Pet CT

PET/CT
Study online at https://quizlet.com/_bs73il
1. 4 things you need to know before getting started 1. Correct patient

with 2 identifiers
2. Medical History
3.Protocol Or-
dered
4.Reason for the
exam
2. What are the 4 main components of a PET/CT scan? 1. FDG amount

2. Injection site
3. Uptake period
4. Imaging proto-
col
3. The amount needed for optimal images mostly de- detector material
pends on the type of __________ ________ in the
scanner.
4. 3 Options based on PATIENT SIZE (FDG Amount) 1. Same dose,

vary imaging time
2. Dose ranges
based on patient
weight
3. Calculate dose
for each patient
5. FDG is injected... Intravenously (IV)

or Port (20+ mL
flush)
6. Choice of injection site depends on... (3 things) 1. Quality of pa-

tient's veins
2. Indication of the
scan
3. Central line or
Port
7. 3 things to consider during uptake period 1. Patient should

be resting
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PET/CT
2. Patient should
be warm
3. Little to no talk-
ing or movement
8. Considerations for uptake time period (3) 1. 2hr half

life (therefore the
longer the de-
lay before imag-
ing, the fewer the
counts in the im-
ages or longer
scan time)
2. FDG uptake in
tumors rises over
time
3. The longer the
delay, the higher
the target-to-back-
ground ratio
(45-60 min uptake

period)
9. Imaging protocol is chosen on the___________ clinical question

__________.
10. skull- base to mid thigh imaging protocol is used for most typical for
cancer imaging
11. head to toe imaging protocol is used for melanoma, multi-

ple myeloma
12. brain imaging is used for recurrent brain tu-

mors, seizure fo-
cus, dementia
13. Why are brain mets difficult to see? high level of

glucose metabo-
2 / 59
PET/CT
lism (needle in a
haystack)
14. head and neck imaging protocol is used for usually performed
magnified, longer
duration image of
head and neck
along with scan
through body to
mid-thigh
15. arms up or down imaging protocol depends on

area(s) of interest
and patient ability
16. The CT must line up with the PET image for the im- fusion
age to _________ and for the ____________________ attenuation cor-
_________________ of the PET images. rection
17. The CT portion time span 20-60 seconds
18. PET portion of exam is done using what method? step and shoot
(moving every 2-3
minutes)
19. 2 Reasons CT is important! 1. Fusion

2. Attenuation
Correction
20. CT Basics: Define X-ray Tube evacuated con-

tainer comprised
of the an-
ode and cathode
in which x-rays
are produced and
surrounded by
the tube hous-
ing, which provid-
ed electrical safety
and radiation pro-
3 / 59
PET/CT
tection from leak-
age x-rays
21. CT basics: Define Anode The Target--> the

positively charged
electrode that at-
tracts free elec-
trons to subse-
quently produce
x-rays; fixed an-
odes and rotating
disk designs are
common
22. CT Basics: Define Cathode The Source-->

the negatively
charged elec-
trode, typically
comprised of a fil-
ament, that pro-
duces free elec-
trons
23. kVp (kilovolt peak) the peak voltage

that is applied be-
tween the cathode
and anode
24. mA (milliampere) the unit of electric

current that de-
scribes the flow of
charge per second
25. pitch the ratio of table

movement per
resolution over the
collimated slice
thickness of one
row of a multislice
CT detector (spi-
4 / 59
PET/CT
ral). Also known
as the table move-
ment through the
scanner
26. voltage and current the 2 primary set-

tings that can be
adjusted in the
x-ray tube
27. mAs current per sec-

ond
28. Energy variation for PET/CT 80-140kVp
29. kVp selection depends on 2 things 1. patient size

2. image quality
requirements
30. limited set of energies usually available for CT scan- 80,100,120,140

ner
31. higher energy photons are needed to penetrate large kVp

bones therefore higher _________ setting is required
32. kVp setting defines the fraction of

photons that will
successfully reach
the detectors of
the scanner, be-
cause higher en-
ergy photons are
less attenuated by
the body
33. As energy of photons increase (3) 1. more photons

reach the detec-
tors
2. less noise in the
image
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PET/CT
3. radiation expo-
sure to the patient
increases
34. 3 Advantages to using a higher kVp 1.greater penetra-

tion through the
body
2. decrease in
noise
3. reduction in
beam hardening
artifacts
35. 2 Disadvantages of using a higher kVp 1. higher dose to

patient
2. reduction in tis-
sue density differ-
ence
36. CT Current Variation (4) 1. there is a pro-

portional increase
in the number of
x-rays, at all en-
ergies, when the
current is in-
creased
2. in planar x-ray,
current setting is
in mAs, meaning
mA is multiplies by
exposure time in
seconds
3. in CT, current
setting is in mAs,
meaning mA is
multiplied by rota-
tion time in sec-
onds
4. range of cur-
6 / 59
PET/CT
rents used in
CT are typically
50-400 mA; opera-
tor is not limited to
a few presets
37. As current increases (3) 1. decrease in im-

age noise
2. increase in con-
trast resolution
3. increase in radi-
ation dose to pa-
tient
38. CT Voltage and Current Relationship Rule Rule is that a de-

crease of approxi-
mately 15% in kVp
roughly equivalent
to DOUBLING the
mAs
39. CT can be enhanced with (3) 1. oral contrast

2. IV contrast
3. both
40. Oral Contrast distends GI tract

to differentiate ad-
jacent structures
41. IV Contrast differentiates soft

tissue structures
and organs
42. What are the 2 types of oral contrast? positive and neu-
tral
43. Positive Oral Contrast distends and

opacifies the GI
tract, bright on
scan (higher HU)
7 / 59
PET/CT
allows for dif-
ferentiation be-
tween bowel and
adjacent struc-
tures and poten-
tial pathology can
cause some atten-
uation overcorrec-
tion on PET im-
ages
44. Neutral Oral Contrast also called wa-

ter-equivalent (HU
same as water)
distends the GI
tract, but does not
opacify it has no
effect on attenua-
tion correction of
PET images
45. Oral Contrast Unit Hounsfield

