Multiple Choice
Identify the
choice that best completes the statement or answers the question.
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1.
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What is the energy emission of Thallium-201?
a. | 512-536 KeV | c. | 93-123 KeV | b. | 324-517 KeV | d. | 69-83 KeV |
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2.
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Which of the following is not used in a brain tumors scan?
a. | [123I] labeled tracers | c. | 18F-FDG | b. | 11C-acetate | d. | 201TI |
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3.
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What is the quantitative assessment of 18F-FDG?
i
Metabolic rate of glucose utilization
ii Tumor/cortex ratio
iii Tumor/white matter
ratio
iv Tumor/background ratio
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4.
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Which of the following will alter cerebral metabolism?
i
Sedatives
ii Narcotics
iii Caffeine
iv Corticosteroids
a. | ii, iii, iv | d. | i, ii, iv | b. | i, iii, iv | e. | all of the above | c. | i, ii,
iii |
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5.
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Which of the following is the function of PET scan?
i Glucose
metabolism
ii Protein synthesis
iii Cellular metabolism
iv Aminoacid
transport
a. | ii, iii, iv | d. | i, ii, iii | b. | i, iii, iv | e. | all of the above | c. | i, ii,
iv |
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6.
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Which of the following tracers is used in SPECT?
i
99mTc-HMPAO
ii 99mTc-DTPA
iii
[123I]alphamethyl-L-Tyrosine
iv
[123I]N-isopropyl-p-Iodoamphetamine
a. | i, iii, iv | d. | i, ii, iii | b. | ii, iii, iv | e. | i, ii, iv | c. | all of the
above |
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7.
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Which of the following materials is not prohibited from intake for patient
before the procedure?
a. | water | c. | alcohol | b. | caffeine | d. | drugs |
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8.
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Which of the following radiopharmaceutical is not used in brain scan in a planar
gamma camera?
a. | 99mTc-Glucoheptonate | c. | 99mTc-DTPA | b. | 99mTc-sestamibi | d. | 99mTc-pertecnetate |
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9.
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Organs receiving the largest radiation dose in using 18F-FDG as
radiopharmaceutical in PET are ______.
a. | skin | c. | liver | b. | urinary bladder | d. | lung |
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10.
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If the blood glucose of the patient is greater than ______, physician should
reschedule the patient for another scan.
a. | 50 - 100 mg/dL | c. | 0 -50 mg/dL | b. | 150 - 200 mg/dL | d. | 100 - 150 mg/dL |
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11.
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The brain can be studied with nuclear medicine procedures to
assess:
i Metabolism
ii Brain blood barrier integrity
iii
Cellularity
iv Receptors
a. | i, iii, iv | d. | i, ii, iii | b. | ii, iii, iv | e. | all of the above | c. | i, ii,
iv |
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12.
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Monitoring of EEG should be started ______ before injection in order to ensure
that 18F-FDG is not injected in a postictal state.
a. | 3 hours | c. | 30 minutes | b. | 1 hours | d. | 2 hours |
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13.
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IN the brain, glucose metabolism provide approximately ______ of adenosine
triphosphate required for brain function.
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14.
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Which of the following is related to the mechanism of tumor localization for
thallium-201?
i Blood flow
ii Tumor viability
iii Calcium ion channel
exchange
iv Increased cell membrane permeability
a. | i, ii, iv | d. | ii, iii, iv | b. | i, ii, iii | e. | i, iii, iv | c. | all of the
above |
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15.
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Some PET system is using radiation source for attenuation purpose. Which of the
following radioactive sources is used?
i 68Ge
ii
68Ga
iii 123I
iv 137Cs
a. | i, ii, iii | d. | i, ii, iv | b. | i, iii, iv | e. | ii, iii, iv | c. | all of the
above |
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16.
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Which of the following is the advantage of PET/CT scan over transmission scan
for the purpose of attenuation corrections?
i Lower cost
ii The detection of X-rays from the CT scan is not affected by the emission
photons
iii Reduced time
iv Lower energy consumption
a. | i, iii | c. | ii, iv | b. | i, iv | d. | ii, iii |
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17.
