Cardiac - Myocardial Perfusion Imaging

Question 1 of 54

1

Why is it necessary to inject two doses of 99mTc-MIBI for a myocardial perfusion study under both rest and stress conditions?

Select one of the following:

the physical half-life of 99mTc is too short to obtain both image sets from one injection
the effective half-life of 99mTc is too short to obtain both image sets from one injection
there is no redistribution of 99mTc-MIBI within the myocardium
Sestamibi is not retained by the myocardium for a sufficient amount of time
Images would be degraded on stress images after exercise

Explanation

Question 2 of 54

1

To help clear the thyroid, liver, and bowel when performing a cardiac perfusion study with sestamibi, a technologist may give what before imaging?

Select one of the following:

a high carb meal
dobutamine
dextrose intravenously
adenosine
a glass of cold water

Explanation

Question 3 of 54

1

Which of the following is an advantage of 99mTc-tetrofosmin over 99mTc-sestamibi?

Select one of the following:

it redistributes
one-day stress-rest protocol can be used
faster tracer clearance from the GI system
stress and rest images can be acquired with one tracer dose
higher activities may be administered

Explanation

Question 4 of 54

1

Which of the following would NOT be a characteristic of an ideal myocardial perfusion agent?

Select one of the following:

high first-pass myocardial extraction proportional to blood flow
adequate imaging window
high target:non-target ratio
ability to complete both rest and stress imaging in 2 days
half-life sufficient to complete the cardiac study

Explanation

Question 5 of 54

1

Why is it necessary to wait 45-90 minutes between the stress injection with Myoview and imaging?

Select one of the following:

to allow for respiratory motion to decrease
to allow for liver and lung activity to decrease
to allow time for uptake in the myocardium
to allow time to monitor the patient
to give the patient time to eat a fatty meal

Explanation

Question 6 of 54

1

In the 1-day protocol for myocardial perfusion imaging with a 99mTc-labelled tracer, the larger amount of activity is administered:

Select one of the following:

for the rest study
for the study performed second
for the study performed first
for the stress study
for the study performed third

Explanation

Question 7 of 54

1

Advantages of using 99mTc-sestamibi for myocardial perfusion imaging include all of the following except:

Select one of the following:

no redistribution of tracer
acquisition of ventricular function information
completion of stress and rest imaging on the same day
flexibility in the time of imaging following tracer administration
acquisition of stress and rest images with one tracer dose

Explanation

Question 8 of 54

1

A contraindication for performing a myocardial perfusion rest study is:

Select one of the following:

fasting 4-12 hours before the study
drinking cold water before the study
having a normal sinus rhythm
being NPO 4-12 hours before the study
having a nitroglycerin drip

Explanation

Question 9 of 54

1

Which of the following agents used for pharmacologic stress testing remain in the plasma for the greatest length of time?

Select one of the following:

dobutamine
adenosine
nitroglycerin
dipyridamole
regadenoson

Explanation

Question 10 of 54

1

Persantine is supplied to a nuclear medicine department in 10 mL vials, each containing 50 mg. If a patient weighs 155 lbs, how many mL must be injected for the patient to receive 0.56 mg/kg?

Select one of the following:

7.9 mL
8.7 mL
17.4 mL
39.5 mL
5.3 mL

Explanation

Question 11 of 54

1

Which of the following pharmacologic stress agents indirectly affects adenosine receptor sites on cell membranes?

Select one of the following:

dobutamine
adenosine
atropine
esmolol
dipyridamole

Explanation

Question 12 of 54

1

Which of the following agents used for pharmacologic stress testing has the longest plasma half life?

Select one of the following:

adenosine
dipyridamole
dobutamine
nitroglycerin
atropine

Explanation

Question 13 of 54

1

Which of the following pharmacologic stressing agents should NOT be administered to a patient with asthma or bronchospastic disease?

Select one of the following:

both adenosine and dipyridamole
both atropine and adenosine
dobutamine
adenosine
atropine

Explanation

Question 14 of 54

1

Treatment of the adverse effects induced by dipyridamole involves the adminstration of:

Select one of the following:

aminophylline
adenosine
acetazolamide
nitroglycerin
aspirin

Explanation

Question 15 of 54

1

What is an advantage of performing exercise stress testing over pharmaceutical stress?