HU—Hounsfield
Unit—a unit of
measured value
placed into the
pixels of a CT
image. The value
represents a
relative density to
water, which has
a value of zero on
the scale.
Densities lower
than water have a
negative value
and densities
higher than water
8 / 59
PET/CT
have a positive
value.
46. CT without contrast parenchyma,

blood vessels,
muscles, and
lymph nodes are
hard to
differentiate they
have similar HU
range (30-70)
47. CT with contrast more accurate

differentiation of
anatomic struc-
tures, higher ac-
curacy in lesion
detection, HU are
less similar
48. Parenchyma the functional

parts of an organ
49. Stroma the structural tis-

sue of organs
framwork
50. Before giving IV CT contrast 1. must review the

patient's history
2. indicate
whether or not
they have had a
reaction to the
contrast before
51. GFR> 60 normal
52. GFR 45-60 patient may be hy-

drated with saline
prior to contrast
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PET/CT
53. GFR <45 most likely will not

receive the con-
trast
54. GFR Glomerular Filtra-

tion Rate
55. GFR for Diabetic patients >70
56. The approach to patients about to undergo a con- 1. to assure that

trast-enhanced examination has 3 general goals the administration
of the contrast is
appropriate for the
patient
2. to minimize the
likelihood of a con-
trast reaction
3. to be fully pre-
pared to treat a re-
action should one
occur
57. Main Risk Factors to Consider for Constrast allergy, asthma,

renal insufficiency,
and caridac status
58. Other Risk Factors to Consider anxiety, multiple

myeloma, sickle
cell anemia, thy-
roid cancer/condi-
tion
59. Premeditation for Allergic and At-Risk Patients Corticosteroid and

Benadryl
60. When injecting IV contrast, what is an important pre- Ensure that the
caution to take? vein or port can
withstand the flow
rate required.
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PET/CT
61. 2 Possible Problems with Contrast Injection Extravastion and

Air Embolism
62. Mild Reactions Signs and symp-

toms are self-lim-
ited without evi-
dence of progres-
sion
63. Moderate Reactions Signs and symp-

toms are more
pronounced and
commonly require
medical manage-
ment. Some of
these reactions
have the potential
to become severe
if not treated
64. Severe Reactions Signs and symp-

toms are of-
ten life-threaten-
ing and can result
in permanent mor-
bidity or death if
not managed ap-
propriately.
65. Reasons why CT scans might be over-ordered by Financial incen-

physicans tives, fear of law-
suit, uninformed
physicians, patient
demand, repeat
exams (2nd opin-
ion)
66. Reasons why CT scans may be performed with higher Lack of feder-
radiation levels than recommended al radiation equip-
11 / 59
PET/CT
ment operator reg-
ulations, Person-
al preferences of
reading radiolo-
gist, Lack of pa-
tient cooperation
or inability to
hold still (repeat-
ing scans), Not
checking and dou-
ble checking pro-
cedure and set-
tings prior to "but-
ton pushing"
67. CT is regulated by who? FDA
68. PET/CT is regulated by who? FDA (x-ray)

NRC (radiophar-
maceutical)
69. CT dose is dependent upon Patient size and

body habitus
Area of Interest
70. PET dose is dependent upon Patient size and

body habitus
71. Challenges in Reducing PET dose (4) 1. Short Half-life

2. Uptake time
minimum of 45
minutes
3. Longer imaging
times
4. Decline in co-
operation from pa-
tients
72. Financial challenges in Reducing PET dose (2) 1. Less efficient

patient throughput
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PET/CT
2. Charged per
dose, not per mCi
--> no cost differ-
ence
73. When is it decided that the risk outweighs the bene- 1. Then we bal-
fit... (2) ance image opti-
mization while giv-
ing the lowest ra-
diation dose pos-
sible
2. Don't decrease
the dose so much
that you compro-
mise image quality
74. PET-related methods to reduce dose (5) 1. Optimize/mini-

mize injected dose
of FDG
2. Encourage hy-
dration and fre-
quent voiding to
reduce urinary
bladder and ad-
jacent pelvic or-
gan radiation dose
from FDG excre-
tion
3. Use 3D PET
Emission acquisi-
tion mode
4. Increase dura-
tion of acquisition
time per bed posi-
tion
75. CT-related methods to reduce dose (5) 1. Minimize z-axis

coverage whenev-
er possible
13 / 59
PET/CT
2. Decrease tube
voltage (kVp)
3. Decrease tube
current and expo-
sure time (mAs)
4. Increase pitch
5. Use automatic
tube current mod-
ulation
76. Which organ receives the highest dose from FDG? Bladder
77. Which organ receives the lowest dose from FDG? Lungs and Thyroid
78. What are the 3 sources of radiation exposure to tech- 1. Dose Vial
nologists? 2. Unit Dose Sy-
ringes
3. Patient after In-
jection
79. NRC Guidelines for Occupational Exposure Con- Whole Body Limit:
cerns 5 rem/y
Extremity Limit: 50
rem/y
80. Define ALARA As Low as Rea-

sonably Achiev-
able
81. ALARA for Occupational Exposure Concerns Time, Distance,

Sheilding
82. 511 keV energy of annihilation photons is ______ 3.65

times the energy of 140 keV photons from Tc-99m.
83. Radiation dose is _______ related to the time of expo- directly

sure.
84. Ways to Reduce Time *Limiting dose

prep time
14 / 59
PET/CT
*Multi-dose vial in-
jection system
* Unit doses
* If only multi-dose
vial is available,
calculate volume
needed before at-
tempting to draw
dose
* Keep dose
shielded
* Rotate tech-
nologists through
tasks of drawing,
assaying, and in-
jecting doses
*maintain good IV
access to reduce
injection time and
ensure good injec-
tions.
85. The Law to reduce Distance Inverse Square

Law
86. Apply the Inverse Square Law when (2) *handling patients
* many points of
contact- injection
through escorting
them out of the de-
partment
87. Define Half-Value Layer the thickness of

the material at
which intensity of
radiation entering
it id reduced by
ONE HALF
88. Half-Value Layer for Tc-99m (140 keV) 0.17 mm of lead

15 / 59
PET/CT
89. Half-Value Layer for F-18 (511 keV) 4.1 mm of lead
90. How much lead is needed to effectively shield 511 keV 1.61 inches of
photons? lead!
91. Types of Shielding Devices (6) * L-Shield

* Lead Cabinets
* Syringe Shields
* Dose Carriers
*Rolling Shields
* Shielding in
Walls
92. Strategies to Reduce Occupational Exposure in 1. Use Appropri-

PET/CT ate shielding
2. Follow package
receipt protocols
3. Assay the dose
immediately prior
to injection
4. Handle the dose
a little as possible
5. Talk First, Inject
Later
6. place angiocath
7. Restrict access
to holding area
8. Shield waste
storage area
9. Escort patient,
but be quick
93. Most important limitation of anatomic imaging is inability to de-

its...... tect cancer until it
has grown large
enough to differ-
entiate from nor-
mal tissue
16 / 59
PET/CT
94. In anatomic imaging Masses adjoining normal struc- undetected
tures are commonly ___________.
95. Anatomic Imaging commonly fails to detect small tu-

mors
96. Anatomic imaging does NOT define the composition

____________ of the mass.
97. Lymph nodes are detected but not characterized as malignant or be-
________ or ________. nign
98. Although the tumor is not shrinking it could be responding to the

treatment.
99. FDG Fact: it is the "______" of PET Imaging workhorse
100. FDG Fact: Emits? Positron Emitter
101. FDG Fact: Produced? Cyclotron
102. FDG Fact: Half-Life 110 minutes or

