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mock questions for board exam....

Terms in this set (211)

In general how many capillaries are blocked when a perfusion lung scan using Tc99m is performed?
a) fewer than 1 in 1000
b)<0.1%
c) both a and c
d) none of the above

c) more than 80% of particles are removed on the first pass, blocking less than 1 in 1000 capillaries (<0.1%)

This distribution of aerosol particles in the lungs is influenced by all of the following except:
a) Turbulent air flow
b) amount of technetium added
c) rate of air flow
d) particle size

b) the amount of technetium added to the kit will not affect the distribution of the aerosol particles, but only a small portion of the activity administered will actually be delivered to the patient. (it is estimated that of 25-35 mCi added to the nebulizer, a patient will receive 1-5mCi. Therefore it is important to do the ventilation scan first when planning both ventilation with aerosol and perfusion imaging.) The distribution of the particles may be altered if patient has COPD (which impedes flow rate and causes turbulence) or if the aerosol particle size is large. Breathing the aerosol in the supine position will improve uniformity of distribution.

What best describes the normal blood flow to the lungs in an erect patient?
a)largely uniform
b) decreased flow to apices relative to bases
c) Increased flow to upper lobes
d) none of the above

b) decreased flow to apices relative to bases.
patient should be injected for perfusion scans while supine to ensure uniform distribution to the lungs.

During a lung perfusion study, activity is noted in the head and in the area of the kidneys. This represents:
a) incorrect particle size
b) probable mets
c) free technetium in MAA
d) right to left shunt

d- Normally the first capillary bed that the radiopharmaceutical encounters is in the lungs. If there is a right-to-left cardiac shunt, renal activity will be present, and the head should be imaged.

On lung ventilation images, activity is seen in the trachea and the stomach. This indicates;
a) a right to left shunt
b) incorrect particle size
c) that the stud was performed with Tc99m DTPA
d) that the study was performed with Xe133
e) a contaminated delivery system

c) activity in the central airway (often due to turbulent flow in patients with COPD) and stomach (from swallowed droplets) is often present on ventilation scans using aerosolized radiopharmaceuticals

Which of the following describes the correct procedure for injection of Tc99m MAA for a perfusion lung study?
a) Injection should be made through an existing IV line if possible
b) ensure that a minimum of 800,000 MAA particles are injected
c) Small amount of blood should be withdrawn into the syringe to ensure venous access before injection
d) patient should be in supine position

d) it is preferable to inject directly into the vein (if an indwelling catheter is used, it should be flushed following injection), and 800,000 particles are beyond the recommended dose. Supine positioning during injection increases the uniformity of particle distribution.

Advantages of using Kr81m for ventilation lung scans include:
a) ability to perfectly match perfusion and ventilation positioning.
b) short half-life decreases exposure to technologists if patient removes mask.
c) ventilation and perfusion studies can be acquired simultaneously
d) all of the above
e) a and d only

d) Kr81m is useful for ventilation imaging. Its short half-life(13s) and slightly higher photon energy allow the technologist to perform ventilation before or after perfusion imaging, or as simultaneous scan, positioning once, imaging one isotope after another before moving the patient to the next position. The shorter half life of Kr81m (13s) may result in less exposure for technologists (in the event that the patient removes the ventilation mask) than with Xe133.

Increases risk of pulmonary embolism is associated with-
a) smoking
b) use of oral contraceptives
c) recent survey
d) all of the above
e) a and c only

d) Risk factors for pulmonary embolism include oral contraceptive use or hormone therapy, prolonged inactivity (e.g. bed rest), recent surgery, and being postpartum. Some, but not all sources cite smoking and obesity as risk factors.

Which dose would be the best choice to administer for a ventilation scan with Tc99m DTPA aerosol?
a) 1-2 mCi
b) 3-5 mCi
c) 8-15 mCi
d) 20 mCi

d) the dose administered with aerosolized Tc99m DTPA will be much higher than the dose the patient actually receives. The Society of Nuclear Medicine Guidelines state that of 25-35 mCi administer, the patient will receive only 0.5-1 mCi

Lung quantitation is often used to assist physicians in the diagnosis of pulmonary embolism.
a) true
b) false

b) lung quantitation may be used preoperatively in patients for whom lung resection is planned.

An Maa kit has an average of 8,000,000 particles and a reconstituted using 90 mCi of Tc99m in 5 ml at 8:00am. Can the kit be used at 2pm without injecting the patient with more than 800,000 particles?
a) yes
b) no
c) cannot be determined from the information given

a) at 2pm, the activity has decreased by one half-life, meaning that the activity is 45 mCi and there are 8,000,000 particles in 5 ml provided no dose has been withdrawn from the vial. The concentration is now 1,600,000 particles per ml and 9 mCi per ml. If 0.4 ml is withdrawn into a syringe there will be 3.6 mCi and 640,000 particles in the dose.

A perfusion lung scan is being quantified. If counts obtained from an ROI around the left lung are 142,857 and the counts within the ROI about the right lung are 192,246, what percentage of perfusion is directed to the right lung?
a) 28%
b) 42%
c) 58%
d) 65%
e) 73%

c) total lung counts are 338,103. Right lung counts divided by total counts gives a percentage of 57.7%

The capillaries surrounding alveoli have a diameter of:
a) 0.3-1.0 um
b) 0.4-2.0 um
c) 7.0-10.0 um
d) 5-10.0 um
e) 10-20 um

c) the capillaries surrounding the alveoli measure 0.7-10 um in adults. MAA particles measure 5-100um, most between 10 and 30 um. Particles greater than 10 um are trapped.

When Tc99m MAA breaks down after injection, what happens to particle fragments?
a) they are excreted through the urine
b) they are excreted through the bowel
c) they are removed from the blood by the liver and spleen
d) they combine with other fragments in the bloodstream and are again stopped in the lung capillary bed.

c) particle fragments break down (some as soon as 30 min after injection) enter the bloodstream. and then are removed by the liver and spleen

Ventilation images are usually performed:
a) with the patient supine so that perfusion is relatively uniform throughout the lungs
b) anteriorly, because more emboli occur anteriorly than posteriorly
c) posteriorly to reduce soft tissue attenuation and decrease distance to detector
d) with the patient erect, so that perfusion is relatively uniform throughout the lungs.

c) Ventilation images ca be performed with the patient erect or supine. Posterior images reduce patient to detector distance and avoid breast attenuation, particularly important with lower-energy photon like that from Xe133.

When performing a V/Q lung study with Tc99m MAA and Xe133 which portion of the exam should be performed first?
a) ventilation
b) perfusion
c) either may be performed first
d) they maybe performed stiumtaneouly

a) Xe133 has a lower photon energy (81 keV) than Tc99m (140 keV), and ventilation scans are usually performed first when using this gas.

Trapping systems for Xe133 should be installed at the level of the____, because Xe133 is ______ than air?
a) ceiling, heavier
b) ceiling, lighter
c) floor, heavier
d) floor, lighter

c) since Xe133 is heavier than air, it will drop and can be trapped by a floor system, in addition, ventilation scans should be performed in a room at negative pressure to surrounding areas.

Stomach visualization on a ventilation scan performed using Tc99m DTPA aerosol indicates:
a) there was a turbulent air flow
b) the nebulizer is not functioning properly
c) the patient was a smoker
d) the patient swallowed some of the radiopharmaceutical
e) the patient has a right to left cardiac shunt.

d) the stomach is often seen on aerosol lung scans for this reason.

The radiopharmaceutical used for ventilation scanning with the highest administered dose is:
a) Xe133 gas
b) Tc99m DTPA aerosol
c) Xe 127 gas
d) Kr81m
e) Tc99m MAA

b) the dose administered with aerosolized Tc99m DTPA will be much higher than the dose the patient actually receives. The Society of Nuclear Medicine Guidelines state that of 25-35 mCi administer, the patient will receive only 0.5-1 mCi

Only half of the administered dose of Tc99m DTPA aerosol is delivered to the patient:
a) true
b) false

b) must less than half is delivered. For this reason, aerosol ventilation scans are usually performed before perfusion scans.

Patient education prior to a ventilation scan may:
a) improve image quality
b) relax the patient and thereby speed washout
c) reduce the radiation dose to the technologist
d) all of the above
e) a and c only

e) a patient must understand the effect of cooperation on the quality of the exam and of the increased exposure to healthcare workers if the ventilation apparatus is removed prematurely

The liver may be seen in the washout phase of a ventilation study because:
a) Tc99m DTPA aerosol was swallowed and then entered the bloodstream via the stomach
b) Xe133 gas is fat soluble
c) particle size is too small
d) air flow is turbulent

b) Xe is fat soluble and partially soluble in blood and often appears during the washout phase of a ventilation scan.

An advantage of Xe127 over Xe133 is that:
a) it has a shorter half-life
b) it is inexpensive
c) it can be used after Tc99m MAA perfusion study
d) it requires no special trapping because of its short half-life

c) ventilation can be performed after the perfusion scan because of the higher photon energy of Xe127 relative to Tc99m (203 keV vs. 140 keV), and , therefore the ventilation scan may be canceled if the perfusion is negative. It has a 36-day half-life and is expensive and is therefore not often used.

When used in conjunction with Tc99m, Kr81m can be used to perform ventilation imaging:
a) before
b) during
c) after
d) all of the above

d) Kr81m can be used at any time relative to Tc99m, but it is most efficient to do the scans in tandem.

Xe133 can be used to perform ventilation scans with a portable camera in the intensive care unit
a) true
b) false

b) It is not likely that the safe conditions will be present in the ICU

a V/Q scan can be used:
a) to determine the likelihood of PE
b) to evaluate resolution of PE
c) to quantify differential pulmonary function before pulmonary surgery
d) to evaluate cardiac shunts
e) all of the above

e) in addition a V/Q scan can be used to evaluate hepatic pulmonary syndrome and lung transplants.