Select one of the following:

it is safer
imaging can begin sooner after tracer injection
it is less technically challenging
a cardiologist does not need to be present
patients tolerate it better

Explanation

Question 16 of 54

1

Dobutamine is contraindicated for stress testing in patients with all of the following conditions except:

Select one of the following:

severe aortic stenosis
blood glucose level above 200 mg/dL
ejection fraction below 15%
unstable angina
severe hypertension

Explanation

Question 17 of 54

1

Caffeine is a contraindication for which of the following interventional pharmacologic agents?

Select one of the following:

CCK
adenosine
insulin
furosemide
captopril

Explanation

Question 18 of 54

1

The recommended dose of adenosine is:

Select one of the following:

140 mcg/kg/min
14 mcg/kg/min
1.4 mcg/kg/min
1400 mcg/kg/min
14,000 mcg/kg/min

Explanation

Question 19 of 54

1

Which of the following must be discontinued for at least 24 hours before administration of dipyridamole?

Select one of the following:

water
theophylline
insulin
Lasix
aspirin

Explanation

Question 20 of 54

1

Adenosine is contraindicated for patients with which of the following conditions?

Select one of the following:

asthma
stress-induced myocardial ischemia
diabetes
peripheral vascular disease
stroke

Explanation

Question 21 of 54

1

Which of the following diagrams is a correctly labelled representative slice of the horizontal long axis of the left ventricular myocardium?

Select one of the following:

A
B
C
D

Explanation

Question 22 of 54

1

Which tomographic plane of the heart displays all walls of the left ventricle?

Select one of the following:

horizontal long axis
short axis
transaxial
vertical long axis
sagittal

Explanation

Question 23 of 54

1

Mr. Brown is 65 year old man in the nuclear medicine department for a myocardial perfusion scan with 99mTc-sestamibi. During exercise stress testing he reached a heartrate of 125 bpm. His rest and stress images showed no apparent perfusion defects. How may this scan be reported?

Select one of the following:

Negative for coronary artery disease
Positive for coronary artery disease
Potentially a false negative for coronary artery disease due to inadequate stress
Potentially a false positive for coronary artery disease due to inadequate stress
Unequivocal for coronary artery disease

Explanation

Question 24 of 54

1

Which of the following functional images represents the magnitude of ventricular contraction?

Select one of the following:

non-phase image
paradox image
phase image
stroke-volume image
amplitude image

Explanation

Question 25 of 54

1

In processing a myocardial perfusion study, a slice from which body axis is used to identify the degree to which the heart points to the left and to construct slices in the three opposing cardiac planes?

Select one of the following:

horizontal long axis
transaxial
vertical long axis
short axis
horizontal short axis

Explanation

Question 26 of 54

1

A patient is booked for a 1 day rest-stress myocardial perfusion study, and the hybrid CT scanner is failing quality control. The cardiologist insists that the test be performed today. As the technologist, what do you do?

Select one of the following:

Inform the cardiologist that it will be impossible to perform the test
Use CT for attenuation correction
Perform only the rest study only today
Image the patient in the prone position for both rest and stress studies
Perform the emission imaging as normal and eliminate the transmission imaging for today's studies

Explanation

Question 27 of 54

1

Diaphragmatic attenuation may be reduced by:

Select one of the following:

360 degree acquisition
supine acquisition
delayed imaging
prone acquisition
giving a bolus injection

Explanation

Question 28 of 54

1

Which vessels are affected based on these images?

Select one of the following:

right coronary artery and left anterior descending
left anterior descending only
left circumflex artery and right coronary artery
left circumflex artery only
right coronary artery only

Explanation

Question 29 of 54

1

Perfusion of the ventricular septum in the heart is provided by which coronary artery?

Select one of the following:

right coronary
left circumflex
left anterior descending
left coronary
right circumflex

Explanation

Question 30 of 54

1

Which SPECT cardiac slice is used to generate a polar plot?

