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71 Cards in this Set

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Nucs QC

Limit for Al breakthrough?

Limit for 99Mo contamination?
Al breakthrough
<10 microg / mL

99Mo contamination
<0.15 microCi 99Mo /1 mCi 99mTc
Nucs QC
How often check
-Gamma-Camera Peaking
-Gamma-Cam Energy Resolution
-Extrinsic field uniformity
-Bar phantom
-Field uniformity
-Center of Rotation
-Jaczak phantom
Gamma-Camera Peaking - Daily
Gamma-Cam Energy Rez - Daily
Extrinsic field unif - Daily
Bar phantom - Weekly
Field uniformity - Monthly
Center of rotation - Monthly
Jaczak phantom - Quarterly
Morphine dosing and administration
- 0.04 mg/kg IV over 3-5 min, max 4 mg
- Causes functional obstruction
-do not give until SB visualized
CCK dosing and administration
- For GB EF, .02-0.04 microg/kg IV in 10 mL saline, injected slowly
- may also give if SB not seen (relaxes sphincter of Oddi)
Lasix dosing for renal nucs study
0.5 – 1 mg/kg IV over 1 min

at 15 min. post-injection 99mTc-MAG3
If suspect biliary atresia, what can be done prior to study?
Phenobarbital 5 mg/kg/dy for 5 dys before study
Diamox dosing and administration
1 gm IV before Cerebral Perfusion study
Captopril dosing for renal scan
25-50 mg PO, 1hr. before imaging
BP should be measured q15 min
Dosage of aminophylline for reversal of persantine stress
50-100 mg IV
Bone scan shows cold bone lesion

DDx
HM RANT

Histiocytosis X
Multiple myeloma
Renal cell carcinoma
Anaplastic tumors (retic cell CA)
Neuroblastoma
Thyroid carcinoma
What cancers DON'T show up on PET scans?
*Prostate CA
*Neuroendocrine – Carcinoid
*Lung – BAC, carcinoid, mucinous AdenoCA
*Breast – Lobular
*Lymphoma – MALT
*Thyroid – some 131I-positive
*Colorectal – Mucinous AdenoCA
*Also, small size (< 1 cm)
V/Q scan classification
LOW
* single mod defect w/nl CXR
* defect<CXR abnl
* non-segmental
* mult small

HIGH
* 2 large defects not accounted for by CXR
Note: 1 lge = 2 mod
Gallium scan shows lung uptake
Sarcoid/TB/fungus
CMV/PCP
Lymphoma
UIP, Asbestosis / Silicosis
Radiation
Drugs: Bleomycin, Amiodarone, Nitrofurantoin, Cytoxan (“BANC”)
DDx of "superscan"
* Mets (usu focal)
- Prost(mc), Breast, Lung
* Metabolic
- Renal Osteodystrophy
- Osteomalacia
- Hyperparathyroidism
- Paget's
* Myelofibrosis (big spleen)
* Mastocytosis (systemic)
Renal uptake of MDP

DDx
NO SCAR
*Nephrocalcinosis
*Obstruction
*Sulfur colloid/thallium
*Chemotherapy
*ATN (think of SCD)
*Radiation
Cold nodule on thyroid scan
Adenoma/colloid cyst (85%)
CA (10%)
Focal thyroiditis
Hemorrhage
Lymph node
Abscess
Parathyroid adenoma
What takes up MIBG?
Neuroblastoma
Pheochromocytoma
Carcinoid
Medullary thyroid Cancer
What takes up octreotide?
Paraganglioma (glomus)
Pancreatic islet cell
Pituitary adenoma
Pheochromocytoma
Carcinoid
Gastrinoma
Medullary CA of Thyroid
Small Cell Lung Cancer
V/Q mismatch DDx
* PE
* tumor compression of PA
* hypoplastic PA
* vasculitis
* atelectasis (reverse mismatch)
Matched V/Q defects: DDx
consolidation / atelectasis
COPD
tumor
bulla / pneumonectomy
Lung scan findings
*R->L shunt
*central deposition of DTPA
*liver uptake on perfusion
*liver uptake on ventilation
*Xe leak
*R->L shunt – activity in kidneys & brain
*central deposition of DTPA – COPD
*liver uptake on perfusion study – SVC obstruction
*liver uptake on vent study – fatty liver
*Xe leak – BPF
GB not visualized on HIDA
acute cholecystitis
prolonged fasting
recent meal
cholecystectomy
GB agenesis
Sulfur colloid study
-focal liver uptake
-renal transplant uptake
-colloid shift
* Focal liver uptake - FNH, regen nodule, Budd-Chiari (hot caudate), SVC or IVC obstr
* Renal transplant uptake – rejection
* Colloid shift (marrow, spleen, lungs, kidneys) – severe liver dysf
* All liver masses cold exc for FNH
* Filtered SC for sentinel node study – breast, melanoma
Abnormal tracer collections on HIDA scan
*Bile leak
*Choledochal cyst
*Caroli’s
*Duodenal diverticulum

