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68 Cards in this Set

  • Front
  • Back
nuclear medicine pharmaceuticals
quality assurance for radiopharmaceuticals
generator
aluminum bkthg < 10ug/ml
molybdenum bkthg <0.15 uci/1mci of tc99m
Mo bkthg determined by counting the eluate in a well counter without and with a lead shield

radiochemical purity
determined by thin layer chromatography
free tco4 migrates in saline and methanol
tc99m migrates in saline only
vq mismatch
pulmonary embolism
vasculitis, radiation therapy, wegeners, autoimmune
tumor compression of PA
pleura effusion
radiation therapy
hypoplastic PA
PE causes
venous thrombus (most common)
fat embolism
tumor embolism
amniotic fluid embolism
parasites,esp schistosomiasis
talc embolism in IV drug use, widespread micronodular dz of lungs
oil embolism from ethiodol following lymphangiogram
mercury embolism
air embolism
matched vq defects
any primary pulmoary parenchyma abnormality may result in 2ndary arteriolar constriction causing vq defect

consolidation, pneumonia, edema
copds
atelectasis
tumor
bullous disease
pneumonectomy, surgery
pneumonia
enlarged hilar nodes
edema
fibrosis
pulmonary infarction
decreased perfusion in one lung
embolus
pneumothorax
massive effusion
tumor
pulmonary agenesis or hypoplasia
swyer-james syndrome
false negative thallium studies
submaximal exercise (high splachnic uptake)
noncritical stenosis (<40%)
small ischemic area
coronary collaterals
multivessel disease
medications
blunted cardiac response to exercise-beta blockers, calcium channel blockers, digoxin)
altered myocardia extraction (furosemid, lidocaine, dipyrimadole, dexamethasone, isoproteranol)
false positive thallium
any cardiomyopathy
aortic valve stenosis
mitral valve prolapse
left bundle branch block
infiltrative cardiac disease (sarcoidosis, chagas disease, amyloidosis)
paradoxical septal movement
septal ischemia
previous cardiac surgery
rv overload
lbbb or pacer placement
pyrophosphate uptake
MI
unstable angina
lv aneurysm
cardiomyopathy
valvular calcification
any cause of myocardial injury
contusion or surgery
cardioversion
myocarditis
pericarditis
gb not visualized on HIDA
give morphine to increase pressure or cholecystokinin to contract GB
acute cholecystitis
prolonged fasting
recent meal
biliary system not visualized on HIDA
biliary atresia
long-standing bile duct obstruction
low hepatic activity, renal activity on HIDA
severe hepatocellular disease
neonatal hepatitis, pt. can be pretx with phenobarbital 5mg/kg for 5 days
bowel not visaulized on hida
choledocholithiasis
ampullary stenosis
abnormal tracer collections on HIDA
bile leak
choledochal cyst
caroli's disease
duodenal diverticulum
false negative HIDA
duodenal diverticulum simulating GB
accessory cystic duct
false positive HIDA
recent meal in 4 hours
prolonged fasting, ICU patients, parenteral nutrition
pancreatitis
hepatocellular dysfunction
right lower lobe pneumonia
cholangiocarcinoma involving cystic duct
focal liver uptake with tc99m sulfur colloid
FNH
regenerating nodule
budd chiari syndrome (hot caudate lobe)
vena cava obstruction (umbilical vein delivery to segment 1)
bleeding studies
uptake conforming to bowel with no change over time-IBD, faulty labeling with free tech excreted into bowel

uptake conforming to bowel with progressive accumulation over time-hemorrhage

upatke not conforming to bowel, aneurysm
RLQ activity on meckel scan
meckels diverticulum or other duplication cysts with ectopic gastric mucosa

renal (ectopic kidney, ureteral stenosis)

very active bleeding sites
tumors
IBD
rapid gastric emptying
postoperative-BI, BII
peptic ulcer disease, ZE syndrome
drugs-erythromycin, metoclopramide, domperidone
sprue
vagotomy with distal partial gastrectomy
delayed gastric emptying
diabetes
hyperglycemia
acidosis
ileus
chronic gastritis
chronic ulcer disease
drugs-opiates, antacids, gastrin
focal renal defects
tumor-solid, cystic
infections-abcess, cortical scarring
congenital-duplex system
trauma
vascular-complete stenosis
focal hot renal lesions
collecting system
urinary leak
cross-fused ectopia
horshoe kidney
dilated ureter or collecting system
reflux
obstructed ureter
delayed uptake and excretion
prerenal (unilateral, poor flow and uptake)
arterial stenosis
venous thrombosis

