Test Bank for Nuclear Medicine and PET CT, 7th Edition: Chrisitan

Test Bank for Nuclear Medicine and PET CT, 7th

Edition: Chrisitan

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Chapter 10: PET Instrumentation
Test Bank

MULTIPLE CHOICE

1. With PET radionuclides, the higher the energy particle:

a. the greater the mean range for the travel of the positron
b. the shorter the mean range for the travel of the positron
c. has no effect on the mean range for the travel of the positron
d. reduces the mean range for the travel of the positron
ANS: A
Each PET radionuclide emits its positron with a different energy, with higher energy particles
having greater path lengths and greater mean ranges for the travel of the positron.

REF: p. 321

2. 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
ANS: C
A large particle range results in a slight mispositioning of the annihilation event from the
actual location of the positron-emitting atom. Therefore a scan performed with 18F (2.4 mm
maximum and 0.2 mm average range) will produce a higher resolution image than 82Rb,
which has a 15.6 mm maximum and 2.6 mm mean range in tissue.

REF: p. 321

3. Rubidium-82 is an analog to:

a. calcium
b. potassium
c. sodium
d. glucose
ANS: B
Rubidium-82, which has a 75-second half-life, is an analog of potassium and is therefore a
myocardial perfusion imaging agent.

REF: p. 321

4. In comparing PET myocardial imaging to SPECT myocardial imaging for myocardial disease,
PET demonstrates:
a. increased resolution, decreased sensitivity, and increased specificity
b. decreased resolution, increased sensitivity, and increased specificity
c. increased resolution, increased sensitivity, and increased specificity
d. decreased resolution, increased sensitivity, and decreased specificity
ANS: C
 Since PET scanners have higher sensitivity and resolution than SPECT, PET myocardial
images provide substantially better quality with increased sensitivity and specificity for
detecting coronary artery disease.

REF: p. 321

5. The production of a single PET radiopharmaceutical requires all of the following EXCEPT:
a. a cyclotron
b. a target
c. a hot cell
d. collimator
ANS: D
The production of a single PET radiopharmaceutical requires very expensive equipment,
including the cyclotron, target, automated synthesis module, hot cell (to contain the synthesis
module), and any additional radiopharmaceutical quality control or precursor preparation
equipment.

REF: p. 322

6. Characteristics of the bismuth germinate crystal include that fact that it:
a. is a fast scintillator
b. yields more light than an NaI (Tl) crystal
c. is very good at stopping 511-keV photons
d. has excellent energy resolution
ANS: C
Bismuth germinate (Bi4Ge3O12) is commonly known as BGO. Bismuth has a high atomic
number and is therefore very good at stopping the 511-keV photons. BGO is unfortunately a
relatively slow scintillator and also yields a relatively small amount of light compared with
NaI (Tl). In addition, BGO has poor energy resolution that requires energy windows that span
from about 350 to 650 keV. The stopping power of BGO compensates for its other
deficiencies and it is still a good scintillator for 2D-dedicated PET scanners.

REF: p. 322

7. All of the following have been used as crystals for PET imaging EXCEPT:
a. BGO
b. LSO
c. LYSO
d. YBGO
ANS: D
Some dedicated PET scanners use other scintillation crystal materials. Lutetium orthosilicate
(Lu2SiO5 [Ce]; LSO), lutetium yttrium orthosilicate (LYSO), and gadolinium orthosilicate
(Gd2SiO5 [Ce]; GSO) are now available in some commercial PET systems. These crystals
have slightly lower stopping power than bismuth germinate (BGO).

REF: p. 322

8. In a PET scanner, the determination of the annihilation event is made possible by:
a. electronic collimation
 b. parallel hole collimation
c. back-scatter projection
d. filtered back-scatter projection
ANS: A
PET scanners have electronic collimation to determine the location of the annihilation event.
The detectors used for coincidence detection to identify an annihilation gamma pair and
determine a line of response (LOR) path representing the path of the photon pair.

REF: p. 322

9. In a dedicated PET scanner, there is a photomultiplier tube (PMT) for:

a. each crystal
b. every other crystal
c. a group of crystals
d. every ring in crystals
ANS: C
PET scanners have 10,000 to 28,000 or more crystals, which are laid out to form several rings
of detectors. Each crystal is too small to have its own PMT; therefore, a group of crystals is
put together in a detector block. Most commonly, four PMTs are used on a block to collect the
light from all the crystals, measure the photon energy, and identify which crystal in the block
was struck by the photon.

REF: p. 322

10. In PET scanners with a “reflective block of crystals” design, reflective material surrounds:
a. each crystal
b. every other crystal
c. every block of crystals
d. every ring of crystals
ANS: A
The alternative reflective block approach is to create a block from a group of small individual
crystals. Each crystal is surrounded by a carefully designed amount of reflective material that
spreads the light in a designated pattern onto the photomultiplier tubes (PMTs); therefore both
the cut block and reflective block designs do the same thing—they use reflective surfaces on
the sides of individual crystals to distribute the scintillation photons to the PMTs.

