TEST BANK for Nuclear Medicine and Pet CT 8th Edition by Kristen Waterstram-Rich, David Gilmore by ACADEMIAMILL

Nuclear Medicine and Pet CT 8th Edition WaterstramRich Test Bank Chapter 01: Mathematics and Statistics Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. The radiation intensity from a point source of 99mTc is 9 mR/hr at 3 m from the source. If the

distance is changed to 9 m, what is the new radiation intensity? a. 0.5 mR/hr b. 1.0 mR/hr c. 2.0 mR/hr d. 3.0 mR/hr ANS: B

The inverse square law results in the radiation intensity quadrupling if the distance from the source is halved, or it results in the radiation intensity decreasing to one fourth of its value if the distance is doubled. REF: p. 4 2. A technologist is sitting near a bone mineral densitometer, which is a point source of x-rays. If

the x-ray intensity at 1 m from the x-ray beam is 0.20 mR/hr, to what distance from the x-ray beam should the technologist move to decrease total weekly exposure to the occupational limit of 2 mR for a 40-hour workweek? a. 0.5 m b. 1.5 m c. 2.0 m d. 2.5 m ANS: C

The inverse square law results in the radiation intensity quadrupling if the distance from the source is halved, or it results in the radiation intensity decreasing to one fourth of its value if the distance is doubled. The unit of intensity is mR/hr, but a 40-hour workweek must be taken into consideration when calculating the final answer. REF: p. 4 3. 10 mCi is equal to how many becquerels? a. 370 Bq b. 370 kBq c. 370 MBq d. 370 GBq ANS: C

1 curie = 3.7  1010 disintegrations per second [dps], and in Système International d’Unités (SI units), 1 Bq = 1 dps; therefore, 1 Ci = 37 GBq and 1 mCi = 37 MBq. In this problem, activity in Bq =

REF: p. 5 4. 20 mCi is equal to how many becquerels? a. 0.74 GBq b. 0.37 GBq c. 0.54 GBq d. 0.20 GBq ANS: A

1 curie = 3.7  1010 disintegrations per second [dps], and in SI units 1 Bq = 1 dps; therefore, 1 Ci = 37 GBq and 1 mCi = 37 MBq. In this problem, activity in Bq =

REF: p. 5 5. The dose equivalent for occupational whole-body exposure is commonly limited to 50 mSv.

How many rem is this? a. 5000 rem b. 500 rem c. 50 rem d. 5 rem ANS: D

To convert the dose equivalent in the new SI units of 1 cSv into the old unit of rem: Dose equivalent =

REF: p. 6 6. A source of

is delivered to the nuclear medicine department calibrated for

100 mCi at 8:00 AM on Monday. If this radioactivity is injected into a patient at noon on Tuesday, what radioactivity will the patient receive? a. 80 mCi b. 85 mCi c. 90 mCi d. 95 mCi ANS: C

Solving the differential equation yields the radioactive decay law: A = A0e–t where A = activity at time t, A0 = activity at starting time,  = decay constant, t = time since starting time. The decay constant  is the fraction of atoms that decay per (small) time interval, and has units of 1 over time (e.g., 1/hr) or inverse time (hr–1). The typical radioactive decay calculation required in nuclear medicine specifies three of the four variables (A, A0, , t) in the decay equation, requiring that the fourth unknown variable be solved for.

REF: p. 10 7. A patient was injected with 131I on Monday at 10:00 AM. On Tuesday at 10:00 AM, the

thyroid probe was placed over the thyroid and produced 100,000 counts. On Thursday at 10:00 AM, the probe showed 25,000 counts. What is the effective half-life in this patient’s thyroid? a. 12 hours b. 24 hours c. 48 hours d. 72 hours ANS: B

Typically the patient’s organ excretes the radiopharmaceutical with some biologic half-life tB while the radioactivity also decays physically with a physical half-life that is denoted as tP. The counts observed by the gamma camera follow an exponential decay law based on the effective half-life tE, where: purposes,

or, in a format that is much easier for calculation

. The effective half-life is always less than or equal to the smaller of tP

or tB. REF: p. 15 8. A 99Mo-99mTc generator is eluted Monday at 7:00 AM, producing 1.8 Ci of 99mTc in the eluate

vial, in 20 ml saline. WhatTvE olS um eA ofNeK luSatEeLshLoEuR ld.bC eO wM ithdrawn from the eluate vial into a TB 99m syringe in order to inject a patient with 20 mCi of Tc at 3:00 PM? (Given the half-life of 99m Tc is 6.02 hours.) a. 0.56 ml b. 0.66 ml c. 0.76 ml d. 0.86 ml ANS: A

The radioactive decay law can be algebraically rearranged (dividing both sides of the decay equation by A0) as: . After solving for the half-life, the concentration (radioactivity per volume) in the eluate vial is then determined and the volume needed to be withdrawn into the syringe can be calculated from the equation activity = concentration  volume: A = C  V. REF: p. 10 9. If the HVL for some radionuclide in lead is 0.30 mm, what thickness of lead shielding is

necessary to reduce the radiation exposure from 8 mR/hr to 1 mR/hr? a. 0.30 mm b. 0.45 mm c. 0.60 mm d. 0.90 mm

ANS: D

It is common to follow the method used in radioactive decay and define a half-value layer (HVL) as that thickness of material that absorbs 50% of the photons. The HVL is the analog of t/2in radioactive decay. One HVL transmits 50% of the photons. The equation of photon attenuation then can be expressed as: I = I0e–x = I0e–0.693  (x/HVL) and a relationship exists between  and HVL, given by  = 0.693/HVL. Remember the units of x and HVL must be the same, and remember that this equation calculates the transmitted intensity. REF: p. 16 10. The linear attenuation coefficient in lead for 99mTc gamma rays (140 keV) is 23 cm–1. What

percentage of these gamma rays will be absorbed by a lead apron that contains 0.60 mm of lead? a. 75% b. 50% c. 25% d. 12.5% ANS: A

The intensity of the transmitted radiation is given by: I = I0e–x where  is the linear attenuation coefficient, or the fraction of the beam absorbed in some (very small) thickness x. The linear attenuation coefficient  is the analog of the decay constant  in radioactive decay. The linear attenuation coefficient  depends on the type of absorbing material and the energy of the photons. REF: p. 15 11. A new gamma camera/computer system that uses a new method of calculating cardiac

ejection fraction (EF) is installed in a nuclear medicine department. The department decides to calculate EF for the next 25 patients on both the old gamma camera and the new gamma camera before discontinuing the use of the old camera. In the future, if it is desirable to convert the new EF value to that which would have been obtained on the old gamma camera (e.g., to assess if the patient’s EF had changed), the mathematical analysis to be used is called a(n) a. independent t-test. b. linear regression. c. standard error. d. chi-square. ANS: B

The least squares method, or linear regression, calculates the best-fit values for y-intercept (a) and slope (b) in the best-fit straight line: y = a + bx. The line of identity is often drawn on regression graphs when the same parameter, here the ejection fraction, is being plotted on both the x and y axes. The line of identity facilitates an evaluation of whether the two methods (the x and y axes) are predicting the same result for ejection fraction. If the two methods produce the same value for ejection fraction, then the regression line should be the same as the line of identity. REF: p. 20

12. What is the standard deviation of 40,000 counts? a. 4000 counts b. 2000 counts c. 400 counts d. 200 counts ANS: D

Counting statistics, meaning the number of counts expected from a sample, follow the Poisson distribution. In the Poisson distribution, the standard deviation (C) for any number of counts (C) is fixed at the square root of C: This fixed definition of standard deviation does not exist in Gaussian distributions; essentially only counting statistics are Poisson. REF: p. 24 13. What is the coefficient of variation of 40,000 counts? a. 2% b. 1% c. 0.5% d. 0.25% ANS: C

The standard deviation can be expressed as a percentage of the mean value, which is frequently called the percent standard deviation, or coefficient of variation (CV):

TESTBANKSELLER.COM In this problem, the counts would be substituted for the mean in the equation. REF: p. 25 14. How many counts should be acquired into each pixel of a nuclear medicine flood image if it is

desired to be 95% confident that the true count in each pixel is within 1% of the measured counts in each pixel? a. 100,000 counts b. 40,000 counts c. 10,000 counts d. 4000 counts ANS: B

Counting statistics, besides being Poisson, are also described by a Gaussian distribution as long as the number of counts is greater than about 30. Hence, given some number of counts C, the standard deviation is automatically known. It is also known that 68% of repeat measures of the sample fall within C ± and 95% of repeat measures of the sample fall within C ± and so on (95% confidence = C ± 2c = C ± ).

Sometimes this type of problem is expressed by saying that a certain number of counts are needed to be 95% confident that the true count is within 2% of the measured value. The presence of two different percentage values can seem confusing. The 95% confidence interval on 10,000 counts is ±200 counts, and this figure of 200 counts represents 2% of 10,000 counts. The general formula expressing the number of counts needed to be “n” sure that the true answer is within some percent (p) of the measured counts is given by:

In this formula, n is replaced with a 1 for 68% confidence, a 2 for 95% confidence, and a 3 for 99% confidence. REF: p. 25 15. A patient’s thyroid is counted with the thyroid probe and produces 8000 counts. Then the

patient is removed and background is found to be 2000 counts. The (net counts) ± (standard deviation in the net counts) in this patient is a. 10,000 ± 100 counts. b. 10,000 ± 77 counts. c. 6000 ± 77 counts. d. 6000 ± 100 counts. ANS: D

Background counts are a problem in most measurements of counts from a radioactive sample. Background arises from naTtuEraSlTteBrrAesNtrKiaSl E anLdLcE osRm.iC c sOoM urces of radioactivity or from other nearby sources of radioactive material. The sample is usually counted in the presence of some background radiation, yielding a gross count for sample plus background, denoted by the letter C. The sample is then removed from the counter, and the background B is counted. The net, or true counts, which represents the sample only, is denoted by N and given by: N=C–B The standard deviation of the net counts is given by: This is an example of the rules for combinations of errors, which states that for addition or subtraction, errors add in quadrature within the square root: Additionally, since and we obtain

REF: p. 26 16. The gamma camera seems to be producing erratic results. A 57Co flood source is counted 10

times, producing the following count values: 1000, 975, 1032, 1096, 982, 997, 1012, 1090, 994, 977. What is the chi-square value for these counts? a. 19.3

b. 18.3 c. 17.3 d. 16.3 ANS: C

Too little or too much variation in repeat measurements indicates equipment may not be functioning properly. The chi-square test is used to determine an acceptable range of variability in the repeat measurements. The mean of the 10 measurements is determined ( = C/n), and chi-square is calculated as:

. REF: p. 26 17. Which expression describes the operation of the gamma camera in question 16? a. Operating properly b. Showing too much variation c. Showing too little variation d. Not enough information to answer the question ANS: B

The definition of acceptable chi-square is given by looking up the probability (P) of this chi-square value for the n repeated measures in a table. Too little variation is shown by a chi-square smaller than the P = 0.9 value; an amount of variation exactly as expected from the statistical nature of the decay process would yield P = 0.50; and an unacceptably large chi-square would yield a PTvEalSuT eB grA eaNteKrSthEaL nL 0.E 10R..SC o,OPM= 0.90–0.10 range is acceptable. REF: p. 26 18. One group of 20 patients is given a drug that is thought to have an effect on kidney function,

and another group of 20 patients is given a placebo (i.e., sugar pill, which is known not to have an effect on kidney function). The nuclear medicine gamma camera is used to calculate the glomerular filtration rate (GFR) in these two groups of patients. What would be the proper statistical test to use to test the hypothesis that no difference in GFR exists between these two groups of patients? a. Chi-square test b. Paired t-test c. Independent t-test d. Linear regression analysis ANS: C

The t-test is used to test for differences between mean values. The two forms of the t-test are for independent samples and paired samples. For independent t-tests, two independent groups of data are used. The two groups are completely independent. No relationship or correlation exists between the two groups, typically because the groups represent different patients. The two groups have mean and standard deviations denoted by , SD1, , and SD2.

REF: p. 28 19. A nuclear medicine test produces a positive test result in only 80 of the 100 patients known to

be ill. Similarly, the test produces a negative test result in only 190 of the 200 patients known to be not ill. Which is correct? a. Sensitivity = 80%, specificity = 95%, accuracy = 90%, prevalence = 33% b. Sensitivity = 90%, specificity = 95%, accuracy = 90%, prevalence = 33% c. Sensitivity = 90%, specificity = 80%, accuracy = 90%, prevalence = 33% d. Sensitivity = 90%, specificity = 80%, accuracy = 70%, prevalence = 33% ANS: A

The sensitivity, or true positive fraction (TPF), is the percentage or fraction of ill patients who have a positive test: The specificity, or true negative fraction (TNF), is the percentage or fraction of well patients who have a negative test:

TESTBANKSELLER.COM The prevalence is the fraction or percentage of ill persons in the study population:

REF: p. 31 20. One radiologist is known to be a lax reader compared with another radiologist who is known

to be a strict reader. In comparing these radiologists, how would one expect their sensitivity and specificity to compare? a. The lax reader would have lower sensitivity and higher specificity. b. The lax reader would have higher sensitivity and lower specificity. c. The readers would be expected to have the same sensitivity and specificity. d. Not enough information is given to answer the question. ANS: B

For an example, data that show a sensitivity of 78%, less than the specificity of 95%, mean that this test does a better job at correctly diagnosing well people than it does at correctly diagnosing ill people. High sensitivity = correctly finding ill people; high specificity = correctly finding well people. REF: p. 31 21. A 99Mo-99mTc generator is calibrated for 1.00 Ci of 99Mo at 7:00 AM Monday. The generator

is eluted daily Monday through Friday at 8:00 AM, but the workload is especially heavy on Friday so the generator is eluted again at 3:00 PM to obtain more 99mTc. Assuming 100% elution efficiency, how many mCi of 99mTc will be eluted at 3:00 PM Friday? a. 930 mCi b. 710 mCi c. 160 mCi d. 80 mCi ANS: C

The 99mTc radioactivity expected to be eluted from the generator can be calculated by knowing three values: (1) the activity of 99Mo in the generator, (2) the time since the last elution of the generator, and (3) the ratio of 99mTc to 99Mo in the generator. Using the equation, A = Ci  e –0.693  (t/65.9 hr), enter in the known values and solve for the unknown. REF: p. 14 137 22. A radioactive source of Cs (t1/2= 30 y) was calibrated on October 23, 2000, to contain 10

Ci. This is used as a daily accuracy check source in the dose calibrator. Presuming the dose calibrator is working propeTrlEyS ,w t aNcK tivSiE tyLsL hoEuR ld.tC heOdMose calibrator show on April 23, ThBaA 2006? a. 9.6 Ci b. 8.8 Ci c. 5.4 Ci d. 2.2 Ci ANS: B

The radioactive decay law can be algebraically rearranged (dividing both sides of the decay equation by A0) as A/A0 = e–0.693(t/t1/2). REF: p. 11 18 23. A source of F (t1/2 = approximately 2 hr) is noted to contain 3 mCi at noon. What was the

radioactivity at 8:00 AM that same day? a. 24 mCi b. 18 mCi c. 12 mCi d. 6 mCi ANS: C

The radioactive decay law can be algebraically rearranged (dividing both sides of the decay equation by A0) as: A/A0 = e–0.693  (t/t1/2). REF: p. 11

24. The biological half-life of 131I in a particular patient is 30 days. The physical half-life is 193

hours. If the patient’s thyroid is counted with the thyroid probe detector, what effective half-life will be observed? a. 26 days b. 6.3 days c. 5.1 days d. 1.2 days ANS: B

Typically the patient’s organ excretes the radiopharmaceutical with some biological half-life tB while the radioactivity also decays physically with a physical half-life that is denoted as tP. The counts observed by the gamma camera follow an exponential decay law based on the effective half-life tE, where:

or in a format that is much easier for calculation purposes,

The effective half-life is always less than or equal to the smaller of tP or tB. REF: p. 15 25. A radioactive source decays from 20 mCi to 2.5 mCi in 18 hours. What is the physical

half-life? a. 8 hours b. 7 hours c. 6 hours d. 5 hours ANS: C

The

, which depends on the radioactive material involved, is the time in which the activity

is decreased to half its original value. The radioactive decay law may alternatively be expressed as The factor 0.693 is actually ln 2, which is commonly written with three significant figures. Each half-life of radioactive decay causes the activity level to drop by 50%. REF: p. 10 26. A sample shows a count rate of 36,000 cpm during a 3-minute counting period. Express this

as the count rate ± standard deviation. a. 36,000 ± 220 cpm b. 36,000 ± 110 cpm c. 12,000 ± 55 cpm d. 12,000 ± 28 cpm

ANS: B

Counting statistics, meaning the number of counts expected from a sample, follow the Poisson distribution. In the Poisson distribution, the standard deviation (C) for any number of counts (C) is fixed at the square root of C: This fixed definition of standard deviation does not exist in Gaussian distributions; essentially only counting statistics are Poisson. In this problem, cpm must be calculated first. REF: p. 24 27. A long-lived radioactive source is counted for 1 minute and yields 10,000 counts. If this

source is counted immediately again, there is a 95% probability that the result will be in the range: a. 9950 to 10,050 b. 9900 to 10,100 c. 9800 to 10,200 d. 9700 to 10,300 ANS: C

Counting statistics, besides being Poisson, are also described by a Gaussian distribution as long as the number of counts is greater than approximately 30. Hence given some number of counts C, the standard deviation is automatically known. It is also known that 68% of repeat measures of the sample fall within C ± and 95% of repeat measures of the sample fall within C ± , and so on: 95% confidence = C ± 2c = C ± . REF: p. 25 28. A 5-ml sample of a standard diluted 1:10,000 produces 27,200 counts in the well counter. A

5-ml sample of patient plasma, counted for the same time as the diluted standard sample, produces 99,100 counts. What is the plasma volume? a. 10.8 liter b. 2.74 liter c. 1.73 liter d. 0.91 liter ANS: B

The dilution principle can also be used to measure an unknown volume. Using the dilution principle, it is possible to estimate a patient’s plasma volume, C1V1 = C2V2. Because the standard may be too concentrated, a portion of the standard is diluted and counted while the full-strength undiluted standard can be injected into the patient. The standard can be diluted by adding 1 ml of it to a flask, which is then filled to 500 ml with distilled water. It could then be expressed as a 1:500 diluted standard. The standard counts have to be multiplied by the dilution factor of 500 to obtain the true standard concentration that was injected into the patient. Taking this into consideration, the new equation to be used to calculate the plasma volume would be C1V1 = (DF)C2V2. REF: p. 5 29. Readers are encouraged to use Microsoft Excel to solve this problem. What is the mean of the

following five numbers: 6.40, 7.20, 3.50, 9.20, 5.10?

a. b. c. d.

9.01 6.28 5.97 4.83

ANS: B

Precision refers to the spread, or range, of data values obtained when some parameter is measured many times or in many patients. A small precision means that little variation exists in the data values. Then, the mean (or average) of the n values of the parameters x is defined by the symbol: The symbol x means the sum of all the measurements of x. REF: p. 22-23 30. Readers are encouraged to use Microsoft Excel to solve this problem. What is the standard

deviation of the following five numbers: 6.40, 7.20, 3.50, 9.20, 5.10? a. 4.02 b. 3.26 c. 2.15 d. 1.92 ANS: C

The standard deviation, a measure of the precision of the data, is given by the symbol , defined as:

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Recall that an exponent of

means the same as the square root

. The standard

deviation is a measure of the deviation or spread of the data points from the mean value. The standard deviation is often expressed in a format of the mean value ±. A large  value indicates data with a large range and, therefore, poor precision. REF: p. 23 31. Readers are encouraged to use Microsoft Excel to solve this problem. What is the coefficient

of variation (CV) of the following five numbers: 6.40, 7.20, 3.50, 9.20, 5.10? a. 34% b. 31% c. 28% d. 12% ANS: A

The standard deviation is a percentage of the mean value, which is frequently called the percent standard deviation, or coefficient of variation (CV):

REF: p. 23 32. Readers are encouraged to use Microsoft Excel to solve this problem. In a nuclear medicine

technology training program, the students wonder if their final exam grade in their training program is related to their subsequent board score on the NMTCB exam. The five students attain the following pairs of scores (exam score, board score) = (72, 60), (84, 74), (88, 71), (68, 60), (91, 79). What is the linear correlation coefficient, r, between exam score and board score? a. 0.99 b. 0.95 c. 0.86 d. 0.75 ANS: B

The value of goodness-of-fit parameters helps determine whether it is reasonable that the data points are truly represented by a straight line. The linear correlation coefficient, r, is calculated from the sums used to find the intercept and slope, along with one additional sum from the data points (y2):

The sign of the correlation coefficient is merely the same as the sign of the slope.

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REF: p. 21 33. Using Table 1-9 in the book, what is the P value for the linear correlation coefficient r in

question 31? a. P = 0.001 b. 0.01 < P < 0.05 c. 0.05 < P < 0.1 d. P > 0.10 ANS: B

A correlation r = 1 is a perfect fit, with the straight line passing exactly through each data point. The closer r is to 1, the more highly correlated are the x and y data. A chance, or probability (P), always exists that data that are truly not linearly related to each other will randomly appear in a fairly linear fashion. The statistical significance of correlation values less than 1 must be evaluated from statistical tables of probability. REF: p. 21 34. Using Table 1-9 in the book, does a linear correlation coefficient r = 0.95 for n = 5 data points

indicate a statistically significant linear relationship between the x and y variables? a. Yes b. No c. There is not enough information to answer the question.

d. None ANS: A

A correlation r = 1 is a perfect fit, with the straight line passing exactly through each data point. The closer r is to 1, the more highly correlated are the x and y data. A chance, or probability (P), always exists that data that are truly not linearly related to each other will randomly appear in a fairly linear fashion. The statistical significance of correlation values less than 1 must be evaluated from statistical tables of probability. REF: p. 21 35. Readers are encouraged to use Microsoft Excel to solve this problem. What is the slope and

intercept in the regression equation for problem 31? (board score) = intercept + (slope)  (exam score) a. Intercept = 7.15, slope = 0.502 b. Intercept = 6.15, slope = 0.602 c. Intercept = 5.15, slope = 0.702 d. Intercept = 4.15, slope = 0.802 ANS: D

The intercept and slope are calculated

REF: p. 20 36. Using the regression equation in Problem 31, if your training program exam score was 84,

what does the regression equation predict for your board score? a. 92 b. 82 c. 72 d. 62 ANS: C

The standard deviation can be expressed as a percentage of the mean value, which is frequently called the percent standard deviation, or coefficient of variation (CV):

In this problem, the score would be substituted for the mean in the equation. REF: p. 23 37. A thyroid uptake dose of 10 Ci is equal to how much radioactivity in SI units? a. 37 kBq b. 370 kBq c. 3.7 MBq d. 37 MBq ANS: B

The curie = 3.7  1010 disintegrations per second [dps], and the Bq =1 dps; therefore, 1 Ci = 37 GBq and 1 mCi = 37 MBq and 1 Ci = 37 kBq. REF: p. 5-6 38. What is the proper number of significant figures for the quotient (6.1  10−2)/(0.1232)? a. 0.49513 b. 0.4951 c. 0.495 d. 0.50 ANS: D

The exponent on the 10 specifies how many places the decimal point in the number is to be shifted to the left (for negative exponents) or shifted to the right (for positive exponents). In addition, the accuracy of the result in multiplication or division is such that the product or quotient has the number of significant figures equal to that of the term with the smaller number of significant figures. REF: p. 2 39. What is the proper number of decimal places in the sum of (0.3) + (3.5264)? a. 3.8264 b. 3.826 c. 3.83 d. 3.8 ANS: D

For addition and subtractioTnEthSeTfB inA alNreKsS ulE tL haLs EthRe.saCmOeMnumber of significant decimal places (rather than significant figures) as the number in the problem with the least number of significant decimal places. REF: p. 9 40. It is known that 75% of a radionuclide decays away in 12 hours. If starting with 10 mCi, how

much will be left after 6 hours? a. 7.5 mCi b. 5 mCi c. 2.5 mCi d. 1.25 mCi ANS: B

Calculations in nuclear medicine often involve expressing a mathematical concept as a ratio. The equation generally contains several numbers and one unknown value; here the unknown value is (x). The object is to solve for the unknown value by rearranging the terms in the equation. In this situation, the half-life of the material is t hours. Start with 10 mCi. After t hours, there is 5 mCi left. After another t hours, there is 2.5 mCi left. Starting with 10 mCi, after 2t hours, there is 2.5 mCi left, which is only 25% of the initial quantity, and so 75% decayed away. It is given that 75% decays away in 12 hours. So 2t = 12 hours and t = 6 hours. With a half-life of 6 hours, starting with 10 mCi, there would be 5 mCi left after 6 hours. REF: p. 3

41. Convert 5 mBq to kBq and GBq. a. 50 kBq and 0.5 GBq b. 500 kBq and 0.05 GBq c. 5000 kBq and 0.005 GBq d. 5  104 and 5  10−4 GBq ANS: C

The decimal point can be shifted left if the exponent is increased by 1 for each left shift and the decimal can be shifted to the right if the exponent is decreased. REF: p. 3 42.42. a. b. c. d. ANS: D

Fractions, such as , consist of a numerator (1) that is to be divided by a denominator (3). When using fractions to perform the calculations, a common denominator must be used. The mathematical manipulationToEfSfrTaB ctA ioN nsKrS eqEuLirL esEcRa. reCaO sM to the number of digits and placement of the decimal point. The safest way to handle the mathematical manipulation of fractions is to simply use the power of the pocket calculator to perform calculations such as 1/3 + 9/4 by first converting the fractions to decimals and then carrying out the other arithmetic. REF: p. 3 43. 30% of 7 ml = a. 0.23 ml. b. 2.10 ml. c. 2.30 ml. d. 4.90 ml. ANS: B

Percentages are values expressed as a fraction of some whole, entire value: 75% of some number is the same as 0.75 multiplied by that number. REF: p. 3 44. A patient may have had a kidney function test last month that showed a kidney clearance rate

of 45 milliliters per minute (ml/min). The patient returns today and has a kidney clearance rate of 60 ml/min. What is the percent increase in kidney function? a. 7% b. 14%

c. 25% d. 33% ANS: D

Percentages are often used to express percentage change between two values: % change = [(new value – old value)/old value]  100. REF: p. 3 45. An intensity setting of 250 on a display screen may produce a suitable image for a bar

phantom with 500K counts in the acquisition. Now it is desired to change to 350K counts in the image. The intensity on the screen is known to change linearly with the intensity control setting. What intensity setting should be used for the new 350K-count image? a. 100,000 b. 150,000 c. 175,000 d. 200,000 ANS: C

Calculations in nuclear medicine often involve expressing a mathematical concept as a ratio. The equation generally contains several numbers and one unknown value; here the new intensity setting is the unknown value (x). The object is to solve for the unknown value by rearranging the terms in the equation. Cross-multiplying is a technique used to solve a proportion

REF: p. 3 46. The morning elution of the 99Mo-99mTc generator yields 850 mCi of 99mTc radioactivity in 20

ml of saline eluate. What volume should be withdrawn from the eluate vial into a patient syringe to immediately perform a 25-mCi patient scan? a. 0.2 ml b. 0.30 ml c. 0.59 ml d. 1.7 ml ANS: C

Chapter 02: Cell and Molecular Biology Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Which of the following is an organelle of a eukaryotic cell? a. Photolipid b. Cisternae c. Centrosome d. Endocyte ANS: C

The centrosome is the main site of microtubule assembly in the cell and is therefore referred to as the microtubule organizing center. REF: p. 43 2. The large organelle often referred to as “the control center” of the cell is the a. lysosome. b. nucleus. c. centrosome. d. Golgi body. ANS: B

The nucleus is the large organelle that is often referred to as “the control center” of the cell. REF: p. 43 3. An organelle composed of a network of interconnected, closed, membrane-bounded vesicles

that extend from the nucleus to the cell membrane is the a. Golgi body. b. endoplasmic reticulum. c. centrosome. d. lysosome. ANS: B

The endoplasmic reticulum (ER) is an organelle composed of a network of interconnected, closed, membrane-bounded vesicles that extend from the nucleus to the cell membrane. REF: p. 42 4. Phagocytosis, endocytosis, and autophagy are processes that are performed by the a. Golgi bodies. b. ribosomes. c. nucleus. d. lysosomes. ANS: D

Lysosomes degrade extracellular materials taken up by the cell through three main processes; phagocytosis, endocytosis, and autophagy.

REF: p. 42-43 5. Messenger RNA (mRNA) is converted into a protein within the

of eukaryotic

cell. a. nucleus b. mitochondria c. ribosome d. Golgi body ANS: C

The process of converting (translating) mRNA into protein is carried out by ribosomes. REF: p. 42 6. Which term denotes the process by which a gene is transformed into messenger RNA

(mRNA)? a. Transcription b. Initiation c. Translation d. Synthesis ANS: A

Transcription is the process by which a gene is transcribed into mRNA. The three steps of this process are initiation, elongation, and termination. REF: p. 45 7. The three steps of the transcription process are a. initiation, elongation, and termination. b. interphase, prophase, and telophase. c. expression, translation, and suppression. d. synthesis, regulation, and termination. ANS: A

Transcription is the process by which a gene is transcribed into mRNA. The three steps of this process are initiation, elongation, and termination. REF: p. 45 8. The process by which a gene is used as a template to transcribe messenger RNA (mRNA) is

termed: a. gene mutation. b. gene expression. c. regulation. d. post-translation modification. ANS: B

Gene expression is often described as the process by which a gene is used as a template to produce (transcribe) mRNA. REF: p. 45

9. All of the following are steps in gene expression, EXCEPT a. transcription. b. translation. c. termination. d. post-transcriptional modifications. ANS: C

Gene expression is an extremely complex, multistep, tightly regulated process that involves hundreds of proteins and other molecules. Steps include the mechanisms of transcription, post-transcriptional modifications, translation, and post-translational modification of proteins. REF: p. 45 10. The phases of mitosis are a. interphase, metaphase, synthesis, and replication. b. telophase, mitosis, interphase, and S-phase. c. G0, G1, interphase, and S-phase. d. prophase, metaphase, anaphase, and telophase. ANS: D

Mitosis is divided into four separate steps, prophase, metaphase, anaphase, and telophase, that are summarized in Table 2.1. REF: p. 48 11. CDK2 is the partner for both cyclins: a. A and E. b. D and E. c. A and B. d. D and B. ANS: A

Cyclin E binds to CDK2 at the end of G1. This interaction is required for the cell to commit to DNA replication and advances the cell into S-phase. Cyclin A binds to CDK2 during S-phase and this interaction is required to initiate the G2 to M transition. See Table 2-2. REF: p. 49 12. Which are the three main cell cycle checkpoints? a. G1, restriction, and metaphase/anaphase b. G1, G2/M, and mitotic spindle c. G1, G2/M, and anaphase/telophase d. Restriction, DMA damage, and anaphase/telophase ANS: B

In addition to the complicated series of steps and layers of regulation discussed above, there are three main cell cycle checkpoints: the G1 (or restriction checkpoint), the G2/M checkpoint (or the DNA damage checkpoint), and the mitotic spindle checkpoint (also called the metaphase/anaphase checkpoint). These control mechanisms can detect errors that may have occurred (e.g., DNA replication errors or chromosomes that did not segregate properly) and halt progression of the cell cycle at specific points, giving the cells an opportunity to correct any errors before they are passed on to the daughter cells. REF: p. 49 13. All of the following are the groups of genes associated with cancer, EXCEPT a. proto-oncogenes. b. angiosynthesis genes. c. tumor suppressor genes. d. DNA repair genes. ANS: B

The genes associated with cancer can be classified into three groups. (1) Proto-oncogenes are genes that produce proteins that promote cell division (e.g., growth factors) or inhibit apoptosis. The mutated forms of these genes are called oncogenes and will promote unregulated cell division. (2) Tumor suppressor genes produce proteins that normally prevent cell division or promote cell death. Mutations that destroy production of tumor suppressor proteins therefore promote cell proliferation. (3) DNA repair genes produce proteins that prevent or correct mutations in DNA. REF: p. 50-51

TESTBANKSELLER.COM

14. Which term describes a group of diseases in which cells no longer respond to the normal

constraints placed on their proliferation and instead grow indefinitely? a. Metastasis b. Angiogenesis c. Cancer d. Mutation ANS: C

Cancer is a term used to describe a group of diseases in which cells no longer respond to the normal constraints placed on their proliferation and instead grow indefinitely. REF: p. 50 15. All of the following are viruses linked to cancer, EXCEPT a. influenza A. b. hepatitis B. c. human papilloma virus (HPV). d. Epstein-Barr. ANS: A

Influenza A is not linked as being a cancer-causing virus. REF: p. 52-53

Chapter 03: Chemistry/Biochemistry Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Titrations are procedures in which a. an accurately measured but unknown volume of solution must be determined. b. an accurate volume of a known substance must be determined. c. an accurate volume of a ligand must be determined and measured. d. an accurate volume is used to determine an unknown redox reaction. ANS: A

Procedures such as titrations, in which an accurately measured but unknown volume of solution must be determined, are conveniently performed by use of a buret. Titrations are performed by taking an aliquot (V2, a precisely measured volume) of the solution containing an unknown quantity (N2) of acid or base and placing it in a titration vessel, usually an Erlenmeyer flask. A standard solution of acid or base, whose concentration is precisely known, is then carefully delivered into the titration flask by use of a buret. REF: p. 69 2. The physical properties of a substance may be affected by a change in conditions. If this

occurs, when the substance returns to its original condition, the physical properties a. result in the formation of one or more “new” substances. b. will be the same as theTinEitS iaTl B prAoN peKrtS ieE s.LLER.COM c. will still be different because they cannot have their change reversed. d. result in a change of physical state. ANS: B

A substance that has undergone a change in physical properties because of a change in conditions will exhibit the initial properties when the substance is returned to its original condition. REF: p. 57 3. The chemical properties of a substance may be affected by a change in conditions. If this

occurs, the change will a. result in the formation of one or more “new” substances. b. exhibit the initial properties of the substance. c. always be irreversible. d. result in a change of the physical state of the substance. ANS: A

A chemical change always results in the formation of one or more “new” substances, each of which has unique chemical and physical properties. REF: p. 57 4. The atomic number of an element is defined as the

a. b. c. d.

number of neutrons in an atom. atomic mass of an atom. number of protons in an atom. the number of protons minus the number of neutrons.