renal (bilateral)
ATN, normal flow, poor uptake
glomerulonephritis, poor flow and poor uptake
chronic renal failure

postrenal
obstruction-dilated calyces
nonvisualized kidney
nephrectomy
ectopic kidney pelvis, fused ectopia
renal artery embolus
renal artery occlusion
testicular anomalies
decreased uptake
torsion
orchiectomy
increased uptake
ochioepididymitis
ring sign
late torsion
tumor
abscess
traume
focal hot bone lesions

TIC MTV
tumor
inflammation
osteomyelitis
infectious, inflammatory, metabolic arthritis

congenital
osteogenesis imperfect
TORCH
metabolic (usually diffuse, multifocal)
marrow hyperplasia
pagets
fibrous dysplasia

trauma
stress fracture, avulsion injuries
osteonecrosis
sudecks dystrophy
total hip replacement
child abuse

vascular
sickle cell (infection vs infarcts)
focal cold bone lesions
mets most common 80%
multiple myeloma, lymphoma
renal
thyroid
neuroblastoma
primary bone lesions
unicameral bone cyst, ABC, EG
vascular
infarction (acute)
aseptic necrosis (early)
radiation therapy (endarteritis obliterans)

artifact
overlying pacemaker, barium, jewelry
superscan

diffuse high bone uptake, diminished soft tissue and renal activity, high sternal uptake (tie sign), increased uptake at costochondral junction (beading)
mets
prostate mets (most common)
lung cancer
breast
metabolic
hyperparathyroidism
renal osteodystrophy
osteomalacia
pagets diseaes (hot and cold lesions are typically combined)

myeloproliferative diseaes
myelofibrosis (large spleen)
diffuse periosteal uptake (tram track sign)
bilateral diffuse periosteal uptake

hypertrophic osteoarthropathy (lower extremity>upper extremity)
child abuse
thyroid acropachy
extraosseous activity

normally kidneys and bladder are only organs are apparent on bone scan
increased soft tissue activity

renal failure
radiotherapy ports
myositis
myositis ossificans
dermatomyositis
rhabdomyolysis
tumors with calcifications
kidney
focal
obstruction
calcifying mets
radiation to kidney
rcc
diffuse
obstruction
dehydration
mets
rcc
chemotherapy
thalassemia
iron overload
pyelonephritis
breast
pregnancy, lactation
inflammatory breast lesions
steroids
stomach, GI
free tech
hyperparathyroidism
bowel infarction

liver
mets
simultaneous/prior administration of sulfur colloid
diffuse hepatic necrosis
elevated serum aluminum levels
colloid formation
hepatoma
amyloidosis

spleen
blood dyscrasia
chest
cardiac infarction
lung tumors
other
urine contamination
diffusely increased thyroid uptkae
>30% uptake, enlarged gland, pyramidal lobe

graves diseaes (usually hyperthyroid)
early hashimoto's thyroiditis (usually euthyroid)
rare
iodine starvation
thyroid metabolism anomalies
diffusely decreased thyroid uptake
nonvisualized gland or low uptake, salivary glands may show high uptake because of adjusted windowing

thyroiditis
painful (subacute granulomatous, deQuervains disease)
painless (subacute lymphocytic)
late hashimoto's disease

medications
thyroid hormone therapy
iodine
iodinated contrast agents
vitamin preparations
lugols solution
PTU
Tapazole
Thyroid ablation
surgery
I131
heterogenous thyroid uptake
enlarged gland (goiter), hot and cold areas

multinodular goiter
multiple autonomous nodules
hashimoto's thyroiditis
cancer
cyclotron or accelerator produced radionuclides
used for production of Ga67, I123, 201Tl, F18
fission produced radionuclies
I131, 99Mo, carrier free
pet rubidium generator
81Rb
99Mo breakthrough test

