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ARRT BOARD Clinical Procedures

Terms in this set (65)

Explain the procedure for a hepatic hemangioma study.
-Intravenous injection of Tc 99m labeled red blood cells
-Tagging method can either be in vitro using UltraTag or in vivo using PYP
-Dose is Tc99m 25 to 35 mCi
-Images consist of dynamic phase, static imaging, SPECT imaging.
-Review of an abdominal CT scan is necessary prior to injection of Tc99m labeled RBC's to ensure proper location of suspected hemangioma.
-Once location of suspected hemangioma is known inject labeled RBC's
-Begin dynamic phase
-After dynamic imaging start Static images
-After statics are completed patient waits for 2 hours.
-Acquire second set of images in the identical anterior, posterior, and right lateral positions.
Explain how a GI bleeding procedure is preformed.
-Labeling of RBC's with Tc99m pertechnetate using either in vivo or invitro method.
-Patient should be in supine position.
-Place detector over the abdomen.
-Inject the tracer.
-Start dynamic for 60 min of imaging.
-After dynamic the patient should void.
-After voiding take a 1,00 count static image if requested.
Discuss the indications for a GI bleeding procedure.
-Localize the site of active GI bleed so it can be surgically corrected.
-Primary indication is presence of blood in stool.
Describe the procedure for preforming a gastroesophageal reflux study in children.
_Child should be NPO
-Position child semi recumbent with their back to the camera with their mouth and stomach in the FOV.
-Child ingests 150 microcuries of Tc99m SC and 30 mL of milk or baby formula.
-While child is drinking start Dynamic images.
-Once done drinking give patient unlabled milk or formula to rinse the mouth and esophagus.
-Put patient is supine position.
-Start dynamic imaging for 60 min.
-After dynamic start static images Ant and Post images for 300 seconds to check for aspiration in the lungs.
List the indications for a gastroesophageal reflux study.
-Gastrointestinal reflux such as chest pain or vomiting.
- Evaluating the response of gastroesophageal reflux to a medical or a surgical intervention.
List the different meals that me be administered for a gastric emptying study.
-Chicken liver labeled with Tc99m sulfur colloid in vivo
-Tc99m SC labeled scrambled eggs taken by mouth
-Tc99m SC in bowl of oatmeal
Describe the procedure for preforming a gastroesophageal reflux study in adults.
-NPO 8 hours
-Patient drinks a mixture of 150 mL of orange juice 150 mL of 0.1 N hydrochlorid acid and 300 microcuries of Tc 99m SC.
-Place abdominal binder
-Take static image of patient in erect position for 30 sec .- Abdominal binder is inflated to pressure of 20 mm/Hg
-Take static image
-process is repeated at each 20 mm/ Hg increment until max abdominal pressure of 100 mm/ Hg.
- Binder is then repeatedly deflated to release the pressure on the abdominal wall.
-Procedure is repeated with the patient in supine position.
Explain the procedure for a gastric emptying study.
-NPO 8 hours prior to test
-Ingest the radioactive meal containing approx 1 mCi of Tc 99m S.
-Patient should eat the meal in under 5 min.
-Static images should be taken 15 minutes for 2 hours.
- This should include 60 seconds of images with the patient in the erect position.
If using dynamic protocol images should be set for 120 images at 60 seconds for a total of 120 minutes.
Explain the indication for a gastric emptying study.
-Eval for delayed gastric emptying and quantify the rate of gastric emptying for individuals suspected of having gastric motility problems.
List the indications for liver/ spleen images.
-Diagnosis of hepatomegaly, splenomegaly, and other abdominal masses.
- Pre-op eval of liver metastases in patients with known malignancies.
-Eval patients with liver disease such as cirrhosis and hepatitis.
-Trauma patients for liver rupture or hematoma.
Define hepatic hemangioma.
Abnormal, non cancerous tumor in the liver that consists of dilated blood vessels.
Explain the procedure for imaging lung ventilation with XE-133
-Turn on the exhaust system in the neg pressure room
- Position the patient in front of the detector
-Attach the face mask to the patient
-Computer should be programmed for 32 frames at 15 seconds per frame for a total of 8 minutes.
-Instruct the patient to take a deep breath.
-Simultaneously administer 10-15 mCi of Xe-133.
- Begin the dynamic imaging
-Instruct patient to hold their breath
-Initial deep breathing image is taken
-instruct patient to breath normally for the remainder of the procedure.
