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40 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which of the following pairs are being used simultaneously studying gastric emptying of both liquids and solids?
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99m-Tc sulfur colloid scambled eggs and 111 In DTPA
To simultaneously image gastric emptying of liquids and solids two radionuclides are neccessary. - The most common practice is to use Tc-99m sulfur colloid with whatever solid mean is preferred and along with In 111 in liquid |
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Question 2
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p.g 93
Shows the stomach being outlined by regions of interest for the purpose of calculating the % of emptying over time |
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Which of the following can be radiopharmaceuticals can be used to study the spleen
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-51 Cr labeled damaged red blood cells
- 99mTc labeled damaed RBC - 99m Tc sulfur colloid - all of the above - b and c only |
all of the above
- damaged RBC are removed from the circulation by the spleen, so tagged damaged RBC as well as tagged colloids can be used to image the spleen |
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How is a radopharmaceutical adm. when a LeVeen shunt is evaluated
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- by intravenous injection
- by intraperitoneal injection - by subcutaneous injection - by intrathecal injection |
- by intraperitoneal injection
A LeVeen shunt ascites from the peritoneum to the superior vena cava... therefore the radioisotope is injected into the peritoneal space |
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peritoneal
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the serous membrane lining the cavity of the abdomen and covering the abdominal organs.
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The ejection fraction of the GB can be evaluated
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-cimetide
- dipyridamole - cholecystokinin - dobutamine |
cholecystokinin
CCK is a hormone secreted by the duodenum, that causes the gall bladder to contract and secret bile. Sincalide is a synthetic form of CCK that can be used before radiopharm. injection in patients who have fated for extended period of time. It also used to determine gallbladder ejection fraction and normal is any number above 50% |
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If no GB is seen at least one hour following injection of 99m-Tc DISIDA, what should be done?
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-cimetide should be done
- images should be taken at 24 hours -images should be taken at 4 hours - the exam should be ended |
images at 4 hours
- Patients should fast 2-4 hours before HIDA scan. The GB may not be visualized in patients who have recently eaten and in patients who have fasted for extended periods of time. The use of morphine can hasten visualization of the GB by increasing bile flow to the GB relative to the intestine. Sincalide may also be used which is the usally done. If there is no GB seen one hour following injection of the radiopharm. delayed images should be obtained. |
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While performing a liver scan with sulfur collid, the tech. notices that lung uptake is present. Why?
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- free pertechnetate in the sulfur colloid preparation
- too much Al3+ ion in the pertechnetate that was used for labeling - lung metastases - patient being injected in the supine position |
too much Al +3 ion the pertechetate that was used for labeling
- Lung activity on a liver/spleen scan using sulfur colloid may be the result of clumping of particles, a particle that is too large or too much Al+3 ion in the technetium used to prepare the kit. |
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The function of a LeVeen Shunt is to
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- treat hydrocephalus
- drain peritoneal fluid into the inferior vena cava -drain peritoneal fluid into the superior vena cava -divert CSF flow |
- drain peritoneal fluid into the superior vena cava
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A technologist receives a request to perform a scan with 99Tc albumin colloid to rule out acute cholecystitis...What should the tech. do next?
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- check if albumin colloid is available
- alert the nuclear medicine physician to the problem - change the order to Tc-99m IDA - perform the study as ordered |
- alert the nuclear medicine physician to the problem
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When performing a SPECT STUDY of the liver & spleen, the camera should be positioned:
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- so that the costaal margin is at the bottom of the detector face
- so that it touches the left side of the patient when rotating - so that it touches the right side of the patient when rotating - as close as possible but without touching the patient during rotation. |
- as close as possible but without touching the patient during rotation.
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Radiocolloids are cleared from the circulation by
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liver parenchymal cells
hepayocytes kupffer cells hemangiomas |
kupffer cells
- Radio-colloids are cleared by the liver's Kupffer cells also by the spleen and the bone marrow. In certain hepatic conditions, colloid shift may be present; this manifests as greater clearance by the spleen and bone marrow relative to the liver |
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Which is commonly used to image cavernous hemangioma ( begin blood tumor of blood vessel) ?
