1) What portion of an EKG wave represents the depolarization of the ventricles?
a. QRS complex b. P-wave c. ST segment d. T-wave
2) A patient is only able to tolerate 3 images during a 201Tl chloride myocardial perfusion study. From those views listed, which would be the best choice of images to obtain?
a. RAO 10, LAO 45, and left lateral b. anterior, LAO 25 and LAO 60 c. anterior, LAO 45 and LAO 70 d. anterior, LAO 70 and left lateral
3) Within what time frame must imaging be initiated following injection of201Tl chloride in an exercise perfusion study?
a. within 5 minutes b. within 10–15 minutes c. within 20–30 minutes d. within a 4 hours
4) Of the choices offered, which is the best imaging view for calculating right ejection fraction?
a. RAO 60%
b. RAO 30%
c. anterior d. LAO 10%
5) Of the choices offered, which is the best imaging view for calculating left ejection fraction?
a. anterior b. LAO 5%
c. LAO 45%
d. left lateral
6) Given the data below, calculate the left ventricular ejection fraction.
net ED = 58, 219 net ES = 35,317 a. 16%
b. 39%
c. 43%
d. 60%
7) The left ventricular ejection fraction determined in question 6 is within the normal range.
a. true b. false
8) Figure 8.1 (p. 66) shows computer generated time activity curves over a cardiac cycle for two patients. Which curve represents the patient with the higher ejection fraction?
a. upper curve b. lower curve
9) Which of the following cannot be evaluated by a MUGA scan?
a. wall motion b. wall thickness c. aneurysmal flow d. vessel patency
24610 22149 19688 17227 14766 12305 9844 7363 4922 2461 C o u n t s
p e r
R e g i o n
0
ES
ED
Fourier
ED pix = 398 ES pix = 197 ED cnts = 24614 ES cnts = 8148
0 6
0 1 2 0
1 8 0
2 4 0
3 0 0
3 6 0
4 2 0
4 8 0
5 4 0
6 0 0
6 6 0
7 2 0
7 8 0
8 4 0
9 0 0 TPFR
Time (ms)
Figure 8.1
15320 13788 12256 10724 9192 7660 6128 4596 3064 1532 C o u n t s
p e r
R e g i o n
0
ES ED
Fourier
ED pix = 317 ES pix = 218 ED cnts = 15319 ES cnts = 7886
0 3
7 7
4 1
1 1
1 4 8
1 8 5
2 2 2
2 5 9
2 9 6
3 3 3
3 7 0
4 0 7
4 4 4
4 8 1
5 1 8
5 5 5 TPFR
Time (ms) 왖
Bkg
왖 Bkg 7383
10) The images in Figure 8.2 represent:
a. short axis b. vertical long axis c. horizontal long axis d. none of the above
11) During a gated study, 24 images per cardiac cycle are obtained. If the patient’s heart rate is 65 bpm, the length of time per image is:
a. 3.8 msec b. 38 msec c. 4.1 msec d. 41 msec
12) A right anterior oblique is useful for:
a. facilitating calculation of LVEF and RVEF on first pass
b. separation of ventricles from stomach on first pass c. visualizing the lateral wall of the left ventricle d. increasing patient comfort and potentially improving
image quality
13) What will reverse the effects of dipyridamole?
a. dobutamine b. cholecystokinin c. aminophylline d. adenosine e. thallium Figure 8.2
14) Which of the following will most negatively affect radionuclide ventriculography?
