ST:8 Flashcards
Caffeine is contraindicated for which of the following interventional pharmacologic agents?
(a)CCK
(b) adenosine
(c) insulin
(d) furosemide
(e) captopril
(b) Products that contain methylxanthine should be held at least 12 hours before administration of adenosine. Products that contain methylxanthine include caffeine, theophylline, and theobromine.
The recommended dosage of adenosine is:
(a)140 mcg/kg/min
(b) 14 mcg/kg/min
(c) 1.4 mcg/kg/min
(d) 1,400 mcg/kg/min
(e) 14,000 mcg/kg/min
(a) Adenosine should be administered using an infusion pump and given at a rate of 140 ug/kg/ min over the source of 6 minutes.
An adult patient who has been administered adenosine starts to break out in hives and suddenly passes out, what is the first thing you should do?
(a)Shake the person and shout, “Are you okay?”
(b) Call a code.
(c) Check for a pulse.
(d) Give 2 breaths.
(e) Give 30 chest compressions.
(a) The technologist should activate the emergency response system. The first step in this situation for the healthcare provider is to verify victim unresponsiveness. This is usually done by the “shake and shout” approach.
The process of eluting a dry 99Mo/99mTc generator relies on:
(a)positive pressure
(b) neutral pressure
(c) negative pressure
(d) electrical conductivity
(e) magnetic resonance
(c) The dry column generator uses up to a 20 mL saline charge that is applied to the exterior of the generator system. An evacuated vial is placed on the collection port and draws saline from the saline charge over the column through negative pressure to produce the yield product.
If the results of a 99Mo/99mTc generator Moly breakthrough test are 1.2 Ci of 99mTc and 25 uCi of 99Mo, what is the approximate ratio of 99Mo to 99mTc for a Moly breakthrough determination?
(a)0.02
(b) 48
(c) 20.8
(d) 0.048
(e) 50
(a) Mo/Tc =
25 uCi 99Mo/ mCi 99mTc
0.025 uCi 99Mo / 1.2 Ci 99mTc = 0.02
The USP has set the aluminum breakthrough for a 99Mo/99mTc generator at or below what amount?
(a)10 ug/mL
(b) 100 ug/mL
(c) 10 ug/ul
(d) 100 ug/uL
(e) 0.15 ug/uL
(a) The U.S. Pharmacopeia has set the concentration limit for Al3+ to be no greater than 10 ug/mL of the eluate.
What is the approximate dose range for a 99mTc sulfur colloid gastric emptying study?
(a)1-5 mCi
(b) 1-5 uCi
(c) 2 uCi - 200 uCi
(d) 500 uCi - 1 mCi
(e) 10 - 15 mCi
(d) Part of the standard meal given to teh patient for the gastric emptying study is the mixture of 500 uCi to 1 mCi of Tc99m sulfur colloid with liquid egg whites.
When performing a 3-phase bone scan, when should imaging begin?
(a)immediately upon injection
(b) 2 hours post-injection
(c) 10 minutes post-injection
(d) 24 hours post-injection
(e) There are no imaging requirements for a 3-phase bone scan.
(a) The radiopharmaceutical should be administered via bolus injection. Dynamic images of the blood flow are acquired immediately upon injection and continuing for at least 1 minute after.
The color and clarity of which the following radiopharmaceuticals would be expected to be turbid and white?
(a)99mTc-MDP
(b) 99mTc-Hida
(c) 99mTc-MAA
(d) 99mTc-SC
(e) 99mTc-HMPAO
(c) The normal color and clarity of reconstituted 99mTc-MAA is turbid and white in appearance.
If the bound radiochemical purity % is 92% and the hydrolyzed % is 3.2%, what amount of free 99mTc is in the product?
(a)92%
(b) 3.2%
(c) 4.8%
(d) 2.3%
(e) 8.1%
(c) 100% - 92% radiochemical purity - 3.2% hydrolyzed product = 4.8% free 99mTc
A radiopharmaceutical kit has to be made up (reconstituted) at 0800. Given the following information, what approximate amount of 99mTc-TcO4 and saline would be needed to make up the kit?
99Mo/99mTc Generator Eluate: 850 mCi in 20 mL at 0600
Preservative-free Saline: 50 mL available
Package Insert Kit Preparation information: 8 mL kit with 65 mCi of 99mTc needed at reconstitution
(a)2 mL eluate and 6 mL saline
(b) 6 mL eluate and 2 mL saline
(c) 1.5 mL eluate and 6.5 mL saline
(d) 6.5 mL eluate and 1.5 mL saline
(e) 1.7 mL eluate and 6.3 mL saline
(a) 850 mCi 99mTc / 20 mL saline = 42.5 mCi/mL at 0600
Decay-correct for 2 hours for 99mTc
Decay factor = A = Ao x 0.5^(t/T1/2)
A = 42.5 mCi/mL x 0.5^(2hr/6hr) = 33.73 mCi/mL at 0800
65 mCi 99mTc needed at 0800 / 33.73 mCi/mL at 0800
= approximately 2 mL of 99mTcO4-
Total volume needed = 8 mL. Therefore, 8 mL - 2 mL = 6 mL saline needed.
