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HSC4020 Nuclear Med > Week 2 Part 1 > Flashcards

Week 2 Part 1 Flashcards

(134 cards)

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1
Q

What radiopharmaceuticals used in bone scans

A

MDP, HMDP

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2
Q

MDP

A

Methylene diphosphonate

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3
Q

HMDP

A

Hydroxymethylene diphosphonate

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4
Q

Radiation dose of bone scans

A

15 - 25 mCi

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5
Q

Purpose of bone scans

A

Cancer staging and detection

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6
Q

Procedure for bone scans

A

Inject IV > wait 3 hours to excrete tracers > scan

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7
Q

Localization mechanism of bone scans

A

MDP / HDMP binds to calcium crystals.

If injured or high metabolism, more crystals formed, more MDP / HDMP localized

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8
Q

How are abnormalities seen in bone scans

A

Hot spots which show increased radioactivity

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9
Q

Where is the normal distribution of tracers in bone scans

A

Bone, kidneys and bladder

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10
Q

Which is excreted faster: MDP or HDMP

A

HDMP

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11
Q

Blood pool imaging is done using ___

A

MUGA with labelled RBCs

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12
Q

Procedure for blood pool imaging

A

Inject SnCI2 / SnF2 > wait 15 mins > inject TcO4 > Sn++ reduces hemoglobin > binds to TcO4

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13
Q

Advantages of blood pool imaging

A

Convenient and fast

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14
Q

Disadvantages of blood pool imaging

A

Low labelling efficiency usually 80 - 85% free TcO4

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15
Q

Indications of MUGA study

A

Monitoring heart function before / during / after chemotherapy

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16
Q

Left ventricle ejection fraction

A

% of blood pumped out from left ventricle in each contraction of left ventricle

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17
Q

Normal diastolic count

A

40,000

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18
Q

Normal systolic count

A

10,000

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19
Q

Normal value of left ventricle ejection fraction

A

> 50%

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20
Q

Myocardial perfusion images __

A

Blood supply to myocardium

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21
Q

Stress protocol of myocardial perfusion scans

A

Patient runs on treadmill > inject radiopharmaceutical at maximum exercise > scan

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22
Q

Myocardial perfusion agents

A

Tc-99m labelled with Myoview (tetrofosmin) + cardiolite (sestamibi)

