Procedures: Other Imaging (10%)

ARRT-N · 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?