ANS: C

The number above a chemical symbol is the atomic number (Z number) of the element, and the number below a chemical symbol is the average atomic mass (A number) of the element. Z number indicates the number of protons. REF: p. 58 5. The Pauli exclusion principle states that a. no electrons can be in the nucleus. b. no two electrons can have the same set of quantum numbers. c. only one electron can occupy the same orbital. d. no electron can be at a subenergy level. ANS: B

Only two electrons may occupy the same orbital and each must have opposite spins; no two electrons can have the same set of quantum numbers. REF: p. 58 Z 6. In the chemical symbol XA , the A number is a. the number of protons and neutrons. b. the number of protons and electrons. c. the number of protons T mE inSuT s tBhA eN nuKmSbEerLoLfEelRec.tC roO nsM. d. the number of neutrons minus the number of protons.

ANS: B

The atomic mass minus the atomic number gives the number of neutrons present in the nucleus. The atomic mass is the sum of the protons and neutrons. REF: p. 60 7. Atoms that differ only in the number of neutrons present in the nucleus are called a. isomers. b. isotones. c. isotopes. d. isomorphs. ANS: C

Atoms that differ only in the number of neutrons present in the nucleus are called isotopes. REF: p. 61 8. On the periodic table, there is a family of elements that are not very reactive but do form

compounds under special conditions. The elements in this family are referred to as a. noble gases. b. transition metals. c. alkaline metals.

d. radioactive. ANS: A

Certain elements are unreactive and will not combine with other elements to give compounds; these elements are all members of the eighth group shown in the periodic table and constitute a family. They all exist in the gaseous state under normal conditions and, being inert, are commonly referred to as the noble gases. REF: p. 61 9. A compound, regardless of its origin or method of preparation, always contains the same

elements in the same proportions by weight; this is called a. the law of constant composition. b. the law of multiple proportions. c. a complex ion. d. a ligand. ANS: A

The fact that elements generally react with other elements to attain a noble gas electron configuration leads to the conclusion that any two elements that undergo reaction must do so in a definite ratio of atoms, that is, one Na to one F and one C to four Cl. It then follows that the elements must also react to definite ratios by weight. This is stated by the law of constant composition: a compound, regardless of its origin or method of preparation, always contains the same elements in the same proportions by weight. REF: p. 63 10. Avogadro’s number is a. the ratio of the weight of each element in a compound. b. equal to the atomic mass of an element. c. the number of atoms or molecules in 1 gaw or gmw. d. the electron configuration of an element. ANS: C

One gram molecular weight (1 gmw) of any two substances will contain the same number of atoms or molecules. The number of atoms or molecules in 1 gram atom weight (1 gaw) or gmw has been shown by experiment to be 6.02  1023. This number is called Avogadro’s number, and 1 gaw or gmw of any substance is commonly referred to as 1 mole. REF: p. 64 11. A solution is a homogeneous mixture a. of two substances. b. of particles and a solute. c. of particles and a solvent. d. of a substance and a ligand. ANS: A

A solution by definition is a homogeneous mixture of two or more substances. The solute can be a gas, liquid, or solid, and the solvent is generally a liquid. REF: p. 64-65

12. A colloid is a type of mixture in which a. the particles are aerosolized. b. the particles settle and result in a layered mixture. c. the particles remain suspended in the dispersing medium indefinitely. d. all of the particles are of equal size and shape. ANS: C

Dispersed colloid particles remain suspended in the dispersing medium indefinitely; the behavior is attributed to a constant bombardment of the dispersed particles by the molecules of the dispersing medium; thus, the colloid particles are in constant motion. The phenomenon is called the Brownian movement. REF: p. 66 13. The products of a neutralization reaction are a. an acid and a base. b. salt and water. c. a chelate and a ligand. d. a standard solution. ANS: B

The process of neutralization involves the reaction of acids with bases as defined by the Arrhenius concept: H+ or

and OH–. The products of neutralization are invariably a salt

and water. If equal quantities (as defined by normality of an acid and base) are mixed, the resulting solution is neither acidic nor basic. REF: p. 69 14. The equation used for calculation of the quantity of an acid or base in a given sample is a. C1V1 = C2V2. b. V1N12= V2N2. 2 c. C V = C V . d. V1 N1 2 = V2 N2 2. 1

2 2

ANS: B

This is a useful relationship for calculation of the quantity of an acid or base: V1 = Volume of the standard solution (prepared in the laboratory) N1 = Normality of the standard solution V2 = Volume of the unknown solution N2 = Normality of the unknown solution REF: p. 69 15. A characterization of a weak acid is that it a. completely dissociates in water. b. does not completely dissociate in water. c. needs a buffer water. d. neutralizes water. ANS: B

Many acids are defined as weak acids in that they do not completely dissociate in water, because the conjugate base of the acid is of nearly the same base strength as water. REF: p. 69 16. The pH of a solution is determined to be 6. This solution would be considered a. neutral. b. acidic. c. basic. d. water. ANS: B

Any solution in which [H3O+] is equal to [OH–] must be neutral, and any solution in which [OH–] and [H3O+] are unequal must be either basic or acidic. The concentration of H3O+ is expressed as moles/liter and is commonly expressed in terms of pH (from the French phrase puissance d’hydrogene, meaning “power of hydrogen”) as a number between 0 and 14. For those solutions in which [H3O+] is larger than 10–7, the solution will contain a concentration of H3O+ ions greater than that of OH– ions, and will therefore be acidic. Whenever the [H3O+] is greater than [OH–], the pH will be less than 7, and for those solutions in which the [H3O+] is less than [OH–], the pH will be greater than 7 and the solution will be basic. REF: p. 70 17. A buffer solution a. helps maintain pH. b. is necessary for a neutralization reaction. c. is necessary for the suspension of colloids. d. is important in redox reTaE ctS ioT nsB. ANKSELLER.COM ANS: A

A means by which pH limits can be maintained is referred to as buffering and involves a solution that contains a mixture—some that are acidic and others that are basic. REF: p. 71 18. Each family of simple organic compounds is characterized by a functional group that

determines a. the number of covalent bonds necessary for interactions within the family. b. the number of aromatic rings for each family. c. their location on the periodic table. d. the chemical reactions that all members of the family undergo. ANS: D

Each family of simple organic compounds is characterized by a functional group, the most reactive site of the molecule, that determines the chemical reactions that all members of the family will undergo. REF: p. 72 19. Which type of compound is held together by purely electrostatic forces? a. Ionic b. Covalent

c. Constant d. Cooperative ANS: A

Ionic compounds bond through purely electrostatic forces by trading electrons to form stable outer shells. REF: p. 61 20. Sharing of electrons between two bonded elements forms a(an) a. ionic bond. b. covalent bond. c. coordinate bond. d. cooperative bond. ANS: B

Covalent bonds are formed by the sharing of electrons rather than the transfer of electrons. REF: p. 62 21. All of the following are types of organic compounds, EXCEPT a. halides. b. amines. c. acids. d. alkenes. ANS: C

Acids are not organic compounds, as they do not contain carbon, the required element of an TESTBANKSELLER.COM organic compound. REF: p. 71 22. Nitrate has a a. neutral charge. b. –3 charge. c. +1 charge. d. –1 charge. ANS: D

Table 3-4 shows the charges of many common ions, such as nitrate. REF: p. 67 23. What is the simplest aromatic compound? a. Benzene b. Ethene c. Ethanol d. Methane ANS: A

Benzene is the simplest aromatic compound. REF: p. 75

24. All of the following organic compounds are used in radiopharmaceuticals, EXCEPT a. arenes. b. alcohols. c. phenols. d. esters. ANS: D

Esters, functioning as derivatives of carboxylic acids, are formed by means of an acid-catalyzed condensation reaction between a carboxylic acid and an alcohol. These substances have not as yet been found to be useful as precursors to radiopharmaceuticals. REF: p. 76

Chapter 04: Radiochemistry/Radiopharmacology Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. The consequence of a neutron-rich nucleus is a. an Auger electron. b. electron capture. c. production of positron emission. d. production of negative beta particle. ANS: D

If a nucleus has a neutron/proton (N/P) ratio that is too high for stability (neutron-rich), it will undergo radioactive decay in a manner such that the N/P ratio decreases to approach the line of stability. The consequence is the production of a negative beta particle. REF: p. 78 2. If the N/P ratio is too low for stability, radioactive decay is accomplished through either a. positron emission or electron capture. b. negative beta particle production or electron capture. c. positron or Auger electron emission. d. production of a negative or positive beta particle. ANS: A

If the N/P is too low for staTbE ilS ityT, B raAdN ioK acStiE veLdLeEcaRy.oCccOuMrs in a manner that will reduce the number of protons and increase the number of neutrons by the net conversion of a proton or a neutron. This is accomplished through either positron emission or absorption by the nucleus of an orbital electron (EC). REF: p. 78 3. Annihilation radiation is characteristic of a. electron capture. b. position decay. c. negative beta decay. d. isometric transition. ANS: B

Positron decay leaves the daughter nuclide two electron mass units lower than the parent, requiring at least 1.022 MeV (2  0.511 MeV/electron) of transition energy. Once released from the nucleus, the + reacts with an electron, resulting in the release of two 0.511-MeV photons, which are called annihilation radiation, emitted in opposite directions. REF: p. 78 4. Radionuclides used to label radiopharmaceuticals for nuclear imaging should decay by a. alpha or negative beta. b. negative beta or positron.

c. positron or gamma. d. gamma or auger electron. ANS: C

Radionuclides used to label radiopharmaceuticals (RaPhs) for nuclear medicine imaging should decay by either gamma or positron (+) emission. Gamma radiation emitted from RaPhs readily penetrates tissues and escapes from the body. Positron-emitting radionuclides produce two 0.511-MeV gamma photons emitted in opposite directions from the positron-electron annihilation. The angle of nearly 180 degrees of the emitted 0.511-MeV photons is exploited in positron emission tomography (PET) to allow electronic collimation of the radiation and determination of the three-dimensional location of the decay event. REF: p. 79 5. Specific activity is defined as the a. activity of a radioactive isotope per gram of that same element. b. amount of radioactive isotope in a patient dose. c. percentage of carrier-free radioisotope activity in its production. d. percentage of stable isotope activity within a radioisotope. ANS: A

The specific activity of a radioactive isotope is defined as the activity of a radioactive isotope per gram of that same element. REF: p. 79 6. The 99Mo-99mTc generator is an example of a. a transient equilibriumTsyEsS teT mB. ANKSELLER.COM b. the separation of fission products. c. a secular equilibrium system. d. an accelerator product. ANS: A

In a transient equilibrium system, the half-life of the parent is a factor 10 to 100 times greater than that of the daughter. REF: p. 81 7. The 113Sn-118mIn generator is an example of a. a transient equilibrium system. b. the separation of fission products. c. a secular equilibrium system. d. an accelerator product. ANS: C

In secular equilibrium the half-life of the parent is 100 to 1000 times greater than that of the daughter. REF: p. 81 8. In the 99Mo-99mTc generator, the percentage of 99Mo that decays to 99mTc is a. 100.

b. 94. c. 86. d. 78. ANS: C

At equilibrium, both activities appear to decay with the half-life of the parent, but only 86% of 99 Mo present decays to 99mTc. REF: p. 82 9. When compared to the wet column 99Mo-99mTc generator, the dry column 99Mo-99mTc

generator has a. a better elution yield due to decreased radiolysis products. b. a poorer elution yield due to decreased radiolysis products. c. a better elution yield due to increased radiolysis products. d. a poorer elution yield due to increased radiolysis products. ANS: A

The dry column generator system was developed to alleviate poor elution yields of 99mTcO4– by removing saline from the column after elution; this decreases the amount of radiolysis products formed. REF: p. 83 99m TcO4–, patients are often pretreated with a(n) 10. In studies using a. iodine solution. b. sodium solution. c. potassium iodide solutiToE n.STBANKSELLER.COM d. sodium iodide solution.

ANS: C

Oral administration of potassium perchlorate, Lugol’s solution (5% iodine + 10% potassium iodide), or SSKI (supersaturated solution of potassium iodide) before the administration of 99m TcO4– influences the distribution of the RaPh. Perchlorate is approximately the same size as pertechnetate and competitively inhibits the uptake of 99mTcO4– into the thyroid and salivary glands, choroid plexus, and gastric mucosa. REF: p. 85 11. It is expected in a normal patient who is injected with 99mTc-sulfur colloid (SC) that a. 85% will localize in the liver and the remainder is sequestered by the spleen and

bone marrow. b. 85% will localize in the spleen and bone marrow and the remainder is sequestered

by the liver. c. 85% will localize in the lungs and the remainder is sequestered by liver, spleen, and bone marrow. d. 85% will localize in the liver, spleen, and bone marrow and the remainder is eliminated via bowel. ANS: A

After intravenous (IV) injection, 99mTc-SC is rapidly cleared from the blood. The mechanism of action is phagocytosis, in which cells of the reticuloendothelial system engulf the colloidal particles. In normal subjects, approximately 85% of the 99mTc-SC is localized in the liver, 10% in the spleen, and the remainder in the bone marrow. REF: p. 85 12. When labeling red blood cells using the in vitro method, acid-citrate-dextrose (ACD) is added

to the aliquot of patient’s blood to a. “thin” the blood. b. reduce any extracellular stannous chloride. c. prevent clotting. d. stop the tagging. ANS: C

An aliquot of the patient’s blood, anticoagulated with heparin or acid-citrate-dextrose (ACD), is removed and added to the reaction vial containing stannous chloride. REF: p. 86 13.

99m

a. b. c. d.

Tc-MIBI has a cardiac extraction rate of approximately 10%. 35%. 65%. 85%.

ANS: C

MIBI has an approximatelyTE 65S%TB exAtrN acKtiS oE nL raL teE ;m inC imOaMl or no redistribution occurs. R. REF: p. 88 14. Hepatocyte function can be imagined using a. 99mTc-sulfur colloid. b. 99mTcO4–. c. 99mTc-disofenin. d. 99mTcO 4––tagged red blood cells. ANS: C

Both disofenin and mebrofenin provide information on hepatocyte function, outline the biliary tract, and provide evidence of bile flow or obstruction. REF: p. 89 15.

99m

Tc-exametazime is prepared for a brain scan at 8:00 AM, but the patient does not arrive until 2:00 PM. The technologist should a. adjust the dose to account for decay of the radionuclide. b. make a new kit. c. draw up a new dose. d. add methylene to the dose. ANS: B

After preparation of 99mTc-exametazime, the kit can be used for 4 hours.

REF: p. 89 16.

99m

Tc-L, L-ethyl cysteinate dimer (ECD) is prepared for a brain scan at 8:00 AM, but the patient does not arrive until 2:00 PM. The technologist should a. adjust the dose to account for decay of the radionuclide. b. make a new kit. c. draw up a new dose. d. add methylene to the dose. ANS: A 99m

Tc-ECD kit formulation is stable for 6 hours.

REF: p. 90 17. Gallium-67 is an example of a radionuclide that is a. generator produced. b. reactor produced. c. cyclotron produced. d. byproduct material. ANS: C

Cyclotron production of 67Ga can be accomplished by several different nuclear reactions. REF: p. 90 18.

Ga-citrate has slow plasma clearance because the gallium becomes bound to polypeptides. transferrin. neutrophils. lipocytes.

a. b. c. d.

ANS: B

On injection of 67Ga-citrate, more than 90% of the gallium becomes bound to plasma proteins, particularly transferrin, resulting in slow clearance from plasma. REF: p. 91 19. In the resting state, the maximum concentration of 201Tl in the heart occurs approximately a. 5 to 9 minutes after injection. b. 10 to 30 minutes after injection. c. 40 to 60 minutes after injection. d. 100 to 120 minutes after injection. ANS: B

Thallium clears rapidly from the blood, with maximum concentration in the heart approximately 10 to 30 minutes after injection in the resting state and 5 minutes after stress induced by either exercise or pharmacological intervention at the time of administration. REF: p. 92

20. Dipyridamole is administered to a patient as part of a pharmacological stress test. The patient

has an onset of angina pectoris. To reverse this adverse reaction of the dipyridamole, the patient is given a. morphine. b. aminophylline. c. atropine. d. nitroglycerin. ANS: B

The most frequent adverse reaction reported with dipyridamole was angina pectoris/chest pain; parenteral aminophylline (50 to 250 mg) can be administered by intravenous injection. This drug should be available during dipyridamole stress testing to relieve adverse reactions such as chest pain or bronchospasm. REF: p. 92 21.

C-acetate is a tracer used in the study of Helicobacter pylori. colorectal cancer. myocardial metabolism. neurological disorders.

a. b. c. d.

ANS: C

One compound routinely prepared is 11C-acetate, a tracer used in the study of myocardial metabolism. REF: p. 94 22.

Mo found in 99mTc is an example of a a. radionuclidic impurity. b. radiochemical impurity. c. radiopharmaceutical impurity. d. radiopyrogenetic impurity. 99

ANS: A

Radionuclidic purity is defined as the proportion of the total radioactivity present as the stated radionuclide; 99Mo is a radionuclidic impurity in 99mTc. REF: p. 99 23. After elution of the generator, the concentration of 99Mo found in the 99mTc is 0.10 µCi/mCi of 99m

a. b. c. d.

Tc. The technologist should not use the 99mTc and reelute the generator. not use the 99mTc and wait 6 hours before reeluting the generator. use the 99mTc as usual to make the kits. use instant thin-layer chromatography (ITLC).

ANS: C

The NRC-allowable 99Mo contamination is greater than 0.15 µCi/mCi of 99mTc. REF: p. 99

24. When using radiochromatography to evaluate the percentage of radiochemical purity in the

reduced soluble 99mTc radiopharmaceuticals, the technologist checks for the percentages of a. free pertechnetate, hydrolized technetium, and labeled radiopharmaceutical. b. hydrolyzed technetium and free pertechnetate. c. free pertechnetate and bound radiopharmaceutical. d. reduced hydrolyzed 99mTc and lipophilic impurities. ANS: A

The ideal separation of a component in a solvent system gives an Rf value greater than 0 but less than 1. A component that migrates at the solvent front (Rf=1) or remains at the origin (Rf=0) is not truly separated. However, for routine rapid quality control of technetium RaPh and the separation of known impurities, free pertechnetate (99mTcO4–) and reduced hydrolyzed 99m Tc from the labeled RaPh, Rf values of 1 and 0 are considered acceptable. REF: p. 100 25. A concentration of aluminum of 15 g/ml in the preparation of a 99mTc-labeled

radiopharmaceutical a. would have no affect on a scan. b. could result in liver uptake. c. is within the NRC limits. d. is necessary for proper tagging. ANS: B

The presence of excess Al3+ can cause the formation of colloidal 99mTc-Al particles, resulting in liver uptake; the NRC limit is less than 10 g/ml. REF: p. 103 26. Bacterial endotoxin testing (BET) is used for a. sterility testing. b. chemical impurity testing. c. pyrogen testing. d. determining expiration dates on kits. ANS: C

BET uses limulus amebocyte lysate (LAL) to determine the presence of gram-negative endotoxins, recognized as the most important source of pyrogen contamination. REF: p. 103 27. Prerelease testing for each batch of 18F-FDG should include a. determination of aluminum concentration. b. titration testing. c. identity testing. d. lipophilic testing. ANS: C

Identity testing of 18F-FDG involves decay analysis over a defined period of time and should be performed prerelease for each batch of 18F-FDG; sterility is a postrelease test. REF: p. 104

28. A patient is having a reaction to regadenoson. The technologist should ensure the availability

of a dose of a. nitroglycerin. b. aminophylline. c. morphine. d. nothing; it has rapid reversal. ANS: B

Regadenson is an adenosine agonist that produces coronary vasodilation and increase in coronary blood flow. The drug can be reversed with aminophylline 100 mg injected IV over 60 seconds. REF: p. 92 29. A patient is having a reaction to adenosine. The technologist should ensure the availability of

a dose of a. nitroglycerin. b. aminophylline. c. morphine. d. nothing; it has rapid reversal. ANS: D

Adenosine is another coronary vasodilator. It has a very short biological half-life, less than 10 seconds, which allows rapid reversal of the pharmacological effect without injection of another drug. REF: p. 92 30. All of the following are commonly used PET radionuclides, EXCEPT a. 15O. b. 13N. c. 14C. d. 18F. ANS: C 11

C, not 14C is a common PET radionuclide.

REF: p. 93 31. The most commonly used cyclotron-produced radiohalogen is a. 123I. b. 131I. c. 125I. d. 121I. ANS: A

The most commonly used cyclotron-produced radiohalogen is 123I. REF: p. 92

32. A patient is having a reaction during dipyridamole stress testing manifesting as

bronchospasm. The technologist should ensure the availability of a dose of a. nitroglycerin. b. aminophylline. c. morphine. d. nothing; it has rapid reversal. ANS: B

Aminophylline should be available during dipyridamole stress testing for relieving adverse reactions such as bronchospasm or chest pain. REF: p. 92

Chapter 05: Radiation Safety in Nuclear Medicine Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Radiation levels outside a room are such that an individual could receive 0.30 rem in 1 hour.

According to the Nuclear Regulatory Commission (NRC), the technologist should a. post a Caution: Radioactive Materials sign. b. post a Radiation Area sign. c. post a High Radiation Area sign. d. not post a sign; it is considered an unrestricted area. ANS: C

NRC regulation 10 CFR 20.1902, posting requirements, states: “Posting of high radiation areas. The licensee shall post each high radiation area with a conspicuous sign or signs bearing the radiation symbol and the words ‘CAUTION, HIGH RADIATION AREA’ or ‘DANGER, HIGH RADIATION AREA’.” High radiation area means an area, accessible to individuals, in which radiation levels from radiation sources external to the body could result in an individual receiving a dose in excess of 0.1 rem (1 mSv) in 1 hour at 30 centimeters from the radiation source or 30 centimeters from any surface that the radiation penetrates. REF: p. 121 2. The Geiger-Mueller (GM) meter in a nuclear medicine department was calibrated on

December 1, 2006. AccordTinEgStoTB thA eN NK RS CE , aLrrLanEgRe. mC enOtsMshould be made to have the meter recalibrated before a. March 1, 2007. b. June 1, 2007. c. September 1, 2007. d. December 1, 2007. ANS: D

According to the NRC, radiation detection equipment must be calibrated annually. REF: p. 113 3. Ionization meters should be used when surveying a. contamination. b. large sources of radioactivity. c. very small sources of radioactivity. d. background radiation. ANS: B

Ion chambers are unable to detect very small amounts of activity such as those associated with contamination. Ionization survey meters may be used to measure high exposure rates accurately and should be used when surveying a large source of radioactivity. REF: p. 114

4. A nuclear medicine technologist is going to measure the wipe tests that were performed at the

end of the day. The instrument with the highest efficiency for this is usually a a. GM meter. b. scintillation detector. c. well counter. d. liquid scintillation counter. ANS: C

The high sensitivity of the scintillation detector makes it particularly useful for detecting very low levels of activity. A sodium iodide well counter is used for determination of radioactivity, usually in disintegrations per minute, from wipe tests and leak tests. REF: p. 115 5. It is determined that a health care worker could receive 300 millirem per year. According to

NRC regulations, this worker a. needs to be issued a personnel dosimeter. b. does not need to be issued a personnel dosimeter. c. needs to be issued a body and hand personnel dosimeter. d. needs to be issued a pocket dosimeter. ANS: B

The conditions of the RAM regulations require that dosimeters be issued to personnel who could receive in excess of 10% of the occupational limit (i.e., 500 millirem/yr). REF: p. 116

dE icS inT eB teA chNnK olSoE giL stLpE utR s. onCaOrMing badge before work. The ring 6. A right-handed nuclear meT should probably be worn a. on the right hand with the thermoluminescent dosimeter (TLD) chip facing the palm of the hand. b. on the right hand with the TLD chip facing the back of the hand. c. on the left hand with the TLD chip facing the palm of the hand. d. on the left hand with the TLD chip facing the back of the hand. ANS: A

The ring badge is worn with the sensitive material facing toward the palm of the hand on the hand that is likely to receive the highest exposure. REF: p. 116 7. The TLDs store the energy from the exposure in matrices in the TLD material, which a. can be read instantly. b. serves to attenuate the radiation to assist in determining energy and quantity. c. releases the energy by application of heat or laser light when processed. d. darkens with the energy that is deposited and is developed later. ANS: C

The TLD and optically stimulated laser (OSL) badge stores the energy in matrices in the TLD materials which releases the energy by application of heat or laser light when processed. REF: p. 116

8. A technologist declares her pregnancy. Her exposure should a. not exceed 500 mrem to the fetus during gestation. b. not exceed 50 mrem to the fetus during gestation. c. not exceed 5 mrem to the fetus during gestation. d. not exceed 2 mrem to the fetus during gestation. ANS: A

The exposure limit is 500 mrem to the fetus during gestation. REF: p. 118 9. A technologist is in the room when a patient receives a therapeutic administration of 131I

sodium iodide for thyroid ablation. The technologist should a. have a bioassay before and after participating in the administration. b. have a bioassay between 6 and 72 hours after participating in the administration. c. only have a bioassay if the airborne concentration of the 131I is less than 10% of the annual dose. d. only have a bioassay if the room background levels exceed 2 mrem/hr. ANS: B

Typical bioassay procedures state that personnel who handle therapeutic quantities of unsealed radioactive sodium iodide or who are in the room during patient administration of these amounts must have a thyroid bioassay between 6 and 72 hours following involvement. REF: p. 118 10. A package with a TransporTtaEtiS onTB InA deNxK(S TIE) L ofL3Ew Ro.uCldOiMndicate to the technologist that the

package a. contains 3 mCi of radioactive material. b. will read 3 mrem on the surface. c. will read 1 mrem at 3 m. d. will read 3 mrem at 1 m. ANS: D

The TI is equal to the mrem/hr at 1 m from the package. REF: p. 119 11. A package arrives with a surface reading of 10 mrem/hr; the label should be a. White I. b. Yellow II. c. Yellow III. d. No label is necessary ANS: B

The Department of Transportation determines the labeling and packaging requirements. The labeling for radioactive materials is distinctive and is designed to give some important basic information. Unless the shipment is exempt, there will be a package label of a Radioactive White I, Yellow II, or Yellow III, which communicates the general level of exposure from the package. On the label is also marked the TI information, which is a unitless number that communicates the degree of control to be exercised when handling the package and is equal to the mrem per hour exposure at a distance of 1 m from the package. Yellow II label indicates greater than 0.005 mSv/hr (0.5 mrem/hr) but less than or equal to 0.5 mSv/hr (50 mrem/hr). REF: p. 118 12. The exposure rate from a point source radioactive source is 250 mrem/hr at 2 m. What would

be the exposure in mrem/hr at 3 m? a. 13.8 b. 42 c. 111 d. 562 ANS: B

When dealing with a point source, the exposure rate is proportional to the inverse square of the distance from the source. REF: p. 120 13. A point source with an exposure rate of 0.20 mrem/hr is placed behind 4 HVL of lead. What

is the exposure rate in mrem/hr to the technologist with the shielding in place? a. 0.050 b. 0.800 c. 0.125 d. 0.0125 ANS: D

1 HVL is the amount of material needed to reduce the radiation intensity by half. REF: p. 120 14. According to NRC regulations, the exposure rate in mrem/hr in unrestricted areas should not

exceed a. 0.05. b. 0.5. c. 2. d. 10. ANS: C

Surveys must be performed in unrestricted areas to ensure that members of the public are not exposed to dose rates that would contribute more than 100 mrem in 1 year or 2 mrem in 1 hour to any member of the public. REF: p. 121

15. According to regulations, a radiation area requiring a sign with the radiation symbol and the

words “CAUTION RADIATION AREA” is required where individuals could receive a dose equivalent to a. 0.0005 rem/hr. b. 0.0002 rem/hr. c. 0.005 rem/hr. d. 0.002 rem/hr. ANS: C

In posting of radiation areas, the licensee shall post each radiation area with a conspicuous sign or signs bearing the radiation symbol and the words “CAUTION, RADIATION AREA.” Radiation area means an area, accessible to individuals, in which radiation levels could result in an individual receiving a dose equivalent to in excess of 0.005 rem (0.05 mSv) in 1 hour at 30 cm from the radiation source or from any surface that the radiation penetrates. REF: p. 121 16. According to NRC regulations, radioactive waste from P-32 a. should be shipped for land burial. b. should be returned to the manufacturer. c. can be held for decay-in-storage. d. should be flushed into the sanitary sewer. ANS: C

Radioactive waste with half-life of 120 days or less may be stored for extensive decay before disposing of material. REF: p. 123 17. Skin that is contaminated with a radioactive material should be washed with soap or a

commercial radioactive decontaminating agent a. vigorously under tepid water. b. vigorously under cold water. c. gently under tepid water. d. gently under cold water. ANS: C

Skin contamination is removed by gentle washing with tepid water and soap or a commercial decontaminating agent. Do not irritate or abrade the skin, which may cause absorption of the contamination. REF: p. 125 18. The federal agency that is responsible for the regulation of the uses of byproduct material is

the a. b. c. d.

NRC. EPA. FDA. None

ANS: A

The U.S. NRC is responsible for the regulation of the uses of byproduct radioactive material. The regulations are found in Title 10 of the Code of Federal Regulations as referenced throughout this chapter. The general requirements are found in 10 CFR 20, “Standards for Protection Against Radiation,” and the sections that further relate to medical uses are found in 10 CFR 35, “Medical Use of Byproduct Material.” REF: p. 130 19. The federal agency responsible for the regulation of the use of general x-ray–producing

machines and machine-generated radioactive material (e.g., PET) isotopes is the a. NRC. b. EPA. c. FDA. d. None ANS: D

There is currently no federal agency with express regulatory responsibility for this equipment; states have been able to regulate these areas. REF: p. 130 20. A systemic illness caused by high-dose, acute exposure to ionizing radiation that is exhibited

in the blood-forming and respiratory (mucosal) tissues and appears after a whole-body dose of about 200 rad (2 Gy) is a. marrow syndrome. b. GI syndrome. c. hemopoietic syndrome. d. CNS syndrome. ANS: C

Hemopoietic syndrome is a systemic illness caused by high-dose, acute exposure to ionizing radiation and is exhibited in the blood-forming and respiratory (mucosal) tissues. It appears after a whole-body dose of about 200 rad (2 Gy). REF: p. 109

Chapter 06: Patient Care Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. For inpatients, patient verification requires a. an EMR. b. contacting the nurse in charge of the patient’s care. c. two means of identification. d. asking the family member accompanying the patient. ANS: C

With hospitalized patients, matching the name and medical record number on an arm band to those on the order can serve as a means of identifying the patient. The Joint Commission requires that two patient identifiers be used when identifying patients. The intent of the requirement is to ensure the correct patient undergoes the correct procedure. Electronic identification, such as bar coding technology, will comply with this requirement if it uses two or more person-specific indicators. REF: p. 143 2. The written material related to a medical procedure that will be distributed to the public is

usually written at the a. first-grade level. b. fifth-grade level. c. seventh-grade level. d. 10th-grade level. ANS: D

It is also important to use terminology appropriate to the patient’s understanding. There are approximately 77 million Americans with basic or below-basic health literacy. Although approximately 23 percent of adults read at the fifth-grade level, most health care material is written at the 10th-grade level or higher. REF: p. 142 3. When using proper body mechanics to move heavy objects or equipment, the technologist

should a. use back muscles for balance. b. relax stomach muscles. c. push rather than pull. d. pull rather than push. ANS: C

When moving heavy objects or equipment, push rather than pull while using leg and abdominal muscles. REF: p. 148

4. When transferring an orthopedic or a neurologically impaired patient into a wheelchair, the

technologist should: a. position the patient’s strongest side toward the area to which the patient is being transferred. b. position the wheelchair at a 90-degree angle with the bed. c. use restraints for patient safety. d. hold the patient around his or her waist. ANS: A

Orthopedic or neurologically impaired patients require more assistance. Always position the patient’s strongest side toward the area to which he or she is being transferred. Stand facing the patient. Reaching under the patient’s shoulders, place hands over the scapulae. To move a patient from the wheelchair to a locked imaging table, place the wheelchair at a 45-degree angle to the table with the patient’s strongest side toward the table. REF: p. 148 5. A draw sheet is used with patients to a. protect the bedding from possible patient incontinence. b. provide added warmth. c. provide added cushioning. d. aid in patient transfer. ANS: D

A draw sheet is a sheet folded in half that is placed under the patient when transferring the patient; the sheet is rolled up close to the patient to provide a handhold for lifting and pulling the patient onto the imaging table. REF: p. 149 6. The six rights of a correct administration of a pharmaceutical include a. the use of a generic drug. b. following HIPAA regulations. c. the right route. d. an explanation of possible side effects. ANS: C

The correct administration of pharmaceuticals includes the six rights system as follows: right dose, right medication, right patient, right time, right route, and right documentation. REF: p. 151 7. Parenteral routes of administration include all of the following EXCEPT a. sublingual. b. subcutaneous. c. intramuscular. d. intrathecal. ANS: A

In the parenteral route of administration, medications are injected directly into the body and are classified according to depth of injection; in the sublingual route, the medication is placed beneath the tongue to be absorbed.

