osseous structures, diffuse lung activity, thymus, surgical wounds and in children ( epiphyseal plates,thymus and spleen). At 48 hours and beyond , renal/lung activity light, lacrimals/salivates light,liver/colon/spine/sternum, genitalia still present.

Question 685

Abscess/infection Procedure: gallium scan: Instrumentation: Abnormal:

Answer 685

Inflammations show up as hot spots within 6 hours; 6hours scan is also good for abdominal abscess. Any Bowel activity in the 4/6 hour scan is significant in patients with AIDS who have a fever. Persistent focal or diffuse non-moving activity in delayed imaging. Large hemangiomas present as cold spots; benign sarcoidosis present as intense uptake Organs, lung activity that persists; can show AIDS related pulmonary infections especially when compared with a recent chest x-ray. Neoplasia(tumors) associated with Hopkins disease, hepatomas from alcoholism cirrhosis, and malignant melanomas of bone, brain and lung as increase focus or the fusion activity. Persistent renal activity at 48 hours may indicate hypertension pyelonephritis or interstitial nephritis; 72 hours may indicate inflammation, infection, acute tubular necrosis, acute pyelonephritis, impaired renal function, etc. increased parotid or lacrimal uptake could be sarcoid activity or Sjögren’s syndrome.

Question 686

Absence/infection procedure gallium scan.instrumentation: Ancillary Equipment:

Answer 686

Gamma camera

Question 687

Bone Scan: (Skeletal Imaging): Radiopharmaceuticals: Selection:

Answer 687

Tc-99m MDP or HDP

Question 688

Bone Scan(Skeletal imaging): Radiopharmaceuticals: Dosage :

Answer 688

20-30 mCi, peds by weight

Question 689

Bone Scan(Skeletal imaging): RAS: Administration:

Answer 689

Intervenors = straight stick, butterfly or existing catheter with saline flush. Flow requires fast bolus injection:

Question 690

Bone(Skeletal Imaging): Radiopharmaceuticals: Biodistribution:

Answer 690

Chemisorption, chemically bonds on surface of hydroxyapatite crystals. Process of osteoblastic activity of bone repair.

Question 691

Bone y( Skeletal Imaging): patient preparation: Indicators:

Answer 691

Detection of primary and staging metastatic disease ( types known; bone, breast, lung ,(prostate kidney). Evaluation of neoplasm or known lesions. Differentiation of mono-stoic ( single bone) and polyostocic tumors. Differentiation between osteomyelitis ( bone/bone marrow inflammation) and cellulitis ( cellular/connective tissue inflammation); 3-phase flow study is indicated and a 4- phase includes a 24 hours delay. Evaluation of prosthesis concerning suspected fracture, inflammation and reabsorption by soft bone), osteoporosis and osteomalacia. arthritis/joint disease, bone graft viability, bone surgery, etc.

Question 692

Bone scan(skeletal imaging): patient Preparation Indicators: Contraindications:

Answer 692

Patient who has recently ingested contrast, (particularly barium) for a different study or has one schedule between injections and imaging. Patient who has recently, 24-48 hours, had TC -99m Nuclear medicine scam performed.

Question 693

Bone scan, skeletal Imaging, Patient Preparation pregnancy and nursing

Answer 693

N/A

Question 694

Bone scan(Skeletal Imaging): patient Preparation. Dietary Restrictions.

Answer 694

Instruct patient to drink lots of fluids and urinate often before imaging. Instruct patient to return and 2-4 hours after injection for delay Statics. Whole body or SPECT.

Question 695

Bone scan(skeletal Imaging): patient Preparation.Adverse reactions/artifacts:

Answer 695

Artifacts in clothing, prosthetics bladder may need lead shield or catheterization patient movements are rotations make this tort views, bad tag of radiopharmaceutical Imaging too soon or with the patient not Adequately hydrating may slow excessive activity in the soft tissue,degenerative joint disease/surgery and old trauma may give false-positives scan ordered too early for fractures(usually takes 3 to 5 days to appear).

Question 696

Bone scan(skeletal imaging): patient preparation: medication:

Answer 696

(Drug interactions) Bone visualization decreased = iron containing compounds, phosphate containing Mixtures. Bone uptake increased=( mimics osteomyelitis) calcium gluconate, heparin, meleridine. Breast uptake= estrogens.