NRC limit

USP limit
1 microCi 99Mo per mCi 99mTcm

0.15 microCi 99Mo per mCi 99mTc
Mo shield test
allows 740 and 780 KeV 99Mo photons to be measured by dose calibrator but blocks 140 KeV
Mo chemical test
reaction of Mo and phenylhydrazine will form colored complexes on eluate
Al3+ breakthrough test
degrades image quality

nrc limit

20 microgram per ml eluate from thermal activation generator

10 microgram per mL of eluate from fission generator

chemical evaluation-standard test kit measures Al ion colorimetrically on special test paper strip containing aluminum reagent
other impurities

hydrolyzed reduced Tc
effect RES uptake, poor image quality, increased radiation dose

limit <2%
Tc99m eluate other parameters
pH 4.5-7.5

other nonparent radionuclide impurities

eluate-sodium chloride USP grade

pyrogenicity and sterility precautions
radiochemical purity
chromatography
radiopharmaceutical sterility and pyrogenicity
limulus lysate for pyrogens

culture for sterility
gamma camera qc
intrinsic/extrinsic uniformity

spatial resolution-daily, variable pattern phantoms

linearity-daily, parallel line equal spacing phantom and other phantoms

energy resolution-6 months

sensitivity-monthly

temporal resolution-6 months

energy registration-6 months

accessory devices-6 months

center of roration (SPECT), monthly
PET systems
detector material-BGO, LSO, GSO, NaI
major isotopes for PET-f18, n13, o15, c11

generator isotopes, Ga68, others
units of dose
absorbed dose

1 rad 0.01 gray
100 rad 1 gray

dose equivalent
1 rem 0.01 sv
100 rem 1 sv
activity measurements
1 mCi = 3.7 MBq

1 curie = 3.7 x 10^10 distintegrations/second

1 bequerel = 1 distintegration/second
signage requirements
unrestricted area: <2 mrem/hr and <100 mrem over 7 consecutive days

more than this control required
radiation area sign
>5 mrem/hr at 30 cm from source
high radiation sign
>100 mrem/hr at 30 cm from source
badge requirements
personell likely to receive > 10 % of occupation dose limits

any minor or pregnant female likely to receive more than 100 mrem (1mSv)

TLD or other device on upper torsa

ring dosimetry
acceptance and monitoring packages
monitor external surface of labeled package for radioactive contamination (>6600 dpm 300 cm2)

monitor for external radiation levels of a labeled package
-radiactive yellow white I- max 0.5 mrem/hr

radioactive yellow II-max 50 mrem/hr

radioactive yellow III-max 200 mrem/hr

if contamination or radiation level >200 mrema/hr or 10 mrem at 1 m, notify delivery carrier and NRC or state by telephone
public dose limit
100 mrem effective dose equivalent
annual occupational
5 rem effective dose to body
15 rem to the eye
50 rem to any organ or tissue
fetal
500 mrem during pregnancy
doses to visitors
500 mrem for all visits to hospitalized patient
doses at 1 meter from patient (tc99m)
tc-99m 20 mCi (740 MBq)

0.9 mrad/hr at 0 time
0.35 mrad/hr at 3 hrs
doses at 1 meter from patient (th201)
10 mCi (370 MBq)

2.0 mrad/hr at 0 time
doses at 1 meter from patient (f18)
10 mCi (370 MBq)
-30 mrad/hr at 0 time
5 mrad/hr at 1 hr
doses at 1 meter from patient (I131)
cancer tx 100 mCi (3.7 GBq)
-22 mrad/hr at 0 time
12 mrad/hr at 12 hours
-1.8 mrad/hr at 72 hours
release of radioisotope therapy patients
release on calculations- not likely to exceed 500 mrem to any other individual

if dose to other >100 mrem written instructions to minimized dose to others

relased based on retained activity-<33 mCi of I131, no limits for Sr-89, P-32, or Samarium 153

general instructions-avoid pregnant people for 2 weeks, stay away from people by about 1 m for 5-7 days
breast feeding
f18-none
tc99m 0-24 hours
gal, indium 1-4 weeks
i131 stop
major spill
100 mCi Tc99m, TI 201
10 mCi Ga-67 or I-123
1 mCi I-131, Sr-89
major spill actions
call RSO, do not clean up. clear and secure area, cover spill, radiactive signage, potentially shield, decontaminate persons