Select one of the following:

transverse
HLA
VLA
SA
sagittal

Explanation

Question 31 of 54

1

A disadvantage of using the polar map display to assess myocardial perfusion data is:

Select one of the following:

perfusion defects at the base of the heart tend to be underrepresented
perfusion defects at the apex tend to be underrepresented
the polar map display does not provide accurate quantitative information and should only be used as a visual representation of perfusion
stress and rest datasets cannot be accurately compared
the polar map display can provide information on reversible defects but not fixed defects

Explanation

Question 32 of 54

1

When assessing a myocardial perfusion study that has been processed using filtered back projection, it may be useful to compare the filtered images to the unfiltered images to rule out:

Select one of the following:

a processing-induced septal wall defect
a processing-induced inferior wall defect
myocardial ischemia
myocardial infarction
patient motion

Explanation

Question 33 of 54

1

Delayed improvement of perfusion after coronary artery revascularization is referred to as:

Select one of the following:

hibernating myocardium
infarcted myocardium
stunned myocardium
necrosed myocardium
myocarditis

Explanation

Question 34 of 54

1

Which of the following is/are advantages of G-SPECT?

1. Identification of suspected attenuation artifacts
2. Enhanced detection of multivessel CAD
3. Assessment of myocardial viability
4. Distinguishing ischemic from nonischemic cardiomyopathy
5. Simpler procedure than non-gated SPECT

Select one of the following:

1, 2, 3, 4, and 5
1, 2, 3, and 4
1 only
2 and 5
2, 3, and 4

Explanation

Question 35 of 54

1

Functional cardiac studies may be performed to evaluate wall-motion abnormalities caused by all of the following except:

Select one of the following:

aneurysm
myocardial infarction
myocardial perfusion patency
myocardial ischemia
myocarditis

Explanation

Question 36 of 54

1

Which of the following will NOT give information on left ventricular function?

Select one of the following:

gated equilibrium radionuclide angiography
gated myocardial perfusion imaging
ungated first-pass study
gated myocardial PET
ungated myocardial SPECT

Explanation

Question 37 of 54

1

Ischemia means:

Select one of the following:

necrotic tissue
infarction
decreased blood flow
the superior portion of the pelvis
scar tissue

Explanation

Question 38 of 54

1

A patient with known myocardial ischemia affecting the right coronary artery undergoes a 2 day rest-stress myocardial imaging procedure using 99mTc-sestamibi and pharmacological stressing with Persantine. How will perfusion to the inferior wall of the left ventricular myocardium differ between the rest and Persantine stress images?

Select one of the following:

Myocardial perfusion to the inferior wall will be mostly unchanged between rest and stress
Myocardial perfusion to the inferior wall will increase following administration of Persantine
Myocardial perfusion to the inferior wall will decrease following administration of Persantine
It is impossible to predict how myocardial perfusion to the inferior wall will be affected by Persantine

Explanation

Question 39 of 54

1

When processing a myocardial perfusion study using automatic edge detection software, part of the adjacent bowel is included in the inferior contour of the rest images only. What effect may this have on the results?

Select one of the following:

apparent dyskinesia
falsely elevated lung:heart ratio
falsely low summed difference score
no effect
falsely elevated TID

Explanation

Question 40 of 54

1

Which of the following is the most likely cause of false anterior or lateral wall defects on myocardial perfusion imaging?

Select one of the following:

centre of rotation error
respiratory motion
too few projections
attenuation by breast tissue or implant
multiple pulmonary emboli

Explanation

Question 41 of 54

1

Which of the following may result in a false positive result on a myocardial perfusion scan?

Select one of the following:

triple vessel disease
exercise stressing a patient with LBBB
radiopharmaceutical injected before the target heart rate is achieved
patient motion of 1 pixel
non-transmural infarction

Explanation

Question 42 of 54

1

Which of the following may be indicated by a reversible defect?

1. Ischemia
2. Hibernating myocardium
3. Stunned myocardium
4. Infarction

Select one of the following:

1 only
1 and 3
1 and 4
2, 3, and 4
4 only

Explanation

Question 43 of 54

1

Which of the following patients would benefit most from coronary revascularization?