A patient dose is needed at 1300, based on the information provided below, what approximate volume would be needed for this 99mTc-based product?
RP Kit equals 150 mCi in 6 mL at 0900, dose needed at 1300 is 25 mCi
(a)2.6 mL
(b) 1.0 mL
(c) 0.63 mL
(d) 1.6 mL
(e) 0.4 mL
(d) 150 mCi 99mTc / 6 mL saline = 25 mCi/mL at 0900
Decay-correct for 4 hours for 99mTc
Decay factor = A = Ao x 0.5^(t/T1/2)
A = 25 mCi/mL x 0.5^(4hr/6hr) = 15.7 mCi/mL at 1300
25 mCi 99mTc needed at 1300 / 15.7 mCi/mL at 1300 = approximately 1.6 mL of 99mTc needs to be drawn.
For a 90Y ibritumomab tiuxetan monoclonal antibody therapy, the prescribed dose is 25.6 mCi, according to NRC and CFR regulations what would be the approximate dose range for this radioimmunotherapy?
(a)20.5-30.7 mCi
(b) 23.2-28.4 mCi
(c) no more than 32 mCi
(d) no less than 15 mCi
(e) 0-32 mCi
(a) Therapeutic dose should not differ from +- 20% of prescribed dose.
When using 51Cr for red blood cell labeling, what mechanism binds 80-95% of the chromate ion after 30 minutes of incubation?
(a)liver to splenic involvement traps annealed red blood cells
(b) compartmentalization of hemoglobin ion chain
(c) active transport through blood-brain barrier
(d) chromate ion is transported across red cell membrane and binds to alpha chain of hemoglobin molecule
(e) chromate ion is transported across red cell membrane and binds to beta chain of hemoglobin molecule
(e) When labeling RBCs with 51Cr ascorbic acid, approximately 80% to 95% of the chromate ion is promptly transported across the RBC membrane and binds to the beta chain of the hemoglobin molecule.
To determine plasma volume using 125I human serum albumin, one technique is to collect three 10 mL heparinized blood samples at what time intervals post-injection?
(a)1, 3, and 5 minutes
(b) 5, 10, and 15 minutes
(c) 10, 20, and 30 minutes
(d) 20, 30, and 40 minutes
(e) 30, 60, and 90 minutes
(c) Three 10 mL heparinized blood samples are collected at exactly 10, 20, and 30 minutes after injection from a venous site other than the injection site.
If the clinical indication for a study was evaluation of an abnormal thyroid serum laboratory result, the proper nuclear medicine procedure would be a:
(a)pancreatic scan
(b) thyroid uptake
(c) pituitary scan
(d) liver uptake with GFR determination
(e) GBEF
(b) Thyroid iodine uptake (24-hour iodine uptake) is a frequently requested nuclear medicine procedure to assess or confirm thyroid function particularly in patients suspected of having hyperthyroidism based on either symptoms or confirmatory laboratory test, especially suppressed TSH. Elevated levels of TSH are suggestive of hypothyroidism.
The SNMMI Pediatric Tool Kit recommended dosage of [18F]FDG for brain imaging in pediatric patients is 0.10 mCi/kg. If a pediatric patient weighs 45 lbs, what approximate dose should the patient receive?
(a)20 mCi
(b) 2.0 mCi
(c) 4.5 mCi
(d) 45 mCi
(e) 0.20 mCi
(b) 45 lbs / 2.2 lbs/kg = 20.45 kg
20. 45 kg x 0.1 mCi = approximately 2.0 mCi [18F]FDG
An adjunctive medication of furosemide is needed for a renal study. The prescribed dosage is 0.1 mg/kg as a bolus injection. If the dose is supplied as 25 mg/mL and the patient weighs 377 lbs, what approximate volume is needed for the patient dose?
(a)0.69 mL
(b) 6.8 mL
(c) 1.5 mL
(d) 0.15 mL
(e) 4.2 mL
(a) 377 lbs / 2.2 lbs/kg = 171.36 kg
171. 36 kg x 0.1 mg/kg = 17.136 mg needed
17. 136 mg needed / 25 mg/mL = 0.69 mL needed
What is a radiopharmaceuticals that can be used for a brain perfusion study?
(a)[111In]WBCs
(b) [99mTc]RBCs
(c) [99mTc]MAA
(d) [99mTc]sulfur colloid
(e) [99mTc]bicisate
(e) The two primary radiopharmaceuticals used for brain perfusion imaging are 99mTc-exametazime (HMPAO) and 99mTc-bicisate (ECD).