REF: p. 151 8. Intrathecal medications should be administered a. on a transdermal patch. b. beneath the tongue. c. in the form of granules. d. into the subarachnoid space. ANS: D

Intrathecal medications are administered using a spinal needle to inject medications directly into the subarachnoid space of the spinal cord. REF: p. 152 9. The vein usually used for the administration of radiopharmaceuticals is the a. carotid. b. antecubital. c. vastus lateralis. d. most superficial vein. ANS: B

The antecubital or median cubital vein on the anterior surface of the elbow is usually used. REF: p. 152 10. In a needle, as the gauge increases, a. the length increases. b. the bore diameter increases. c. the length decreases. d. the bore diameter decreases. ANS: D

Needles are supplied in various diameters and lengths, and the gauge of the needle indicates the diameter; as the gauge number increases, the diameter of the bore decreases. REF: p. 152 11. During the injection of a patient, the technologist notices a swelling around the injection site.

The technologist should a. release the tourniquet. b. continue with the injection. c. check for a flashback of blood. d. discontinue the injection. ANS: D

Stop the injection immediately if the patient complains of discomfort at the injection site, if any resistance to the injection is felt, or if swelling around the site is observed. REF: p. 156 12. When withdrawing nonradioactive substances

a. b. c. d.

no air should be introduced into the vial. a volume of air equal to the dose may be inserted into the vial. saline should be used to adjust the dose volume. the volume should be equal for the volume of radiopharmaceutical to be used.

ANS: B

When withdrawing nonradioactive substances, a volume of air equal to the dose may be inserted into the vial. REF: p. 161 13. A technologist should be careful to keep a patient’s IV solution a. 2 to 3 inches below the level of the imaging table. b. even with the level of the vein. c. 18 to 20 inches above the level of the vein. d. greater than 20 inches above the level of the vein. ANS: C

The drip infusion set should always be positioned approximately 18 to 20 inches above the vein. If it is placed too low, fluid may flow back into the tubing, causing it to coagulate and form a clot. Infusion sets placed too high above the vein may cause infiltration due to increased pressure. REF: p. 162 14. When administering a radiopharmaceutical dose via an IV line, preparation is made for a. a bolus injection. b. a flush with at least 10TmElSsaTliBnA e.NKSELLER.COM c. detaching the IV line for the injection. d. administering heparin. ANS: B

Flush the port with a minimum of 10 ml saline. If resistance is experienced, confirm patency. REF: p. 164 15. Radiopaque contrast media (ROCM) are used in CT procedures to better visualize a. low-contrast tissue. b. the functional units of the organs. c. high-contrast tissues. d. solid structures. ANS: A

ROCM are often used in CT to better visualize low-contrast tissues in the body. REF: p. 164 16. Following a procedure, a patient experiences syncope. The technologist should a. have the patient walk more slowly. b. have the patient lie down. c. contact the patient’s family. d. arrange for administration of IV solution.

ANS: B

Weakness or change in mental acuity may accompany this condition. Protecting the patient’s head is the primary concern while easing the patient to the floor or any flat surface. Place the patient in the dorsal recumbent position, and elevate the patient’s feet. REF: p. 175 17. ROCM for CT images are used a. to decrease levels of density in the tissues. b. to visualize low-contrast tissues. c. to visualize disease. d. to blur areas that are not areas of interest. ANS: B

ROCM are often used in CT procedures to visualize low-contrast tissues in the body. Contrast media are composed of elements with high atomic numbers, such as iodine. REF: p. 164 18. A technologist is preparing to perform a procedure on a geriatric patient in which ROCM is

required. The patient should a. receive a neutral osmolality ROCM because of his or her age. b. receive low-osmolality ROCM because of the high risk of extravasation. c. receive a high-osmolality ROCM because of probable weakened vessels. d. receive an ROCM concentration equal to that needed in conventional radiology procedures. ANS: B

Patients at high risk for extravasation should receive low-osmolality ROCM to lessen the toxicity to the surrounding tissues if infiltrated. Patients at increased risk are those with limited communication abilities, such as pediatric and geriatric patients, severely ill patients, and patients with altered circulation. REF: p. 168 19. Before the administration of ROCM, the technologist should know the patient’s a. BUN level. b. creatinine level. c. T4 level. d. alkaline phosphatase level. ANS: B

It is imperative to know the patient’s serum creatinine level before administering any type of ROCM. There is a direct relationship between the dose of ROCM and adverse renal side effects in patients with an elevated serum creatinine level. REF: p. 167 20. The most direct way to intervene in the cycle of infection is to a. provide a susceptible host for the pathogen outside of the human body. b. limit contact with patients.

c. prevent transmission of the pathogen from the reservoir to a susceptible host. d. isolate vector-borne pathogens. ANS: C

The most direct way to intervene in the cycle of infection is to prevent transmission of the pathogen from the reservoir to a susceptible host. The most effective system to prevent the transmission of disease is the practice of “Standard Precautions.” REF: p. 169 21. According to the Centers for Disease Control and Prevention (CDC), the preferred

disinfectant for preventing the spread of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) is a. antibacterial soap. b. antifungal soap. c. phosphorous hyposulfite bleach. d. sodium hypochlorite bleach. ANS: D

The CDC recommends sodium hypochlorite bleach (Clorox) as the preferred disinfectant for preventing the spread of HIV and HBV, especially because HBV can survive in dried blood for up to 7 days. REF: p. 171 22. A technologist determines a patient’s pulse rate to be 120 beats per minute (bpm). The

technologist recognizes this to be a. eucardia. b. bradycardia. c. tachycardia. d. hypocardia. ANS: C

The normal adult rate is 60 to 90 bpm. A rapid pulse is called tachycardia (greater than 100 bpm). A slow pulse rate is called bradycardia (less than 60 bpm). REF: p. 171 23. A note in a patient’s chart states that the patient has hypertension. The technologist recognizes

this as a. advanced renal disease. b. cardiomegaly. c. elevated blood pressure. d. tachycardia. ANS: C

Elevated blood pressure is hypertension; low blood pressure is hypotension and may indicate shock. REF: p. 172

24. While waiting for a scan, a diabetic patient develops hypoglycemia. The symptoms may

include all of the following EXCEPT a. hot, feverish skin. b. general weakness. c. sweating. d. tremors. ANS: A

Patients with diabetes may develop hypoglycemia (low blood sugar). The onset of symptoms may be sudden and may include general weakness, sweating, clammy and cold skin, tremors, nervousness, irritability, hunger, blurred vision, and loss of consciousness. REF: p. 173 25. A patient enters the nuclear medicine department breathing oxygen through a nasal cannula.

The technologist should take note that the oxygen flow rate is a. no less than 6 L/min. b. no more than 0.5 L/min. c. between 0.5 and 6 L/min. d. between 0.5 and 6 ml/min. ANS: C

The nasal cannula is inserted into the patients’ nostrils, providing a direct source of oxygen at a minimum flow rate of 0.5 L/min and a maximum rate of 6 L/min. Simple masks must be set at an oxygen flow rate of no less than 6 L/min to prevent buildup of exhaled carbon dioxide. REF: p. 177 26. A patient with a urinary catheter arrives in the nuclear medicine department for a scan. To

prevent backflow, the technologist must ensure that the bag is a. placed on the floor. b. kept below the bladder. c. laid beside the patient on the bed. d. clamped off during the procedure. ANS: B

To prevent backflow of urine, the bag must be kept below the level of the bladder. REF: p. 175 27. A patient has an ileostomy. The technologist knows that the patient has a. an NG tube for feeding. b. a catheter for collection of urine. c. surgical dressings that may need to be changed. d. a plastic pouch for collection of feces. ANS: D

Colostomies (surgical opening into the colon) and ileostomies (surgical opening into the ileum) allow for drainage of feces. The opening (stoma) is covered by plastic disposable bags or pouches (appliances), which must be changed frequently. REF: p. 179

28. The hospital in which a technologist is working is said to be accredited. The accreditation for

the hospital would be issued by the a. AMA. b. TJC. c. NRC. d. ACR. ANS: B

The Joint Commission (TJC), formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is the nation’s predominant standard setting and accrediting body in health care. It is an independent, not-for-profit organization that evaluates and accredits more than 15,000 health care organizations. REF: p. 142 29. All of the following may be used to premedicate patients to reduce the risk of an adverse

reaction to ROCM, except a. prednisone. b. diphenhydramine. c. metformin. d. methylprednisone. ANS: C

Metformin is a commonly used drug for management of diabetes. This drug is not used to counteract the adverse effects of ROCM. REF: p. 167 TRUE/FALSE 1. MR contrast media is administered in high doses compared to CT contrast media. ANS: F

The contrast media used in MR is administered in low doses resulting in a decreased occurrence of adverse effects compared with the administration of CT contrast media. REF: p. 167

Chapter 07: Department Administration Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Leaders should develop and practice five specific behaviors, including all of the following,

EXCEPT a. encourage the heart. b. inspire a shared vision. c. enable others to act. d. make models of others. ANS: D

Kouzes and Posner encourage all leaders (with or without formal management titles) to develop and practice the five specific behaviors: (1) Model the Way - Gain buy-in and build momentum for an initiative by actively exhibiting the attitude and behaviors that you seek from peers, subordinates, and superiors. (2) Inspire a Shared Vision - Seek to imagine what an ideal future for a group, department, organization, or system might look like. Plant the seeds of collective excitement and passion for the vision, and encourage others to see the possibilities. (3) Challenge the Process - Refuse to accept the status quo as the only alternative for the future. Apply creativity, innovation, and calculated risk-taking in an effort to solve problems and improve performance. Take time to reflect and learn from both successes and failures. (4) Enable Others to Act - Foster an environment rich with respect and collaboration. Empower and strengthen others in order to benefit from a diverse set of voices and capabilities. (5) EncourageTtE heSH rt N -K DS evEoL teLtiEmRe.toCpOrM eserving morale and collective TeBaA determination. Celebrate victories and recognize individuals who have contributed to progress. REF: p. 182 2. The leadership behavior that refuses to accept the status quo as the only alternative for the

future is a. model the way. b. encourage the heart. c. challenge the process. d. inspire a shared vision. ANS: C

The leadership behavior of challenge the process involves refusing to accept the status quo as the only alternative for the future, applying creativity, innovation, and calculated risk-taking in an effort to solve problems and improve performance, and taking time to reflect and learn from both successes and failures. REF: p. 182 3. When a leader celebrates and recognizes the accomplishments of team members, this

leadership behavior is termed a. encourage the heart. b. inspire a shared vision.

c. enable others to act. d. model the way. ANS: A

A leader who practices the behavior of encourage the heart devotes time to preserving morale and collective determination, celebrates victories, and recognizes individuals who have contributed to progress. REF: p. 182 4. Which leader skill set requires the leader to appreciate and understand their role in the

relationship between the organizational structure and culture? a. Change management b. Marketing c. Law and ethics d. Organizational behavior ANS: D

Leaders must appreciate and understand their role in the relationship between the structure and the culture (beliefs, values, rituals) of a department or organization. Important organizational behavior concepts include motivation, power and influence, and interpersonal communication and relationship building. REF: p. 182 5. All of the following are leadership skill sets, EXCEPT a. negotiations. b. operations and change T mEanSaTgB em t. SELLER.COM AeNnK c. marketing. d. financial strategy. ANS: C

Effective leaders can navigate the complexities of the health care environment and strike a balance between the priorities of various stakeholders by continuously developing skill sets in these areas: organizational behavior; negotiations; operations/quality and measurement; change management; health care information technology (HIT); marketing; financial strategy; and law and ethics. REF: p. 182 6. The 4 P’s of marketing are a. production, promotion, placement, preparation. b. preparation, production, practice, process. c. product (service), pricing, place, promotion. d. process, price, procurement, procedure. ANS: C

The 4 P’s of marketing are product/service, pricing, place, promotion. An understanding of these is part of the leader’s marketing skill set. REF: p. 183

7. What are numeric or alpha and numeric combinations associated with specific descriptions of

procedures that are the basis for payment for procedures and products? a. Coding systems b. Reimbursement systems c. Coverage systems d. Quality management systems ANS: A

The coding systems are numeric or alpha and numeric combinations associated with specific descriptions of procedures that are the basis for payment for procedures and products. REF: p. 183 8. What are the three components of reimbursement? a. Coverage, payment, and refund b. Policy, procedure, and payment c. Policy, coverage, and refund d. Coding, coverage, and payment ANS: D

There are three key components of reimbursement: coding, coverage, and payment. REF: p. 183 9. CPT codes used to describe nuclear medicine procedures are Category: a. I. b. II. c. III. d. IV. ANS: A

Category I CPT codes are used to describe procedures in nuclear medicine. REF: p. 183 10. The CPT Category codes for diagnostic nuclear medicine begin with a a. 10. b. 55. c. 78. d. 97. ANS: C

Diagnostic nuclear medicine CPT Category I codes begin with a 78 and are followed by three more numbers. Therapeutic nuclear medicine Category I codes begin with a 79, again followed by three numbers. REF: p. 183 11. What are the first two digits for the CPT Category code for therapeutic nuclear medicine

procedures? a. 78 b. 79

c. 09 d. 10 ANS: B

Diagnostic nuclear medicine CPT Category I codes begin with a 78 and are followed by three more numbers. Therapeutic nuclear medicine Category I codes begin with a 79, again followed by three numbers. REF: p. 183 12. Which legal branch of the federal government has billing compliance program resources? a. Office of Inspector General b. Supreme Court c. Drug Enforcement Agency d. Food and Drug Administration ANS: A

The legal branch of the federal government, the Office of Inspector General (OIG), has a list of compliance program resources for hospitals, physician practices, pharmaceuticals, and third-party billing located at www.oig.hhs.gov. REF: p. 185 13. All of these provide quality guidelines for nuclear medicine, EXCEPT a. American College of Radiology. b. The Joint Commission. c. American Society of Radiologic Technologists. d. Nuclear Regulatory CoT mEmSisTsB ioA n.NKSELLER.COM ANS: D

For a nuclear medicine department, guidelines for providing high-quality care stem from the work of several important organizations and programs, including The Joint Commission (TJC), the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), the American Society of Radiologic Technologists (ASRT), the Radiologic Society of North America (RSNA) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). REF: p. 186 14. Which term is defined as the aggregate of activities such as design analysis and inspection of

defects to ensure adequate quality? a. Quality improvement b. Quality assurance c. Quality control d. Quality management ANS: C

Most technologists are familiar with the term quality control (QC) as it relates to daily, weekly, monthly, or quarterly checks on cameras and other radiation detection equipment. QC also includes equipment calibration, acceptance testing, preventive equipment maintenance, film-badge monitoring, and providing standardized imaging protocols. QC can be defined as the aggregate of activities such as design analysis and inspection of defects to ensure adequate quality. REF: p. 186 15. A departmental and systematic approach to monitoring and evaluating the various aspects of a

project, service, or facility to ensure that standards of quality are met defines a. quality control. b. quality assurance. c. quality monitoring. d. quality management. ANS: B

Quality assurance, QA, can be defined as a departmental and systematic approach to monitoring and evaluating the various aspects of a project, service, or facility to ensure that standards of quality are met. QA traditionally involves only a few individuals; data are reviewed to solve “special” problems, emphasizing the identification of outliers and then taking steps to bring these outliers in line with the norm. REF: p. 187 16. All of the following are problem-solving techniques or tools, EXCEPT a. force field analysis. b. brainstorming. c. contingency diagram. d. satisfaction survey. ANS: D

Many problem-solving techniques or tools may be used in combination or alone to improve a process, including brainstorming, affinity diagram, cause-and-effect (fishbone) diagram, force field analysis, flowchart, contingency diagram, and the interrelationship digraph. Satisfaction surveys are generally used as a quality management tool. REF: p. 190 17. Which hospital-based quality management tool involves the review of active or past patient

medical records to assure proper and complete documentation? a. Benchmarking b. Open- or closed-chart reviews c. Satisfaction surveys d. Time studies ANS: B

Open- or closed-chart reviews require the review of active or past patients’ medical records, ensuring that necessary documentation is present and filled in completely. These reviews are useful in assessing paper flow medical records department as well as other departments. State and hospital accreditation surveyors often choose this tool to assess overall compliance to hospital policies and professional standards. REF: p. 192 18. Licensure and certification are forms of a. accreditation. b. problem-solving techniques. c. evaluation. d. credentialing. ANS: D

The terms used for the credentialing of individuals include certification and licensure. The term accreditation is used for facilities, specific entities within a facility, educational institutions, and academic programs. The general public often uses these terms interchangeably; however, they are not synonymous and there are functional distinctions between each concept. REF: p. 197 19. A term used with respect to third-party designation of an institution meeting criteria

established by experts in the field is a. registration. b. certification. c. credentialing. d. accreditation. ANS: D

Accreditation is a term used with respect to third-party designation of an institution meeting criteria established by experts in the field. REF: p. 199 20. What does the acronym SMART stand for? a. Specific, measureable, assignable, realistic, and time-related b. Systematic, manageable, accurate, reliable, and timely c. Specific, manageable, assignable, representative, and trending d. Systematic, measureable, accurate, reliable, and time-related ANS: C

SMART (specific, measurable, assignable, realistic, and time-related) criteria should apply to objectives in a QI plan. REF: p. 199

Chapter 08: Clinical Research Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Which term is used to denote the type of clinical research that involves the testing of

interventions on health-related outcomes? a. Clinical practice b. Clinical trial c. Developmental research d. Developmental trial ANS: B

Types of clinical research that involve the testing of interventions on health-related outcomes are termed clinical trials or clinical studies. REF: p. 202 2. What are the two categories of clinical trials? a. Subsidized and investigator initiated b. Sponsored and independent c. Sponsored and investigator initiated d. Subsidized and independent ANS: C

Clinical research, or trials,TaE reSloToBseAlyNcKaS teE goLrL izE edRa.sCeO ithMer sponsored (e.g., by a pharmaceutical or device company) or investigator initiated (e.g., an investigator plans and conducts a research study). REF: p. 202 3. Which term refers to the entity that accepts all responsibility for regulatory aspects of

conducting the trial, including protection of human subjects and data integrity? a. Principal investigator b. Primary investigator c. Clinical research associate d. Sponsor ANS: D

The sponsor is the entity that accepts all responsibility for regulatory aspects of conducting the trial, including protection of human subjects and data integrity. REF: p. 202 4. Which of the following is the DHHS Federal Policy for the Protection of Human Subjects? a. Common Rule b. Good Clinical Practice c. HIPAA d. Institutional Review Board

ANS: A

The DHHS Federal Policy for the Protection of Human Subjects, known as the “Common Rule,” is codified in regulations governing 15 federal agencies including the Department of Agriculture, Department of Defense, and the National Science Foundation. The Common Rule regulates research that is conducted by these federal agencies such as studies involving US military personnel, and/or that receive government funding such as an academic institution (e.g., cancer institute) that receives federal grant money. The Common Rule is described in the Code of Federal Regulations (CFR) Title 45 Part 46: Protection of Human Subjects. REF: p. 202 5. The Food and Drug Administration governs clinical research performed by a. the Department of Agriculture. b. manufacturers of drugs, devices, and biologicals. c. the Nuclear Regulatory Agency. d. all investigators. ANS: B

Clinical research by manufacturers (drugs, devices, and biologicals) is governed by FDA federal code. REF: p. 202 6. Researchers and sponsors must follow privacy protection rules for research involving human

subjects as codified in the a. Health Insurance Portability and Accountability Act. b. Food and Drug Administration, Title 21. c. Good Clinical PracticeT . ESTBANKSELLER.COM d. Common Rule. ANS: A

Patient privacy is a serious concern in clinical research. Researchers and sponsors must follow privacy protection rules for research as codified in Parts 160 and 164 of the Health Insurance Portability and Accountability Act. REF: p. 202 7. What is the code of clinical research practices followed by sponsors and researchers on an

international level? a. HIPAA b. Good Clinical Practice c. ALCOA d. Common Rule ANS: B

In addition to the US Code of Federal Regulations, there is another code of practice that is followed by sponsors and researchers on an international level. This code is called Good Clinical Practice (GCP), and was developed by the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use, generally referred to simply as ICH. REF: p. 202

8. A document that describes the objective(s), design, methodology, statistical considerations,

and organization of the trial is the a. informed consent. b. source document. c. protocol. d. contract research organization. ANS: C

The study protocol is a document that describes the objective(s), design, methodology, statistical considerations, and organization of the trial. The protocol document must contain specific elements. REF: p. 203 9. All of the following must be included within the protocol document, EXCEPT a. purpose and objectives of the study. b. number of patients to be included in the study. c. description of the design. d. expected outcomes of the trial. ANS: D

The study protocol is a document that describes the objective(s), design, methodology, statistical considerations, and organization of the trial. The protocol document must contain the following elements: a statement of the study objectives and purpose; the criteria for patient inclusion/exclusion as well as an estimate of the number of patients to be studied; a description of the design of the study, including the kind of control group to be used (if any) and a description of methoT dsEtS oT beBuAsN edKtSoEmLinLiE mR iz. eC biO asMon the part of subjects, analysts and investigators; method for determining the dose(s) to be administered, the planned maximum dosage and duration of individual exposure to the subject from the study drug; objectives of the study, which include an explanation of observations and measurements to be made; and a description of clinical procedures, laboratory tests or other measures to be taken to monitor the effects of the drug in subjects and to minimize risk. REF: p. 203 10. The one individual who is entirely responsible for the conduct of the trial is the a. lead technologist. b. protocol supervisor. c. primary investigator. d. contracted researcher. ANS: C

An investigator (sometimes referred to as principal or primary investigator) is an individual under whose authority the clinical trial takes place. This one individual is entirely responsible for the conduct of the trial, but he/she can delegate study tasks to other individuals. REF: p. 203

11. Which term is defined as a process whereby the subject is given an opportunity to review all

of the study procedures, benefits and risks of the study, and alternative treatment available to them if they choose not to participate in the study? a. Informed consent b. Institutional review board c. Protocol document d. Source document ANS: A

Informed consent is a process whereby the subject is given an opportunity to review all of the study procedures, benefits and risks of the study, and alternative treatment available to them if they choose not to participate in the study. The requirements of the informed consent form (ICF) are documented in 21CFR50, and include elements such as privacy, whom to contact if the subject has questions, and the right to refuse participation in the study. REF: p. 203 12. In the U.S., clinical trials must be approved by an independent ethics committee, which is

called the a. Contract Research Organization (CRO). b. Good Clinical Practice (GPC). c. Institutional Review Board (IRB). d. Common Rule. ANS: C

It is also the responsibility of the investigator to ensure that the study and ICF are reviewed and approved by an independent ethics committee, known in the US as the Institutional NeKdSicEalLcLenEteRr. Review Board (IRB) (9). ATcE adSeT mBicAm sC tyO piM cally have an IRB, but there are also private IRBs that can be used for non-academic sites that are not affiliated with a university. The required constitution and operation of an IRB is prescribed in 21CFR54. REF: p. 203 13. How many members are required to comprise an Institutional Review Board? a. Three b. Five c. Seven d. Nine ANS: B

It is also the responsibility of the investigator to ensure that the study and ICF are reviewed and approved by an independent ethics committee, known in the US as the IRB. Academic medical centers typically have an IRB, but there are also private IRBs that can be used for non-academic sites that are not affiliated with a university. The required constitution and operation of an IRB is prescribed in 21CFR54. REF: p. 203 14. The protection of rights, safety, and well-being of human subjects is the primary responsibility

of the a. protocol document.

b. primary investigator. c. Institutional Review Board. d. monitor. ANS: C

The primary responsibility of the IRB is the protection of rights, safety, and well-being of human subjects. REF: p. 204 15. What is a protocol deviation? a. A variation from processes or procedures defined in a protocol b. A significant departure from the processes or procedures as required by the clinical

trial protocol c. An irrelevant consequence of clinical trial studies d. An avoidable data breach that invalidates the clinical trial ANS: A

The imaging site personnel involved in clinical research are obligated to follow all aspects of the clinical trial protocol, including all imaging procedures that are provided in the imaging manual, and to not deviate from any of those procedures as they are written. However, instances occur when something is out of the imaging staff’s control – such as a patient being late for a scanning appointment, or a blood-draw being late because the intravenous line failed. When these things happen, they are considered a protocol deviation: a variation from processes or procedures defined in a protocol. REF: p. 204 16. Which of the following often results in data not deemed evaluable for a protocol analysis? a. Protocol deviation b. Protocol violation c. Study aberration d. Study eccentricity ANS: B

A protocol violation is a more serious concern – when there is a significant departure from the processes or procedures as required by the clinical trial protocol. A protocol violation often results in data not deemed evaluable for a protocol analysis. REF: p. 204 17. Which acronym is used to aid in proper documentation during a clinical trial? a. IRB b. GCP c. CRO d. ALCOA ANS: D

This acronym stands for Attributable, Legible, Contemporaneous, Original, and Accurate and is an effective way to develop excellent “documentation hygiene” during clinical research. REF: p. 205

18. Original medical records used as documentation in a clinical trial are termed a. protocol documents. b. research contracts. c. source documents. d. investigator notes. ANS: C

Source documents are defined in GCP as “Original documents, data, and records (e.g., hospital records, clinical and office charts, laboratory notes,…pharmacy dispensing records, recorded data from automated instruments,…photographic negatives, microfilm or magnetic media, x-rays, subject files, and records kept at the pharmacy, at the laboratories, and at medico-technical departments involved in the clinical trial).” REF: p. 204 19. All of the following are responsibilities of a monitor, EXCEPT a. obtain the study sponsor. b. insure the accuracy of the clinical trial data. c. check for proper informed consent procedures. d. check for appropriate documentation. ANS: A

Monitors are hired by either the sponsor or the CRO, and have deep expertise in GCP and clinical trial regulations. Their primary function is to ensure the integrity and accuracy of clinical trial data, which includes checking that all informed consent procedures were conducted and documented appropriately, all study procedures were followed as directed in CeOnM the protocol, and that everyTtE hiS ngTiBnAthNeKCSREFLisLdEoR cu.m ted in an original source. REF: p. 205 20. A record of clinical study observations and other information that a study protocol designates

that must be completed for each subject is the a. clinical report form. b. case report form. c. source document. d. monitor report. ANS: B

A case report form (CRF) is not the same as the source document, and this can be a confusing concept for imaging sites that are new to research. A CRF is defined as “A printed, optical, or electronic document designed to record all of the protocol-required information to be reported to the sponsor for each trial subject.” It is a record of clinical study observations and other information that a study protocol designates must be completed for each subject. REF: p. 205

Chapter 09: Health Informatics in Imaging Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. In an imaging computer system, the analog-to-digital converter (ADC) allows for the a. localization of the appropriate pixel into which the gamma event is recorded. b. averaging of the x, y, and z pulses. c. processing of the energy pulse by the pulse-height analyzer. d. conversion of x and y information into analog format. ANS: A

Digitization is accomplished by ADCs to provide a quantitative location of the scintillation event. The digital location information locates the appropriate pixel into which the gamma event can be recorded. REF: p. 209 2. The image density for each pixel is determined by a. the gamma-ray counts stored within a pixel. b. the ratio of the z pulse to the x and y pulse. c. the counts detected minus the rollover counts. d. size of the matrices in which the pixels configured. ANS: A

The image density for eachTpEixSeT lB isAdN etK erS mEinLeL dE byRt.hC eO nuMmber of gamma-ray counts stored within a pixel. For image display, the highest pixel count is assigned the brightest intensity on the display with other pixel counts assigned to appropriate intermediate and lower intensities. REF: p. 209 3. If a pixel can contain only 1 byte of information, and if the counts per pixel reaches 256

counts, pixel rollover may occur and would result in the a. averaging of all of the subsequent counts before storage. b. addition of the subsequent counts to the pixel counts. c. pixel value going back to 0. d. spillage of counts into the adjoining pixel. ANS: C

A pixel able to contain only 1 byte of information allows the storage of 256 different numbers (0 to 255). If the counts per pixel reach the maximum of 255, pixel rollover may occur when the 256th count is reached and the pixel value would go back to 0. REF: p. 209 4. On a computer, image resolution a. deteriorates as the acquisition matrix size increases. b. deteriorates as the acquisition matrix size decreases. c. remains consistent across matrix size for a given camera.

d. remains consistent across matrices if pixel rollover is controlled. ANS: B

The image resolution deteriorates as the selected acquisition matrix size gets smaller. REF: p. 210 5. Hardware magnification or zoom a. decreases resolution. b. increases noise. c. only increases image size. d. increases sensitivity. ANS: B

Although zooming increases resolution, there is a decrease in the number of counts per pixel, resulting in a noisier image. REF: p. 211 6.

Software magnification a. increases resolution. b. decreases noise. c. only increases image size. d. increases sensitivity. ANS: C

Magnification of areas on digitized images can also be performed. Most commonly, magnification (software zoom) is used to improve the visual display, though there is no increase in resolution. REF: p. 211 7. When using list mode to acquire a gated cardiac study, all of the following are true EXCEPT a. a significant amount of disk space is required to store the data. b. physiological markers are placed in the list of data. c. calculations can be made from selected data. d. timing marks are not needed for data collection. ANS: D

In list mode acquisition, a timing mark is stored along with the x and y locations of the scintillations event. In addition, a physiological marker is placed in the list of data. List mode acquisition mode requires a significant amount of storage but the advantage is that acquired data can be evaluated and images constructed only from those desired heart rates. The advantage of this technique is that after data have been acquired as a list of gamma-ray events, the data can be evaluated, the desired R-R interval can be selected from the acquired data, and images can be constructed only from those of the desired heart rate. If the reformatted data are found to be unacceptable, a new R-R interval can be selected and a new series of images can be formatted. REF: p. 212 8. In an 8-bit color image, the range of displayed color intensities would be

a. b. c. d.

0 to 64. 0 to 100. 0 to 128. 0 to 255.

ANS: D

Although the human eye can differentiate fewer than 100 shades of gray, most computer systems generate an 8-bit image, assigning display intensities from 0 to 255. REF: p. 213 9. When using nine-point image smoothing, all of the following is true EXCEPT a. there is a slight increase in image resolution. b. there is a slight decrease in image resolution. c. there is a blending of pixel values. d. it creates a more aesthetic image. ANS: A

Nine-point smoothing blends each pixel value with those of its neighbors, creating a smoother, more aesthetic image; however, there is a slight loss of resolution and the detail is slightly blurred. REF: p. 214 10. When using temporal smoothing a. noise is removed without loss of spatial resolution. b. noise is removed with a slight loss of spatial resolution. c. noise is not removed, bTuE t tS heTrB eA isNaKslSigEhL t iL nE crR ea.seCiOnMspatial resolution. d. results are the same as nine-point image smoothing except it is applied to dynamic

studies. ANS: A

Temporal filtering is applied most frequently to gated cardiac images with the filter applied in a closed loop. Temporal filtering removes noise without a loss of spatial resolution as occurs with the nine-point smoothing. REF: p. 215 11. Digital Imaging and Communications in Medicine (DICOM) is the standard for a. analog to digital conversion. b. filtering software. c. the system in each hospital for archiving EHRs. d. data set-up to allow for image transfer among systems. ANS: D

DICOM is the standard for transferring data and images between vendor computer formats. DICOM data are set up in data sets. REF: p. 219 12. Dynamic data acquisition during a multiple gated acquisition is linked to the a. P wave.

b. R wave. c. SA node. d. Q wave. ANS: B

Data acquisition of the gated radionuclide ventriculogram (RVG) requires synchronization of dynamic data acquisition with the cardiac cycle. More commonly known as multiple gated acquisition (MUGA), or equilibrium radionuclide angiography (ERNA), the RR interval of the ECG is divided equally into a series of frames or images (frame mode). From 16 to 32 images are used to acquire the data through the length of time for one cardiac cycle. An additional input to the computer to receive the R wave signal from an ECG is required. Data are acquired each time an R wave occurs. REF: p. 212 13. The quality of the cardiac data during a MUGA can be compromised by a. breathing. b. bradycardia. c. tachycardia. d. PVCs. ANS: D

In patients with arrhythmias, the quality of the data is compromised by premature ventricular contractions (PVCs) and the compensatory beats that follow PVCs. REF: p. 212 TRUE/FALSE 1. A 256  256 matrix has a smaller pixel size than does a 64  64 matrix. ANS: T

A 256  256 matrix has a smaller pixel size than does a 64  64 matrix. REF: p. 211 2. Interpolation results in a loss of image data. ANS: F

Interpolation is the process of changing the matrix size after the image has been acquired. The matrix can be changed from a larger size to a smaller size, or from a smaller size to a larger size. When an image is interpolated, there is no loss of data. The data is redistributed from one pixel to the adjacent pixels. Because of the shifting of counts from one pixel to the next, smoothing (linear) should be applied to the image to ensure an even distribution of counts. REF: p. 214

Chapter 10: Physics of Nuclear Medicine Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. An atom a. is the smallest quantity of an element that retains all the chemical properties of that

element. b. can be broken into smaller particles to combine with other elements. c. is the smallest particle of a chemical compound that retains all the chemical

properties of that element. d. is a form of electromagnetic radiation. ANS: A

An atom is the smallest quantity of an element (e.g., hydrogen, carbon) that retains all the chemical properties of that element. Atoms cannot be broken into smaller particles. REF: p. 225 2. The smallest particle of a chemical compound that retains all the chemical properties is a(n) a. atom. b. isotope. c. element. d. molecule. ANS: D

Two or more atoms may combine to form a molecule. A molecule is the smallest particle of a chemical compound that retains all the chemical characteristics of that compound. REF: p. 225 3. The part of the atom that is responsible for all chemical interactions with other atoms is a. the proton. b. the neutron. c. the outermost electrons. d. the innermost electrons. ANS: C

The extranuclear region of the atom is the area outside the nucleus. This region of the atom, specifically the outermost electrons, is responsible for all chemical interactions with other atoms and is the area in which most of the interactions of radiation and matter occur. REF: p. 225 4. When using the standard notation in the physical sciences for representing elements with a

one- or two-letter chemical name symbol, the letter Z represents the a. atomic mass. b. atomic number. c. number of neutrons.

d. number of electrons. ANS: B

The total number of protons in an atom is the atomic number, symbolized by the letter Z, and is unique for each element. REF: p. 225 5. If indium has an atomic number of 49 and an atomic mass of 112, how many neutrons are

found in a stable element of indium-112? a. 14 b. 49 c. 63 d. 112 ANS: C

Z is the element’s atomic number (number of protons), and A represents the atomic mass number of the atom (protons plus neutrons). Although the number of neutrons can be indicated as a trailing subscript number, it is usually not written because it can be calculated by subtracting Z from A. REF: p. 225 6. Isotopes are different forms of a specific element that have a. a different number of protons. b. a different number of neutrons. c. a different number of electrons. d. a different atomic massT. ESTBANKSELLER.COM ANS: B

The term isotope defines a specific element, with different forms of that element each containing different numbers of neutrons. The isotopes will follow a horizontal line on the chart of the nuclides (e.g., 97Tc, 98Tc, 99Tc, 100Tc, and 101Tc). REF: p. 225 7. Which of the following is not true of isotopes? a. They have the same atomic number. b. They have the same mass number. c. They have the same number of neutrons. d. They have the same chemical properties. ANS: C

The same element will always have a specific number of protons as listed by the atomic number Z and will have the same chemical properties; however, the number of neutrons can differ. These atoms with different numbers of neutrons are isotopes. The word isotope comes from the Greek words iso (meaning “same”) and topos (meaning “place”), indicating that the atoms have the same position on the periodic table of elements. REF: p. 225

8. Atoms that have identical physical attributes but a different amount of nuclear energy are

called a. isotones. b. isotopes. c. isomers. d. isobars. ANS: C

Isomers are atoms that have identical physical attributes, such as the number of protons, neutrons, and electrons; however, they contain a different amount of nuclear energy. REF: p. 226 9.