-Turn off xenon delivery system
- Remove patients face mask.
Discuss the decay method of dose calibrator linearity testing.
-Record a BG reading
-Record the reading of the TC99m dose.
-Subtract the GD reading
-Document the value obtained.
-Repeat this several times throughout the ady at 1 to 2 hr increments.
-Document the values.
-Obtain readings until the original dose of Tc99m pertechnetate has decayed to approx. 10 uCi.
-Calculate the expected readings for all documented items using the decay formula.
-Plot the 2 lines of the actual readings against the calculated readings.
-Readings should be within 10% of calculated readings.
Discuss the calicheck method of dose calibrator testing.
-Requires a checklist kit which consists of 6 lead covered tubes used to simulate radioactive decay.
-Record the BG reading for the dose calibrator.
-Record the reading of the Tc99m dose
-Subtract the BG reading and document the value obtained.
-Repeat the readings with each of the 6 lead covered tubes and document the values.
-Once all the readings have been obtained and recorded, calculate the expected readings for all documented times using the decay formula.
-Plot 2 lines of the actual readings against the calculated readings.
-ALL actual readings should be within 10% calculated readings.
Discuss the procedure for dose calibration accuracy testing.
- Calculate current activity of the reference vials using the decay formula.
-A BG reading should be recorded prior to accuracy testing.
-Assay the first reference vial
-Subtract the BG reading
-Document the final result,
-Repeat the reading 2 more times for a total of 3 readings.
-Document the findings.
-Average the 3 readings
-If the average of the actual reading differed from the calculated current activity by more than 10% the dose calibrator needs to be repaired of replaced.
-Repeat procedure for the second reference vial.
Define nosocomial infection.
Infections directly related to treatment in a hospital or other healthcare facility
-Caused by not preforming proper hygiene such as hand washing .
Describe ways in which a medical professional can be exposed to blood borne pathogens.
-Accidental puncture wounds from needles, scalpels, broken glass, or razor blades.
-If contaminated body fluids came in contact with an open wound on the skin.
Explain the significance of dose calibrator linearity testing.
-Accuracy calibrates every dose regardless of the activity of the dose.
-Does calibrator linearity evaluation should be performed immediately upon receipt of the equipment and quarterly
-linearity valuations can be performed with the decay method or the Calicheck method.
Discussed the procedure for performing dose calibrator geometry evaluation's
-Begin a dose calibrator geometry evaluation by obtaining 30 ML vile then adding a small amount of volume in a small amount of radioactivity
-less than 10 mCi in approximately in 1ML a volume
-Record the initial reading of the sample
-Continuously add volume to the sample in increments such as five, 10, 15, 20, 25 and 30 ML's and record the readings
-The reading should be the same at all volumes
-A correction factor needs to be applied if the readings very
-if the 15 ML volume reads 10.2 mCi when it should be reading no more than 10 mCi the following calculation should be applied: 15 ML volume CF equals 10÷10.2= 0.98
List all quality control procedures that are required on a daily basis
-Well counter should be calibrated -background
-uptake probe
-floods
-constancy evaluation
-does calibrator
-daily department survey
-daily wipes
Explain the significance of Dose calibrator constancy testing
-this is performed on a daily basis to measure the consistency of the piece of equipment
-this is tested with cesium 137
Define HIPPA
-HIPPA was enacted to protect the privacy of personal health information by setting limits on the use in the disclosure of such information without patient authorization
Discuss the indications for breast imaging
-Performed after a non-diagnostic mammogram to identify sites of malignancy within the breast or sites of metastasis from known primary breast carcinoma
-Performed by using thallium 201 or technetium mibi
Explain the procedure for breast imaging
-IV injection of 3 mCi of thallium-201 or 25 mCi of tech mibi
-injection should be in the opposite arm of the suspected malignancy
-Wait five minutes for proper circulation of the isotope
-Static imaging with a patient on the imaging table in the supine position with the arms placed above the head
-Cobalt disc Marco should be placed in the armpit area in an area of the suspected malignancy
-images are acquired in the anterior right anterior oblique and left anterior oblique positions
Discussed the indications for a radionuclide cisternography
-evaluate the flow of cerebral spinal fluid through the spinal column
-also used to evaluate Hydrosyphilis, shunting, and to diagnose and localized cerebral spinal fluid leak such as rhinorrhea and otorrhea
Explain the procedure for radionuclide cisternography.