Select one of the following:

A 52 year old male whose rest and stress perfusion studies show matched defects and whose gated data indicate paradoxical motion
A 36 year old female who demonstrates normal perfusion on both stress and rest images, but whose gated data indicate akinesis of the anterior, septal, and apical walls
A 64 year old female patient whose rest images appear normal but with anterior, apical, and septal defects on the stress images with matching mild hypokinesis
A 40 year old male whose rest images appear normal but with a large inferior wall defect on stress images and a LVEF of 65%.

Explanation

Question 44 of 54

1

Which of the following may result in a false negative myocardial perfusion imaging result?

Select one of the following:

A 75 year old female achieving a maximum heart rate of 124 bpm before tracer injection
A 46 year old patient with hypertensive myocardial hypertrophy
A 72 year old male patient with a left bundle-branch block
A 58 year old patient with balanced myocardial ischemia
A 60 year old female patient with aortic regurgitation

Explanation

Question 45 of 54

1

An advantage of 201Tl-thallium chloride is that it:

Select one of the following:

has a high photon flux at a high-energy window
is a calcium analogue
has a short half-life
redistributes
has a high first-pass extraction and stays fixed in the myocardium

Explanation

Question 46 of 54

1

In preparation for a Tl-201 stress test, patients are instructed to fast to:

Select one of the following:

prevent gastrointestinal upsets during exercise
minimize tracer uptake in the gastrointestinal tract
enhance myocardial tracer uptake
standardize test conditions among patients
prevent redistribution of the tracer

Explanation

Question 47 of 54

1

After stress myocardial imaging with 201Tl-thallous chloride, 37-55 MBq of 201Tl-thallous chloride may be administered before rest imaging to:

Select one of the following:

improve patient throughput
demonstrate reversible ischemia more readily
demonstrate infarct size more precisely
minimize visualization of attenuation artifacts
maximize visualization of attenuation artifacts

Explanation

Question 48 of 54

1

Which of the following are differences between myocardial perfusion imaging with 201Tl-chloride versus 99mTc-sestamibi?

1. A high resolution collimator should be used with 201Tl-chloride
2. There is less soft tissue attenuation with 201Tl-chloride
3. 99mTc-sestamibi results in higher photon flux
4. There is less respiratory motion with 201Tl-chloride

Select one of the following:

1, 2, 3, and 4
2 & 4
3 & 4
1 & 3
3 only

Explanation

Question 49 of 54

1

Which of the following protocols would be most appropriate for dual-isotope myocardial perfusion imaging?

Select one of the following:

Rest first: 111MBq 201Tl-chloride
Stress second: 925 MBq 99mTc-MIBI
Rest first: 925MBq 99mTc-MIBI
Stress second: 111 MBq 201Tl-chloride
Stress first: 925MBq 99mTc-MIBI
Rest second: 111MBq 201Tl-chloride
Stress first: 111MBq 201Tl-chloride
Rest second: 925MBq 99mTc-MIBI
Rest first: 925MBq 99mTc-MIBI
Stress second: 925MBq 99mTc-tetrofosmin

Explanation

Question 50 of 54

1

Myocardial perfusion imaging is a relatively high radiation dose nuclear medicine procedure. All of the following are useful methods to reduce patient doses EXCEPT:

Select one of the following:

Using PET/CT imaging techniques
Using a stress-only protocol in low-risk patients with normal post-stress images
Encouraging the patient to stay hydrated and to empty their bladder frequently
Using a dedicated cardiac camera that enables shorter imaging times
Using a longer imaging time so that a smaller dose can be administered

Explanation

Question 51 of 54

1

What is the most likely diagnosis?

Select one of the following:

dilated cardiomyopathy
normal myocardium
lateral wall ischemia
multi-vessel ischemia
hibernating septal wall myocardium

Explanation

Question 52 of 54

1

A patient presents with the following quantitative results on a 99mTc-sestamibi myocardial perfusion study:

SSS = 31; SRS = 30

What is the most likely diagnosis?

Select one of the following:

negative for coronary artery disease
hibernating myocardium
myocardial infarction
myocardial ischemia
dilated cardiomyopathy

Explanation

Question 53 of 54

1

What is the purpose of glucose loading when assessing myocardial viability with 18FDG?

