10 Gastrointestinal Tract Scintigraphy

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10 Gastrointestinal Tract Scintigraphy

1) Which of the following pairs of radiopharmaceuticals is used for simultaneously studying gastric emptying of both liquids and solids?

a. ^99mTc sulfur colloid chicken livers and ¹¹¹In DTPA scrambled eggs

b. ^99mTc albumin colloid scrambled eggs and ^99mTc colloid in milk

c. ^99mTc sulfur colloid scrambled eggs and ¹¹¹In DTPA in water

d. ¹¹¹In DTPA scrambled eggs and ^99mTc sulfur colloid in water

2) What structure is outlined by the ROI on Figure 10.1?

a. esophagus b. stomach

c. common bile duct d. duodenum

3) Which of the following radiopharmaceuticals can be used to study the spleen?

a. ⁵¹Cr labeled damaged red blood cells b. ^99mTc labeled damaged red blood cells c. ^99mTc sulfur colloid

d. all of the above e. b and c only

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Figure 10.1

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4) How is a radiopharmaceutical administered when a LeVeen shunt is evaluated?

a. by intravenous injection b. by intraperitoneal injection c. by subcutaneous injection d. by intrathecal injection

5) The ejection fraction of the gallbladder can be evaluated using:

a. cimetidine b. dipyridamole c. cholecystokinin d. dobutamine

6) If no gallbladder is seen at one hour following injection of^99mTc DISIDA, what should be done?

a. cimetidine should be given b. images should be taken at 24 hours c. images should be taken at 4 hours d. the exam should be ended

7) While performing a liver scan with sulfur colloid, the technologist notices that lung uptake is present. This is probably due to:

a. free pertechnetate in the sulfur colloid preparation b. too much Al³⁺ion in the pertechnetate that was used

for labeling c. lung metastases

d. patient being injected in the supine position 8) The function of a LeVeen shunt is to:

a. treat hydrocephalus

b. drain peritoneal fluid into the inferior vena cava c. drain peritoneal fluid into the superior vena cava d. divert CSF flow

10 Gastrointestinal Tract Scintigraphy 98

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9) A technologist receives a request to perform a scan with

99mTc albumin colloid to rule out acute cholecystitis.

What should he or she do next?

a. check if albumin colloid is available

b. alert the nuclear medicine physician to the problem c. change the order to ^99mTc IDA

d. perform the study as ordered

10) When performing a SPECT study of the liver and spleen, the camera should be positioned:

a. so that the costal margin is at the bottom of the detector face

b. so that it touches the left side of the patient when rotating

c. so that it touches the right side of the patient when rotating

d. as close as possible but without touching the patient during rotation

11) Radiocolloids are cleared from the circulation by:

a. liver parenchymal cells b. hepatocytes

c. Kupffer cells d. hemangiomas

12) Which radiopharmaceutical is commonly used to image cavernous hemangioma?

a. ^99mTc albumin colloid b. ^99mTc RBCs

c. ^99mTc IDA

d. ^99mTc pertechnetate e. ^99mTc sulfur colloid

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13) Colloid shift refers to:

a. small colloid particles clumped together to form large particles which localize in the lungs

b. ^99mTc sulfur colloid changing into albumin colloid c. increased uptake of colloid in the spleen and bone

marrow relative to liver

d. the redistribution of colloid within the liver over time 14) Which of the following does not involve the use

of labeled RBCs?

a. blood pool imaging of the liver b. GI bleed imaging

c. spleen imaging d. Meckel’s diverticulum e. both a and d

15) Cimetidine:

a. prevents the gallbladder from contracting b. prevents the release of pertechnetate from gastric

mucosa

c. increases uptake of pertechnetate in the gastric mucosa

d. decreases peristalsis

16) The approximate time for half of the activity to empty from the stomach during a solid phase gastric emptying exam is:

a. 25 minutes b. 40 minutes c. 90 minutes d. 180 minutes

17) Esophageal reflux studies are usually performed with both solid and liquid phases.

a. true b. false

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18) Which imaging study is acquired while an abdominal binder is inflated to increasing pressures?

a. Meckel’s diverticulum study b. gastric emptying study c. esophageal transit study d. esophageal reflux study e. gastrointestinal bleeding study

