ARRT-N practice questions
ARRT · ARRT-N · 300 questions
Original practice questions for the ARRT Nuclear Medicine Technology (N) Certification Examination exam, covering every domain of the official exam outline.
This course contains the use of artificial intelligence.
About the ARRT-N exam
- Questions
- 200 scored questions plus 30 unscored (pilot) questions
- Passing score
- Not published in the content specifications
- Format
- Computer-based, administered at a standardized testing center
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Exam details published by the vendor, checked 3 November 2026. Vendors change fees and formats without notice — confirm on the vendor's own page before you book.
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Patient Care: Patient Interactions and Management (13%) · 39 questions
- At shift start, three patients arrive on a medical unit: one with fever and cough being evaluated for pulmonary tuberculosis, one with a draining wound colonized with vancomycin-resistant enterococcus, and one who recently received an allogeneic hematopoietic stem-cell transplant. Which set of transmission-based and protective-environment precautions matches each patient?
- A patient checks in for a scheduled Tc-99m sestamibi parathyroid study, but the signed order lists the clinical indication as restaging of metastatic melanoma after therapy while the visit note documents workup of a suspected parathyroid adenoma. Department policy requires a confirmed patient identity and an order that matches the documented reason for care before dosing. Which verification sequence must be completed before any activity is drawn?
- A patient nods through the pre-scan explanation but then asks whether the injection will make them radioactive and what a tracer does. The technologist used terms like radiopharmaceutical, scintigraphy, and uptake throughout. Which communication technique would best confirm that the patient understands the explanation?
- Midway through a renal dynamic study, a competent inpatient says she wants the scan stopped. Her daughter at the bedside asks what the imaging has shown so far, and the patient says she is still waiting for the hospital's Patient Care Partnership brochure. Which response best protects her consent and confidentiality rights right now?
- A patient in the injection room begins to cry after learning the scan will run late and asks what happens next. Other patients are within earshot, the patient is upset, and the plan has to be clear enough to repeat back. Which combination of verbal and nonverbal communication meets all three needs?
- During a pharmacologic stress infusion the pump stops with an occlusion alarm while the patient feels well and the vitals hold steady. Policy here holds the infusion until the device is cleared, calls for your supervisor to be told right away, and requires the alarm code to be entered in the equipment log. Which response handles this infusion-pump malfunction while meeting all three rules?
- A patient scheduled for an outpatient scan asks two things at once: whether the radiation could harm family members at home and why the scan is worth that risk. Preparation and appointment instructions have already been covered in plain language. Which content completes this patient's education on radiation risk and scan benefit before the injection?
- After drawing a Tc-99m dose, the prep bench holds a used needle with a drop of blood, a gauze pad soiled with blood and radiopharmaceutical, and an absorbent pad that soaked up a spilled dose. Facility policy requires radioactive items to be held for decay-in-storage before disposal, with blood-contaminated items then disposed of as regulated medical waste. Which route for the needle, gauze, and absorbent pad follows policy?
- A 78-year-old with limited English and marked hearing loss, who reads lips only in her first language, arrives for a hepatobiliary scan with her daughter, who answers every question before the patient can reply. You need the history straight from the patient and must confirm that she understands the procedure. Which communication approach handles her language and hearing barriers while giving you an accurate history?
- An alert adult on the oncology unit is offered enrollment in a trial of an investigational radiopharmaceutical. The patient has an advance directive on file, holds a DNR order signed today, and asks whether declining will change the imaging already ordered. Which point should anchor the informed consent discussion?
- An elderly outpatient who uses a cane and has fallen twice in the past month stands up in the waiting room and reports light-headedness before a bone scan. The study needs the patient to walk to the camera and empty the bladder first. Which steps should the technologist take before any further standing or walking?
- During a scheduled study, a competent patient clearly tells the technologist to stop before the tracer is injected, but the team continues because the physician's order is already written. The patient finishes the study, is physically unharmed, and then complains to the department. Which legal concept best describes the violation that occurred?
- At the dose-calibration bench, a tech knocks over a bottle of solvent used to clean well-counter parts; the label is soaked through and the vapor is strong. The safety officer asks that cleanup follow the product's safety data sheet. Which SDS section should the responder consult to choose the spill cleanup method?
- An outpatient arrives for whole-body bone scintigraphy with an intravenously injected phosphonate agent. Before the tracer is injected and again at discharge, the technologist reviews what the patient should do at home. Which instruction set correctly covers hydration and voiding before the injection and after the study ends?
- A patient scheduled for a myocardial perfusion study nods along as you describe the tracer and the stress phase, but when you ask what happens during the study they say they will just take the picture medicine and walk a bit. Which communication approach will improve this patient's understanding before the study?
- After a mild anxiolytic before a myocardial perfusion study, a patient dozes on the imaging table and begins to slide toward the foot of it. The technologist tucks a foam wedge under the knees that the patient could push aside, and fastens a padded strap across the thighs that the patient would be unable to remove even when awake. Which classification applies to each device under patient-rights restraint rules?
- A 47-year-old outpatient becomes flushed and itchy two minutes after an IV Tc-99m injection, then develops stridor, audible wheeze, and a blood pressure of 78/40. Epinephrine, diphenhydramine, oxygen, and IV fluids are stocked in the injection room, and the waiting area is busy. Which first-line treatment should you give for this suspected anaphylaxis?
- You are covering the injection room on a busy afternoon. Two identifiers on the armband match the order, and the appointment time matches the schedule, but the order gives the reason as restaging of colon cancer while the chart shows the patient is being worked up for a hip infection. The tray is still empty at this point. Which first step resolves the mismatch between the order's indication and the clinical picture?
- During check-in for a bone scintigraphy appointment, a patient with asthma and a previous iodinated contrast reaction asks how nuclear medicine differs from the CT she had last month. Department policy requires allergies and prior reactions, pregnancy status, and current medications to be reviewed before the radiopharmaceutical order. Which history review and patient explanation best meets those check-in requirements?
- A 57-year-old who had a thyroidectomy for papillary carcinoma arrives for a diagnostic I-131 whole-body scan to check for leftover or spread disease. She has been off her thyroid hormone for several weeks as instructed, feels well, and this morning's labs are already in the chart. Which lab value must be verified before the I-131 dose is given?
- A 33-year-old scheduled for a myocardial perfusion scan arrives anxious after reading about radiation online and asks what the tracer does, what the benefit is, and how much dose the scan adds. The department requires the tracer, benefit, radiation risk and alternatives to be covered in everyday words, with understanding confirmed before the tracer is given. Which patient-education approach best meets those requirements for this patient?
- A 77-year-old outpatient finishes a whole-body bone scan, and while checking the delayed images the technologist spots an unexpected focal finding in a weight-bearing bone that the team would want acted on today. The patient is dressed and ready to leave, the ordering physician is in clinic, and department policy requires closed-loop communication for urgent findings. Which communication approach meets that requirement before the patient is discharged?
- A patient having a blood-pool study says the signed consent form is fine but still has questions about what the injected tracer will do, and their spouse is waiting just outside the room. Which response best applies the ARRT Standards of Ethics at this moment?
- A signed consent form for a hepatobiliary study is on file when the patient is called from the waiting room. The patient says the exam was fully explained but has changed their mind and turns away from the chair. Because the paperwork is complete, a colleague starts prepping the arm anyway. Which legal claim best describes proceeding after that withdrawal of consent?
- Within minutes of an intravenous radiopharmaceutical injection, a patient develops generalized hives, a raspy voice and audible wheeze, and the blood pressure drops. The injection site itself is comfortable with normal skin color. Which emergency medication should be given first to treat this systemic reaction?
- A patient with diabetes calls two days before their first nuclear medicine study, which starts after an overnight fast. They ask what to change at home beforehand and what to do afterward. Which approach gives the best pre- and post-exam instructions?
- A patient who is unable to bear weight through the legs, unable to stand from the bed, and lacking the arm strength to push up must be moved from bed to a wheelchair this morning. Two staff members are available, the patient follows directions, and the room has space to work. Which patient transfer method fits this mobility and staffing situation?
- During a busy morning in an outpatient nuclear medicine department, a patient waiting for a hepatobiliary study is hard of hearing, depends on lip reading, and the waiting area is loud. You must explain the delayed imaging steps and confirm the patient understands before the tracer is injected. Which communication approach best combines verbal and nonverbal modes for this patient?
- During a slow therapy infusion the pump sounds a downstream occlusion alarm and stops. The tubing is visibly kinked where it passes under the patient's arm, the IV site shows no swelling or redness, and vital signs and oxygen saturation are normal. Which action should you take first to address the alarm and, if appropriate, resume the infusion?
- A man at the outpatient desk says he is the patient's spouse and asks for a copy of yesterday's myocardial perfusion report. The patient is still in the scan room, the file lists only the patient as authorized to receive results, and the department expects staff to help legitimate requesters begin the release process. Which HIPAA confidentiality step should the technologist take first?
- An inpatient with suspected Clostridioides difficile diarrhea used the nuclear medicine anteroom restroom before an injection appointment. Housekeeping removed the visible contamination, but staff must reuse the room within the hour. Which control measure best breaks the chain of infection in this restroom?
- During a whole-body bone scan, an adult with Parkinson's disease struggles to hold position because of resting tremor. A colleague proposes a padded strap fastened across the chest and thighs, while you prefer sandbags supporting the arms and a pillow beneath the knees. The patient is alert, follows directions, and can lift away any support that simply rests on the body. Which device choice correctly applies the ethical and legal distinction between restraints and positioning aids?
- A patient treated for breast cancer asks why her physician ordered a nuclear medicine bone scan instead of another CT scan. Her history notes possible spread to several bones, and the order calls for a survey of the whole skeleton's activity. Which explanation correctly compares the whole-skeleton activity shown by the bone scan with the anatomy shown by CT?
- A patient who is profoundly deaf and speaks limited English arrives for a bone scan with her adult son, who has been interpreting casually throughout the visit. The upcoming injection requires explaining allergies, radiation precautions, and how to respond to discomfort. Which interpreter arrangement should the technologist use for this injection discussion?
- In the hot lab, a technologist draws three patient doses from a single eluted vial for a busy afternoon list, and each syringe is headed to a different patient. Lab policy requires sterile doses with no cross-contamination. Which preparation sequence follows correct aseptic technique for this task?
- A research coordinator is enrolling hospitalized adults into a nuclear medicine study that adds an extra imaging session and a research-only radiopharmaceutical. One candidate has a DNR documented and another has an advance directive limiting certain interventions. Which consent requirement must be satisfied before either patient is enrolled?