Mo, 99Tc, and 100Ru are examples of a. isotopes. b. isotones. c. isomers. d. isobars. 98

ANS: B

Isotones are atoms of different elements that have the same number of neutrons but varying numbers of protons. 98Mo, 99Tc, and 100Ru are isotones: all having 56 neutrons and form a vertical line on the chart of the nuclides. REF: p. 225 10. The alpha particles consist of a. one proton and two neuTtrEoS nsT. BANKSELLER.COM b. two protons and one neutron. c. two protons and two neutrons. d. two protons and three neutrons. ANS: C

Alpha particles (helium nuclei consisting of two protons and two neutrons) are radioactive decay products from radionuclides having a large, unstable mass. REF: p. 230 11. When an unstable element undergoes a radioactive decay process resulting in a new element,

the process is called a. conversion. b. transition. c. isolation. d. transmutation. ANS: D

The formation of a different element by a radioactive decay process is called transmutation, or isobaric radioactive decay. REF: p. 237-238

12. After beta-minus decay of iodine, which has an atomic number of 131 and an atomic mass of

53, the resultant nuclide will have the following mass number (A) and atomic number (Z): a. (A) = 131, (Z) = 52 b. (A) = 131, (Z) = 54 c. (A) = 130, (Z) = 53 d. (A) = 132, (Z) = 53 ANS: D

This nuclear decay process is termed beta-minus or simply beta decay. The parent element M with atomic number Z and mass number A decays by beta emission as: 131 I → 54131Xe + e– + ve. 53 REF: p. 230 13. Positron decay comes from the nucleus that is a. proton-rich. b. neutron-rich. c. electron-rich. d. neutrino-rich. ANS: A

A nucleus that is proton-rich (neutron-poor) can reduce its proton surplus by two possible decay processes: positron decay or electron capture. REF: p. 230 14. When electron capture occurs, a. an orbital electron is caTpE tuS reTdBaA ndNcKoS mE biLnL edEw Ri.thCaOpMroton to form a neutron. b. a beta-minus electron is recaptured and added to a proton to form a neutron. c. there is a transfer of energy from the nucleus to an orbital electron. d. an orbital electron is captured and converted to a positron. ANS: A

Electron capture occurs when an orbital electron travels in the proximity of the nucleus and is captured and combined with a proton to form a neutron. (Answer C describes internal conversion.) REF: p. 231 15. Gamma emission usually occurs a. when there is an excess of protons in the excited nucleus. b. when there is greater than 100 keV of excess energy in the excited nucleus. c. whenever a K-shell electron is captured. d. as particulate radiation to eliminate excess energy from the nucleus. ANS: B

Gamma emission usually occurs when there is greater than 100 keV of excess energy in the excited nucleus; it is a mechanism for an excited nucleus to release energy. The gamma ray may be part of another decay process or a release of energy from a metastable nucleus. REF: p. 232

16. The transition of 99mTc to 99Tc is considered to be a. isotonic. b. isobaric. c. isomeric. d. isotopic. ANS: C

When a metastable nucleus is present, there is a significant amount of time from any previous radioactive decay before a further release of energy. The release from a metastable state is termed an isomeric transition. In this transition, the nucleus goes from a higher energy level to a lower energy level through electromagnetic radiation (usually greater than 100 keV); this is sometimes referred to as gamma decay. REF: p. 232 17. Gamma rays differ from x-rays in that they have different a. masses. b. charges. c. velocities. d. origins. ANS: D

Gamma rays and x-rays have the same characteristics but the names are based on their origin; gamma rays are emitted from the nucleus and x-rays from the electron shells. REF: p. 232

ow 18. 10 millicuries is equal to hT ESmTanByAm NeKgSabEeLquLeEreRls.?COM a. 0.37 b. 3.7 c. 37 d. 370 ANS: D

Multiply the number of millicuries by 37 MBq/mCi to convert to the number of megabecquerels. For example, 20 mCi  37 MBq/mCi = 740 MBq. Conversely, convert the number of megabecquerels to millicuries by dividing by 37 MBq/mCi; for example, 111 MBq/(37 MBq/mCi) = 3 mCi. REF: p. 235 19. Assuming the biological half-life of 99mTc-MAA is 3 hours, what would be the effective

half-life? a. 0.3 hour b. 0.5 hour c. 2 hours d. 3 hours ANS: C

where teff = effective half-life, tb = biological half-life, tp = physical half-life

REF: p. 237 20. Removal of an electron from a neutral atom is called a. excitation. b. ionization. c. pairing. d. bonding. ANS: B

Ionization of an atom results from the collision of radiation with the electron structure of an atom. Ionization occurs only when the radiation has sufficient energy to completely remove an electron from its orbit. REF: p. 238 21. All of the following are true about bremsstrahlung radiation EXCEPT a. it occurs when a beta particle is deflected and slowed in its path. b. there is a low probability of occurrence when shielding beta particles with lead. c. its probability increases when shielding betas with materials that have a high Z

number. d. it is the method used to produce x-rays in computed tomography (CT) scanners. ANS: B

As the beta particle is deflected and slowed in its path, there is a release of energy as x-rays, called bremsstrahlung radiation. These x-rays are released in a continuous spectrum because of the variations in kinetic energy and path geometry of the beta particle. Bremsstrahlung interactions increase in proTbE abSilT itB yA wN ithKS mE atL erL iaE lsRth.aCt O haMve a high Z number. REF: p. 239 22. The minimum MeV photon energy required for pair production is a. 0.511. b. 1.022. c. 5.110. d. 10.22. ANS: B

In the annihilation process, the rest masses of the positron and negatron are identical (0.511 MeV), giving a total energy of 1.022 MeV. REF: p. 239 23. For the photoelectric effect to occur, the energy of the incident photon must be a. less than that of the binding energy of the orbital electron. b. equal to that of the binding energy of the orbital electron. c. greater than that of the binding energy of the orbital electron. d. equal to the binding energy minus the photon energy. ANS: C

For the photoelectric effect to occur, the energy of the incident photon must be greater than the binding energy of the orbital electron.

REF: p. 240 24. In the photoelectric process, the energy of the incoming photon a. is completely absorbed. b. scatters with no change of energy. c. scatters with a loss of energy. d. scatters with an increase of energy. ANS: A

In the photoelectric effect, the photon energy is completely absorbed with some of its energy used to break the bond of the electron in its shell, and the remaining energy is given to the electron in the form of motion or kinetic energy. REF: p. 240 25. The probability of a photoelectric interaction a. increases with low-Z material. b. increases with high-Z material. c. is high in tissue. d. is high in water. ANS: B

The probability of a photoelectric interaction occurring depends on the energy of the incident gamma ray and the atomic number of the material. As a photon’s energy increases, the probability for photoelectric interactions decreases. The probability of a photoelectric interaction increases dramatically with the atomic number; that is, photoelectric interactions are unlikely to occur in lowT-E Z SmTaB teA riaNlsKsSuE chLaLsEwRa. teC r aOnMd tissue but are likely to occur in high-Z materials such as the iodine in a sodium iodide crystal or in lead. The photoelectric effect is therefore the primary type of interaction for detecting gamma rays with nuclear medicine instruments. REF: p. 240 26. In Compton scattering, the energy of the emitted electron a. is equal to the energy of the incoming photon. b. is less than the energy of the incoming photon. c. is greater than the energy of the incoming photon. d. is equal to the binding energy of the electron. ANS: B

The energy and wavelength of the scattered photon are always lower than those of the incident photon, and the scattered photon’s energy also depends on the atomic number of the scattering material, the incident photon’s energy, and the angle of the scatter. REF: p. 240 27. Pair production is always followed by a. annihilation. b. Compton scatter. c. electron capture. d. the photoelectric effect.

ANS: A

Pair production is an interaction produced when a photon with an energy greater than 1.02 MeV passes near the high-electric field of the nucleus. The strong electrical force brings about the energy-mass conversion. When the photon comes near the nucleus, it disappears totally and two particles of matter are created, an electron and a positron, each possessing the mass equivalence of 0.511 MeV. REF: p. 239 28. An alternative process to the emission of a characteristic x-ray is a. pair production. b. photoelectric effect. c. Compton scatter. d. Auger effect. ANS: D

Characteristic x-rays are produced as part of the process of reducing excess energy when electrons fill vacancies in the inner shells. An alternative to characteristic x-rays is the Auger effect. In this interaction, the surplus energy is given to another orbital electron that is ejected. The ejected electron is called an Auger electron and the atom is left with two vacancies occurring in the electron structure. REF: p. 233 29. The relationship between the linear attenuation coefficient (u) and the half-value layer (HVL)

is given by a. HVL/ = 0.693. b.  = 0.693/HVL. c. HVL = 0.693 . d. HVL 2 = 0.693. ANS: B

The linear attenuation coefficient  is the probability of attenuation per distance traveled through an absorber. The HVL is the thickness of the absorber necessary to diminish the intensity of the radiation to half its initial strength. The linear attenuation coefficient  is related to the HVL of the material by:  = 0.693/HVL. REF: p. 241 30. The half-value layer (HVL) for annihilation radiation in lead is 4.1 cm. Approximately what

percentage of a of 511 keV photon beam will penetrate 15 cm of lead? a. 50% b. 37% c. 33% d. 25% ANS: D

The HVL is the thickness of the absorber necessary to diminish the intensity of the radiation to half its initial strength. Because 4.1 cm is equal to one HVL, 8 cm is equal to approximately 2 HVLs, thereby diminishing the intensity of radiation to one-fourth of the original intensity. The equation is: I = I0e–0.693x/HVL REF: p. 241 TRUE/FALSE 1. Forms of electromagnetic radiation differ only in frequency and wavelength. ANS: T

Heat waves, radio waves, infrared light, visible light, ultraviolet light, and x-rays and gamma rays are all forms of electromagnetic radiation (Figure 2-1). They differ only in frequency and wavelength. REF: p. 226 2. An electrically neutral atom has the same number of protons and neutrons. ANS: F

An electrically neutral atom has an equal number of protons and electrons. REF: p. 224 3. The total number of protonTsE isSrT efB erAreNdKtoSaEsLthLeEaR to.mCicOm Mass. ANS: F

The total number of protons in an atom is the atomic number, symbolized by the letter Z, and is unique for each element. REF: p. 225 4. Electrons can be deflected by an electronic or a magnetic field. ANS: T

Because electrons carry a negative charge, they are deflected by electric or magnetic fields. REF: p. 239 5. An unstable configuration of protons and neutrons is referred to as nuclides. ANS: F

Any configuration of protons and neutrons forming an atom is called a nuclide. Of the approximately 3100 nuclides, most are unstable and spontaneously release energy or subatomic particles in an attempt to reach a more stable state. Approximately 270 nuclides are in a stable form, comprising only 83 elements. The remainder of the approximately 3100 nuclides are radioactive and are referred to as radionuclides. REF: p. 225

Chapter 11: Instrumentation Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Quenching gas is used in a(n) a. dose calibrator. b. Geiger-Mueller (GM) detector. c. ionization chamber. d. pocket dosimeter. ANS: B

A small amount of a quench gas, either chlorine or bromine, has been added to the detector chamber to stop the discharge so that the GM counter can recover for a new event. REF: p. 252 2. Which survey meter is appropriate to use when measuring high levels of radiation? a. Ionization chamber b. Dose calibrator c. GM meter d. Body badge ANS: A

Ionization chamber (Cutie Pie) is the appropriate device to use for the high levels of radiation. REF: p. 252 3. The gas in a dose calibrator is usually a. air. b. helium. c. argon. d. quenching. ANS: C

The dose calibrator is a thin-walled aluminum chamber configured as a reentrant well that contains argon at high pressure. REF: p. 254 4. Which detector is confined for use in detecting radiation where the exposure levels are below

2000 mR/hr? a. Ionization chamber b. Dose calibrator c. GM meter d. Body badge ANS: C

The recovery time for the anode to recharge after an event is about 100 µsec. Additional events that occur during this time interval (also called the deadtime) prolong the recovery and can even stop the detector from operating when the exposure rate is too high. As a result, GM detectors are confined to use in areas where the exposure level are below 2000 mR/hr. REF: p. 252 5. Detector efficiency is defined as a. the ratio of the number of detected events to the number of source emissions. b. the geometric efficiency and is defined as the fraction of emitted photons (gamma

or x-rays) that hit the detector; it depends on the detector configuration and its distance from the source. c. the fraction of gamma rays that are detected when they hit the detector; it depends on the thickness (t) and attenuation coefficient () of the detecting material. d. the amount of blurring that is produced by an imaging system, characterized by point spread function and line spread function. ANS: A

Detector efficiency has a simple definition; it is the ratio of the number of detected events to the number of source emissions. REF: p. 247 6. Geometric efficiency is defined a. as the ratio of the number of detected events to the number of source emissions. b. as the fraction of emitted photons (gamma or x-rays) that hit the detector; it

depends on the detector configuration and its distance from the source. c. as the fraction of gamma rays that are detected when they hit the detector; it

depends on the thickness (t) and attenuation coefficient () of the detecting material. d. as the amount of blurring that is produced by an imaging system, characterized by point spread function and line spread function. ANS: B

Geometric efficiency is defined as the fraction of emitted photons (gamma or x-rays) that hit the detector, and it depends on the detector configuration and its distance from the source. REF: p. 247 7. Intrinsic efficiency is defined as a. the ratio of the number of detected events to the number of source emissions. b. geometric efficiency and is defined as the fraction of emitted photons (gamma or

x-rays) that hit the detector; it depends on the detector configuration and its distance from the source. c. the fraction of gamma rays that are detected when they hit the detector; it depends on the thickness (t) and attenuation coefficient () of the detecting material. d. the amount of blurring that is produced by an imaging system characterized by point spread function and line spread function. ANS: C

The fraction of gamma rays that are detected when they hit the detector is called the intrinsic efficiency (). Intrinsic efficiency is determined from:  = 1–e-t. It depends on the thickness (t) and attenuation coefficient () of the detecting material. REF: p. 247 8. Spatial resolution is defined as a. the ratio of the number of detected events to the number of source emissions. b. geometric efficiency and is defined as the fraction of emitted photons (gamma or

Spatial resolution refers to the amount of blurring that is produced by an imaging system. All imaging systems cause some blurring, and nuclear medicine imaging systems have the poorest spatial resolution of all the medical diagnostic modalities. Two ways to characterize system resolution are the point spread function and the line spread function. REF: p. 249 9. The anticoincidence component on a pulse-height analyzer determines if a. more than one photon at the same energy is counted. b. two photons are counteTdEaS t tT heBsAaN mK eS tiE mL e.LER.COM c. the lower discriminator is triggered, but not the upper energy discriminator. d. the upper and lower energy discriminators are triggered simultaneously. ANS: C

The pulse-height analyzer (PHA) receives the output of the amplifier and determines if it falls within a selected energy range on the basis of the pulse height. The electronics within the PHA check the height of the pulse against lower and upper voltage levels. If the pulse height is within the defined range, the PHA puts out a standard-sized pulse that will be transmitted to a scaler or rate meter; otherwise, no signal is generated. The PHA consists of three components: a lower-level discriminator, an upper-level discriminator, and an anticoincidence circuit that determines when the lower discriminator is triggered but not the upper energy discriminator, signaling that a pulse is received between the two windows. REF: p. 249 10. When performing quality control on a well counter or thyroid probe, constancy is tested by

performing a(n) a. chi-square test. b. FWHM. c. intrinsic resolution check. d. count for each radionuclide used. ANS: A

The stability of the system is checked with a constancy test using 137Cs to verify that the gain settings or high voltage have not drifted. A chi-square evaluation is required at least quarterly and is done by collecting 10 measurements from the 137Cs standard and verifying that result falls within the 0.1 to 0.9 probability range (see Chapter 1 for details). REF: p. 296 11. When performing quality control on a well counter or thyroid probe, energy resolution is

evaluated a. weekly. b. monthly. c. quarterly. d. annually. ANS: C

Energy resolution is also evaluated quarterly with a 137Cs source or other monoenergetic source and may be reported as verification of the calibration procedure. REF: p. 255 12. A PHA includes all of the following EXCEPT a. lower-level discriminator. b. upper-level discriminator. c. anticoincidence circuit. d. amplifier. ANS: D

The PHA receives the outpTuE t oSfTthBeAaN mK plSifE ieL rL anEdRd. etC erOmMines if it falls within a selected energy range on the basis of the pulse height. The electronics within the PHA check the height of the pulse against lower and upper voltage levels. If the pulse height is within the defined range, the PHA puts out a standard-sized pulse that will be transmitted to a scaler or rate meter; otherwise no signal is generated. The PHA consists of three components: a lower-level discriminator, an upper-level discriminator, and an anticoincidence circuit that determines when the lower discriminator is triggered but not the upper energy discriminator, signaling that a pulse is received between the two windows. REF: p. 260 13. When performing quality control on a dose calibrator, the testing of the correct activity over

the entire range of radioactivity used in the laboratory is the a. accuracy test. b. geometry test. c. linearity test. d. constancy test. ANS: C

The linearity test checks that the calibrator is able to assay the correct activity over the entire range of radioactivity used in your laboratory. REF: p. 255

14. When performing quality control on a dose calibrator, it is required that the constancy test is

performed a. daily. b. quarterly. c. annually. d. at installation. ANS: A

The constancy test is done each day before clinical use to verify that the dose calibrator measurements are reliable. REF: p. 255 15. When performing quality control on a dose calibrator, it is required that the accuracy test is

performed a. daily. b. quarterly. c. annually. d. at installation. ANS: C

The accuracy of the dose calibrator must be validated annually using calibrated radioactive sources traceable to the National Institute of Standards and Technology (NIST). REF: p. 255 16. When performing quality control on a dose calibrator, it is recommended to test geometry: a. daily. b. quarterly. c. annually. d. at installation. ANS: D

The geometry test monitors how the activity measurement changes with sample volume or configuration. The geometry test is performed at installation and must be repeated if the dose calibrator is relocated or serviced. REF: p. 256 17. The percent full width at half maximum (FWHM) is often used as a measure of a. precision. b. sensitivity. c. intensity. d. resolution. ANS: D

All spatial resolution values are expressed as the FWHM of a line spread function and are measured in millimeters. REF: p. 278 18. Extrinsic spatial resolution is monitored using

a. b. c. d.

FWHM. quadrant bar phantom. flat field collimator. electronic zoom.

ANS: B

Extrinsic spatial resolution can be monitored with a quadrant bar phantom interposed between the collimator and a flood source. REF: p. 289 19. In a scintillation camera, geometric resolution depends on a. the size of the patient. b. the position of the source. c. the configuration of the holes in a collimator. d. filtering the image. ANS: C

The collimator contribution to spatial resolution depends on the configuration of the holes and is referred to as geometric resolution. REF: p. 262 20. For a parallel-hole collimator, spatial resolution degrades as a. the source-to-collimator distance increases. b. the source-to-collimator distance decreases. c. the collimator holes decrease in size. d. the collimator holes incTrE eaS seTiB nA nuNm KbSeEr.LLER.COM ANS: A

Collimator spatial resolution degrades as the source-to-collimator distance increases. REF: p. 262 21. In multihole low-energy collimators, longer and smaller holes produce a. better uniformity. b. better sensitivity. c. better intrinsic resolution. d. better spatial resolution. ANS: D

The parameters that determine spatial resolution are the collimator thickness (i.e., hole length) and the hole size and shape. Longer and smaller holes produce better spatial resolution. REF: p. 262 22. Quench gas is used in a Geiger-Mueller counter to a. enhance ionizations. b. stop the discharge. c. alter the voltage. d. improve the counting of alphas. ANS: B

A small amount of a quench gas, either chlorine or bromine, has been added to the detector chamber to stop the discharge so that the GM counter can recover for a new event. REF: p. 252 23. According to the Nuclear Regulatory Commission (NRC), survey meters must be calibrated: a. daily. b. monthly. c. quarterly. d. annually. ANS: D

The NRC has specification recommendations for survey meter calibration, which are located in 10 CFR 35.61. These regulations require annual calibrations for all scales up to 10 mSv (1000 mR) per hour with two separate calibrations made at each scale setting. REF: p. 254 24. The devices that operate in the saturation range include all of the following EXCEPT a. dose calibrator. b. ionization chamber. c. personnel dosimeters. d. Geiger-Mueller counter. ANS: D

This plateau is called the saturation region. In this region, several ionization chamber devices are operated, such as the ionization survey meter (Cutie Pie), personnel dosimeters, and the dose calibrator. REF: p. 251 25. When referring to image quality, contrast a. refers to how well objects can be separated in space. b. determines whether two objects have different activity concentrations. c. refers to the ability to see the edge of a structure. d. occurs because of the random nature of counting statistics. ANS: B

Resolution refers to how well objects can be separated in space (as opposed to blurring them together); contrast refers to how well different levels of brightness can be seen (brightness represents density for radiographs, and radionuclide concentration in scintigrams); and noise refers to random additions to the image that interfere with the viewer’s perception. In a scintigraphic image, resolution allows separation of two objects that are close together. Contrast allows the determination of whether two objects have different activity concentrations. Noise is primarily due to counting statistics. Contrast in scintigraphic images can be defined as the measure of counts (or intensity) in the target (the object being imaged) compared with the intensity in a background region. REF: p. 285 26. Digitization of the signal of each photomultiplier tube (PMT) a. increases sensitivity.

b. decreases scan time. c. increases contrast. d. increases processing flexibility. ANS: D

Digitization of the signal of each PMT allows computer software to replace the complicated analog circuitry for positioning and pulse height analysis. This allows greater processing flexibility, resulting in improved energy and spatial resolution. REF: p. 296 27. Compared to a low-energy collimator, a high-energy collimator will have all of the following

EXCEPT a. thicker septa. b. longer holes. c. lower resolution. d. higher sensitivity. ANS: D

To recapture some of the sensitivity lost by thicker septa, most medium- and high-energy collimators are designed for lower resolution than low-energy collimators. REF: p. 254-255 28. Increased sensitivity for SPECT imaging can be achieved by using a a. general-purpose collimator. b. converging collimator. c. high-energy collimatorT . ESTBANKSELLER.COM d. high-resolution collimator. ANS: B

Parallel hole collimators are most commonly used for SPECT, but increased sensitivity can be obtained with converging collimators in which the holes converge on a line (fan beam) or a point (cone beam). REF: p. 260 29. The 360-degree orbit is most often used in SPECT studies EXCEPT for scans of a. the brain. b. the heart. c. the liver. d. bone. ANS: B

The theory of SPECT requires that the scintillation camera acquire enough images of the patient at different angles to obtain a complete description of the distribution of the radioactive tracer. Several projections over a 180-degree orbit would be satisfactory if there were no scatter or attenuation. Because this is not often the case, 360-degree orbits are used for most SPECT studies (the exception is cardiac SPECT). The heart is located forward and to one side of the center of the thorax, resulting in a great deal of attenuation when the camera is behind the patient. The angles chosen for the 180 degrees are those closest to the heart, from 45 degrees right anterior oblique (RAO) to 45 degrees left posterior oblique (LPO). These projections are affected least by attenuation, scatter, and detector response because they are the closest to the heart. Reconstructions from 180-degree acquisitions have higher resolution and contrast than those from 360-degree acquisitions. REF: p. 271 30. Body contouring or elliptical orbits in SPECT imaging have an advantage over circular orbits

because they a. improve the accuracy of gantry location. b. reduce the camera-to-patient distance. c. maximize resolution. d. minimize noise. ANS: C

Body-contour orbits seek to keep the camera as close to the body as possible throughout the tomographic acquisition, thereby maximizing resolution. The radius is changed angle-by-angle to minimize the distance while maintaining the same angles used in a circular orbit. The simplest body-contour orbits assume the shape of an ellipse, although some manufacturers offer sophisT tiE caSteTdBseAnNsoKrS s tEhL atLmEinRi. mC izO eM the camera-to-body distance in real time at each angle. REF: p. 272 31. In general, the pixel size should be less than: a. one-quarter the system resolution. b. one-third the system resolution. c. one-quarter the system efficiency. d. one-third the system efficiency. ANS: B

In general, the pixel size should be less than one-third the system resolution (measured as full width at half maximum [FWHM]). The number of counts in each pixel is also related to the system resolution; the higher the resolution, the lower the number of counts obtained per pixel. REF: p. 286 32. Ramp-filtered projections are characterized by a. a star artifact. b. edge information enhancement. c. smoothing of edge information. d. enhancing noise.

ANS: B

The ramp-filtered projections are characterized by enhancement of edge information and the introduction of negative values (or lobes) into the filtered projections. During superposition in the back-projection process, these negative values cancel portions of the other angular contributions and help to eliminate the star artifact. REF: p. 273 33. A low-pass filter a. allows low frequencies to pass and blocks high frequencies. b. blocks low frequencies and allows high frequencies to pass. c. smoothes images by reducing low frequencies. d. reduces noise by blocking low frequencies. ANS: A

Filters that remove high frequencies are called low-pass filters, because they preserve (pass) only the low frequencies. This reduces noise but blurs edges. REF: p. 276 34. In the reconstruction of SPECT images, segmenting refers to a. volume rendering. b. determining the number of counts per pixel. c. separating the organ from the background or nearby structures. d. dividing an organ into different components. ANS: C

Segmentation is the procesTs E ofSsTepBaA raNtiK ngStEhL eL orE gaRn.fC roOmMthe background or nearby structures. It can be accomplished using various methods, such as hand tracing the volume of interest, using a thresholding technique in which pixels with values greater than the threshold are assumed to be part of the organ and all other pixels are assumed to be background or complicated boundary detection algorithms. REF: p. 283 35. When the same nonuniformity is back-projected at each of the angles of acquisition, the result

is a. b. c. d.

blurring. a star artifact. a ring artifact. streak artifact.

ANS: C

A circular, or ring, artifact results when the same nonuniformity is back-projected at each of the angles of acquisition. The higher the acquired counts for that slice, the more prominent the artifact, because it rides above the random noise error. Also, the closer the local nonuniformity to the axis of rotation, the higher the amplitude of the artifact, because the back-projected lines are closer together (there is more overlapping of count values). REF: p. 291 36. The center-of-rotation measurement

a. b. c. d.

determines the number of projections. corresponds to the pixel size at the center of the orbit. corresponds to the radius. determines the offset between the camera center and projections.

ANS: D

The center of rotation (COR) is the axis about which the camera rotates. The COR measurement determines the offset between the center of the camera matrix and projection of the center of rotation of the camera face (they do not automatically correspond). REF: p. 292 37. When referring to image quality, resolution a. refers to how well objects can be separated in space. b. determines whether two objects have different activity concentrations. c. refers to the ability to see the edge of a structure. d. occurs because of the random nature of counting statistics. ANS: A

Resolution refers to how well objects can be separated in space (as opposed to blurring them together); contrast refers to how well different levels of brightness can be seen (brightness represents density for radiographs, and radionuclide concentration in scintigrams); and noise refers to random additions to the image that interfere with the viewer’s perception. In a scintigraphic image, resolution allows separation of two objects that are close together. Contrast allows the determination of whether two objects have different activity concentrations. Noise is primarily due to counting statistics. Contrast in scintigraphic images can be defined as the measure of counts (or intensity) in the target (the object being imaged) compared with the intensitT yE inSaTbBaA ckNgK roS unEdLrL egEioRn.. COM REF: p. 269 TRUE/FALSE 1. If a detector can produce an electronic signal for each individual interaction whose amplitude

reflects the amount of energy absorbed, it is said to have spatial resolution. ANS: F

Detectors that produce an electronic signal for each individual interaction and whose amplitude reflects the amount of energy absorbed are said to have energy resolution. Energy resolution is advantageous for selective gamma ray detection. REF: p. 248 2. In SPECT/CT imaging, it is best if the patient does shallow breathing throughout the scan. ANS: T

If standard CT procedures are followed and the patient is asked to hold his or her breath throughout the entire acquisition, it will almost guarantee that the two image sets do not match. Shallow breathing throughout the scan is recommended to minimize this source of image mismatch.