REF: p. 323

11. Whole body imaging in PET scans typically covers imaging:

a. from head to toe
b. from the hips through the base of the brain
c. from the knees through the base of the brain
d. from the knees to the head
ANS: B
“Whole body” PET scans are used in most oncology studies and actually cover only the hips
up through the base of the brain (approximately 90 cm) or about six to eight bed positions.
Total body (nearly head to toe) scans are required with certain types of cancer where
malignant tissue may grow in any area of the body, as with melanoma.
 REF: p. 323

12. The BGO crystal:

a. is efficient at rejecting scatter photons because of its narrow window
b. is efficient at rejecting scatter photons because of its wide window
c. is not efficient at rejecting scatter photons because of its narrow window
d. is not efficient at rejecting scatter photons because of its wide window
ANS: D
With most scintillation materials, a narrow energy window is effective at rejecting scattered
photons, which will have a lower energy. The wide energy window employed with bismuth
germinate (BGO) is thereby not very efficient at rejecting scattered photons, and a method for
scatter correction will be used during reconstruction.

REF: pp. 323, 324

13. A true coincidence event occurs when:

a. a pair of annihilation gamma rays strike two detectors at the same time
b. a pair of annihilation gamma rays strike one detector at the same time
c. photons from two different annihilation events are detected at the same time
d. photons from two different annihilation events collide, resulting in a third
annihilation event
ANS: A
A pair of annihilation gamma rays striking two detectors at the same time is termed a true
coincidence annihilation event (see Figure 10-8, A and D). When two atoms decay at nearly
the same time, photons from two different annihilation events may be detected within the
timing window. When this happens, a false event, referred to as a “random” event, is
recorded.

REF: p. 324

14. When performing 3D imaging:

a. scatter correction is important
b. photon scatter is not a problem
c. hot organs near the FOV do not pose a problem
d. 2D images are converted to 3D images electronically
ANS: A
Scatter correction is very important in 3D imaging, particularly when hot organs are nearby or
just outside the field of view (FOV) of the detectors. Approximately 50% of photons scatter
within the body; therefore, scatter correction and accurate attenuation correction are
imperative when quantitative information is needed.

REF: p. 326

15. The line of response (LOR):

a. is determined for each crystal within a detector system
b. is determined for each detector system and each crystal type
c. is created by the detection of an annihilation photon pair by opposing crystals
d. is created to perform scatter correction techniques
 ANS: C
The detection of an annihilation photon pair by opposing crystals creates one event or
LOR between two detectors. Millions of LORs will be acquired and stored for use in the
reconstruction of the 3D distribution of radiotracer.

REF: p. 327

16. Spatial resolution on PET scanners is determined primarily by:

a. the collimator used and the size of the septa
b. the size of the crystals and their separation
c. the sensitivity of the system and the number of rings
d. the scatter correction and the accuracy of the attenuation correction
ANS: B
Spatial resolution of PET scanners is determined primarily by the size of the crystals and their
separation. The spatial resolution of PET images will therefore be very close to the size of the
crystal, typically 3 to 5 mm. Thus since all of the crystals are identical, the full width at half
maximum (FWHM) will be about the same resolution over the diameter of the ring.

REF: p. 327

17. On a PET sinogram, the horizontal row represents:

a. each angle from which the projection was taken
b. the count profile across the distance of the gantry as seen from each angle
c. the set of reconstructed transaxial slices as seen from each angle
d. the angle from which the projection is taken over 180 degrees
ANS: B
Each horizontal row in the sinogram represents the count profile (or projection) across the
distance of the gantry as seen from each angle. The vertical axis of a sonogram represents the
angle from which the projection is taken over 180 degrees. The sinogram will therefore
contain all the data that will be needed to reconstruct one transaxial slice; therefore, a
sinogram is needed for each slice in the image volume.

REF: p. 328

18. Regarding septa on a PET system, all of the following are true EXCEPT:
a. they limit the field of view of events to those within the same detector ring, or
events with contiguous planes
b. they reduce the number of scatter and random events from outside the plane
c. they allow for the system to operate in 2D mode
d. they allow for the system to operate in 3D mode
ANS: D
Septa limit the field of view of events to those within the same detector ring, or events with
contiguous planes; they also reduce the number of scatter and random events from outside the
plane. With septa in place, the scanner operates in 2D mode. Retracting the septa creates the
ability to place the scanner in 3D detection mode.

REF: pp. 329, 330

19. Whole-body imaging with a scanner in 3D mode can result in:
a. decreased need for correction techniques
b. increased pyramidal shaped sensitivity
c. reduced reconstruction time
d. an increase in acquisition time
ANS: B
With much more data and the added complexity of corrections, there is a significant increase
in the reconstruction time needed for 3D data. 3D data sets also slow down processing,
transferring, and archiving of 3D data. Whole-body imaging with the scanner in 3D mode
improves patient throughput because it provides an increase in scanner sensitivity and may
allow a decrease in the time required for emission imaging. In 3D mode the wide acceptance
angle creates high sensitivity in the center, which diminishes at the edges, creating a
pyramid-shaped sensitivity distribution.