1.83 hours
103. FDG Fact: No ________ effect pharmacological
104. FDG Fact: Identifies Identifies hyper-

metabolic areas
105. What can PET imaging do that traditional anatomic 1. Differentiate be-
imaging cannot? (3) tween benign and
malignant tumors
2. (Sometimes)
Detect primary
vs metastatic dis-
ease
3. Can stage can-
cers prior to thera-
py by being able to
17 / 59
PET/CT
image all organs
in one scan.
106. PET can show the more active spot of the tumor biopsy
therefore where to _______.
107. Stage 0 Just a few cells
108. Stage 1 1 Tumor
109. Stage 2 Based on size
110. Stage 3 Certain size

and/or started into
lymph nodes
111. Stage 4 Has reached 1 or

more organ
112. Cancer Cells modestly depend

in insulin for FDG
uptake
113. Cardiac Cells VERY dependent

on insulin for FDG
uptake
114. FDG is ____ tumor specific! NOT!
115. FDG is a tracer that exploits the alteration or a general cancer

process in _____cells.
116. Glucose metabolism is ___________ in cancer cells accelerated; how-

ever this is not
specific to cancer
117. Over-expression of glucose transporters in cancer aid in transport of

cells; glucose from out-
side to inside the
18 / 59
PET/CT
cell at the molecu-
lar level
118. Over-expression of some hexokinase enzymes; proteins in early

phase of glucose
metabolsim
119. FDG is similar enough to glucose to get into the trapped

cells, but different enough from glucose that it gets
_______ in the cells.
120. Patient Preparation 1. Fasting (6+

hours)
2. Diabetic Med-
ication held for 4
hours
3. BGL <300 mg/dl
121. BGL > 300 Options 1. inject the FDG

2. Have patient
walk around for
15-30 min and
recheck BGL
3. Inject insulin
and wait 3-4
hrs before inject-
ing FDG
4. Reschedule the
patient, most likely
when BGL > 325
122. Patient Preparation "NO"s NO IV Dextrose,

glucose, or to-
tal parenteral nu-
trition
NO cough drops,
mints, or gum
NO tube feedings
or liquid nutrition
19 / 59
PET/CT
123. Requests to evaluate small lesions * lesions <5 mm
are often unde-
tectable with PET,
due to resolution
and count limita-
tions
* if more wide-
spread mets are
suspected, it may
be reasonable to
perform
124. Requests to evaluate the presence of residual tumor *there is normal-

shortly after surgery ly FDG uptake
in surgical wounds
and scars
* if a wounds is
infected it is even
harder to differen-
tiate residual tu-
mor from infection
125. Other patients that may nor be a candidate for PET/CT Claustrophobic,
morbidly obese,
patient with
movement
disorders, patient
who cannot lie
down, and poorly
controlled
diabetics
126. Patient Preparation for FDG Imaging Goal for patient to have
low insulin levels
at the time of injec-
tion and low blood
sugar level
127. Patient Preparation for FDG (HOW) 1. Fast for 6+

hours
20 / 59
PET/CT
2. diabetics:
overnight fast
128. What else is important for Patient Preparation for Avoid extensive
FDG Imaging. exercise the day
before the PET
scan
Stay hydrated with
water before the
PET scan.
129. Knowing that FDG is not tumor specific helps us false positive
understand ________ ________ results with FDG.
130. FDG Uptake in Benign Processes *Acute and chron-

ic infection
* Inflammatory
processes
*Lactation
* Salivary Glands
* Skeletal Muscle
* GI Tract Process-
es
* Brown Adipose
Tissue
*Genitourinary
Uptake
* Thymic Uptake
*Bone Marrow
131. FDG Uptake in Benign Processes: Inflammatory postoperative

Processes Example(s) healing,
post-radiation
therapy, arthritis,
thyroiditis
132. FDG Uptake in Benign Processes: Skeletal Muscle enhanced by exer-

Example(s) cise, tension, per-
sistent coughing,
persistent talking
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PET/CT
133. FDG Uptake in Benign Processes: GI Tract Processes Active smooth

Example(s) muscle and mu-
cosa, colonic mi-
crobial uptake
134. FDG Uptake in Benign Processes: Brown Adipose thermogenic area

Tissue (Brown Fat) Example(s) of fat in neck and
supraclavicular re-
gion
135. FDG Uptake in Benign Processes: Genitourinary Up- FDG is fil-

take Example(s) tered through the
glomeruli, without
reabsorption
~ Therefore, ac-
tivity is seen
within the renal
collecting system,
ureters, and blad-
der
~ Increased up-
take in nor-
mal uterus during
menstruation
136. FDG Uptake in Benign Processes: Thymic Uptake Ex- In children and
ample(s) young adults. Thy-
mus hyperplasia
is a normal vari-
ant in adults post
chemotherapy
137. FDG Uptake in Benign Processes: Bone Marrow Ex- recovery after
ample(s) chemotherapy, in-
tense uptake
in patients tak-
ing hematopoet-
ic growth factor
(stimulates bone
22 / 59
PET/CT
marrow to pro-
duce blood cells)
138. Hallmarks of Cancer *Sustaining prolif-

erative signaling
-Evading growth
suppressors
-Avoiding immune
destruction
-Enabling replica-
tive immortality
-Tumor-promoting
inflammation
-Activating inva-
sion & metastasis
- Inducing angio-
genesis
-Genome instabili-
ty & mutation
- Resisting Cell
Death
- Deregulating
Cellualr Energet-
ics
139. "Perhaps no other imaging test has had as much FDG

impact in the fundamental understanding of human
caner as _______"
140. Hallmark #9 Reprogramming Energy Metabolism: UNCON-

What Defines Cancer? TROLLED
GROWTH
141. Hallmark #9 Reprogramming Energy Metabolism: Cells replicate

Growth requires cells to replicate their DNA, RNA,
proteins and lipids
~ All must be dou-
bled to divide into
daughter cells
23 / 59
PET/CT
142. Hallmark #9 Reprogramming Energy Metabolism: ENERGY!
What do cells need to replicate?
143. Respiration 101: Cells Require Energy to (4): 1. Absorb nutri-

ents
2. React to
changes in their
environment
3. Maintain their
internal environ-
ment
4.Grow and repli-
cate
144. Define Respiration The process by

which cells obtain
energy by break-
ing down nutrients
145. Respiration Process(3) 1. This ener-

gy is stored as
ATP, adenosine tri-
posphate
2. Cells use respi-
ration to construct
molecules of ATP
3. Cells then break
down the ATP to
fuel their metabol-
ic reactions
146. Under normal conditions, cells undergo __________ AERBOIC

respiration.
147. First Form of Respiration: Aerobic Respiration 1. Uses oxygen

Process(4) 2. Glucose is bro-
ken down into
pyruvate
3. Which forms 32
ATP molecules
24 / 59
PET/CT
4. Carbon dioxide
released as waste
product
148. The oxygen needed is obtained from the air transported

we breathe, diffuses into our blood and is then
__________ across all our tissues and organs.
149. When there is not enough oxygen, cells switch to ANAEROBIC

a different type of a respiration called __________
respiration.
150. Second Form of Respiration: Anaerobic Respiration 1. Glucose is bro-