Question 697

Bone Scan( Skeletal imaging): Patient preparation: Age specific/other considerations

Answer 697

N/A

Question 698

Bone Scan (Skeletal imaging): patient preparation: Lab Values:

Answer 698

Physician met do labs before test including imaging.

Question 699

Bone Scan ( Skeletal imaging): Imaging Techniques: Anatomical Landmarks

Answer 699

Whole body

Question 700

Bone Scan (Skeletal imaging): imaging Techniques: Views

Answer 700

ANT,POST

Question 701

Bone Scan (Skeletal imaging): imaging Techniques: patient-detector orientation:

Answer 701

Supine

Question 702

Bone Scan ( Skeletal imaging): imaging Techniques: Fusion imaging

Answer 702

N/A

Question 703

Bone Scan (Skeletal imaging): imaging Techniques: Procedure:

Answer 703

Instruct patient to empty bladder, empty pockets, remove anything that can cause artifacts/attenuation. Note location of pacemaker, pumps, colostomy bag, etc. for whole body, place patient supine ( prone, sitting or standing is not common), arms at side, knee pillow and foot band for need. For SPECT, position ROI in center FOV. 3 Phase: Obtain flow and immediate blood pool. Position ROI in view. And jacked radiopharmaceuticals start pictures after slight delay to caption for flow into the ROI, watch for the first sign of blush in the P scope take a little longer for feet or elderly patients. Obtain immediate Blood Paul Imaging after flow, 200,000 -500,000 counts. For extremities,obtain at least immediate blood pool or ROI; also may take images of the nearest joint and LATS. For reflex sympathetic dystrophy (RSD),Obtain flow to wrist, then bilateral statics hands to shoulders. If hands or wrists need to be flowed, consider a foot vein injection. Statics:2-4 hours after injection, 24 hour delays (4th phase) uncommon but can be requested. Extremities: ANT/POST, proximal and distal joints; legs add laterals and medials. With flow, Obtain images the same as with flow. Be sure to include ROI, images to closest proximal joint and lateral/ medials. Whole Body: Statics: 2-4 hours after injection, overlapping images. Sweep, 20-30 min/10-20 cm per min. If anything is visualized that cannot be easily identified or the position assessed, add static OBL and LAT.

Question 704

Bone Scan ( Skeletal imaging): instrumentation: Detector System:

Answer 704

LEAP/LEHR

Question 705

Bone Scan (Skeletal imaging): Instrumentation: Data Acquisition:

Answer 705

Flows: Dynamic,2-4seconds for 60 secs. With immediate blood pool image -500,000 counts. Statics: Extremities, 200,000-300,000 counts. Torso 500,000-800,000 counts. Whole Body: check length of patient, usually 10-14 cm/min, and patient orientation. SPECT: 360*64 stops,20-25sec/stop; ROI centered).

Question 706

Bone Scan (Skeletal imaging): Instrumentation: Data analysis: Normal:

Answer 706

Symmetric,uniform uptake with increased activity in joints, junctions and scapulas. Nasopharynx and soft tissue uptake. Kidneys show lightly, bladder shows brightly. Liver uptake can be a normal variant if there is a slow release or live disease. Epiphyseal plates and cranial sutures show brightly in growing children. The top or front of the cranium will sometimes show increased activity ( hyperostosis frontals internus, not associated with any pathology). Especially in women. Older patients can have a globally poor-quality scan. It usually takes 3-5 days for new fractures to patients can positive but may present early as 24 hours .