intrathecal injection of one millicurie of indium 111 DT PA
-patient is placed on the imaging table in the fetal position to allow the displays to open
-the physician then cleanses the patient's back and administers the isotope
-immediately following the lumbar puncture put the patient on the imaging table in supine position
-acquire a 600 second static to ensure proper placement of the isotope
-static images should be obtained at 2,6,24, and 48 hours after the isotope administration in the anterior right lateral and left lateral positions using that identical parameters
Discuss the medication furosemide and its role in renal studies
-A medication used to reduce swelling, urine retention, and high blood pressure
-evaluates flow and function of the kidneys
Discuss the indications for a renal scan
-Used to evaluate overall kidney function either in native or transplanted kidneys
-also used for evaluatingGFR and renal plasma flow
-also for diagnosing renal artery and ureteral Obstruction
- also assessing patients with suspected renovascular hypertension
Explain the procedure for imaging lung ventilation with tech 99M DTPA
-30 to 40 Millicuries of technetium 99m DTPA should be inserted into a nebulizer
- instruct the patient to insert the mouthpiece or apply the facemask tightly so it covers the nose and mouth
-turn the oxygen on instructed patient to breathe normally for 4 to minutes
-remove the mouthpiece or facemask and begin static imaging with the patient on the imaging table in the supine position
-static images are routinely acquired in the anterior right lateral RPO posterior LPO and left lateral positions
Discussed the indications for lung perfusion imaging
-Evaluate patients for pulmonary embolism
-also performed in patients with non-pulmonary emboli to evaluate the progress of the treatment
Explain the procedure for performing a renogram
IV administration of 10 to 15 mCi of either tech 99M MAG3 or tech 99 M DTPA
-patient should be placed on the imaging table in the supine position with the camera in the posterior position
-check the landmarks of the xiphoid process in the symphysis pubis should be marked
-following the administration of tech 99M MAG3 or DTPA and initial flow dynamic phase should be started
-immediately following an initial flow dynamic a functional dynamic phase should be acquired for 120 frames for a total of 31 minutes of imaging time
Define informed consent
Informed consent is communication between a patient in healthcare provider that results in the patient give me the provider permission to perform in specific medical procedure
Discussed the procedure for dose calibrator constancy testing
-Constancy testing is performed on a daily basis
-it is tested with cesium 137
-A room background should be documented
-first the high-voltage reading for the dose calibrator should be recorded
-place the cesium 137 source in the dose calibrator and record the reading while the calibrator is set for cesium 137
-tech 99M, Co57, Ga67, I123,
I 131, IN 111, Tl201 should be among the dose calibrator settings recorded in the daily constancy evaluation's
Explain The significance of dose calibrator accuracy testing
-Helps to ensure that does calibrators accurately read the activity of several different isotopes with several different energies
- should involve at least two different isotopes such as cesium 137 cobalt 57 or barium 133
-accuracy testing is required upon receipt of the piece of equipment and annually there after
Explain the significance of those calibrator geometry evaluations
-Ensures the calibrator is accurately calibrating radioactivity regardless of the volume of the sample
-geometric evaluation should be performed immediately upon receipt of the piece of equipment and immediately upon repair of the piece of equipment
Explain the procedure free captopril renal scan
-Administration of 10 to 15 mCi of either tech 99M MAG3 or tech 99 M DTPA
-25 to 50 Mg of captopril should be administered orally one hour prior to the study
-the patient's blood pressure should be monitored every 15 minutes after the captopril is administered since captopril may cause hypertension
-patient should be placed in the imaging table in the supine position with the camera in the posterior position
-mark the landmarks of the xiphoid process and the symphysis pubis to ensure kidneys are in the field of view
-after the administration of MAG3 or DTPA an initial flow dynamic phase should be acquired for 60 frames at one second per frame
- A functional dynamic phase should be acquired for 180 frames for a total of 46 minutes of imaging time
Discuss the medication captopril in its role in Renal study
-Captopril is a ace inhibiter
-a captopril renal study will reveal a slight increase in renal function if the kidneys are not blocked and a decrease in renal function if renal artery blockage is present
Discuss the indications for a hepatobiliary imaging
-Indications are acute cholecystitis
- it is used to evaluate gallbladder function in patients with chronic cholecystitis