When performing an aerosol Tc99m DTPA aerosol V/Q scan which of the following is correct:
a) Tc99m DTPA aerosol ventilation imaging can be performed before or after perfusion imaging
b) the dose used for ventilation imaging is much higher than the perfusion imaging
c) the dose delivered to the lungs of the patient for the ventilation is much higher than the perfusion imaging.
d) the count rate of the second imaging should be three to four times the count of the first imaging.
e) both b and c
f) both c and d

e) the dose used for ventilation is imaging is about 30 mCi Tc99m DTPA, but only about 1 mCi is delivered to the lungs. Tc99m MAA dose is about 5mCi and thus has to be performed after then ventilation.

When performing a Xe133 V/Q scan, which of the following is not correct:
a) perfusion scintigraphy can be performed first and if normal, ventilation scintigraphy can be omitted.
b) The biological half life of the MAA in the lungs is approximately 1.5-3 h
c) Tc99m MAA particles may settle in the vial with time; thus the vial should be agitated and the syringe should be inverted prior to injection
d) the number of MAA particles should be less than 500,000

d) in most cases, the number of particles should be in the range of 200,000-700,000 in adults, but for patients with pulmonary hypertension or right to left shunting. the number may be reduced to 100,000-200,000 particles in adults.

When performing a Tc99m DTPA aerosol V/Q scan, which of the following is not correct:
a) an aerosol ventilation allows multiple projection imaging to match those obtained for perfusion imaging.
b) aerosol ventilation imaging can be performed at the bedside because no special requirement for radioactive gas exhaust
c) aerosol ventilation imaging is not affected by turbulent flow in patients with COPD
d) SPECT images can be obtained

c) one of the major disadvantages of aerosol ventilation imaging is that aerosol deposition is altered by turbulent flow, causing central deposition and suboptimal imaging.

Advantages of V/Q scan over CTA include the following except:
a) can be performed in patient with poor renal function
b) can be performed in patients with pregnancy
c) have more incidental findings to explain patient's symptoms
d) lower radiation exposure

d) in fact, CTA has more incidental findings to explain patients symptoms

When performing a Tc99m MAA lung perfusion scan to evaluate possible right to left shunting, which of the following is correct:
a) multiple planar images of the chest, with stomach and kidneys included
b) multiple planar images of the chest, with thyroid included
c) multiple planar images of the chest, with both kidneys and thyroid included
d) images must include the brain

d) tracer uptake in the thyroid, stomach, and kidneys could be due to Free TcO4

Which of the following radiopharmaceuticals can be used to study the spleen?
a) Cr51- labeled damaged RBC
b) Tc99m- labeled damaged RBC
c) Tc99m sulfur colloid
d) all of the above
e) b and c only

d) Damaged RBC are removed from circulation largely by the spleen, so tagged damaged erythrocytes as well as tagged colloids can be used to image the spleen.

How is a radiopharmaceutical administered when a LeVeen shunt is evaluated?
a) by IV injection
b) intraperitoneal
c) subcutaneous
d) intrathecal

b) LaVeen shunt routes ascites from the peritoneum to the SVC; therefore the radioiostope is injected into the peritoneal space.

While performing a liver scan with sulfur colloid the technologist notices that lung uptake is present, This is probably due to:
a) free pertechnetate in the sulfur colloid preparation
b) too much Al3+ ion in the pertechnetate that was used for labeling
c) lung mets
d) patient being injected in the supine position

b) Lung activity on a liver/spleen scan using Tc99m sulfur colloid may be the result of clumping of particles, a particle that is too large or too much AL3+ ion in the technetium used to prepare the kit.

The function of a LaVeen shunt is to:
a) treat hydrocephalus
b) drain peritoneal fluid into the IVC
c) drain peritoneal fluid into the SVC
d) divert CSF flow

c) drain peritoneal fluid into the SVC

Which of the following doses does not involve the use of RBCs?
a) blood pool imaging of the liver
b) Gi bleed imaging
c) spleen imaging
d)Meckels diverticulum
e) both a and b

d) the listed choices a,b and c can all be performed using labeled RBCs. Tc99m pertechnetate is taken up by gastric mucosa, Meckel's diverticulum is congenital out pouching of the intestine, which may contain ectopic gastric mucosa, so imaging with Tc99m pertechnetate can be useful for diagnosis.

Cimetidine:
a) prevents the GB from contracting
b) prevents the release of pertechnetate from gastric mucosa
c) increases uptake of pertechnetate in the gastric mucosa
d) decreases peristalsis

b) increase uptake of pertechnetate in the gastric mucosa. It may be administered to patients 1-2 days prior to performing an exam to improve sensitivity of detection of meckels diverticulum.

Esophageal reflux studies are usually performed with both solid and liquid phases:
a) true
b) false

b) esophageal reflux studies typically use a radiopharmaceutical in liquid

an appropriate adult dose and radiopharmaceutical for meckels diverticulum is:
a) 10 mCi of Tc99m pertechnetate
b) 300 uCi of Tc99m sulfur colloid in water
c) 300 uCi in Tc99m albumin colloid in 150 ml of orange juice
d) 20 mCi of Tc99m labeled RBCs
e) 6 mCi of Tc99m albumin colloid

a) 10 mCi of Tc99m pertechnetate.

A patient with a bilirubin level of 35 mg/dl is scheduled for hepatobiliary imaging. The bet radiopharmaceutical to use would be:
a) Tc99m pertechnetate
b) Tc99m disofenin
c) Tc99m mebrofenin
d) Tc99m sulfur colloid
e) Tc99m labeled RBCs

c) the uptake and distribution following injection of a hepatobiliary imaging agent depend in part on the patients bilirubin level, increased bilirubin is associated with decreased excretion of the radiopharmaceutical.

If 15 min after injection of 8 mCi of Tc99m disofenin, the liver is not visualized, but the heart and kidneys are, what is the most likely reason?
a) to little DISIDA was injected
b) the liver is not functioning properly
c) the GB is obstructed
d) the patient is taking morphine
e) the patient has a very low bilirubin level

b) iminodiacetic acids (IDAs) are cleared from the blood by the hepatocytes before they are secreted into the canaliculi. If the liver is not seen but there is cardiac and renal activity at 15 min after injection, this is likely indicates that there is a problem of the liver function

What are the possible effects on the hepatobiliary scan if the patient has eaten 2h before the study?
a) a false positive
b) Nonvisualization of the GB within an hr
c) intermittent contraction of the GB
d) all of the above
e) a and b only

e) if there is insufficient fasting , the radiopharmaceutical may not be able to enter the gallbladder, resulting in a false positive.

If the maximum counts obtained from an ROI about the gallbladder are 285,000 and the minimum counts obtained from the same ROI are 187,000, what is the ejection fraction of the gallbladder?
(a) 22 %
(b) 34 %
(c) 52 %
(d) 66 %
(e) 73 %

b) images pre and post cck or fatty meal are used to draw ROIs for calculation of GBEF. use this formula
NET max counts- met min counts/ net max counts x 100%.

Is the ejection fraction of 34% normal?
a) yes
b) no

B) no

What will be visualized in the first hour of a normal HIDA?
a) common duct
b) GB
c) duodenum
d) all of the above
e) a and b only

d) within an hour, a normal HIDA is expected to show liver, CBD, GB, and small intestine

Morphine given during a hepatobiliary scan can:
a) constrict the sphincter of Oddi
b) enhance the GB filling
c) shorten the study time
d) all of the above
e) a and c only

d) as morphine enhances the muscle tone of the sphincter of Oddi, pressure will increase in the bile ducts and may result in GB filling. This may be an alternative to delayed imaging.

Which of the following would not be useful in further examining a suspicious area of activity when evaluating a patient for lower GI bleed with Tc99m labeled RBCs?
a) delayed imaging to visualize a change in configuration of the activity
b) delayed imaging to visualize increasing activity
c) use of cine mode
d) anterior obliques
e) none of the above

e) the use of cine mode, oblique imaging, and delayed imaging is useful in detection of GI bleeds.

Why is labeling efficiency important for imaging of GI bleeding with Tc99m RBC?
a) a small decrease in labeling efficiency may lead to a false negative result
b) if the patient is actively bleeding the radiopharmaceutical must be prepared as quickly as possible
c) Tc99m pertechnetate will be taken up by the kupffer cells
d) free pertechnetate is secreted by the stomach and the kidneys.

d) Labeling the cells in vitro will result in the highest labeling efficiency. Free tech will cause increased activity in the kidneys and gastric mucosa and may interfere with image interpretation

When performing GI bleeding scan using Tc99m RBCs which of the following is correct
a) dynamic imaging are obtained at 1 min/frame for 60 min
b) if positive findings of active bleeding are observed by the tech, they can stop the imaging acquisition at that time point.
c) if the positive findings of active bleeding are observed by the tech, they can stop the imaging so that the first part imaging can be reviewed by the rad.
d)) if the test is negative in the 60 min period of imaging, the patient should be sent back to the floor, but delayed imaging can be performed later if there is evidence of active bleeding later.

e) GI bleeding imaging is normally for 60 min but can be longer. If more imaging is needed, it should be performed continuously. Delayed imaging after interruption often does not help.

Poor Tc99m RBC labeling may be caused by:
a) heparin
b) iodinated contrast
c) doxorubicin
d) lidocaine
e) all of the above

e) other medicines that affect Tc99m RBC labeling include : methyldopa, hydralazine, quinidine, etc..

When performing Meckel's scan to detect ectopic gastric mucosa, patients can be pretreated with the following medications to increase the sensitivity:
a) cimetidine
b) pentagastrin
c) glucagon
d) all of the above

d) all can be used but cimetidine is the most commonly used.