- A patient recovering from a stroke is non-weight-bearing and has limited use of both arms, so two staff members must move the patient from the bed onto the nuclear medicine table for a bone scan. The bed and the table sit at fixed, unequal heights, and the department has a draw sheet and a slide board while its mechanical lift is in use on another unit. Which action best protects the patient and the staff?
- A nuclear medicine technologist finds that a colleague entered 'QC passed' in the dose calibrator log for a linearity check that had been skipped, and that page is headed for a regulatory inspection next week. The colleague is a friend who has covered extra shifts. Facility policy requires any record discrepancy to be reported to the supervisor. Which action best meets the ARRT Standards of Ethics here?
- A 72-year-old is booked for a myocardial perfusion study using a pharmacologic stress agent. Department protocol requires baseline vital signs before any stress medication, continuous ECG with blood pressure checks during the stress phase, and escort-level assistance afterward because the patient has dizzied when standing before. Two cameras are running with staff split between them. Which monitoring plan covers every requirement for this stress study?
Safety: Radiation Physics, Radiobiology, and Regulations (13.5%) · 41 questions
- A nuclear pharmacy elutes the same Mo-99/Tc-99m generator every morning. On the column between elutions the Tc-99m rises for about a day and then falls, even though Tc-99m alone has a 6-hour half-life. Which principle explains that rise and slower decline?
- A busy hot lab has sent all of its lead syringe shields to decon, so a technologist must draw ten Tc-99m doses from unshielded vials using only a lead L-block. Each syringe is checked against the logbook before release, and the bench is too narrow to step away from. Which technique best keeps extremity exposure ALARA during these draws?
- At closing, two freshly drawn Tc-99m vials and a sealed Cs-137 check source must be secured overnight; neither vial has been labeled, the only refrigerator holds staff lunches, and the storage cabinet locks. Which storage plan meets radioactive materials requirements?
- A physics resident logs four observations: a Tc-99m nucleus passes its excitation energy to an inner orbital electron, an inner-shell vacancy is followed by low-energy electron emission, beta particles stopped in thick lead create a broad x-ray continuum, and a gamma beam weakens exponentially as absorber thickness grows. Which radiation physics phenomenon accounts for each observation in order?
- During a busy afternoon, a visitor stays at a seated patient's side for three hours after a Tc-99m injection. The visitor is a family member rather than staff, arrives without a personal dosimeter, and a survey estimates 45 mrem to the whole body for the visit. The radiation safety officer is reviewing the log. Which regulatory dose limit should the officer compare the 45 mrem against?
- While drawing a dose, a syringe of Tc-99m pertechnetate cracks on the hot lab bench, and the puddle stays on that surface. Policy here keeps shielding in place during cleanup, calls for a fresh survey after it, and records every spill. Which response manages this minor spill while satisfying all three rules?
- Your department must send a sealed Tc-99m radiopharmaceutical vial by ground courier. The shipment is a non-excepted Type A liquid package assigned the RADIOACTIVE YELLOW-II label, and the preparation sits well within its labeled lifetime. Department policy requires absorbent material sufficient to hold any leaked liquid inside the package, and signed shipping papers. Which packaging and labeling actions must be completed before the carton leaves the department?
- While surveying the hot lab, a technologist records 6 mR/h on an ion chamber meter near a shielded syringe, and the personal dosimeter worn during that shift reads 15 mrem. The supervisor asks students to name each quantity before any occupational limit is considered. Which statement correctly pairs each reading with the dose quantity it represents?
- A technologist who receives and assays I-131 patient doses in a dispensing area needs whole-body monitoring, hand monitoring, and an audible warning while the task is under way. For this task, the collar is the location where the highest deep dose is expected. Which personnel monitoring arrangement meets all four requirements?
- A patient who received outpatient radionuclide therapy is ready to go home, and the family plans to drive with a toddler in the back seat. The patient feels well and asks whether a blood test can settle whether leaving today is safe. Under NRC requirements, which factor determines when this patient may be released?
- During a briefing, a technologist explains that Tc-99m imaging uses a 140 keV photon, that the camera records a photopeak plus a scatter tail, and that most interactions occur in soft tissue with a low atomic number. Which interaction accounts for most of those soft-tissue events at 140 keV?
- A nuclear medicine department uses absorbent pads, gloves and syringes with a short-lived imaging agent, plus one long-lived sealed reference source that stays in the lab. The safety officer requires each item to leave by the route matching its half-life, with release documented before disposal. Which disposal route applies to the absorbent pads, gloves and syringes?
- At an outpatient imaging center licensed by the NRC, a technologist discovers after lunch that a patient was injected this morning with a radioactive drug other than the one ordered and prescribed. The administration is confirmed as a wrong-drug medical event while the record is still being assembled. Which action satisfies the medical event notification requirement?
- A radiopharmacy technician prepares a dose of a therapeutic agent that is a pure beta emitter with no usable gamma emission. While the dose sits in its shielded container, a survey meter records penetrating photons coming from the shield itself. Which physical interaction between the beta particle and the shield produces those photons?
- A nuclear medicine technologist's dosimeter reads a deep-dose equivalent of 60 mrem for the month, and a bioassay after she handled a ruptured syringe estimates an intake with a committed effective dose of 45 mrem. There is no pregnancy declaration on file for her. Which comparison correctly applies NRC dose limits to her exposure?
- In a therapy planning meeting, the team compares an alpha-emitting agent with a beta-emitting agent that delivers the same absorbed dose to the red marrow, and the alpha agent causes markedly more severe marrow suppression. Which factor best accounts for the greater biological effect at an equal absorbed dose?
- At the end of a busy shift the hot lab holds two multi-dose vials of different nuclides, several drawn patient doses, and the sealed flood source used for daily camera checks. The department requires shielding, separation of unsealed material from sealed sources, and restricted overnight access. Which storage arrangement for the radiopharmaceuticals and sealed source meets all three requirements?
- A busy radiopharmacy needs sealed Tc-99m vials that passed their expiration date moved out of active stock. The safety officer requires that the material stay in the department until surveys read background and that each held container remain traceable. Which handling plan meets these radioactive materials requirements?
- A 60-year-old is discharged the same afternoon after oral iodine-131 treatment for hyperthyroidism. The discharge survey shows a low dose rate at one meter, but the patient will ride public transport home and lives with a family member. The dose estimate predicts that, without precautions, an individual could receive more than 0.1 rem but less than 0.5 rem. Written distance and contact instructions are expected to keep each individual's dose below 0.5 rem. Which release approach best meets the federal patient release rule and keeps others' exposure as low as reasonably achievable?
- A late Tc-99m kit leaves residual activity in a vial, and a used syringe and contaminated wipe sit in the injection room. Your license lists short-lived laboratory stock for decay in storage, and the procedure requires an isotope and date entry plus a background survey before the container is cleared. Which waste-handling route best follows these radioactive materials rules?
- A patient receives a whole-body absorbed dose high enough to cause radiation-induced nausea and vomiting about four hours later; the symptoms settle by the next day. Meanwhile, a technologist receives repeated low occupational doses over a long career, with a possible long-term cancer risk. Which classification by onset and dose response fits these two scenarios?
- A radiation safety briefing describes a quantity that starts with the energy deposited in tissue from a contaminated glove, then multiplies it by a radiation quality factor so it can be compared with an extremity limit. Which dose quantity does that description match?
- After a Tc-99m pertechnetate spill wets the hot lab bench, the technologist must document both the dose rate a worker stands in and whether the bench holds removable contamination before cleanup. Which pair of measurements gives both the removable contamination result and the dose rate at the workstation?
- A radiopharmacy elutes a Mo-99/Tc-99m generator every morning; the Mo-99 parent has a 66-hour half-life, the Tc-99m daughter a 6-hour half-life, and the column holds the parent for the generator's life. Which statement best explains why useful Tc-99m activity is available again the next morning?
- During an afternoon clinic, staff realize a patient received a radiopharmaceutical ordered for another patient. The activity matched the order exactly, the images are complete, and the authorized user is available. The dose to the unintended patient exceeded 0.05 Sv effective dose equivalent. Which reporting requirement applies to this misadministration?
- A worker with a substantial whole-body dose feels nausea about two hours after the exposure, then feels well during a quiet interval. About two weeks later the blood counts fall, and the worker develops fever and bruising. Which acute radiation syndrome pattern best explains this sequence?
- In a radiation biology exercise, two tissue samples receive the same absorbed dose from the same low-energy x-ray beam: one is lymphoid tissue packed with dividing, immature cells, the other is mature skeletal muscle. Which prediction of their relative response correctly combines LET, RBE and the Bergonie-Tribondeau law?
- At the end of an F-18 injection session, a wipe of the counter beside the dose calibrator returns counts well above the lab's removable-contamination action level. A survey meter shows the dose rate there stays below the level that requires area posting. Under the lab's contamination-control procedure, which response is required for that bench?
- At the end of a busy day the hot lab holds leftover unit doses, a partly used multi-dose vial and contaminated syringes from injections. The safety officer wants every item tracked until it can leave the radioactive materials program. Which storage and disposal practice should the department follow for eligible short-lived radioactive waste?
- A training session uses a technetium-99m source to show how gamma photons interact in tissue. One photon strikes a K-shell electron in a soft tissue atom, disappears completely, and ejects the electron with energy equal to the photon energy minus the binding energy. Which interaction is being demonstrated?
- After a small Tc-99m eluate spill, staff wipe and decontaminate the dose bench and then must document that any removable activity is below the site's action level. The lab holds an ion chamber, a thin-window Geiger-Muller probe, a sodium iodide well counter, and a dose calibrator. Which instrument and method should verify removable contamination on the bench?
- Within a few weeks of a high-activity therapy infusion, a patient develops a temporary drop in blood counts. Separately, a technologist with 25 years of handling unsealed sources has no symptoms, but the department tracks the worker's dose to estimate long-term health risk. Which classification fits both the patient's count change and the worker's long-term risk?
- A nuclear pharmacy notices that after a molybdenum-99 and technetium-99m generator is eluted, the measurable Tc-99m yield climbs for about a day and then declines. Which physical principle accounts for the rise and fall of the daughter activity?
- A Tc-99m unit dose for the first stress patient sits capped on the hot lab counter while two technologists prepare kits nearby. The patient will be called in a few minutes, so the dose must stay ready, and the lead pot on the bench is empty. Which bench practice best applies time, distance, and shielding under ALARA for the whole team?
- During an afternoon dispensing run, a small, low-activity Tc-99m spill is confined to the hot-lab bench; the floor is clean, and a hand survey shows no staff contamination. Under the lab’s written minor-spill procedure, which cleanup, monitoring, and documentation steps are appropriate before the bench is reused?
