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48 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Name the 3 radiopharmaceuticals used in skeletal imaging
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Tc99m PYP pyrophosphate
Tc99m HDP oxidronate (hydroxyethelen diphosphonic acid) Tc99m MDP medonate (methylene diphosphonic acid) |
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On a normal bone scan where does a high degree of uptake occur?
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sacroilliac joints, hip joints, glenoid fossa, acromioclavicular joints, sternoclacicular joints, ends of long bones, growing epiphyses, vertebral column
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How should the patient be prepared prior and after scan?
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well hydrated - 2-3 glasses of water between injection and imaging; urinate prior to imaging. drink and urinate as much as possible 4-6 hrs after. breast feeding discontinued 24 hrs after
verify orders and explain procedure question females of child bearing age |
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What is a whole body scan done for?
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Tumor evaluaton
Increased alkaline phosphatrase Hyperparathyroidism Paget's disease |
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Name the 4 type scans that are done in skeletal imaging?
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3 phase bone scan
Whole body bone scan Limited bone scan SPECT |
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What is limited bone scan for?
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specific site pain for unknown etiology
chronic pain |
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What are the 3 parts of a 3 phase bone scan?
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Flow study (dynamic acquisition)
Immediate blood pool Delayed images (planar) |
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Name some reasons a 3 phase scan would be done?
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Osteomyelitis (infection of bone)
Acute fracture Stress fracture Reflex sympathetic dystrophy (RSD) Prosthetic loosening |
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For a whole body (WB) scan what are the general protocols for time delay, speed adjustment/counts, dosage and matrix to get the best image?
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25 mCi Tc99m MDP
2hr delay 12 cm/min 512x512 or 512x1024 |
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When doing spot images after a WB scan how many counts do you need for each of the following: 1. pelvis, spine, chest 2. skull and 3. extremities
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1. pelvis, spine and chest - 1 mil
2. skull - 700k 3. extremities - 500k |
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What is important to consider when imaging a specific anatomy of interest?
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Make sure the image is zoomed in enough to include the anatomy of interest and not so far out to make rendering a diagnosis impossible
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What scan best demonstrates fractures and trauma?
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3 phase bone scan
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When doing a bone scan what are we looking for?
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Hot spots which indicate activity
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Generally speaking what are the radiopharmacuticals called when tagged for bone scanning and how do they work?
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they are called calcium analogs, the body sees it as calcium and has a special affinity for areas of altered osteogenesis (healing, changes in bone, etc that require calcium)
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Generally speaking when injecting with PYP, HDP or MDP how long do you have to wait before imaging?
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2-4 hours is prime imaging range where dose is localized in the bone
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What are some of the possible hypersensitivity adverse reactions to PYP, HDP or MDP?
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itching, skin rashes, hypotension, fever, chills, nausea, vomiting and dizziness
what percentage of people get a reaction? |
less than 1%
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Why do we see some bones better than others?
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size and shape of the bone, bones that are closer to the camera, the thicker and closer the bone the better we will see it. soft tissue attenuation also blocks image as well
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What is the correct scan?
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Giving the radiologist what they need
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It is essential to include the arms in a whole body bone scan?
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Not absolutely, better if you do, but if there is pain or etiology in the arm a separate specific scan will be done
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What is a "zipper" on an image?
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on older smaller view cameras the sweep would not get the whole body longitudinally and then would have to be stitched together
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What is the purpose in doing a 3 phase bone scan?
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phase 1 flow will show immediate osteogenesis taking place that is more acute. phase 2 will show blood pooling in that area, if less acute phase 1 will be negative but 2 positive. phase 3 , delayed image shows uptake in the bone backing up acute condition if 1 & 2 were positive; if 1 & 2 were negative and 3 positive than that indicates a chronic condition (fx can show up for a year) what does it indicate if only 1 & 2 positive and 3 negative?
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soft tissue uptake only
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Is static the same as a planar image?
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yes the terms are used interchangeably
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What is the 'squat" shot and what is it done for?
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Pt sits on edge of table, camera below shooting straight up. done to move bladder out of the way
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What is a superscan?
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when there is so much uptake in the whole skeletal system you cannot see the kidneys. Can indicates widespread metastases or healing
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How can we tell what hotspots indicate?
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by the pattern they leave. metastases will be random, fx will be in a pattern indicating fx, in joints-arthritis, etc
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On a 3 phase study what does it indicate when phase 1 and 2 are positive and 3 is negative?
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soft tissue inflammation only, no uptake on delayed phase 3 image
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What is a bolus injection on dynamic flow study?
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take a small amount of isotope and inject quickly, flush with saline, start image and release tourniquet
Where is this usually done on the body? |
mostly on extremities, if done on thoracic cavity the heart and lung vascular system will be in the way
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What is possible 4th phase on a 3 phase study?
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waiting 24 hrs for another scan
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How do most facilities orient feet and hands when done by themselves?
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hands up, and feet down
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What happens when there is a kit breakdown from the pharmacy?
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There is now free technetium in the body which does not go where it is supposed to. fuzzy image with uptake to thyroid and stomach
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Epigraph
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A saying or statement on the title page of a work, or used as a heading for a chapter or other section of a work.
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What is a non-osseous uptake?
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something other than bone that can cause a hot spot, renal cyst, soft tissue metastases, cardiac, calcifications or artifacts: contamination, radiopharaceutical, extravasation
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what would cause uptake in the lungs during a bone scan?
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Idopathic pulmonary hemosiderosis
improper radiopharmaceutical prepartion malignant plural effusion metastic calcifications hypercalcermia |
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What happens when the gamma camera is set at wrong energy peak?
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image is fuzzy as it is not recording output at its peak but recording scatter radiation
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What are the proper trouble shooting steps when image doesn't look right?
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1. right isotope?
2. right setting? 3. right collimator? |
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What is renal hydronephrosis and how can it interfere with bone study?
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stenosis of ureters in kidneys causing obstruction and poor out flow of isotope so kidneys are too hot. pt may complain of back pain if this is the case
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What would cause cardiac uptake when doing a bone scan?
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hyperparathyroidism
myocardial contusion myocardial infarct when using PYP |
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What problem does calcification represent?
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uptake in area other than bone, like costal cartilage, scar tissue, hx breast cancer
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What is the concern when a pt has nephrostomy drains?
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they need to be moved out of the way as they will block bones
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What problem can happen on image when there are muscle contusions?
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uptake in muscles instead of bone
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What problems can anti-inflammatory injections present on an image?
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uptake in soft tissue instead of bone uptake
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Drug interactions can cause what problems?
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any drug with potassium or sodium phosphates causes saturation so MDP does not have any uptake
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Why should urine contamination be avoided?
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Urine will be hot and if it gets on pt's clothes it will show up
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When contamination takes place what can it be mistaken for?
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metastases
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What actions should be taken to avoid contamination?
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use gauze at injection site and exercise caution when withdrawing needle
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What is extravasation and what problem does it cause?
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infiltration of dose outside of vein, causes lymph node uptake and errant hot spots
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In the event you inject pharmaceutical into artery what would happen?
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there would be uptake in soft tissue
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Can a pregnant woman ever have a bone scan done?
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Yes, in the case of a woman in the third trimester chemotherapy has been deemed safe so scan can be done. Baby will only receive about half a rad, most rad will come from mother's bladder
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