Advanced Nuclear Medicine
Textbook Exam Questions
Course Introduction
Advanced Nuclear Medicine delves into the principles and cutting-edge applications of nuclear imaging and therapy. The course covers the physics of radionuclide production, sophisticated imaging technologies such as PET and SPECT, radiopharmaceutical design, and quantitative analysis methods. Emphasis is placed on clinical protocols for diagnosing and managing various diseases, including oncological, cardiovascular, and neurological disorders. Students will also explore safety, regulatory considerations, and recent advances in molecular imaging and targeted radionuclide therapies, preparing them for research or clinical practice in the evolving field of nuclear medicine.
Recommended Textbook
Nuclear Medicine and PETCT Technology and Techniques 8th Edition by Kristen M. Waterstram
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Chapter 1: Mathematics and Statistics
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Sample Questions
Q1) The biological half-life of <sup>131</sup>I in a particular patient is 30 days.The physical half-life is 193 hours.If the patient's thyroid is counted with the thyroid probe detector, what effective half-life will be observed?
A)26 days
B)6.3 days
C)5.1 days
D)1.2 days
Answer: B
Q2) Using Table 1-9 in the book, what is the P value for the linear correlation coefficient r in question 31?
A)P = 0.001
B)0.01 < P < 0.05
C)0.05 < P < 0.1
D)P > 0.10
Answer: B
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Chapter 2: Cell and Molecular Biology
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Q1) Phagocytosis, endocytosis, and autophagy are processes that are performed by the A)Golgi bodies.
B)ribosomes.
C)nucleus.
D)lysosomes.
Answer: D
Q2) All of the following are viruses linked to cancer, EXCEPT A)influenza A.
B)hepatitis B.
C)human papilloma virus (HPV).
D)Epstein-Barr.
Answer: A
Q3) All of the following are steps in gene expression, EXCEPT A)transcription.
B)translation.
C)termination.
D)post-transcriptional modifications.
Answer: C
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Chapter 3: Chemistry/biochemistry
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Sample Questions
Q1) On the periodic table, there is a family of elements that are not very reactive but do form compounds under special conditions.The elements in this family are referred to as A)noble gases.
B)transition metals.
C)alkaline metals.
D)radioactive.
Answer: A
Q2) A characterization of a weak acid is that it
A)completely dissociates in water.
B)does not completely dissociate in water.
C)needs a buffer water.
D)neutralizes water.
Answer: B
Q3) In the chemical symbol <sup>Z</sup>X<sub>A </sub>, the A number is A)the number of protons and neutrons.
B)the number of protons and electrons.
C)the number of protons minus the number of electrons.
D)the number of neutrons minus the number of protons.
Answer: B
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Chapter 4: Radio-Chemistry/Radio-Pharmacology
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Q1) Dipyridamole is administered to a patient as part of a pharmacological stress test.The patient has an onset of angina pectoris.To reverse this adverse reaction of the dipyridamole, the patient is given A)morphine.
B)aminophylline.
C)atropine.
D)nitroglycerin.
Q2) When using radiochromatography to evaluate the percentage of radiochemical purity in the reduced soluble <sup>99m</sup>Tc radiopharmaceuticals, the technologist checks for the percentages of
A)free pertechnetate, hydrolized technetium, and labeled radiopharmaceutical.
B)hydrolyzed technetium and free pertechnetate.
C)free pertechnetate and bound radiopharmaceutical.
D)reduced hydrolyzed <sup>99m</sup>Tc and lipophilic impurities.
Q3) Specific activity is defined as the
A)activity of a radioactive isotope per gram of that same element.
B)amount of radioactive isotope in a patient dose.
C)percentage of carrier-free radioisotope activity in its production.
D)percentage of stable isotope activity within a radioisotope.
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Page 6
Chapter 5: Radiation Safety in Nuclear Medicine
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Q1) Radiation levels outside a room are such that an individual could receive 0.30 rem in 1 hour.According to the Nuclear Regulatory Commission (NRC), the technologist should
A)post a Caution: Radioactive Materials sign.
B)post a Radiation Area sign.
C)post a High Radiation Area sign.
D)not post a sign; it is considered an unrestricted area.
Q2) A nuclear medicine technologist is going to measure the wipe tests that were performed at the end of the day.The instrument with the highest efficiency for this is usually a
A)GM meter.
B)scintillation detector.
C)well counter.
D)liquid scintillation counter.
Q3) According to NRC regulations, radioactive waste from P-32
A)should be shipped for land burial.
B)should be returned to the manufacturer.
C)can be held for decay-in-storage.
D)should be flushed into the sanitary sewer.
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Chapter 6: Patient Care
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Sample Questions
Q1) A patient has an ileostomy.The technologist knows that the patient has
A)an NG tube for feeding.
B)a catheter for collection of urine.