Process (3) ken down into
pyruvate
2. Which forms 2
ATP molecules
3. Lactic acid re-
leased as waste
product
151. Define Glycolosis the process in

which cells break
glucose
down into pyru-
vate, the first
step in construct-
ing the energy
transfer molecule
ATP. One of the
main observations
of the metabolism
of cancer cells is
that they display
an enhanced rate
of glycolysis dur-
ing periods of fast
growth
152.
25 / 59
PET/CT
Metabolic Pathway of Cancer Cells: Glycolosis 1. Glucose is bro-
Process (3) ken down into
pyruvate
2. Which forms 2
ATP molecules
3. Lactic acid re-
leased as waste
product
153. Caner cells consume more than _______ times as 20; secrete
much glucose compared to normal cells, but ______
lactic acid instead of breaking it down completely into
carbon dioxide.
154. Why do cancer cells choose this inefficient metabolic 100

pathway when they could obtain
16 times as much ATP per molecule of glucose by
opting for normal respiration?
Cancer cells produce less ATP, but produce ATP al-

most a _____times faster than normal cells
155. Why do cancer cells choose this inefficient metabolic aerobic glycolysis
pathway when they could obtain
16 times as much ATP per molecule of glucose by
opting for normal respiration?
It is not just about ATP production. Cancer cells un-

dergoing ______________ ______________ also pro-
duce many intermediate molecules that are used as
building blocks for the production of proteins, lipids
and DNA required by the rapidly dividing cells.
156. 2 Types of Essential Tissue for the Development of Epithelial and stro-
Cancer mal
157. Epithelial Tissue grow in monolay-

ers along a sin-
26 / 59
PET/CT
gle axis, line body
surfaces, cavities,
ducts, and tubes
158. Stromal Tissue grow in response

to morphogenic
gradients in any
direction, connec-
tive tissue con-
taining fibroblasts,
muscle, blood &
lymphatic vessels
159. In a mature organ, epithelial and stromal cells basement mem-

are physically separated by a ______________ brane (BM)
__________________.
160. The basement membrane consists of (3) 1. Laminin

2. Collagen
3. Proteglycan &
Various Growth
Factors
161. Stages of Cancer Development: There are distinct "pre-cancerous"

stages of cancer development from _______ condi- metastatic dis-
tions to ____________ ___________. ease
162. Define Hyperplasia an abnormal or

unusual increase
in the number of
cells composing a
tissue
163. Define Dysplasia an abnormal

anatomical struc-
ture due to abnor-
mal growth
~ can include car-
cinoma in situ
(non-invasive)
27 / 59
PET/CT
164. Define Neoplasia the formation of a

tumor
165. Stages of Cancer Development: Cancerous tumors stroma

progress while remaining separated from the ______.
166. Stages of Cancer Development: Once the basement locally invasive

membrane is breached and contact with stroma is
made, the cancer is ________ ________.
167. Stages of Cancer Development: ______________ diseased

cells then partner with stromal cells to eventually
enter the lymphatic system.
168. Stages of Cancer Development: Once the diseased metastatic dis-

cells go to the bloodstream, they can invade distant ease
sites causing ___________ __________.
169. Stages of Cancer Development Picture
170. Challenges in PET/CT Interpretation (4 Main) 1. Some malignant

lesions have low
avidity for FDG
• Prostate cancer
• Bronchoalveolar
cell carcinoma •
Low-grade sarco-
ma
• Certain
low-grade
non-Hodgkin's
lymphomas •
Some well
differentiated
adenocarcinomas
of lung •
Neuroendocrine
tumors • GIST- GI
stromal tumors •
28 / 59
PET/CT
Lobular breast
cancer
2. Small lesions or
unusual presenta-
tion/location
• Typically, tumors
< 8mm must be
very hypermeta-
bolic to be
visualized on PET
3. Preparation in
Patients with poor
glucose control
• For Type
2 diabetics, an
overnight fast and
an early morning
appointment typ-
ically give ade-
quate images
• For diabetics with
poor glucose con-
trol and/or insulin
dependent
diabetics, a small
meal and regu-
lar morning insulin
dose is preferred
with the FDG in-
jection scheduled
6 hours later. This
gets
the patient's in-
sulin level down to
an acceptable lev-
el but the
glucose level has
29 / 59
PET/CT
not yet risen too
high
4. Bone Marrow
Activation has In-
tense FDG Uptake
• Rebounding af-
ter chemothera-
py • Receiving
cytokine therapy
(interferon, inter-
leukin) • Receiv-
ing colony stimu-
lating factor thera-
py (neulasta, neu-
pogen) • Anemia
{**Imaging should
be delayed up
to 3 weeks after
therapy injections
and/or chemother-
apy}
171. __________ & ___________ can be indications for Infection and In-
doing FDG PET/CT imaging! flammation
172. Anatomic imaging is especially challenging with altered

___________ anatomy from surgical or other inter-
ventions
173. Infection and Inflammation Imaging: ________ detec- Timely

tion of inflammation and infection is critical for ap-
propriate treatment for patients
174. Infection and Inflammation Imaging: CT, MR, US, fre- structural
quent;y utilized in these cases but are limited to de-
tecting _________ changes only.
175.
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PET/CT
Infection and Inflammation Imaging: Anatomic in later stages of
techniques are NOT suitable for early diag- disease
nosis because anatomic changes only occur
__________________________________.
176. Infection and Inflammation: __________ changes oc- Physiologic

cur in early stages, making FDG PET/CT a valuable
tool in such cases
177. Define a neutrophil a type of granulo-

cyte (white blood
cell), it is filled with
tiny sacs which
contain enzymes
that digest mi-
croorganisms.
178. Define Macrophages also a type of

white blood cells
that ingests for-
eign material.
179. Activated lymphocytes, neutrophils and infection and in-

macrophages are present in _______________ & flammatory
________________ processes.
180. Infection and Inflammatory Imaging: Due to high increased

glycolytic activity, activated inflammatory cells have
__________ FDG uptake
181. Infection and Inflammatory Imaging: In addition, bacterial infection

