Procedures: Endocrine and Oncology (12%)

ARRT-N · 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?