- After a therapeutic administration, a wipe survey shows removable contamination above the limit specified in the facility’s written procedure on the exam couch and floor of a room with two more patients scheduled that morning. The procedure requires restricting and posting the area, documenting the finding, and verifying decontamination before reuse. Which actions satisfy these requirements?
- A shipment of a Tc-99m labeled radiopharmaceutical arrives at your outpatient clinic, but the outer carton is crushed on one corner and the radioactive label is partially torn. No liquid or powder is visible, and the tote is still sealed. You are the only technologist on duty. Which package receipt step must you complete first?
- Four radiation events get confused in practice: a fast electron slowing in a shield, an excited nucleus handing energy to an orbital electron, an inner-shell vacancy ejecting an electron, and a photon beam crossing matter. Each has its own mechanism, energy pattern, and range. Which statement correctly describes the physics of attenuation, bremsstrahlung, internal conversion, or Auger emission?
- A nuclear medicine technologist draws Tc-99m unit doses behind an L-block each morning and stays with therapy patients all afternoon. The radiation safety officer is checking monitor placement before the next exchange, and both hand dose and the highest plausible whole-body dose must be on record. Which personnel monitoring arrangement should the technologist wear during the shift?
- A quality review of a Tc-99m SPECT study attributes reduced contrast to photons scattered inside an average-size patient. The camera records events that deposit only part of the 140 keV photon energy and change direction. Which photon interaction in soft tissue best explains these scattered events?
- Heritable effects in humans and effects on a developing embryo are separate ideas that patients often mix together when they ask about radiation and future children. Which statement about the genetic effects of radiation is the accurate one to explain?
Image Production: Instrumentation (15%) · 45 questions
- A nuclear medicine department runs one well counter for thyroid uptake samples and serum binding assays whose activities vary more than tenfold. The QC log includes a 10-minute background count, a reference-source spectrum, a chi-square test on repeated counts, and a series of counts from sources spanning the activity range used clinically. Which log entry shows the counter stays trustworthy across that whole range?
- A PET/CT protocol calls for dynamic imaging of the first pass with frame boundaries that the reviewer may change after the images are seen. The patient's injected activity and bed time are fixed by protocol, and the scanner can acquire either in list mode or in preset frames. Which acquisition format should the technologist select?
- After a photomultiplier tube was replaced on one gamma camera head, the service engineer adjusted the gain and asked for quality control before the camera returns to clinical use. Which test will show whether every region of the detector responds evenly to a uniform radioactive source?
- PACS becomes unavailable while two SPECT studies are being processed, and the radiologist still needs both images for same-day interpretation. Which downtime workflow keeps the studies identifiable, readable today, and fully accounted for after recovery?
- Before the day's Tc-99m workload, a technologist checks two survey meters. With both probes capped the ionization chamber needle sits above zero while the GM meter already reads zero, and the SOP requires each meter to indicate zero before the first survey. Which first step makes the ionization chamber ready for use?
- A 62-year-old outpatient arrives for an FDG PET study at 0800. The dose is given at 0805, but the injection time was entered as 0740, and the camera begins at 0905. Blood glucose is logged and the patient's weight is current. The radiologist wants accurate SUV values before the report is released. Which correction should the technologist make to the study record before the SUV is calculated?
- A technologist is setting up a whole-body bone scan with Tc-99m MDP. Available for the camera are low-energy high-resolution, low-energy high-sensitivity, and medium-energy high-sensitivity collimators. The order requires coverage from skull to toes in one continuous pass, the patient can tolerate only a short table time, and the tracer emits 140 keV photons. Which collimator and acquisition setting fits this whole-body study?
- A supplier change brings thicker 5 mL vials for unit doses, and readings on the new vials run several percent high while the daily constancy check with the sealed reference source stays on its control chart. Which dose calibrator performance test best evaluates how the new vials affect the reading?
- On a 64-year-old's PET/CT for lymphoma restaging, a bright crescent of uptake appears along the diaphragm on the attenuation-corrected image but is absent from the non-corrected emission image, and the CT liver dome sits lower than the PET liver dome. Which CT acquisition technique should you verify before the next chest study to reduce the chance of this mismatch recurring?
- A hospital is choosing an aerosol delivery system for Tc-99m DTPA ventilation imaging in an exam room that opens onto a busy corridor. The study needs uniform lower-airway deposition from several minutes of quiet mouthpiece breathing, and spent aerosol must be captured before it reaches room air. Which nebulizer specification should the department require?
- A hospital opens a satellite nuclear medicine room that must handle three jobs: quantify exposure rate at the prep counter, screen the bench for surface contamination, and assay a syringe of radiopharmaceutical before injection. An ionization chamber survey meter, a GM survey meter with an end-window probe, a dose calibrator, and a well counter are available. Which assignment of instrument to job is correct?
- While reviewing a myocardial perfusion SPECT study, you note that the camera logged a shift in the patient's position partway through acquisition, and the summed images show displaced subdiaphragmatic activity over the inferior wall. Which data processing approach should be applied to correct this dataset?
- Today's intrinsic flood is accepted as even and the Tc-99m photopeak sits correctly, yet two SPECT acquisitions show the same circular smearing of activity around the center of the reconstruction. Which quality control test should the technologist run first to trace this artifact?
- A physician orders a 20-minute study after tracer administration so that a region of interest over one organ can be plotted as a time-activity curve. The camera must stay in a single position, images must be captured in successive short intervals, and the counts from each interval must remain separate for later analysis. Which gamma camera acquisition mode produces the data set the team needs?
- Before the thyroid uptake clinic opens, the technologist runs well counter QC and finds that counts from the daily check source are 12 percent below the established reference value, while background is unchanged and the photopeak sits low in the channel. Which well counter QC procedure should be performed first?
- The PACS server will be offline all morning while the full schedule keeps running, and the assigned reader is off site and wants to work through the cases during that window. Every study must also stay traceable with its original images recoverable for later loading. Which interim approach keeps the studies readable and recoverable until the system returns?
- Each morning at a busy hospital, before any patient doses are drawn, the technologist measures the same sealed reference source in the dose calibrator and compares today's reading with its decay-corrected baseline. Which quality control test does this routine represent?
- A 54-year-old thyroid cancer patient returns for a whole-body survey five days after oral I-131 therapy. The shelf holds low-energy high-resolution, medium-energy general-purpose, and high-energy parallel-hole collimators, and the scan still needs enough counts to reveal small deposits. Which collimator and photopeak setting best fit this I-131 whole-body study?
- Morning quality control on the PET/CT scanner shows the 511 keV photopeak from the reference source sitting above the expected energy window, and the flood image looks grainy rather than smooth. With an hour before the first patient, which PET calibration should be repeated to restore accurate counting?
- A 67-year-old with newly noted hydronephrosis is positioned posteriorly for a diuretic renogram. The technologist is redrawing the regions of interest before reprocessing the study. Which region-of-interest strategy is appropriate for generating renal time-activity curves?
- Your department is setting up a small room for aerosol ventilation imaging. The setup has a nebulizer, a mouthpiece and a length of tubing, and the room shares its return-air duct with the rest of the suite. The plan must keep released aerosol out of that shared air while the patient breathes. Which change to the delivery setup best contains the released aerosol?
- A GM survey meter returns to service after its detector cable was reconnected during bench work. The battery check passes and background sits inside the control range, but the check-source response is lower than last month's reference value. Which test should qualified service personnel perform to confirm the tube's operating point is on its plateau?
- A rest and stress myocardial perfusion SPECT study on a 58-year-old with a low-risk stress test shows a reversible defect along the inferior wall on the uncorrected images, and the hybrid scanner can also acquire CT. Which processing approach will best show whether soft-tissue attenuation explains the finding?
- Before the first patient arrives, the nuclear medicine department runs weekly quality control on the well counter and the thyroid uptake probe. The supervisor wants proof that the counting system stays stable during long counts. Which QC test best demonstrates that counting stability?
- A nodule in the lower lung sits just under the diaphragm, and the team wants a time-activity curve from it while the patient breathes shallowly but unevenly. Counts are limited, so image noise should stay low and the data must stay re-sortable after the scan. Which PET acquisition setup preserves the framing, gating and noise advantages this study needs?
- Morning checks on a SPECT system show uniformity within tolerance and a correctly positioned photopeak, but a bone tomogram acquired afterward shows structures shifting side to side between adjacent transverse slices. Which camera quality control test should be examined first?
- A 30-year-old with a transplanted kidney is scheduled for a diuretic renogram. The study must show the tracer arriving and moving through the renal pelvis during the first two minutes with near-second timing, then continue long enough to watch drainage after the IV diuretic given at about twenty minutes, and the curves must be quantitated from defined time frames. Which gamma camera acquisition mode and framing plan fits this renogram?
- A department plans Tc-99m aerosol ventilation studies in an interior room and occasional Xe-133 inhalation work. The room shares the building return-air plenum with the corridor, the door stays closed during procedures, and the nebulizer sits on the counter beside the patient. Which room condition must be verified before aerosol and radioactive gas studies begin?
- During a busy afternoon, a scheduled patient is missing from the modality worklist. The RIS shows the exam under a record whose name and date of birth were corrected last week, and the study must be finished before the clinic closes. Which step should the technologist take first to link the images to the correct patient record?
- The PET/CT system sat idle overnight, and the morning list starts with an FDG study that needs CT-based attenuation correction. The console shows the scanner's required daily CT calibration is still pending. Which quality control step must be completed before the first patient acquisition?
- The daily constancy check on a dose calibrator has read low for three straight days. The reference source is still the original one, the instrument has had no service work, and readings on the other nuclide settings remain unchanged. Which test should be performed next to determine whether the reference source or the instrument is responsible?
- A follow-up PET/CT shows SUV values shifted from the prior study even though the reconstructed and attenuation-corrected images look normal and both the scanner's daily quality control and the dose calibrator constancy check passed this morning. Which calibration check should the department perform first to explain the quantitative mismatch?
- A patient is booked for In-111 octreotide scintigraphy, but the camera still has the low-energy collimator from a Tc-99m bone study. The tracer's photopeaks sit at 171 and 245 keV. Which collimator and window setup best preserves image quality for this study?
- A technologist runs SPECT quality control on a uniform phantom after a detector service visit. Reconstructions show a symmetric rotating spot artifact and wavy sinogram traces, while today's flood uniformity, energy peak and resolution checks all meet tolerance. Which camera QC test should be run first to investigate the rotating artifact?
