TC-99 = keV of 140

½ half life of 6 hours

DTPA and pertechnetate = perfusion agents – do not cross blood brain barrier.
-uncommonly used
-highlights the scalp, sinuses, subarachnoid space, cerebral arteries

TC 99 HMPAO/TC99 ECD
Lipohilic and cross blood brain barrier
HMPAO is a marker of perfusion while ECD only by living cells
ECD represents infarct core

Imaging Technecium early = just the lungs light up (4 hours)

Imaging technecium late after 24 hours = lungs and bowels light up

MC bone scan
TC 99 with MDP
Tumors, fractures, infections = more bone turnover

Degenerative changes, facet arthroopathy, lytic lesions,sclerotic lesions

Sulfur colloid = 2-3 minutes

Gallium = binds to transferrin and good for infection

Isomeric transition of TC-99M to TC to release gmama ray

Unit of radioactivity
Activity = # of decays / time
SI unit = Bq = decays/second

1mCI = 37 MBq
Half lifes
Gamma emitters:
Tc-99m = 6 hours 140 keV
I -123 = 13 hours 159 KeV
I-131 = 8 days 365 kEV (good for therapy….contraindicated in kids nad pregnantwoman)
Ga 67 = 3 day (78 hours) 100-400 kEV
Thalium = 3 days = 80 kEV
Xe-133 = 5 days 80 keV
Rubidium 82 = 75 seconds (cardiac perfusion agent)

Beta Positron emitters

F-18 FDG and F-18 Na = 110 minutes 511 kEV volts from the annihilation event
Rubidium

Planar SPECT and PET

Planar and SPECT have gamma cameras

PET has PET detector

Standardized Uptake Value = Injection dose (MBq/patient’s weight)

Activity dose in

F18 is positron emitter that is connected to FDG which is a radiopharmaceutical

Positron diffuses away from the F18

In annihilation event, 2 gamma photons are produced that travel at 180 degrees

MIBG = Neuroendocrine tumors (Liver + spleen)

Ln (Indium)-111 = Octreotide scan (Spleen > Liver) for thyroid cancer (medullary)
neuroendocrine)

TC-99 WBC 4 hours = lung uptake

24 hours = bowel uptake

Skeletal imaging
TC-99 MDP

What organ gets the highest dose of MDP?

Bone

What organ gets the highest dose of F18?

Bladder
80 percent of the time, single lesion on TC99 MDP is benign and not mets. If it were mets, it
would most likely be in the spine

Honda sign
Sacral insufficiency fracture

Prostate cancer bone mets are uncommon with a PSA of less then 10

Equivocal lesion on bone scan?

Next step is plain film comparison.
If not seen on plain film, get an MRI

Cardiac stress agents

Regadenoson
Dipyramidole
Adenosine

What kind of scan is it.

Ventilation
Xenon 133 ( 30 seconds 80 kev) vs. TC 99 DTPA

What processes have gamma rays

Planar - isometric transition - single photon emission
SPECT - isometric transition - single photon emission
PET - Beta positive - Dual photon emission (511+511)
FDG mechanism?
Facilitated diffusion

Too much blood glucose

Falsely low SUV

Fat?
Falsely high SUV (Fat absorbs less glucose)

Increased Muscle uptake?

They just took insulin

Classic brown fat location?

Around the traps

Lung nodule and PET

If hot, more likely to be inflammation/infection
If cold, more likely to be cancer

When to do PET after chemo?

2-3 weeks

When to do PET after radiation?

8-12 weeks

Tumors that are PET cold?

Lung
Carcinoid
RCC
Anything mucinous
Prostate

Not cancer that is hot

Infection
Inflammation
Musles (nervous people or insulin)
Brown Fact
Thymus
Ovaries (follicular phase)

Does lung adenocarcinoma show up as hot or cold on PET?

Cold
NSCLC is hot

1 milicurie = 37bequerels
Beta decay (Proton conversion to neutron) = PET = Z-1. A stays the same.

Isometric transition (Tc-99) Any process that gives off gamma rays and number of proton and
neutrons are unchanged.

George Muller Counte Handheld used to detect radioactive contamination

Main Radiopharmaceutical for VQ

TECHNETIUM 99M MICROALBUMIN
Mechanism = capiullary blockade

Pulmonary embolisms on VQ
Pertechnetate
Likes to be in the stomach or thyroid

Xenon-133 = half life of 5.3 days and KEV of 81

DMSA = Renal cortex

DTPA = Renal, brain, lung
HMPAO = brain perfusion and infection
MAA = lung perfusion
Pertechnetate= thyroid, salivary, meckel, testicular
F18 Sodium = Bone
FDG = tumor, cardiac, brain, infection
F18 Florbetapir = amyloid

How does elevated insulin impact FDG?