* rim sign specific for acute cholecystitis
False positive HIDA
-recent meal
-prolonged fasting
-liver dysfunction
-hyperalimentation
Bowel not visualized on HIDA scan
choledocholithiasis
ampullary stenosis
CCK given pre-scan
Meckel's scan shows RLQ hot spot
*Meckel’s diverticulum w/ectopic gastric mucosa (25%)
*other duplication cyst w/ectopic gastric mucosa
*renal
*active bleeding sites
*tumor
*IBD

prep w/pentagastrin & cimetidine
Testicular scan
Significance of:
- high uptake
- low uptake
- ring sign
High uptake - torsion, orchiectomy

Low uptake - epididymoorchitis

Ring sign
-late torsion
-tumor w/ central necrosis
-abscess
-trauma
Hot spots on bone scan
*Tumor
*inflamm – osteo, arthritis
*congenital – OI, TORCH
*metabolic – marrow hyperplasia, Paget’s, FD
*trauma – fx (rib fxs linear), stress fx (e.g. Honda sign), avulsion injury, AVN, RSD, THR (neg within 6 mos), spondylolysis, child abuse
*vascular – sickle cell
*transient osteoporosis of hip
*flare phenomenon – good response to chemo
Cold spots on bone scan
*mets most common – myeloma, lymphoma, renal, thyr, neuroblastoma
*primary bone lesions – SBC, ABC, EG
*vascular – infarct, AVN (get pinhole view), RTX
*artifact – overlying pacemaker, barium, jewelry, prosthesis
Positive 3-phase bone scan

Appearance of
-cellulitis
-shin splints
*Osteo, healing fx, tumor, orthopedic implants, AVN, RSD, neuropathic
*Cellulitis – flow & blood pool positive, delayed negative
*Shin splints – flow & blood pool neg, delayed positive
Diffuse periosteal uptake (tramtrack)
HPO
child abuse
venous insufficiency
thyroid acropachy
Bone scan shows uptake in soft tissues
cellulitis
renal failure
radiotherapy ports
myositis ossificans
dermatomyositis
rhabdomyolysis
tumors with calcifications
neuroblastoma in child
sinusitis
SVC obstruction (upper body)
IVC obstruction (lower body)
lymphedema (arm + ant ribs)
Bone scan shows uptake in kidney
Dehydration (most common)
Urinary tract obstruction
hypercalcemia
chemotherapy
radiation
Al contamination
Bone scan shows uptake in breast
pregnancy
lactation
mastitis
inflammatory breast CA
steroids
radiation
Bone scan shows uptake in stomach
free TcO4
HPT
hypercalcemia
bowel infarction
prior MIBI scan
Bone scan shows uptake in spleen
sickle cell
thalassemia
breast CA
lymphoma
Bone scan shows uptake in lung
HPT
lung tumor
pulmonary hemosiderosis
alveolar microlithiasis
metastatic osteosarcoma
prior lung scan
Bone scan shows uptake in pleura
malignant pleural effusion
pleural met
mesothelioma
chest wall tumor
fibrothorax
Bone scan appearance of:
-hypercalcemia
-Al contamination
-excess TcO4
-bisphosphonates
-amyloid
*hypercalcemia – hot in lung, stomach & kidney
*Al contam – high uptake in liver & kidney
*excess TcO4 – high uptake in soft tissues, salivary, thyr, stomach, choroid plexus, low uptake in bone
*bisphosphonates – diffuse low uptake in bones
*amyloid – diffuse increased uptake in myocardium
Bone scan shows uptake in liver
Mets
Prior sulfur colloid scan
Al contamination
Tc-99m

