Skeletal Imaging Board

Front 1

Which of the following is a malignant bone disease?

Back 1

Paget's Disease
Ewing's Disease
osteomyelitis
osteoid osteoma

Hint 1

Ewing's Disease

Front 2

A three phase bone scan is often referred to differentiate

Back 2

osteoporosis vs. cellulitis
osteomyelitis vs. diskitis
osteomyelitis vs. cellulitis
osteoporosis vs. septic arthritis

Hint 2

osteomyelitis vs. cellulitis

Front 3

The presence of gastric and thyroid activity on a bone scan signals the presence of

Back 3

metastatic disease
free pertechnetate
radionucloide impurity
reducing agent

Hint 3

free pertechnetate

Front 4

What is the purpose of the reducing agent in a 99Tc disphosphonate kit?

Back 4

to oxidize technetium
to lower the valence state of technetium
to improve the tag efficiency

Hint 4

both b & c

Front 5

What is the dose of 99mTc-MDP most often for a planar bone scan?

Back 5

1-3 mCi
5-10mCi
10-30mCi
30-35mCi

Hint 5

10-30mCi

Front 6

Which of the following is least likely to cause an artifact on a bone scan?

Back 6

snap on trousers
colostomy bag
skin contaminated by urine
injection site

Hint 6

colostomy bag

Front 7

What is not an indication for a bone scan?

Back 7

metastatic disease
osteoporosis
cellulitis
avascular necrosis

Hint 7

osteoporosis

Front 8

The presence of free pertechnetate on a bone scan may be the result of

Back 8

-using a radiopharmaceutical which was prepared too long ago
-introduction of air into the kit vial while adding technetium
-increased blood flow to the bones

Hint 8

both a & b

Front 9

What is the purpose of hydration and voiding after an injection for a bone scan?

Back 9

- to block the update of unlabeled technetium by the stomach
- to reduce the possibility of urine contamination
- to obtain a superscan
- to reduce the radiation dose to the bladder

Hint 9

to reduce the radiation dose to the bladder

Front 10

What could be the cause of generalized, diffuse activity in the abdomen on a bone scan?

Back 10

free Tc
malignant ascities
pacemaker
bone cyst

Hint 10

malignant ascities

Front 11

What timing protocol best describes a 4 phase bone scan?

Back 11

during injection, immediately following injection, 2-4 hours after, and 18-24 hours

Front 12

A focal hot spot near the left femur shows up on a bone scan. What is/are the best ways to proceed?

Back 12

-change to pinhole collimator and image
- perform SPECT imaging
- have patient remove clothing from that area
- ask patient to wash the skin in that area with soap and water

Hint 12

both c & d

Front 13

A bone scan showing relatively uniformly increased skeletal uptake of the radiopharmaceutical with almost absent renal and bladder activity is usually

Back 13

flare phenomenon
superscan
renal failure
suprascan

Hint 13

superscan

Front 14

The glove phenomenon is usally the result of

Back 14

reactive arthritis
intravenous injection
arterial injection
subcutaneous injection

Hint 14

arterial injection

Front 15

What are common sites of bony metastasis?

Back 15

pelvis
spine
ribs
all of the above

Hint 15

all of the above = pelvis, ribs and spine

Front 16

What is the purpose of a stannous ion in a diphosphonate kit?

Back 16

- act as a reducing agent
- act as an oxidizing agent
- provide stabilizing force
- maintain particle size

Hint 16

Act as a reducing agent

Front 17

appendicular skeleton

Back 17

lower

Front 18

Axial skeleton

Back 18

upper

Front 19

The appendicular skeleton includes the following bones except?

Back 19

the femurs
the skull
the phalanges
the radius

Hint 19

the skull

Front 20

The axial skeleton contains

Back 20

the ribs
the skull
the vertebral column
all of the above
a,b,c only

Hint 20

a,b,c, only
the ribs
the skull
the vertebral column

Front 21

By what mechanism do diphosphonates localize in the bone?

Back 21

capillary blockade
active transport
ion exchange
phagocytosis

Hint 21

ion exchange

Front 22

epiphyseal plates

Back 22

The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone. The plate is found in children and adolescents; in adults, who have stopped growing, the plate is replaced by an epiphyseal line.

Front 23

Which of the following describes a pediatric bone scan?