Question 707

Bones Scan(skeletal imaging): instrumentation: Abnormal:

Answer 707

Asymmetric, focal areas of increased or decreased activity. Super scan with bone uptake shinning brightly: caused by intense/widespread metastases involvement. Tumors causing this type are prostate,breast, lung renal,bladder or lymphoma. NonTumor: (metabolic disease) causes are hyperparathyroidism, hyperthyroidism, osteomalacia, Paget’s disease or fibrous dysplasia. Paget’s Disease: may present with Halloween mask skull and uptake in sacrum pelvis and long bones. Cold spots: Diminished activity or none is indicative of osteonecrosis, osteoporosis, osteomalacia, multiple myeloma, end-stage cancer, patients with diminished metabolism,renal cell carcinoma, thyroid cancer, anaplastic tumor neuroblastoma. Osteomyelitis: increased in flow, blood pool, and delays. Cellulitis: increased uptake in flow and blood pool with mild or no uptake in delays. Prosthesis: (loosening and/or infection): increased activity around prosthetics on bone surfaces and inside bone surfaces. TC 99MW BC or IN111 WBC or GA 67 scans may help differentiate infection from loosening. Primary malignant tumors. Increase vascular flow, blood Pool and delay focally. Benign primary tumors. Increase blood Pool and delays, focally intense; may have double intensity sign of hot area surrounded by less but increased intensity. Arthritis: presents as increase activity in and around joints and flow, blood Pool and delays. “Donut” sign or lesion usually in cranium looks like a hot halo in skull; could be caused by eosinophilic granuloma, metastasis,sickle cell infarct, Paget’s disease, a vascular necrosis, etc. Heart uptake: Amyloidosis ( soft-tissue deposition of amyloid protein has affinity to bone agents) on a background of tuberculosis, prostate cancer and CAD.

Question 708

Bone Scan ( Skeletal imaging): Instrumentation: Ancillary Equipment:

Answer 708

Gamma camera.

Question 709

Central Nervous System: Brain Scan/ Death: Radiopharmaceuticals: Selection:

Answer 709

(Non-blood-brain barrier(BBB) penetrating) = Tc04 Tc-GH( Glucoheptonate) and DTPA (BBB-penetrating)=TcHMPAO(Ceretec):

Question 710

Central nervous system brain scan/death radiopharmaceutical. Dosage:

Answer 710

15-30mCi

Question 711

Central nervous system brain scan/death radiopharmaceutical: Administration:

Answer 711

Bolus IV

Question 712

Central nervous system brain scan/death radiopharmaceutical: Biodistribution:

Answer 712

Compartmental to blood supply.

Question 713

Central nervous system brain scan/ Death: patient Preparations : Indicators:

Answer 713

Determination of brain death, most common usage of brain flow because other studies and moderations are as good/better for other indicators. Evaluation of blood flow, location of Primary and mastitis tumors, abscesses, subdural hematomas and lesions. Detection of vascular malformations, inflammatory or infectious diseases, cerebrovascular accidents(CVA’s) and transient ischemic attacks (TIAs). Differentiation between contusion from simple concussions or brain tumors from vascular accidents. Evaluation of suspected arteriovenous malformations ( AVMs), surgical procedure, rad therapy, chemotherapy, intracerebral inflammatory or degenerative disease, unexplained neurologic symptoms.

Question 714

Central nervous system brain scan/DEF Patient Preparation: Contraindications:

Answer 714

Patient to agitated or uncooperative to remain still for acquisition. In brain death, metal components of halo exam.

Question 715

Central nervous system brain scan/deaf patient preparation pregnancy and nursing:

Answer 715

N/A

Question 716

Central nervous system brain scan/death patient preparation: Dietary restrictions:

Answer 716

N/A

Question 717

Central nervous system brain scan/death patient preparation: Adverse reactions/artifacts:

Answer 717

The flow is all important. Don’t blow the flow if necessary set for 120 seconds and start as soon as or just before injection. Increase blood pool activity/increased optic superior sagittal sinus and transverse sinuses = aluminum containing antacids, sulfanilamides,pyrophosphates, other Radiopharmaceuticals present in the system. Patient movement, metal plates and respirator or life support equipment attenuation.

Question 718

Central nervous system brain scan/death patient preparation medications:

Answer 718

N/A

Question 719

Central nervous system brain scan/death Patient Preparation: Age specific/ other considerations:

Answer 719

Instruct patient to remain motionless during imaging.

Question 720

Central nervous system brain scans/death lab values:

Answer 720

Physician will probably do blood work before any scans and other tests.

Question 721

Central nervous system brain scan/death imaging Techniques: Anatomical Landmarks:

Answer 721

Position patient supine, camera ANT as close as possible entire cranium in FOV. Head flexed back facing straight up.