REF: p. 271

Chapter 12: CT Physics and Instrumentation Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. In x-ray tubes, the types of reactions that produce x-rays include a. Bremsstrahlung and scatter. b. Bremsstrahlung and characteristic. c. characteristic and scatter. d. characteristic and refraction. ANS: B

In x-ray tubes, the types of reactions that produce x-rays are Bremsstrahlung radiation and characteristic x-rays. REF: p. 300 2. In an x-ray tube, of the energy applied to the system, the percentage of x-rays that exit is a. 1%. b. 10%. c. 50%. d. 99%. ANS: A

Only about 1% of the energy applied to the system is converted into x-rays that exit the tube TEoSf T window; the remaining 99% enBeA rgN yKcrSeE atL esLhEeaRt. . COM REF: p. 301 3. In an x-ray tube, the anode, for the most part, is most commonly constructed from a. tungsten. b. lead. c. rhenium. d. silver. ANS: A

The surface layer of the anode, where the electron beam strikes the anode, and x-rays are produced via Bremsstrahlung interactions, is most commonly constructed from 90% tungsten and 10% rhenium. In addition to Bremsstrahlung radiation, the electrons cause some ionization of the lower-energy shells of the atoms in the anode tungsten target. REF: p. 302 4. In a CT scanner, the oil bath that may surround the rotating anode tubes serves to a. make the tubes rotate more quickly. b. make the tubes rotate more smoothly. c. cool the tubes. d. provide efficient conduction of the current. ANS: C

Rotating anode tubes are required to remove the vast amount of heat that is generated by modern CT scanners. Often the tube may be surrounded by an oil bath to efficiently remove heat, and chilled water or cooled air may also be required in order to remove heat quickly so that the tube does not require a long cool-down time between uses. REF: p. 301 5. In an x-ray tube, a low kVp results in a. high-energy Bremsstrahlung x-rays. b. low-energy Bremsstrahlung x-rays. c. fewer Bremsstrahlung x-rays. d. an increase in tungsten characteristic x-rays. ANS: B

The voltage applied to the electrodes of an x-ray tube is typically in the range of 30 to 150 kVp (peak kilovoltage) for a wide range of x-ray applications. A low kVp potential difference on the electrodes will accelerate the electrons from the cathode with very little force, and the Bremsstrahlung x-rays that are produced will have low energy. REF: p. 301 6. In an x-ray tube, a high kVp results in a. low-energy Bremsstrahlung x-rays. b. a decrease in tungsten characteristic x-rays. c. an increase in tungsten characteristic x-rays. d. fewer Bremsstrahlung x-rays. ANS: C

An increase in the high voltage applied to the x-ray tube will result in a corresponding increase in the maximum energy of x-rays that are produced. In addition, there is an increase in the amplitude of the spectrum as more x-rays are produced by the higher velocity of the electrons that have been accelerated to the anode (see Figure 12-4). Note that not only is the amplitude of overall spectrum increased, but there also is a significant change in the contribution of characteristic tungsten x-rays with higher kVp settings. REF: p. 302 7. Energies required for typical PET/CT studies of the body will be in the range of a. 20 to 30 kVp. b. 40 to 75 kVp. c. 80 to 140 kVp. d. 145 to 160 kVp. ANS: C

The energies required for typical PET/CT studies of the body will be in the range of 80 to 140 kVp, depending on the size of the patient and the detail that is required for the clinical application. The energies that can be selected on a CT scanner are usually defined by a limited set of energies, such as 80, 100, 120, and 140 kVp, so there are no continuous energy options available to the operator. REF: p. 302

8. A general rule is that a 15% increase in kVp results in a. a 15% increase in mAs. b. doubling the mAs. c. a 15% reduction in mAs. d. no affect on mAs. ANS: B

A general rule is that a 15% increase in kVp is roughly equivalent to doubling the mAs. REF: p. 302 9. All of the following are true about the kVp setting EXCEPT a. it selects the maximum possible energy of the x-ray beam. b. it defines the fraction of photons that will reach the detectors. c. it affects the radiation exposure to the patient. d. it increases beam hardening. ANS: D

The kVp setting selects the maximum possible energy of the x-ray beam and defines the fraction of photons that will successfully reach the detectors of the scanner, as higher- energy photons are less attenuated by the body and result in lower quantum noise in the images; therefore, the radiation exposure to the patient will increase. REF: p. 302 10. In an x-ray tube, when the milliamperes (mA) are increased: a. Bremsstrahlung and characteristic x-rays increase. b. Bremsstrahlung and chT arEaS ctT erB isA ticNxK-S raE ysLdLeE crR ea.sC e.OM c. Bremsstrahlung x-rays increases and characteristic x-rays decrease. d. Bremsstrahlung x-rays decrease and characteristic x-rays increase. ANS: A

The applied current is the other primary setting that can be adjusted in the x-ray tube. When the current in mA is increased, both the Bremsstrahlung and characteristic x-rays that are produced increase proportionally with the current. REF: p. 302 11. Using a higher mA a. results in an increase in image noise. b. results in an increase in contrast resolution. c. results in a decrease in dose to the patient. d. shortens the imaging time for the patient. ANS: B

The mA is a direct defining parameter of the number of photons generated by the x-ray tube. A higher mA results in a decrease in image noise, an increase in contrast resolution, and an increased dose to the patient. An increase in kVp also results in greater penetration through the body. REF: p. 303

12. The purpose of using a filter in CT scanning is a. to absorb the very-low-energy x-rays. b. to act as an upper level discriminator. c. to act as a window. d. To attenuate the high-energy x-rays. ANS: A

Both planar x-ray and CT imaging systems position an absorbing x-ray filter into the x-ray beam. The beam-modifying filter has two purposes: (1) filtering absorbs the very- low-energy x-rays that would not have sufficient energy to transmit through the body tissue and would thus only increase patient exposure without adding information to the imaging process. By removing the low-energy x-rays, the beam is hardened so that the broad energy distribution has been somewhat removed and the result is a somewhat more uniform average energy of the beam. The filter may reduce patient radiation exposure by as much as 50%. (2) Filtering aids in shaping the energy distribution of the beam used to prevent the edges of the beam from hardening; therefore, the energy distribution across the field of the detectors is more uniform. REF: p. 303 13. Computed tomography (CT) scanning accomplishes all of the following EXCEPT a. minimal superimposition of tissues. b. improved contrast resolution. c. reduction of radiation dose compared to conventional radiography. d. differentiation of tissue densities. ANS: C

CT scanning achieves not only minimal superimposition of tissues, but also improved contrast differences of tissues over T plEanSaTr B x-AraNyKteScE hnLiL quEeR s..CCTOaM lso has the ability to differentiate tissue densities. REF: p. 305 14. Collimators in CT scanning are used to do all of the following EXCEPT a. limit the beam size. b. reduce scattered x-rays. c. define slice thickness. d. offset the alignment of the tube and detector array to optimize the beam location. ANS: D

The collimator must be in perfect alignment with the tube and detector array to optimize the beam location. CT scanners therefore use collimators to protect the patient and limit the beam to the size of the detector array that is active during data acquisition. Prepatient collimators restrict the width and shape the beam to the area of interest for a single rotation of the tube and detectors around the patient. Postpatient collimators, if present, reduce the scattered x-rays from entering the detector array, which would reduce the image contrast. These detector collimators also define the slice thickness, REF: p. 307 15. In helical CT, pitch is defined as a. the ratio of the patient’s movement through the gantry during one 360-degree

beam rotation relative to the beam collimation. b. the total time for a patient to move through the gantry during a CT scan. c. the ratio of the beam collimation relative to the mAs for a CT scan. d. the coordination of a patient’s possible movement, e.g., breathing, during the CT

scan relative to slice thickness. ANS: A

In helical CT, pitch is the ratio of the patient’s movement through the gantry during one 360-degree beam rotation relative to the beam collimation. REF: p. 309 16. Important technical developments that define current helical CT systems include all of the

following EXCEPT a. continuous reduction in radiation of the x-ray tube. b. continuous-motion gantry using slip-ring technology. c. continuous motion of the imaging table. d. continuous data transfer from the detector array. ANS: A

There are four important technical developments that define current helical CT systems: continuous radiation of the x-ray tube, continuous-motion gantry using slip-ring technology, continuous motion of the imaging table, and continuous data transfer from the detector array. REF: p. 311 17. Which of the following may be used to reduce streaking artifacts when scanning anatomy

with high-density objects? a. Bow-tie filter b. Adaptive detector array c. Thinner collimation d. Decreased kVp ANS: C

Thinner collimation helps to reduce streaking artifacts when scanning high-density objects. REF: p. 308 18. Which of the following restricts the width and shapes the beam to the area of interest for a

single rotation of the tube and detectors around the patient? a. Prepatient collimators b. Postpatient collimators c. Pitch d. Rotation speed ANS: A

Prepatient collimators restrict the width and shape the beam to the area of interest for a single rotation of the tube and detectors around the patient. REF: p. 307 19. What is a reconstruction kernel?

a. b. c. d.

A unit of data in a reconstructed CT image The entire data set used to produce reconstructed images in CT A measurement used to determine the data set used for CT reconstruction An algorithm that defines the clinical application and amount of image smoothing applied in the reconstruction

ANS: D

A reconstruction kernel is an algorithm that, in the case of CT reconstruction, defines the clinical application and amount of smoothing that will be applied in the reconstruction process. REF: p. 313 20. What is the purpose of administering a contrast agent for a CT procedure? a. Reduce patient dose for longer scans that require thinner slicers b. Reduce streaking artifacts when scanning high-density objects c. Reduce attenuating properties of tissues with wide variances in density d. Enhance detection of lesions and aid in defining normal structures ANS: D

CT has difficulty with differentiating various soft tissues, because they have very similar attenuating densities. To enhance the detection of lesions and to aid in defining normal structures, a contrast agent is frequently used. REF: p. 318 21. What is the CT number for water? a. 0 b. 10 c. 100 d. 1000 ANS: A

CT numbers (the same as Hounsfield units) relate tissue density compared to water and are defined by the relationship CTtissue = (tissue–water )/water  1000. The CT number for water is 0, and for air the CT number is –1000. REF: p. 319 TRUE/FALSE 1. The slice thickness that may be reconstructed can be up to half as thin as the collimator width. ANS: F

The slice thickness that may be reconstructed can never be thinner than the collimator width. REF: p. 307 2. Thin collimation has an advantage because it results in faster scanning time. ANS: F

Compromises of thinner collimation include increased quantum mottle and increased scanning time, and may result in an increased number of slices as defined by the reconstruction slice thickness. REF: p. 308 3. A disadvantage to having image overlap on CT images is the possibility of artificially creating

small lesions. ANS: F

Advantages of overlapping slices include greater overlap of body areas to generate smooth, 3D reformatted images and a reduction in the possibility of missing small lesions. REF: p. 310 4. In high-performance CT scanners, the speed of the data transfer from the detector array

determines the maximum resolution. ANS: F

The beam width as set by the detector size and collimator determines the maximum resolution that may be obtained in the study. REF: p. 311

Chapter 13: PET Instrumentation Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. With PET radionuclides, the higher the energy particle, a. the greater the mean range for the travel of the positron. b. the shorter the mean range for the travel of the positron. c. won’t have an effect on the mean range for the travel of the positron. d. it reduces the mean range for the travel of the positron. ANS: A

Each PET radionuclide emits its positron with a different energy, with higher-energy particles having greater path lengths and greater mean ranges for the travel of the positron. REF: p. 326 2. In PET imaging, a large particle range results in a. better resolution of annihilation events. b. an overcalculation of the annihilation event from the positron-emitting atom. c. a slight mispositioning of the annihilation event from the positron-emitting atom. d. truer positioning of the annihilation event with the positron-emitting atom. ANS: C

A large particle range results in a slight mispositioning of the annihilation event from the actual location of the positT roE nS -eT mB itA tinNgKaS toEmL. L TE heRre.foCrO eM a scan performed with 18F (2.4 mm maximum and 0.2 mm average range) will produce a higher-resolution image than 82Rb, which has a 15.6 mm maximum and 2.6 mm mean range in tissue. REF: p. 326 3. Rubidium-82 is an analog to a. calcium. b. potassium. c. sodium. d. glucose. ANS: B

Rubidium-82, which has a 75-second half-life, is an analog of potassium and is therefore a myocardial perfusion imaging agent. REF: p. 327 4. In comparing PET myocardial imaging to SPECT myocardial imaging for myocardial disease,

PET demonstrates a. increased resolution, decreased sensitivity, and increased specificity. b. decreased resolution, increased sensitivity, and increased specificity. c. increased resolution, increased sensitivity, and increased specificity. d. decreased resolution, increased sensitivity, and decreased specificity.

ANS: C

Since PET scanners have higher sensitivity and resolution than SPECT, PET myocardial images provide substantially better quality with increased sensitivity and specificity for detecting coronary artery disease. REF: p. 327 5. The production of a single PET radiopharmaceutical requires all of the following EXCEPT a. a cyclotron. b. a target. c. a hot cell. d. a collimator. ANS: D

The production of a single PET radiopharmaceutical requires very expensive equipment, including the cyclotron, target, automated synthesis module, hot cell (to contain the synthesis module), and any additional radiopharmaceutical quality control or precursor preparation equipment. REF: p. 327 6. Characteristics of the bismuth germinate crystal include that fact that it a. is a fast scintillator. b. yields more light than an NaI (Tl) crystal. c. is very good at stopping 511-keV photons. d. has excellent energy resolution. ANS: C

Bismuth germinate (Bi4Ge3O12) is commonly known as BGO. Bismuth has a high atomic number and is therefore very good at stopping the 511-keV photons. BGO is unfortunately a relatively slow scintillator and also yields a relatively small amount of light compared with NaI (Tl). In addition, BGO has poor energy resolution that requires energy windows that span from about 350 to 650 keV. The stopping power of BGO compensates for its other deficiencies, and it is still a good scintillator for 2D-dedicated PET scanners. REF: p. 327-328 7. All of the following have been used as crystals for PET imaging EXCEPT a. BGO. b. LSO. c. LYSO. d. YBGO. ANS: D

Some dedicated PET scanners use other scintillation crystal materials. Lutetium orthosilicate (Lu2SiO5 [Ce]; LSO), lutetium yttrium orthosilicate (LYSO), and gadolinium orthosilicate (Gd2SiO5 [Ce]; GSO) are now available in some commercial PET systems. These crystals have slightly lower stopping power than bismuth germinate (BGO). REF: p. 328 8. In a PET scanner, the determination of the annihilation event is made possible by

a. b. c. d.

electronic collimation. parallel hole collimation. back-scatter projection. filtered back-scatter projection.

ANS: A

PET scanners have electronic collimation to determine the location of the annihilation event. The detectors are used for coincidence detection to identify an annihilation gamma pair and determine a line of response (LOR) path representing the path of the photon pair. REF: p. 328 9. In a dedicated PET scanner, there is a photomultiplier tube (PMT) for a. each crystal. b. every other crystal. c. a group of crystals. d. every ring in crystals. ANS: C

PET scanners have 10,000 to 28,000 or more crystals, which are laid out to form several rings of detectors. Each crystal is too small to have its own PMT; therefore, a group of crystals is put together in a detector block. Most commonly, four PMTs are used on a block to collect the light from all the crystals, measure the photon energy, and identify which crystal in the block was struck by the photon. REF: p. 329

flE ecStiT veBbAlN ocKkSoE f cLrL ysEtaRls.”CdO esM ign, reflective material surrounds 10. In PET scanners with a “reT a. each crystal. b. every other crystal. c. every block of crystals. d. every ring of crystals. ANS: A

The alternative reflective block approach is to create a block from a group of small individual crystals. Each crystal is surrounded by a carefully designed amount of reflective material that spreads the light in a designated pattern onto the photomultiplier tubes (PMTs); therefore both the cut block and reflective block designs do the same thing—they use reflective surfaces on the sides of individual crystals to distribute the scintillation photons to the PMTs. REF: p. 329 11. Whole body imaging in PET scans typically covers imaging a. from head to toe. b. from the hips through the base of the brain. c. from the knees through the base of the brain. d. from the knees to the head. ANS: B

“Whole body” PET scans are used in most oncology studies and actually cover only the hips up through the base of the brain (approximately 90 cm) or about six to eight bed positions. Total body (nearly head to toe) scans are required with certain types of cancer where malignant tissue may grow in any area of the body, as with melanoma. REF: p. 330 12. The BGO crystal a. is efficient at rejecting scatter photons because of its narrow window. b. is efficient at rejecting scatter photons because of its wide window. c. is not efficient at rejecting scatter photons because of its narrow window. d. is not efficient at rejecting scatter photons because of its wide window. ANS: D

With most scintillation materials, a narrow energy window is effective at rejecting scattered photons, which will have a lower energy. The wide energy window employed with bismuth germinate (BGO) is thereby not very efficient at rejecting scattered photons, and a method for scatter correction will be used during reconstruction. REF: p. 330 13. A true coincidence event occurs when a. a pair of annihilation gamma rays strike two detectors at the same time. b. a pair of annihilation gamma rays strike one detector at the same time. c. photons from two different annihilation events are detected at the same time. d. photons from two different annihilation events collide, resulting in a third

annihilation event. ANS: A

A pair of annihilation gamma rays striking two detectors at the same time is termed a true coincidence annihilation event (see Figure 13-8, A and D). When two atoms decay at nearly the same time, photons from two different annihilation events may be detected within the timing window. When this happens, a false event, referred to as a “random” event, is recorded. REF: p. 331 14. When performing 3D imaging a. scatter correction is important. b. photon scatter is not a problem. c. hot organs near the FOV do not pose a problem. d. 2D images are converted to 3D images electronically. ANS: A

Scatter correction is very important in 3D imaging, particularly when hot organs are nearby or just outside the field of view (FOV) of the detectors. Approximately 50% of photons scatter within the body; therefore, scatter correction and accurate attenuation correction are imperative when quantitative information is needed. REF: p. 331 15. The line of response (LOR)

a. b. c. d.

is determined for each crystal within a detector system. is determined for each detector system and each crystal type. is created by the detection of an annihilation photon pair by opposing crystals. is created to perform scatter correction techniques.

ANS: C

The detection of an annihilation photon pair by opposing crystals creates one event or LOR between two detectors. Millions of LORs will be acquired and stored for use in the reconstruction of the 3D distribution of radiotracer. REF: p. 332 16. Spatial resolution on PET scanners is determined primarily by a. the collimator used and the size of the septa. b. the size of the crystals and their separation. c. the sensitivity of the system and the number of rings. d. the scatter correction and the accuracy of the attenuation correction. ANS: B

Spatial resolution of PET scanners is determined primarily by the size of the crystals and their separation. The spatial resolution of PET images will therefore be very close to the size of the crystal, typically 3 to 5 mm. Thus since all of the crystals are identical, the full width at half maximum (FWHM) will be about the same resolution over the diameter of the ring. REF: p. 332 17. On a PET sinogram, the horizontal row represents a. each angle from whichTthEeSpT roBjeAcN tioKnSw en.. COM EaLs LtaEkR b. the count profile across the distance of the gantry as seen from each angle. c. the set of reconstructed transaxial slices as seen from each angle. d. the angle from which the projection is taken over 180 degrees. ANS: B

Each horizontal row in the sinogram represents the count profile (or projection) across the distance of the gantry as seen from each angle. The vertical axis of a sinogram represents the angle from which the projection is taken over 180 degrees. The sinogram will therefore contain all the data that will be needed to reconstruct one transaxial slice; therefore, a sinogram is needed for each slice in the image volume. REF: p. 333-334 18. Regarding septa on a PET system, all of the following are true EXCEPT a. they limit the field of view of events to those within the same detector ring, or

events with contiguous planes. b. they reduce the number of scatter and random events from outside the plane. c. they allow for the system to operate in 2D mode. d. they allow for the system to operate in 3D mode. ANS: D

Septa limit the field of view of events to those within the same detector ring, or events with contiguous planes; they also reduce the number of scatter and random events from outside the plane. With septa in place, the scanner operates in 2D mode. Retracting the septa creates the ability to place the scanner in 3D detection mode. REF: p. 335-336 19. Whole-body imaging with a scanner in 3D mode can result in a. decreased need for correction techniques. b. increased pyramidal-shaped sensitivity. c. reduced reconstruction time. d. an increase in acquisition time. ANS: B

With much more data and the added complexity of corrections, there is a significant increase in the reconstruction time needed for 3D data. 3D data sets also slow down processing, transferring, and archiving of 3D data. Whole-body imaging with the scanner in 3D mode improves patient throughput because it provides an increase in scanner sensitivity and may allow a decrease in the time required for emission imaging. In 3D mode the wide acceptance angle creates high sensitivity in the center, which diminishes at the edges, creating a pyramid-shaped sensitivity distribution. REF: p. 336 20. In PET reconstruction, filtered back-projection a. creates streak or star artifacts. b. eliminates streak or star artifacts. c. increases contrast in thT eE imSaT geB.ANKSELLER.COM d. equates with iterative reconstruction. ANS: A

Filtered back-projection (FBP) techniques are the simplest and quickest way to create the image slice from the projection information stored in a sinogram. However, FBP creates severe streak or star artifacts, increasing image noise and thus reducing contrast, which may mask lesions. Iterative reconstruction algorithms are techniques that sequentially refine estimated pixel values and provide a more accurate reconstruction of the radiotracer distribution in the body. Iterative algorithms significantly reduce streak artifacts compared with FBP reconstruction techniques but provide images with a lower signal-to-noise ratio. REF: p. 338 21. In PET imaging, the purpose of a transmission scan is a. for quality control purposes. b. to compensate for the variable attenuation in tissues. c. for registration purposes. d. to provide data for scatter correction. ANS: B

The body has a complex mixture of tissues, each with a different effect on gamma-ray attenuation. The only way to accurately compensate for this variable attenuation is to pass a beam of radiation through the body and measure or “map” the attenuation. On PET-only instruments, the measured attenuation data for each slice are obtained by rotating a line source of radioactivity. Transmission scan data are reconstructed into attenuation correction maps for each slice. REF: p. 342 22. In a PET system, energy window calibration is typically performed after repair as well as a. daily. b. weekly. c. quarterly. d. annually. ANS: C

Energy window calibration is typically only performed after repair, during quarterly preventive maintenance (PM) service, or just before a normalization calibration is done. REF: p. 348 23. In a PET system, gain update calibration should be performed at least a. weekly. b. quarterly. c. annually. d. following repair. ANS: A

Gain updating compensates for variations in the changes in detector module gain over time. Gain update calibration procedures should be run at least weekly, or even daily, to keep systems in top performance and to prevent sensitivity drift. The more frequently they are run, the more uniform will be the performance of the scanner. REF: p. 348 24. In PET scanning, blank scans are performed a. daily. b. quarterly. c. annually. d. upon installation. ANS: A

Blank scans are performed daily to provide accurate transmission scan data for the attenuation correction of images. Radioactive decay of the transmission sources, dead-time corrections, and detector sensitivity may vary frequently; therefore, a blank scan must be obtained each morning before clinical use of the scanner. REF: p. 349 25. In PET imaging, blank scans are used a. to subtract background. b. to calculate scatter correction.

c. to determine deadtime. d. in attenuation correction. ANS: D

Blank scans are used as a reference uniformity measure for the transmission scan used in attenuation correction. It is very important to acquire and evaluate blank scans daily, because attenuation correction made with poor or outdated blank scans will have artifacts that will show up in the patient images. REF: p. 349 26. 2D normalization is done to a. subtract background from all LORs. b. measure the efficiency for all LORs. c. average the data from all LORs. d. determine the deadtime across the LORs. ANS: B

2D normalization calibrations are done to measure the efficiency for all LORs. Normalization calibration is performed by rotating radioactive rod sources, which contain a low activity source of radioactivity, and acquiring data that will be used to balance the efficiency of all detectors in the scanner. REF: p. 349 27. Absolute activity calibrations should be performed after a major service, as well as a. daily. b. weekly. c. quarterly. d. annually. ANS: C

Well counter calibration is an historical term for a calibration more appropriately referred to as absolute activity calibration. Absolute activity calibration factors are used to convert pixel values into a measure of absolute activity per voxel. Absolute activity calibrations are performed only after all other calibrations have been performed and should be done quarterly or after major service. REF: p. 349 28.

The standard uptake value is useful in a. performing attenuation correction. b. calculating scatter correction. c. differentiating between malignant and benign tissue. d. determining the time span between injection and scan. ANS: C

The absolute quantitative uptake of the radiotracer in tumors can be measured in an effort to differentiate between malignant and benign tissue. The standard uptake value (SUV) can be useful in measuring tumor metabolic function. REF: p. 351

29. When compared to non–time of flight (ToF) scanners, ToF scanners a. have a decreased resolution for small lesions. b. require a longer acquisition time. c. do not have a full LOR across the FOV. d. have decreased image quality. ANS: C

The distinct advantage of ToF is that there is not a full LOR across the FOV of the scanner but rather only a short line in which the annihilation event took place. The effect on the signal-to-noise ratio of a small lesion is the same effect as acquiring at least 2.5 times the number of events to improve lesion detection. ToF scanners thus can produce high-quality images using a slightly shorter acquisition time. In ToF imaging, there is image improvement as the likelihood of detecting random events is reduced. REF: p. 346 30. In PET reconstructions, OSEM and RAMLA are most commonly used over FBP because a. they are faster with less data storage. b. of reduced streak artifacts and image noise. c. of increased image contrast. d. of fewer mispositioning artifacts. ANS: B

In PET reconstruction, OSEM and RAMLA are the most commonly used because they reduce streak artifacts and image noise compared with FBP. REF: p. 340

Chapter 14: Principles of Magnetic Resonance Imaging Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. The most common MRI scanner used in clinical practice has a magnet strength of a. 1.5 T. b. 2.0 T. c. 2.5 T. d. 3.0 T. ANS: A

Clinically, MR systems are divided into high field and low field categories, which essentially denotes a magnet strength of 1.0 tesla (T) or greater for the former and less than 1.0 T for the latter. In clinical practice, the vast majority of MRI is performed at 1.5 T or below, with 3.0 T scanners becoming more popular. Even higher magnet field strengths exist, but these are mostly limited to research at this time as the potential effects of these stronger systems on the human body are investigated. REF: p. 360 2. The magnetic moment describes the magnetic field characteristics of the a. neutron. b. nucleus. c. cell. d. proton. ANS: B

The magnetic moment represents a vector indicating magnitude and direction and describes the magnetic field characteristics of the nucleus. REF: p. 358 3. A nucleus with an even number of protons and neutrons has a magnetic moment of a. –1. b. 0. c. 1. d. Does not have a magnetic moment ANS: B

The composition within a nucleus can contain either an even number of protons and neutrons (determined by the mass number), which will result in a magnetic moment of zero, or an odd number of protons and neutrons, which will generate a magnetic moment. REF: p. 358 4. Diamagnetic substances exhibit a. no magnetic properties outside of the magnetic field but within an external

magnetic field they are slightly repelled and have a negative magnetic

susceptibility. b. no magnetic properties outside of the magnetic field but within a magnetic field

they are slightly attracted and have a positive magnetic susceptibility. c. a strong attraction when exposed to an external magnetic field and can act as a

projectile. d. magnetic properties outside of a magnetic field but within a magnetic field the

magnetism is neutralized. ANS: A

Magnetism is a fundamental property of matter and can be diamagnetic, paramagnetic, or ferromagnetic. Outside a magnetic field, diamagnetic substances exhibit no magnetic properties; however, when placed within an external magnetic field, they are slightly repelled and have negative magnetic susceptibility. REF: p. 358 5. Paramagnetic substances exhibit a. no magnetic properties outside of the magnetic field but within an external

magnetic field they are slightly repelled and have a negative magnetic susceptibility. b. no magnetic properties outside of the magnetic field but within an external magnetic field they are slightly attracted and have a positive magnetic susceptibility. c. a strong attraction when exposed to an external magnetic field and can act as projectiles. d. magnetic properties outside of a magnetic field but within a magnetic field their magnetism is neutralizT edE. STBANKSELLER.COM ANS: B

Paramagnetic substances also exhibit no magnetic properties outside of a magnetic field but when placed within an external magnetic field are slightly attracted, which increases with an increase in the external magnetic field. These substances have positive magnetic susceptibility. REF: p. 365 6. Ferromagnetic substances exhibit a. no magnetic properties outside of the magnetic field but within an external

magnetic field they are slightly repelled and have a negative magnetic susceptibility. b. no magnetic properties outside of the magnetic field but within a magnetic field they are slightly attracted and have a positive magnetic susceptibility. c. a strong attraction when exposed to an external magnetic field and can act as projectiles. d. magnetic properties outside of a magnetic field but within a magnetic field their magnetism is neutralized. ANS: C

Ferromagnetic substances exhibit very strong attraction when exposed to the external magnetic field and can act as projectiles. These substances are of extreme importance in the discussion of MRI safety.

REF: p. 368 7. In a strong magnetic field, hydrogen atoms can align a. perpendicular or antiperpendicular to the magnetic field. b. parallel or antiparallel to the magnetic field. c. oblique or antioblique to the magnetic field. d. at random to the magnetic field. ANS: B

In the absence of an applied magnetic field, the magnetic moments of the hydrogen nuclei are randomly oriented. Upon placing the nuclei within a strong external magnetic field (B0), the magnetic moments of the hydrogen nuclei align with the magnetic field. Some align parallel with the magnetic field (in the same direction) and some align antiparallel (in the opposite direction). REF: p. 359 8. All of the following are true about spin-up nuclei EXCEPT a. they are larger in number than spin-down nuclei. b. they align parallel to the magnetic field. c. they are of low energy. d. they are cancelled out by spin-down nuclei. ANS: D

Based on quantum mechanics, these hydrogen nuclei possess energy in two discrete quantities: low and high. Low-energy nuclei align their magnetic moments parallel to the external magnetic field andTaEreStTeB rmAeN d KspSinE-L upLnEuRc. leC i. O HM igh-energy nuclei align their magnetic moments in the antiparallel direction and are termed spin-down nuclei. The strength of the external magnetic field determines which nuclei will orient spin-up or spin-down. There are always fewer high-energy (spin-down) nuclei than low-energy nuclei; therefore, the small number of spin-down nuclei will be cancelled out by the larger number of spin-up nuclei. REF: p. 359 9. All of the following are true regarding the gyromagnetic ratio EXCEPT a. it is a constant. b. it relates angular momentum and magnetic moment. c. it is characteristic of each nuclei. d. it relates the number of spin-up and spin-down nuclei. ANS: D

The Larmor equation includes the main magnetic field strength multiplied by a constant. The constant is called the gyromagnetic ratio, which is a relationship between the angular momentum and magnetic moment of each MR active nucleus and is a characteristic of each type of nuclei. REF: p. 359-360 10. If energy is delivered to the hydrogen nuclei at a different frequency than that of the Larmor

frequency of the nucleus, then a. resonance will occur.

b. resonance will not occur. c. it will stop any resonance. d. precession is increased. ANS: B

The Larmor frequency is important because if energy is delivered to the hydrogen nuclei at a different frequency to that of the Larmor frequency of the nucleus, resonance will not occur. REF: p. 359-360 11. When an RF pulse is applied and its energy is absorbed, the net magnetization vector moves

from a. transverse direction toward longitudinal direction. b. parallel direction toward antiparallel direction. c. longitudinal direction toward transverse direction. d. antiparallel direction toward parallel direction. ANS: C

An RF pulse is then applied and its energy is absorbed, which results in the rotation of the net magnetization vector away from the longitudinal direction toward the transverse direction. REF: p. 360 12. Contrast is controlled by varying a. resonance. b. precession. c. pulse sequences. d. the gyromagnetic ratioT . ESTBANKSELLER.COM ANS: C

Contrast is controlled by varying MR pulse sequences to accentuate or diminish characteristics of certain diseases, normal tissues, or even foreign objects. REF: p. 362-363 13.

Artifacts caused by anatomy “moves” can be remedied by equating the phase and frequency encoding directions. use of postsaturation pulses. decoding the phase. gating.

a. b. c. d.