Clearance of Tc99m MAG3 is by:
a) active transport
b) tubular secretion
c) Glomerular filtration
d) none of the above

b) Tc99m MAG3 is cleared by the proximal tubules, DTPA is cleared by glomerular filtration, DSMA binds to proximal renal tubules, and GH is cleared by both glomerular and tubules

A patient with Cushing's syndrome might receive a dose of:
a) I 131 NP-59 to study the adrenal cortex
b) I 131 NP-59 to study the adrenal medulla
c) I 131 MIBG to study the adrenal cortex
d) I 131 MIBG to study the adrenal medulla

a)I131 NP59 binds to receptors on the adrenal cortex and may be useful in Cushing's syndrome and hyperaldosteronism and hyperandrogenism. MIBG is taken up by the chromaffin cells which are in the adrenal medulla and the paraganglia of the sympathetic nervous system it is usually labeled with I131 and is used to image neuroectodermally derived tumors such as pheochromocytomas, neuroblastomas and paragangliomas.

Which of the following is excreted by glomerular filtration?
a) Tc99m DTPA
b) Tc99m DSMA
c) Tc99m MAG3
d) Tc99m GH

a) Tc99m MAG3 is cleared by the proximal tubules, DTPA is cleared by glomerular filtration, DSMA binds to proximal renal tubules, and GH is cleared by both glomerular and tubules

Normal glomerular filtration rate is:
a) 25 ml/min
b) 50 ml/min
c) 100 ml/min
d) 125 ml/min

d) glomerular filtration is the process that removes excess water, salts, and urea from the blood. This filtration takes place in the glomeruli following which the filtered blood flows into Bowman's capsule. GFR varies according to age, race and gender but approximate normal value is 120-155 ml/min for both kidneys in young and middle aged adults.

For visualizing intraparenchymal lesions in the kidneys, the
radiopharmaceutical of choice from the list below is:
(a) 99m Tc DMSA
(b) 99m Tc DTPA
(c) 99m Tc MAG3
(d) 131 I OIH

a) Tc99m MAG3 is cleared by the proximal tubules, DTPA is cleared by glomerular filtration, DSMA binds to proximal renal tubules, and GH is cleared by both glomerular and tubules

Performing an evaluation of a renal transplant includes the following considerations:
a) the best imaging will be obtained posteriorly
b) detector face should be centered over all the right or left iliac fossa
c) uptake of radiopharmaceutical is usually delayed in the transplanted kidneys relative to native.
d) all of the above

b) imaging of transplants is performed anteriorly with the detector centered over the relevant iliac fossa.

The left kidney is usually lower than the right because of the spleen
a) true
b) false

b) the right kidney is often, but not always lower than the left, probably because of its proximity to the liver.

Radionuclide cystography is most often performed to:
a) determine transplant function
b) evaluate renal perfusion
c) detect vesicoureteral reflux
d) visualize space occupying lesions in the bladder.

c) radionuclide cystography is performed to evaluate patients for vesicoureteral reflux. The radiopharmaceutical is introduced into the bladder with saline and the patient is imaged during bladder filling and voiding to detect reflux of activity from the bladder into the ureters.

The expected bladder capacity for a 6 year old is:
a 50 ml
b 120 ml
c 240 ml
d 500 ml

c) a formula for estimating bladder capacity is needed to prepare an appropriate amount of saline for bladder filling. The formula used is as follows (age+2) x 30 ml

Which of the following describes normal images from radionuclide cystography during bladder filling?
a) increasing activity in the bladder over time
b) homogenous activity in both ureters
c) decreasing activity in the kidneys over time
d) none of the above

a) normal cystography will show an increase in activity in the bladder during filling and decreasing activity during voiding with no activity in ureters or kidneys.

In normal patients, a volume of up to 1.5 ml max reflux into the ureters and kidneys at maximum bladder filling
a) true
b) false

b) any reflux into the ureters or kidneys is abnormal. Small volumes of reflux into the distal ureters may be difficult to detect.

Which of the following is not true regarding glomerular filtration rate?
a) it usually becomes abnormal before serum creatinine levels become abnormal
b) it is typically obtained through the use of Tc99m DTPA
c) it can be determined only by taking blood or urine specimens
d) it is a measure of the ability of the kidneys to clear inulin from the plasma
e) all except b

c) Glomerular filtration rate is the amount filled of fluid filtered from glomerular capillaries to the bowman's capsule in a given amount of time, normally expressed as ml/min. It is defined as the ability of the kidneys to clear inulin from plasma; inulin is a substance that is filtered by the glomeruli and is not secreted or reabsorbed by the tubules. Significant kidney function may be lost before serum creatinine becomes abnormal, so GFR is an important measurement. Tc99m DTPA is cleared by the glomeruli and is used for measuring glomerular filtration rate.

Which radiopharmaceutical can be used to determine effective renal plasma flow?
a) Tc99m MAG3
b) I 131 OIH
c) Tc99m DTPA
d) a and b only
e) a and c only

d) Renal plasma flow is defined as the clearance of paraamiohippurate (PAH, which is secreted and filtered by the renal tubules) from plasma. In nuclear medicine, effective renal plasma flow (ERPF) as been measured using I131 OIH in the past and more recently Tc99m MAG3. It is determined effective because it does not equal the clearance of PAH but approximates it.

Which saline bottle would be sufficient to fill the bladder of a 8 year old during radionuclide cystography?
a) 125ml
b) 250 ml
c) 400 ml
d) none of the above

b)a formula for estimating bladder capacity is needed to prepare an appropriate amount of saline for bladder filling. The formula used is as follows (age+2) x 30 ml

A tech prepares a radiopharmaceutical for renal imaging at 8 am. The patient arrives at 12:!5pm and therefore a new kit has to be made. The radiopharmaceutical is:
a) Tc99m MAG3
b) Tc99m DSMA
c) Tc99m DTPA
d) Tc99m GH

b) DSMA should be discarded after 4h.

Following the injection of I131 NP-59. Imaging for adrenal lesion is performed:
a) 6h later
b) 24-48h
c)48-72h
d) 5-7 days
e) none of the above

d) imaging usually begins at 5-7 days but may commence earlier depending on the history of the patient. (suspected hyperaldosteronism)and the question asked for the exam.

Which of the following is a tuft of capillaries?
a) loop of Henle
b) the glomerulus
c) renal pyramid
d) collecting tubule

b) the glomerulus is a tuft of capillaries within the nephron. The loop of Henle is the hairpin loop that the tubule makes.

In a patient with renal artery stenosis:
a) a post captopril study will show increase GFR
b) a post captopril study will down decrease GFR
c) a post captopril study will show GFR to be unchanged

b) Patients who have renal artery stenosis, when given an ACE inhibitor, will show a decrease in GFR. Therefore captopril renography is an effective examination to determine whether renal artery stenosis is the cause of hypertension.

When performing captopril renography, captopril should be administered:
a) 1h prior to the injection of radiopharmaceutical
b) 20 min after the injection of radiopharmaceutical
c) only if activity persists in the renal pelvis 20 min after radiopharmaceutical administration
d) at the same time as the injection of radiopharmaceutical

a) in captopril renography, the captopril is administered orally 1 h before the injection of the radiopharmaceutical.

Preparation for captopril renography includes:
a) ACE inhibitors stopped
b) fasting to enhance absorption of oral captopril
c) well hydrated
d) all of the above
e) none of the above

d) the patient should be well hydrated, fasting, and off all ace inhibitors before study is begun. The length of time that the medications should be held depends on the type of medication, typically 3 days for captopril and 1 week for other medications.

When performing ACEI renography, all of the following is correct except for:
a) patient should be well hydrated
b) severe hypotension may occur due to administration of ACEI
c) blood pressure and pulse should be monitored continuously throughout the study
d) if a patient is already on ACEI therapy, no further ACEI is needed before ACEI renography

d- if a patient is already on ACEI therapy, ACEI should be discontinued for 3-5 days (depending on half-life) before ACEI renography.

How should Tc99m sestamibi be administered when used for breast tumor imaging?
a) intramammary injection
b) via indwelling catheter
c) via intravenous injection in the arm contralateral to involved breast
d) none of the above
e) b and c

e) because any infiltrated dose may cause uptake inthe axillary nodes, the injection should be made through an indwelling catheter an din the arm contralateral to the suspected abnormality. If there is infiltration, this information should be made available to assist image interpretation

What is the optimal scanning time for neoplasm when using Ga67 citrate?
a) 4h
b) 6h
c) 24h
d) 48h

d) Ga67 has a half-life of 72h, and so imaging can take place over several days. Imaging for infection is often performed on the same day as the injection and continues at 24h and onward at 24h intervals. Tumor imaging is usually begun at 48h and continued at 24h intervals.

Lymphoscintigraphy is used to:
a) map lymphatic channels
b) determine drainage pathways from malignant neoplasms
c) identify the sentinel node
d) all of the above
e) a and b only

d) lymphoscintigraphy is performed by injecting a radicolloid near a tumor and can be used to identify the sentinel node and lymphatic drainage from a tumor. Dynamic and delayed imaging is often used.

In111 pentetreotide is a:
a) potassium analog
b) monoclonal antibody
c) somatostatin analog
d) radiocolloid

c) pentetreotide (octreotide) is a synthetic form of somatostatin. Somatostatin is a neuropeptide that, among other things, inhibits the secretion of growth hormone. Somatostatin receptor imaging is performed for the detection of neuroendocrine and some non-neuroendocrine tumors with high density of somatostatin receptors. These are often tumors that originate from somatostatin receptors are pancreatic islet cell tumors, certain brain tumors, pituitary adenoma, gastrinoma, small cell lung cancer, pheochromocytoma, medullary thyroid carcinoma, some breast cancers, and lymphomas.

A HAMA response occurs because:
a) a kit contains pyrogens
b) monoclonal antibodies are produces from mouse cells which the human body recognizes as a foreign protein.
c) a patient is allergic to In111
d) monoclonal antibodies are produced from human cells that trigger an immune response in the patient

b) HAMA stands for human antimurine (aka antimouse) antibody. It is a response that the human immune system may mount against a foreign antigen.

a dose of In111satumomab pendetide should be ____ before injection.
a) shielded
b) filtered
c) assayed
d) all of the above
e) a and c only

d) all radiopharmaceuticals should be assayed and emission appropriate shielding should be used. In addition, In111 satumomab pendetide should be filtered before injection because it is a protein and has the potential for particle formation.