C)surgical dressings that may need to be changed.
D)a plastic pouch for collection of feces.
Q2) Following a procedure, a patient experiences syncope.The technologist should A)have the patient walk more slowly.
B)have the patient lie down.
C)contact the patient's family.
D)arrange for administration of IV solution.
Q3) While waiting for a scan, a diabetic patient develops hypoglycemia.The symptoms may include all of the following EXCEPT
A)hot, feverish skin.
B)general weakness.
C)sweating.
D)tremors.
Q4) MR contrast media is administered in high doses compared to CT contrast media.
A)True
B)False
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Chapter 7: Department Administration
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Q1) The 4 P's of marketing are
A)production, promotion, placement, preparation.
B)preparation, production, practice, process.
C)product (service), pricing, place, promotion.
D)process, price, procurement, procedure.
Q2) Which leader skill set requires the leader to appreciate and understand their role in the relationship between the organizational structure and culture?
A)Change management
B)Marketing
C)Law and ethics
D)Organizational behavior
Q3) All of the following are leadership skill sets, EXCEPT
A)negotiations.
B)operations and change management.
C)marketing.
D)financial strategy.
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Chapter 8: Clinical Research
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Q1) A document that describes the objective(s), design, methodology, statistical considerations, and organization of the trial is the
A)informed consent.
B)source document.
C)protocol.
D)contract research organization.
Q2) The Food and Drug Administration governs clinical research performed by
A)the Department of Agriculture.
B)manufacturers of drugs, devices, and biologicals.
C)the Nuclear Regulatory Agency.
D)all investigators.
Q3) How many members are required to comprise an Institutional Review Board?
A)Three
B)Five
C)Seven
D)Nine
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Chapter 9: Health Informatics in Imaging
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Sample Questions
Q1) The quality of the cardiac data during a MUGA can be compromised by A)breathing.
B)bradycardia.
C)tachycardia.
D)PVCs.
Q2) On a computer, image resolution
A)deteriorates as the acquisition matrix size increases.
B)deteriorates as the acquisition matrix size decreases.
C)remains consistent across matrix size for a given camera.
D)remains consistent across matrices if pixel rollover is controlled.
Q3) In an 8-bit color image, the range of displayed color intensities would be
A)0 to 64.
B)0 to 100.
C)0 to 128.
D)0 to 255.
Q4) Hardware magnification or zoom
A)decreases resolution.
B)increases noise.
C)only increases image size.
D)increases sensitivity.
11
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Chapter 10: Physics of Nuclear Medicine
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Sample Questions
Q1) The minimum MeV photon energy required for pair production is
A)0.511.
B)1.022.
C)5.110.
D)10.22.
Q2) When using the standard notation in the physical sciences for representing elements with a one- or two-letter chemical name symbol, the letter Z represents the A)atomic mass.
B)atomic number.
C)number of neutrons.
D)number of electrons.
Q3) An unstable configuration of protons and neutrons is referred to as nuclides.
A)True
B)False
Q4) Which of the following is not true of isotopes?
A)They have the same atomic number.
B)They have the same mass number.
C)They have the same number of neutrons.
D)They have the same chemical properties.
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Chapter 11: Instrumentation
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Sample Questions
Q1) The center-of-rotation measurement
A)determines the number of projections.
B)corresponds to the pixel size at the center of the orbit.
C)corresponds to the radius.
D)determines the offset between the camera center and projections.
Q2) When referring to image quality, resolution
A)refers to how well objects can be separated in space.
B)determines whether two objects have different activity concentrations.
C)refers to the ability to see the edge of a structure.
D)occurs because of the random nature of counting statistics.
Q3) Which detector is confined for use in detecting radiation where the exposure levels are below 2000 mR/hr?
A)Ionization chamber
B)Dose calibrator
C)GM meter
D)Body badge
Q4) In SPECT/CT imaging, it is best if the patient does shallow breathing throughout the scan.
A)True
B)False
Page 13
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Chapter 12: CT Physics and Instrumentation
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Sample Questions
Q1) Collimators in CT scanning are used to do all of the following EXCEPT
A)limit the beam size.
B)reduce scattered x-rays.
C)define slice thickness.
D)offset the alignment of the tube and detector array to optimize the beam location.
Q2) What is the purpose of administering a contrast agent for a CT procedure?
A)Reduce patient dose for longer scans that require thinner slicers
B)Reduce streaking artifacts when scanning high-density objects
C)Reduce attenuating properties of tissues with wide variances in density
D)Enhance detection of lesions and aid in defining normal structures
Q3) Energies required for typical PET/CT studies of the body will be in the range of
A)20 to 30 kVp.
B)40 to 75 kVp.
C)80 to 140 kVp.
D)145 to 160 kVp.
Q4) The slice thickness that may be reconstructed can be up to half as thin as the collimator width.