- A 63-year-old patient arrives for a myocardial perfusion PET study after the radiopharmacy delivery runs late, so acquisition timing may need adjustment afterward. Body habitus raises image noise, and the reading cardiologist wants respiratory motion controlled. Which PET imaging setup satisfies all three needs for this exam?
- A community nuclear medicine department runs thyroid uptake measurements every morning with an uptake probe, a neck phantom, and a well counter. The manufacturer's service engineer replaced the probe's photomultiplier tube yesterday. Which quality control check should be completed first to verify the probe's energy response before any patient is counted?
- A first-pass cardiac study is ordered for an adult patient, and the cardiologist wants to compare the same injection data at two different frame rates, with the choice made after the study ends. No detected events should be discarded during acquisition. Which acquisition mode keeps the data usable at frame rates chosen later?
- A repeat gated blood-pool study reports an ejection fraction of 26% for a patient whose study three years earlier read 51%. On review, the fixed ventricle region includes part of the left atrium and adjacent lung, and the time-activity curve is noisy around an irregular end-systolic trough. Which correction should be made before this ejection fraction is released?
- Geiger-Muller tubes and ionization chambers are both gas-filled detectors in daily use, and both pass this morning's background and constancy checks. The GM tube is the department's usual tool for low-level contamination surveys. Which statement correctly explains how each detector turns radiation into a reading?
- A mobile nebulizer is set up in a small imaging room for an adult aerosol ventilation study, and a staff member stays at the bedside for the whole breathing period. Which containment controls should be verified and recorded before the patient starts inhaling?
- The daily constancy check on the dose calibrator reads about 10 percent low for the sealed reference source on every radionuclide setting, with the battery check passing and background normal. Repeating the measurement with the source centered in the well gives the same low result. Which dose calibrator QC test should be performed next to help identify the cause?
- The PET/CT sat idle overnight, and the CT tube has been off since yesterday's last attenuation-correction scan. The manufacturer's protocol requires a tube warm-up after this shutdown. The department runs calibration and image-quality checks on a weekly cycle, so only the steps that address the idle period are due now. The first patient is on the table for a routine whole-body study. Which CT tube preparation step is required before the first patient exposure?
- Morning PET/CT quality control passes on this unit: energy peaking, uniformity flood, and the CT air-water calibration are all within tolerance. A repeat study of a stable patient still shows SUVs consistently higher than baseline despite identical injected activity, uptake time, and decay correction. Which calibration check should the technologist run next to explain the shift?
- A thyroid-cancer patient returns two days after a therapeutic dose of iodine-131 for a whole-body scan. The camera offers low-, medium-, and high-energy parallel-hole collimators plus a pinhole head, and the energy window is still on the preset left by the previous technetium study. The schedule allows full imaging time, so contrast matters more than raw count rate. Which collimator and energy window should be set for this acquisition?
- A SPECT study of the lumbar spine was acquired with the patient still, but the low count density and a sharp reconstruction filter leave the summed images grainy with speckled hot spots over the vertebral bodies. You need images reliable enough to judge focal uptake. Which reconstruction change should you make before reading this study?
Procedures: Radionuclides and Radiopharmaceuticals (14%) · 42 questions
- A technologist draws a Tc-99m sestamibi dose for a resting perfusion study. The vial label lists the drug name, activity, volume, and expiration time, and a tungsten syringe shield sits ready on the cart. Department policy requires the patient's identity and every label field checked against the order while the syringe stays shielded. Which verification and handling step must be completed before the syringe leaves the dosing area?
- A patient is referred for parathyroid scintigraphy with Tc-99m sestamibi. The dosimetry summary states that the urinary bladder wall receives the highest absorbed dose of any organ, while the parathyroid tissue supplies the diagnostic image. How should the team classify the target organ and the critical organ for this study?
- During quality control in a hospital radiopharmacy, one result shows that a freshly eluted Tc-99m generator sample is within its molybdenum breakthrough limit, and a second shows that a sulfur colloid preparation contains no free pertechnetate. Which type of purity does each result verify?
- A technologist draws a Tc-99m dose that reads 800 MBq at 7:00 AM for a patient booked at 1:00 PM, and the appointment slips to 7:00 PM with no fresh dose available. The same syringe will be used, and the department logs the activity at administration. What activity should be documented when the patient is injected at 7:00 PM?
- A community hospital wants F-18 FDG PET for 8:00 AM weekday patients but cannot buy a cyclotron, and the nearest producer is two hours away by road. F-18 has a half-life of about 110 minutes. Which supply plan fits this schedule?
- A department prepares the same technetium-99m kit throughout the day, adjusting each draw for decay so every kit receives the target activity. Batches made late in the afternoon label less efficiently than morning batches, although all draws come from the same eluate held since the morning and eluate pH, incubation temperature, and incubation time stay within the package insert ranges. Which remaining preparation variable best explains the drop in labeling efficiency?
- A colleague has just drawn a Tc-99m sestamibi dose for an outpatient myocardial perfusion study, and the syringe sits unshielded on the counter while the activity is recorded. Verify the patient, radiopharmaceutical, and prescribed activity against the written order; also confirm the labeled activity’s calibration time and the drawn volume. Hand exposure must stay low. Which plan meets both requirements?
- A patient two minutes into a slow intravenous radiopharmaceutical injection develops widespread hives, audible wheeze, and throat tightness while the syringe is still connected. The emergency drugs are in the adjacent room and the technologist is alone at the bedside. Which immediate action best manages this administration reaction?
- A quality check on a freshly prepared Tc-99m kit shows more free pertechnetate than the package insert allows. The eluate was drawn within its labeled time and used within its stated stability period, the kit vial was stored as labeled and is in date, and the first dose was drawn only after the full incubation period. Which preparation condition most likely accounts for the excess free pertechnetate?
- A clear, solution-type technetium-99m preparation for a renal study appears free of visible matter under backlighting, yet chromatography on the same vial produces a large free pertechnetate peak. The release decision hinges on one quality control measurement for this batch. Which quality control result determines whether this vial is released to the clinic?
- A radiopharmacy checks a Mo-99/Tc-99m generator eluate against its release sheet: aluminum ions and pH are within limits, radiochemical purity of pertechnetate exceeds 95%, and 99.9% of the activity is Tc-99m. Which purity aspect does the 99.9% figure describe for this eluate?
- During morning dose preparation, a bone imaging referral arrives for an adult with a known prostate primary being staged for osseous spread. The tracer must settle onto calcium phosphate mineral where new bone is being formed, and it must come from a generator-eluted kit. Which radiopharmaceutical's localization mechanism matches this study?
- During a myocardial perfusion study, an adult outpatient who reports fainting with past blood draws becomes pale, clammy, and lightheaded a few minutes after a radiopharmaceutical injection through a peripheral IV, and the pulse is slow. Which immediate intervention best reverses the mechanism behind this injection reaction?
- A patient with biopsy-proven cirrhosis is scheduled for a liver-spleen scintigram ordered to evaluate reticuloendothelial function. Before drawing up the dose, the technologist confirms why the ordered agent accumulates in the liver. Which localization mechanism accounts for this agent's liver uptake?
- Tc-99m sulfur colloid for a liver-spleen study passes chromatography for radiochemical purity and passes visual inspection, yet the measured particle size falls outside the stated range. Why does the particle size result alone make this preparation unusable?
- A cardiac PET program performs rest and stress myocardial perfusion imaging during one visit, with the stress injection about half an hour after the rest injection. The perfusion agent is rubidium-82, a positron emitter with a physical half-life of roughly 75 seconds. Which production method supplies a usable dose for both injections?
- At 8:00 AM the dose calibrator shows a Tc-99m radiopharmaceutical vial containing 800 MBq in 4.0 mL. The prescription calls for 200 MBq to be injected at 2:00 PM, and Tc-99m has a physical half-life of about six hours. Which syringe volume drawn at 2:00 PM delivers the ordered activity?
- A patient asks how long the injected tracer will keep decaying after the appointment, and the team notes a 6-hour physical half-life with a 12-hour biological half-life for this agent. Which value best estimates how fast the total activity in the patient falls?
- A technologist is drawing an afternoon Tc-99m sestamibi dose for a patient on the stress table. Policy requires the full label checked against the written order, the patient positively identified, and hand dose kept as low as possible during handling. Which dose-handling practice meets the label, identification, and shielding rules?
- A resident asks how fast a tracer leaves the body when its physical half-life is 8 hours and its whole-body biological half-life is 24 hours. Which value should you report as the time for the body's total activity to fall by half?
- Routine quality control on a technetium-99m generator eluate shows molybdenum-99 activity above the permitted level for the amount of technetium-99m present, so the vial is set aside before any dose is drawn. Which explanation correctly identifies the kind of purity failure the eluate has?
- A patient is referred for whole-body bone scintigraphy with Tc-99m MDP because metastatic disease is suspected. The radiopharmacist notes that the agent binds to bone while unbound activity travels through the kidneys into urine over the next few hours. Which statement correctly identifies the study's target organ and its critical organ?
- A hospital with no cyclotron or reactor schedules an ordered technetium-99m sestamibi SPECT study with the first patient at 07:00, while its only isotope delivery arrives between 09:00 and 11:00. Which supply arrangement can dose the first patient on time?
- A liver and spleen study requires 185 MBq of technetium-99m sulfur colloid. The unit-dose syringe is calibrated for 12:00 PM and holds 925 MBq in 5.0 mL, a concentration of 185 MBq per milliliter at noon. The appointment moves to 6:00 PM, and the full 185 MBq must be in the syringe at injection. Using technetium-99m's six-hour physical half-life, what volume should be drawn at 6:00 PM to deliver the prescribed activity?
- During an outpatient visit, a dose is pushed through an existing catheter when the patient reports sharp pain and the site blanches and swells; some drug has entered the tissue, the syringe still holds the rest, and department policy requires physician assessment before the patient leaves. Which immediate response best limits tissue damage from this infiltration?
- On a busy afternoon, a technologist reconstitutes a lyophilized kit with freshly drawn eluate for a liver-spleen study. The package insert specifies the holding conditions, quality control includes a chemical check, and the doses must go out before the evening schedule fills. Which preparation verification must be completed before any dose from this kit is released to a patient?
- A 48-year-old with primary hyperparathyroidism is scheduled for a two-phase neck study this afternoon. The protocol calls for a lipophilic cation that diffuses into mitochondria-rich cells and clears from normal thyroid faster than it clears from an adenoma. Which radiopharmaceutical matches that localization mechanism?