T 1/2
energy
decay type
6 hr
140 keV
IT
I-123

T 1/2
energy
decay type
13.3 hr
159 keV
EC
I-131

T 1/2
energy
decay type
8.1 d
364 keV
beta
In-111

T 1/2
energy
decay type
2.8 d
172, 247 keV
EC
Ga-67

T 1/2
energy
decay type
78 hr
93, 185, 300 keV
EC
Co-57

T 1/2
energy
decay type
270 d
122, 136 keV
EC
Cr-51

T 1/2
energy
decay type
28 d
320 keV
EC
F-18

T 1/2
energy
decay type
109 min
511 keV
positron
Xe-133

T 1/2
energy
decay type
5.3 d
81 keV
beta
Tl-201

T 1/2
energy
decay type
73 hr
69-83 keV
EC
Diffuse increased thyroid uptake
-Graves
-early Hashimoto’s thyroiditis
-toxic MNG
-functioning adenoma (focal)
Diffuse decreased thyroid uptake
*thyroiditis – subacute, postpartum, late Hashimoto’s
*meds – thyroid therapy, iodine intake or contrast, PTU, tapazole
*thyroid ablation – surgery, I131
*lingual thyroid
*unilat – surgery, replacement by hypofunctioning tumor, suppression by hot nodule
Heterogeneous thyroid uptake
MNG
multiple autonomous nodules
Hashimoto’s
CA
Positive parathyroid scan
*parathyroid adenoma
*hyperplasia
*thyroid adenoma
*lymph node
*CA
I-131 therapy
*Graves 10-15 mCi
*Plummer’s 30 mCi
*residual tissue 30-100 mCi
*mets 100-200 mCi
Cardiac nucs
-reversible
-fixed
-wall motion
reversible =ischemia
fixed =infarct or hibernating
wall motion – normal, akinesis (scarred), hypokinesis (injured), dyskinesis (paradoxical, CABG, aneurysm) tardokinesis
RUG – adriamycin stopped if EF<45% or drops 15%
Stress test endpoints:
-severe angina
-hypotension
-arrhythmias
-AMI
-fatigue, dyspnea
-target workload achieved
Pharmacologic stress
unable to exercise:
-use persantine (0.142 mg/kg/min), reverse w/ theophylline (50-100mg)
-use dobutamine if COPD on theophylline
-use pharma stress for LBBB (o/w may see reversible septal defect)
Increased lung uptake on thallium
-LV failure
-pulmonary venous HTN
Viable myocardium
Viable myocardium: normal, reversible defect, fixed defect with >50% tracer uptake of normal myocardium
*hibernating – blood flow & function chronically down
*stunned – blood flow normal, function down
Causes of thallium being
-false neg
-false pos
False neg: submax exercise, noncritical stenosis, small ischemic area, meds

False pos: cardiomyopathy, LBBB, infiltrative cardiac dz, ST attenuation
Paradoxical septal movement
-septal ischemia
-previous cardiac surgery
-LBBB or pacemaker
-RV overload
Pyrophosphate uptake
MI
LV aneurysm
cardiomyopathy
myocarditis
pericarditis
amyloid
Gastric emptying
-what's nl?
-delayed DDx
-rapid DDx
* Nl >= 50% in 50 min

* delayed – diabetic gastroparesis, obstruction

* rapid - postoperative, PUD, ZE syndrome, drugs
Focal cold defect on nuclear renal scan
tumor, cyst, abscess, scar, duplex collecting system, trauma, infarct

DMSA – pyelonephritis, scar
Focal hot spot on nuclear renal scan
collecting system
leak
cross-fused ectopic
horseshoe
Nuclear scan shows delayed uptake and excretion (renal failure)
prerenal – poor flow and uptake, unilateral, RAS (ascending pattern with captopril, beware of hypotension), RVT
renal – bilateral, ATN (nl uptake, poor excretion), GN (poor uptake and excretion), CRF
postrenal – obstruction
Nonvisualized kidney
nephrectomy
ectopic kidney
renal artery occlusion
transplant - hyperacute reject
Nucs brain scan
Focal brain cold defect DDx
Infarct
neoplasm
hemorrhage
interictal seizure focus
X-ed cerebellar diaschisis (contralateral cerebellum no uptake after stroke)

diagnostic patterns – Alzheimer’s (temp, pariet)
Pick’s (front, temp)
multiinfarct dementia
Gallium positive scan:
*sarcoid (lambda & panda sign)
*PCP
*lymphoma (Thal better for low-grade)
*osteo (better than wbc study for discitis/osteo)

*KS is Ga(-)/thal(+)
*high lung uptake – sarcoid, PCP, TB, MAI, CMV, lymphoma, chemo (bleomycin), lipiodol
*increased parotid & lacrimal uptake – sarcoid, Sjogren’s, radiation