A)True
B)False
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Chapter 13: Pet Instrumentation
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Sample Questions
Q1) In a PET system, energy window calibration is typically performed after repair as well as
A)daily.
B)weekly.
C)quarterly.
D)annually.
Q2) In PET imaging, a large particle range results in
A)better resolution of annihilation events.
B)an overcalculation of the annihilation event from the positron-emitting atom.
C)a slight mispositioning of the annihilation event from the positron-emitting atom.
D)truer positioning of the annihilation event with the positron-emitting atom.
Q3) The standard uptake value is useful in
A)performing attenuation correction.
B)calculating scatter correction.
C)differentiating between malignant and benign tissue.
D)determining the time span between injection and scan.
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Chapter 14: Principles of Magnetic Resonance Imaging
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Sample Questions
Q1) T2 refers to the recovery of transverse magnetization.
A)True
B)False
Q2) Which scan parameter determines the amount of time between each initial RF pulse used to excite the protons in a given region of anatomy?
A)Free induction decay (FID)
B)Time to repetition (TR)
C)Time to echo (TE)
D)Flip angle
Q3) The most common MRI scanner used in clinical practice has a magnet strength of
A)1.5 T.
B)2.0 T.
C)2.5 T.
D)3.0 T.
Q4) Artifacts caused by anatomy "moves" can be remedied by
A)equating the phase and frequency encoding directions.
B)use of postsaturation pulses.
C)decoding the phase.
D)gating.
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Chapter 15: Clinical Petct in Oncology
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Sample Questions
Q1) Which of the following diagnoses requires a head-to-toe PET scan?
A)Lymphoma
B)Melanoma
C)Colorectal cancer
D)Mesothelioma
Q2) Standard uptake values (SUVs) are useful in distinguishing between benign and malignant disease.
A)True
B)False
Q3) In the United States, breakthrough reimbursement for PET scans was determined by the
A)U.S.Department of Health and Human Services (DHHS).
B)Centers for Medicare and Medicaid Services (CMS).
C)Centers for Disease Control and Prevention (CDC).
D)U.S.Food and Drug Administration (FDA).
Q4) FDG enters cells by means of
A)active transport.
B)phagocytosis.
C)facilitated diffusion.
D)capillary action.
Page 17
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Chapter 16: Central Nervous System
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Sample Questions
Q1) Following a nuclear medicine study to assess CSF dynamics, the patient should be instructed to
A)remain in a horizontal position for 2 hours after injection.
B)drink plenty of fluids and void urine frequently.
C)keep distance between themselves and children for 2 days after injection.
D)not have any radiographic brain studies for 1 week.
Q2) Which radiopharmaceutical is used for ictal SPECT imaging?
A)(<sup>99m</sup>)Tc-HMPAO
B)(<sup>111</sup>)In-labeled DTPA
C)(<sup>99m</sup>)Tc-pertechnetate
D)(<sup>18</sup>)F-FDG
Q3) The images in a cerebrospinal fluid leak study show an initial wide segmental appearance with no activity in the basal cisterns at 2 to 3 hours after injection.The technologist should
A)count the pledgets.
B)continue routine images at 6, 24, and 48 hours after injection.
C)prepare for a reinjection.
D)have the patient change position and then repeat the image.
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Chapter 17: Endocrine System
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Q1) On a scan, within the thyroid, thyroid carcinoma is often seen as
A)a hyperactive ("hot") area.
B)a hypoactive ("cold") area.
C)diffuse areas of increased activity.
D)total suppression of gland activity.
Q2) The radionuclide therapy used for the treatment of either hyperthyroidism or thyroid carcinoma is
A)<sup>123</sup>I.
B)<sup>125</sup>I.
C)<sup>131</sup>I.
D)<sup>123</sup>I-MIBG.
Q3) A patient is scheduled for adrenal medullary imaging.The preferred radiopharmaceutical for this study is
A)(<sup>123</sup>)I-MIBG.
B)(<sup>111</sup>)In-DTPA pentetreotide.
C)(<sup>131</sup>)I NP-59.
D)(<sup>99m</sup>)Tc-MIBI.
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Chapter 18: Respiratory System
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Sample Questions
Q1) Which ventilation agent has the longest half-life?
A)(<sup>99m</sup>)Tc-DTPA Aerosol
B)(<sup>133</sup>)Xe
C)(<sup>99m</sup>)Tc MAA
D)All have equal half-lives
Q2) A patient has a nuclear medicine lung scan.Once the particles have been injected, the technologist notices activity in the brain and other organs.The technologist recognizes this as
A)a right-to-left shunt.
B)normal.
C)too many particles injected.
D)an expired kit.
Q3) One-half dose (reduced number of particles) should be given to patients with all of the following EXCEPT
A)pulmonary hypertension.
B)right-to-left shunts.
C)a pneumonectomy.