- Two patients are scheduled this morning for the same perfusion study, and a shielded unit dose was drawn at the calibrator forty minutes ago before you reached the suite. Before you enter the patient's room, which label details must you confirm to complete the unit dose verification?
- A radiopharmacy reviews a stock radionuclide solution before releasing it for kit preparation. Assay activity, sterility and pH all pass, and the reviewer still must document that the radioactivity is the intended nuclide. Which measurement establishes radionuclidic purity for this release?
- During a protocol in-service, a student argues that the organ showing the greatest uptake on a bone scan must also be the organ receiving the highest radiation dose. The agent in question shows strong cortical bone uptake, yet a sizable fraction is cleared by the kidneys and dwells in the bladder until the patient voids. Which statement correctly distinguishes the target organ from the critical organ for this agent?
- The insert for a reconstituted Tc-99m kit requires eluate pH within a stated range, incubation at a set temperature and time, and a label carrying preparation and expiration times. USP <825> also requires applicable radiopharmaceutical identification and activity information on the label. The pH strip reads at the edge of the range. Which preparation sequence satisfies the insert and USP <825> before the vial is released?
- Indium-111 oxine-labeled autologous white blood cells are reinjected for a patient being evaluated for a suspected deep abdominal abscess, with imaging about a day later. Which mechanism carries the activity to the infected focus and causes it to accumulate there?
- A medical physicist is reviewing a dosimetry worksheet for a patient with reduced renal clearance, where the tracer is cleared more slowly than in a healthy adult. The worksheet lists the physical half-life and the biological half-life separately, and the physician needs the effective value that reflects both processes. Which statement correctly compares physical, biological and effective half-life for this patient?
- A hospital PET service plans a new tracer that decays by positron emission, has a half-life near two hours, and has a parent nuclide that would decay away before it could be stored. The tracer must be produced on site for a same-morning injection. Which production route best fits this tracer?
- During a slow IV infusion of a radiopharmaceutical, a middle-aged patient develops flushing, hives, and itching about halfway through the dose. The IV line is patent and must stay usable for emergency medication, and unit policy requires the physician to be told at once. Which immediate action correctly manages this acute reaction?
- A hospital radiopharmacy prepares a Tc-99m albumin aggregate suspension for an adult lung perfusion study. Free pertechnetate would leave the lung field and collect in the stomach, thyroid, and salivary glands, so the supervisor wants the tracer's chemical form confirmed before release. Which quality control test verifies that the activity is bound to the aggregates?
- A radiopharmacy director is comparing three supply routes before signing a new contract: a nuclear reactor, a medical cyclotron, and a generator column. The director wants each route matched to the physical process that actually creates the nuclide. Which statement accurately compares all three production routes?
- A fresh kit of a particulate radiopharmaceutical has just been prepared for a patient booked in the next room. The prep log shows only the time since reconstitution and a note that the vial looks clear. Which release checks should be documented?
- A Tc-99m kit holds 3,700 MBq (100 mCi) in 10.0 mL at its 8:00 calibration time. A bone scan patient is injected at 14:00, and the order specifies 740 MBq (20 mCi) at injection time, with plenty of kit volume left to draw from. What volume must be drawn at 14:00 to deliver the ordered activity?
- A myocardial perfusion tracer concentrates in the heart for imaging and is cleared through the bowel. For this agent, dosimetry shows that the bowel wall receives the highest absorbed dose of any organ. Which organ is the critical organ, and what makes it so?
- A radiopharmaceutical is cleared by the kidneys so quickly that its biological half-life is only a fraction of its physical half-life. Two colleagues are discussing how long the activity actually stays in the patient, and they disagree about how the three half-lives relate. Which statement correctly compares physical, biological, and effective half-life for this tracer?
- After eluting the Tc-99m generator for the afternoon clinic, the technologist runs the routine dose-calibrator check and finds the molybdenum-99 reading above the allowed limit for that eluate. The radiopharmacist pulls the vial and asks the staff to name the product-quality attribute that failed and what it means for the patient. Which statement correctly identifies the failed attribute and its clinical effect?
Procedures: Cardiac (12.5%) · 37 questions
- A patient with heart failure and a reduced ejection fraction is scheduled for Tc-99m PYP imaging to evaluate for transthyretin cardiac amyloidosis. The cardiologist wants myocardial retention graded about one hour after injection, and department protocol requires cross-sectional imaging to keep blood pool activity out of that grade. The patient has eaten breakfast and taken the usual morning medications. Which acquisition plan best completes this amyloid study?
- A 66-year-old scheduled for a same-day Tc-99m sestamibi rest and stress study cannot walk a treadmill because of hip pain and takes theophylline daily for asthma. The protocol requires a higher activity at stress than at rest. Which stress agent and injection pattern fits this patient?
- A patient with severe persistent asthma has suspected coronary artery disease, cannot exercise because of severe osteoarthritis, and the department stocks only Tc-99m perfusion agents. Which stress agent and radiopharmaceutical pairing should be selected?
- A technologist starts a gated SPECT myocardial perfusion acquisition and sees the cycle-length histogram spread widely instead of clustering around one R-R interval; the chest leads were applied over lotion, and the study must finish before the stress lab opens. Which correction should the technologist make before restarting the gated acquisition?
- On a rest and stress myocardial perfusion study, the inferior wall shows reduced tracer uptake on both acquisitions, all frames passed the motion check, and the gated frames show that same segment contracting poorly. Which pathophysiologic explanation best accounts for this pattern?
- A patient with a fixed perfusion defect on rest sestamibi images is being evaluated for revascularization, so cardiology orders FDG viability imaging for the afternoon. The patient's last meal was at noon and blood glucose was drawn then. Which preparation should the technologist arrange before the FDG injection to judge myocardial viability?
- A patient checks in for a vasodilator stress myocardial perfusion study at an outpatient clinic. The patient had caffeinated coffee at breakfast, uses an albuterol inhaler for mild asthma, and takes metformin for type 2 diabetes. The order specifies regadenoson as the stress agent. Which preparation step must be completed before the regadenoson injection proceeds?
- An outpatient scheduled for rest and stress myocardial perfusion imaging cannot use the treadmill because of severe leg pain, and the nurse hears audible wheezing before the stress phase begins. The patient is otherwise stable and ready to proceed today. Which stress approach should the team use for this study?
- A patient with an old anterior infarct, an ejection fraction of 35% and recurring chest pain is being considered for revascularization. The team must distinguish hibernating muscle from scar, compare flow and metabolism in the same walls, and use a controlled myocardial FDG preparation with a documented glucose value. Which myocardial viability plan meets those requirements?
- Myocardial tracer uptake rises with regional coronary blood flow, so perfusion imaging compares stress uptake with rest uptake. A defect with reduced stress uptake and normal rest uptake in the anterior septum and apex, with the inferior and lateral walls normal, is reversible. Which pathophysiology statement best explains that pattern?
- A cardiologist requests noninvasive confirmation of cardiac transthyretin amyloidosis in an older adult with heart failure and preserved ejection fraction. The report must grade myocardial uptake against rib uptake while separating activity from overlying bone and blood pool, and the visit must use the right patient preparation. Which amyloid imaging plan best satisfies these requirements?
- A patient arrives for adenosine stress myocardial perfusion imaging after drinking coffee this morning. Rest images are complete, the patient feels well, and vital signs are normal. Which step best handles the caffeine before the pharmacologic stress phase?
- A patient arrives for a vasodilator stress myocardial perfusion study having just finished a caffeinated drink, and the rhythm review shows frequent premature beats. The final data set has to support both perfusion images and gated volumes with an ejection fraction. Which combined preparation and gating plan keeps both parts of the study valid?
- On a myocardial perfusion study the reduced tracer uptake sits in the inferior wall of the left ventricle on both stress and rest images, while the other walls fill normally. Which coronary artery most commonly supplies the territory where the uptake is reduced?
- A patient with a calcified, narrowed aortic valve and worsening exertional dyspnea is scheduled for stress myocardial perfusion imaging. Cardiology documents pressure overload across the valve. Which left ventricular geometry is the expected adaptation to that load?
- A patient with severe left ventricular dysfunction is referred for F-18 FDG myocardial viability imaging after a fixed defect appeared on a perfusion study. The protocol requires an overnight fast, a glucose check, and glucose loading before injection. Which patient preparation plan best supports this viability protocol?
- A 59-year-old with severe persistent asthma is referred for myocardial perfusion imaging after exertional chest tightness. He cannot reach the target heart rate on the treadmill, and the study will be a gated rest and stress SPECT. Which stress agent paired with Tc-99m sestamibi best fits this patient?
- A 69-year-old with heart failure and suspected cardiac amyloidosis is injected with Tc-99m PYP. At 1 hour, planar images show activity over the left heart with blood pool, sternum, and ribs overlapping, plus a bright liver. The reader must rule out blood pool before calling the study cardiac. Which acquisition best proves the uptake is truly myocardial?
- A patient with an akinetic inferior wall after an old infarction is being evaluated for revascularization. The cardiologist wants resting perfusion and myocardial metabolism compared within a single session so hibernating tissue can be identified, and the metabolic preparation has already started. Which viability protocol plan best meets those requirements?
- During a myocardial perfusion study, the stress images show reduced tracer uptake limited to the anterior wall, and the rest images taken the next day show that same wall taking up tracer normally. Which combination of coronary supply and flow physiology explains this stress-to-rest difference?
- A 61-year-old with exertional chest pressure is booked for a one-day rest and stress myocardial perfusion study with Tc-99m sestamibi, because the cardiology clinic can see the patient only once this week. Rest images are acquired first, and the patient returns the same afternoon for a treadmill stress stage with a second injection. Which injection sequence and relative activity fits this one-day sestamibi protocol?
- A 74-year-old with fatigue, a history of bilateral carpal tunnel release, and preserved ejection fraction is scheduled for Tc-99m PYP imaging to evaluate suspected cardiac amyloidosis. Renal clearance and background activity both influence how clearly myocardial uptake appears. Which preparation instruction matches current published guidance for this study?
- A patient with a markedly reduced ejection fraction and a large prior infarct is being evaluated for revascularization, and the cardiologist needs proof that the poorly contracting territory still holds living muscle. The patient cannot complete treadmill exercise. Which viability protocol should be planned?
- A patient is booked for a vasodilator-stress myocardial perfusion SPECT study to evaluate chest pain, with ECG gating planned for both rest and stress acquisitions. The patient fasted as instructed but mentions having a cup of coffee shortly before arriving. Which preparation decision keeps the stress portion of the study valid?