Question 722

Central nervous system brain scan/death imaging Techniques: Views:

Answer 722

ANT,POST

Question 723

Central nervous system brain scan/death imaging Techniques: Fusion imaging:

Answer 723

N/A

Question 724

Central nervous system brain scan/death imaging Techniques: Procedure:

Answer 724

Position the patient supine, camera ANT, as close as possible, entire cranium in FOV, head flexed back facing straight up( head is held or strapped in place). Or patient supine, camera posterior, as close as possible entire cranium sinus, head straight up ( head is held or strapped in place). Place a tourniquet or ace bandage around head to limit amount of scalp circulation. Inject good Bolus, start camera immediately. Better too early then too late as flow is extremely important to diagnosis. Obtain at least one blood-pool image in same position at end of flow. Optional views include ANT, POST, R and L, LATS and vertex; 200,000-800,000 CPM. Delays: Patient is returning after 2hours for delayed images of ANT,POST, R and L, LATS and vertex. Radiologist might want them repeat again at four or more hours. With HMPAO, imaging acquired at 15 minutes after injection, SPECT may also be performed if required.

Question 725

Central nervous system brain scan/Death: Instrumentation: Detector System:

Answer 725

LEAP/LEHS ( Flow and Blood Pool) LEAP/LEHR ( delays)

Question 726

Central nervous system Brain scan/death: Instrumentation: Data Acquisition:

Answer 726

2-10sec/frame, 60 secs. (Dynamic) 60 sec/frames for 30 mins.

Question 727

Central nervous system brain scan/death: Instrumentation: Data analysis: Normal:

Answer 727

Flow: 3 phases: Arterial: subclavian, carotid, cerebral arteries visualize symmetrically, Capillary: symmetric diffuse activity in both central hemispheres. Venous: Sagittal sinus and venous sins, activity. (Blood pool) soft tissue and venous sinus activity. (Delays): Depending on view: superior rim, Sagittal sinus, transverse sinus( small or absent left sinus not unusual) occipital sinus, facial vascularity, and salivary increased activity. Cerebral cortex normally devoid of activity.

Question 728

Central nervous system brain scan/death: Instrumentation: Abnormal:

Answer 728

Brain death criteria : Flow no intracranial blood flow( arterial, capillary or venous) from base of skull up. No perfusion with BBB penetrators. Blood pool : No visualization of rural sinus. Occasionally, Sagittal or transverse sinus seem faintly over time b/c of scalp circulation or drainage through basilar system. In ped patients, sutures may visualize b/c of diminished bkg. Hot nose Effects: Blood flow is blocked in the internal carotid arteries, shunted to the external carotid arteries, increasing blood flow in the nasal/sinus area presenting on the anterior flow as a hot nose, Other ( look for areas of increased uptake, “doughnuts “ sign lack of uptake, or diminished flow) or abdominal appearance to vascularity. Asymmetric flow. “Flip - flop” sign one side visualizing then the other. Blood pool : focal area(s) of increased or decreased uptake persist and/ or abnormal appearance to vascularity. Delays: Focal area(s) of increased or decreased uptake persist. Perhaps visual of new areas not present on initial dynamic study.

Question 729

Central nervous system brain scans/death: Instrumentation: Ancillary Equipment:

Answer 729

Gamma camera.

Question 730

Cisternography/CSF/Shut Patency: Radiopharmaceuticals: Selection:

Answer 730

In-111 DTPA and Tc- 99 m DTPA

Question 731

Cisternography/CSF/Shut Patency: Radiopharmaceuticals: Dosage /

Answer 731

In-111: 0.5-1.5 mCi,TC-99m: 0.4-12mCi.

Question 732

Cost/CSF/shunt Patency: Radiopharmaceuticals: Administration:

Answer 732

Spinal needle, intrathecal injection ( lumber puncture: slowly into the subarachnoid space of lumbar,spine usually performed by radiologist) patient must lay flat for at least 2 hours post- injection

Question 733

Cisternography/CSF/Shunt Patency: Radiopharmaceuticals: Biodistribution:

Answer 733

Blood flows

Question 734

Cisternography/CSF/Shunt Patency: Patient Preparation: Indicators:

Answer 734

Evaluation of CSF in the spinal column and brain, detection of CSF leak( rhinoceros or otorrhea), evaluation of normal pressure hydrocephalus ( patient should have clinical evidence of dementia, dysphasia ( disturbance in programming, control and execution of conscious movement) and incontinence),evaluation/detection of obstructive hydrocephalus, ventriculopertoneal (VP) or ventricular ray (VA) shunt obstruction or Patency.