FDG rapidly accumulates at sites of ____________
___________ and in reactive lymph nodes
182. Infection and Inflammatory Imaging: There is a high affected and

contrast between __________ and __________ tis- non-involved
sue.
183. Understanding Inflammation: Hierarchy for degree of

FDG uptake
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PET/CT
Neutrophils
>Macrophages >
Lymphocytes
184. Define Inflammation A tissues re-

sponse to dam-
age, injury, or in-
fection
185. 4 Steps in Understanding Inflammation 1. Irritation

2. Inflammation
3. Suppuration
4. Granulation
These 4 acute in-

flammation signs
are only relevant
when the affected
area is on or very
close to the skin.
186. Understanding Inflammation: Irritation (2) -Mild Redness

-Mild Swelling
187. Understanding Inflammation: Inflammation (5) -pain

-redness
-immobility
-swelling
-heat
188. Understanding Inflammation: Suppuration (1) - discharge of pus
189. Understanding Inflammation: Granulation (1) -formation of

wounds of tiny
rounded masses
190. When inflammation occurs _____ ________ the body, deep inside
such as an internal organ, only some of the signs may
be detectable. Some internal or-
gans may not have
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PET/CT
sensory nerve
endings nearby,
so there be no
pain present.
eg—some pneu-
monias
If the internal in-

flammation push-
es against the in-
ner linings of the
body, then there
is pain. eg--peri-
carditis
191. The 3 Main Processes That Occur before and during 1. Dilation of arte-
ACUTE inflammation rioles to the dam-
aged region re-
sulting in increas-
es blood flow
2. Increase in per-
meability of cap-
illaries allowing
fluid and pro-
teins into intersti-
tial spaces
3. Movement
of neutrophils,
and possi-
bly macrophages,
into interstitial
spaces
192. Stages of Tissue Healing: Scar tissue will appear to denser

be _____ and _____ _______ compared with normal non pliable
skin/scalp. It is also common for hair not to grown on
scar tissue.
193. Define Collagen
33 / 59
PET/CT
Granulation tissue
is collagen-rich tis-
sue which forms at
the site of an in-
jury. As the body
heals, this tissue
fills in the injury,
and may eventual-
ly scar over
194. The appearance of granulation tissue is a good sign. fibrous tissue

When a wound starts granulating, it means that
the body is starting to rebuild after the injury. This oxygen
__________________tissue is usually pink because
the body produces numerous small blood vessels to
provide a supply of ___________ and nutrients to re-
move waste. It is also commonly bumpy and uneven,
and may be moist to the touch.
195. Acute Inflammation Characteristics 1. Causative

Agents
2. Major Cells In-
volved
3. Primary Media-
tors
4. Onset
5. Duration
6. Outcomes
196. Acute Inflammation Characteristics: Causative Harmful bacteria

Agents or injury to tissue
197. Acute Inflammation Characteristics: Major Cells In- mainly

volved neutrophils,
basophils (in the
inflammatory
response), and
eosinophils
(response to
parasites and
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PET/CT
worms), and
mononuclear
cells
(macrophages,
monocytes)
198. Acute Inflammation Characteristics: Primary Media- -"local hormones"

tors EICOSANIODS that help in-
crease permeabil-
ity of blood ves-
sels and attract
WBCs
199. Acute Inflammation Characteristics: Primary Media- substance con-

tors VASOCACTIVE AMINES taining amino
groups (eg—his-
timine, serotonin)
that acts on the
blood vessels to
alter their perme-
ability
200. Acute Inflammation Characteristics: Onset (when does the in-

flammation start)
ex: right away
201. Acute Inflammation Characteristics: Duration Ex: short lived,

only a few days
202. Acute Inflammation Characteristics: Outcomes the inflammation

either gets better
(resolution), de-
velops into an
abscess, or be-
comes a chronic
inflammation.
203. Chronic Inflammation: Causative Agent non-degradable

pathogens that
cause persistent
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PET/CT
inflammation,
infection with
some types of
viruses,
persistent foreign
bodies, overactive
immune system
reactions
204. Chronic Inflammation: Major Cells Involved Macrophages,

lymphocytes,
plasma cells
(these three are
mononuclear
cells), and
fibroblasts
205. Chronic Inflammation: Primary Mediators reactive oxygen

species, hydrolyt-
ic enzymes, IFN--
³and other cy-
tokines, growth
factors
206. Chronic Inflammation: Duration from several

months to years
207. Chronic Inflammation: Outcomes the destruction of

tissue, thickening
and scarring of
connective tissue
(fibrosis), death of
cells or tissues
(necrosis).
208. Define Autoimmune Disease(s) is one where

the body initiates
an immune re-
sponse to healthy
tissues, mistaking
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PET/CT
them for harmful
pathogens or irri-
tants. The immune
response triggers
an inflammatory
response too.
209. Examples of Autoimmune Diseases -Rheumatoid

Arthritis
-Ankylosing
Spondylitis
-Celiac Disease
- Fibromyalgia
- Idiopathic Pul-
monary Fibrosis
- Lupus
-Psoriasis
- Addison's Dis-
ease
- Vasculitis
- Transplant rejec-
tion
-Various Allergies
210. The 3 principles of infection spreading depends on 1. source of the

the ability of an agent to propagate agent
2. the mode of
transmission of
the agent
3. susceptibility of
the host agent
211. The chain of infection has 3 main parts 1. A reservoir such

as a human and
an agent such as
an amoeba.
2. The mode of
transmission can
include direct con-
37 / 59
PET/CT
tact, droplets, a
vector such as a
mosquito, a vehi-
cle such as food,
or the airborne
route.
3. The suscepti-
ble host has multi-
ple portals of entry
such as the mouth
or a syringe
212. Understanding Infection: Causative Agent the microorgan-

ism (for example
bacteria, virus or
fungi).
213. Understanding Infection: Reservoir (source) a host which al-

lows the microor-
ganism to live, and
possibly grow, and
multiply. Humans,
animals and the
environment can
all be reservoirs
for microorgan-
isms.
214. Understanding Infection: Port of Exit a path for

the microorgan-
ism to escape
from the host.
The blood, respi-
ratory tract, skin
and mucous mem-
branes, genitouri-
nary tract, gas-
trointestinal tract,
and transplacental
38 / 59
PET/CT
route from mother
to her unborn in-
fant are some ex-
amples
215. Understanding Infection: Mode of Transmission since microorgan-

isms cannot travel
on their own; they
require a vehicle
to carry them to
other people and
places.
216. Understanding Infection: Portal of Entry a path for the mi-

croorganism to get
into a new host,
similar to the por-
tal of exit.
217. Understanding Infection: Susceptible Host a person suscepti-

ble to the microor-
ganism.
218. Understanding Infection: The Characteristics of an 1. Pathogenicity