- A patient with heart failure and a healed anterior infarct is scheduled for Tc-99m PYP scintigraphy for suspected ATTR cardiac amyloidosis. The protocol already includes planar imaging plus SPECT, but the requisition arrives without any laboratory studies and orders an overnight fast with insulin held for a same-day FDG comparison. Which preparation is required before this PYP study can be interpreted as supporting ATTR cardiac amyloidosis?
- A 74-year-old with HFpEF and concentric LV wall thickening is referred for Tc-99m PYP imaging to evaluate suspected ATTR cardiac amyloidosis. Serum and urine monoclonal studies are negative and kidney function is stable. The laboratory's protocol starts with a 1-hour acquisition. Which acquisition plan best separates true myocardial retention from residual blood-pool activity?
- An outpatient arrives for an equilibrium gated blood pool study to evaluate ventricular function. The department uses the modified in vivo-in vitro red blood cell labeling method (stannous pyrophosphate pretreatment, then blood withdrawn for ex vivo technetium incubation), and the patient is at the first step of the prep sequence. Which preparatory step must be completed before the blood sample is drawn for labeling?
- A 64-year-old with new exertional chest pain completes a two-day stress myocardial perfusion study. The raw data show sharp motion-free frames, and the lateral wall takes up less tracer at peak stress but fills in completely on the next morning's resting images. The cardiologist asks what that change means for the muscle. Which myocardial pathophysiology best explains the pattern?
- A patient with severe COPD but no active wheezing reaches only a low heart rate on the treadmill and wants to avoid a long infusion, so the cardiologist plans vasodilator pharmacologic stress with Tc-99m sestamibi imaging. Which stress agent and administration plan best fits this patient?
- A patient with severe left ventricular dysfunction after an anterior infarction is being evaluated for bypass surgery, and the heart team must separate hibernating myocardium from dense scar. The patient cannot exercise, and the study must supply perfusion and metabolic information in the same session so the mismatch pattern can be read. Which viability protocol should be planned?
- A patient with severe asthma after a recent wheezy flare needs a rest and stress myocardial perfusion study, and a painful hip rules out treadmill exercise. The department runs a one-day Tc-99m sestamibi protocol in which stress activity exceeds rest activity. Which combination of radiopharmaceutical, activity pattern and stress agent best fits this patient?
- A gated rest SPECT reports that most beats were rejected and gives an implausible ejection fraction. The patient has frequent premature contractions, caffeine abstention was followed, and the cardiologist needs a dependable ejection fraction. Which acquisition change best improves this gated study?
- A patient is lying still for a gated blood pool study, but the acquisition display shows most heartbeats being rejected, and the ECG trace on the monitor looks small and noisy. The detector is centered over the heart and the patient has removed all jewelry from the chest. Which action will most likely produce a properly synchronized gated acquisition?
- A 58-year-old with exertional chest discomfort undergoes gated myocardial perfusion SPECT. The rest study shows a fixed perfusion defect with akinesis of the anterior wall and mid septum, while the lateral and inferior walls show normal uptake and normal thickening. Which coronary artery territory best explains this regional wall abnormality?
- A patient with stable angina is scheduled for myocardial perfusion imaging today. Severe knee osteoarthritis rules out walking on a treadmill, and the chart documents physician-diagnosed asthma with active wheezing today. Resting rhythm is sinus with normal blood pressure. Which stress agent best fits this perfusion study?
- A 68-year-old with heart failure and suspected cardiac amyloidosis shows clear myocardial tracer uptake on Tc-99m PYP imaging, and SPECT confirms that the uptake sits in the myocardium rather than in the blood pool at one hour. The cardiology team wants a noninvasive confirmation of the amyloid type before therapy starts. Which evaluation must be completed before the study is attributed to ATTR?
- A patient with an akinetic inferior wall and a severely reduced ejection fraction is being evaluated for revascularization, and the cardiology team needs to know whether the resting defect is scar or hibernating myocardium. The nuclear medicine staff must pick a protocol that answers that viability question during a single visit. Which single-visit imaging protocol best answers the viability question?
Procedures: Endocrine and Oncology (12%) · 36 questions
- A 52-year-old with a palpable thyroid nodule is referred for evaluation. The physician wants a numeric 24-hour uptake value and images showing whether the nodule functions, and the patient takes levothyroxine every morning. Which thyroid uptake and imaging plan best meets both requirements?
- A patient with a palpable thyroid nodule needs both a quantitative uptake value and a scintigram. The physician specifies that the value reflect iodine organification and that the images keep sharp resolution. Which radiopharmaceutical and schedule satisfies both requirements?
- A 38-year-old with a palpable thyroid nodule is booked for a 24-hour iodine-123 uptake study with planar imaging, with Tc-99m pertechnetate uptake imaging available as a backup method. The chart documents intravenous iodinated contrast earlier this month and daily kelp supplements. Which iodine-related preparation requirement must be confirmed before the capsule or the pertechnetate dose is given?
- A physician orders a thyroid study for a patient with a palpable nodule that must provide quantified iodine uptake at two time points plus morphologic images; the patient can attend on two consecutive days. Which radiopharmaceutical and timing plan meets these requirements?
- A patient with a palpable thyroid nodule and a suppressed TSH arrives for a thyroid study. The signed order calls for an oral I-123 capsule, a 24-hour uptake measurement, and an image showing which region of the gland traps tracer, and the patient reports stopping seafood and multivitamins three weeks ago. Which visit plan matches this thyroid uptake and imaging order?
- An outpatient with a palpable thyroid nodule needs gland function quantified before a possible treatment decision. The order calls for an iodine uptake percentage at the department's four-to-six-hour time point, images showing where the tracer localizes, completion in a single visit, and the lowest practical radiation dose. Which thyroid uptake and imaging plan meets all four requirements?
- A 50-year-old outpatient with biochemically confirmed hyperparathyroidism needs preoperative localization. Neck ultrasound shows a thyroid nodule that could retain tracer, the surgeon wants early and delayed sets to judge washout, and the gland may sit behind the sternum. Which imaging plan best localizes the abnormal parathyroid?
- An endocrine surgeon plans a minimally focused neck incision for a patient with biochemically confirmed primary hyperparathyroidism and an unremarkable ultrasound, with possible mediastinal exploration. The study must show parathyroid function and provide anatomic guidance for the incision. Which parathyroid imaging plan best meets the surgical request?
- A patient with raised parathyroid hormone and hypercalcemia has a negative neck ultrasound but is booked for a minimally invasive parathyroidectomy. The surgeon needs the overactive tissue located in three dimensions, covered down into the chest, and distinguished from the thyroid. Which parathyroid localization plan meets those requirements?
- A patient with primary hyperparathyroidism is referred for localization before a minimally invasive parathyroidectomy. Neck ultrasound shows a thyroid nodule in the same area, with no recent iodine exposure reported. The department offers dual-phase planar sestamibi, same-day sestamibi with pertechnetate subtraction, sestamibi SPECT without CT, and side-by-side comparison of sestamibi and pertechnetate thyroid images. Which acquisition plan best separates thyroid uptake from hyperfunctioning parathyroid tissue?
- A patient with biochemically confirmed primary hyperparathyroidism has a nondiagnostic neck ultrasound, and the surgeon plans a minimally invasive, image-guided exploration and wants the gland's precise side, level and depth. Which parathyroid imaging plan best satisfies that localization request?
- A patient with biochemically confirmed primary hyperparathyroidism needs preoperative localization before a minimally invasive parathyroidectomy. Thyroid scintigraphy shows a functioning nodule, and the surgeon also wants to know whether an adenoma lies low in the neck or behind the sternum. Which imaging plan best meets these localization requirements?
- A patient with newly diagnosed lymphoma starts chemotherapy next week, and FDG PET/CT is scheduled to stage disease beforehand. Department policy requires metabolic checks before the injection, a set waiting period afterward, and coverage from the base of the skull through the upper legs with the arms kept out of the chest images. Which preparation and acquisition sequence should the technologist follow?
- A patient with a history of breast cancer returns for a routine whole-body bone scan. The anterior and posterior images show one faint, ill-defined focus in the midsacrum that overlaps bladder activity, and the ordering physician wants better detail on that focus before therapy changes tomorrow. The patient has driven a long way, so the answer must come from today's visit. Which imaging approach should add clarity to that indeterminate sacral uptake today?
- A 68-year-old man with treated prostate cancer has a rising PSA level. The radiologist wants the whole skeleton screened for metastatic disease and a questionable lower lumbar spine focus separated from adjacent degenerative uptake using anatomic correlation. Which imaging plan best satisfies both requirements for this tumor study?
- A 54-year-old is six weeks after total thyroidectomy for papillary carcinoma and returns for a diagnostic whole-body iodine-131 scan. The protocol requires anterior and posterior views, and the survey must cover the entire body because distant spread is possible. Any focal area of uptake needs higher-detail images before the report is issued. Which acquisition plan best fits these requirements?
- A 54-year-old with a well-differentiated neuroendocrine tumor of the small bowel is being evaluated for receptor-positive metastases before targeted therapy is considered. The plan must survey the entire body and give anatomic detail for small or indeterminate foci. Which imaging plan best maps this patient's receptor-positive disease?
- A patient treated for lymphoma returns for restaging, and the order specifies metabolic imaging from the base of the skull to the upper legs, correction from the CT data, images after the standard uptake period, and the arms held above the head. Which acquisition plan best matches this restaging order?
- A patient with a metastatic neuroendocrine tumor is booked for Ga-68 DOTATATE PET/CT, and the chart shows a monthly long-acting somatostatin analog injection, with the last dose given a few weeks ago. The patient eats normally and the medication list shows only that injection. Which medication step best protects receptor availability for this scan?
- A 70-year-old with castration-resistant prostate cancer has a rising PSA after prostatectomy, and the physician wants a PET study that can show small-volume recurrent soft tissue and nodal disease at low PSA levels. Which agent and patient preparation pairing best fits the request?
- A patient with a well-differentiated neuroendocrine tumor has a new liver lesion, and the oncology team wants proof that the lesion expresses somatostatin receptors before selecting a receptor-targeted therapy. The team also requires uptake to be measured on PET for eligibility review. Which tracer and preparation combination should be arranged?
- A patient with metastatic neuroendocrine tumor arrives for receptor PET. The chart shows monthly long-acting somatostatin analogue injections, a fasting sheet printed for tomorrow's lymphoma PET, and a note that extra fluids support PSMA imaging. Which preparation is appropriate before this receptor PET tracer is injected?
- A 58-year-old patient with a well-differentiated metastatic midgut neuroendocrine tumor returns for staging before therapy planning. The physician wants somatostatin receptor density mapped in one high-resolution whole-body acquisition. Which radiopharmaceutical should be ordered for this tumor imaging study?