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Which of the following is the clinical indications for functional brain
imaging?
i Differentiation of focal infection from focal lymphoma in acquired immune
deficiency patients.
ii Differentiation of viable tumor from edema surrounding the
tumor.
iii Determination of the hystological grade.
iv Differentiation of recurrent and
persistent tumor from radiation necrosis.
a. | ii, iii, iv | d. | all of the above | b. | i, iii, iv | e. | i, ii, iv | c. | i, ii,
iii |
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18.
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Which of the following is not used to show anatomical imaging of brain
tumors?
i CT
ii MRI
iii SPECT
iv PET
a. | i, ii | c. | ii, iii | b. | i, iv | d. | iii, iv |
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Matching
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a. | 2D acquisition mode | e. | 3D acquisition mode | b. | Euglycemic | f. | Hyperglycemia | c. | Dynamic tomographic
images | g. | Static limited field
tomographic images | d. | Cold transmission | h. | Hot
transmission |
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19.
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______ is the standard procedure for older generation full ring PET systems for
the measurement of attenuation prior to FDG-injection.
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20.
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______ happen when there is increased competition of elevated plasma glucose
with FDG at the carrier enzyme.
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21.
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Best results for clinical FDG imaging of the brain in diabetics can be achieved
in a ______ situation during stable therapeutic management.
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22.
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In ______, coincidences are detected only
within a single detector ring and between adjacent detector rings.
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23.
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______ will took multiple sequential images in a field of view, usually
covering the whole brain.
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a. | Compartmental modeling | e. | Neurodegenerative diseases | b. | Normalization
procedure | f. | Stereotactic
surface projection
displays | c. | Hybrid attenuation
correction | g. | Hippocampal
axis | d. | Absolute glucose metabolism | h. | Atypical parkinsonian
syndromes |
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24.
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______ is used to ensure the existence of an adequate correction of the changes
in efficiency among the crystals of the detectors.
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25.
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Typical topographic patterns of hypometabolism may
help diagnose the main ______ at a predementia stage.
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26.
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______ calculate an attenuation image based on a
short transmission measurement followed by image segmentation.
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27.
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______ is a quantitative analysis that performed when it is possible
to
calculate the curve of the arterial FDG concentration against time.
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28.
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______ is used for estimating rate constants.
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29.
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18F-FDG PET can be used for the
differentiation between Parkinson's disease and ______.
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30.
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Individual statistical maps such as Z score maps are based on slice display or
______.
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31.
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Re-slicing along the ______ is preferred for evaluation of suspected temporal
lobe epilepsy.
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a. | Morphological abnormalities | c. | Pulse
oximetry | b. | Lumped constant |
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32.
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Matching of cortical hypometabolism with ______ on
MRI or with the EEG help to plan for epilepsy surgery.
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33.
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______ should be performed to recognize the
possibility of cardiopulmonary depression in the usage of sedative.
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34.
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A correction factor called ______, can be used to
convert the FDG values to values reflecting glucose metabolism.
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True/False
Indicate whether the
statement is true or false.
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35.
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The retention of the 99mTc compounds is mainly dependent upon the viability of
the tissue.
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36.
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When hyperglycemia is present, stochastic noise may increase and contrast
between white and grey matter uptake will decreased and causing diagnostic accuracy decrease.
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37.
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For low grade tumors such as astrocytomas grade III-IV will have a
18F-FDG uptake of 7.4  3.5mg/100g/min.
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38.
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Patient with tumors with a high metabolism have a 33 months median
survival.
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39.
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Correction factors for attenuation are obtained by measuring the ratio between a
blank scan and a transmission scan.
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40.
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Type, location and medication for epilepsy should be obtained before performing
the procedure.
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41.
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Transmission imaging following FDG injection is less favorable with Ge-68/68-Ga
because of the potential overestimation of attenuation of structures with high uptake, especially in
sub-cortical regions.
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42.
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The advantage of using PET/CT system for attenuation correction is that the
detection of X-rays from the CT scan is not affected by the emission
photons.
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43.
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18F-FDG ability to accumulate in neuronal tissue depending on
facilitated transport of glucose and hexokinase mediated phosphorylation make it a good candidate for
imaging regional cerebral glucose consumption with PET.
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44.
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Typical pixel size for a PET image is 8-10 mm.
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45.
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Deviation from resting state during the uptake period and scanning needs to be
recorded and considered when interpreting scans.
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46.
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Benzodiazepine is used to apply conscious sedation for uncooperative
patients.
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47.
