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HSC4020 Nuclear Med > Week 8 Renal > Flashcards

Week 8 Renal Flashcards

(67 cards)

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1
Q

Compared to CT imaging, what is the primary advantage of nuclear renography in renal
assessment?
A. Clear visualization of ureters and renal vasculature
B. High-resolution imaging of kidney parenchyma
C. Functional evaluation of renal perfusion and excretion
D. Detailed anatomical mapping of calyces and pelvis

A

C. Functional evaluation of renal perfusion and excretion

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2
Q

Which process is best evaluated using a radiopharmaceutical primarily cleared by
glomerular filtration?
A. Tubular reabsorption
B. Renal plasma flow
C. Glomerular filtration rate (GFR)
D. Tubular secretion

A

C. Glomerular filtration rate (GFR)

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3
Q

what is NM renography used to assess primarily

A

perfusion, filtration, excretion & drainage

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4
Q

MAG3 AKA

A

Mercaptoacetyltriglycine

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5
Q

what radiopharmaceutical is best for patients with poor renal function

A

Tc-99m MAG3

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6
Q

Tc-99m MAG3 is mainly excreted via

A

tubular secretion

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7
Q

patient prep for Tc-99m MAG3

A
  • oral hydration
  • void before scan
  • diaper before scan
  • clarify kidney surgeries / congenital defects
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8
Q

why should patients void before scanning

A

If bladder is full, it delays upper urinary tract from emptying due to pressure from bladder = False positive

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9
Q

what is the patient position for Tc-99m MAG3

A

supine

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10
Q

photopeak selection for Tc-99m MAG3

A

140 keV

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11
Q

collimator for Tc-99m MAG3

A

LEHR

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12
Q

Tc-99m MAG3 activity dose

A

5 mCi for adults

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13
Q

what views should be done for Tc-99m MAG3`

A

posterior views only but anterior for transplants

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14
Q

image type of Tc-99m MAG3

A

dynamic and static pre & post voiding

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15
Q

what is the dynamic imaging of Tc-99m MAG3

A

30 minutes: 15 fps for 120 frames of kidneys

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16
Q

what is the planar/static pre and post void images of Tc-99m MAG3

A

2 mins per static image of kidneys and bladder

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17
Q

what is the procedure of renal MAG3 post void

A
  • patient void bladder and remove diaper after pre-void
  • patient walk around for gravity assisted drainage to bladder
  • void bladder again 1 hr after Tc-99m MAG3 injection
  • acquire post void image
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18
Q

what is the purpose of Lasix administration for Tc-99m MAG3 procedure

A

differentiate between dilated renal collecting system from an obstructed renal collecting system

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19
Q

how does dilated unobstructed renal collecting system appear

A

increase urine flow rate = increased urine output and washout of activity from collecting system

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20
Q

how does dilated obstructed renal collecting system appear

A

kidneys cannot increase urine flow rate and longer washout of activity from collecting system

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21
Q

Which of the following is the most appropriate reason for instructing the patient to void the
bladder before the renal MAG3 scan?
A. To prevent dehydration during the scan
B. To reduce interference from bladder pressure that may cause false positive obstruction
C. To improve radiotracer uptake in the kidneys
D. To allow earlier acquisition of dynamic images

A

B. To reduce interference from bladder pressure that may cause false positive obstruction

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22
Q

what parts of renal system are evaluated using Tc-99m MAG3

A

renal plasma flow, tubular secretion, glomerular filtration rate

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23
Q

what parts of renal system are evaluated using Tc-99m DMSA

A

tubular reabsorption

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24
Q

What is the main purpose of using Lasix during a renal MAG3 scan?
A. To measure glomerular filtration rate
B. To reduce radiation exposure to the bladder
C. To differentiate between obstructed and non-obstructed dilated collecting systems
D. To increase tracer uptake in the renal parenchyma