ANS: D

The anatomy “moves” between these steps and become mismapped into the field of view when the image is read out during the frequency encoding step (see Figure 14-15). This artifact can be remedied by changing the phase encoding direction, swapping phase, and frequency encoding directions (x and y, as discussed earlier). Many other techniques can also be used, such as presaturation pulses, respiratory compensation techniques, or gating. REF: p. 362 14. In what year was the first MRI scan performed? a. 1946

b. 1952 c. 1967 d. 1977 ANS: D

In 1977, the first MRI scan was performed. Acquiring a single image took almost 5 hours. REF: p. 358 15. A T2-weighted image is useful for the evaluation of a. pathology. b. anatomy. c. articular cartilage. d. muscle tissue. ANS: A

A T2-weighted image is useful for the evaluation of pathology. REF: p. 361 16. Which scan parameter determines the amount of time between each initial RF pulse used to

excite the protons in a given region of anatomy? a. Free induction decay (FID) b. Time to repetition (TR) c. Time to echo (TE) d. Flip angle ANS: B

Time to repetition (TR) is the scan parameter that sets the amount of time between each initial RF pulse used to excite the protons in a given region of anatomy. REF: p. 363 TRUE/FALSE 1. There is a risk of thermal injury with MRI. ANS: T

Of great importance is the risk of thermal injury, because electric currents and voltages can be induced in electrically conductive materials when placed within the MRI scanner during the imaging. REF: p. 366 2. T1 refers to the recovery of longitudinal magnetization. ANS: T

T1 refers to the recovery of longitudinal magnetization (T1 recovery), and T2 refers to the decay of transverse magnetization (T2 decay). Longitudinal magnetization is also referred to as MZ, and transverse magnetization as MXY. REF: p. 360

3. T1 is also referred to as MXY. ANS: F

T2 decay results from the loss of transverse magnetization (MXY) as the protons lose the energy absorbed by the RF pulse and decay from a high energy state to a lower energy state in the longitudinal direction. T2 decay loses its energy by exchanging its energy with the surrounding nuclei, which is called spin-spin relaxation. REF: p. 362 6. Fat has a long T1 and a long T2. ANS: F

Decay and recovery times are used to produce images with specific contrast. For example, water has a long T1 and long T2, fat has a short T1 and short T2, cerebrospinal fluid has a long T1 and long T2, white matter has a short T1 and short T2, and gray matter has an intermediate T1 and intermediate T2 (see Figure 12-14). If we were to create an image at a time when these curves were widely separated, we would produce an image that has high contrast between these tissues. REF: p. 361

Chapter 15: Clinical PET/CT in Oncology Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. The use of 18F-fluorodeoxyglucose (FDG) in cancer imaging is based on the fact that a. tissue cells surrounding tumors use glucose at a faster rate than normal cells. b. cancer cells use glucose at a faster rate than normal cells. c. it is specific for distinguishing between benign and malignant diseases. d. necrotic cells use glucose at a faster rate than normal cells. ANS: B

The ability to externally image cellular glucose metabolism is important in oncologic applications, because many cancer cells use glucose at higher rates than normal cells. Current research also demonstrates that numerous malignant tumors express higher numbers of specific membrane transport proteins, with greater affinity for glucose than normal cells. This results in increased glucose flow into cancerous cells. REF: p. 372 2. Patient preparation for a PET scan includes all of the following EXCEPT a. avoidance of strenuous exercise for 24 hours before the study. b. rest prior to, during, and after injection. c. keeping baseline metabolic activity low. d. eating a meal just priorTtE oS scT anBnAinNgKbS ecEaL usLeEoR f t.hC eO tim Me involved with the study. ANS: D

FDG is extremely sensitive to small changes in tissue metabolism. It is critical, therefore, to ensure that the patient’s baseline metabolic activity starts at appropriately low levels and that the patient remains at rest prior to, during, and after injection of the radiotracer. To prevent muscle uptake, patients should not participate in strenuous exercise for 24 hours before the study. In addition, to reduce the pretest peripheral blood glucose level, patients arriving for an FDG PET scan should fast for 4 to 6 hours before the appointment. REF: p. 374 3. At the time of a PET scan, ideally the blood glucose level should not be above a. 60 mg/dL. b. 100 mg/dL. c. 120 mg/dL. d. 180 mg/dL. ANS: C

The peripheral blood glucose level can be measured with a glucometer. Ideally, the value should be less than 120 mg/dL. Increased blood glucose levels can compete with FDG, resulting in little difference between tumor and normal soft tissue uptake as well as very low-contrast images. REF: p. 374

4. An inpatient who is receiving total parental nutrition is scheduled for PET exam at 3:00 PM.

Those responsible for his care should a. discontinue the feeding 2 hours before the study. b. discontinue the feeding 4 hours before the study. c. discontinue the feeding 6 to 8 hours before the study. d. not have to discontinue this type of feeding. ANS: C

If the patient is receiving dextrose solution or total parental nutrition, it should be discontinued 6 to 8 hours prior to the injection of the 18F-FDG. This is so that competition for binding sites does not occur between the radioactive sugar analog used in PET imaging and sugar compounds in these items. REF: p. 375 5. When imaging lymphomas, PET a. can distinguish between scar tissue and residual tumor after therapy. b. is comparable to CT in distinguishing scar tissue and residual tumor after therapy. c. is comparable to MRI in distinguishing scar tissue and residual tumor after

therapy. d. is not involved in staging but is involved in therapy evaluation. ANS: A

PET outshines all other anatomic imaging modalities in the evaluation of lymphomas (especially in the evaluation of the therapeutic response), because neither CT nor MRI can distinguish between scar tissue and residual tumor after therapy. Persistent FDG tumor activity after therapy stronT glE yS suTgB geAsN tsKreSsE idL uaLl EoR r r.ecCuOrrM ent tumor. Lack of FDG activity essentially excludes persistent tumor, especially if FDG activity was present on the pretherapy examination. REF: p. 378 6. If an injection of contrast media is going to follow an injection of FDG, the technologist

should use a. a butterfly needle to inject. b. an 18- to 20-gauge intracatheter. c. an indwelling central catheter. d. a port-a-cath. ANS: B

If the patient is going to have iodinated contrast along with the PET/CT exam, an 18- to 20-gauge intracatheter should be used for FDG injection and then kept for use with the contrast media. Residual measurements for FDG in the injecting apparatus will not be possible, so it is imperative that proper injection technique is used. A 20- to 30-ml saline flush after the FDG injection helps to reduce venous FDG uptake in the upper extremity. Port-a-caths or indwelling central catheters should not be used to inject FDG unless absolutely necessary. REF: p. 375

7. FDG enters cells by means of a. active transport. b. phagocytosis. c. facilitated diffusion. d. capillary action. ANS: C

Both glucose and FDG are absorbed by facilitated diffusion into cells, with the assistance of certain specific membrane transport proteins. REF: p. 402 8. Once in the cell’s cytosol, FDG adds a phosphate group and proceeds with further

transformation. This change in FDG results in a. conversion of FDG to glucose. b. release of FDG from the cell. c. FDG becoming trapped in the cell. d. removal of FDG from the cytosol. ANS: C

The cell membrane is impermeable to both of these intermediate phosphorylated compounds, and neither can recross the cell membrane. Glucose-6-phosphate (G-6-P) continues through the next glycolytic step with its transformation into fructose-6-phosphate by the action of phosphoglucoisomerase. However, because of its chemical structure, FDG cannot be enzymatically transformed into fructose-6-phosphate (see Figure 15-1). Because FDG-6-P cannot be broken down or recross the cell membrane, it remains “trapped” within the cell. As more FDG molecules enter the cell and are transformed into FDG-6-P, they continue to accumulate within the celluTlE arScT ytB oA soN l.KSELLER.COM REF: p. 573 9. Once the intravenous line is started for the FDG injection, the patient should a. relax for 10 minutes and refrain from talking. b. be positioned for imaging. c. have a blood glucose level measured. d. be instructed to return to the department in 1 hour for the procedure. ANS: A

After the intravenous line is started, the patient should be placed on a bed or in a reclining chair for 10 minutes and asked to relax and refrain from talking. If the brain is to be imaged, the patient should also close the eyes, and the room should be quiet and dark. REF: p. 574 10. In the United States, breakthrough reimbursement for PET scans was determined by the a. U.S. Department of Health and Human Services (DHHS). b. Centers for Medicare and Medicaid Services (CMS). c. Centers for Disease Control and Prevention (CDC). d. U.S. Food and Drug Administration (FDA). ANS: B

In 1998, the CMS announced that FDG PET scans would be reimbursed for patients with solitary pulmonary nodules or non–small-cell lung cancer. This breakthrough in reimbursement opened the door for Medicare payments for patients with other cancers in which experience had shown that PET was the most accurate imaging technique for identifying and staging the disease. Reimbursement coverage has now been extended to melanoma, lymphoma, colorectal, head/neck, esophageal, recurrent breast cancers, and thyroid carcinoma. Private insurance companies may cover FDG PET studies in other types of cancer, usually after a thorough review of individual patient needs and circumstances. However, insurance carriers usually require preauthorization for any PET examination. REF: p. 372 11. Which of the following diagnoses requires a head-to-toe PET scan? a. Lymphoma b. Melanoma c. Colorectal cancer d. Mesothelioma ANS: B

Any patient with a history of melanoma, even if referred for another indication, should have a total (head-to-toe) body scan. REF: p. 376 12. Which anatomic areas present with normal variations in FDG localization? a. Mouth and salivary glands b. Myocardium of the left ventricle c. Extraocular muscles d. All of these ANS: D

The mouth and salivary glands, cardiac muscle (myocardium), extraocular muscles, thyroid, GI tract, and muscular areas with brown fat can show variations in FDG localization. REF: p. 379 13. Which type of testicular tumor avidly takes up FDG? a. Seminoma b. Mature teratoma c. Non-seminoma d. Adenoma ANS: A

Testicular cancers, especially seminomas, avidly take up FDG. REF: p. 394 TRUE/FALSE 1. Standard uptake values (SUVs) are useful in distinguishing between benign and malignant

disease.

ANS: F

SUVs cannot distinguish between benign and malignant diseases with any helpful degree of accuracy because, as mentioned previously, common fungal and infectious processes can use FDG at very high rates and bronchoalveolar cell carcinoma or other low-grade tumors can use FDG at background levels. REF: p. 385 2. PET has proved to be effective as a screening tool for colorectal cancers. ANS: T

PET is a superb, cost-effective screening tool for colorectal cancers, mainly because it identifies more sites of tumor involvement and more accurately determines nonresectable disease, thereby avoiding unnecessary and more costly surgical procedures. REF: p. 389 3. In head and neck imaging, normal variants, such as salivary gland uptake and lingual, buccal,

pharyngeal, laryngeal, and neck muscle activity, can cause diagnostic difficulties. ANS: T

Normal variants, such as salivary gland uptake and lingual, buccal, pharyngeal, laryngeal, and neck muscle activity, can cause many diagnostic difficulties in the evaluation of head and neck tumors. Fortunately, correlation with complementary anatomical imaging and a physical examination can usually determine the true tumor status. REF: p. 389 4. Brain tumors are easily identified with FDG imaging. ANS: F

Because the normal cerebral and cerebellar neurons use FDG avidly, primary and metastatic brain tumors can be, and are, missed. Figure 15-26 shows a brain tumor that cannot be identified with FDG imaging. REF: p. 391

Chapter 16: Central Nervous System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. All of the following are true about acetazolamide or its use in brain imaging EXCEPT a. it acts as a vasodilator. b. it causes increased perfusion. c. it serves to localize an epileptogenic focus. d. it improves diagnostic accuracy in cerebral vascular disease. ANS: B

With the administration of acetazolamide (Diamox), a carbonic anhydrase inhibitor, vasodilation and increased perfusion are normally seen. Abnormal vessels unable to dilate to the same extent as normal vessels cause blood to be shunted away from damaged areas toward tissue supplied by normal vessels. Therefore, comparing pre- and post-Diamox images causes perfusion abnormalities to be accentuated, improving diagnostic accuracy. REF: p. 423 2. The intrathecal injection for CSF imaging allows for the dose to be a. administered during a seizure. b. administered into the subdural space. c. administered into the subarachnoid space. d. administered into the sT piE naSl T coBrA d.NKSELLER.COM ANS: C

To perform the procedure, a physician administers 500 Ci of 111In-DTPA intrathecally (into the subarachnoid space), between L3 and L4. REF: p. 416 3. A patient is scheduled for a 99mTc-HMPAO brain scan. The technologist must remember that 99m

a. b. c. d.

Tc-HMPAO only crosses a compromised blood-brain barrier and in proportion to blood flow. remains trapped in the subarachnoid space for 20 minutes after injection. acts as an analog to thallium-201. remains trapped in the brain in proportion to cerebral blood flow at the time of injection.

ANS: D 99m

Tc-HMPAO is a neutral lipid-soluble radiopharmaceutical that crosses the blood-brain barrier and then becomes a polar hydrophilic molecule that remains trapped in the brain in a distribution proportional to the cerebral blood flow. REF: p. 415 4. A patient is sent to the nuclear medicine department to have a CNS 111In-DTPA study

performed to

a. b. c. d.

assess integrity of the blood-brain barrier. assess cerebral spinal flow dynamics. localize seizure focal points. assess brain death.

ANS: B 111

In-DTPA is the ideal radiopharmaceutical for assessment of cerebrospinal fluid (CSF) dynamics, because it is physiologically governed by CSF flow. REF: p. 416 5. Following a nuclear medicine study to assess CSF dynamics, the patient should be instructed

to a. b. c. d.

remain in a horizontal position for 2 hours after injection. drink plenty of fluids and void urine frequently. keep distance between themselves and children for 2 days after injection. not have any radiographic brain studies for 1 week.

ANS: A

The patient is kept in a horizontal position for 2 hours after injection to minimize headaches caused by CSF leakage or changes in the CSF pressure caused by the lumbar puncture. REF: p. 416 6. A patient is sent to the nuclear medicine department for a CSF study. The technologist

prepares for the radiopharmaceutical injection by a. dimming the lights in the procedure room. b. setting up a three-way T stE opScToB ckAw shO. M NiKthSaEsLalLinEeRfl.uC c. setting up for an intrathecal injection. d. observing the patient for seizures. ANS: C

To perform the procedure, a physician administers 500 Ci of 111In-DTPA intrathecally (into the subarachnoid space), between L3 and L4. REF: p. 416 7. A patient arrives at a nuclear medicine department for a CSF shunt evaluation. The

technologist readies the patient for an injection into the a. antecubital vein. b. shunt reservoir. c. subarachnoid space. d. shunt tubing. ANS: B

The tracer is injected into the shunt reservoir, and images of the head and abdomen are obtained. REF: p. 418 8. The images in a cerebrospinal fluid leak study show an initial wide segmental appearance

with no activity in the basal cisterns at 2 to 3 hours after injection. The technologist should

a. b. c. d.

count the pledgets. continue routine images at 6, 24, and 48 hours after injection. prepare for a reinjection. have the patient change position and then repeat the image.

ANS: C

Images should be obtained with the patient in a position that optimizes visualization of the suspected site of CSF leakage. If a wide, segmental appearance is seen initially with no activity in the basal cisterns at 2 to 3 hours, reinjection is required. REF: p. 420 9. A patient is scheduled for a SPECT brain procedure. Before the radiopharmaceutical is

administered, the patient should a. be well hydrated. b. be placed in a quiet, dimly lit room. c. have received Lugol’s solution. d. have undergone a CT scan of the brain. ANS: B

To minimize changes in local metabolic demands within the brain, the patient should be instructed to rest quietly following tracer injection and the imaging room should be quiet and dimly lit to minimize environmental stimuli. REF: p. 416 10. To produce high-resolution, low-noise images, the resolution in the images on a SPECT brain

scan, the technologist will a. use the electronic zoom. b. use pre- and postprocessing filters. c. perform the attenuation correction outside the ellipse. d. use a transmission scan. ANS: B

To produce high-resolution, low-noise images, often a combination of preprocessing, back-projection, and postprocessing filters is used. REF: p. 417 11.

99m

Tc-HMPAO is an example of radiopharmaceutical that a. does not cross the blood-brain barrier but diffuses across an altered blood-brain barrier. b. most accurately demonstrates CSF dynamics and any altered CSF pathology. c. is a neutral lipid-soluble radiopharmaceutical and crosses the blood-brain barrier. d. is an analog to glucose and is avidly picked up by the brain. ANS: C 99m

12.

Tc-pertechnetate and 99mTc-DTPA are two examples of radiopharmaceuticals that a. distribute in the cerebral parenchyma according to blood flow. b. distribute in the blood vessels. c. can distribute between synapses to image psychological disorders. d. only distribute in situations of an altered blood-brain barrier. 99m

ANS: B

Technetium-99m-DTPA and 99mTc-pertechnetate are hydrophilic agents that accumulate in the brain parenchyma as a result of leakage from the circulation through a compromised blood-brain barrier (e.g., with stroke or tumor). REF: p. 415 13. Acetylcholine is a. excitatory in the brain and inhibitory in the heart. b. inhibitory in the brain and excitatory in the heart. c. excitatory in the brain and excitatory in the heart. d. inhibitory in the brain and inhibitory in the heart. ANS: A

Acetylcholine and the catecholamines norepinephrine and dopamine are examples of neurotransmitters. Each of these substances has a characteristic inhibitory or excitatory effect on the postsynaptic neuron. The effect of acetylcholine is excitatory in the brain and inhibitory in the heart. REF: p. 408 14. All of the following are true regarding SPECT or PET functional brain imaging on patients

with neurodegenerative disease, EXCEPT a. may show structural changes before anatomic imaging. b. may identify those patients with mild cognitive impairment who are more likely to progress. c. may slow the progression of certain forms of neurodegenerative disease. d. certain patterns of radiopharmaceutical distribution are suggestive for specific types of dementia. ANS: C

Functional brain imaging with SPECT or PET may show changes in patients with neurodegenerative disease well before structural changes are apparent on anatomic imaging. Further, functional imaging may identify those patients with mild cognitive impairment who are more likely to progress. Certain patterns of radiopharmaceutical distribution are suggestive for specific types of dementia such as in Alzheimer’s disease, Lewy body disease, Parkinson’s disease, Pick disease, primary progressive aphasia, and vascular dementia. However, slowing progression is not one of the advantages of functional brain imaging. Yet, it is hoped that in future PET might be able to identify patients who could benefit from therapy aimed at: (1) enhancing cognitive function and memory, and (2) slowing the processes of neurodegeneration. REF: p. 426

15. All of the following may be spared from the effects of Alzheimer’s disease, EXCEPT a. thalamus. b. basal ganglia. c. visual cortex. d. frontal lobe. ANS: D

During the early stages the pattern of radiotracer uptake associated with metabolism may be asymmetrical, becoming more pronounced and diffuse later on in the course of the disease. Involvement of the frontal lobe and posterior cingulate region may be seen. Of note, there is often sparing of the basal ganglia, thalamus, sensorimotor cortex, occipital visual cortex, and cerebellum. REF: p. 426 16. Which form of dementia demonstrates on SPECT with hypoperfusion and PET with reduced

glucose metabolism in the frontal and temporal lobes with sparing of the remaining cerebral cortex? a. Alzheimer’s disease b. Parkinson’s disease c. Frontotemporal dementias d. Lewy body dementia ANS: C

The frontotemporal dementias represent a diverse group of diseases with differential diagnosis including familial frontotemporal dementia, Pick disease, semantic dementia, and primary progressive aphasia. Frontotemporal degeneration occurs in approximately 16% of early dementias and is clinicallyTcE haSraTcB teA riN zeKdSbE yL beLhEavRi. orC alOdMisturbances more than by losses of cognitive capacity and memory. SPECT shows hypoperfusion and PET shows reduced glucose metabolism in the frontal and temporal lobes with sparing of the remaining cerebral cortex. REF: p. 428 17. Which radiopharmaceutical is used for ictal SPECT imaging? a. 99mTc-HMPAO b. 111In-labeled DTPA c. 99mTc-pertechnetate d. 18F-FDG ANS: A

Ictal SPECT acquired with either 99mTc-HMPAO or 99mTc-ECD shows a characteristic area of hyperperfusion in the epileptic region with adjacent hypoperfusion27 and is felt to be the most sensitive imaging technique for localizing an epileptogenic focus. In particular, sensitivity and specificity are high when both ictal and interictal SPECT are done followed by the construction of subtraction images. REF: p. 424 18. The most commonly encountered radiopharmaceutical for imaging CNS tumors is a. 99mTc-ECD.

b. c. d.

F-FDG. F-thymidine. 11 C-methionine. 18

ANS: A 18

F-FDG is probably the most commonly encountered radiopharmaceutical for imaging CNS tumors. REF: p. 424

Chapter 17: Endocrine System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1.

131

a. b. c. d.

I-Metaiodobenzylguanidine is used to treat hyperthyroidism. metastatic thyroid cancer. metastatic pheochromocytoma. hyperparathyroidism.

ANS: C 131

I-Metaiodobenzylguanidine is used to treat metastatic pheochromocytoma and paraganglioma. REF: p. 432 2. A patient’s thyroid gland is known to have developed but not to have migrated into the usual

location. On the thyroid scan, the technologist would most likely see the patient’s thyroid a. in a substernal position. b. at the base of the tongue. c. astride the thyroid cartilage. d. condensed in the isthmus. ANS: B

TiBthAoN The thyroid gland can deveTloEpSw utKmSigErL atL inEgRin.toCtOhM e usual location astride the thyroid cartilage, resulting in a lingual thyroid that is found at the base of the tongue. REF: p. 422 3. Thyroid hormone synthesis depends on the a. trapping and secretion of iodine. b. regulation and secretion of iodine. c. organification and regulation of iodine. d. trapping and organification of iodine. ANS: D

Thyroid hormone synthesis depends on the trapping and organification of iodine ingested in food and water. REF: p. 433-434 4. The overall function of the thyroid gland is regulated by the hypothalamus-pituitary axis via a. T4 and T3. b. TRH. c. TBG. d. TSH. ANS: D

The overall function of the thyroid gland is regulated by the hypothalamus-pituitary axis via thyroid-stimulating hormone (TSH), which is secreted by the pituitary gland. The hypothalamus communicates with the pituitary via thyrotropin-releasing hormone (TRH). REF: p. 466 5. When the thyroid gland is the source of excessive thyroid hormone, is diffusely large, and is

homogenously active, it is characteristic of a. Graves’ disease. b. Plummer’s disease. c. multinodular goiter. d. thyroid cancer. ANS: A

When the thyroid gland is the source of excessive thyroid hormone, the gland is usually diffusely enlarged as in Graves’ disease and homogeneously active. REF: p. 437 6. Secondary hypothyroidism is the result of a deficiency of a. T3. b. TBG. c. TSH. d. TRH. ANS: C

Occasionally the thyroid gland is intact but TSH is deficient (so-called secondary hypothyroidism) either conTgE enSitTalBlyAoNrK ,m eL coEmRm.oCnO lyM , secondary to a pituitary tumor that SoErL interferes with normal pituitary production and release of TSH. REF: p. 437 7. On a scan, within the thyroid, thyroid carcinoma is often seen as a. a hyperactive (“hot”) area. b. a hypoactive (“cold”) area. c. diffuse areas of increased activity. d. total suppression of gland activity. ANS: B

Within the thyroid, thyroid carcinoma is seen as a cold area, because even differentiated malignant tissue generally functions less efficiently (less iodine trapping) than normal thyroid tissue. REF: p. 438 8. After a total thyroidectomy, a patient is referred to the nuclear medicine department for

imaging. For effective evaluation and identification of residual thyroid tissue or tumor, the technologist should review the patient’s recent history to determine if the patient has taken steps to raise the plasma a. TSH level. b. TRH level. c. TBG level.

d. T3 level. ANS: A

For effective evaluation and identification of residual thyroid tissue or tumor, steps should be taken to raise the plasma TSH before administration of the diagnostic tracer. REF: p. 438 9. The radionuclide therapy used for the treatment of either hyperthyroidism or thyroid

carcinoma is a. 123I. b. 125I. c. 131I. d. 123I-MIBG. ANS: C

The beta particle emission from 131I is the basis for radionuclide therapy of hyperthyroidism, for thyroid remnant ablation, and for thyroid cancer treatment. REF: p. 440 10.

99m

Tc-pertechnetate can be used for thyroid imaging because it is a. trapped by the thyroid gland. b. organified by the thyroid gland. c. used for coupling in the thyroid gland. d. synthesized by the thyroid gland. ANS: A

The charge and size of the pertechnetate ion are sufficiently similar to the iodide ion to be recognized by the thyroidal iodide trap. Consequently, 99mTc-pertechnetate enters the intrathyroidal iodine pool and is not organified. REF: p. 440 11. When a patient is administered 99mTc-pertechnetate for a thyroid scan, the technologist should

take the static images a. immediately upon injection. b. 5 to 10 minutes after injection. c. 15 to 20 minutes after injection. d. 30 minutes after injection. ANS: C

When using 99mTc-pertechnetate, images are obtained 15 to 20 minutes after injection. REF: p. 441 12. When performing thyroid imaging, using an electronic zoom a. is preferred over using a pinhole collimator. b. can only be used when using 99mTc-pertechnetate. c. is NOT preferred over using a pinhole collimator. d. is best for evaluating thyroid nodules of about 1 cm. ANS: C

Thyroid imaging is performed with a gamma camera and a pinhole collimator. Zoomed images using a parallel hole collimator should not be used to evaluate thyroid nodules, because a small (~1 cm) “cold” nodule will not be detected. REF: p. 443 13. When performing a thyroid scan, in addition to an anterior view, oblique views should be

taken a. to provide better information on the localization of the gland. b. to provide better information on the thickness of the gland. c. to better define nodules that may be on the anterior or posterior surface. d. to demonstrate nodules, if any, in more than one plane. ANS: C

Oblique views better define nodules that may be on the anterior or posterior surface of the gland and thus obscured by activity within the normal lobe. REF: p. 444 14. One of the three basic approaches to selecting the dose of 131I to be administered as therapy

for hyperthyroidism is a. a relatively fixed dose in which the patient receives 50 to 100 mCi of 131I. b. a dose based on millicuries delivered per kilogram of thyroid tissue. c. a dose based on selecting a radiation absorbed dose to the thyroid. d. a dose based on selecting the organification rate of the thyroid. ANS: C

The three basic approachesTtE oS seTleBcA tinNgKtS heEdLoL seEoRf.13C1IOtoM be administered as therapy for hyperthyroidism are a relatively fixed dose in which patients receive 5 to 10 mCi of 131I, a dose based on microcurie delivered per gram of thyroid tissue in which the estimated weight of the thyroid gland is taken into account, and a dose based on selecting a radiation absorbed dose. REF: p. 450 15. A patient receives a thyroid ablation dose of 75 mCi of 131I. In the United States, according

Nuclear Regulatory Commission (NRC) regulations, the patient a. must remain isolated in the hospital until the calculated dose is less than 30 mCi. b. can be released from the hospital. c. can be released only if he or she lives alone and therefore will not expose others to radiation. d. must remain in the hospital for observation until the calculated dose is less than 30 mCi but does not have to be isolated. ANS: B

In the past, patients receiving greater than 30 mCi of 131I were classified as radiation sources by the NRC. These patients were hospitalized until their body burden (radioactivity) fell to less than 30 mCi. In general, in the United States, this is no longer an issue. REF: p. 452

16. When looking at the blood test results in a chart of a patient with hyperparathyroidism, a

technologist will most likely see evidence of a. excessive catecholamine. b. elevated serum calcium. c. an excess of glucosteroids. d. elevated cortisol levels. ANS: B

A principal component of this disorder is the elevation of the serum calcium (hypercalcemia). REF: p. 453 17. When using a 99mTc-MIBI double-phase study for imaging the parathyroid gland, after the

early phase, the technologist should repeat images a. 20 to 30 minutes after injection. b. 40 to 60 minutes after injection. c. 90 to 120 minutes after injection. d. 24 hours after injection. ANS: C

The images of the neck are acquired after approximately 30 minutes, the so-called early phase. Repeat imaging of the neck follows at 90 to 120 minutes. REF: p. 455 18. A patient has a possible pheochromocytoma. The technologist should prepare to image the a. parathyroid glands. b. pituitary gland. c. kidneys. d. adrenal glands. ANS: D

Pheochromocytoma occurs as an apparently spontaneous benign or malignant tumor of the adrenal medulla but may arise from any site of autonomic nervous tissue. REF: p. 457 19. A patient is scheduled for adrenal medullary imaging. The preferred radiopharmaceutical for

this study is a. 123I-MIBG. b. 111In-DTPA pentetreotide. c. 131I NP-59. d. 99mTc-MIBI. ANS: A 123

I-MIBG is currently considered to be the preferred radiotracer for the detection of pheochromocytoma. REF: p. 464

Chapter 18: Respiratory System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Where do alveoli first appear? a. Alveolar sacs b. Respiratory bronchioles c. Lobar bronchi d. Main stem bronchi ANS: B

Alveoli first appear in the respiratory bronchioles, but are most numerous around the alveolar sacs. REF: p. 470 2. In an adult human, what is the approximate number of capillaries to which each alveolus gives

rise? a. 7 to 10 b. 35 c. 1000 d. 250 to 300 million ANS: C

OiMllion in an adult, is supplied by a Each alveolus, and there arTeEabSoTuB t 2A5N0KmSilE liL onLtE oR3. 00Cm terminal pulmonary arteriole, which has a diameter of about 35 µm and which gives rise to about 1000 capillaries per alveolus. REF: p. 471 3. The diameter of a normal capillary is approximately a. 0.05 to 0.1 µm. b. 7 to 10 µm. c. 30 to 40 µm. d. 45 µm. ANS: B

Capillaries are 7 to 10 µm in diameter. REF: p. 471 4. With respect to a supply of lymphatics, the lungs are a. similar in supply to most areas of the body. b. void of supply. c. lacking in supply. d. rich in supply. ANS: D

The lungs are richly supplied with lymphatics. Some course over the pleura and pass into the lungs, whereas others arise in the interstitial spaces of the lungs. Lymphatic vessels travel toward the hilum of the lung, with airways and blood vessels, reaching lymph nodes there and continuing into the mediastinum. REF: p. 471 5. The volume of air breathed out in a normal breath is called a. total lung capacity. b. functional residual capacity. c. residual volume. d. tidal volume. ANS: D

The volume of air exhaled in a normal breath is called the tidal volume. REF: p. 472 6. The volume of air in the lungs at the end of a normal breath is called a. total lung capacity. b. functional residual capacity. c. residual volume. d. tidal volume. ANS: B

The volume of air in the lungs at the end of a normal breath is called functional residual capacity. REF: p. 472 7. The volume of air in the lungs when as much air has been inhaled as possible is called a. total lung capacity. b. functional residual capacity. c. residual volume. d. tidal volume. ANS: A

The volume of air in the lungs when as much air has been inhaled as possible is called total lung capacity. REF: p. 472 8. The volume of air left in the lungs after complete exhalation is called a. total lung capacity. b. functional residual capacity. c. residual volume. d. tidal volume. ANS: C

The volume of air left in the lungs after complete exhalation is called residual volume. REF: p. 472

9. All of the following are true regarding compliance (as the term is used with respect to the

lung) EXCEPT a. it is the change in volume for a change in pressure. b. it is the change in volume for a change in position. c. it is the measurement of the distensibility of the lungs. d. it can be altered by diseases of lung parenchyma. ANS: B

The change in volume for a change in pressure is called compliance, which is a measurement of the distensibility of the lungs. The compliance of the lungs can be altered by diseases of the lung parenchyma, such as pulmonary fibrosis. REF: p. 472 10. In the upright position, ventilation of the upper parts of the lung a. is uniform from apex to base. b. increases from about 1 1/2 to 2 times from upper third to lower third. c. decreases from about 1 1/2 to 2 times from upper third to lower third. d. has a gradient from anterior to posterior. ANS: B

In the upright position, ventilation of the upper parts of the lung increases about 1 1/2 to 2 times from upper third to lower third. REF: p. 472 11. In the supine position, venT tilE atS ioTnBoA fN thK eS upEpL erLpEaR rts.oCfOthMe lung a. has the same distribution as in the upright position. b. increases from about 1 1/2 to 2 times from upper third to lower third. c. decreases from about 1 1/2 to 2 times from upper third to lower third. d. has a gradient from anterior to posterior. ANS: D

In the supine position, the distribution is more uniform from apex to the base, but there is a gradient from the anterior to the posterior. REF: p. 472 12. In the upright position, blood flow a. is uniform from apex to base. b. is 3 to 5 times higher in the base than the upper part of the lung. c. is 3 to 5 times higher in the upper part of the lung than the base. d. is the same as in the supine position. ANS: B

In the upright position, blood flow is threefold to fivefold higher in the base than in the upper parts of the lung. In fact, the upper one-fourth of the lungs gets very little blood flow at rest while a person is sitting upright. REF: p. 472

13. In the upright position, the ratio between ventilation and blood flow in the lungs is a. ventilation exceeds blood flow anterior to posterior. b. ventilation exceeds blood flow by 2:1 to 3:1 in the upper zones. c. ventilation exceeds blood flow by 2:1 to 3:1 in the lower zones. d. mixed uniformly from top to bottom. ANS: B

The ratio in which ventilation and blood flow are mixed is not uniform from top to bottom in the upright position. Ventilation exceeds blood flow by 2:1 or 3:1 in the upper lung. In the mid zones, they are more closely matched, whereas in the lower parts of the lung, blood flow exceeds ventilation. REF: p. 473 14. Pulmonary emboli most often arise from a. the left side of the heart. b. the carotid arteries. c. the deep venous system of the lower extremities. d. the intricate venous system of the liver. ANS: C

Pulmonary emboli usually arise from deep venous thromboses (DVTs); however, they may originate from the pelvic, renal, or upper extremity veins or the right side of the heart. REF: p. 473 15. The diameter of macroaggregated albumin (MAA) particles is a. 0.05 to 0.10 µm. b. 0.5 to 5 µm. c. 10 to 90 µm. d. 1 to 2 m. ANS: C

The particles, which range from 10 to 90 µm in diameter, pass through the right atrium and right ventricle, where they are well mixed with blood, and then into the pulmonary artery. REF: p. 475 16. The fate of MAA particles is that they are broken up a. by and removed by an anticoagulant. b. and eliminated via the urinary system. c. and removed by the liver and spleen. d. and removed via the bowel. ANS: C

MAA and human-serum albumin microspheres (HAM) and other particles that pass through the pulmonary capillaries are removed from circulation in the liver and spleen. REF: p. 475 17. One-half dose (reduced number of particles) should be given to patients with all of the

following EXCEPT

a. b. c. d.

pulmonary hypertension. right-to-left shunts. a pneumonectomy. bronchitis.

ANS: D

Special care should be taken to administer half of the usual dose, and therefore a reduced number of particles should be given to patients who are known to have severe pulmonary hypertension, right-to-left shunts, or a pneumonectomy. REF: p. 476 18. A patient has a nuclear medicine lung scan. Once the particles have been injected, the

technologist notices activity in the brain and other organs. The technologist recognizes this as a. a right-to-left shunt. b. normal. c. too many particles injected. d. an expired kit. ANS: A

In patients with right-to-left shunts, particles pass through to the systemic circulation and embolize to the brain, kidneys, heart, and other organs. REF: p. 476 19. In a dose of 1 to 4 mCi of 99mTc-MAA, there are approximately 200,000 to 700,000 particles.

This dose a. should provide a satisfaTcE toSryTaBmAoNuK ntSoE fL paLrtEicRle.s C foOrMa pediatric patient. b. should provide a satisfactory perfusion image in a normal patient. c. should be stored for 3 hours prior to injecting a patient. d. should not be used. ANS: B

In a normal patient, a satisfactory image can be obtained using 1 to 4 mCi 99mTc-MAA with 200,000 to 700,00 particles. REF: p. 477 20. There were 100,000 particles in an MAA dose that a technologist prepared for a normal lung

scan. The scan resulted in a. a homogeneous distribution of activity. b. the appearance of increased intensity. c. a blotchy appearance. d. the appearance of decreased intensity. ANS: C

In a normal patient, a satisfactory image can be obtained using 1 to 4 mCi 99mTc-MAA with 200,000 to 700,000 particles. If too few particles are given, the scans have an obvious blotchy appearance. REF: p. 477

21. Having patients in the supine position when being injected with MAA is important because a. it will make up for any variance in the number of particles. b. there will be a larger proportion of the particles distributed toward the bases. c. there will be a more homogenous distribution of particles. d. there will be a larger proportion of particles distributed toward the apices. ANS: C

Patients injected while supine demonstrate a more homogeneous distribution of particles from the bases to the apices; patients who receive an injection while upright tend to have a larger proportion of the particles distributed toward the bases. REF: p. 478 22. A common procedure for lung imaging is to perform the posterior view first and then each of

the other views for the same time that it took for the posterior view. This procedure is especially helpful because a. of shine-through from the posterior to the anterior. b. of shine-through from the contralateral lung during lateral imaging. c. of shine-through from the contralateral base during oblique imaging. d. the lungs are different sizes. ANS: B

Because of shine-through, about one-third of the counts from the contralateral lung are included during lateral imaging; therefore, imaging for a set time rather than for a set number of counts will maintain relative count density between images. REF: p. 479 23. In a ventilation single-breath study, the single-breath image following a bolus of xenon gas

demonstrates a. tidal volume. b. total lung capacity. c. functional residual capacity. d. residual volume. ANS: B

Single-breath studies show the total lung capacity—a somewhat unphysiological situation. REF: p. 480 24. Because of the importance of the washout phase in a xenon ventilation study, it is technically a. advantageous to perform the ventilation prior to the perfusion. b. advantageous to perform the perfusion prior to the ventilation. c. advantageous to perform the ventilation with SPECT. d. unimportant to perform the perfusion prior to the ventilation. ANS: A

Because the energy of 133Xe is lower than that of 99mTc and the Compton scatter from the 99m Tc would interfere with the images, and because of the importance of the washout phase, it is technically advantageous to perform the ventilation study before the perfusion examination. REF: p. 480

25. In an effort to prevent the release of radioactive xenon during the washout phase of a lung

ventilation study, commercial ventilation units use a. soda lime crystals. b. calcium sulfate crystals. c. cobalt chloride crystals. d. activated charcoal. ANS: D

Commercial ventilation units use xenon traps that utilize activated charcoal to prevent the release of radioactive xenon during the washout phase of a study. REF: p. 481 26. If the image of an aerosol ventilation study shows activity in the bronchi and the stomach, the

technologist a. checks the particle size of the aerosol to be certain it is within the limits. b. performed the perfusion study first. c. continues with the study because this is normal. d. adjusts the nebulizer flow rate. ANS: C

Normal aerosol scans look much like perfusion scans, except that the trachea and main stem bronchi usually can be seen and the esophagus and stomach may also be seen because of swallowed material. REF: p. 482 27. A technologist performs a lung scan that demonstrates a relatively normal ventilation scan and

is accompanied by a perfusion scan demonstrating segmental defects. The technologist should a. check to see if the patient received the injection while in the upright position. b. check the particle size of the MAA. c. recognize this as a pattern for a possible PE. d. recognize this as a pattern for COPD. ANS: C

In PE, the defects in blood flow correspond to anatomical subdivisions of the lung, such as segments or lobes, in 75% of patients. If the patient had previously healthy lungs, ventilation is usually well maintained to the affected parts of the lung. REF: p. 483 28. Which ventilation agent has the longest half-life? a. 99mTc-DTPA Aerosol b. 133Xe c. 99mTc MAA d. All have equal half-lives ANS: B

Table 18-2 allows for comparison of the agents used in lung scintigraphy and shows that the half-life of 133Xe is much longer than the other ventilation agent.