19) An appropriate adult dose and radiopharmaceutical for a Meckel’s diverticulum is:

a. 10 mCi of^99mTc pertechnetate

b. 300 µCi of^99mTc sulfur colloid in water c. 300 µCi of ^99mTc albumin colloid in 150 ml

of orange juice

d. 20 mCi of^99mTc labeled red blood cells e. 6 mCi of ^99mTc albumin colloid

20) A patient with a bilirubin level of 35 mg/dL is scheduled for hepatobiliary imaging. The best radiopharmaceutical to use would be:

a. ^99mTc pertechnetate b. ^99mTc disofenin c. ^99mTc mebrofenin d. ^99mTc sulfur colloid e. ^99mTc labeled RBCs

21) If 15 minutes after injection of 8 mCi of^99mTc disofenin, the liver is not visualized, but the heart and kidneys are, what is the most likely reason?

a. too little DISIDA was injected b. the liver is not functioning properly c. the gallbladder is obstructed d. the patient is taking morphine

e. the patient has a very low bilirubin level

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22) A synthetic form of cholecystokinin is:

a. glucagon b. cimetidine c. pentagastrin d. sincalide e. mebrofenin

23) What are the possible effects on a hepatobiliary scan if the patient has eaten 2 hours before the study?

a. a false positive

b. nonvisualization of the gallbladder within an hour c. intermittent contraction of the gallbladder d. all of the above

e. a and b only

24) If the maximum counts obtained from an ROI about the gallbladder are 285,000 and the minimum counts obtained from the same ROI are 187,000 what is the ejection fraction of the gallbladder?

a. 22%

b. 34%

c. 52%

d. 66%

e. 73%

25) Is the ejection fraction in question 25 within the normal range?

a. yes b. no

26) What will be visualized in the first hour of a normal hepatobiliary scan?

a. common duct b. gallbladder c. duodenum d. all of the above e. a and b only

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27) Cholecystokinin is a hormone secreted by the duodenum that stimulates gallbladder contraction.

a. true b. false

28) Morphine given during an hepatobiliary scan can:

a. relax the sphincter of Oddi b. enhance gallbladder filling c. shorten the study time d. all of the above e. b and c only

29) Sulfur colloid is best for gastrointestinal bleeding studies if:

a. bleeding is intermittent b. bleeding is active

c. the bleeding site is in the right upper quadrant d. delayed images will be planned

e. none of the above

30) Which of the following would not be useful in further examining a suspicious area of activity when evaluating a patient for lower GI bleed with ^99mTc labeled red blood cells.

a. delayed imaging to visualize a change in configuration of the activity

b. delayed imaging to visualize increasing activity c. use of cine mode

d. anterior obliques e. none of the above

31) Potassium perchlorate should not be administered pediatric patients undergoing scanning for Meckel’s diverticulum with ^99mTc pertechnetate.

a. true b. false

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32) Which is the method of choice for labeling red blood cells with ^99mTc if the goal is to have the least amount of free pertechnetate in the resulting dose?

a. invitro b. invivo

c. modified invivo

d. the amount of free pertechnetate will be the same in all cases

33) Why is the labeling efficiency important for imaging of GI bleeding with ^99mTc RBCs?

a. a small decrease in labeling efficiency may lead to a false negative result

b. if the patient is actively bleeding, the radiopharmaceutical must be prepared as quickly as possible c. ^99mTc pertechnetate will be taken up by the Kupffer

cells

d. free pertechnetate is secreted by the stomach and the kidneys

34) When performing a gastric emptying study, it is important to scan the patient in the erect position to promote emptying.

a. true b. false

35) Which of the following studies does not require any fasting prior to the examination?

a. gastric emptying study b. hepatobiliary scan c. esophageal transit

d. gastroesophageal reflux study e. gastrointestinal bleeding scan

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36) Symptoms of cholecystitis may include:

a. pain the right upper quadrant b. back pain

c. nausea

d. all of the above e. a and c only

37) In order to reach the duodenum, bile must pass through the gallbladder.

a. true b. false

38) A positive urea breath test indicates the presence of Helicobacter pylori based on:

a. the body’s inability to produce urea in the presence of H. pylori

b. the fact that H. pylori needs a carbon rich environ- ment in which to survive

c. the inability of radioactive carbon to exist in the form of carbon dioxide

d. the ability of H. pylori to break up urea into nitrogen and carbon

39) Urea normally leaves the body:

a. in the urine b. in the stool

c. as exhaled carbon dioxide

d. when ¹³C has decayed to background levels