a. sinus tachycardia b. sinus bradycardia c. long QT interval d. occasional PVC e. sinus arrhythmia
15) The vertical long axis view of the heart is most comparable to a:
a. coronal image b. sagittal image c. transverse image
16) As an alternative to exercise studies, pharmacologic stress can be achieved through the use of any of the following except:
a. dipyridamole b. aminophylline c. dobutamine d. adenosine
17) In multigated analysis of the left ventricular, end systole is best described as:
a. the frame with the highest number of counts in the ROI around the left ventricle
b. the frame with the lowest number of counts in the ROI around the right ventricle
c. the frame with the lowest number of counts in the ROI around the left ventricle, plus the counts from the background ROI
d. all of the above e. none of the above
18) All of the following will negatively affect a myocardial study with 201Tl chloride except:
a. wrong collimator b. arrhythmia c. incorrect COR
d. increased patient to detector distance e. none of the above
19) Dipyridamole is supplied to a nuclear medicine department in 10 ml vials, each containing 50 mg. If a patient weighs 155 pounds, how many milliliters must be injected for him to receive 0.56 mg/kg?
a. 7.9 ml b. 8.7 ml c. 17.4 ml d. 39.5 ml
20) Which of the following does not describe correct preparation for an exercise myocardial study?
a. NPO at least 4 hours prior to radiopharmaceutical administration
b. catheter placement for injection of radiopharma- ceutical during exercise
c. halt all medication 24 hours before study d. none of the above
21) During an exercise gated study, the ECG pattern suddenly becomes dramatically different, although the patient is responsive, has an unchanged pulse rate, continues to exercise, and has no pain. The technologist should first:
a. start CPR b. call a code
c. check for a disconnected lead d. call the referring physician e. do nothing
22) Which of the following radiopharmaceuticals is not used to study the heart?
a. 99mTc sestamibi b. 99mTc HSA c. 99mTc PYP d. 99mTc WBCs e. both b and d
23) Which of the following is not a critical factor in obtaining a gated first pass study?
a. tracer bolus of small volume b. regular heartbeat
c. use of a multi-crystal gamma camera
d. positioning heart in the center of the field of view e. injection of at least 10 mCi of radiotracer
24) The best collimator for use during a first pass study is:
a. LEAP
b. high sensitivity c. high resolution d. medium energy
25) A neonatal first pass study is performed and the time activity curve for the ROI around the left ventricle shows a peak of activity occurring before the activity peak on the lung ROI. This most likely indicates:
a. improperly drawn regions of interest b. interventricular shunt
c. prolapsed mitral valve
d. radiotracer contained in too high a volume
26) A nuclear medicine physician prefers that static myocardial perfusion images be obtained according to the best septal visualization. If the septum is well visualized on LAO 45°, what other views should be obtained?
a. anterior, LAO 70°
b. RAO 20°, LAO 60°
c. anterior, LAO 60°
d. RAO 5°, LAO 65°
27) Cardiac contraction is initiated in the:
a. SI node b. AV node c. bundle of His d. P wave
28) Treadmill exercise tests increase heart rate by:
a. increasing the resistance of the treadmill b. increasing treadmill speed
c. simulating infarct d. all of the above
29) A high resolution collimator would be most appropriate for:
a. myocardial perfusion study with 201Tl chloride b. myocardial perfusion with 99mTc sestamibi c. first pass study with 99mTc DTPA
d. myocardial imaging with 99mTc pyrophosphate
30) On Monday morning, a technologist receives a telephone request to perform a myocardial study with 99mTc PYP for detection of a myocardial infarct suspected to have taken place that morning at about 8:00 a.m. What should be done?
a. the patient should be injected, but not scanned until at least 8:00 a.m. on Tuesday
b. the study should be delayed until 8:00 a.m.
on Tuesday
c. the study should be delayed until 8:00 a.m.
on Thursday
d. the patient should be injected and scanned as soon as possible
31) Infarct-avid myocardial imaging with 99mTc PYP is usually interpreted by comparing cardiac activity in:
a. rib b. sternum c. kidneys d. all of the above e. a and b only
32) If a SPECT myocardial study with 99mTc PYP is
performed using 64 views of 20 seconds each over 360°, how long will the study take assuming continuous rotation?