Agent that Enable it to Spread Include... (6) 2. Virulence
3. Toxicity
4. Invasiveness
5. Resistance to
physical factors
6. Dose of infec-
tion
219. Understanding Infection: The Characteristics of an capacity to cause

Agent that Enable it to Spread--> PATHOGENICITY disease
220. Understanding Infection: The Characteristics of an ability to invade

Agent that Enable it to Spread--> VIRULENCE and cause serious
disease
221.
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PET/CT
Understanding Infection: The Characteristics of an ability to harm by
Agent that Enable it to Spread--> TOXICITY creating toxins
222. Understanding Infection: The Characteristics of an ability to penetrate

Agent that Enable it to Spread--> INVASIVENESS host tissue and
survive for some
time
223. Understanding Infection: The Characteristics of an extreme tempera-

Agent that Enable it to Spread--> RESISTANCE TO tures, radiation
PHYSICAL FACTORS
224. Understanding Infection: The Characteristics of an quantity of agent

Agent that Enable it to Spread--> DOSE OF INFEC- that penetrates
TION the organism
225. Infection Indications for PET/CT Fever of Unknown

Origin
Bone infection
Diabetic foot infec-
tions
Evaluation of ther-
apy
Prosthesis infec-
tions
Vascular graft in-
fections
Vasculitis
AIDS/ tuberculo-
sis
226. Definition of Fever of Unknown Origin (FUO) 1. Recurrent fever

equal to or over
38.3 degrees Cel-
sius
2. Lasting 2-3
weeks or longer
3. Undiagnosed
after 1 week of
40 / 59
PET/CT
hospital evalua-
tion
227. Fever of Unknown Causes 1. Infection

2. Non infec-
tions inflammatory
Process
3. Neoplasm
228. Additional benefit of PET/CT performed as

whole body pro-
cedure in relative-
ly short time that
allows delineation
of both location
and number of foci
even at sites not
suspected clinical-
ly
229. Na18F Bone Imaging Dates back to when? 50s and early 60s
230. When did the FDA approve Na18F for bone imaging? 1972
231. *What 3 events led to the abandonment of Na18F 1. Development

bone imaging? of 99Mo/99mTc
Generator
2. Development
of 99mTc-phos-
phate compounds
3. Introduction of
the gamma cam-
era
232. 3 Reasons why Na18F Bone imaging has been "redis- 1. Cyclotrons are
covered"? more available
2.PET/CT scan-
ners are more
mainstream
3. Provides an
41 / 59
PET/CT
alternate during
99mTc shortages
233. Na18F is chemical precursor used commercially to 18-FDG

make ______, therefore, it is readily available.
234. Commercial cyclotrons produce Na18F by proton bombard-

_______________________________. ment of O-18
235. After IV injection, Na18F has ____________ rapid clearance

__________ to bone and excretion into the
_________. urine
236. Greater than ____% of the dose is cleared through the 20%
kidneys in the first ____ hours. 1-2 hours
237. The uptake mechanism of 18F-fluoride resembles 1. faster blood

that of 99mTc-methylene diphosphonate (MDP), with clearance
better pharmacokinetic characteristics (2) 2. 2-fold higher up-
take in bone
238. Uptake of 18F-fluoride reflects ________ _______ and blood flow and
bone __________. bone remodeling
239. Half Life of 99m Tc MDP 6 hours
240. Uptake Period for Tc-MDP 3 hours
241. Gamma Energy for Tc-MDP 140 keV
242. Half Value Layer for Tc-MDP 0.17mm lead
243. Practical Resolution for Tc-MDP SPECT 15mm
244. Critical Organ dose for Tc-MDP 0.03 mGy/MBq
245. Target Organ doe for Tc-MDP 0.035 mGy/MBq
246. Half Life for Na18F 2 hours
247. Uptake period for Na18F 1 hour

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PET/CT
248. Gamma Energy for Na18F 511 keV
249. Half Value Layer for Na18F 4.1 mm lead
250. Practical Resolution for Na18F PET 8 mm
251. Critical Organ Dose for Na18F 0.19 mGy/MBq
252. Target Organ Dose for Na18F 0.012 mGy/MBq
253. PET/CT 18F bone scans used to identify skeletal metas-

______________ __________ including localization tases
and determination of the extent of disease
254. Bone Metastasis is most likely in these cancers (5) Breast, prostate,
lung. kidney, thy-
roid
255. 14 Indications for a NaF Bone Scan 1. Back pain and

otherwise unex-
plained bone pain
2. Child abuse
3. Abnormal radi-
ographic or labo-
ratory findings
4. Osteomyelitis
5. Trauma
6. Inflammatory
and degenerative
arthritis
7. Avascular
necrosis
8. Osteonecrosis
of the mandible
9. Condylar hyper-
plasia
10. Metabolic
bone disease
11. Paget disease
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PET/CT
12. Bone graft via-
bility
13. Complications
of prosthetic joints
14. Reflex sympa-
thetic dystrophy
256. Protocol: Patient Preparation for Na18F Bone Imag- None

ing
257. Protocol: Tracer for Na18F IV Injection of

5-10mCi Na18F
258. Protocol: Uptake Time for Na1F 45 minutes; 90

minutes for head
to toe imaging (no
restrictions)
259. Protocol: Imaging Time for Na18F Typically 2-3 min-

utes per bed, 1
minutes per bed
on lower extremi-
ties
260. Protocol: Imaging for Na18F By physician with

training in reading
NaF studies.
261. Protocol: Na18F Positioning Arm position dur-

ing scanning de-
pends on the in-
dications for the
study. The arms
may be by
the sides for
whole-body imag-
ing or elevated
when only the
axial skeleton is
scanned.
44 / 59
PET/CT
-Vertex to Mid-
thigh
-Vertex to Toes
262. Define Gamma Rays high frequency

with short wave
lengths
263. The best way to think of EMR is as a wave pocket a photon

called
264. Define Photons photons are

chargeless bun-
dles of energy that
travel in a vacuum
at the velocity of
light
265. Velocity of light (c) 3 X 10^ 10

cm/sec or 186,000
miles/sec
266. Since light travels at a constant velocity, the oscillat- Lambda (wave-
ing electromagnetic field wavelength and frequency length)= c(speed
are related by the equation: of light)/ v (fre-
quency)
267. In PET imaging, we are imaging photons. These pho- short wavelengths
tons have very _____ wavelengths and ___ energy. high energy
268. What does EMR stand for? Electro Magnetic

Radiation
269. What happens when a positron interacts with an elec- Annihilation Event
tron? according to
E=mc^2
270. The rest mass of e- and e+ are _______ identical

(0.511MeV)
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PET/CT
271. The total energy of interaction between a positron 1.022 MeV
and electron is
272. The mass is converted into two 511 keV