-assess for biliary leakage in post surgical patients
Discuss the contradictions for hepatobiliary imaging
Contradictions are eating opiate pain medications and morphine and Dilaudid
Define chronic cholecystitis
-Long term swelling and inflammation of the gallbladder
- this leads to thickened gallbladder walls shrinking the gallbladder itself and inhibiting the overall function of the gallbladder
Define acute cholecystitis
-A sudden inflammation of the gallbladder that causes severe abdominal pain
-if acute cholecystitis is not diagnosed in a timely manner serious infection or perforation of the gallbladder may result
Define call cholecystokinin and discuss its role in hepatobiliary imaging
-Used to contract the gallbladder diagnostically
- helps to diagnose certain medical issues
-evaluating gallbladder and pancreatic function
Discuss the two different methods of obtaining long ventilation images
Xe133 or TC DTPA aerosol
Explain the procedure for long ventilation/ perfusion imaging
-Initially 30 to 40 mCi of TC DTPA should be inserted into a nebulizer
-instruct the patient to insert the mouthpiece or apply the mask tightly so it covers the nose and mouth —
-instruct the patient to breathe normally for 4 to 5 minutes
-begin static images with the patient on the imaging table in the supine position
-anterior, right lateral, RPO
,posterior, LPO, and left lateral positions
-once ventilation images are obtained an IV injection of 4 to 6 mCi of TC MAA is administered
-perfusion images are then obtained in the identical positions as the vent images
Define Lavigne shunt
-Device used to remove excess fluid from the peritoneal cavity
-the venous tube has a one-way valve that opens when the pressure of the fluid in the Pacino cavity is greater than the pressure in the superior Venna cava
Explain the procedure for a quantitive lung perfusion imaging
-performed prior to surgical procedures such as pneumonectomy or lung reduction
- IV injection of 4 to 6 mCi of tech 99M MAA
-static images are acquired in the anterior posterior right lateral left lateral RPO and LPO positions
-Regions of interest should be drawn around each long on both of the anterior and posterior projections
Explain the procedure performing a hepatobiliary study
-Patient should be NPO and should not have received any opiate pain medications for at least 6 hours prior to the procedure
-IV injection of 4 to 6 mCi of TC 99M Choletec, mebrofenin, or disofenin. —
-static images are obtained
-abdomen with the liver in the center of field of view
-60 minutes of imaging
-it should be possible to visualize activity in the liver gallbladder in small intestines
Explain the procedure for liver/ spleen imaging
IV administration of 6 to 10 mCi of TC 99
-A 10 minute wait. Should be allowed to ensure proper uptake into the liver and spleen
- static images are then obtained in the Anterior, anterior with a liver marker, posterior, right lateral, left lateral, RAO and LAO
-A SPECT can be taken if ordered by a doctor
Explain the difference between medical and surgical asepsis
-Medical asepsis is a technique used to prevent the spread of micro organisms
-surgical asepsis is a technique procedure to illuminate all micro organisms from an object instrument or area
-medical a sepsis means clean
-surgical a sepsis mean sterile
What is a Living will
It's spells out a patient's wishes regarding medical care should he or she be in capable of making those decisions when the medical situation arises
Define blood-borne pathogen's
-Blood-borne pathogen's are micro organisms in the blood or other body fluids that can cause illness and disease in people
- it can be transmitted through contact with contaminated blood and body fluids
Define universal precautions
Medical practice guidelines used to avoid contact with the patient blood or bodily fluids
Discuss the role of regadenoson in pharmaceutical stress testing
-Produce coronary dilation and increase blood flow through a coronary vessel
-contradictions is the presence of second or third degree AV block
-maximum absorption occurs 1 to 4 minutes after administration
Discuss's Zevalin (Y-90 ibritumamab) and its role in clinical nuclear medicine
-Y 90 labeled monoclonal antibodies treatment for follicular non-Hodgkin's lymphoma that has not been treated or has reoccurred after chemotherapy
-Zevlin therapeutic regimen consist of monoclonal antibodies Rituximab,
In-111 labeled zevalin for imaging, and Y 90 labeled Zevlin for therapy
Discuss the indications for a Meckel's diverticulum study
To look lies the site of a Meckel's diverticulum that is causing gastrointestinal bleeding
Explain the procedure for a leVeen shunt study
-Used to evaluate the proper functioning of a living shunt study
-injection of 2 to 5 mCi of TC 99 MAA
-prior to intraperitoneal injection The patient must be placed in the imaging table in the supine position
-the patient's abdomen must be then cleaned in a sterile manner