In111 satumomab pendetide is used to image:
a) extrahepatic metastases from colorectal and ovarian cancer
b) breast tumors
c) neuroendocrine tumors
d) lymphatic channels

a) In111 satumomab pendetide is a monoclonal antibody that allows tumor imaging because it binds to certain tumor antigens. It is used most commonly in colorectal and ovarian cancers.

Advantages of Tl201chloride over Ga67 citrate include:
a) much shorter half-life
b) less uptake in inflammatory processes
c) imaging may take place sooner
d) all of the above
e) b and c only

e) Both Tl201 and Ga67 citrate can be used to image lymphoma, but Ga67 citrate may be taken up in infection, and there is a longer delay before imaging. However, Tl201 has less sensitivity for detecting small lesions. They have comparable half-lives.

It is possible to use Tc99m sestamibi for breast tumor imaging because there is no uptake of sestamibi in the normal breast.
a) true
b) false

b) there is low-intensity , homogenous uptake of Tc99m sestamibi in normal breast tissue.

A monoclonal antibody is developed which displays cross reaction. This means:
a) the antibody triggers an immune response in the patient
b) the antibody will bind antigens other than the one it was formed with
c) the antibody can be labeled with either Tc99m or In111
d) none of the above

b) antibodies are proteins that are produced in response to presence of an antigen, and they bind to that antigen. Cross-reactivity means a reaction to a similar but different antigen.

Examples of neuroendocrine tumor include:
a) pituitary adenoma
b) small- cell lung cancer
c) neuroblastomas
d) all of the aboe
e) a and c only

d) neuroendocrine tumors have been called apudomas (taking the first letters from amine precursor uptake and decarboxylation) or tumors arising from APUD cells. APUD cells secrete polypeptides, amines, or both. The neuroendocrine system compromises the nervous system and the endocrine glands and the interactions between the two. Examples include carcinoids, small cell lung cancer, pituitary adenomas, pheochromocytomas, some brain tumors, and islet cell tumors.

Visualization of kidneys at 48h is ________ on a scan using In111 pentetreotide and ____________ on a Ga67 citrate scan.
a) normal, abnormal
b) abnormal abnormal
c) normal, normal
d) abnormal, normal

a) genitourinary activity may be seen even on delayed images obtained with In111 pentetreotide. It is not normally seen on delayed images (>24h) obtained using Ga67 citrate.

FDG18 can be used to image tumors because the glycolytic rate is higher in tumor than in normal tissues.
a) true
b) false

a) FDG18 uptake in tumors is due to their high glycolytic rates. Poorly differentiated tumors have greater uptake than well differentiated tumors. This is the reason that the SUV has prognostic value.

Which of the following are true regarding FDG18 tumor imaging?
a) PET scanning is required
b) the patient should fast before exam
c) only brain tumors can be detected
d) all of the above
e) all except c

e) F18 is a positron emitter. FDG18 is a glucose analog that is taken up preferentially in many tumor types due to their higher glycolytic rates. Patients should fast in preparation for the exam because hyperglycemia can reduce tumor uptake of FDG18.

On a Monday morning, a tech learns that a patient needs to be scheduled for imaging with Ga67 citrate and also a lower GI. If the ordering physician wishes that both exams be done within the week, how should these studies be scheduled?
a) lower GI on Monday morning and Ga67 citrate on monday afternoon
b) lower GI on monday and Ga67 citrate on wednesday
c) Ga67 injection on Monday morning followed by imaging each day and lower GI at noon on friday
d) inject patient with Ga67 citrate on Monday morning, send for lower GI, and then perform first imaging of gallium on monday afternoon.

c) studies involving barium in the week prior to the exam can interfere with visualization. Additionally gadolinium, when used within 24 h of gallium injection, may decrease localization of gallium. Chemotherapy can also negatively affect the uptake of gallium; scans should be performed at least 3 weeks after chemotherapy.

Pheochromocytomas are imaged using:
a) I131 MIBG
b) I131 NP-59

a) I131 NP-59 is used to image the adrenal cortex. I131 MIBG is useful for imaging pheochromocytomas, which are often in the adrenal medulla Somatostatin receptor imaging is also useful for pheochromocytoma.

There use of PET imaging in oncology takes advantage of the________ differences between normal and neoplastic tissue.
a) structural
b) metabolic
c) denisty
d) hormonal

b) malignant cells have altered glucose and methionine metabolism; hence, FDG18 and C11 methionine can be used for tumor imaging.

Hodgkin's disease is a type of:
a) lung cancer
b) lymphoma
c) AIDS
d) lupus

b) Hodgkin's disease is a kind of lymphoma; it is most common in young adults. One of the first complaints is painless, enlarged lymph nodes. It has been imaged using Ga67 citrate and more recently FDG18

Normal areas of uptake for Ga67 citrate include all of the following except:
a) intestinal mucosa
b) parathyroid glands
c) liver
d) epiphyses in pediatric patients

b) areas of physiologic uptake of Ga67 citrate include the nasopharynx, lacrimal and salivary glands, liver, and pediatric epiphyses.

If a low- energy collimator is sued for imaging Ga67, what will the effect be?
a) there is increased septal penetration
b) poor spatial resolution
c) decreased sensitivity
d) a and c
e) a and b

e) low-energy collimation is generally used for photo peaks <150 keV. Using insufficient collimation will result in increased septal penetration with the concomitant negative effect on resolution. The decreased septal depth will increase sensitivity.

F18 fluciclovine is currently an FDA approved imaging agent for what type of cancer?
a) thyroid cancer
b) lung cancer
c) liver cancer
d) prostate cancer

d) prostate cancer is currently imaged with F18 fluciclovine

What is the half-life of Ga68 dotatate?
a) 68min
b) 78h
c) 6h
d) 110 min

a) 68 min is the half-life of gallium 68 dotatate

Gallium 68 is ___________produced?
a) generator
b) cyclotron

a) gallium 68 is generator produced PET imaging agent

Gallium 68 dotatate is indicated for imaging what type of cancers utilizing PET?
a) non-small cell lung cancer
b) neuroendocrine tumors
c) prostate cancer
d) breast cancer

b) binds to somatostatin receptors in neuroendocrine tumors

a) the recommended dose is 10 mCi

Which of the following is true of Ga67 citrate and In111 labeled leukocytes?
a) both require the use of a medium- energy collimator
b) both can be used to effectively image neoplasms and infections
c) both have three gamma peaks available for imaging
d) all of the above
e) a and b only

a- Ga67 emits gamma rays of 93, 184, 269, and 394 keV. In111 emits gamma rays of 172, 247 keV. Labeled leukocytes are used for infection imaging rather than neoplasms. Medium energy collimation is used for both.

In general, the best radiopharmaceutical to use for a suspected
abdominal abscess is:
(a) 67 Ga citrate
(b) 111 In-labeled leukocytes
(c) 111 In satumomab pendetide
(d) 111 In octreotide

b) it is best to use a radiopharmaceutical with less gastrointestinal excretion; therefore, Ga67 should be excluded. Octreotide is used for tumors with somatostatin receptors, and satumomab pendetide is a monoclonal antibody used mainly for colorectal and ovarian cancers, so these are not helpful. In111 leukocytes would be useful; GI actively will not be present when disease is absent.

For imaging of inflammation or infection, leukocytes maybe labeled with
a) In111 oxine
b) Tc99m exametazime
c) Ga67 citrate
d) All of the above
e) a and b onl

e) leukocytes are labeled with In111 and Tc99m for infection imaging, but Ga76 labeled leukocytes are not used clincially

If platelets are inadvertently labeled along with leukocytes during labeling with In111 oxine for imaging infection, the resulting scan maybe:
a) false negative
b) false positive

b) it can be assumed, because of the high activity present at 24h, that the image was not obtained using Tc99m radiopharmaceutical. One would expect to see bowel and nasopharyngeal activity if Ga67 were used.

The collection of whole blood for leukocyte labeling should be performed:
a) with a small-bore needle
b) through an existing IV line
c) using a heparinized syringe
d) with a shielded syringe

b) Inadvertently labeled platelets may show thrombosis to prevent clotting either heparin, ACD solution or other anticoagulant should be used in the collecting syringe. Heparin is less desirable as some patients display hypersensitivity. Small- bore needles may damage cells, and, as there is not yet activity present, no syringe shield is needed.

To screen for infection in a severely leukopenia patient, the
best choice of radiopharmaceutical would be:
(a) 99m Tc-labeled WBCs
(b) 67 Ga citrate
(c) 111 In-labeled WBCs
(d) 99m Tc sulfur colloid

b) gravity sedimentation is the settling of solids to the bottom of a liquid based on weight and does not require centrifugation or magnets. It may be used for separation of erythrocytes and is often facilitated by the addition of heta-starch to increase the attraction of erythrocytes to one another.

the most appropriate dose to inject for imaging inflammation with In111 labeled leukocytes is:
a) 0.5-1.0 mCi
b) 2.0-4.0 mCi
c) 5-10 mCi
d) 6-8mCi

b) five hundred uCi to 1.0 mCi of In111 oxine- labeled leukocytes is a common dose range for imaging infection. Using Tc99m exametazime allows more activity to be administered and offers a shorter injection to imaging time.

Ga67 is often used with three phase bone scans to detect:
a) arthritis
b) lung mets
c) osteomyelitis
d) avascular necrosis
e) rib fractures

c) the immediate and blood pool phases of bone scans can be used to differentiate cellulitis and osteomyelitis; Ga67 citrate is helpful addition in cases of complicated osteomyelitis.

Gravity sedimentation involves the settling of cells:
(a) After centrifugation
(b) After time has passed
(c) After the syringe or test tube is inverted
(d) After the sample has been placed over a magnet

a) if scanning for infection the In111 leukocyte exam could be used, it the radiation dose to the patient might be avoided by obtaining further images over time to confirm whether the activity is changing as gallium is excreted through bowel. Hydration and voiding are not helpful in ruling out bowel excretion of gallium, neither are subtracted liver/spleen images. Laxatives or enemas may also be of help.