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23
Q

How does Tc-99m cardiolite and myoview enter myocardium

A

Passive diffusion

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24
Q

Tc-99m cardiolite binds to __

A

Mitochondria

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25
Uptake of Tc-99m cardiolite into myocardium is proportional to __
Blood flow
26
Distribution of Tc-99m cardiolite is to __
Gallbladder, heart, liver, spleen, lungs
27
To decrease uptake of gallbladder and liver for Tc-99m cardiolite, what should be given to patients
Milk
28
Tc-99m cardiolite activity decreases in ___ but remains constant in ___
Liver, spleen, lung; heart
29
One day protocol of Tc-99m cardiolite
Stress imaging > rest imaging by rest dose must be at least 3x stress dose
30
2 day protocol
Stress imaging on 1 day > rest imaging next day but rest dose at least 1.5x stress dose
31
Preparation of Tc-99m cardiolite
1. Add Tc-99m into cardiolite vial 2. Place vial in boiling water for 10 mins 3. QC
32
Tc-99m ___ does not bind to mitochondria
Myoview
33
What factors are Myoview & cardiolite similar in
Distribution, protocols, dosage
34
Kidney imaging agents
Tc-99m DTPA, Mag 3, DMSA; chelating agent
35
Tc-99m DTPA is excreted exclusively from kidneys by ____
Glomerular filtration
36
Kidney localisation by DTPA reaches its max by ___ after injection
3 - 5 mins
37
Tc-99m DTPA is good to visualize ___
Kidney collection system
38
Dosage of Tc-99m DTPA
10 - 15 mCi
39
Preparation of Tc-99m DTPA
Inject TcO4 into DTPA vial > wait 10 mins at Room Temp > QC
40
Renogram uses ___ to describe kidney function
Radioactivity-time curve
41
Tc-99m Mag 3 is superior to DTPA in terms of ___
Higher protein binding, remain in blood pool longer, more stable
42
Dosage of Tc-99m Mag3
5 -15 mCi
43
Preparation of Tc-99m Mag3
Inject TcO4 into MAG3 kit > boil for 10 mins > QC
44
Tc-99m DTPA has the same use as
Tc-99m Mag3
45
Tc-99m DMSA is used to image ___
Renal cortex & kidney structure, lesions and hydronephrosis
46
Scans using Tc-99m DMSA starts ___ after injection
3 hours
47
Dosage of Tc-99m DMSA
5 - 10 mCi
48
Lung imaging agents are used to detect for __
Pulmonary embolism by studying blood flow into lungs
49
Tc-99m MAA AKA
Macroaggregated Albumin
50
Preparation of Tc-99m MAA
Inject TcO4 into MAA kit > room temperature 10 - 15 mins
51
Dosage of Tc-99m MAA
5 mCi
52
Size of Tc-99m MAA particles must not be larger than
100 micrometers
53
How does Tc-99m MAA work
Albumin particles will be caught inside small capillaries of lungs to show blood flow map and areas without blood supply are known as cold areas
54
Determination of Tc-99m MAA particles are done using __
Hemocytometer under microscope
55
Contraindications of Tc-99m MAA are _
Protein hypersensitivity & allergic reactions to protein
56
Ventilation scans are used to study ___ of lungs
Compliance
57
What agents are used for lung ventilation scans
Tc-99m aerosol & gas
58
How do ventilation scans appear
Area not contracting properly will be shown as hot spots because aerosol or gas is trapped there
59
Preparation of Tc-99m DTPA aerosol
1. Tc-99m DTPA liquid inside nebulizer 2. Oxygen / air pass through nebulizer at high speed and carries small Tc-99m DTPA liquid drops with it 3. Filtered to remove larger drops 4. Patient breathes in
60
Preparation of Tc-99m “gas”
1. Inject TcO4 into gas producer 2. Tc-99m absorbed onto carbon fibres and burnt t high temperatures into small particles and passes through carrier gas
61
How do thyroid scans work
1. NaTcO4- taken into thyroid similar to iodine due to overall -1 charge 2. No metabolism; only washed out several hours later
62
Thyroid scans look for ___
Hyperthyroidism (hot spots) & thyroid cancer (cold spots)
63
Dosage of thyroid scans
5 - 10 mCi
64
Agents used in thyroid scans
I-131, I-123
65
Half life of I-131
8 days
66
Half life of I-123
13 hours
67
I-131 is more suitable for therapy of __
Hyperthyroidism and thyroid cancer
68
Liver imaging agent
Tc-99m sulfur colloid
69
Sulfur colloid labelling kit contains
1. Reaction vial = sodium thiosulfate, gelatin, sodium EDTA 2. Vial A = 0.25N hydrochloride acid 3. Vial B = phosphate buffer
70
Sulfur colloid labelling procedure includes
1. Adding 0.25N HCl into reaction vial 2. Add TcO4 into it 3. Boil for 10 mins 4. Cool down to room temperature 5. Add phosphate
71
Dosage of liver scans
5 - 10 mCi
72
Dosage of sentinel node imaging
0.1 mCi
73
What happens if sulfur colloid boils for too long
Localised in lungs
74
What happens if sulfur colloid boils for too short
Spleen and bone marrow
75
Mechanism of localization of sulfur colloid
Phagocytosis
76
What is responsible for removing foreign particles in blood
Liver muffler cells (RES)
77
How are sulfur colloid labels shown