More skeletal and cardiac uptake

Regadenason
Selective A1A receptor agonist -> selective coronary vasodilator 

3 radiotracers for renal studies

TC 99 DTPA (evaluates GFR)
TC MAG 3 (renal perfusion
TC 99 DMSA (cortex)

I-131 Side effects

Pulm. Fibrosis
Sialdenitis
Nausia
Hypospermia

Galium 68
68 minutes
Binds somatostatin receptor
Critical organ is spleen

Cancers that PET-CT has limited role

HCC (since HCC has a lot of phosphatase)
RCC and bladder cancer
Prostate cancer
MALT lymphoma, SLL

What if there is free pertechnetat

Activity in the thyroid

TC 99 Sulfur colloid half life

2-3 minutes
Taken up by reticuloendothelial cells

TC 99 ECD or HMPAO is better?

ECD is better

What do you do if can’t tell if it’s parathyroid or thyroid adenoma on STESTMAMIBI?

Give pertechnatate (thyroid will take this up)

I – 131
Decays by beta emission
Half life of 8 days
KEV 364

I-123
Decays by electron capture
Half life of 13 hours
KEV 159

TC 99 in the thyroid
Trapped in the thyroid just like iodide but does not undergo organification.
Released as pertechnetate

TC 99 mechanism
Isomeric transition
6 hours
140 KEV

When does positron emission occur?

When at least 1.02 MeV of energy in the nucleus.

Pertechnetate distribution
Activity is seen in the salivary glands, thyroid gland, saliva, stomach, and bladder.

Contraindication to TC-99 MAA?

Pulm. HTN

Best Infection nuclear

Indium 111
TC leuko
Gallium 67
F18 FDG

Mechanism = chemotaxis

TC 99 mechanism
Chemisorption

When is morphine used with HIDA?

When there is nonvisualization of the gallbladder

Tc-99m DTPA images show multilobar heterogeneous uptake of radiotracer most compatible with obstructive airways
disease (asthma, COPD).
Sinaclide
Pharmaceutical used for evaluation of chronic cholecystitis

DMSA
Renal cortex evaluation

DTPA
GFR evaluation
VQ scan

MAG3
Renal tubule function

Thymic Rebound
Chevron shaped normal

TC Heat damaged RBC

Good for splenosis

DMSA mechanism
Tubular binding

DTPA mechanism
Filtration

TC-99 WBC 4 hours vs. 24 hours

4 hours is in lungs
24 hours is in bowel
Differentiate TC from Indium?
TC has bowel uptake

Can see the heart and kidneys?

SESTAMIBI

Free technetium?
Either from air in the tube
OR, forgot to put in stannous ion

Tram tracking in bones on free tch

Hypertrophic osteoarthropathy

Double density Sign

Osteoid osteoma

Hot hemipelvis?
Paget

What emits gamma rays?

Planar (through isometric transition)
SPECT (through isometric transition)
PET (through decay) (dual photons)

FDG mechanism?
Facilitated diffusion

TC ADP mechanism?
Chemisorption/isometric transition

TC HMPAO and ECD mechanism

Passive diffusion

DMSA mechanism
Tubular binding

DTPA mechanism
Filtration

I-123 Mechanism
Active transport

Rubidium, thalium iodine, DMSA, MIBG, pertechnetate mechanisms?

Active transport

MAG-3 mechanism?
Tubular secretion

Heat treated RBC mechanism?

Sequestration

Perfusion VQ mechanism?
Capillary blockade

Octreotide/DAT scan mechanism

Receptor binding

HIDA scan signs of acute cholecystitis?

RIM sign
Cystic duct sign.

Phenobarbital
Good for biliary atresia

MAG-3 mechanism?
Cleared by the proximal tubule

Electron capture
Gallium, Indium, Iodine 123

Radioisotope to help with imaging (TC-99) with pharmaceutical to target where you want it to
go (albumin)

Positron emission does not happen unless 1.02 MeV available in the nucleus
Proton - neutron (Z-1)

HIDA mechanism
Active transport
Advantage of Indium over technetium?
Better for GI eval since normally not excreted into the GI and urinary tracts

FDG is shit for

Adenocarcinoma

Cimetidine
Reduces release of pertechnetate

Lipophilic perfusion agent

TC 99 HMPAO

I-123 half life

13 hours

GA 68 is PET agent
Half life 68 mins
Binds somatostatin receptor
Critical organ spleen
GA 67 is general nuclear medicine agent half life 3 days
4 energy peaks 100 200 300 400
electron capture
-gallium 67 has lacrimal gland uptake
-better for spinal osteomyelitis
-critical organ is the colon

Indium 111
67 hours
175 and 250 KEV
electron capture
Preferred for inflammatory bowel disease

I-131
Only one that uses high energy collimator
KEV=365
Half life = 8 days
Cessation of breastfeeding

I 123
13 hours half life
KEV of 159
Electron capture
Can resume breastfeeding in 2-3 days

TC-99
Half life 6 hours
KEV 140
Wait 24 hours before breastfeeding

TC99 MAA used for perfusion

TC DTPA used for ventilation

TC99m Mebrofenin = HIDA

Single hot lesion on bone scan = 80 percent chance of being benign

HIDA scan
-similar to lidocaine
-similar to bilirubin physioloogy

-purpose of CCK
--give it to cause gallbladder constriction to eval ejection fraction for chronic cholecystitis

-morphine constricts the sphincter of oddi which increases backpressure in the biliary tree and
promotes gallbladder filling

What seperates level 2b from level 3 lymph nodes?