______________________________, to conform to photons travel-
the LAW OF CONSERVATION OF MOMENTUM. ing ~180 degrees
from one another
273. PET creates _________ images of __________ functional

processes by allowing investigation at the _________ metabolic
level. cellular
274. CT creates _________ images used for anatomical

_________ _________ of PET images and for attenuation cor-
_________________ __________________. rection
anatomic correc-
tion
275. What is coincidence imaging? when 2 photons

arrive at 2 different
detectors at the
same time
276. In conventional PET, events are recorded along "lines of respons-

___________ es
277. What are the 3 Goals of a Scanner Design? 1. To have as

much sensitivity
as possible to de-
tecting true events
2. To have good
spatial resolution
3. To limit back-
ground counts
278. Name 2 limits to Spatial Resolution. 1. The positron

goes a short dis-
tance (<1mm) in
tissue before it an-
nihilates. It is the
46 / 59
PET/CT
location of the de-
cay that is of inter-
est, but the scan-
ner sees the anni-
hilation sited. This
leads to blurring.
2. The photons are
not emitted at ex-
actly 180 degrees
from one anoth-
er due to the
momentum of the
positron.
279. When occurs when the Septa is ON? -decrease in

counts
-decrease in sen-
sitivity
-cut out other
counts from the
body
280. Define Attenuation When one or both

of the annihilation
photons scatter in
the body, it is pre-
vented from being
detected appropri-
ately
It may be detect-
ed by a different
detector, resulting
in a SCATTERED
COINCIDENCE
281. What are the 4 negative effects when the loss of TRUE 1. Loss of events
COINCIDENCE EVENTS due to attenuation are leads to increased
image noise
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PET/CT
2. Larger bodies
lose more counts
to attenuation
3. Without ac-
curate attenuation
correction, mea-
surements of ra-
dioactivity cannot
be quantitatively
accurate
4. Attenuation ef-
fect is not the
same in all areas
282. The potential problems for CT-based attenuation cor- 1. Attenuation is

rection with PET/CT (6) the largest correc-
tion we apply to
the PET data
2. Artifacts in the
CT image propa-
gate into the PET
image, since the
CT is used for at-
tenuation correc-
tion of the PET
data
3. Difference in CT
and PET respira-
tory patterns
-can lead to ar-
tifacts near the
dome of the liv-
er unless mo-
tion compensation
methods are used
(respiratory gat-
ing)
4.Contrast agents,
implants, or calci-
48 / 59
PET/CT
um deposits
-can cause incor-
rect values in PET
image unless cor-
rect CT-based at-
tenuation correc-
tion tables are
used
5. Truncation of CT
image
-can cause ar-
tifacts in corre-
sponding regions
in PET image un-
less wide-field CT
image reconstruc-
tion is used-this
should always be
used by default
6. Bias in the
CT image due
to beam-harden-
ing and scatter
from the arms in
the field of view
283. Standard Uptake Values (SUV)= mCi/mL in tissue

(decay corrected)/
mCi injected/body
weight
284. In theory, if the radiotracer was ______ distributes uniformity

throughout the body and there was no excretion, then
the SUV=1
285. To ensure accuracy for SUV one needs to know (3) 1. amount injected
2. time of injection
3. patient's body
weight
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PET/CT
286. SUVs are best used to monitor __________ patient treatment
__________ ________. response
287. _____________________ IS KEY!!! CONSTANCY
288. SUV: Other facts to consider (3) 1. blood glucose

levels
2. kidney function
3. how long the pa-
tient was NPO
289. SUV: During interpretation, reading physicians must 1. size f regions of

be consistent with.. (2) interest (ROIs) be-
tween studies
2. reporting SU-
Vave versus SU-
Vmax
290. SUV "rule of thumb" SUV >2.5 is high

probability for ma-
lignancy
291. Different method of measuring SUV body weight (4) 1. SUVbw us-
ing body weight
(weight of patient)
2. SUVibw using
Ideal Body Weight
3. SUVlbs using
Lean Body Mass
4. SUVbsa using
body surface area
292. Equation for Ideal Body Weight IBW= 45.5 + 0.91

(height -152)
293. Equation for Lean Body Mass IBM= 1.07

(height)- 148
(weight/height)^2
294. Equation for Body Surface Area

50 / 59
PET/CT
BSA=
(weight)^0.425 X
(height)^0.725 X
0.007184
295. Factors Affecting SUVs: Uptake Period Longer Up-

take Period------In-
crease SUV
296. Factors Affecting SUVs: Size of ROI Smaller Size of

ROI------ Increase
SUV
297. Factors Affecting SUVs: Pixels size of image Higher Pixel Size
of Image------In-
crease SUV
298. Factors Affecting SUVs: Reconstruction Resolution Higher

Reconstruction
Resolution----In-
crease SUV
299. Factors Affecting SUVs: Body Mass Index Higher Body Mass
Index----- Increase
SUV
300. Factors Affecting SUVs: Blood Glucose Level Higher Blood Glu-
cose Level----De-
creases SUV
301. Factors Affectign SUVs: Quality of Injection Poorer Quality

of Injection----De-
creases SUV
302. Cancer: Bladder Metastasis:__________ Bone, liver, lung
303. Cancer: Breast Metastasis:__________ Bone, Brain, Liver,

Lung
304. Cancer: Colorectal Metastasis:__________

51 / 59
PET/CT
Liver, Lung, Peri-
toneum
305. Cancer: Kidney Metastasis:__________ Adrenal Gland,

Bone, Brain, Liver,
Lung
306. Cancer: Lung Metastasis:__________ Adrenal Gland,

Bone, Brain, Liver,
Other Lung
307. Cancer: Melanoma Metastasis:__________ Bone, Brain, Liver,

Lung, Skin/Muscls
308. Cancer: Ovary Metastasis:__________ Liver, Lung, Peri-

toneum
309. Cancer: Pancreas Metastasis:__________ Liver, Lung, Peri-

toneum
310. Cancer: Prostate Metastasis:__________ Adrenal Gland,

Bone, Liver, Lung
311. Cancer: Stomach Metastasis:__________ Liver, Lung, Peri-

toneum
312. Cancer: Thyroid Metastasis:__________ Bone, Liver, Lung
313. Cancer: Uterus Metastasis:__________ Bone, Liver, Lung,