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Lowering serum glucose by administration of insulin can be considered, but the
administration of FDG should be delayed following insulin administration
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48.
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For preoperative evaluation of epilepsy, continuous EEG recording should be
used.
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49.
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From 2-4 hours injection, 201TI will accumulated within the tumor and
slowly washout.
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50.
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When using thresholding, it should be based upon knowledge of a normal database
for FDG and instruments used in acquiring the study to avoid artifacts.
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51.
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201Thallium and 99mTc Tetrofosmin were excluded almost completely from normal
cerebral tissue and their distribution within all the lesions was substantially parallel.
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52.
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11C-methionine is currently the most
accurate in-vivo method for the investigation of regional human brain metabolism.
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53.
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Under physiological conditions, there is no connection between glucose
metabolism and neuronal activity.
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54.
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Gallium 68 generator is used to synthesis galium-68 by extracting by elution
from germanium-68.
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55.
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LEAP collimator has a higher resolution than a LEHR collimator thus have a
better result in a brain scan.
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56.
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Intravenous fluid containing dextrose or parenteral feeding should be withheld
for 12 hours before the scan.
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57.
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The administered activity for 18F-FDG in adult are 125-250 MBq
in 2D mode.
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58.
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Input function retrieved from PET images using the aorta, or left ventricle can
be used for arterial blood sampling.
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59.
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3D mode acquisition is used in infants and small children in order to decrease
the radiation burden.
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60.
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Statement containing the reason why the study are difficult to interpret should
be including inside the report to aid the referring physician to better understand why a specific
diagnostic entity could not be ascribed to the pattern noted.
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61.
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3D acquisition have a longer acquisition time than 2D as it required longer time
to achieve adequate count density.
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62.
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Changes in neuronal activity induced by disease will be reflected in an
alteration of glucose metabolism.
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63.
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Patient history such as past or current drug use or head trauma, neurological
examination, psychiatric exam, mental status exam is not important in order to perform the
procedure.
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64.
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Differences in mathematical attenuation correction
may appear especially in the occipital and cerebellar regions making it not comparable.
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65.
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Corticosteroids usage will cause an opposite effect with hyperglycaemia.
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66.
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The emission acquisition typically begins 30-60 minutes post injection and lasts
between 5 and 60 minutes depending on the injected activity, the type of scanner and acquisition
protocol used (2D or 3D).
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67.
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Dynamic studies is used to quantitatively assess the regional rates of FDG
metabolism by determining appropriate kinetic rate or influx constants.
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68.
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PET/CT scanners with LSO or GSO crystals only acquire images in 3D mode.
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69.
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A low dose CT scan for the purpose of attenuation correction have the advantage
of reducing the radiation exposure almost to the level of germanium-based transmission
measurement.
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70.
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Additional re-sliced images in coronal and sagital sections should be displayed
routinely which would helps better delineation of lesions.
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71.
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Hanning or Shepp-Logan are the most commonly used filters for reconstruction of
image using filtered back projection.
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72.
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High grade tumors have a high rate of glucose utilization and thus a high
18F-FDG uptake.
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73.
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Adults have a greater relative brain mass (10%) than
infants (2-3%), so the percentage of uptake of the injected FDG activity is higher.
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74.
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High intracellular glucose and circulating insulin levels will drive
18F-FDG into muscle and result in reduced uptake in the brain.
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75.
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Sedation is recommended for patient with dementia or children and should be
performed as late as possible following administration of 18F-FDG.
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76.
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Quantitative assessment of 18F-FDG including tumor/white matter ratio
and tumor/cortex ratio.
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77.
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The equation of activity administered for 18F-FDG for children is :
activity administered = baseline activity x multiple (dosage card).
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78.
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Acute correction of hyperglycaemia with insulin
usually does not improve brain image quality substantially, because the correction of increased
intracellular glucose level lags behind the correction of the plasma glucose level.
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79.
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Psychotropic pharmaceuticals may influence regional metabolic rate of
glucose.
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80.
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In parkinsonian patients, the administration of levodopa had no effect in
glucose metabolism.
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81.
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Physicians should avoid interaction with the patient prior to, during, and up to
at least 30 minutes post injection of 18F-FDG.
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82.
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The 201TI retention index are applied as follows: RI= (early uptake -
delayed uptake)/delayed uptake x100.
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