Hyoid bone

What seperates level 3 from level 4 ?

Cricoid cartilage

What kinds of lymphoma have low FDG?

MALT and SLL

Does pertechnetate get taken up in thyroid or parathyroid?

Thyroid

Complication of paget?
Malignant degen to oseteosarcoma

What is a REM?
Measures biologic damage caused by ionizing radiation

Cancers that are limited with FDG?

Malt/SLL
HCC (high levels of phosphatates)
RCC/Bladder
Prostate
Bronchialveolar
Carcinoid

3 phases of bone scan?

Flow (increased flow means hyperemia)
Blood pool
Delayed

S/p Radioiodine therapy with increasing Thyroglobulin…

I-123 and if increased give I-131

Chronic cholecystitis on HIDA?

Low GB EF <35 percent pre and post CCK

Metformin with FDG uptake

Can cause increase in colonic uptake and small bowel FDG uptake
Diffuse mild to moderate uptake is normal

Ventilation portion of VQ scan?

DTPA

Cellulitis on 3 phase bone scan

increased activity on flow phase and soft tissue phase but negative skeletal phase

Radiopharmaceutical = Radioisotope (Techneitium) + Pharmacutical (MDP)

SPECT = gamma cameras and have them rotate around the body

Bone scan is good for blastic metastases (breast and prostate)

FDG/PET Is good for lytic metastases (Renal, MM)

Standard bone scan is a single delayed image.

Gastric emptyting
Sullfur colloid attached to egg white
90 percent at 1 hour
60 percent at 2 hours
30 percent at 3 nhours
10 percent at 4 hours

value at 240 minutes is the most sensitive for delayed gastric emptying

Renal
1) Does indium show physiologic renal or GI uptake?
No , but TC-99 does
2) which of the renal scans are secreted?
MAG3
3) 3 phases of mag3?
Blood flow cortical phase - clearance phase
4) t1/2 showing obstruction?
Greater then 20 minutes following Lasix represents significant obstruction
10-15 = mild degree of onsturction
Less then 10 = normal
5) common coronary vasodilators
Adenosine, dipyramidole, regadenoson
6) Good indicator for using TC-99 over Iodine for thyroid imaging?
Recently received iodinated contrast
7) What is organification with I-123?
Iodine gets oxidized by thyroid peroxidase and then binds to tryrosyl so itcanot get washed out
of thyroid. It will stay there for a while
TC-99 will not get organified but trapped for a brief time
8) Blood supply to thyroid
Superior thyroid artery which is a branch of external carotid
Inferior thyroid which is a branch of the thyrocervical trunk
9) Graves antibodies
TSH antibodies
10) Hashimoto antibodies
TPO antibodies and antithyroglobulin antibodies
11) Malignancy associated with hashimoto?
Primary thyroid lymphoma
12) When can you resume breastfeeding after I123?
2 days
13) When can you resume breastfeeding after T99?
12 hours
14) Which thyroid cancer may not take up I131?
Medullary thyroid
15) What scans can have high lacrimal?
Pertechnetate
Gallium 67
16) F18 sodium fluoride vs. ADP bone scan?
F18 will be much higher quality
17) Cardiac uptake scans
TC-99 Sestamibi, thallium, MIBG
18) How to know if you are looking at PET fluciclovine study?
Pancreas is super hot
19) Gastric Emptying most common pharmaceutical
TC-99 sulfur colloid
20) Most common CSF study?
In-111 DTPA
21) Most sensitive radiotracer for neuroendocrine?
GA 68 dotatate (half life of 68 mins)
22) colloid shift
Sulfur colloid accumulation in the spleen and bone marrow 2/2 to cirrhosis
23) Double density sign on bone scan
Increased uptake surrounded by more uptake
--osteoid osteoma
--brodie abscess
--stress fx.

24) Bleeding rate to be detected on tagged RBC scan?

0.2 mL/min
25) Bleeding rate to be detected on angiography?
1mL/min
26) Radiopharmaceutical for gastric emptying?
Sulfur colloid
27) Signs of alzheimers dementia on nucs?
Parietal and temporal hypometabolism
28) MIBG
For neuroblastoma or pheochromocytoma
29) Does RCC cause lytic or blastic lesions?
Lytic lesions
30) Best element for evaluating cardiac viability?
F18 FDG
31)