- A 58-year-old with biochemically recurrent prostate cancer is scheduled for a receptor-targeted PET study. The radiopharmacy holds an on-site germanium-68/gallium-68 generator with lyophilized kits, and the only PET radiopharmacy shipment this week carries FDG from the local cyclotron. Which radiopharmaceutical meets the targeting and on-site preparation needs?
- A 68-year-old woman with painful bone metastases from breast cancer aches in several bones even after radiation to her spine. Her oncologist expects her to live well beyond a few months, her platelet count is safe, and the team wants a systemic radiopharmaceutical labeled for painful skeletal metastases from her cancer. Which palliative bone therapy agent best fits this patient?
- A patient with Graves' hyperthyroidism and a large goiter is booked for iodine-131 therapy. The endocrinologist notes that iodinated contrast was given a few weeks ago and may still be suppressing uptake, the patient takes methimazole every day, and gland size varies a great deal between patients. Which iodine-131 therapy plan best matches these findings?
- After a total thyroidectomy for papillary thyroid cancer, a patient has a rising thyroglobulin and uptake in both lungs on a diagnostic iodine scan, so radioiodine therapy is scheduled. The department must give the therapy dose and then image where the administered activity localizes before the next course is planned. Which treatment plan best delivers the therapy dose and images where the activity goes?
- A patient with hepatocellular carcinoma confined to the right lobe is scheduled for yttrium-90 radioembolization, with compensated liver function and an unresectable tumor. Before the microsphere activity is ordered, the team must estimate how much of the dose could reach the lungs through an arteriovenous shunt. Which planning study supplies the lung shunt measurement?
- A patient with metastatic pancreatic neuroendocrine tumor has somatostatin receptor-positive disease in lymph nodes and liver on receptor imaging, a clear bone survey, and progression despite long-acting octreotide. The team plans receptor-mediated radionuclide therapy. Which targeted treatment best matches the receptor target?
- Six weeks after a total thyroidectomy for intermediate-risk papillary carcinoma, a patient is booked for I-131 remnant ablation in three days. A contrast-enhanced CT was done last week, and the patient is of childbearing age. Which readiness checks must be documented before the activity is administered?
- After outpatient I-131 therapy, an adult returns home to a house where a young grandchild stays overnight, and department policy gives every therapy patient written home precautions at discharge. Which release basis and instruction content best fits this discharge?
- After receiving radioactive iodine therapy for an overactive thyroid, a patient is cleared to go home and will ride in a small car with a spouse and a toddler in the back seat. At home there is one bathroom and a shared bedroom. Which release instructions should be documented and given before this patient goes home?
- After an oral I-131 therapy dose this morning, a 26-year-old patient of childbearing potential meets release criteria and plans a 45-minute crowded train ride home to an apartment shared with one housemate and a single bathroom. Which complete set of release precautions fits this patient's situation?
- An adult is discharged the same day after outpatient I-131 therapy for thyroid cancer and meets the regulatory release criteria for going home. At home a pregnant spouse shares the bed, a toddler is in the house, and a second bathroom is down the hall. Which I-131 release instructions best protect the family at home?
- After outpatient I-131 therapy, a patient is cleared to go home to a spouse and a grandchild who visits daily. The record holds a written directive for the therapy, an estimated dose of 2 mSv to the household member most likely to receive the highest dose, written safety instructions, and a teach-back in which the patient repeated the key rules correctly. Which documented conditions support releasing this patient under the NRC release criteria?
- A woman receiving outpatient radioiodine therapy for thyroid cancer is scheduled to go home the same day, and her radiation safety officer requires a post-therapy dose survey before release. She will be caring for an infant at home, so the discharge advice must address close contact. Which release requirement decides when she may leave the department?
Procedures: Gastrointestinal and Genitourinary (10%) · 30 questions
- A patient with long-standing diabetes is referred for a gastric emptying study, and at the two-hour image more than half of the radiolabeled meal is still in the stomach. The patient is comfortable, the order asks for a quantitative emptying curve, and the camera room is free for another hour. Which acquisition step should the technologist take next?
- A 55-year-old with long-standing diabetes is scheduled for solid-meal gastric emptying scintigraphy. The patient arrives after an overnight fast, finishes the labeled egg meal within the allowed time, and feels much better by the 2-hour image, so the nurse suggests ending the study there. Which imaging schedule best answers the referring clinician's question about delayed emptying?
- A 58-year-old outpatient with diabetes and early satiety is booked for a solid-meal gastric emptying study to check for gastroparesis. He has fasted since midnight and the order calls for a four-hour protocol. Which meal timing and imaging schedule suits this gastric emptying study?
- A hospital schedules two gastrointestinal studies one morning: an adult for solid-meal gastric emptying after fasting since midnight, and an infant with suspected reflux who will be fed at 8 AM. Which acquisition plan matches both the gastric emptying and reflux protocols?
- An outpatient arrives for a gastric emptying study planning to have coffee and juice with the usual breakfast, and the patient follows a special diet at home. The radiologist wants the emptying curve compared with the laboratory's normal range. Which instruction keeps the gastric emptying result comparable to that normal range?
- A patient is scheduled for a solid-meal gastric emptying study and reports having eaten toast and coffee forty-five minutes earlier, since the appointment reminder only listed the arrival time. The study must measure emptying of the labeled test meal alone. Which preparation condition must be confirmed before imaging begins?
- A busy nuclear medicine department schedules two studies back to back: a young patient with recurrent painless rectal bleeding and suspected ectopic gastric mucosa whose focus may appear only after several minutes of circulation, and an older inpatient with recurrent melena after inconclusive endoscopy whose bleeding is slow and intermittent. Which pair of gastrointestinal studies fits both referrals?
- A surgical ward patient has had three episodes of maroon-colored stool over the past day with stable vital signs and a stable hemoglobin. Endoscopy was nondiagnostic, and the surgeon wants the bleeding site localized during the next episode. The department offers labeled red blood cell imaging, a pertechnetate Meckel study, and a sulfur colloid bleed study. Which imaging plan is best for localizing this patient's bleeding?
- An 11-year-old has had two episodes of painless, bright-red rectal bleeding, and colonoscopy plus upper endoscopy are normal. The surgeon suspects a Meckel diverticulum with ectopic gastric mucosa. Which Meckel scan plan best demonstrates that ectopic gastric tissue?
- A young adult with recurrent painless rectal bleeding is scheduled for a Meckel diverticulum study, and the surgical team wants the earliest possible answer about ectopic gastric mucosa. A low-lying focus could sit among bladder and ureteral activity in the pelvis. Which acquisition plan captures uptake earliest while still clearing bladder activity from the pelvis?
- An adolescent with painless recurrent lower gastrointestinal bleeding is referred for scintigraphy, and the clinical team suspects a Meckel diverticulum containing ectopic gastric mucosa. The study has to show tracer being taken up by that tissue while bowel activity and motion are kept low. Which radiopharmaceutical and acquisition plan best demonstrates ectopic gastric mucosa?
- A young adult reports several episodes of maroon stools over two days, but a CT angiogram taken between episodes showed no active bleeding. The team also weighs a Meckel diverticulum scan. Which protocol plan best matches this slow, intermittent gastrointestinal bleeding?
- A 54-year-old outpatient has a 2 cm hypervascular lesion in the right hepatic lobe found incidentally on an abdominal CT after a minor traffic collision. The surgeon wants noninvasive confirmation that the lesion is a hemangioma before considering a biopsy, and the patient can return for a later appointment. Which radiopharmaceutical study and imaging plan should be scheduled to characterize the lesion as a hemangioma?
- A patient with a small, rounded lesion in the right lobe of the liver on ultrasound is sent for a nuclear medicine study, and the radiologist suspects a hemangioma and wants images showing it fill with blood over time. The exam must be finished in a single visit and the lesion is only about two centimeters wide. Which liver blood-pool study plan meets all of these requirements?
- An outpatient has a small, well-defined lesion in the right lobe of the liver, and the referring physician wants imaging that shows whether the lesion slowly fills with blood to confirm a cavernous hemangioma. The department stocks sulfur colloid, a hepatobiliary agent, and a red blood cell labeling kit. Which study best demonstrates the blood-pool pattern?
- A small well-circumscribed lesion is seen in the right lobe of the liver on ultrasound, and the radiologist wants to know whether it is a hemangioma. The patient is booked for in-vitro labeled red blood cell imaging, and SPECT is available in the department. Which acquisition plan will show the lesion's blood pool behavior most reliably?
- A 47-year-old with a 2 cm lesion in the left hepatic lobe needs nuclear confirmation of a hemangioma before the oncology team sets the follow-up plan. The unit has SPECT/CT, technetium-99m pertechnetate, and in vitro red-cell labeling supplies. Which study plan best demonstrates slow blood pooling in the lesion?
- A 1.8 cm lesion is seen on ultrasound in the right lobe of the liver, and the radiologist has ordered a red blood cell blood-pool study to see whether it behaves like a hemangioma. The cells are labeled in vitro and reinjected, and the patient can come back later the same afternoon. Which timed imaging plan best characterizes this lesion?
- A patient with a 5 mm ureteral stone, new hydronephrosis and rising creatinine is referred to nuclear medicine. Urology needs to know whether the kidney is obstructed and how much function each kidney contributes before deciding on surgery. Which renogram study best fits this referral?
- A diuretic renogram is ordered for a mildly dilated collecting system found on a prior ultrasound. Post-furosemide images show slow clearance of tracer, yet from the first minutes the affected kidney showed weak cortical uptake and a flat, poorly rising curve. Which interpretation of the delayed drainage is best supported by this study?
- An adult with a dilated renal pelvis on ultrasound is scheduled for a diuretic renogram to separate true obstruction from a system that simply drains slowly. The patient arrives after a dry morning with a full bladder, and the order specifies a diuretic after peak uptake. Which preparation sequence will give the most interpretable washout curve?
- A patient with new hydronephrosis has a dilated collecting system and mildly reduced kidney function, and the referral asks whether outflow is truly obstructed before surgery is considered. The team also wants a split-function number and a current clearance value. The patient can hydrate, void on command, and lie still for a dynamic run. Which renal study best separates obstruction from a system that drains slowly on its own?
- An outpatient with a dilated right collecting system is referred for a diuretic renogram because clinicians cannot tell whether the dilation is a true obstruction. The camera is positioned and the tracer is drawn up. Which study plan answers the obstruction question most directly?