Select one of the following:

To decrease the absorbed dose from radiation delivered to the myocardium
To prevent patients with diabetes from having a reaction during the procedure
So that the heart switches from fatty acid to glucose utilization, increasing uptake of FDG
A loading dose of glucose should not be administered for myocardial viability imaging with 18F-FDG
To reduce extracardiac uptake of 18FDG.

Explanation

Question 54 of 54

1

What is the most likely diagnosis?

Select one of the following:

dextrocardia
breast attenuation artifact
diaphragmatic attenuation artifact
large anterior-apical infarct
ischemic dilatation

	Created by Siobhan Pett over 6 years ago

CAMRT Nuclear Medicine Technology (Clinical) Quiz on Cardiac - Myocardial Perfusion Imaging, created by Siobhan Pett on 20/06/2020.

Cardiac - Myocardial Perfusion Imaging

Question 1 of 54

Why is it necessary to inject two doses of 99mTc-MIBI for a myocardial perfusion study under both rest and stress conditions?

Select one of the following:

Explanation

Question 2 of 54

To help clear the thyroid, liver, and bowel when performing a cardiac perfusion study with sestamibi, a technologist may give what before imaging?

Select one of the following:

Explanation

Question 3 of 54

Which of the following is an advantage of 99mTc-tetrofosmin over 99mTc-sestamibi?

Select one of the following:

Explanation

Question 4 of 54

Which of the following would NOT be a characteristic of an ideal myocardial perfusion agent?

Select one of the following:

Explanation

Question 5 of 54

Why is it necessary to wait 45-90 minutes between the stress injection with Myoview and imaging?

Select one of the following:

Explanation

Question 6 of 54

In the 1-day protocol for myocardial perfusion imaging with a 99mTc-labelled tracer, the larger amount of activity is administered:

Select one of the following:

Explanation

Question 7 of 54

Advantages of using 99mTc-sestamibi for myocardial perfusion imaging include all of the following except:

Select one of the following:

Explanation

Question 8 of 54

A contraindication for performing a myocardial perfusion rest study is:

Select one of the following:

Explanation

Question 9 of 54

Which of the following agents used for pharmacologic stress testing remain in the plasma for the greatest length of time?

Select one of the following:

Explanation

Question 10 of 54

Persantine is supplied to a nuclear medicine department in 10 mL vials, each containing 50 mg. If a patient weighs 155 lbs, how many mL must be injected for the patient to receive 0.56 mg/kg?

Select one of the following:

Explanation

Question 11 of 54

Which of the following pharmacologic stress agents indirectly affects adenosine receptor sites on cell membranes?

Select one of the following:

Explanation

Question 12 of 54

Which of the following agents used for pharmacologic stress testing has the longest plasma half life?

Select one of the following:

Explanation

Question 13 of 54

Which of the following pharmacologic stressing agents should NOT be administered to a patient with asthma or bronchospastic disease?

Select one of the following:

Explanation

Question 14 of 54

Treatment of the adverse effects induced by dipyridamole involves the adminstration of:

Select one of the following:

Explanation

Question 15 of 54

What is an advantage of performing exercise stress testing over pharmaceutical stress?

Select one of the following:

Explanation

Question 16 of 54

Dobutamine is contraindicated for stress testing in patients with all of the following conditions except:

Select one of the following:

Explanation

Question 17 of 54

Caffeine is a contraindication for which of the following interventional pharmacologic agents?

Select one of the following:

Explanation

Question 18 of 54

The recommended dose of adenosine is:

Select one of the following:

Explanation

Question 19 of 54

Which of the following must be discontinued for at least 24 hours before administration of dipyridamole?

Select one of the following:

Explanation

Question 20 of 54

Adenosine is contraindicated for patients with which of the following conditions?

Which of the following is/are advantages of G-SPECT?

1. Identification of suspected attenuation artifacts
2. Enhanced detection of multivessel CAD
3. Assessment of myocardial viability
4. Distinguishing ischemic from nonischemic cardiomyopathy
5. Simpler procedure than non-gated SPECT