On planar abdominal images obtained with Ga67 citrate, suspicious activity is noticed. Which technique would be the first choice for further investigation of that activity?
a) sequential SPECT scanning to observe change in the activity
b) subtract images obtained with Tc99m sulfur colloid
c) hydrate the patient and encourage voiding before reimaging.
d) perform another exam with In111 leukocytes

d) Ga67 provides high sensitivity for the diagnosis of vertebralosteomyelitis

A patient has suspected osteomyelitis of lumbar spine. Which of the following stud is best indicated.
a) triple phase bone scan
b) In111 WBC scan
c) Tc99m WBC scan
d) Ga67 citrate scan

b) In111 WBC scan is the best choice. Tc99m WBC scan and Ga67 citrate scan both have physiologic activity in the abdomen and thus complicate the study. Bone scan has no role here.

To evaluate suspected infection in pediatric patients, ____________ is preferred because of ____________.
a) In111 WBC scan, better image quality
b) In111 WBC scan, lower dose
c) Tc99m WBC scan, better image quality
d) Tc99m WBC scan, lower radiation

d) Tc99m WBC scan is perfer in pediatric patients, due to lower radiaiton.

When In111 WBC scan is used to evaluate osteomyelitis Tc99m sulfur colloid imaging is commonly included because Tc99m sulfur colloid imaging may:
a) Increase the sensitivity of In111 WBC scan
b) Increase to the specificity of In111 WBC scan
c) decrease nonspecific uptake of In111 WBC imaging
d) Increase specific uptake of In111 WBC imaging

b) Tc99m sulfur colloid imaging help to determine if increased In111 WBC activity is due to excess of bone marrow tissue, thus increase the specificity of In111 WBC scan.

The differences between In111 WBC scan and Tc99m WBC scan include:
a) different half-life
b) different excretion
c) different imaging time
d) different mechanism in detecting infection
e) a-c

e) Tc99m WBC has shorter half-life, higher dose can be used, and imaging starts 2-4 h after tracer injection. However, In111 WBC and Tc99m WBC scan share similar mechanism in detecting infection.

The highest physiologic activity on In111 WBC scan is noted at:
a) liver
b) spleen
c) bone marrow
d) GI tract
e) a-c

b) spleen has the highest physiologic activity on In111 WBC scan

Tc99m sulfur colloid is cleared by the:
a) liver
b) spleen
c) bone marrow
d) GI tract
e) a-c

e) Tc99m sulfur colloid is cleared by mononuclear phagocyte system, including liver, spleen, and bone marrow

For a patient with acute osteomyelitis, 3 phase bone scan will show:
a) increased uptake in the first phase
b) increased uptake in the second phase
c) increased uptake in the third phase
d) three phase bone scan does not directly valuate acute osteomyelitis
e) a-c

e) acute osteomyelitis will show positive will show positive findings on all three phases of bone scan.

a negative 3phase bone scan:
a) is not helpful for the differential diagnosis of osteomyelitis
b) helpful for the differential diagnosis of osteomyelitis only when In111 WBC scan is included .
c) is helpful for the differential diagnosis of osteomyelitis only when Ga67 citrate scan is included.
d) is more helpful for the differential diagnosis of osteomyelitis than a positive three phase bone scan does.

d) a negative three phase bone scan essentially rules out the diagnosis of osteomyelitis, thus very helpful in the differential diagnosis. In contrast, a positive three phase bone scan may be caused by multiple etiologies.

A patient had left hip replacement and now has a three phase bone scan to evaluate for possible loosening/infection.
a) increase MDP uptake in the hip is abnormal if it is most than 6 months after surgery
b) increased MDP uptake in the hip is abnormal if it is most than 12 months after surgery.
c) Increased MDP uptake in the hip is abnormal if it is most than 2 years after surgery.
d) absence of increased MDP uptake in the hip rules out prosthesis loosening/infection.

d) after hip replacement, MDP uptake in most cases returns to normal in 12 months, but it is not rare to see persistent uptake lasting for more than 2 years. However, a negative bone scan essentially rules out the diagnosis of loosening/infection.

Infection and tumor are two major causes of fever of unknown origin FUO. Patient with fever of unknown origin is recommended to be evaluated with:
a) FDG PET/CT
b) In111 WBC scan
c) Tc99m WBC scan
d) Ga67 citrate scan
e) a and d

e) FDG PET CT and Ga67 citrate scan are able to evaluate infection and tumor at the same time and are thus preferred study for patients with fever of unknown origin.

For evaluation of infection and inflammation, F18 FDG PET/CT can be used in the following conditions
a) sarcoidosis
b) osteomyelitis
c) fever of unknown origin
d) giant cell arteritis
e) all of the above

e all of the above

For evaluation of infection and inflammation y F18 FDG PET CT, which of the following is not correct:
a) the patient should avoid strenuous physical exercise within 24h before injection.
b) hyperglycemia is not an absolute contraindication for preforming the study.
c) F18 FDG dose adjustment(less dose) is not necessary for patient with renal failure
d) noncaloric beverages (such as water or coffee) are allowed, and NPO of at least 4h before FDG imaging is not required for evaluating infection.

d) while noncaloric beverages are allowed, NPO for at least 4h is also required.

Is the uptake value determined in question 1 normal value?
a) yes
b) no

a- the normal rand for 6h uptake is about 6-18% for 24h, it is normally 20-30% although these numbers vary according to the laboratory

a technologist is performing a thyroid uptake with I123 sodium iodide. The capsule is counted before being administered to patient, and 850,192 is obtained. Six hours after swallowing from the thigh, 34, 982. Background for the uptake probe is 239 cpm, and the 6h decay factor for I123 is 0.730. What is the 6h uptake?
a) 7.0%
b) 9.5%
c) 13.1%
d) 18.7%

c- the percent uptake is calculated by the following formula: thyroid counts- thigh counts/ (capsule counts- background)(decay factor) x 100%. Because a standard is not being used, the capsule has been counted before administration, background is subtracted, and activity is multiplied by the decay factor. If a standard was used, the formula would be thyroid counts- thigh counts/ counts in standard x 100%

what will the effect be if a technologist places the uptake probe over the proximal thigh when counting background in the patient?
a) the background will be falsely elevated
b) the background will be falsely decreases
c) the calculated uptake will decrease
d) a and c
e) b and c

d- because of the proximity to the bladder, counts will be higher, and this will result in a falsely low uptake

Which of the following dietary supplements will affect thyroid uptake?
a) Vit A
b) Vit B
c) St. Johns wort
d) Kelp tablets
e) lactobacillus

d- kelp tablets contain iodine and therefore may affect measured values of thyroid uptake.

Which of the following will not affect thyroid uptake?
a) Iodinated contrast media
b) propylthiouracil
c) thyroid hormones
d) betablockers

d- choices a, b, and c may affect measured values of thyroid uptake, but beta blockers should not.

Thyrotropin is also known as:
a) TRH
b) TSH
c) T3
d) T4

b- thyrotropin is also known as TSH. It is secreted by the anterior pituitary and causes the thyroid to releases thyroxine (t4)

Which of the following statements is not true?
a) TRH stimulates the releases of TSH by the anterior pituitary
b) Release of T3 is inhibited by elevation of T4
c) T3 and T4 are both hormones which are manufactured by the thyroid
d) TRH is synthesized in the hypothalamus

b- TRH is thyrotropin- releasing hormone which is secreted by the hypothalamus and stimulates the secretion of TSH by the anterior pituitary. The thyroid releases the hormones T3 and T4.

Most people have 4 parathyroid glands:
a) true
b) false

a) most people have 4 but a small percentage of people may have more or less.

The salivary glands include:
a) the parotid glands
b) sublingual salivary glands
c) submaxillary salivary glands
d) all of the above
e) b and c only

d- the major salivary glands include the parotid, the sublingual, and submaxillary glands. There are also minor glands in the cheeks, lips, mouth, and throat

Which of the following are used to image the parathyroid?
a) Tc99m pertechnetate
b) Tc99m sestamibi
c) Tl201
d) a and b
e) b and c

e- sometimes, one of these imagine agents is paired with pertechnetate imaging to create images that will allow subtraction of the thyroid.

The collimator attached to the thyroid uptake probe is:
a) converging
b) diverging
c) pinhole
d) flat field
e) low energy all purpose

d- the pinhole may be used for imaging, but the flat field is used for uptake.

Which of the following is part of the preparation for a thyroid uptake?
a) NPO from midnight
b) administer Lugol's solution
c) have the patient void before administration of radio pharmaceutical
d) withhold caffeine-containing beverages for 24h prior to examination
e) none of the above

a- lugol's solution is iodine and should not be administered. Voiding is not necessary before administration of the radiopharmaceutical, nor is withholding caffeine. Most laboratories have a policy of fasting before and for a few hours following the dosing, to enhance digestion of the dose.

When performing a thyroid uptake, the tech neglects to count the capsule before it is administered to the patient. What are the implications?
a) it will not be possible to calculate uptake values
b) an identical capsule must be counted in a neck phantom in order to obtain uptake values.
c) no decay factor will be used in the calculation of uptake values.
d) none of the above
e) b and c

e- the percent uptake is calculated by the following formula: thyroid counts- thigh counts/ (capsule counts- background)(decay factor) x 100%. Because a standard is not being used, the capsule has been counted before administration, background is subtracted, and activity is multiplied by the decay factor. If a standard was used, the formula would be thyroid counts- thigh counts/ counts in standard x 100%

While taking information from a patient who is scheduled for a thyroid uptake and scan with I123 sodium iodide, a tech learns the patient has been taking Cytomel that week. What does this mean?
a) nothing; thyroid uptake will not be affected by cytomel
b) imaging may still be obtained using Tl201 chloride
c) both the uptake and scan can be performed using I131
d) study should be performed as ordered, but the uptake will be inaccurate.
e) none of the above

b- Cytomel is a synthetic form of T3 and will affect iodine uptake, so if images are needed, they can be obtained using thallium. any uptake values obtained would be falsely low; this medication should be stopped at least 2 weeks before uptake and scanning using radioiodine.

