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46 Cards in this Set

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Instances when the amount of particles would be reduced for a patient.


Pediatric




Pulmonary Hypertension




Right to Left Heart Shunt

Why does PE show as a wedge shaped defect on a scan?

Because bronchi usually branch off in a tree shaped form, so when one is blocked the rest of the bronchiole and alveoli will not show up on our images.
What exactly is occurring when a patient has a R - L shunt and what does that have to do with perfusion lung scan?

Right to Left shunt is when blood moves from the right side of the heart to the left side of the heart, if we give the full does we will increase particle flow to the kidney brain and stomach.

When taking images for ventilation scan using Xe133 and 99mTC DTPA aerosol - identify two differences.


Aerosol- 8 views - nebulizer - can perfrom in any room




Xe133 - mask - zero pressure room - only one view

Tachycardia

increased heart rate. usually above 100bpm

Dyspnea


difficulty breathing - SOB




Infarction

area of dead tissue - no blood supply

Embolism

obstruction in a blood vessel

Peripheral occlusion

obstruction or closure of the outer part of an organ or vessel

Pleuritic

Pertaining to the membrane surrounding the lungs
Hemoptysis

coughing up blood
Syncope

fainting

Orthopnea

Hard time breathing when laying flat

DVT

deep vein thrombosis

Right to Left Shunt

Small hole that allows blood to flow from right side of heart into left side of heart
Pulmonary hypertension

High blood pressure in pulmonary arteries

Congestive Heart Failure

heart isn't pumping properly resulting in the insufficient supply of blood and oxygen to the cells in the body. Also can interfere with the movement of bodily fluids.
Three important steps to take when injecting a patient with MAA

1. Agitate vial


2. Lay patient supine and have them take deep breathes before and after


3. limit blood draw back

What is the purpose for a XR in the diagnosis of PE.

Just to suggest the presence of PE

What is a pulmonary embolism

Blockage of a pulmonary artery in the lungs by a blood clot or other foreign matter like fat or tumor.
Most common symptom of PE


dyspnea and pleuritic chest pain




Diagnostic Tests that can be performed to evaluate PE.
Spiral CT, V/Q scan, chest XR, blood test, angiogram, MRI

PIOPED

Prospective Investigation of Pulmonary Embolism Diagnosis, designed to evaluate effective diagnostic techniques of PE.

Why aren't angiograms performed on all patients?


Very invasive and has a high morbidity rate.


- vessel damage, kidney failure, contrast allergies


Advantages of MRI for PE


No radiation and no contrast



Disadvantages of CT for PE


high radiation


contrast required


holding breath required


What is the particle size for MAA?

10-90um

What is the treatment for PE?

Blood thinners - heparin, coumadin

What is the brand name for MAA?

Technescan

What preservative is added to MAA vial?

NONE

What is the particle size found in MAA vial?


10-90um




How long does it take the particles to reach the lung once injected?

1 -- 5 minutes

Where will the particle smaller than 10 microns end up once injected?

The reticuloendothelial system ( spleen, bone marrow and liver)
What happen to the particles after they have been in the lung for awhile?

They start to erode and pass to the reticuloendothelial system.
If a patient has shunt will we see MAA in the lungs?

If the shunt is working correctly we WILL see it in the lungs.

If a patient has a R-L shunt what will happen to the particles?

They will mix with peritoneal fluid they cleary rapidly or slowly into the blood system.
What must 99TC not contain!

oxidizing agents

What will happen if the vial or syringe sits for awhile?

Particles will settle and become non homogenous, resulting in a non uniform distribution of RRX in the lugs so it must be mixed, after 8 hours you shouldn't use it at all.
What are the two things that are done to prevent the particles from clumping any further.

Protect from air - swirl - don't use after 8 hours - don't mix with blood.
What is the critical organ for lung imaging?

LUNG

Once 99mtc is added to the vial what needs to be done?

Agitate for a few seconds and let sit at room temp for 15 min.
What is the recommended adult does of MAA?

1-4mci

What is the max activity that can be added to a vial?


What is the minimum volume that 99mTC can be?


What is the average particle size for MAA?

10-90 um

What happens to particles after thy have been