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99m-Tc albumin colloid
99m-Tc RBC 99m-Tc IDA 99m- Tc pertechnetate 99m-Tc sulfur colloid |
99m-Tc RBC
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Colloid Shift refers to:
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- small colloid particles clumped together to form large particles which localize in the lungs
- 99m-Tc sulfur colloid changing into albumin colloid - increased uptake of colloid in the spleen and bone marrow relative to liver - the redistribution of colloid within the liver over time |
increased uptake of colloid in the spleen and bone marrow relative to liver
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Which of the following does not involve the use of labeled RBC?
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- blood pool imaging of the liver
-GI bleed -spleen imaging -Meckel's divertivulum - both a & d |
Meckel's divertivulum
- 99 Tc is taken up by the gastric mucosa Meckel's diverticulum is a congenital out-pouching of the intestine which may contain ectopic gastric mucosa. |
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Cimetidine
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- prevents the gallbladder from contracting
- prevents the release of pertechnetate from gastric mucosa - increase uptake of pertechnetate in the gastric mucosa - decreases persistalsis |
prevents the release of pertechnetate from gastric mucosa
Cimetidine = inhibits the release of Tc from the gastric mucosa. It may be adm. to patients 2 days prior to performing an exam to improve sensitivty of dectection of Meckel's diverticulum |
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The approximate time for half of the activity to empty from the stomach during a solid phase gastric emptying exam is:
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25 min
40 min 90 min 180 min |
90 min
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Esophageal reflux studies are usually performed with both solid and liquid phases
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true
false |
false
Esophageal reflux studies use a radiopharmaceutical in liquid phase. |
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Which imaging study is acquired while an abdominal binder is inflated to increasing pressures?
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- Meckel's diverticulum
- gastric emptying study - esophageal transit study - esophageal reflux study - gastointestinal bleeding study |
esophageal reflux study
- It involves an abdominal binder to increase pressure over time while imaging. This pressure, together with the supine positioning, and all the addition of acid into the radiopharm. all seek to provoke reflux. |
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An appropriate adult dose and radiopharmaceutical for a Meckel's diverticulum is
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10 mCi of Tc-99m pertechnetate
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If 15 minutes after injection of 8 mCi of 99m-Tc disofenin, the liver is not visualized, but the heart and kidneys are....what is the most likely reason?
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- too little DISIDA was injected
- the liver is not functioning properly - the GB is obstructed - the patient is taking morphine - the patient has very low bilirubin level |
the liver is not functioning properly
IDA's or iminodiacetic acids are cleared from the blood by the hepatocytes before they are secreted. If the liver is not seen but there is cardiac and renal activity 15 minutes after injection, this is likely due to a liver problem function |
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A patient with a bilirubin level of 35mg/dL is scheduled for hepatobiliary imaging....the best isotope to use is
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Tc-99m pertechnetate
Tc-99m disofenin Tc-99m mebrofenin Tc-99m sulfur colloid Tc-99m labeled RBC |
Tc-99m mebrofenin
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A synthetic form of cholecystokinin is
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- glucagon
- cimetidine -pentagastrin -sincalide -mebrofenin |
sincalide
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What are possible effects on a hepatobiliary scan if the patient has eaten 2 hours before the study?
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- a false positive
- non-visualization of the gallbladder within an hour - intermittent contraction of the gallbladder - all of the above - a & b only |
all of the above
If there is insufficient fasting, radiopharm may not be able to enter the gallbladder, resulting in a false positive. |
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question 24
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page 99
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Is the ejection fraction withing the normal range from question #24?
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no
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What will be visualized withing the 1st hour of a normal hepatobiliary scan?
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- common duct
- gallbladder - duodenum - all of the above - a and b only |
all of the above
- Within an hour, a normal HIDA scan with 8mCi of 99mTc- DISIDA is expected to show the liver, the common bile duct, the gallbladder and the small intestine |
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Choleckystokinin or CCK is a hormone secreted by the duodenum that stimulates the GB???