What is the method of localization of Tc99m pertechnetate in the thyroid?
a) sequestration
b) active transport
c) receptor binding
d) diffusion
e) phagocytosis

b- pertechnetate localizes in the thyroid by active transport; it is trapped in the gland, but unlike iodine, not organified

Imaging of the thyroid takes place:
a) approximately 20 min after injection of Tc99m pertechnetate
b) 6h after administration of I123 sodium iodine capsule
c) 24h after the administration of I123 sodium iodine capsule
d) all of the above

d- imaging may be performed in all cases, but images taken at 6h after radioiodine ingestion will have a higher body background relative to 24h images. Those obtained at 24h will have a lower count rate, but images may be superior due to the decreased body background.

Which of the following will not optimize images of they thyroid?
a) use of a pinhole collimator
b) having the patient avoid swallowing during acquisition
c) hyperextending the neck
d) placing a radioactive marker on the xiphoid process

d- the xiphoid process will not likely be in the FOV

a linear area of activity in the esophagus is seen on a thyroid image taken using Tc99m pertechnetate. What does it represent?
a) sublingual thyroid
b) parathyroid
c) pertechnetate that was secreted by the salivary glands and swallowed
d) parotid gland

c- activity that localizes in the salivary glands and is secreted may be swallowed resulting in esophageal activity. If this is seen on pertechnetate scan, the artifact can be distinguished from the pyramidal lobe by having the patient drink.

The use of I131 for thyroid imaging:
a) is common if an uptake is also planned
b) is typically only used when scanning the whole body for metastatic thyroid disease after thyroidectomy
c) delivers a lower radiation dose to the thyroid than dose Tc99m pertechnetate, since only uCi amounts are administered
d) all of the above

b- whole body scanning with I131 to rule out metastatic disease is often performed after thyroidectomy. The dose used is 3-5 mCi. Thyroid uptake and scanning is typically performed using I23

a patient receives both 3mCi of Tl201 and 5mCi of Tc99m pertechnetate, and pinhole images of the neck are taken after each administration. If the pertechnetate image is subtracted from the Tl201 image, the activity that remains represents?
a) thyroid
b) parathyroid
c) salivary glands
d) hypothalamus
e) nonfunctioning thyroid tissue

b- sometimes one of these imaging agents is paired with pertechnetate imaging to create images that will allow subtraction of the thyroid.

The salivary glands may be imaged using:
a) 3 mCi of Tl201
b) 5 mCi of Tc99m sestamibi
c) 5 mCi of Tc99m pertechnetate
d) 200 uCi of I123 sodium iodide

c- pertechnetate is used for imaging the salivary glands, often to evaluate function or rule out masses.

Which of the following describes delayed images at 2-3 h after injection of Tc99m sestamibi?
a) persistent activity in the normal thyroid with complete washout of activity in the parathyroid
b) persistent activity in parathyroid adenomas and decreased activity in the thyroid relative to early images
c) persistent activity in the hyperfunctioning thyroid tissue and no activity in the parathyroid or salivary glands.
d) activity in the salivary glands and normal parathyroid tissue.

b- Tc99m sestamibi washes out of the thyroid over time, and parathyroid adenomas, which may appear more intense that the thyroid on early images, often retain activity on delayed images.

a hot nodule on a thyroid image will most likely be benign.
a) true
b) false

a- the majority of hot nodules seen on thyroid scans are benign.

Which of the following are symptoms of hyperthyroidism?
a) exophthalmos
b) bradycardia
c) cold intolerance
d) all of the above
e) b and c

e- bradycardia means slowing of the heart rate; rapid heart rate may be a symptom of hyperthyroidism. Cold intolerance is one of the symptoms of hypothyroidism. Exophthalmos or protrusion of the eyeballs, may be seen in hyperthyroid patients.

A patient with a 45% uptake of I 123 sodium iodide at 24 h is :
a) euthroid
b) hyperthyroid
c) hypothyroid
d) athryoid

b, hyperthyroid

the highest dose of therapeutic I131 are given to patients with:
a) graves disease
b) toxic multinodular goiter
c) thyroid cancer
d) chronic thyroiditis

c) the therapeutic dose of radioiodine for thyroid cancer is 150-200 uCi and may be higher if distant metastases are being targeted.

On anterior- view thyroid images taken using I123 sodium iodide, the right lobe appears to be larger than the left. The explanation for this is:
a) a right hem goiter
b) a hypo functioning left lobe
c) a normal findings
d) the patients head was turned slightly to the left
e) the patient's head was turned slightly to the right

c- the thyroid appears as a butterfly shape on imaging, with the isthmus often not visualized, or displaying decreased activity relative to the right and left lobes. A slightly larger right lobe is commonly seen and is usually a normal finding.

Iodine is needed of the thyroid hormone secreted into the blood is in the form of:
a) thyroxine
b) triiodothyronine
c) thyroglobulin
d) thyrotropin
e) Iodothyronine

a- The thyroid secretes much more thyroxin T4 than triiodothyronine T3. Both are secreted by the follicular cells of the gland. If too little T4 is secreted, myxedema will result.

the part of the thyroid that lies anterior to the trachea and is often not seen on thyroid imaging is the:
a) right lobe
b) left lobe
c) isthmus
d) parathyroid
e) superior thyroid notch

a- ingested iodine is absorbed in the small intestine and transported to the thyroid where it is needed for the synthesis of T3 and T4

a patient with hyperparathyroidism will have:
a) myxedema
b) exophthalmos
c) cold nodules in the thyroid
d) increased fracture risk
e) more than four parathyroid glands

b-exophthalmos

Why is 6h thyroid uptake obtained?
a) in case the patient does not show up the following day for the 24h uptake
b) to detect hyperthyroidism when the turnover is so rapid that the 24h uptake maybe normal
c) in case an error is made in calculation of the 24h uptake
d) so that the patient can resume eating

b- in cases of extremely rapid iodine turnover, only the 6h uptake may be abnormal, for example Grave's disease

Which patient will have the longest wait before an accurate thyroid uptake with I123 can be obtained?
a) a patient who had a myelogram
b)a patient who took Synthroid
c) a patient who had an IVP
d) a patient who was given lugol's solution
e) a patient who took kelp tablets

a- SNM recommends that patients wait 2-4 weeks after examinations using iodinated contrast agents before having a thyroid uptake measurement, but many departments recommend up to 6 weeks. If the myelogram was performed using pant opaque, 2 years delay may be needed, but this is not often used because of the possible association with arachnoiditis.

To stimulate secretion during salivary gland scintigraphy, which of the following is often used?
a) Tc99m sestamibi
b) lemon juice
c) lugols solution
d) captopril
e) furosemide

b- Lemon juice stimulates the salivary glands to secrete saliva and pertechnetate, with a resulting decrease in activity in the glands

Ectopic thyroid tissue may occur:
a) in the pelvis
b) in the neck
c) in the mediastinum
d) at the base of the tongue
e) all of the above

e- Ectopic thyroid tissue may be present in many places; in this case, I131 imaging may be helpful. It is not taken up by the salivary glands, the long half life allows imaging after the target to background ratio has become higher, and there has been urinary excretion of much of the dose.

if the salivary glands are not seen on a thyroid scan obtained with the use of Tc99m pertechnetate, it may mean:
a) That the thyroid is hyperfunctioning and trapped the majority of the tracer
b) that the salivary gland function is compromised
c) that the salivary gland lies inferior to the thyroid and cannot be seen on anterior images
d) a and b
e) b and c

d- it is typical to see salivary glands superior to the thyroid on images obtained using pertechnetate. If they are non seen, it may be because the patient has grave's disease or because salivary gland function is compromised.

When would a LEAP be used for thyroid examinations?
a) during uptake counting
b) when searching for ectopic thyroid with I131 sodium iodide
c) when performing whole body with I131 sodium iodide scanning after thyroidectomy
d) when obtaining a blood pool image of the thyroid with Tc99m pertechnetate to differentiate cystic and solid mases
e) all except a

d- the LEAP collimator is ideal for imaging with technetium if magnification of the gland is not needed. images obtained with the pinhole collimator may follow. Uptake counting requires a flat-field collimator, and medium or high energy may be used for I131.

Radioactive iodine and Tc99m pertechnetate cross the placenta.
a) true
b) false

a- Both radioiodine and pertechnetate will cross the planceta

A technologist performs a thyroid uptake using an identical capsule to the one administered to the patient as a standard. Given the following data obtained 6h after the capsule was swallowed, what is the uptake?
Neck- 55213 cpm
Thigh-2085 cpm
standard- 345987 cpm
background- 48 cpm

a) 1.5%
b) 15.4%
c) 16.6%
d) 30.7%

b- the percent uptake is calculated by the following formula: thyroid counts- thigh counts/ (capsule counts- background)(decay factor) x 100%. Because a standard is not being used, the capsule has been counted before administration, background is subtracted, and activity is multiplied by the decay factor. If a standard was used, the formula would be thyroid counts- thigh counts/ counts in standard x 100%

An indication for a thyroid uptake is for use in calculation of the amount of radioiodine therapy for hypertension.
a) true
b) false

a- the calculation of dose for radioiodine therapy takes the uptake into consideration

When performing a radioiodine thyroid scintigraphy for a patient with suspected hyperthyroidism, a technologist found that the thyroid radioiodine uptake is close to zero, and there is only background activity on the images. which of the following is correct.
a) the imaging time should be extended until good image of the thyroid gland is seen
b) there is likely a technical problem with the gamma camera
c) patient should be re-dosed as the findings are not consistent with provided history of hyperthyroidism
d) talk to our nuclear medicine physician

d- the findings are likely real. The technologist should consulta physician at this time.

When performing a radioiodine thyroid scintigraphy, the major advantage of I131 iodine is:
a) lower dose
b) less radiation exposure
c) better imaging quality
d) higher sensitivity for detecting occult lesions

d- all others are wrong.