Question 735

Cisternography/CSF/Shunt a Patency: Patient Preparation: Indicators: Contraindications:

Answer 735

N/A

Question 736

Cisternography/CSF/Shunt Patency: patient preparation: Pregnancy and nursing

Answer 736

N/A

Question 737

Cisternography/CSF/Shunt Patency: patient preparation: Dietary Restrictions:

Answer 737

N/A

Question 738

Cisternography/CSF/Shunt Patency: Patient Preparation: Adverse reactions/ artifacts:

Answer 738

Injection into spinal fluid is difficult and often missed, patient’s monitor to a minimize necklace metal plates in head or metal glasses may give artifacts.

Question 739

Cisternography/CSF/Shunt/Patency: patient preparation: Medications:

Answer 739

N/A

Question 740

Cisternography/CSF/shunt/ Patency: Patient preparation: Age specific/ other considerations:

Answer 740

Instruct patient to remain horizontal for two hours after injection to minimize headaches from CSF leak.

Question 741

Cisternography/CSF/ Shunt Patency: patient preparation: LAB Values:

Answer 741

Physician met have done before test or scans.

Question 742

Cisternography/CSF/Shunt Patency: Imaging Techniques: Anatomical Landmarks:

Answer 742

Position patient supine with camera ANT ( generally). To image injection site if extravasation suspected, place patient in a lateral decubitus position; obtain image at injection site 5-30mins. Repeat delays images at 4,24,48 and 72 hours. At 2hours.

Question 743

Cisternography/CSF/Shunt Patency: Imaging Techniques: Views:

Answer 743

ANT, LAT and Vertex, Sometimes POST.

Question 744

Cisternography/CSF/Shunt Patency: Patient Detector Orientation:

Answer 744

Supine If extravasation suspected, lateral decubitus. Position:

Question 745

Cisternography/CSF/Shunt Patency: Imaging Techniques: Fusion imaging:

Answer 745

N/A

Question 746

Cisternography/CSF/Shunt Patency: Imaging Techniques:

Answer 746

``` Patient is injected by physician with patient in left or right lateral decubitus position. Position patient supine with camera ANT (generally). To image injection site if extravasation suspected,place patient in a lateral decubitus position; obtain image at injection site for 5-30 mins. Obtain vies including POST of the spinal column and skill. Obtain repeat delayed images at 4,24,48 and 72 hours. If there is little or no activity at 2 hours after injection, obtain image of injection site, to confirm extravasation, which if confirmed, study may be terminated. CSF leaks ( otorrhea rhinorrhea) Pledge (cotton 1.5x1.5cm) bilaterally inserted by otolaryngologist (ENT) either before injection or within 1 hr after. Suggested placements are at both cribriform plates, at each sphenoethmiod recess under the middle turbinate and the Buffalo mucosa (underside of tongue) for a control (counted to use for black ground). Image injection site shortly after injection to confirm success. Place in separate labeled pre- weighed tubes; separately weigh, subtract tube weight and counter. Count all tubes the same amount of time, about 10 mins. If leak is suspected, 24 hr images can be performed with or without new pledget placement/counting. POST images should be added if leak presents in other images. ```

Question 747

Cisternography/CFS/Shunt Patency: Instrumentation: Detector System:

Answer 747

In-111= Parallel hole, Tc-99m= LEAP/LEHR:

Question 748

Cisternography/CSF/ Shunt Patency: Instrumentation: Data Acquisition:

Answer 748

Statics: 500,000-200,000 counts per image.

Question 749

Cisternography/CSF/Shunt Patency: instrumentation: Data analysis: Normal:

Answer 749

Activity appears in Basel cisterns by 3 hours after injection, then enters inter-hemispheric and Sylvia’s fissures forming Neptunes Tris I’m irate or Viking helmet flow over cerebral convexities to the sagittal sinus and activity in the basal cisterns should begin to clear by 24 hours. No reflex into ventricles is seen, although transient reflex at 12-24 hours is not considered significant. Shunt Patency: Using Tc-99, with manual pressure on the distal limb,After injection into port, there should be promptly visual of activity in ventricle. When manual pressure is released from distal limb,there Should be print passage of radio-tracer though distal limb. For a VP shunt, the radio-tracer reaches the systemic circulation and visualizes in kidneys. With In-111, rph will show an area of increased activity particularly on the side of the shunt and more identifiable in 48/72 hr delays as there is an increase in target to background ratio/more time for movement to that area. Leakage(otorrhea or rhinorrhea): Ratio of pledget to plasma.

Question 750

Cisternography/CSF/ Shunt: Patency: Instrumentation: Abnormal:

Answer 750

Persistence of activity in lateral ventricles is abnormal. Ascent over the cerebral convexities is markedly delayed. Hydrocephalus (enlargement of the ventricles): Increase in CSF volume caused by overproducing, decreased absorption blockage of flow or Cerebral atrophy. Non-obstructive= cerebral atrophy; Obstructive = communicating obstructive = era ventricular blockage(EX cisterns or villi). Normal pressure hydrocephalus ( look for dementia, gait disorder,urinary incontinence)= ventricle reflux that persists on 24, 48, even 72 hr imaging ; urinary incontinence)= leakage (otorrhea or rhinorrhea), it is considered significant leakage and positive if ratio of pledget to plasma activity is greater then 1.5/1. Leak should have corroborating images and pledget help localize leak.

Question 751

Cisternography/CSF/Shunt Patency: Ancillary Equipment:

Answer 751

Gamma camera

Question 752

Lung : Radiopharmaceuticals: Selection:

Answer 752

Tc-99m MAA

Question 753

Lung Radiopharmaceuticals: Dosage:

Answer 753

2-6mCi

Question 754

Lung Radiopharmaceuticals: Administration:

Answer 754

Patient supine; IV injection or if existing IV catheter, slowly, flush heavily with saline only ( MAA and heparin do not mix). No reblush or blood in the hub of the needle ( it may clot and cause a hot spot or flase-positive). Lift injecting through any indwelling catheter that contains a filter or chemo line.

Question 755

Lung: Biodistribution:

Answer 755

Blood flow to pulmonary capillary or arteriolar embolism

Question 756

Lung: patient Preparation: Indicators:

Answer 756

Evaluation for pulmonary embolism (PE,main cause of deep vein thromboses, DVTs), clots from recent surgery or trauma. If perfusion defects match with same areas as ventilation defects, chronic obstructive pulmonary disease (COPD) is the diagnosis. If defects mismatch, PE is the diagnosis. A reverse mismatch is most common due to atelectasis ( collapsed lung). Evaluation of pulmonary perfusion, chest pain, SOB, low blood oxygen saturation management of carcinoma , perfusion affected by emphysema, chronic bronchitis, asthma, inflammatory disease, detection of right to left cardiac shunt, lungs for per/post-surgery and lung transplantation.

Question 757

Lung: patient preparation Indicators: Contraindications:

Answer 757

Should not be performed on patients with pulmonary hypertension, dose must be adjusted down If to do be done studies on patients with knowledge activity pneumonia or other known debilitating lung disease will yield a non-determinable result for PE. Right to left shunts unless it is the reason for scan. Hypersensitivity to human serum albumin.

Question 758

Lung: patient Preparation: Pregnancy and nursing:

Answer 758

N/A

Question 759

Lung patient Preparation: Dietary Restrictions:

Answer 759

N/A

Question 760

Lung: patient preparation: Adverse reactions/artifacts:

Answer 760

Indeterminant lung scan if>75% of a lung zone has obstruction lung diseases. Turn syringe before injection to mix MAA in dose. Do NOT pull blush back and reinject next as hot spots may occur b/c of radioactive clots injected into system; patient should be injected supine to avoid gravity fill of lower lobes. Jewelry, buttons items in shirt pockets can cause artifacts. Test on patients with known compromised pulmonary function( disease,shunting,arteriole malformations,liver disease) or one lung must be performed with a reduced tracer ( hence reduced number of injected particles)