-the radiologist and administers 2 to 5 mCi of TC MAA directly into the peritoneum
-immediately following static images of the chest and abdomen are required
-static images should be taken every 15 minutes for 60 minutes
-delayed images are occasionally required at 2 hours or 4 hours post injection
-the study is complete and consider normal when the lungs become visible
- if the lungs do not become visible the study is considered positive and the shunt is dysfunctional
Define Meckel's diverticulum
Is a congenital birth defect that manifest as a pouch on the wall of the lower part of the small bowel the pouch may contain stomach tissue or pancreatic tissue
Explain the procedure for a Meckel's diverticulum study
-Patient has been NPO for a minimum of 4hours
- 15 mCi for adults and 200 Microcuries per kilogram with a minimum dose of 2 mCi for children
-patient should be instructed to empty the bladder completely immediately prior to IV administration of pertechnetate
- static images of the abdomen are obtain immediately then every five minutes for 60 minutes
- after 60 minutes a patient is instructed to completely empty the bladder once again
-60 minutes post void anterior and lateral images are than obtained using the same parameters
Explain the indications for esophageal transit imaging
-Diagnosis of dysphagia or any other abnormality with esophageal motility
-can accurately quantify these abnormalities
Discuss the significance of Opiate medications such as morphine in hepatobiliary imaging
Contraction of the sphincter of Odie in, bile duct morphine may cause bio to fill the gallbladder by increasing the pressure of the sphincter of Odie leading to a false negative result for acute cholecystitis
Discuss the role of Bexxar (I-131 tositumomab) in clinical nuclear medicine
-Bexxar is an I-131 labeled monoclonal antibody treatment for follicular non- hodgkins lymphoma that has recurred after chemotherapy.
-Bexxar is given as an IV injection once a week for 2 weeks.
-The first dose is called the dosimetric dose and is given with just a small amount of I-131.
-Approximately 2 to 4 days after the dosimetric dose and again at approx. 6 to 7 days after, the patient is scanned to see where the Bexxar is being distributed in the body.
-The theraputic dose is given between 7 and 14 days after the dosimetric dose, once the optimum dose is calculated based on previous scans.
Describe the procedure for an esophageal transit study
-Patient should be NPO for minimum of 8 hours
-Liquid prep of 30 mL of water is combined with approx. 300 microcuries of SC
- The initial swallow phase is acquired for 1 second per frame for 60 seconds.
-The second phase or washout phase is acquired for 15 seconds per frame for 10 minutes for a total study time of 11 minutes.
-Study beings when the patient is instructed to turn his or her head to one side to allow for ingestion of the water and S.C. mixture,
-The patient sips the mixture through the straw and holds it in his or her mouth without swallowing
-Dynamic acquisition is begun
-Patient is instructed to swallow the mixture and then to fry swallow every 15 seconds for the remainder of the 11 min procedure.
Explain the procedure for preforming a complete Zevalin therapeutic regimen
- Day one
* patient should be pre medicated with acetaminophen and diphenhydamine followed by IV administration of rituximab.
*within 4 hours of rituximab infusion, In-111 labeled zevlin is given as a IV injection

Day three to four
*An imaging scan is done to confirm acceptable distribution of In-111 labeled Zevaline throughout the patients body and to ensure is ti safe for the patient to receive the therapeutic dose of Y-90 labeled zevlin.

Day seven, eight, nine
* the patient should be pre mediciated with with acetaminophen and diphenhydamine followed by administration of rituximab infusion.
* Within 4 hours of the rituximab infusion, Y-90 labeled zevaln is given as an intravenous injection.
* Y-90 labeled zevalin is a monoclonal antibody combined with a radioisotope that attacks B- cells and provides the therapeutic component of the Zevalin regimen.
Explain how to convert counts per minute (CPM) to disintegrations per minute (DPM)
Disintegrations per min = Counts per in (CPM)
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Efficiency
Explain the procedure for a furosemide renal scan.
-Iv administration of 10-15 mCi of either Tc-99m Mag3 or DTPA
-patient should be positioned on the imaging table in the supine position with the camera in the posterior position.
-Landmarks of the Xiphoid process and the symphysis pubis should be marked to ensure the kidneys are in the FOV
-Following the administration of MAG3 or DTPA and initial flow dynamic phase should be acquired.
-Approx 10 min after the study has began 40 mg of furosemide should be administered IV.
-Furosemide will increase kidney function and urine output.
-Patietn may not be able to withstand the entire 46 min procedure urge to urinate may be too strong.
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