A

C. To differentiate between obstructed and non-obstructed dilated collecting systems

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25
Which property of 99mTc-MAG3 makes it the preferred radiopharmaceutical in patients with impaired renal function? A. High glomerular filtration rate B. Low protein binding and rapid hepatic clearance C. Tubular secretion as the dominant excretion pathway D. Low extraction fraction
C. Tubular secretion as the dominant excretion pathway
26
During the MAG3 scan, anterior imaging is performed only in which of the following scenarios? A. When imaging children under 5 years old B. When the patient has undergone renal transplantation C. To reduce patient exposure to gamma rays D. To evaluate the urinary bladder in female patients
B. When the patient has undergone renal transplantation
27
why is anterior imaging done for transplanted kidneys
anterior pelvis / iliac fossa
28
what are the expectations of normal renogram studies
- Maximum parenchymal uptake 3-5 minutes into study - Cortical activity should decrease over 30 minutes
29
when drawing ROIs where should it be placed
over each kidney and must include pelvic system
30
what are the 3 phases of renograms
vascular phase, transit phase, elimination phase
31
what happens in vascular phase of renogram
rapid radiotracer arrival in renal arteries and cortex and reflects renal blood perfusion within 30-60s
32
what happens in transit phase of renogram
radiotracer taken up by renal parenchyma and retains temporarily before excretion. if reduced uptake or flat curve = poor tubular function / GFR at 1-3 mins
33
what happens in elimination phase of renogram
radiotracer excreted into bladder and shows gradual fall as tracer leaves but persistent high activity suggests obstruction or impaired drainage at 3+ mins
34
Which of the following best describes the expected pattern in a normal renogram using Tc- 99m MAG3? A. Rapid tracer washout followed by increasing cortical activity B. Continuous increase in activity over 30 minutes C. Peak cortical uptake at 3–5 minutes followed by gradual clearance D. Uniform tracer uptake and immediate bladder filling
C. Peak cortical uptake at 3–5 minutes followed by gradual clearance
35
When placing regions of interest (ROIs) for renogram analysis, what is the most critical consideration? A. Ensuring only upper poles are included to avoid bladder overlap B. Using rectangular ROI to standardise measurements C. Including entire kidney and pelvis to represent function accurately D. Placing ROIs near the spleen and liver for background reference
C. Including entire kidney and pelvis to represent function accurately
36
Which of the following time-activity curve patterns suggests obstruction despite furosemide administration? A. Peak at 3 min, steady decline B. Gradual rise, delayed peak, no significant decline after furosemide C. Immediate tracer excretion with bladder filling D. Double peak pattern indicating reflux
B. Gradual rise, delayed peak, no significant decline after furosemide
37
In a normal time-activity curve, what does the second phase (transit phase) primarily represent? A. Radiotracer arrival in renal artery B. Movement through the renal parenchyma C. Excretion into the bladder D. Tracer uptake in the collecting ducts
B. Movement through the renal parenchyma
38
In a normal time-activity curve, what does the second phase (transit phase) primarily represent? A. Radiotracer arrival in renal artery B. Movement through the renal parenchyma C. Excretion into the bladder D. Tracer uptake in the collecting ducts
B. Movement through the renal parenchyma
39
what does a double peak pattern suggest
vesicoureteral reflux
40
A renogram shows tracer retention in one kidney, even after furosemide administration. What is the most likely interpretation? A. Dilated but unobstructed system B. Artifact from poor patient hydration C. Mechanical obstruction D. Normal physiological variant
C. Mechanical obstruction
41
DMSA AKA
Dimercaptosuccinic Acid
42
what are the indications of DMSA
UTI, kidney shape, split renal function before operation/radiotherapy, relative function of congenital abnormalities
43
where does Tc-99m DMSA concentrate at
largely in renal cortex in functioning proximal tubule cells
44
what is expected 2h post injection
50% retained in kidneys but no visualization of primary collecting system
45
patient prep for Tc-99m DMSA
no fasting, patient hydrated, void before scan
46
patient position for Tc-99m DMSA
prone
47
photopeak selection of Tc-99m DMSA
140 keV
48
Tc-99m DMSA activity dose
3mCi for adults
49
Tc-99m DMSA collimator
LEHR
50
kidneys are imaged ___ post injection for Tc-99m DMSA
2-3 hrs
51
what is the image type of Tc-99m DMSA
static imaging
52
what views are gathered for planar/static imaging of Tc-99m DMSA
anterior, posterior, RPO, LPO
53
counts for static views
anterior & posterior: 1000k counts RPO & LPO: 700k counts
54
scan duration for Tc-99m DMSA
45 mins
55
where is ROI drawn for Tc-99m DMSA
around kidneys on anterior and posterior images plus background
56
what is the normal split function
44% and 56%
57
what should kidneys be assessed for in Tc-99m DMSA
photopenic defects
58
1. What is the primary clinical role of Tc-99m DMSA in renal imaging? a) Assessing renal perfusion b) Evaluating obstruction c) Morphological imaging and detecting cortical defects d) Assessing bladder capacity
c) Morphological imaging and detecting cortical defects
59
what renogram study is used to evaluate obstruction
Tc-99m MAG3 + furosemide
60
what is used to assess bladder capacity
urodynamic studies or cystography
61
what is the gold standard for cortical imaging and renal scarring detection
Tc-99m DMSA
62
Which part of the nephron is Tc-99m DMSA primarily retained in? a) Collecting ducts b) Loop of Henle c) Renal cortex (proximal tubules) d) Glomerulus
c) Renal cortex (proximal tubules)
63
When is imaging typically performed after administering Tc-99m DMSA? a) Immediately after injection b) 30 minutes post-injection c) 2–3 hours post-injection d) Next day
c) 2–3 hours post-injection
64
Why is prone positioning preferred for DMSA imaging? a) Better lung clearance b) Better cortical imaging without kidney overlap c) Minimizes bladder activity d) Reduces patient discomfort
Better cortical imaging without kidney overlap
65
why is less than 30 mins post injection of TC-99m DMSA not good for renograms
insufficient time for optimal renal cortical binding
66
In DMSA imaging, a photopenic defect is most likely indicative of: a) Functional obstruction b) Parenchymal scarring or damage c) Renal calculi d) Overflow incontinence
Parenchymal scarring or damage
67
what are photopenic defects
areas of decreased / absent tracer uptake = cortical damage or scarring

HSC4020 Nuclear Med (13 decks)

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