REF: p. 480 29. All of the following are indications for lung scintigraphy, EXCEPT a. evaluate lung transplants. b. evaluate congenital heart or lung disease. c. determine the likelihood for pulmonary embolism. d. differentiate lung neoplasms. ANS: D

Lung scintigraphy is not used to image lung neoplasms. REF: p. 475 30. Which of the following is part of the patient preparation for lung scintigraphy? a. Recent chest x-ray (within 24 hours) b. Preceding meal withheld prior to contrast injection c. NPO for a minimum of 8 hours prior to the exam d. Pre-medications for increased uptake of radionuclide ANS: A

The patient preparation for ventilation or perfusion imaging does not require any dietary restrictions or pre-medication. A recent chest x-ray (no more than 24 hours prior), as well as a thorough patient history (surgery, immobilization, smoking, stroke, malignancy, venous thromboembolism) are needed. REF: p. 476

Chapter 19: Cardiovascular System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Systole represents the a. period of ventricular relaxation. b. period of ventricular contraction. c. period of atrial contraction. d. cardiac output. ANS: B

Each cardiac cycle (i.e., one beat) consists of systole—the period of ventricular contraction—and diastole—the period of ventricular relaxation. REF: p. 492 2. The quantity of blood in the ventricles at the end of ventricular relaxation is called a. stroke volume. b. cardiac output. c. end-systolic volume. d. end-diastolic volume. ANS: D

The quantity of blood in the ventricle at the end of diastole, the period of ventricular EeL(L1E .lCiO relaxation, is called the endT-E diS asTtoBliAcNvK olS um 50Rm nM the left ventricle of an average 70-kg adult and about 170 ml in the right ventricle). REF: p. 492 3. The amount of blood ejected in a single beat is called the a. stroke volume. b. cardiac output. c. end-systolic volume. d. end-diastolic volume. ANS: A

The cardiac output is the amount of blood ejected from the left ventricle during a 1-minute interval. The amount of blood ejected in a single beat is the stroke volume (usually expressed in milliliters). The normal stroke volume is 80 to 100 ml. REF: p. 492 4. The major categories of radiopharmaceuticals used in cardiac imaging include all of the

following EXCEPT a. perfusion tracers. b. blood pool tracers. c. glucose and fatty acid analogs. d. phosphorous analogs.

ANS: D

The five major categories of radiopharmaceuticals used in clinical cardiac imaging are (1) perfusion tracers, (2) blood pool tracers, (3) glucose and fatty acid analogs to measure metabolism, (4) analogs of epinephrine to measure sympathetic innervation, and (5) tracers that localize in areas of acute myocardial necrosis. REF: p. 516 5. In cardiac SPECT imaging, the transverse slices are reoriented along the a. long axis of the left ventricle. b. short axis of the left ventricle. c. horizontal axis of the left ventricle. d. vertical long axis. ANS: A

The individual projections are reconstructed into a series of transverse slices through the imaged volume. The transverse slices are reoriented along the long axis of the left ventricle to produce three standard views: vertical long axis, horizontal long axis, and short axis. REF: p. 501 6. In cardiac SPECT imaging, the vertical long-axis view corresponds to a. sagittal views, presented from the apex to the base. b. coronal images, presented from the septum to the lateral wall. c. septal images, presented from the septum to the posterior wall. d. transverse sections, presented from the inferior to the anterior surface. ANS: B

The transverse slices are reoriented along the long axis of the left ventricle, to produce three standard cardiac views: vertical long axis (corresponding to coronal images, presented from the septum to lateral wall), horizontal long axis (corresponding to transverse sections, presented from the inferior to the anterior surface), and short axis (corresponding to sagittal views, presented from the apex to the base). REF: p. 516 7. In cardiac SPECT imaging, the short axis view corresponds to a. sagittal views, presented from the apex to the base. b. coronal images, presented from the septum to the lateral wall. c. septal images, presented from the septum to the posterior wall. d. transverse sections, presented from the inferior to the anterior surface. ANS: A

a. b. c. d.

sagittal views, presented from the apex to the base. coronal images, presented from the septum to the lateral wall. septal images, presented from the septum to the posterior wall. transverse sections, presented from the inferior to the anterior surface.

ANS: D

The transverse slices are reoriented along the long axis of the left ventricle, to produce three standard cardiac views: vertical long axis (corresponding to coronal images, presented from the septum to the lateral wall), horizontal long axis (corresponding to transverse sections, presented from the inferior to the anterior surface), and short axis (corresponding to sagittal views, presented from the apex to the base). REF: p. 516 9. For myocardial SPECT imaging, often the technologist will position the patient a. supine with the left arm above the head. b. on their right side with the left arm above the head. c. on their left side with the right arm above the head. d. prone with the right arm above the head. ANS: A

During the 20- to 30-minute SPECT data acquisition, the patient lies supine with the left arm above the head (a fairly uncomfortable position). SPECT images may also be recorded with the patient prone, to minimize attenuation from the diaphragm. Prone patients also elevate the left arm to minimize attenuation. REF: p. 501 10. Myocardial perfusion imaging is performed to a. determine ejection fraction. b. record the rate of delivery of a bolus injection. c. detect the location and extent of ischemia. d. evaluate wall motion of the ventricles. ANS: C

Myocardial perfusion imaging is performed to detect myocardial ischemia and to determine its location and extent. REF: p. 494 11. Clearance or redistribution of thallium takes place a. immediately post injection. b. immediately post injection during stress. c. over the course of 30 minutes to 1 hour post injection. d. over the course of about 4 hours post injection. ANS: D

After myocardial uptake of thallium-201, the tracer does not remain fixed in the myocardium. Over the course of about 4 hours, the myocardial concentration of thallium will decrease by 30% to 50%, with more rapid clearance from areas of normal perfusion than from regions of diminished perfusion. This nonuniform clearance causes thallium to “redistribute.”

REF: p. 496 12. When comparing the use of technetium agents with thallium for the purposes of performing

myocardial perfusion imaging, technetium agents a. require the same 2-day protocol used for thallium. b. have a slightly faster blood clearance rate than thallium. c. have minimal redistribution when compared to thallium. d. have a higher myocardial extraction than thallium. ANS: A

These agents have slightly slower blood clearance than thallium. Because technetium agents have minimal redistribution, separate injections are required to depict perfusion at rest and stress. REF: p. 497 13. In comparison with the Bruce protocol, when using a modified Bruce protocol for myocardial

stress imaging, it is important to remember that a. the patient will not achieve the necessary heart rate. b. it will take longer for the patient to achieve the necessary heart rate. c. pharmacological agents will be necessary to achieve the necessary heart rate. d. it will take a shorter time for the patient to achieve the necessary heart rate. ANS: B

Treadmill exercise is usually done using the standard Bruce protocol, but if necessary the protocol can be altered. A modified Bruce protocol starts at a lower work level. Thus, the person who does 9 minutes in the modified protocol does the same workload as 3 minutes on KS the Bruce protocol; 12 minTuE teS sT onBtA heNm odEifL ieLdEpR ro. toCcO olMis the same as 6 minutes on the Bruce protocol. REF: p. 496 14. When performing a myocardial perfusion exercise stress test, ideally the radiopharmaceutical

should be injected at a. the beginning of stress. b. peak stress and the exercise continued for 1 to 2 minutes. c. peak stress and the exercise terminated immediately. d. 1 to 2 minutes after peak stress and the exercise terminated within 1 minute. ANS: B

To maximize the likelihood of detection of coronary artery disease with perfusion imaging, the radiopharmaceutical should be administered at the peak of exercise and the exercise should continue for an additional 1 to 2 minutes to permit the tracer to clear from the blood and localize in the myocardium in proportion to perfusion at the peak of exercise. REF: p. 498 15. When performing a pharmacological myocardial stress test using adenosine, the drug that

must be available if needed to reverse the effects of adenosine is a. xanthine. b. atropine.

c. morphine. d. aminophylline. ANS: D

The effects of dipyridamole, adenosine, and regadenoson can be reversed by the administration of aminophylline. REF: p. 499-500 16. A patient with a history of bronchospasmatic disease arrives for a pharmacological

myocardial stress test. The technologist will most likely perform the study using a. exercise stress. b. dipyridamole. c. adenosine. d. dobutamine. ANS: D

Adenosine and dipyridamole both increase tissue levels of adenosine. Both adenosine and dipyridamole may cause bronchoconstriction, and are contraindicated in patients who are actively wheezing or have a history of significant bronchospastic disease. REF: p. 500 17. In myocardial perfusion imaging, after high-level stress exercise it is recommended that

SPECT imaging begin when respiration has returned to normal to avoid a. bradycardia effects. b. upward creep. c. attenuation by the stomTaE chS. TBANKSELLER.COM d. an increase in background uptake. ANS: B

After high-level exercise (>10 METS), SPECT imaging should not commence until respiration has returned to normal. This will eliminate an artifact caused by a change in the extent of diaphragmatic excursion during SPECT acquisition. This phenomenon of upward creep typically results in an artifactual lesion in the inferior or inferoseptal regions of the left ventricle. REF: p. 504 18. A bull’s-eye display of myocardial perfusion data is constructed by stacking

reconstructed/reoriented a. slices of all axis slices. b. vertical long-axis slices. c. horizontal long-axis slices. d. short-axis slices. ANS: D

19. In a bull’s-eye display of SPECT myocardial perfusion images, the apex of the ventricle

appears a. on the left periphery. b. on the top. c. on the bottom. d. in the center. ANS: D

SPECT images are usually quantified by stacking the reconstructed/reoriented short-axis slices onto a bull’s eye display, where the apex is at the center and the basal slice is at the periphery. REF: p. 505 20. Rubidium-82 (82Rb) behaves physiologically similar to a. strontium-82. b. technetium-99m. c. thallium-201. d. oxygen-15. ANS: C 82

Rb chloride is available from a strontium-82 generator. 82Rb behaves physiologically similarly to thallium-201 and is initially concentrated in the myocardium in proportion to regional perfusion, with an extraction of 70%. REF: p. 509 21. When performing PET in a patient with a history of coronary disease and multiple infarcts,

myocardial perfusion imaging with fluorodeoxyglucose (FDG), FDG reflects the relatively a. decreased utilization of glucose in regions of ischemic tissue. b. increased utilization of glucose in regions of decreased perfusion. c. increased utilization of glucose in regions of scarred tissue. d. decreased utilization of glucose in surrounding tissue. ANS: B

Viability is typically assessed in a patient with a history of coronary disease and multiple infarcts, with a reduced ejection fraction and heart failure. In these patients, rest injected perfusion images are compared to the regional distribution of FDG in the myocardium (after glucose loading) to detect regions of relatively increased utilization of glucose in regions of decreased perfusion. REF: p. 511 22. When fusing PET and CT or SPECT and CT images of the heart, misregistration can be

overcome by taking several steps, including a. equating the acquisition time between CT and PET or SPECT. b. blurring the CT data. c. acquiring PET or SPECT images over a longer period of time. d. blurring the PET or SPECT data. ANS: A

Transmission and emission data were often obtained under circumstances of breath holding for the CT and free breathing for the emission scan. This disparity results in misregistration of the images. The registration problem can be overcome by blurring the CT, decreasing the mA on the x-ray tube, and acquiring the CT data over 30 to 120 seconds. These “blurred” CT data are used for attenuation correction on the emission scan. REF: p. 511 23. When performing equilibrium-gated blood pool studies to determine cardiac function, the

preferred tracer is a. thallium-201 chloride. b. technetium-99m–labeled tetrofosmin. c. radiolabeled autologous RBCs. d. technetium-99m–labeled sestamibi. ANS: C

Based on common protocol, the other tracers mentioned are used for myocardial perfusion imaging. REF: p. 512 24. When performing equilibrium-gated blood pool studies, the computer is programmed to have

the first frame of data recorded at the a. R wave. b. Q wave. c. QRS complex. d. T wave. ANS: A

The computer is programmed to record data from the first portion of the cardiac cycle into the first frame, the second portion of the cycle in the second frame, and so on until the last frame is reached or the next R wave is sensed, which resets the recording of the first frame to repeat the process. REF: p. 500 25. When performing equilibrium-gated blood pool imaging, temporal smoothing should be used

only when a. the heart rate is regular. b. the heart rate is erratic. c. premature contractions are detected. d. there are tall P waves in the cardiac cycle. ANS: A

Temporal smoothing should be used only when the heart rate is regular. If the R-R interval has significant variation, temporal smoothing causes errors. The latter frames of the acquisition, which contain fewer counts, are averaged with the initial frames. If these data are used to calculate the ejection fraction, the end-diastolic counts in the left ventricle are lower than they should be, resulting in a calculated ejection fraction that is too low. REF: p. 514

26. When processing an equilibrium-gated blood pool study, subtraction of too much background

results in a falsely a. elevated ejection fraction. b. depressed ejection fraction. c. equivocal ejection fraction. d. normal ejection fraction. ANS: A

A background region should be selected at the 3 to 6 o’clock positions from the left ventricle away from pulmonary artery, left atrium, and the spleen. Too much background subtraction results in a falsely elevated ejection fraction (EF), and subtraction of too little produces a falsely depressed EF. REF: p. 514 27. In a phase analysis of a cardiac wall motion study, the amplitude represents the a. timing of the changes. b. amount of change. c. area of dyskinesis. d. cardiac output. ANS: B

Phase analysis assumes that the heart contracts in a specific pattern that resembles the wave form of a cosine function. Each pixel in the image can be evaluated for the timing (phase) of these changes in activity and for its amount of change (amplitude) between the maximum and minimum count values in the pixel. REF: p. 514 28. To allow for a repeat study, a radiopharmaceutical used to acquire a first-pass study is a. 99mTc-tetrofosmin. b. 99mTc-sestamibi. c. 99mTc-teboroxime. d. 99mTc-DTPA. ANS: D

To provide the possibility of repeat studies, the tracer must be cleared rapidly from the blood and must not accumulate in an organ, which would cause interference with subsequent imaging. 99mTc-DTPA is the most commonly used because of its rapid clearance through the kidneys. REF: p. 495 29. The left ventricular ejection fraction, expressed as a percentage, for a patient with net

end-systolic counts of 11,500 and net end-diastolic counts of 30,800 would be a. 13%. b. 17%. c. 37%. d. 63%. ANS: D

The equation is

EF = (ED cts − ES cts)/ED cts therefore

The EF is calculated from the time-activity curve. An alternative approach to calculate the EF uses a single region of interest, based on the end-diastolic frame, to measure the time-activity curve. The LVEF can also be calculated from the gated SPECT data, by counting the pixels in the left ventricular region of interest at diastole and systole. The equation for calculation of the left ventricular ejection fraction, expressed as a percentage, is as follows: EF = (end-diastolic counts − end-systolic counts)/end-diastolic counts. REF: p. 514 30.

123

a. b. c. d.

I-MIBG in cardiac imaging is used to image cardiac infection. myocardial necrosis. myocardial ischemia. neuronal status of the heart.

ANS: D 123

I-MIBG was the first radiopharmaceutical used for the assessment of adrenergic innervation and is the most commonly used tracer for assessing neuronal status of the heart. REF: p. 516

Chapter 20: Gastrointestinal System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. The indication on a patient’s requisition is xerostomia. The procedure for which the

technologist prepares the room is a. sialography. b. esophageal transit. c. oropharyngeal study. d. C14 breath test. ANS: A

Salivary gland imaging is also known as sialography. The main clinical indication for salivary gland imaging is the evaluation of the symptoms of dryness of the mouth, or xerostomia. REF: p. 520 2. When positioning the patient for sialography, the head is tilted back to a. prominently display the esophagus. b. remove the sinuses from the field of view. c. prevent superimposition of the thyroid gland. d. remove the nasal cavity from the field of view. ANS: C

To prevent superimpositioT nE ofStT heBtA hyNrK oiS dE glLanLdEoRn.thCeOsM alivary glands, the patient’s head should be tilted backward with the neck extended as far as possible, allowing the chin to make contact with the camera face. REF: p. 520 3. After administration of the radiopharmaceutical for a radionuclide oropharyngeal study, the

patient is instructed to a. return for delayed imaging in 30 minutes. b. return for delayed imaging in 1 1/2 to 2 hours. c. dry swallow every 15 seconds for 5 minutes while images are taken. d. take a sip of water every 15 seconds for 5 minutes while images are taken. ANS: C

After swallowing the radiopharmaceutical, the patient is instructed to dry swallow every 15 seconds on command. Images are acquired dynamically for 5 minutes. REF: p. 523 4. An oropharyngeal study is usually accompanied by a. sialography. b. thyroid evaluation. c. esophageal transit study. d. gastric emptying evaluation.

ANS: C

The radionuclide oropharyngeal study is usually combined with esophageal transit and gastroesophageal reflux studies. REF: p. 521 5. In preparation for an esophageal transit study, the technologist prepares a. 300 mCi of 111In in tap water. b. a meal for the patient using 300 µCi of 111In. c. a meal for the patient using 300 µCi of 99mTc–sulfur colloid. d. 300 µCi of 99mTc–sulfur colloid in tap water. ANS: D

The patient should fast for at least 2 hours before the examination; the radiopharmaceutical is prepared by mixing 300 µCi of 99mTc–sulfur colloid in 15 ml of tap water. REF: p. 521 6. Using the condensed image method to display results of an esophageal transit study allows for

the display of a. a gated dynamic sequence. b. the complete dynamic sequence in a single image. c. the count rate to be calculated using a region of interest (ROI) over the entire esophagus. d. four parameters from a single curve. ANS: B

The concept of the condenT seE dSim TaBgAe NreKfeSrsEtLo LthEeRsu.mCm OiMng of all computer frames during the transit of the bolus that produces a topographical picture or condensed picture of the esophagus. This method of display depicts a complete dynamic sequence in one single image. REF: p. 526 7. Delayed images of the thorax following an esophageal transit study may be ordered to

determine a. the site of an esophageal stricture. b. aspirated radionuclide. c. scleroderma prognosis. d. reflux. ANS: B

A routine esophageal transit study may be combined with delayed images of the thorax in the anterior and posterior projections for the detection of aspirated radionuclide. REF: p. 527 8. The gastroesophageal reflux data are provided below. What is the reflux percentage for the

patient? ROI Esophagus Maximum gastri

Counts per 30 seconds 1200 40,000

a. b. c. d.

1% 3% 33% 97%

ANS: B

Computer analysis of this study is accomplished by recalling the separate images and drawing regions of interest for the stomach and esophagus. The counts in the stomach region of interest and in the esophageal region of interest are noted and used to calculate a gastroesophageal reflux index for each level of abdominal pressure using the following formula: Based on GERI = (Ep/Gmax)  100, where GERI is the gastroesophageal reflux index in percent, Ep is the esophageal counts at a specific pressure point p, and Gmax is the maximum gastric count obtained for one image in this study. REF: p. 530 9. The result of a patient’s gastroesophageal reflux study was calculated to be 5%. This finding a. is normal. b. is consistent with reflux. c. suggests the study should be repeated. d. suggests the binder was not positioned properly. ANS: B

A normal gastroesophageal reflux study has a reflux index of less than 4%; this is the level at which gastroesophageal reflux cannot be visualized. An index greater than 4% is considered to be abnormal and usually can be visualized in the images. REF: p. 530 10. The main determinant of the rate of liquid gastric emptying is a. particle size. b. composition. c. volume. d. osmolyte action. ANS: C

The main determinant of the rate of liquid gastric emptying is volume. Saline, neutral, isomolar, and calorically inert solutions (e.g., water) empty in a single exponential manner. REF: p. 530 11. The “lag phase” of the curve demonstrating the results of a solid-phase gastric emptying study

corresponds to a. gastric emptying half-time. b. the time of peak activity in the distal stomach. c. the time of peak activity in the fundus. d. the time between the liquid and solid phases. ANS: B

The lag phase corresponds qualitatively and quantitatively to the redistribution of solid food particles from the fundus to the distal stomach and more specifically to the time of peak activity in the distal stomach. REF: p. 532 12. In patients with a partial gastrectomy a. the solid phase empties faster than the liquid phase. b. the liquid phase empties faster than the solid phase. c. the liquid and solid phases empty in a similar fashion. d. the lag time is increased. ANS: C

In patients with a partial gastrectomy, there is an initial precipitous emptying followed by a slow evacuation phase resulting in a delay in both solid and liquid emptying. There is no lag phase, and both liquids and solids empty in a similar fashion. REF: p. 535 13. When performing the 99mTc–sulfur colloid technique for identification of a gastrointestinal

bleed, the technologist should begin imaging a. with an anterior flow study for 2 to 3 minutes and static every 1 to 2 minutes for 20 to 30 minutes thereafter. b. within 5 minutes of the injection and every 5 minutes, and for 20 to 30 minutes thereafter. c. after 20 minutes and every 1 to 2 minutes for the next 20 minutes. d. with an immediate static image after a bolus injection and every 5 minutes TE thereafter for 20 to 30 m inS utTesB. ANKSELLER.COM ANS: A 99m

Tc–sulfur colloid is injected as an intravenous bolus, and an anterior flow study of the abdomen is obtained at 1 to 2 sec/frame for 2 to 3 minutes and every 1 to 2 minutes for 20 to 30 minutes thereafter. REF: p. 539 14. When positioning a patient for a gastrointestinal bleed study using 99mTc–sulfur colloid, care

should be taken to a. avoid any liver and spleen activity in the field of view. b. include small margins of the liver and spleen in the field of view. c. avoid having the bladder in the field of view. d. include the kidneys in the field of view. ANS: B

Care should be taken in positioning the patient so that only small margins of the liver and spleen are seen in the images. This brings out abdominal activity. REF: p. 539 15. The 99mTc-labeled red blood cell technique for imaging a gastrointestinal bleed is preferred by

investigators for a. active bleeds.

b. intermittent bleeds. c. patients with cirrhosis. d. patients bleeding profusely. ANS: B 99m

Tc-labeled red blood cells, with their prolonged retention in the intravascular pool, are preferred by investigators who maintain that gastrointestinal bleeding is most often intermittent and slow; it allows imaging for up to 36 hours. REF: p. 539 16. Meckel diverticulum is characterized by a. bleeding. b. its appearance at mid-age. c. its association with Barrett’s esophagus. d. containing gastric mucosa. ANS: A

Meckel diverticulum is a congenital defect in which a small sac forms in the ileum, a common cause of GI tract bleeding in children. REF: p. 540 17. When performing a normal liver/spleen study, following the blood pool image the

technologist should begin imaging a. immediately. b. approximately 15 minutes after injection. c. approximately 30 minuTteEsSafTteBrA inNjeKcS tioEnL. LER.COM d. approximately 45 minutes after injection. ANS: B

Blood flow imaging should continue for at least 1 minute, possibly longer, and then an immediate postinjection static image, or blood pool image, should be obtained. After a wait of approximately 15 minutes, planar static imaging may begin. REF: p. 543 18. A 99mTc sulfur colloid liver/spleen scan demonstrates the function of a. hepatocytes. b. Kupffer cells. c. bile ducts. d. parenchyma cells. ANS: B

Following injection of the sulfur colloid, 80% to 90% is taken up by the Kupffer cells of the liver, and 5% to 10% is taken up by the spleen. REF: p. 543 19. When imaging for a hemangioma, the technologist uses which of the following

radiopharmaceuticals? a. 99mTc–sulfur colloid

b. c. d.

99m

Tc-IDA compound In-oxine 99m Tc-labeled RBCs 111

ANS: D

Any non–heat-treated method for labeling RBCs can be used for imaging hemangiomas. REF: p. 545 20. Two hours after injection of 99mTc–labeled, non–heat-treated RBCs, there remains increased

activity in the liver. This finding is most consistent with a. hemangiomas. b. hepatic carcinoma. c. metastatic disease. d. lymphoma. ANS: A

Other types of lesions, such as hepatic carcinoma and metastatic disease, can show increased blood flow and early accretion of the radiolabeled cells, but they do not retain the cells for long. Only hemangiomas retain RBCs until the 2-hour interval. REF: p. 545 21. In cholescintigraphy, nonvisualization of the gallbladder is consistent with a. cholesteatoma. b. chronic cholecystitis. c. acute cholecystitis. d. choledochitis. ANS: C

In acute cholecystitis, the gallbladder will still fail to visualize up to 4 hours after injection. REF: p. 546 22. Administration of morphine sulfate serves to a. reduce the patient’s pain. b. relax the sphincter of Oddi. c. contract the sphincter of Oddi. d. dilate the common bile duct. ANS: C

Morphine sulfate contracts the sphincter of Oddi and generates an increase in pressure in the common bile duct and cystic duct. REF: p. 546-547 23. Data from a hepatobiliary study are given below. What is the ejection fraction of the

gallbladder? Net maximum gallbladder counts = 235,000 Net minimum gallbladder counts = 75,000 a. 3% b. 21%

c. 32% d. 68% ANS: D

GBEF % = [(net GB counts max-net GB counts min)/net GB counts max]  100. So

REF: p. 547 24. In a normal hepatobiliary study, one would expect to see the a. gastrointestinal (GI) tract by 30 minutes and gallbladder by 45 to 60 minutes. b. gallbladder by 30 minutes and the GI tract by 45 to 60 minutes. c. GI tract by 15 minutes and the gallbladder by 30 minutes. d. gallbladder by 15 minutes and the GI tract by 30 minutes. ANS: A

The gallbladder is typically well visualized by 45 to 60 minutes, and radioactivity is identified in the GI tract by 30 minutes after injection. REF: p. 547 25. For identifying the stomach when performing dual isotope enterogastric reflux imaging, the

radiopharmaceuticals used are a. 99mTc-IDA and 111In-DTPA. b. 99mTc–sulfur colloid and 111In-DTPA. c. 99mTc-IDA and 111In-oxTiE neS. TBANKSELLER.COM d. 99mTc–sulfur colloid and 111In-oxine. ANS: A

For identifying the stomach, a dual radiopharmaceutical imaging technique with a radiolabeled test meal is helpful. A 2- to 5-mCi dose of 99mTc-IDA is prepared for IV injection, and a fatty meal is prepared by mixing 100 to 250 mCi of 111In-DTPA with a commercial fatty meal preparation of 250 ml. REF: p. 549 26. For breath testing with 14C-labeled compounds, the two most important gases of the five

principle colonic gases for breath analysis are a. carbon dioxide and methane. b. carbon dioxide and nitrogen. c. carbon dioxide and oxygen. d. carbon dioxide and hydrogen. ANS: D

Of the five principal colonic gases (carbon dioxide, hydrogen, methane, nitrogen, and oxygen), carbon dioxide and hydrogen are the two most important for breath analysis. 14C– carbon dioxide breath is trapped as labeled carbonic acid by a known amount of alkali,such as hyamine hydroxide.

REF: p. 552 27. The 14C-urea breath tests enables detection of a. stomach infection by the H. pylori bacterium. b. urease activity in the lungs. c. esophageal reflux of urease. d. enterogastric urease reflux. ANS: A

H. pylori produces a significant amount of the enzyme urease that is not present in normal tissue. When 14C-labeled urea is administered orally to the patient and urease activity is present in the stomach, 14C-urea is split into ammonia and 14CO2, which is absorbed into the blood and exhaled through the lungs. The 14C activity is trapped in an alkaline solution and measured. REF: p. 552 28. For radionuclide imaging for gastroesophageal reflux, the appropriate volume of solution to

be administered to the patient is a. 15 ml. b. 30 ml. c. 150 ml. d. 300 ml. ANS: D

The patient is given an oral solution containing 300 µCi of 99mTc–sulfur colloid mixed with 150 ml of orange juice and 150 ml of 0.1 N hydrochloric acid. The entire 300 ml of solution EeLoLfEliRqu.iC should be administered, beT caEuS seTtB hiA sN voKlS um dO inMthe stomach opposes induced abdominal pressure. REF: p. 529 29. Technetium-99m–sulfur colloid and 99mTc–albumin colloid are the radiopharmaceuticals most

commonly used for imaging the a. salivary glands. b. liver and spleen. c. gallbladder. d. small intestine. ANS: B

Technetium-99m–sulfur colloid and 99mTc–albumin colloid are the radiopharmaceuticals most commonly used for imaging the liver and spleen. REF: p. 542 30. How long should a patient fast prior to cholescintigraphy? a. Fasting is not necessary prior to cholescintigraphy. b. 2 to 5 hours c. 7 to 10 hours d. A minimum of 12 hours ANS: B

Patients need to be fasting for 2 to 5 hours before the test to enable visualization of the gallbladder. Prolonged fasting (longer than 12 hours) and parenteral alimentation may also cause the gallbladder not to fill in despite a patent cystic duct because of increased intraluminal pressure and viscous, concentrated bile. REF: p. 546

Chapter 21: Genitourinary System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. The kidneys span the distance between the a. 5th and 12th thoracic vertebrae. b. 12th thoracic vertebra and 3rd lumbar vertebrae. c. 1st and 3rd lumbar vertebrae. d. 3rd lumbar vertebra and the sacroiliac joint. ANS: B

The top of each kidney is located just below the ribs in the back, spanning the distance between the 12th thoracic vertebra and the 3rd lumbar vertebra. REF: p. 556 2. The best view for demonstrating a horseshoe kidney is the a. posterior view. b. anterior view. c. left posterior oblique. d. left anterior oblique. ANS: B

Because the spine attenuates the activity coming from the thin band of tissue connecting the Ra.liCtyOmMay be missed if only posterior views lower poles of the kidneysT , tE hiS sT coBnA geNnK itS alEaL bnLoE rm are obtained. An anterior view often clearly shows the band of functioning tissue that connects the lower poles of the kidney. REF: p. 557 3. On a renal scan, the right kidney is slightly lower than the left kidney. Because of this, the

technologist should a. suspect that there is a tumor above the right kidney causing a displacement. b. continue the scan because this is normal. c. take additional views of the right side. d. perform SPECT. ANS: B

The right kidney is slightly lower than the left because it is displaced by the liver. REF: p. 557 4. With planar scintigraphy, the kidney may appear smaller than its normal size if the a. radiopharmaceutical was compounded improperly. b. camera is too far from the patient. c. patient moves during the image acquisition. d. long axis is not parallel to the surface of the camera crystal. ANS: D

With planar scintigraphy, the kidney may appear smaller than its actual size if the long axis is not parallel to the surface of the crystal of the gamma camera. This artifact is called foreshortening. REF: p. 556 5. A neobladder made from a portion of the small bowel is called a. colostomy. b. ileal loop. c. ptotic. d. jejunostomy. ANS: B

Sometimes a patient’s bladder is removed to treat bladder cancer. A new “bladder” (neobladder) can be fashioned from the patient’s gastrointestinal tract and is most commonly made from a portion of the small bowel (ileum), thus being called an ileal loop. Less commonly, a small portion of the colon can be used to construct a neobladder. REF: p. 558 6. The most accurate nuclear medicine technique for measuring renal size is a. SPECT imaging with morphologic agent DMSA. b. SPECT imaging with functional agent hippuran. c. planar imaging with functional agent. d. planar imaging with morphologic agent. ANS: A

With planar scintigraphy, tT heEkSiT dnBeA yN mKaySE apLpL eaEr R sm .aCllOerMthan its actual size if the long axis is not parallel to the surface of the crystal of the gamma camera. This artifact is called foreshortening. SPECT imaging using a morphologic renal imaging agent such as dimercaptosuccinic acid (DMSA) is a more accurate technique for measuring renal size. REF: p. 556 7. It is important to position the crystal of the camera parallel to the surface when performing

renal imaging to prevent the artifact of a. blurring. b. elongation. c. foreshortening. d. enlargement. ANS: C

With planar scintigraphy, the kidney may appear smaller than its actual size if the long axis is not parallel to the surface of the crystal of the gamma camera. This artifact is called foreshortening. REF: p. 556 8. If normal resting cardiac output is 5 L/min; the total renal blood flow would be approximately a. 0.5 L/min. b. 1.2 L/min. c. 2.5 L/min.

d. 3.7 L/min. ANS: B

Approximately 20% to 25% of the cardiac output goes to normally functioning kidneys. Because the resting cardiac output is 5 L/min, total renal blood flow is about 1.2 L/min. REF: p. 559 9. If normal effective renal plasma flow (ERPF) is about 600 mL/min, normal glomerular

filtration rate (GFR) is a. 1.2 L/min. b. 5 L/min. c. 120 mL/min. d. 600 mL/min. ANS: C

Approximately 20% of the plasma passes through the glomerulus into the renal tubules, resulting in a GFR of 120 mL/min. REF: p. 559 10. Angiotensin-converting enzyme inhibitor (ACEI) augments renal studies in patients with a. infection and inflammation. b. vesicoureteral reflux. c. obstructive uropathy. d. renal artery stenosis (RAS)-related hypertension. ANS: D

Patients with hypertension may be classified into three groups: (1) those with hypertension and no significant RAS, (2) those with hypertension in whom RAS is a major contributor to the hypertension, and (3) those with hypertension in whom RAS is an insignificant contributor to the hypertension. Renal imaging with and without an ACE inhibitor is intended to identify patients in whom RAS is a major contributor to the hypertension (group 2). REF: p. 570 11. A morphologic renal tracer is noted for its a. retention in the renal parenchyma for a prolonged period of time. b. retention in the glomerulus for a prolonged period of time. c. rapid excretion from the renal parenchyma. d. rapid excretion from the glomerulus. ANS: A

The hallmark of a morphologic renal tracer is its retention in the renal parenchyma for a prolonged period of time, thereby making possible relatively high-resolution imaging of the renal parenchyma. REF: p. 562 12. The two most common agents used for morphologic renal imaging are a. 99mTc-DMSA and 99mTc-glucoheptonate. b. 99mTc-MAG3 and 99mTc-DTPA.

c. d.