Back 23

- increased uptake in long bones
- decreased uptake along the epiphyeal plates
- increased uptake along the epiphyseal plates
- overall decreased uptake in bone

Hint 23

increased uptake along the epiphyseal plates

Front 24

The first phase of a three phase bone scan is best performed by

Back 24

-bolus injection, followed by dynamic 2 second images for 60 seconds
- bolus injection followed by dynamic 20 second images for 3 minutes
-bolus injection followed by a static 500-600k count image
- bolus injection followed by dynamic 1 second images for 30 seconds

Hint 24

bolus injection, followed by dynamic 2 second images for 60 seconds

Front 25

What radiopharmaceuticals may be used for bone marrow imaging:

Back 25

99mTc albumin colloid
99mTc sulfur colloid
99mTc PYP

Hint 25

a & b
99mTc albumin colloid
99mTc sulfur colloid

Front 26

Splenic uptake on a bone scan is often associated with

Back 26

liver failure
sickle cell disease
splenic abscess
Paget's Disease

Hint 26

sickle cell disease

Front 27

Bone is made up of

Back 27

hydrogen peroxide
hydroxyapatite mineral
collagen

Hint 27

b & c only
hydroxyapatite mineral
collagen

Front 28

Osteoblastic activity refers to

Back 28

-bone marrow biopsy
- destruction and re-absorption of bone
- bone compression
- new bone formation

Hint 28

new bone formation

Front 29

Osteoclastic activity refers to

Back 29

-bone marrow biopsy
- destruction and re-absorption of bone
- bone compression
- new bone formation

Hint 29

destruction and re-absorption of bone

Front 30

What is often used in imaging suspected avascular necrosis of the hip

Back 30

- SPECT imaging
- PET imaging
- pinhole collimator
- diverging collimator
both a & c

Hint 30

pinhole collimator

Front 31

The function of the skeleton is

Back 31

- to provide support
- to protect organs
- production of blood cells
- all of the above

Hint 31

- all of the above

Front 32

Which group shows the highest rate of primary bone tumors?

Back 32

-the elderly
- children
- males
- females

Hint 32

children

Front 33

The radiation dose from a bone scan is highest to the

Back 33

bone marrow
chest
bladder
brain

Hint 33

bladder

Front 34

When performing a bolus injection for a 3-phase bone scan, why would the tourniquet be released and injection delayed for one minute?

Back 34

- to minimize pain during injection
- to reduce transient hyperemia resulting from vasodilation
- to double check dynamic sequence
- to obtain a better bolus

Hint 34

to reduce transient hypermia resulting from vasiodilation

Front 35

32

Back 35

page 55

Front 36

Which of the following is not in the pelvis?

Back 36

the ileum
the ischium
the iridium
none of the above

Hint 36

the iridium

Front 37

Which of the following would be a reason not to inject in the right antecubital fossa?

Back 37

- the patient had blood drawn from the back of the right hand that same day
- the patient was injected on the right for a previous bone scan
- there is a suspicion of osseous abnormality in the right distal humerus
- the patient is left handed

Hint 37

there is a suspicion of osseous abnormality in the right distal humerus

Front 38

The preparation for a bone scan is

Back 38

NPO from midnight
cleansing edema
patient must be off thyroid medication 4 weeks
none of the above

Hint 38

none of the above

Front 39

Metastaases usually affects the axial skeleton before the appendicular skeleton?

Back 39

true
false

Hint 39

true

Front 40

The mechanism of localization for bone marrow scanning is

Back 40

active transport
ion exchange
phagocytosis
capillary blockade

Hint 40

phagocytosis

Front 41

A large amount of diffuse soft tissue activity present on a bone scan at 4 hours means

Back 41

- increased cardiac output
- renal insufficiency
-metastatic disease
-infection

Hint 41

renal insufficiency

Front 42

What imaging agent can be used for the skeleton as well as myocardial infarction?

Back 42

MDP
HDP
PYP
TL Chloride

Hint 42

PYP

Front 43

Rib fractures often show up as

Back 43

-multiple, focal hot spots located in consecutive ribs
- a linear distribution along the axis of the rib
- diffuse activity in the chest cavity
- cold spots

Hint 43

-multiple, focal hot spots located in consecutive ribs

Front 44

The advantage of bone scanning over plain radiography

Back 44

- bone must lose only a minimum of calcium content before lesions are visible on bone scintigraphy
- time
- efficient for multifocal trauma such as child abuse
none of the above

Hint 44

efficient for multifocal trauma such as child abuse

Front 45

number 42

Back 45

page 58

Front 46

Bone Marrow imaging

Back 46

sulfur or albumin colloid particles are phagocytized by the reticuloendothelial cells in the bone marrow

Front 47

Rib fractures are often found in consecutive ribs

Back 47

Bone metastasis is more likely to appear as linear uptake along the rib