Radioiodine therapy is given for:
a) hyperthyroidism
b) thyroid cancer
c) grave's disease
d) all of the above
e) a and b only

d- I131 is used to treat thyroid cancer and hyperthyroidism by ablation. Grave's disease is the most common cause of hyperthyroidism

During a Schilling test, a flushing dose of B12 is given:
a) Intramuscularly
b) Intravenously
c) subcutaneously
d) orally

a- the intramuscular injection of nonradioactive B12 is given to preload the liver and to saturate receptor sites in plasma so that the portion of radioactive B12 absorbed will be passed through the urine

P32 chromic phosphate is a:
a) clear solution
b) bluish-green colloid
c) beta emitter
d) b and c
e) a and c

d- P32 chromic phosphate is a bluish green colloid and is used for intracavitary therapy. P32 sodium phosphate is a clear solution that is used to treat polycythemia vera and bone pain from metastasis and is administered intravenously. P32 is a beta emitter

Before administration, Sr89 chloride must be assayed in a dose calibrator
a) true
b) false

b- as with all radioactive materials, Sr89 should be assayed prior to administration. However the NRC allows administration of Sr89 unit doses without assay because not all dose calibrators assay them accurately.

P32 sodium phosphate is for:
a) intracavitary use
b) intravenous injection
c) intrathecal injection
d) inhalation

b- P32 chromic phosphate is a bluish green colloid and is used for intracavitary therapy. P32 sodium phosphate is a clear solution that is used to treat polycythemia vera and bone pain from metastasis and is administered intravenously. P32 is a beta emitter

Sr89 chloride is used to treat:
a) malignant ascites
b) polycythemia vera
c) bone pain caused by metastases
d) grave's disease
e) a and c

c- P32 chromic phosphate is useful in treating malignant ascites. P32 sodium phosphate is used to treat polycythemia vera. Sr89 (as well as P32 sodium phosphate and Sm153 EDTMP) is used to treat malignant bone pain by localizing where there is bone mineral turnover. I131 may be used to treat graves disease.

Sr89 chloride should be administered:
a) via intracavitary injection
b) via direct venous injection
c) through a patent intravenous line
d) orally

c- Sr89 chloride can be administered by direct venous access, but as it is a beta emitter, it is a better option to access the vein with an intravenous line and check the patency of the system before injection. If the dose is infiltrated into the tissue surrounding the vein, the tissue will be unnecessarily irradiated.

Sr89 and P32 are effectively shielded by:
a) lead pigs
b) plastic syringes
c) paper
d) none of the above

b- Sr89 and P32 are beta emitters and will be effectively shielded with the plastic syringe. Using a lead syringe shield will cause bremsstrahlung.

P32 chromic phosphate is used to treat:
a) polycythemia vera
b) malignant ascites
c) bone pain causes by metastases
d) graves disease
e) a and c

b- malignant ascites

Absorption of Vit B12 in the small bowel requires;
a) a flushing dose of B12
b) intrinsic factor
c) 0.5 mg of Co57 orally
d) 24 h urine collection

b- intrinsic factor is a glycoprotein. It is secreted by the gastric mucosa, and without it Vitamin B12 cannot be absorbed. If a schilling test shows B12 deficiency, the test can be repeated with the intrinsic factor to determine if the lack of it is the cause of malabsorption.

What will be the effect on the results of a schilling test if the patient urinates once and forgets to collect it?
a) the percent excretion may be falsely high
b) the percent excretion may be falsely low
c) there will be no effect

b- the radioactivity in the urine represents the amount of vitamin B12 absorbed. The labeled B12 is excreted through the urine, so if any urine is not collected, the precent excretion will be falsely low.

A patient has a 24h dose excretion of 4% on a stage I schilling test. A stage 2 test is performed and the patient now has a 24h excretion of 12%. What is the most likely diagnosis?
a) malabsorption caused by drug therapy
b) parasitic competition
c) pernicious anemia
d) none of the above

c- the results from the last 24h sample collected during stage 1 are abnormal (normal is >8-10%), and the result from state 2 is 12% which is normal. This indicates that the addition of intrinsic factor has corrected the malabsorption, meaning the patient has pernicious anemia, which is a Vitamin B12 deficiency resulting from a lack of intrinsic factor. There are other causes of B12 which include low intake, pancreatic insufficiency and various medications.

Calculate the percent excretion from a Schilling test given the following values; 55 cpm background, 13500 cpm and 1% standard and 850 cpm in the 5 ml urine sample. The total volume of urine collected was 1100ml.
a) 13.9%
b) 12.9%
c) 1.3%
d) 13.0%

d- to calculate the percent excreted, one uses the following formula:
%= (net cpm of urine sample)(total urine vol/urine sample) divided (net cpm of standard)(standard dilation factor) vol x 100%

(850cpm -55cpm)(1100ml/5ml)x100% divided (!3500-55)(100)
= 174900/1344500x 100% = 13%

The standard dilution factor is a fraction of the patient's dose. If the standard is 5%the dilution factor is found by dividing 100 by the percentage of standard. In this example the standard was 1; we divided 100 by 1 to find a dilution factor of 1. In most cases, the standards are 1, 2, or 5%

Patient instructions for a Schilling test should include all of the following except:
a) careful collection of all urine for 48h in a single container
b) NPO from midnight before the examination begins
c) No vitamin B12 for at least 3 days before the study
d)No enemas or laxatives during the study

a- patients should collect their urine in two separate containers for each 24h period because although the first collection may be abnormal in some disease states, the total excretion may be normal. The second collection may also suggest that the first collection may have been faulty.

Simultaneous performance of stage 1 and stage 2 Schilling test uses:
a) IV injection of Co57 labeled B12 bound to intrinsic factor and oral Co58 labeled B12
b) Oral Co57 labeled B12 bound to intrinsic factor and oral Co58 labeled B12
c) IV injection of Co57 labeled B12 bound to intrinsic factor and oral Co60 labeled B12
d) Oral Co57 labeled B12 bound to intrinsic factor and oral Co60 labeled B12

b- various methods have been used; the most common is Co57 and Co58, both given orally, with one of the isotopes bound to intrinsic factor.

Why must the cpm measured in the standard during a schilling test be multiplied by a standard dilution factor?
a) to account for the standard containing only a portion of the radioactive dose administered to the patient
b) because an undiluted standard would contain too much activity to be efficiently counted in a well counter
c) to account for fecal excretion
d) none of the above
e) both a and b

e- The standard is prepared using a percentage of the patient dose; therefore a dilution factor must be used. The same dose as given to the patient is not used because the standard is counted in a well counter so a lower count rate is necessary.

Beta emitters are effective for therapy because:
(a) They have a short range in soft tissue.
(b) They do not harm healthy tissue.
(c) They can be used for imaging as well as for therapy.
(d) They have short half-lives.

a- a beta particle with energy of 2 MeV has a range of about 1 cm in soft tissue. That means it will expand its energy locally, regardless of tissue type. Some beta emitters are not useful for imaging because of their short range, although higher energy beta emitters may be imaged, for example I131. half-lives varies according to the isotope; P32 has a half-life of 14.3 days, but Co60 has a half-life of 5.26 days.

What is the meaning of polycythemia?
a) an excess of WBC
b) an excess of platelets
c) an excess of RBC
d) an excess of plasma

c- Polycthemia means too many red blood cells. Polycythemia vera is a disease of the bone marrow which may be treated using P32 sodium phosphate.

Which of the following measure the amount of red cells in circulating blood?
a) red cell volume
b) hemoglobin
c) hematocrit
d) a and c
e) all of the above

d-red cell volume and hematocrit are measures are red blood cells in whole blood. Hemoglobin is a specific iron-rich protein that carries oxygen, so it does not directly measure the number of red blood cells. Hemoglobin may be decreased with or without a decrease in the number of red blood cells.

The normal life span of a red blood cell is _______days, following which it is removed from circulation by the __________.
a) 120, spleen
b) 60, spleen
c) 120, bone marrow
d) 60, bone marrow

a- Red blood cells or erythrocytes are produced in bone marrow, live for about 120 days, and are then phagocytized, mainly by the spleen. This is why damaged red blood cells, may be used to image the spleen.

Red blood cells are also known as:
a) leukocytes
b) erythrocytes
c) granulocytes
d) platelets
e) a and d

b- blood contains red blood cells, white blood cells, and platelets (thrombocytes). Red blood cells are erythrocytes, leukocytes are white blood cells, and granulocytes are a kind of white blood cells.

An empty syringe is used to draw 5ml of blood. After several minutes the blood appears separated into a liquid and a solid portion. The liquid portion is called:
a) serum
b) plasma
c) anticoagulant
d) none of the above

a- in the absence of the anticoagulant, the blood will separate into serum and clot containing cells and coagulation proteins.

The functions of WBC include:
a) ingestion of bacteria by phagocytosis
b) antibody production
c) producing cellular immunity
d) all of the above
e) b and c only

d- B cells initiate the production of antibodies, T helper cells mediate cellular immunity, and macrophages ( a kind of white blood cell) phagocytize pathogens.