a. 18 minutes b. 21 minutes c. 92 minutes d. 112 minutes
33) Gated equilibrium cardiac blood pool images can be used to reliably determine:
a. hibernating myocardium b. LVEF
c. interventricular shunt d. ischemia
e. all of the above
34) Akinesis refers to:
a. a lack of wall motion b. diminished wall motion c. paradoxical wall motion d. septal motion
35) The R-R interval represents:
a. only repolarization b. arrhythmia filtering c. the length of a cardiac cycle
d. length of time data is held in a buffer before being accepted or rejected
36) When labeling RBCs with 99mTc for radionuclide ventriculography, the highest labeling efficiency will be obtained by:
a. the invivo method b. the invitro method
c. the modified invivo/invitro method d. all result in the same labeling efficiency 37) In which of the following cases must imaging be
initiated as soon as possible after radiopharmaceutical injection?
a. radionuclide ventriculography with 99mTc labeled RBCs
b. radionuclide ventriculography with 99mTc HSA c. myocardial perfusion imaging with 99mTc sestamibi d. resting myocardial perfusion with 201Tl chloride
38) A patient has an enlarged left atrium. When drawing an ROI for calculation of LVEF following radionuclide ventriculography, the technologist includes some activity from the left atrium. The resulting ejection fraction will be:
a. unchanged b. falsely elevated c. falsely lowered
d. cannot be determined from the information given 39) Gated blood pool ventriculography is often used to:
a. diagnose arrhythmia
b. obtain a baseline measurement of cardiac function in potential radiation therapy patients
c. detect hematologic spread of metastases
d. determine effect of chemotherapy on cardiac function 40) Set up for a SPECT imaging of myocardial perfusion
with 99mTc sestamibi includes all of the following except:
a. ensuring that the detector head will not snag IV lines or oxygen tubing
b. setting a 10° caudal tilt to differentiate left atrium from left ventricle
c. moving patients arms over his or her head d. ensuring that COR correction for high sensitivity
collimator is selected
41) A patient who cannot exercise and who has asthma can undergo a stress myocardial perfusion study through the use of:
a. the Bruce protocol b. dipyridamole c. dobutamine d. adenosine
42) A patient will be asked to fast, or to eat lightly between stress and redistribution studies with 201Tl chloride because:
a. peristalsis will degrade images
b. stomach activity may obscure myocardium c. gall bladder contraction will be stimulated d. the patient will experience nausea following the
stress test
43) Which radiopharmaceutical can be used to assess myocardial perfusion, right ventricle ejection fraction and left ventricle ejection fraction with a single injection?
a. 201Tl chloride b. 99mTc PYP
c. 99mTc labeled RBCs d. 99mTc sestamibi
44) Choose the correct order in which the structures appear during a first pass study.
a. right ventricle, pulmonary artery, lungs, pulmonary veins, left ventricle
b. right ventricle, pulmonary veins, lungs, pulmonary artery, left atrium
c. left ventricle, pulmonary artery, lungs, pulmonary veins, right ventricle
d. left ventricle, pulmonary veins, lungs, pulmonary artery, right ventricle
e. right ventricle, pulmonary artery, lungs, pulmonary veins, left atrium
45) Which of the following is the most likely cause of false anterior or lateral wall defects on myocardial perfusion imaging with 201Tl chloride?
a. center of rotation error b. respiratory motion c. too few projections
d. attenuation by breast tissue or implant
46) During a one day myocardial perfusion study with 99mTc sestamibi including both stress and rest:
a. rest images must be obtained before stress images b. the second dose of sestamibi should be higher than
the first
c. the higher dose of sestamibi is always injected for the stress portion
d. the sestamibi doses should be identical for best comparison of stress and rest
47) Why is it necessary to inject two doses of99mTc sestamibi for a myocardial perfusion study including both stress and rest conditions?