Tc-DMSA and 99mTc-DTPA. Tc-MAG3 and 99mTc-glucoheptonate.

99m 99m

ANS: A 99m

Tc-DMSA and 99mTc-glucoheptonate are considered morphologic imaging agents, because accumulation in the kidney is the result of a complex interaction of blood flow, the GFR, tubular secretion, and tubular resorption. REF: p. 562 13. Two common agents used for functional renal imaging are a. 99mTc-DMSA and 99mTc-glucoheptonate. b. 99mTc-MAG3 and 99mTc-DTPA. c. 99mTc-DMSA and 99mTc-DTPA. d. 99mTc-MAG3 and 99mTc-glucoheptonate. ANS: B

Functional renal imaging using 99mTc-MAG3 or 99mTc-DTPA is the most common radionuclide renal imaging study performed at most medical centers. REF: p. 564 14. Absolute renal function typically refers to the a. blood flow images followed by a sequence of static images. b. ERPF or GFR. c. evaluation of a renal transplant. d. relative renal function. ANS: B

Most medical centers do not measure absolute renal function (ERPF or the GFR) because the most accurate methods are time-consuming and cumbersome, requiring several timed blood samples. REF: p. 564 15. Common morphologic imaging agents include a. 99mTc-DMSA and 99mTc-glucoheptonate. b. 99mTc-MAG3 and 99mTc-DTPA. c. 99mTc-DMSA and 99mTc-DTPA. d. 99mTc-MAG3 and 99mTc-glucoheptonate. ANS: A

Morphological renal imaging after injection of 99mTc-glucoheptonate or 99mTc-DMSA can be used to document global and regional changes in renal function. REF: p. 571 16. A patient is scheduled for a diuretic renal imaging study. The technologist prepares the

radiopharmaceutical and a. furosemide. b. captopril. c. adenosine.

d. saline. ANS: A

At 20 minutes after injection of the radiopharmaceutical, intravenous injection of furosemide (Lasix) is very useful. REF: p. 569 17. A diuretic renal imaging study is most helpful in differentiating a. acute tubular necrosis from rejection in a transplanted kidney. b. ERPF from GFR. c. renovascular hypertension from acute tubular necrosis. d. a dilated from an obstructed renal collecting system. ANS: D

A diuretic renal imaging study is most helpful in differentiating a dilated renal collecting system from an obstructed renal collecting system. REF: p. 567 18. A renogram (time-activity curve) shows prompt uptake of the tracer, with activity in the

kidney peaking at 3 to 5 minutes after injection and decreasing to less than 50% of peak value by 20 minutes. The technologist should a. suspect this to be normal. b. suspect the patient is dehydrated. c. suspect the patient had a contrast radiographic procedure prior to the renogram. d. suspect the patient may need furosemide. ANS: A

The time-activity curve (renogram) from a normal MAG3 study shows prompt uptake of the tracer, with the activity in the kidney peaking at 3 to 5 minutes after injection (when radioactivity is primarily in the parenchyma (functioning tissue)) and decreasing to less than 50% of peak value by 20 minutes. Abnormal curves can result from abnormal renal function, retention of activity in the collecting system, or patient movement. The cause of an abnormal curve usually can be easily determined from visual inspection of the images, with careful attention paid to the fate of activity seen in the peripheral parenchyma (cortex) of the kidney. REF: p. 565 19. After the injection of furosemide in a diuretic renal imaging study, the washout activity from

the collecting system has a clearance half-time of less than 10 minutes. This is most likely indicative of a(n) a. obstruction. b. polycystic kidney. c. dilated but unobstructed kidney. d. normal kidney. ANS: C

A dilated but unobstructed kidney can increase its urine flow rate in response to furosemide; therefore the washout of activity from the collecting system is in the normal range (t <10 minutes).

REF: p. 569 20. Morphologic renal imaging can be used to document a. GFR and ERPF. b. global and regional changes in renal function. c. the existence of an ileal loop. d. the evaluation of acute renal failure. ANS: B

Morphologic renal imaging can be used to document global and regional changes in renal function (e.g., acute pyelonephritis, areas of decreased function, cortical defects). REF: p. 571 21. A patient is scheduled for an indirect cystogram. The technologist should a. prepare a catheter setup for instillation of the tracer. b. prepare the tracer dose for intravenous injection. c. prepare for the instillation of both the tracer and furosemide. d. prepare instillation of the tracer dose and IV injection of furosemide. ANS: B

Radionuclide cystography can be performed via catheter by directly instilling the radionuclide in the bladder or by injecting the patient with the tracer and allowing the bladder to fill with the tracer as it is excreted by the kidneys. REF: p. 571 22. Patient preparation for testT icE ulS arTsB ciAnN tigKrS apEhL yL inE clRu. deCs O thMe taping of the a. testicles over the pubis. b. penis over the pubis. c. scrotum over the pubis. d. penis to the testicles and penis over the pubis. ANS: B

The penis of the supine patient should be taped over the pubis. A tape sling should be used to support the testicles between the thighs. REF: p. 572 23. The most common radio pharmaceutical used in testicular scintigraphy is a. 99mTc-DTPA. b. 99mTc-DMSA. c. 99mTc-MAG3. d. 99mTc-pertechnetate. ANS: D

The purpose of the exam is to evaluate the blood flow in the testes. 99mTc-pertechnetate is the most commonly used radiopharmaceutical. REF: p. 572 24. All of the following are indicators for radionuclide renal scintigraphy, EXCEPT

a. b. c. d.

vesicoureteral reflux. renovascular hypertension. chronic renal failure. infection.

ANS: C

The major indications for radionuclide renal scintigraphy are relative renal function, renal transplant evaluation, acute renal failure, obstructive uropathy, renovascular hypertension, infection and inflammation, and vesicoureteral reflux. REF: p. 564 TRUE/FALSE 1. A patient informs the technologist that he has a ptotic kidney. Because of this, the technologist

positions the patient in a sitting position. ANS: F

Occasionally a kidney may be in an unusual location, such as in the pelvis, particularly if the patient is sitting or standing. When the patient is imaged in the supine position, the kidney may return to a more normal position. A mobile kidney in an abnormal position is called ptotic. REF: p. 558

Chapter 22: Skeletal System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. Accumulation of radionuclides in the bone is related to both the rate of bone production and a. the type of bone. b. the type of analog. c. vascularity. d. amount of activity. ANS: C

Once the material arrives at the bone, heterionic exchange of an ion native to bone for a labeled, bone-seeking ion occurs. Increased blood supply to an area of bone results in a blood pool image (obtained immediately after radiopharmaceutical administration) with increased activity. Localization of various bone-imaging agents is related to their exchange with ions in the bone. The principle of bone imaging relies on the exchange of an ion native to bone for a labeled, bone-seeking ion, a process called heterionic exchange. REF: p. 583 2. Strontium is an analog of a. calcium. b. phosphorous. c. hydroxyl. d. technetium. ANS: A

Strontium-85 (85Sr) is a calcium analog. REF: p. 582 3. Fluorine-18 is an analog of a. calcium. b. phosphorous. c. hydroxyl. d. technetium. ANS: C

Fluorine-18 (18F) is a hydroxyl analog. REF: p. 582 4. Visualization of the kidneys on a 99mTc-MDP scan is considered a. abnormal, because 99mTc-MDP is excreted via the bowel. b. normal, because 99mTc-MDP is excreted via the urinary tract. c. abnormal and is indicative of calcifications. d. rarely seen because of uptake by the vertebra. ANS: B

F- and 99mTc-labeled phosphate compounds demonstrate activity in the kidneys and bladder because they are excreted through the urinary tract. REF: p. 583 5. A bone scan image of a female patient shows radiopharmaceutical uptake in the breasts. The

technologist should a. check to see if the patient was given the correct radiopharmaceutical. b. check for contamination. c. consider this to be a normal variant. d. check the patient’s history of trauma to the chest. ANS: C

Accumulation of the bone-imaging radiopharmaceuticals can occur in the normal female breast and with various diseases of the breast. REF: p. 588 6. For lytic lesions to be seen radiographically, the loss of mineral content of the bone must be

approximately a. 10%. b. 20%. c. 35%. d. 50%. ANS: D

Loss of approximately 50% of the mineral content of the bone must occur before lytic lesions are detected radiographicaT llyE. STBANKSELLER.COM REF: p. 588 7. Patients having a bone scan should be hydrated between injection and delayed imaging in

order to a. increase heterionic exchange. b. aid clearance of the radiopharmaceutical from body. c. aid the osseous phase of the study. d. increase clarity of the blood pool image. ANS: B

Unless contraindicated, patients should be hydrated to aid clearance of the radiopharmaceutical from the body; administration of four to six glasses of liquid during the delay period is adequate. REF: p. 584 8. Patients having a bone scan should be encouraged to void urine frequently between injection

and delayed scanning to a. increase heterionic exchange. b. reduce the radiation dose to the bladder. c. aid the osseous phase of the scan. d. decrease risk of contamination during scan.

ANS: B

Since the 99mTc-labeled bone agents are excreted from the body via the urinary system, the patient should be encouraged to void urine frequently to reduce radiation to the bladder. REF: p. 588 9. Equal-time imaging for bone scanning refers to the technique in which a. one area is imaged for preset counts with the time recorded and all subsequent

images are taken for that same time interval. b. third- and fourth-phase images are taken for the same time interval. c. second- and third-phase images are taken for the same time interval. d. parameters are set so the same amount of time is used for each image in a flow

sequence. ANS: A

Commonly, multiple individual images (or spot views) are taken for an equal amount of time. Equal-time technique allows comparison of the film density in one image with that in another image, because the exposure is made for equal amounts of time. This method is effective as long as adequate statistics are achieved. First, one area of the body (e.g., the anterior or posterior view of the chest) is imaged for a preset number of counts and the time is recorded. Between 400,000 and 600,000 counts are accumulated for a standard-field camera, and between 500,000 and 1 million counts for a large-crystal camera. All subsequent images are taken for the same interval that had been recorded for the first image. REF: p. 584 10. A nomogram is used for a. determining proper scan speed. b. determining proper ID. c. determining equal-time imagery. d. determining sites of superimposition. ANS: A

The scan speed is determined by one of several techniques; most camera manufacturers supply a table, chart, or nomogram for determining the proper scan speed, based on the desired ID in the image and the count rate from the patient. REF: p. 585 11. Typically, skeletal metastatic disease has the greatest involvement in (the) a. appendicular skeleton. b. axial skeleton. c. areas of synarthrosis. d. areas of diarthrosis. ANS: B

The usual pattern of skeletal metastatic disease is multiple focal lesions throughout the skeleton, with the greatest involvement generally in the axial skeleton. REF: p. 589 12. Metastatic lesions that have no osteoblastic activity

a. b. c. d.

can be confused with a renal abnormality. are usually detected as a photon-rich area. are usually detected as a photon-deficient area. often result in breast uptake.

ANS: C

Localization of bone-seeking radiopharmaceuticals depends in large part on bone production, so metastatic lesions that have no associated osteoblastic activity may not be seen on a bone scan or may be detected as a photon-deficient area. REF: p. 588 13. In the evaluation of primary bone neoplasms, bone scans a. are the first step in diagnosis. b. are used to detect disease elsewhere. c. are used instead of radiographs for diagnosis. d. demonstrate the primary bone neoplasm as a photopenic area. ANS: B

The value of bone scanning in patients with primary bone malignancy lies in the detection of the disease elsewhere. Usually the patient has already had a radiograph and the extent of the abnormality on the bone scan is generally not much different. REF: p. 589 14. A patient is entering the osseous phase of a routine three-phase bone scan. The technologist

should a. prepare the room for a T dyEnSam icAsN tuK dyS. ELLER.COM TB b. begin to take blood pool images. c. begin to take 2- to 3-hour delayed images. d. take 5- to 24-hour delayed images. ANS: C

The third phase (also osseous phase, or delayed phase) is routine scanning at 2 to 3 hours after injection. REF: p. 590 15. What are the two types of bone tissue? a. Compact and spongy b. Spongy and trabecular c. Cortical and compact d. Trabecular and cortical ANS: A

The two types of bone tissue are compact and spongy tissue. REF: p. 579

Chapter 23: Inflammatory/ Tumor/Oncology Imaging and Therapy Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th MULTIPLE CHOICE 1. Following the injection of 67Ga-citrate, imaging can begin a. immediately. b. at 1 hour. c. at 3 hours. d. at 6 hours. ANS: D

Imaging with 67Ga-citrate can begin any time from 6 hours to 1 week after injection. REF: p. 601 2. In imaging with 67Ga-citrate, target-to-background ratio increases over time because of

gallium concentration in tissue a. remaining the same while blood clearance progresses. b. decreasing while blood clearance progresses. c. remaining the same while blood clearance decreases. d. decreasing while blood clearance decreases. ANS: A

The gallium concentration in tissue remains while the target-to-background ratio increases as the blood clearance progresses over time. REF: p. 601 3. A technologist is positioning a patient for a 67Ga-citrate imaging study and notices that a

LEAP collimator is on the camera. The recommended action for the technologist to take is to a. continue positioning the patient; the correct collimator is in place. b. change the collimator to a GAP collimator. c. change the collimator to a medium-energy collimator. d. change the collimator to a high-energy collimator. ANS: D

Regardless of whether two or three photopeaks are used, a high-energy collimator is necessary to collimate the higher energies and reduce septal penetration. REF: p. 601 4. A 67Ga image at 48 hours after injection displays bowel activity; the technologist should a. be concerned that the wrong radiopharmaceutical was administered. b. change the collimator to reduce the scatter activity from the bowel. c. continue imaging because this is normal. d. check to see if a radiographic study using contrast was performed. ANS: C

Excretion of the radionuclide into the bowel can be problematic, but the current belief is that bowel preparation can irritate the colon and increase uptake.

REF: p. 601 5.

99m

a. b. c. d.

Tc-exametazime–labeled leukocytes can be used for imaging parathyroid glands. colorectal evaluation. acute inflammation or infection. malignant effusions.

ANS: C 99m

Tc-exametazime–labeled leukocytes began to be used for suspected sites of acute inflammation/infection in patients with fevers, abdominal pain, or positive blood cultures. REF: p. 602 6. All of the following are disadvantages of 111In-WBCs as compared to 67Ga, EXCEPT a. lower specificity. b. requires a large blood volume. c. lower counting statistics. d. not suitable for delayed imaging beyond 24 hours. ANS: B

The drawback for 111In-WBCs is that it requires a large volume of blood (50 ml) to be withdrawn from the patient and a 2- to 3-hour labeling procedure. The reward is that the 111In study has a specificity of 97%, whereas the 67Ga study has a specificity of 64%. Unfortunately, the 111In-WBCs study has significantly lower counting statistics compared to 67 Ga and does not lend itself to delayed imaging much beyond 24 hours. REF: p. 602 7. A technologist is performing a parathyroid study using MIBI. After the flow study, the first

phase (thyroid phase) of imaging should begin within a. 5 to 10 minutes. b. 15 to 20 minutes. c. 60 to 90 minutes. d. 120 minutes. ANS: B

The first or thyroid phase should begin 15 to 20 minutes after injection; the second or parathyroid phase should be performed at 2 hours. REF: p. 603 8. The radionuclide used for imaging in the diagnostic assessment of prostate cancer is a. 99mTc-sestamibi. b. 99mTc-arcitumomab. c. 111In–capromab pendetide. d. 111In-pentetreotide. ANS: C

Indium-111–capromab pendetide is an IgG1 murine monoclonal antibody (mAB) directed toward prostate specific membrane antigen (PSMA), a glycoprotein expressed by prostate epithelium. REF: p. 604 9. Patient preparation for an 111In–capromab pendetide imaging procedure should include a. the administration of a diuretic 24 hours prior to injection. b. adequate hydration prior to imaging. c. an enema during the 24 hours prior to injection. d. an enema on the morning of the imaging. ANS: D

Patient preparation should include a laxative 24 hours prior to imaging and an enema on the morning of the procedure. REF: p. 604 10. For optimal targeting and minimal blood pool activity, 111In–capromab pendetide imaging

should begin at a. 6 to 24 hours after injection. b. 36 to 48 hours after injection. c. 60 to 90 hours after injection. d. 96 to 120 hours after injection. ANS: D

Blood pool activity mapping should be imaged 30 minutes to 4 hours after injection. For optimal targeting and miniT mE alSbTloBoA dN poKoSl E acLtiL viEtyR, . imCaO giMng should begin at 96 to 120 hours after injection. REF: p. 605 11. The radionuclide used in the diagnostic evaluation of recurrent or metastatic colorectal cancer

is a. b. c. d.

99m

Tc-sestamibi. Tc-arcitumomab. 111 In–capromab pendetide. 111 In-pentetreotide. 99m

ANS: B 99m

Tc-arcitumomab is a fragmented antibody (Fab) generated from IMMUJ-4 and reacts with carcinoembryonic antigen (CEA), a tumor-associated antigen expressed on a variety of carcinomas found in the gastrointestinal tract. REF: p. 605 12. The radionuclide used to visualize primary neuroendocrine tumors is a. 99mTc-sestamibi. b. 99mTc-arcitumomab. c. 111In–capromab pendetide. d. 111In-pentetreotide.

ANS: D

Indium-111–pentetreotide is used to visualize primary neuroendocrine tumors and neuroendocrine metastasis. REF: p. 606 13.

111

a. b. c. d.

In-pentetreotide acts as an analog to glucagon. neuroepinephrine. calcium. somatostatin.

ANS: D

Indium-111-pentetreotide is a radiolabeled analog of somatostatin. REF: p. 606 14. Meta-iodobenzylguanidine (MIBG) acts as an analog to a. glucagon. b. neuroepinephrine. c. calcium. d. somatostatin. ANS: B

MIBG is an analog of neuroepinephrine, and is taken up by the adrenergic nervous system of tissues that are derived from the neural crest. REF: p. 607 15. A patient’s indication for a nuclear medicine study is primary pheochromocytoma. The

radiopharmaceutical that the technologist prepares for administration is a. 99mTc-depreotide. b. 123 I-MIBG. c. 111In–capromab pendetide. d. 111In-pentetreotide. ANS: B

Iodine-131 (131I)– or iodine-123 (123I)–labeled iobenguane sulfate (AdreView) has been shown to be effective in the localization of primary or metastatic pheochromocytomas and neuroblastomas. REF: p. 607 16. A patient with bilateral breast cancer is being prepared for scintimammography. The

technologist will administer the 99mTc-MIBI via a. IV injection in the left arm. b. IV injection in the contralateral arm. c. IV injection in the foot. d. IV injection in either arm. ANS: C

Injecting in the contralateral arm minimizes artifacts if the dose is infiltrated and minimizes false-positive uptake in the axillary lymph nodes. When there is bilateral disease, it is recommended that the radiopharmaceutical be injected in the foot for the same reason. REF: p. 607 17. Patient preparation for a 99mTc-depreotide study includes a. hydration prior to and following injection. b. administration of a thyroid blocking agent. c. IV administration of a glucose solution. d. a laxative at 24 hours prior to imaging. ANS: A

Patient preparation includes hydration prior to and following injection and instructions to void urine frequently for the first few hours following injection. REF: p. 609 18. The radiopharmaceutical used to gather additional diagnostic information on a patient with

pulmonary lesions found on CT is a. 99mTc-depreotide. b. 123 I-MIBG. c. 111In–capromab pendetide. d. 111In-pentetreotide. ANS: A 99m

Tc-depreotide is indicated for identification of somatostatin receptor (SSTR)–bearing pulmonary masses in patieT ntE sS prTesBeA ntN inKgSwEitL hLpE ulR m. oC naOryMlesions on CT and/or chest radiography who have known malignancy or who are highly suspect for malignancy. REF: p. 609 19. A patient arrives in a nuclear medicine department for therapy for non–Hodgkin lymphoma

(NHL). The radioimmunotherapy used is a. 89Sr-chloride. b. 90Y–ibritumomab tiuxetan. c. 153Sm-lexidronam. d. 32P-phosphate. ANS: B 90Y–ibutumomab tiuxetan (Zevalin) is a murine IgG

1 kappa monoclonal antibody directed

against the CD20 antigen found on the surface of normal and malignant B cells. REF: p. 611 20. Rituximab (Rituxan) is administered as a(n) a. bolus IV injection. b. infusion over 2 to 6 hours. c. IV injection over 10 minutes. d. catheter instillation. ANS: B

Administer 250 mg/m2 rituximab infusion over 2 to 6 hours; then administer 90Y–ibritumomab tiuxetan (Zevalin) 4 to 8 mL over 10 minutes. REF: p. 611 21. Among the safety instructions a technologist will provide to a patient following 90

Y–ibritumomab tiuxetan administration is to avoid contact with children for 1 to 2 weeks. have home health care for first 3 days following release. use disposable eating utensils. use effective contraceptive methods for 1 year.

a. b. c. d.

ANS: D

It is recommended that a condom be used for 1 week to minimize the transfer of body fluids that are potentially contaminated with radioactive material. The effective use of contraceptive methods for 1 year is recommended for the same concern. As with any radiopharmaceutical therapy or treatment, there is the possibility of damage to a genetic structure by exposure to radioactive materials and the need for the body to repair, replace, or discard potentially damaged cells. REF: p. 612 22. How many radionuclides are currently approved by the FDA for the treatment of bone pain? a. None b. Two c. Four d. Seven ANS: C

Although numerous radionuclides have been successfully used in the treatment of bone pain, only four are currently approved by the FDA: 223Ra dichloride, 89Sr-chloride, 153 Sm-lexidronam, and 32P–sodium phosphate. REF: p. 612 23. Which is NOT a radionuclide used for treatment of bone pain? a. 32P–sodium phosphate b. 123I-tositumomab c. 153Sm-lexidronam d. 223Ra dichloride ANS: B

Although numerous radionuclides have been successfully used in the treatment of bone pain, only four are currently approved by the FDA: 223Ra dichloride, 89Sr-chloride, 153 Sm-lexidronam, and 32P–sodium phosphate. REF: p. 612 24. A patient has polycythemia vera; the technologist will prepare the patient for the

administration of a. 32P–sodium phosphate. b. 32P–chromic phosphate.

c. d.

Sr-chloride. I-tositumomab.

123

ANS: A 32

P–sodium phosphate has been used successfully to treat polycythemia vera.

REF: p. 613 25.

153

a. b. c. d.

Sm-lexidronam is a calcium analog that localizes in the bone. a phosphate compound that concentrates in bone mineral. a hydroxyl analog that concentrates on hydroxyapatite. a potassium compound that localizes in the bone.

ANS: B 153

Sm-lexidronam (Quadramet) is a phosphate compound that concentrates in bone mineral.

REF: p. 613 26. A patient who is to undergo radionuclide therapy for an abdominal malignant effusion is

prepared for a. an IV injection of 32P–sodium chloride. b. an IV injection of 32P–chromic phosphate. c. an abdominal instillation of 32P–sodium chloride. d. an abdominal instillation of 32P–chromic phosphate. ANS: D 32

P–chromic phosphate administered as an abdominal instillation is the treatment of choice for malignant effusion in the thoracic and peritoneal cavities. REF: p. 613 27. Once 99mTc-sulfur colloid is administered as a pretreatment for abdominal malignant effusion

therapy, the patient is instructed to a. refrain from any exercise for the following 4 hours. b. drink fluids and void frequently. c. roll from side to side for 60 to 90 minutes. d. return the following day for administration of the therapy dose. ANS: C

For abdominal protocols, loculation of the abdominal cavity is assessed by pretreatment with 99m Tc-SC. REF: p. 614 28.

165

a. b. c. d.

Dy–ferric hydroxide macroaggregate is used for treatment of malignant effusion. radiosynoviorthesis. bone palliation therapy. liver cancer therapy.

ANS: B

Radiosynoviorthesis is the destruction of synovitis in individual joints by an intra-articular injection of radiocolloids. Radiosynoviorthesis has also been shown to be effective in reducing effusions following surgical implantation of prosthesis. Additional radiocolloids, including 198Au-colloid, 32P–chromic phosphate, and 165Dy–ferric hydroxide macroaggregate, are used in the United States; REF: p. 614 29. In selective internal radiation therapy (SIRT), 90Y microspheres are administered in

incremental a. infusions into the renal vein. b. infusions into the renal artery. c. infusions into the hepatic vein. d. infusions into the hepatic artery. ANS: D 90

Y-embedded microspheres administered through the hepatic artery offer targeted therapy to tumor nodules while sparing normal surrounding liver tissue. REF: p. 614 30. Which organ is the most common site of metastasis for cancers of the abdominal organs? a. Liver b. Lungs c. Bone d. Brain ANS: A

Primary and metastatic liver cancer accounts for the largest cancer-related adult mortality in the world. The liver is the most common site of metastases for cancer of the abdominal organs and approximately one-third of all cancers ultimately spread to the liver. REF: p. 614

Chapter 24: Hematopoietic System Waterstram-Rich: Nuclear Medicine and PET/CT: Technology and Techniques, 8th Edition MULTIPLE CHOICE 1. When blood is collected with an anticoagulant, the whole blood separates into a. red blood cells (RBCs) and white blood cells (WBCs). b. plasma and formed elements. c. serum and cells. d. platelets and serum. ANS: B

When blood is separated by a centrifuge, the blood will divide into two major components: plasma and formed elements. REF: p. 619 2. The hematocrit (Hct) represents the a. percentage of RBCs in whole blood. b. percentage of RBCs in the packed cells. c. ratio of RBCs to platelets. d. ratio of RBCs to WBCs. ANS: A

The percentages and numbers of the different types of blood cells vary from one another. The OhMole blood is called the Hct. The name blood test used to measureTthEeSpT erBcA enNtaKgS eE ofLRLBECRs.inCw of the test is often synonymous with what it represents. REF: p. 620 3. The life span of an RBC is approximately a. 30 days. b. 60 days. c. 90 days. d. 120 days. ANS: D

RBCs are produced in the bone marrow and have a life span of approximately 120 days. REF: p. 620 4.

Anemia refers to a condition of a. a reduced number of WBCs. b. a reduced number of RBCs. c. splenomegaly. d. malabsorption. ANS: B

Anemia is defined as a reduced number of RBCs resulting from either an excess rate of removal of RBCs or deficient RBC production.

REF: p. 621 5. Anemia could be the result of all of the following EXCEPT a. suppression of bone marrow activity. b. hemolysis. c. iron deficiency. d. erythrogenesis. ANS: D

The basic causes of anemia are summarized as follows: excessive rate of removal of RBCs from the circulation, blood loss (chronic or acute), hemolysis, deficient production of RBCs caused by a lack of proper building blocks (e.g., iron), suppression of marrow activity by a wide variety of acute and chronic diseases, or primary disorders of the bone marrow. REF: p. 621-622 6. A patient can have anemia but have a normal Hct because a. he is sufficiently hydrated. b. he has a decreased number of WBCs. c. there is an increased rate of RBC production. d. there is an increased rate of hemolysis. ANS: C

Certain patients have a compensated hemolytic anemia—RBCs with a significantly shortened life span—but have a very active marrow that maintains a normal Hct value via an increased rate of erythrocyte production. REF: p. 622 7. To have a cohort label for RBCs, it would be necessary to tag the a. circulating erythrocytes. b. precursor erythrocytes. c. phagocytized erythrocytes. d. coagulated erythrocytes. ANS: B

Cohort labeling is available only to marrow precursors of a given cell type for a specific and limited length of time; it therefore does not label cells already circulating. REF: p. 622 8. To have a random label for RBCs, it would be necessary to tag the a. circulating erythrocytes. b. precursor erythrocytes. c. phagocytized erythrocytes. d. coagulated erythrocytes. ANS: A

Random labeling refers to the in vitro tagging of circulating cells of the peripheral blood. This process labels all cells in the sample, thereby labeling blood cells of random age.

REF: p. 622 9. Platelet kinetics are best studied using platelets labeled with a. 111In oxine. b. 125I-HAS. c. 32 P–chromic phosphate. d. 51Cr–ascorbic acid. ANS: A

The discovery of 111In-oxine as a random cellular label has made possible precise platelet kinetic and organ distribution studies. REF: p. 622 10. When using the 51Cr–ascorbic acid method to label erythrocytes, the ascorbic acid is added to a. transport the 51Cr across the hemoglobin molecule. b. increase the tagging efficiency. c. stop the tagging procedure. d. increase counting efficiency. ANS: C

Ascorbic acid is added after incubation to reduce the free chromate to chromic ion, which immediately stops the tagging procedure, because the chromic ion is unable to penetrate the RBC membrane. REF: p. 623 11. The conventional agent useTdEfS orTtB heAeNstKim nE ofRp.laCsm a volume is SaEtiLoL OM 111 a. In-oxine. b. 125I-HSA. c. 32 P–chromic phosphate. d. 51Cr–ascorbic acid. ANS: B 125

I-HSA is the conventional agent used for the estimation of plasma volume, because the albumin does not remain in the intravascular space but diffuses rapidly into the extravascular compartments. REF: p. 624 12. In a 51Cr-labeled erythrocyte survival study, a mean normal mean RBC half-life is a. 10 to 20 days. b. 25 to 35 days. c. 50 to 60 days. d. 70 to 80 days. ANS: B

The approximate 1% per day removal of the senescent RBCs from circulation, coupled with the approximate 1% per day removal of 51Cr label from the RBC, gives a mean life span of 25 to 35 days when measured by this technique. REF: p. 627

13. When performing a 51Cr-labeled splenic sequestration study, the technologist does NOT take

counts over the a. liver. b. spleen. c. precordium. d. thyroid. ANS: D

In this study, counts are taken over the precordium, liver, and spleen. REF: p. 627 14. The results of a patient’s splenic sequestration study demonstrate a spleen-to-liver ratio of 2:1.

This result would be considered a. normal. b. an example of sequestration. c. an example of a malpositioned probe. d. administration of a contaminated dose. ANS: B

In patients with active splenic sequestration of cells, the spleen-to-liver ratio often rises to 2:1 to 4:1. REF: p. 628 15. The position typically used for a patient undergoing a spleen count as part of a splenic

sequestration study is a. supine. b. prone. c. upright. d. on the right side. ANS: B

To take counts over the spleen, the patient is placed in the prone position, and the detector is placed two-thirds of the distance from the spinous process to the lateral edge of the body at the level of the ninth and tenth ribs. REF: p. 627 16. The values for a patient that has a 2% standard are:

Standard = 9500 cpm Urine sample = 658 cpm Urine sample volume = 4 mL Total urine volume = 1300 mL The percent excretion for this patient is a. 15%. b. 23%. c. 45%. d. 56%. ANS: C

The percent of 57Co vitamin B12 in 24-hour urine equals:

Remember that a 2% standard results in 1/50th of the dose, resulting in a dilution factor of 50. A result of less than 9% of the administered dose in the first 24-hour urine collection is indicative of malabsorption of vitamin B12. Since the patient is given nonradioactive B12 to saturate the liver and the vitamin B12 binding sites, the unbound radioactive B12 is excreted via urine. The resultant value reflects the amount of intestinal resorption. Under normal circumstances, the flushing dose would have saturated most all (or most) of the many binding sites and the radioactivity would be eliminated. If there is intestinal malabsorption (or other disease state), the binding sites would not have been saturated with the flushing dose, thereby allowing the radioactive B12 to bind to the sites and resulting in a lower percentage excreted. REF: p. 629-630 17. The results of a 24-hour Stage I Schilling Test are 4% excretion of the administered dose. This

patient should be considered a. normal. b. a candidate for a Stage II Schilling test. c. a candidate for a repeated Stage I Schilling test. R1.2.COM d. to have parasitic compeTtE itiS onTB foA rN thK eS viE taL mLinEB ANS: B

If less than 6% of the dose is excreted in 24 hours, a Stage II Schilling test should be performed. REF: p. 630 18. The average volume of blood plasma for a normal adult is a. 25 liters. b. 50 liters. c. 3000 mL. d. 2000 mL. ANS: C

The average blood volume of a normal adult is 5000 to 3000 mL of plasma and 2000 mL of red blood cells. Of the total 40 liters of fluid in the body, 25 liters comprise the intracellular fluid found in the 75 trillion cells of the body. REF: p. 619 TRUE/FALSE 1. In a blood sample, the fluid from which a clot is separated is called serum.

ANS: T

If blood is collected without an anticoagulant, a clot is formed consisting of the cellular elements and the proteins consumed in the coagulation process. The fluid from which the clot is separated is called serum. Serum is plasma without the clotting factors. REF: p. 620 2. Serum is plasma with clotting factors. ANS: F