D)bronchitis.
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Chapter 19: Cardiovascular System
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Q1) Rubidium-82 (<sup>82</sup>Rb) behaves physiologically similar to A)strontium-82.
B)technetium-99m.
C)thallium-201.
D)oxygen-15.
Q2) In myocardial perfusion imaging, after high-level stress exercise it is recommended that SPECT imaging begin when respiration has returned to normal to avoid A)bradycardia effects.
B)upward creep.
C)attenuation by the stomach.
D)an increase in background uptake.
Q3) When fusing PET and CT or SPECT and CT images of the heart, misregistration can be overcome by taking several steps, including
A)equating the acquisition time between CT and PET or SPECT.
B)blurring the CT data.
C)acquiring PET or SPECT images over a longer period of time.
D)blurring the PET or SPECT data.
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Chapter 20: Gastrointestinal System
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Q1) Delayed images of the thorax following an esophageal transit study may be ordered to determine
A)the site of an esophageal stricture.
B)aspirated radionuclide.
C)scleroderma prognosis.
D)reflux.
Q2) Technetium-99m-sulfur colloid and <sup>99m</sup>Tc-albumin colloid are the radiopharmaceuticals most commonly used for imaging the A)salivary glands.
B)liver and spleen.
C)gallbladder.
D)small intestine.
Q3) When performing a normal liver/spleen study, following the blood pool image the technologist should begin imaging
A)immediately.
B)approximately 15 minutes after injection.
C)approximately 30 minutes after injection.
D)approximately 45 minutes after injection.
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Chapter 21: Genitourinary System
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Q1) Angiotensin-converting enzyme inhibitor (ACEI) augments renal studies in patients with A)infection and inflammation.
B)vesicoureteral reflux.
C)obstructive uropathy.
D)renal artery stenosis (RAS)-related hypertension.
Q2) A neobladder made from a portion of the small bowel is called A)colostomy.
B)ileal loop.
C)ptotic.
D)jejunostomy.
Q3) A patient informs the technologist that he has a ptotic kidney.Because of this, the technologist positions the patient in a sitting position.
A)True
B)False
Q4) Morphologic renal imaging can be used to document A)GFR and ERPF.
B)global and regional changes in renal function.
C)the existence of an ileal loop.
D)the evaluation of acute renal failure.
Page 23
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Chapter 22: Skeletal System
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Q1) Metastatic lesions that have no osteoblastic activity
A)can be confused with a renal abnormality.
B)are usually detected as a photon-rich area.
C)are usually detected as a photon-deficient area.
D)often result in breast uptake.
Q2) What are the two types of bone tissue?
A)Compact and spongy
B)Spongy and trabecular
C)Cortical and compact
D)Trabecular and cortical
Q3) In the evaluation of primary bone neoplasms, bone scans
A)are the first step in diagnosis.
B)are used to detect disease elsewhere.
C)are used instead of radiographs for diagnosis.
D)demonstrate the primary bone neoplasm as a photopenic area.
Q4) Typically, skeletal metastatic disease has the greatest involvement in (the)
A)appendicular skeleton.
B)axial skeleton.
C)areas of synarthrosis.
D)areas of diarthrosis.
Page 24
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Chapter 23: Inflammatory Tumoroncology Imaging and Therapy
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Q1) Rituximab (Rituxan) is administered as a(n)
A)bolus IV injection.
B)infusion over 2 to 6 hours.
C)IV injection over 10 minutes.
D)catheter instillation.
Q2) A <sup>67</sup>Ga image at 48 hours after injection displays bowel activity; the technologist should
A)be concerned that the wrong radiopharmaceutical was administered.
B)change the collimator to reduce the scatter activity from the bowel.
C)continue imaging because this is normal.
D)check to see if a radiographic study using contrast was performed.
Q3) A patient's indication for a nuclear medicine study is primary pheochromocytoma.The radiopharmaceutical that the technologist prepares for administration is
A)(<sup>99m</sup>)Tc-depreotide.
B)(<sup>123 </sup>)I-MIBG.
C)(<sup>111</sup>)In-capromab pendetide.
D)(<sup>111</sup>)In-pentetreotide.
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Chapter 24: Hematopoietic System
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Q1) The average volume of blood plasma for a normal adult is A)25 liters.
B)50 liters.
C)3000 mL.
D)2000 mL.
Q2) When performing a <sup>51</sup>Cr-labeled splenic sequestration study, the technologist does NOT take counts over the A)liver.
B)spleen.
C)precordium.
D)thyroid.
Q3) The hematocrit (Hct) represents the
A)percentage of RBCs in whole blood.
B)percentage of RBCs in the packed cells.
C)ratio of RBCs to platelets.
D)ratio of RBCs to WBCs.
Q4) In a blood sample, the fluid from which a clot is separated is called serum.
A)True
B)False
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