Which of the following radiopharmaceuticals would be used for a bone marrow evaluation?
(a)[111In]WBCs
(b) [99mTc]RBCs
(c) [99mTc]MAA
(d) [99mTc]sulfur colloid
(e) [99mTc]bicisate
(d) The radiopharmaceutical used for evaluation of bone marrow is 99mTc-sulfur colloid, Filtered or unfiltered sulfur colloid can be used.
As osteoclastic activity increases in relationship to osteoblastic activity, bone deposition:
(a)increases
(b) decreases
(c) stays constant
(d) forms new osteoclasts
(e) forms new osteoblasts
(b) Osteoblasts are associated with bone growth, and osteoclasts are associated with absorption and removal of bone. Bone has a constant cycle of absorption and growth.
Hydroxyapatite salts of the bone consist of:
(a)stannous pyrophosphate
(b) calcium, strontium, phosphorus
(c) phosphorus and hydroxide
(d) calcium phosphate and calcium carbonate
(e) phosphoric calcium and methyl hydroxide
(d) The bone salt material (inorganic matter) has the crystalline form of an apatite and is composed of the following ions: calcium, phosphate, hydroxyl, carbonate, and citrate.
A 49-year-old female patient receives 25 mCi of 99mTc-MDP for a bone scan. The organ receiving the greatest radiation dose from this injection is:
(a)bones
(b) kidneys
(c) bone marrow
(d) bladder
(e) liver
(d) The bladder wall receives the most radiation dose with the bladder wall - approximately 2.6 rads / 20 mCi at 2 hours.
Bone cancers, bone metastases, and other bone disorders produce extremely high levels of _____ in the blood.
(a)lactic dehydrogenase
(b) alkaline phosphatase
(c) amylase
(d) creatinine kinase
(e) calcium
(b) Patients with osseous metastasis may present with elevated alkaline phosphatase with approximately 77% occurrence.
Normal renal function can be indicated on a bone scan by:
(a)equal kidney activity that is less than bone activity
(b) equal kidney activity that is significantly more intense than bone activity
(c) absence of kidney activity
(d) absence of bladder activity
(e) absence of kidney and bladder activity
(a) 99mTc-MDP or 99mTc-HMDP are excreted via the urinary system and visualization of the kidneys is common. This activity is variable but is usually less than the surrounding bone activity. Kidney diseases is associated with pronounced asymmetry of renal activity.
Visible rib lesions that are arranged in a linear fashion are generally indicative of:
(a)rib metastases
(b) rib trauma
(c) inflammation of the lungs
(d) contamination
(e) lung infiltrates
(b) Rib fractures almost always show intense activity and can often be recognized by their location in consecutive ribs.
Which of the following is the device used to convert scintillation light into an electric signal in a CT scanner?
(a)photomultiplier tube
(b) analog to digital converter
(c) Xenon chamber
(d) photodiode
(e) cathode
(d) Scintillation detectors use solid-state photodiodes to play the role of the photomultiplier tube (PMT) in Gamma Cameras. Photodiodes absorb the scintillations given off by the crystal and, in response, they emit an electric signal.
A bone scan of a 60-year-old female demonstrates a diffuse pattern of intensely increased activity in the skull, proximal femurs, and one side of the pelvis. This appearance is typical of what disease process?
(a)Ewing’s sarcoma
(b) multiple myeloma
(c) Legg-Perthe’s disease
(d) renal failure
(e) Paget’s disease
(e) Paget’s disease is characterized by marked increase in skeletal uptake. Most-common areas are pelvis, spine, skull, femur, scapula, tibia, and humerus.
What portion of the ECG wave represents the depolarization of the ventricles?
(a)P-wave
(b) T-wave
(c) U-wave
(d) QRS complex
(e) ST segment
(d) The QRS complex indicates depolarization of the ventricles.
Dipyridamole is supplied to a nuclear medicine department in 10 mL vials, each containing 50 mg. If a patient weighs 155 pounds, how many mL must be injected for the patient to receive 0.56 mg/kg
(a)7.9 mL
(b) 8.7 mL
(c) 17.4 mL
(d) 39.5 mL
(e) 5.3 mL
(a) 155 lbs / 2.2 lbs/kg = 70.45 kg
70.45 kg x 0.56 mg/kg = 39.45 mg needed
50 mg / 10 mL = 5 mg/mL
39.45 mg needed / 5 mg/mL = approximately 7.9 mL needed
A patient has an enlarged left atrium. When drawing an ROI for calculation of LVEF after radionuclide ventriulography, the technologist includes some activity from the left atrium. The resulting ejection fraction would:
(a)be unchanged
(b) be falsely elevated
(c) be falsely lowered
(d) show akinesias
(e) show paradoxical wall motion
(c) Non-superimposed but adjacent extracardiac activity may also cause a negative reconstruction artifact, resulting in an apparent reduction in activity in the adjacent myocardial segment.
