Board Exam (Green Book)

What is the osmolality of blood plasma?

285-290 mOsm/kg

What are “standard precautions” mean?

The guidelines assume that all patients are potentially infectious; therefore, the same infection control practices should be applied to all patients

What are the symptoms when the patient has low blood glucose levels?

Weakness, hunger, tremor, sweating (including cold sweats), irritability, confusion, and blurred vision

What do you put in with the Tc99m Sulfur Colloid in a Gastroesophageal Reflux study?

150 mL of orange juice and 150 mL of dilute hydrochloride acid and is administered orally.

Which radiopharmaceuticals have monoclonal antibody that is directed against prostate-specific membrane antigen

Indium111- Capromab Pendetide

What is monoclonal antibodies from Indium111-Capromab Pendetide?

Are produced from mouse spleen cells

What is the HAMA response from the Indium111- Capromab Pendetide?

The patient's immune system then begins to produce antibodies against the monoclonal antibody. a process called a HAMA response, which increases the possibility of an allergic response to a second administra- tion of monoclonal antibody and decreases the likelihood of a second successful imaging procedure.

In what ways that Indium111- Pentetreotide should not be administered?

should not be administered into intravenous lines or with total parenteral nutrition solutions.

What is the name of the three computer-generated time activity curve of a renogram?

1. Vascualar

2. Secretory

3. Excretory

What is the vascular phase of the time activity curve?

The vascular phase reflects the arrival of the bolus of activity in the renal area.

What is the secretory phase of the time-activity curve?

In the secretory phase, the tracer is concentrated in the kidneys. The peak transit time, usually 3—5 min after injection, is the time at which the tracer reaches its maximum concentration in the kidneys.

What is the excretory phase of the time-activity curve?

The excretory phase follows, with a fairly rapid drop in the activity curve as the tracer is excreted from the kidney into the bladder.

What is the furosemide dose range?

20-40 mg. The diuretic is injected slowly over 1-2 min while images are acquired and should have an effect within 30-60 sec. Imaging is continued for approximately 20 min.

What is the indirect method for the vesicoureteral reflux?

The indirect method involves intravenous administration of a functional renal agent, such as Tc99m-pentetate or Tc99m-Mertiatide.After the agent is cleared from the kidneys into the bladder, the patient is asked to void while being imaged.

What is the direct method of the vesicoureteral reflux study?

Let the patient void before the study, then catheterize the patient, connect the catheter to a bottle of normal saline to which 1 mCi (37 mBq) Tc99m-Pertechnetate has been added.

What is parenteral administration?

Is the delivery of medications or nutrition directly into the body by bypassing the gastrointestinal tract.

What is hemolytic anemia?

is a blood disorder characterized by the premature destruction of red blood cells, leading to a shortage of these cells in the body.

For a red cell survival test, what is the radiopharmaceutical used?

51Cr-labeled autologous red cells in patients with hemolytic anemia

There should be one material with the 51Cr radiotracer and what is it?

ascorbic acid-labeling technique and as will with a 20-gauge needle, and labeled heparinized blood collection tubes

What is the reason to inject the 51Cr radiotracer?

After labeling, inject the red cells and draw the first blood sample 24 hr later. This time period permits removal of cells that were damaged during the labeling procedure from the circulation, as well as clearance from the blood of any injected plasma activity.

What are the steps of the sampling handling of the red cell survival test?

pipette 5 mL of well-mixed whole blood into a labeled counting tube. Add a pinch of saponin powder to the tube and mix to lyse the red cells. Then store these samples at 4°C until the last day of the study.

What is the dose range for captopril?

25-50 mg

What is the standard dose for furosemide (lasix)?

20-40 mg

What is the dose for Adenosin?

140 ug/kg/min for 6 min or 0.84 mg/min

What is the dose of dipyridamole (persantine)?

0.57 mg/kg IV over 4 min

What is the dose for dobutamine?

Incremental dose rate over 3 min: 15 ug'/kg/min up to 40 ug/kg/min

What is the dose of Regadenosine?

0.4 mg

What is the biodistribution for Indium111-Pentetreotide?

pituitary and thyroid glands, liver, spleen, kidneys, bladder, and sometimes gallbladder

when does gastrointestinal activity appear in a Indium111- Pentetreotide?

typically does not appear until 24 hours after tracer adminstration

Why we use the centrifuge speed for labeling leukocytes with Indium?

to minimize platelets labeling

While labeling leukocytes with Indium. What radiopharmaceutical is used for labeling?

In111-Oxine

For Tc99m labeling for leukocytes, what is the radiopharmaceutical used?

Tc99m-Exametazime

The blue methylene stabilizer is used for what radiopharmaceutical?

In111-Labeled Leukocytes

What is a ACD solution used for 51Cr red blood cell labeling?

Anticoagulant used in blood labeling

What is a ramp filter (or high pass filter)?

Is used to suppress the star artifacts and enhance edges. It is used only in filtered back-projection image reconstruction.

What is considered low frequencies in an image?

Whereas data from the target (the activity in the tissue) are primarily found in the low and medium frequencies. Also, that includes star artifacts.