a. because the physical half life of99mTc is too short to obtain both image sets from one injection b. because there is no redistribution of99mTc sestamibi
within the myocardium
c. because the effective half life is too short
d. because sestamibi is not retained by the myocardium for a sufficient time
48) Soft tissue attenuation is less problematic in:
a. SPECT myocardial imaging with 99mTc sestamibi than with planar imaging with 99mTc sestamibi b. SPECT myocardial imaging with 201Tl chloride
than with planar imaging with 201Tl chloride c. myocardial imaging with 201Tl chloride than
with 99mTc sestamibi
d. myocardial imaging with 99mTc sestamibi than with 201Tl chloride
49) The bulls eye display created after myocardial perfusion imaging represents:
a. only short axis images
b. an entire set of stress or rest SPECT images c. all part of the myocardial wall except the apex d. none of the above
e. b and c
50) Differences between myocardial perfusion imaging with
201Tl chloride and 99mTc sestamibi include:
a. high resolution collimator can be used with 201Tl b. less soft tissue attenuation with 201Tl
c. higher photon flux with 99mTc
d. less respiratory motion with 201Tl due to delay after exercise before imaging
51) When performing a radionuclide venogram to visualize deep venous thrombosis, what should be injected, and where?
a. 99mTc MAA in bilateral pedal veins b. 99mTc MAA subcutaneously in either foot c. 99mTc pertechnetate in the femoral artery d. 99mTc PYP in the left foot
52) Following injection of99mTc sestamibi, during a resting myocardial perfusion study, imaging is delayed for one hour because:
a. respiratory motion will decrease
b. liver and lung activity is too high to allow high quality images of the myocardium
c. until one hour after injection, sestamibi has not had sufficient time to be taken up by the myocardium d. the patient should be monitored for adverse reactions
during the first hour
53) When performing a dual isotope myocardial perfusion rest/stress study, which isotope should be injected first?
a. 201Tl b. 99mTc
c. it doesn’t matter which is injected first, as long as
99mTc is used for the stress study
d. either can be injected first without any consequence
54) Which of the following technical considerations are applicable for radionuclide venography?
a. tourniquets applied about the ankles and just below the knee
b. radioactive markers taped atop each patella c. knees elevated with a pillow
d. all of the above
55) False negative stress myocardial perfusion studies are usually caused by:
a. failure of the myocardium to extract 201Tl chloride from the bloodstream
b. electrocardiogram leads
c. failure of the patient to reach maximal stress d. thallium contained in too large a volume 56) Which of the following should be prepared ahead
of a dipyridamole stress myocardial perfusion study?
a. dose of dipyridamole b. dose of radiopharmaceutical c. dose of aminophylline d. all of the above e. a and b only
57) During a MUGA study, data collection is stopped when:
a. a preset number of counts has been acquired b. a preset number of cardiac cycles has been reached c. a present time has been reached
d. when either a preset number of counts or a preset number of cardiac cycles has been reached e. when either a preset number of cardiac cycles
or a preset time has been reached
58) A technologist injects a patient with 1 mg of unlabeled stannous phosphate. After 20 minutes, 20 mCi of99mTc pertechnetate is administered. This is:
a. an invitro labeling procedure b. an invivo labeling procedure
c. a modified invivo labeling procedure d. none of the above
59) A disadvantage of using 99mTc HSA for radionuclide ventriculography includes:
a. high radiation dose b. lung uptake c. liver uptake
d. relatively low photon flux e. difficult labeling procedure
60) Which of the following may have an effect on the time it takes to acquire a cardiac gated blood pool study?
a. amount of radiopharmaceutical injected b. heart rate
c. use of arrhythmia filtering d. all of the above
e. a and b only
61) Relative to one another,82Rb and 82Sr are:
a. isobars b. isotopes c. isotones
d. none of the above
62) A patient has undergone myocardial PET scans using 13N ammonia and 18FDG. There is little inferoapical activity on the 13N scan, but there is homogeneous uptake in the same area on the 18FDG images. This suggests that:
a. an incorrect dose of13N has been administered.
b. the inferoapical area may revascularize.
c. there is little viable tissue in the inferoapical wall.
d. the system requires a quality control check.
63) Patient A and Patient B are injected with the same dose of13N ammonia for a myocardial PET scan. The patients are the same height but Patient A weighs 120 lbs. and Patient B weighs 180 lbs. From which patient would more true coincidence be detected?
a. Patient A b. Patient B