Which of the following is the most likely cause of false anterior or lateral wall defects on myocardial perfusion imaging?
(a)center of rotation error
(b) respiratory motion
(c) too few projections
(d) attenuation by breast tissue or implant
(e) multiple pulmonary emboli
(d) The combination of prone and supine imaging is useful in distinguishing inferior wall defects from diaphragmatic attenuation, anterior wall defects from breast attenuation, and lateral wall defects from attenuation caused by excessive lateral wall fat.
Why is it necessary to inject two doses of 99mTc-sestamibi for a myocardial perfusion study, including both stress and rest conditions?
(a)The physical half-life of 99mTc is too short to obtain both image sets from one injection.
(b) The effective half-life of 99mTc is too short to obtain both image sets from one injection.
(c) There is not redistribution of 99mTc-sestamibi within the myocardium
(d) Sestamibi is not retained by the myocardium fro a sufficient amount of time.
(e) Images would be degraded on stress images after exercise.
(c) Like [201Tl]thallous chloride, 99mTc-sestamibi is taken up by the myocardium in proportion to blood flow. Unlike [201Tl]thallous chloride, they passively diffuse across the cell membrane, bind to mitochondria, and exhibit limited redistribution. Because of the limited redistribution, one-day protocols require a low-dose/high-dose, two-injection procedure.
When performing a dual isotope myocardial perfusion rest/stress study, which isotope should be injected first?
(a)201Tl
(b) 99mTc
(c) 18F
(d) It does not matter which is injected first, as long as the patient is fasting.
(e) 11C
(a) 3-4 mCi (11-148 MBq) of [201Tl]thallous chloride is administered at rest and images are obtained about 15 minutes later. About 30 minutes after the rest images are completed, the stress portion of the exam - either via treadmill or pharmacologically - is performed with 25-30 mCi of the 99mTc agent.
Persistent pulmonary activity and poor visualization of the left side of the heart represent _____ during a first pass evaluation.
(a)a ventricular aneurysm
(b) a left-to-right intracardiac shunt
(c) a right-to-left intracardiac shunt
(d) a pulmonary embolism
(e) primary pulmonary hypertension
(b) Persistent pulmonary activity and poor visualization of the left side of the heart represent a left-to-right intracardiac shunt during a first-pass evaluation.
Captopril renal scans are commonly ordered to evaluate:
(a)renal failure
(b) renal hypotension
(c) renal hypertension
(d) GFR
(e) ERPF
(c) The use of captopril has an effect on the renogram in patients with unilateral renovascular hypertension. The precaptopril renogram shows normal time course of activity in the right and left kidneys. In the post-captopril renogram, the kidney affected by renal artery stenosis is greatly diminished because of the reduced filtration pressure induced by captopril’s inhibition of angiotensin II production.
The appearance of a renal cyst on a radionuclide scan would most likely:
(a)be more perfused than the surrounding kidney
(b) be photopenic, compared to surrounding kidney
(c) cause the surrounding kidney to take up more tracer than the other kidney
(d) be about the same activity as the surrounding kidney
(e) vary greatly depending on patient weight
(b) Masses not representing renal paraenchyma, such as neoplasms, abscess, cysts, hematoma, or infarcts, present as photopenic lesions in the renal paraenchyma.
Which of the following is used to minimize scatter radiation from tissues beyond the relevant anatomical slice in a CT scanner?
(a)bow-tie filter
(b) analog to digital converter (adc)
(c) grid
(d) rotating target
(e) collimator
(e) Pre-patient collimators define and shape the beam according to the procedure by physically restricting the x-ray beam to the selected slice thickness. This protects the patient from excess radiation and minimizes scatter radiation from tissues beyond the relevant anatomical slice.
All of the following are necessary for an effective renal plasma flow camera method calculation, EXCEPT:
(a)pre-injection syringe counts
(b) post-injection syringe counts
(c) patient height
(d) patient weight
(e) blood draw of at least 1 cc
(e) Camera-based calculations of effective renal plasma flow are not as accurate but require pre- and post-injection syringe counting, imaging, and patient height and weight. No blood draw or urine collection is required.
Pulmonary blood flow in a person sitting in an upright position will be:
(a)more abundant in the base of the lungs
(b) more abundant in the apex of the lungs
(c) more abundant posteriorly than anteriorly throughout the lungs
(d) more abundant anteriorly than posteriorly throughout the lungs
(e) uniformly distributed throughout the lungs
(a) In a normal, upright patient, both ventilation and perfusion increase progressively from the lung apex to the bases. This gradient is more pronounced for perfusion. This is why MAA injections are performed with the patient supine.