What is considered high frequencies?

where there is less activity which has more statistical noise

What is a low pass filter and what it filters?

to decrease the effects of high frequency noise (statistical count fluctuations)

What are the two common low pass filters?

1. Butterworth filter

2. Hanning filter

Which has the two variavles of one of the low pass filters?

Butterworth filter

Which has one variable low pass filters?

Hanning filter

A cardiac stress test requires the placement of how many electrodes on the patient’s body?

10 electrodes

How long after the administration of Tc99m- Pertechnetate does imaging begin for the localization of a Meckel’s diverticulum?

Immediately

What is the dose range for a detection of Liver Hemangioma study?

20-25 mCi of Tc99m-RBC

What is the optional flow study for the Liver Hemangioma parameters?

1 frame/sec for 60 seconds

When is the delayed images are performed for a Liver Hemangiomas?

45-180 minutes after tracer injection

What is the patient preparation for a Meckel’s Diverticulum?

1. patient should fast for at least 2 hours

2. Should not have any laxatives or diagnostic tests that might irritate the intestinal tract for at least 3-4 days before imaging

Why we use Potassium Perchlorate to children for a Meckel’s Diverticulum?

To prevent thyroid uptake of Tc99m-Pertechnetate, but it should not be used in this instance because it also blocks gastric mucosa secretions and may cause false-negative results

What is the drug that enhance the visualization of Meckel’s diverticulum?

Pentagastrin (Peptavlon) stimulates gastric secretion, thereby increasing pertechnetate secretion in the stomach and diverticulum

How is Pentagastrin adminstered in Meckel’s dievertculum?

subcutaneously 15-20 minutes before the study

What is the dose for pentagastrin in Meckel’s?

6 ug/kg and it should be used cautiously in patients with pancreatic or hepatobiliary diseases.

What is the other drug used for Meckel’s?

Cimetidine (Tagamet) because it helps retain Tc99m-Pertechnetate in the gastric mucosa

How is Cimetidine (Tagamet) is administered for Meckel’s?

is usually given orally but may be administered intravenously 1 hour before imaging.

When the oral administration of Cimetidine be given for Meckel’s?

2 days before imaging

What is the dosages of Cimetidine for Meckel’s?

1. Adults: 300 mg four times a day

2. Children: 20 mg/kg/day

3. Neonates: 10-20 mg/kg/day

What is Glucagon purpose for Meckels?

relaxes the smooth muscle of the GI tract, thus slowing down the peristalsis and allowing the pertechnetate to remain stationary for a longer period of time

When is Glucagon administered for Meckel’s?

50 ug/kg is administered intravenously 10 min after injection of Tc99m-pertechnetate

What is the benefits of using Glucagon and pentagastrin in Meckels study?

to increase the uptake of pertechnetate while slowing down the movement of the tracer in the GI tract

What are the radiopharmaceuticals used for a left and right ventricular study?

1. Tc99m-DTPA

2. Tc99m-Pertechnetate

3. Tc99m-sestamibi

4. Tc99m-tetrofosmin

What is the dose for the left and right ventricular function study?

25 mCi for both rest and stress

What areas of the body should be imaged for a In111-Pentetreotide?

Anterior and Posterior whole-body imaging

Which of the following tracers is preferred if a first-pass stress and rest cardiac function examination are to be performed on a patient?

Tc99m-Pentetate (DTPA)

What is Pernicious anemia?

is an autoimmune condition that impairs the body's ability to absorb vitamin B12, leading to a deficiency that can cause serious health issues.

What is a first pass study evaluates?

cardiac shunts, which refers to the movement of blood across the septum

How the radiopharmaceutical should be injected for a first pass study especially for the left-right ventricular function?

A bolus injection of the radionuclide should be pushed through a three-way stop-cock connected to an intravenous catheter that has been placed antecubital or external jugular veins

For the left to right ventricular study what happens when the study needs to be repeated?

If a bolus is fragmented and/or the FWHM is greater than 1 sec, then the study should be repeated

For the right ventricle function should the bolus be slow or fast?

The radionuclide bolus should be pushed slightly slower over 3-4 sec to achieve a FWHM of 2-3 sec for the superior vena cava curve.

What is the normal range for a LVEF for a resting study?

50-80%

What is the normal range for a LVEF for a stress portion?

56% or greater

What is the normal range for a RVEF range for resting?

40%-65%

What is a left-to-right ventricular shunt?

is a congenital heart defect where oxygenated blood from the left ventricle flows abnormally into the right ventricle, increasing pulmonary blood flow and potentially causing heart and lung complications.

What is a Right-to-Left shunt?

Blood that is shunted from the right side to the left bypasses the pulmonary arterial circulation and is prematurely returned to the systemic circulation without being oxygenated. Left untreated, a right to left shunt will cause cyanotic heart disease.

What radiopharmaceutical is used and the dose range for the Right-to Left shunt study?

Tc99m-MAA, 2-5 mCi

What are the list of thyroid medications?

1. thyroxine

2. triiodothyronine

What is the list of anti-thyroid medications?

1. Propylthiouracil

2. Methimazole

Patients that have insulinoma, which radiopharmaceuticals may cause hypoglycemia?

In111-Pentetreotide