- A patient with unilateral hydronephrosis on ultrasound is sent for a diuretic renogram to separate true obstruction from a dilated but freely draining system. The affected kidney shows poor tracer uptake, the study must provoke drainage with a diuretic, and the report needs a numerical drainage time for the collecting system alone rather than the whole kidney. Which renogram protocol should be planned?
- A child is referred for Tc-99m DMSA imaging after a febrile urinary tract infection, and the history suggests scarring in one kidney. The protocol allows several hours for tracer uptake, and the study must show focal defects and relative function in both kidneys. Which imaging plan best demonstrates renal cortical detail?
- A child with a history of febrile urinary tract infection is scheduled for a Tc-99m dimercaptosuccinic acid study to look for a small cortical scar. The dose is drawn and the camera frees up right away, but images need low blood-pool activity, kidneys close to the detector, and an emptied bladder. Which acquisition plan best supports detection of that cortical defect?
- A four-year-old with known reflux is scheduled for cortical imaging to look for scarring. The images must separate small cortical defects from overlying ribs and keep bladder activity from clouding the lower poles. Which acquisition plan best meets those requirements?
- A 4-year-old with a history of febrile urinary tract infection is referred for Tc-99m DMSA renal cortical imaging to look for scarring. The department can schedule imaging 1 hour or 2 to 3 hours after injection and offers planar alone or planar plus SPECT. Which plan is most sensitive for finding a focal cortical defect in this child?
- A four-year-old is booked for planar Tc-99m DMSA imaging to look for cortical scarring after a febrile urinary tract infection. The camera offers low-, medium-, and high-energy collimators, and the protocol calls for each kidney to be seen free of overlap from the spine, liver, and spleen. The child can lie still for one session only, so timing and views must be right the first time. Which acquisition plan fits this renal cortical study?
- A 4-year-old with fever and known vesicoureteral reflux is referred for renal cortical imaging to evaluate scarring and differential function. The child will be awake and must stay still for a single study. Which tracer, timing, and views should be used for this renal cortical study?
Procedures: Other Imaging (10%) · 30 questions
- A patient with COPD and suspected pulmonary embolism needs ventilation imaging that includes a washout phase, and every ventilation view must be matched to the later perfusion view. Which ventilation agent and acquisition plan meets both requirements?
- A distance runner has three weeks of front-shin pain with normal radiographs. The orthopedist wants assessment of blood flow, the full length of tibial involvement, and imaging limited to the painful leg because cancer has been excluded. Which bone scan plan best fits these three requirements?
- During video-EEG monitoring, a 24-year-old with drug-resistant seizures has electrographic seizures lasting about two minutes followed by several minutes of confusion. The team orders ictal Tc-99m ECD SPECT and plans a separate interictal study for subtraction analysis. At what point in the seizure cycle should the tracer for the ictal study be injected so the perfusion pattern of the seizure focus is trapped?
- A patient with a liver tumor is being evaluated for Y-90 microsphere therapy, and the team needs a pretherapy Tc-99m MAA lung shunt estimate before deciding the dose. The MAA has to follow the same route the microspheres will take, and depth-related counting error has to be cancelled. Which Tc-99m MAA plan satisfies those requirements?
- A woman with a palpable upper outer quadrant breast tumor is booked for sentinel node mapping, with injection at 8 AM and transport to surgery at 9:30 AM. The surgeon wants to see the lymphatic channels leaving the primary itself and needs to know how deep the node sits before the incision. Which acquisition plan fits this lymphoscintigraphy study?
- A 62-year-old inpatient has fever after bowel surgery, and CT shows a fluid collection in the right lower quadrant. The surgeon wants an autologous labeled white blood cell study with delayed images before deciding whether to drain it, since the collection sits low in the abdomen where bowel activity can interfere. Which labeling and imaging plan best answers this abscess question?
- A patient with a joint replacement has had fever and rising inflammatory markers for several weeks, and earlier surgery changed the marrow pattern around the prosthesis. The physician must tell true infection apart from normal marrow uptake there. Which imaging plan gives the most specific result?
- A patient with known breast cancer reports new focal low-back pain after finishing therapy. Whole-body planar bone imaging shows no abnormal uptake, and lumbar radiographs show only mild degenerative change. Which added acquisition best localizes the symptomatic lesion?
- During hepatic arterial perfusion scintigraphy for a lung shunt fraction before Y-90 microsphere therapy, the technologist's Tc-99m MAA syringe has been sitting on the counter during a delay while the team secures the catheter in the planned treatment position. Planar images must support a lung-to-liver count comparison. Which preparation and acquisition sequence will produce a valid shunt fraction?
- A patient with breast cancer in the upper outer quadrant is booked for sentinel lymph node mapping and surgery on the same morning, and no nodes are palpable. The surgeon wants the lymphatic channels traced to the first draining node and the site marked on the skin before the incision. Which lymphoscintigraphy plan best fits this surgical timing?
- A patient with severe pulmonary hypertension and a suspected pulmonary embolism is scheduled for a combined ventilation and perfusion study using Tc-99m DTPA aerosol and Tc-99m MAA, and the physician also wants quantitative split-lung values from planar data. Which administration and imaging plan should the technologist follow?
- A patient with clear fluid draining from the nose after a fall is referred for a study to locate the leak, and the physician wants the site confirmed as well as followed through the day because drainage can be intermittent. Which imaging plan best localizes this CSF leak?
- A 71-year-old with a hip prosthesis has six months of pain and a raised inflammatory marker after revision surgery, so reactive marrow is likely around the implant. The physician orders an indium-111 labeled white cell study, and the plan must use collimation matched to the isotope, capture delayed uptake, and allow comparison with normal marrow. Which imaging plan best supports the diagnosis of chronic prosthetic infection?
- A 31-year-old with drug-resistant seizures is admitted so ictal brain perfusion SPECT can be compared with the interictal study. The tracer must go in during the seizure itself, the surroundings shape regional uptake, and the final image set must match the interictal field. Which preparation plan best preserves the ictal perfusion pattern?
- A patient with diabetes has a red, hot, swollen great toe three weeks after a puncture wound, and the physician must choose between antibiotics alone and a bone biopsy. Only one appointment is available tomorrow, and the finding must separate soft-tissue inflammation from actual bone involvement. Which bone imaging protocol best answers this osteomyelitis question?
- A 58-year-old with liver metastases is staged for Y-90 microsphere therapy, and angiography shows the treatment catheter will sit in the proper hepatic artery. Nuclear medicine must produce the pretherapy Tc-99m MAA study to estimate the lung shunt fraction before the dose is ordered. Which injection and imaging plan best supports that shunt estimate?
- An adult is referred after a basilar skull fracture because of clear nasal discharge that is worst when upright. The team can image for several hours after the intrathecal injection and needs the study to show where fluid escapes rather than only confirm that tracer reaches the nose. Which imaging plan will best localize the CSF leak site?
- The day before a sentinel node biopsy for melanoma on the patient's left forearm, the surgeon schedules preoperative lymphoscintigraphy with Tc-99m filtered sulfur colloid. The tracer must enter lymphatic channels beside the lesion, reach the first draining node, and be imaged while it is still moving. Which injection plan best delivers tracer to the first draining node?
- A 71-year-old with an uncertain parkinsonian syndrome is referred for dopamine transporter SPECT/CT to help separate degenerative from non-degenerative causes. The department must finish everything in one visit because the patient travels two hours each way, the product labeling calls for thyroid protection before injection, and imaging has to fall within a defined post-injection window. Which preparation and timing sequence meets all three requirements for this dopamine transporter SPECT/CT?
- A patient with a ventriculoperitoneal shunt has repeated headache and vomiting, and neurosurgery wants a study that shows cerebrospinal fluid still moving through the tubing into the abdominal cavity. The reservoir under the scalp can be tapped safely, and the team wants documentation of how quickly tracer travels the full length of the shunt. Which administration and imaging plan best demonstrates shunt patency?
- A patient is 10 days after a total knee replacement with fever, a warm and swollen knee, and raised inflammatory markers. The surgeon wants to distinguish periprosthetic infection from mechanical loosening before revision work. Which nuclear medicine imaging plan is most appropriate?
- A patient with a biopsy-proven melanoma on the dorsum of the right foot is scheduled for sentinel node lymphoscintigraphy the day before surgery. The lesion has intact overlying skin, and the surgeon wants the draining nodal basin mapped before the incision. Which injection plan best demonstrates lymphatic flow from this skin lesion?
- A 66-year-old smoker with a left upper lobe mass and badly reduced lung capacity is being evaluated for surgery. The surgeon asks nuclear medicine for a number showing how much of the patient's total blood flow each lung contributes, so the resection can be planned safely. Which lung study plan best supplies that split-function result?
- A patient with persistent staphylococcal bacteremia and new mid-back pain is being worked up for vertebral osteomyelitis. Imaging must show labeled white blood cell accumulation rather than bone turnover alone, normal vertebral marrow also avidly takes up labeled cells, and the suspected focus is small and deep in the spine. Which infection imaging plan best confirms the focus?
- A patient with COPD is being evaluated for lung resection, so the surgeon needs each lung's share of blood flow. The study must also let ventilation be compared with perfusion in the same body positions. Which acquisition plan meets both the matching-view comparison and the quantitative lung percentages?
- An adult with a known lung tumor reports new pain between the shoulder blades, and the nuclear medicine team must survey the entire skeleton and pinpoint which part of the thoracic spine is taking up tracer. Which bone imaging plan best meets both needs?
- An adult scheduled for a brain FDG PET/CT to evaluate memory decline arrives having followed the fasting instructions, and a fingerstick glucose still has to be checked before the dose is drawn. The referring clinic wants the exam finished before noon, and the patient is restless and asks to walk the corridors. Which preparation plan should the technologist follow for this CNS study?
- A patient with a clear runny nose after a head injury only leaks fluid when bending forward, and the referring team wants the leak located before surgery. The department can give an intrathecal tracer and can return the patient for delayed imaging later the same day. Which imaging plan will best show where the cerebrospinal fluid is escaping?
- A patient with liver-dominant metastases is mapped for Y-90 microsphere therapy. The Tc-99m MAA study is injected from a common hepatic artery catheter, but the planned treatment will infuse from a more distal position after a variant artery is embolized, and the shunt fraction is calculated from lung and liver counts on planar images. Which approach makes the lung shunt fraction representative of the planned microsphere distribution?
- A patient with Crohn's disease has persistent low-grade fever, and a deep pelvic abscess is suspected. Autologous cells are ready for labeling, the team wants images on each of the next two days, and a deep focus may hide on flat views. Which labeling agent and imaging schedule best plans this abscess study?
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