Abnormal areas have dysfunctional RES and will have cold areas
78
Sentinel node imaging refers to ___
First lymph node in lymphatic drainage of breast cancer
79
Procedure for breast cancer using sulfur colloid
1. Inject sulfur colloid around breast cancer 2. Scan patient at intervals till first node seen 3. Place marker at location of sentinel node
80
Liver and hepatobiliary agent
Tc-99m phytate
81
Preparation of Tc-99m phytate
Add TcO4 into phytate kit > room temperature 10 mins > QC
82
Dose of Tc-99m phytate
10 - 15 mCi
83
Preparation of stannous fluoride / colloid
Add TcO4 into stannous fluoride kit > room temperature 10 mins > QC
84
Dosage of stannous fluoride
5 - 10 mCi
85
DISIDA
Disisopropyl imino diacetic acid
86
Preparation of DISIDA
Add TcO4 into DISIDA kit > room temperature 10 mins > QC
87
Dosage of DISIDA
5 - 10 mCi
88
Mechanism of localization of DISIDA
Active transport
89
DISIDA is transported into ___
Liver > hepatocytes > gall bladder > small intestine
90
DISIDA is commonly used in infants to determine ___
Patency of bile duct
91
How to calculate pediatric dosage
Adult dose x (child weight (kg) / 70)
92
What is the mode of transport for glucose & 18F-FDG
Active transport into dividing cells as energy source
93
Between glucose and 18F-FDG, which is further metabolized
Glucose
94
18F-FDG accumulates into ___
Metabolically viable cells and tissues; hypermetabolic = higher intensity
95
Approximately ___ of total dose is distributed into the brain
5%
96
Which muscle is not affected by 18F-FDG regardless of accumulation
Heart muscles
97
Purpose of 18F-FDG
Detection, staging, recurrence, monitor therapy
98
Biochemical targets of 18F-FDG
Glucose uptake
99
Biochemical targets of 18F-Choline
Choline metabolism
100
Biochemical targets of 18F-MISO
Hypoxia
101
Biochemical targets of 18F-FLT
Proliferation
102
Biochemical targets of 18F-FET
Amino acid metabolism for brain tumor
103
The more malignant a tumor is, the ___ the SUV
Higher
104
SUV
Standardized uptake value
105
Ga-68 may be labelled with ___ for therapy
Lu-177 / Y-90
106
Half life of Ga-68
68 mins
107
Each generator for Ga-68 lasts for ___
6 months
108
Ga-68 radio labelling requires heating at
80 - 100 degrees for 5 - 10 mins
109
radiochemical purity is determined by __
Thin layer chromatography
110
PSMA
Prostate surface membrane antigen
111
PMSA is found in ___
Normal tissues and especially in prostate cancer and its expression is proportional to benign / high grade status
112
Ga-68 PSMA is very useful to detect ___
Recurrence of prostate cancer
113
F-18 FDG is inaccurate in detecting ___
Metastatic recurrence
114
What peptides can bind to cells with somatostatin receptors
DOTATATE & DOTANOC
115
name 2 examples of radioisotopes used for diagnosis
Ga-68, F-18
116
name 2 examples of radioisotopes used for therapy
Lu-177, Y-90
117
theranostic approach includes
- specific treatment - better prediction of treatment response - low toxicity - more accurate
118
name 2 alpha emitters that causes double strand non-repairable DNA break
Ac-225, Ra-223
119
I-131 is used to treat __
hyperthyroidism and thyroid cancer
120
singapore laws mandate that patients receiving a dose of __ must be hospitalized
30 mCi or more
121
what is the radioisotope therapy used for HCC
Y-90 microspheres
122
which artery is the radioisotope injected into for HCC treatment
femoral > hepatic
123
differences between Y-90 sir-spheres and thera-spheres in terms of visualization
sir = easier to see due to yellowish brown thera = clear / difficult to see
124
differences between Y-90 sir-spheres and thera-spheres in terms of density
sir = lower density = easier to infuse thera = higher density (3x more) = harder to infuse
125
differences between Y-90 sir-spheres and thera-spheres in terms of specific activity
sir = lower specific activity = need to infuse more thera = higher specific activity = can infuse lesser
126
why is shunting assessment important for Tc-99m MAA
MAA particle is similar to Y-90 which will reflect distribution of Y-90. Dose should be 15 Gy and lower
127
half-life of Lu-177
6.65 days
128
radiolabeling of Lu-177 PSMA
- 100 - 200 micrograms of peptide to 7 GBq - PSMA dissolved in 1mL of sodium acetate to adjust pH to 5.5 - Add PSMA / Acetate buffer to Lu-177 - Heat at 95 degrees for 30 - 45 minutes - aseptic filtration using 0.22 micrometer millipore filter
129
what is the difference between Lu-177 DOTATATE & Lu-177 PSMA
Lu-177 DOTATATE is infused together with 2.5 % Arginine + 2.5% lysine solution to protect the kidney
130
treatment protocol of Ac-225 PSMA is similar to __
Lu-177 PSMA
131
Ra-223 dichloride emits mainly __
alpha particles
132
half-life of Ra-223
11.43 days
133
radium is a ___ element
calcium-mimetic
134

HSC4020 Nuclear Med (5 decks)

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