A patient should be supine for at least 15 min before the start of a plasma volume determination because the plasma volume _______ when a patient is standing.
a) increases
b) decreases

b- plasma contains mostly water, with dissolved salts and proteins. In many patients, water will move from the blood stream into the extravascular space in the legs

If the dose rate measured at the bedside of a radioiodine therapy patient is 10 mrem/h, how long may a visitor (who is seated at the bedside) stay?
a) 8min
b) 12min
c) 20min
d) 33min

b- since the limit for exposure to nonoccupational individuals is 2 mrem/h we can use the formula below:

Total dose= dose rate x time
Rearrange to= Dose rate x time = total dose
10mrem/h x time= 2mrem
time= 2 mrem/(10 mrem/h)
0.2 h

a patient receives 45 mCi of I131 to treat thyroid cancer. A survey taken at 3 m immediately after administration of the dose reveals 60 mrem/h, how many mCi are left in the patient?
a) 15.5 mCi
b) 22.5 mCi
c) 35 mCi
d) 40 mCi

b- the formula below can be used:

Initial dose rate/ initial mCi= new dose rate/ mCi remaining
(60 mrem/h)/ 45 min= (30mrem/h)/mCi remaining
remaining= 30 mrem/h x 45 min/ 60 mrem/h
= 22.5 mCi

a patient advocate decides to question a patient undergoing radioiodine therapy regarding his or her opinion of the care provided. The dose at 1.5 m from the patient is 5 mrem/h, and it will take at least 30 min for her to interview the patient. What should be done?
a) have her sit 3 m from the patient
b) have her sit at 1.5m from the patient, and let a colleague take over questioning after 20 min
c) have her interview the patient the following day
d) any of the above

d- the exposure limit for nonoccupational individuals is 2 mrem/h. The dose rate is the question 5 mrem/h, so if she stays for one-half hour, she receives a dose of a 2.5 mrem. If her dose by 1/4th of the original, so she would receive 125. If she stays for only 20 min, she receives a dose of 1.7 mrem, and if she returns the nest day, she will receive much less because of the physical reducing the dose to meet NRC requirements. However, is reasonably achievable. So she should not interview the patient at all or wait as long as possible before performing the interview.

according to the Code of Federal Regulations, at what point may a patient who has undergone radioiodine therapy leave the hospital?
a) when another person is unlikely to receive a total effective dose of 0.5 rem or 5mSv from exposure to the patient.
b) if the remaining dose in the thyroid is less than 33 mCi
c) if the remaining dose in the thyroid is less than 35mCi
d) if the time spent in the hospital is greater than 4x the physical half life of the isotope
e) a and d

e- 10 CFR 35.75 states that the patient can be released if the total effective dose equivalent to any other individual from exposure to the released individual is not likely to exceed 5 mSv (0.5 rem) patients who have received < 33 mCi of I131 may be released.

Which of the following objects in a patient's room have potential to become contaminated from a patient who has received radioiodine?
a) tv
b) mattress
c) bathroom fixtures
d) all of the above
e) b and c

d- although bathroom surfaces are most likely to be contaminated, anything the treated patient comes in contact with has the potential to become contaminated.

Preparations for radioiodine therapy include:
a) NPO from midnight
b) screening for pregnancy or breast feeding
c) discontinuance of antithyroid drugs for 5-7 days prior to treatement
d) all of the above

d- all patients who are scheduled for nuclear medicine examinations or therapy should be screened for pregnancy and breast feeding. Radioiodine will be better absorbed if the patient has been fasting. Patients should avoid iodine- containing substances. thyroid hormones, medications that would interfere with iodine uptake into the thyroid, the necessary delay before imaging after stopping various medications varies and the SNM guidelines provide detailed information about this.

Which of the following are used to calculate the dose of I131 needed for administration in the patient with hyperthyroidism?
a) weight of the gland
b) percent uptake
c) presence or absence of nodules
d) all of the above

d- I131 therapy for hyperthyroidism takes into consideration weight of gland (about 15-20g) and the uptake. In general, 80-200 uCi of I131 per gram of thyroid tissue is desirable. One formula used to calculate dose is weight/24h uptake x 10 = dose of I131 in mCi.

a patient has a 6h thyroid uptake of 25% and receives a 20uCi dose of I131 for a thyroid uptake prior to radioiodine therapy. What will the concentration of activity in the patient's thyroid gland be at 6h if his thyroid 45g?
a) 11 mCi/g
b) 11 uCi/g
c) 0.11 uCi/g
d)1.1 uCi/g

c- the uptake is multiplied by the dose administered to find the amount of activity in the gland; this is then divided by the weight of the gland to find the activity/gram.
20 uCi x 0.25= 5 uCi
5 uCi / 45= 0.1 uCi/g

Which of the following make I131 suitable for therapy?
a) uptake in thyroid tissue regardless of function
b) alpha emissions
c) short half-life
d) beta emissions

d- I131 is a pure beta emitter; the beta emmision is responsible for the local effect of treatment. Radioiodine therapy depends on functioning thyroid tissue. I131 half life is about 8.06 days

Alternatives to radioiodine therapy for patients with hyperthyroidism are:
a) surgery
b) antithyroid drugs
c) thyroid storm
d) all of the above
e) a and b only

e- hyperthyroidism may be treated with surgery, radioiodine or drugs to disrupt the production of thyroid hormones. Thyroid storm is potentially a life-threatening condition requiring emergency treatment caused by excessive thyroid hormone; symptoms include high fever, increased heart rate and sweating.

The wash method of labeling red blood cells for the determination
of red cell volume involves repeated centrifugation
of the collected sample. The advantage of this technique
is that:
(a) Anticoagulants are unnecessary.
(b) Free chromate ion is removed.
(c) The use of expensive ascorbic acid is avoided.
(d) Less 51 Cr can be used.

b- during the wash method of red cell labeling the free chromate ion is removed and so is the possibility that they will label circulating red blood cells after reinjection of the labeled preparation. This is a major advantage to the method. Anti coagulant is still used in the initial blood draw, and the same amount of radioactive chromium is used as in the ascorbic acid method. It also negates the need for adding ascorbic acid to reduce the free chromate ion.

If a technologist mistakenly administers P32 chromic phosphate intravenously, what is likely to be the result?
a) the urine will be bluish green for about a week
b) severe radiation damage to the liver
c) hypothyroidism will occur within 1 yr
d) patient should flush toilet at least twice after use.

b- P32 chromic phosphate is a colloid and therefore will be phagocytized by the Kupffer cells of the liver if injected intravenously. Because it is a pure beta emitter, it will cause local radiation damage.

Discharge instructions for a patient who underwent therapy with I131 may include all of the following except:
a) patient is encouraged to increase fluids and void frequently
b) patient should avoid close contact with others
c) patient should collect excreta and store for ten half-lives
d) patient should flush toilet at least twice after use

c- patients need to continue efforts to decrease radiation exposure to others and themselves, including limiting contact with others, frequent voiding, and flushing multiple times after using the toilet. Patients do not need to collect and store excreta.

A survey taken at 1m from a patient who received 35mCi of I131 revealed a dose rate of 9 mrem/h. If the survey made 24h later shows 6.9 mrem/h, what is the remaining dose in the patient, and can he or she be discharged?
a) 27mCi, yes
b) 27mCi, no
c) 4.3mCi, yes
d) 4.3mCi, no
e) cannot be determined from the information given

a- 27 mCi, yes

The NRC required I131 therapy patients to have private rooms, although they may share with another I131 therapy patient.
a) true
b) false

b- the patient must have a private room with a private bathroom or share a room and a bathroom with another patient who also cannot be releases under 10 CFR 37.75

According to the NRC, records of dose rate measurements taken immediately after administration of radioiodine to therapy patients must be kept for:
a) 6 months
b) 1 year
c) 3 years
d) 5 years

c- the NRC requires that these records be kept for 3 yrs

After injection of I125 human serum albumin for determination of plasma volume, it is important to withdraw a small amount of blood into the syringe and reinject it, to ensure that the entire radioactive dose is administered.
a) true
b) false

b- because the injected dose volume must be determined by weighting the syringe before and after injection, one should perform the injection without rinsing the syringe with blood.

a patient who receives Sr89 chloride for palliation of pain from bone metastases dose not have to be admitted to the hospital.
a) true
b) false

a- because the patient dose is 40-60 uCi/kg, the dose is usually not high enough to require hospitalization.

Which of the following is used in the treatment of non Hodgkin's lymphoma?
a) Rb82
b) P32 chromic phosphate
c) Y90 ibritumomab tiuxetan
d) Sm153 microspheres

c- Y 90 ibritumomab tiuxetan is a monoclonal antibody used in the treatment of non-hodgkins lymphoma. Rb82 decays by positron emission and also electron capture and is used in PET imaging. P32 chromic phosphate is a beta emitter used for intracavitary therapy. Sm153 microspheres are being developed for radio synovectomy but not FDA approved at the time of writing.

Patients who have previously demonstrated allergic reactions to mouse proteins have an increased risk of allergic response to:
a) I131 tositumomab
b) Y90 ibritumomab tiuxetan
c) Sm153 lexidronam
d) a and b only
e) b and c only

d- Y90 ibritumomab tiuxetan and I131 tositumomab are labeled monoclonal antibodies produced using mouse cells and will likely cause an allergic response in those patients who have previously demonstrated allergy to mouse proteins.

To perform a thyroid scintigraphy, which of the following is
correct?
(a) If 99mTc pertechnetate is used, imaging can be obtained
at 24 h after tracer injection.
(b) If 99mTc pertechnetate is used, imaging can be obtained
after 2 h but before 24 h after tracer injection.
(c) If 99mTc pertechnetate is used, thyroid uptake can be
obtained either 2 or 24 h after tracer injection.
(d) If 99mTc pertechnetate is used, thyroid uptake can be
obtained 10 min after tracer injection.

d- when Tc99m pertechnetate is used for thyroid scintigraphy, the dose is higher and the radiation exposure is lower, the imaging is obtained 10min after injection and no special patient preparation is needed. However, no thyroid uptake ratio can be calculated.

To perform a whole body radioiodine scintigraphy for thyroid cancer, which of the following is not correct?
a) patient should be low iodine food for 5-7 days
b) patient should discontinue thyroid hormone replacement or have received thyrogen injection before the study.
c) pregnancy is an absolute contraindication of I131 is used.
d) breast feeding should be stopped and cannot be resumed for either I123 or I131 test.

d- breast feeding should be stopped and cannot be resumed if I131 is used. If I123 used, breast feeding can be resumed 1 week later

What is the half-life of radium-225 dichloride?
a) 11.4 days
b) 6h
c) 78h
d) 110min

a- half life is 11.4 days

Radium-225 dischloride is currently FDA approved for patients with what disease process?
a) metastatic lung cancer
b) metastatic thyroid cancer
c) metastatic prostate cancer

c- metastatic prostate cancer

How is radium-225 dischloride administered?
a) IV
b) intrathecal
c) orally
d) inhalation

a- intravenous injection

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