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true
false |
true
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Morphine given during an hepatobiliary scan can?
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- constrict the sphincter of Oddi
- enhance gallbladder filling - shorten the study time - all of the above - b and c only |
all of the above
- As morphine enhances the muscle tone of the sphincter of Oddi, pressure will increase in the bile ducts and may result in gallbladder filling. This may also be an alternative to delayed imaging. |
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Sulfur colloid is best for gastrointestinal bleeding studies if
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- bleeding is intermittent
- bleeding is active - the bleeding is in the right upper quadrant - delayed images will be planned - none of the above |
bleeding is active = this is what we always did at Rahway
99 Tc-m sulfur colloid is rapidly cleared from the blood steam and the patient must be actively bleeding while sulfur colloid is intravascular for the bleed to be seen. Delayed images is therefor not possible but repeat studies can be undertaken within a relatively short time. |
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Which if the following would not be useful in further examining a suspicious area of activity when evaluating a patient for lower GI bleed with 99-m Tc labeled RBC
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- delayed imaging to visualize a change in configuration of the activity
- delayed imaging to visualize increasing activity - use of cine mode -anterior obliques - none of the above |
none of the above
- the use of cine mode, oblique imaging and delayed imaging are all useful in the detection of GI bleeds when using 99-mTc labaled RBC |
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Pottassium perchlorate should not be adm. pediatric patients undergoing scanning for Meckel's diverticuum with 99-mTc pertechnetate
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true
false |
true
see explanation on page 254 #31 |
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Which is the method of choice for labeling red blood cells with 99-mTc if the goal is to have the least amount of free pertechnetate in the resulting dose
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- initro
- invivo - modified invivo - the amount of free pertechetate will be the same in all cases |
invitro (labeling outside the body)
labeling the cells in vitro will result in the highest labeling efficiency i.e the least amount of pertechnetate. Free Tc. will cause increased activity in the kidneys and gastric mucosa and may interfere with image interpretation. |
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Why is the labeling efficiency important for imaging of GI bleeding with Tc- RBC?
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- a small decrease in labeling efficiency may lead to a false negative result
- if the patient is actively bleeding, the isotope must be prepared as quickly as possible - 99 m-Tc will be taken up by the Kupffer cells - free pertechnetate is secreted by the stomach and the kidneys |
free pertechneate is secreted by the stomach and the kidneys
Poor labeling efficiency such as in in-vitro will cause free TC to be present and will cause increase activity in the kidneys and gastric mucosa and may interfere with image interpretation |
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When performing a gastric emptying study, it is important to scan the patient in the erect position to promote empyting?
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true
false |
false
- the patient is imaged supine using continuous dynamic acquisition. However, if it is not in a dynamic acquisition the patient can sit up between images since position can affect emptying |
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Which of the following does not require any fasting prior to the examination?
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gastric emptying scan
hepatbiliary scan esophageal scan gastroesophageal reflux scan gastrointestinal bleeding scan |
gastrointestinal bleeding scan
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Symptoms of cholecystitis may include
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pain in the right upper quadrant
back pain nausea all of the above a & c only |
all of the above
- symptoms of both acute and chronic cholecystitis include nausea and pain, which can be limited to the abdomen, but sometimes extends to the back and right scapular area. |
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In order to reach the duodenum, bile must pass through the gallbladder
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true
false |
false
-Bile is produced in the liver and then enters the biliary canaliculi. From there approximately 2/3 of bile bypasses the gallbladder and enters the duodenum. The remaining bile is stored in the GB until it is needed and secreted |
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question 38
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page 102
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Urea normally leaves the body in
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in the urine
in the stool as exhaled carbon dioxide when 13C has decayed to background levels |
in the urine
Urea is produced in the liver as result of the break-down of ammonia from protein, and is reabsorbed from blood in the kidneys before being exerted in the urine |