REF: pp. 331, 332

20. In PET reconstruction, filtered back-projection:

a. creates streak or star artifacts
b. eliminates streak or star artifacts
c. increases contrast in the image
d. equates with iterative reconstruction
ANS: A
Filtered back-projection (FBP) techniques are the simplest and quickest way to create the
image slice from the projection information stored in a sinogram. However, FBP creates
severe streak or star artifacts, increasing image noise and thus reducing contrast, which may
mask lesions. Iterative reconstruction algorithms are techniques that sequentially refine
estimated pixel values and provide a more accurate reconstruction of the radiotracer
distribution in the body. Iterative algorithms significantly reduce streak artifacts compared
with FBP reconstruction techniques but provide images with a lower signal-to-noise ratio.

REF: pp. 333, 334

21. In PET imaging, the purpose of a transmission scan is:

a. for quality control purposes
b. to compensate for the variable attenuation in tissues
c. for registration purposes
d. to provide data for scatter correction
ANS: B
The body has a complex mixture of tissues, each with a different effect on gamma-ray
attenuation. The only way to accurately compensate for this variable attenuation is to pass a
beam of radiation through the body and measure or “map” the attenuation. On PET-only
instruments, the measured attenuation data for each slice are obtained by rotating a line source
of radioactivity. Transmission scan data are reconstructed into attenuation correction maps for
each slice.

REF: p. 337

22. In a PET system, energy window calibration is typically performed after repair as well as:
 a. daily
b. weekly
c. quarterly
d. annually
ANS: C
Energy window calibration is typically only performed after repair, during quarterly
preventive maintenance (PM) service, or just before a normalization calibration is done.

REF: p. 342

23. In a PET system, gain update calibration should be performed at least:

a. weekly
b. quarterly
c. annually
d. following repair
ANS: A
Gain updating compensates for variations in the changes in detector module gain over time.
Gain update calibration procedures should be run at least weekly, or even daily, to keep
systems in top performance and to prevent sensitivity drift. The more frequently they are run,
the more uniform will be the performance of the scanner.

REF: p. 343

24. In PET scanning, blank scans are performed:

a. daily
b. quarterly
c. annually
d. upon installation
ANS: A
Blank scans are performed daily to provide accurate transmission scan data for the attenuation
correction of images. Radioactive decay of the transmission sources, dead-time corrections,
and detector sensitivity may vary frequently; therefore, a blank scan must be obtained each
morning before clinical use of the scanner.

REF: p. 343

25. In PET imaging, blank scans are used:

a. to subtract background
b. to calculate scatter correction
c. to determine dead time
d. in attenuation correction
ANS: D
Blank scans are used as a reference uniformity measure for the transmission scan used in
attenuation correction. It is very important to acquire and evaluate blank scans daily, because
attenuation correction made with poor or outdated blank scans will have artifacts that will
show up in the patient images.

REF: p. 343
26. 2D normalization is done to:
a. subtract background from all LORs
b. measure the efficiency for all LORs
c. to average the data from all LORs
d. to determine the dead time across the LORs
ANS: B
2D normalization calibrations are done to measure the efficiency for all LORs. Normalization
calibration is performed by rotating radioactive rod sources, which contain a low activity
source of radioactivity, and acquiring data that will be used to balance the efficiency of all
detectors in the scanner.

REF: p. 344

27. Absolute activity calibrations should be performed after a major service as well as:
a. daily
b. weekly
c. quarterly
d. annually
ANS: C
Well counter calibration is an historical term for a calibration more appropriately referred to
as absolute activity calibration. Absolute activity calibration factors are used to convert pixel
values into a measure of absolute activity per voxel. Absolute activity calibrations are
performed only after all other calibrations have been performed and should be done quarterly
or after major service.

REF: p. 344

28. 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
ANS: C
The absolute quantitative uptake of the radiotracer in tumors can be measured in an effort to
differentiate between malignant and benign tissue. The standard uptake value (SUV) can be
useful in measuring tumor metabolic function.

REF: p. 345

29. When compared to non–time of flight (ToF) scanners, ToF scanners:

a. have a decreased resolution for small lesions
b. require a longer acquisition time
c. do not have a full LOR across the FOV
d. decreased image quality
ANS: C
Test Bank for Nuclear Medicine and PET CT, 7th Edition: Chrisitan

The distinct advantage of ToF is that there is not a full LOR across the FOV of the scanner but
rather only a short line in which the annihilation event took place. The effect on the
signal-to-noise ratio of a small lesion is the same effect as acquiring at least 2.5 times the
number of events to improve lesion detection. ToF scanners thus can produce high-quality
images using a slightly shorter acquisition time. In ToF imaging, there is image improvement
as the likelihood of detecting random events is reduced.

REF: pp. 341, 342

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