Procedures: Gastrointestinal and Genitourinary (10%)

ARRT-N · 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?