Peritoneum, Vagi-
na
314. Cancer Cell Metastasis: Define Local Invasion Cancer cells in-
vade nearby nor-
mal tissue
315. Cancer Cell Metastasis: Define Intravasation Cancer cells in-

vade and move
through the walls
of nearby lymph
52 / 59
PET/CT
vessels or blood
vessels
316. Cancer Cell Metastasis: Define Circualtion Cancer cells move

through the lym-
phatic system and
the bloodstream to
other parts of they
body
317. Cancer Cell Metastasis: Define Arrest and Extravasa- Cancer cells ar-
tion rest, or stop mov-
ing in small blood
vessels called
capillaries at a
distance location.
They then invade
the walls of the
capillaries and mi-
grate into the
surrounding tissue
(extravasation)
318. Cancer Cell Metastasis: Define Proliferation Cancer cells mul-

tiply at the dis-
tance location to
form small tu-
mors known as mi-
crometastases
319. Cancer Cell Metastasis: Define Angiogensis Micro-metastases

stimulate the
growth of new
blood vessels to
obtain a blood
supply. A blood
supply is needed
to obtain the
oxygen and
nutrients
53 / 59
PET/CT
necessary for
continued tumor
growth.
320. Because cancers of the lymphatic system or the neck

blood system are already present inside lymph ves-
sels, lymph nodes, or blood vessels, not all of these
steps are needed for their metastasis. The Lymphatic
system drains into the blood system at 2 locations in
the ________.
321. The ability of a cancer cell to metastasize success- noncancerous

fully depends on its individual properties; the prop-
erties of the ______________ cells, including immune
system cells, present at the original location; and the
properties of the cells it encounters in the lymphatic
system or the bloodstream and at the final destina-
tion in another part of the body.
322. Not all cancer cells, by themselves, have the ability dormant
to metastasize. In addition, the noncancerous cells
at the original location may be able to block cancer
cell metastasis. Furthermore, successfully reaching
another location in the body does not guarantee that
a metastatic tumor will form. Metastatic cancer cells
can lie_______ (not grow) at a distant site for many
years before they begin to grow again, if at all.
323. 18-FDG a) increase up-

a) has increased uptake in inflammatory cells take in inflamma-
b) has decreased uptake at recent biopsy sites tory cells
c) has one more hydroxyl group then glucose
d) is metabolized exactly the same way as glucose
324. Which is not an advantage of increasing kVp?

a) reduction in tissue density differences
b) greater penetration through the body
c)reduction in beam hardening artifacts
d) decrease in noise
54 / 59
PET/CT
325. Which is a MAIN factor to consider prior to giving IV a) renal insuffi-
contrast to a patient? ciency
a) renal insufficiency
b) thyroid condition
c) anxiety
d) multiple myeloma
326. Which organ receives the highest radiation dose from a) bladder
an FDG injection?
a) bladder
b) heart
c) thyroid
d) kidneys
327. What is not allowed 4-6 hours prior to an FDG injec- a) diabetes med-
tion? ication
a) diabetes medication
b) pain medication
c) blood pressure medication
d) anxiety medication
328. Which is true about sodium fluoride for bone imag- d) it has faster
ing? clearance than
a) it requires a 3 hour uptake period MDP
b) it has 3 times the uptake as MDP
c) 50% is cleared through the kidneys in the first hour
d) it has faster clearance than MDP
329. What type of cancer is most likely to spread to the d) breast

bones?
a)laryngeal
b) lymphoma
c) colon
d) breast
330. If a patient is not properly kept NPO prior to an FDG a) increases mus-
injection, what is the likely result in his images? cle uptake
a) increased muscle uptake
b) increased brain uptake
55 / 59
PET/CT
c) increased tumor uptake
d) decreased heart uptake
331. Which is nor true concerning acute inflammation? b) affected area

a) increase in permeability of capillaries has decreases
b) affected area has decreased blood flow blood flow
c) neutrophils move into interstitial spaces
d) redness and swelling
332. Which is not an indication for FDG inflammation/in- b) cholecystitis

fection imaging?
a) vasculitis
b) cholecystitis
c) osteomyelitis
d) sarcoidosis
333. As the frequency of electromagnetic radiation in- c) the wavelength

creases decreases
a) the wavelength increase
b) the wavelength does not change
c) the wavelength decreases
d) the velocity of light increases
334. The total energy of a positron annihilation event is b) 1.022 MeV

a) 511 keV
b) 1.022 MeV
c) 1.022 keV
d) 511 MeV
335. When compared to 3D scanning, 2D scanning has a) less sensitivity

a) less sensitivity
b( increased counts
c) higher specificity
d) higher sensitivity
336. Which is not a potential problem of CT- based atten- b) lack of IV con-
uation correction? trast in the CT
a) truncation of CT image
b) lack of IV contrast in the CT
c) difference in respiratory patterns between CT and
56 / 59
PET/CT
PET
d) beam hardening artifacts in the CT scan
337. In order to distinguish between an IV contrast artifact d) uncorrected

and a positive lymph node, which set of images are PET
most helpful?
a) they cannot be differentiated
b) attenuation corrected PET
c) CT scan
d) uncorrected PET
338. To ensure the accuracy of SUVs, which is not neces- d) concentration of

sary to know? the FDG dose
a) weight of the patient
b) time of the injection
c) amount of the injected dose
d) concentration of the FDG dose
339. Which does not influence standard uptake values? c) concentration of

a) uptake time FDG dose
b) blood glucose
c) concentration of FDG dose
d) size of ROI
340. Two photons are emitted in an annihilation event d) an electron

when a positron collides with
a) another positron
b) a proton
c) a neutron
d) an electron
341. The half life of F-18 is a) 1.83 hours

a) 1.83 hours
b) 10 hours
c) 1.83 minutes
d) 10 minutes
342. The PET scanner detects d) gamma rays

a) protons
b) positrons
57 / 59
PET/CT
c) electrons
d) gamma rays
343. For PET tumor imaging, the patient's _______ should a) blood glucose
be checked prior to FDG administration. level
a) blood glucose level
b) hematocrit
c) insulin level
d) hemoglobin
344. FDG is not taken up in which of the following process- b) radiation necro-
es? sis
a) chronic infection
b) radiation necrosis
c) acute inflammation
d) thymic hyperplasia
345. Cardiac cells are very depended on ______ for FDG d) insulin
uptake.
a) glucose
b) dextrose
c) hexokinase
d) insulin
346. FDG stays within cells for imaging because a) it does not go
a) it does not go through glycolosis through glycolosis
b) it has an extra hydroxyl group
c) FDG is not tumor specific
d) it is metabolized exactly like glucose
347. The CT portion of the PET/CT scan a) provided atten-

a) provided attenuation correction for the PET scan uation correction
b) all of the above for the PET scan
c) increases the number of false positives seen on a
PET scan
d) is acquired simultaneously
348. FDG b) exploits the fact

a) increases the patient's blood sugar when injected that cancer cells
b) exploits the fact that cancer cells are hypermeta-
58 / 59
PET/CT
bolic are hypermetabol-
c) is utilized by cancer cells by the process of glycolo- ic
sis
d) is tumor specific
349. Which of the following is not an indication for an FDG d) determining

scan? whether a new-
a) determining whether a patient has recurrent lung ly diagnosed lunch
cancer cancer has brain
b) determining whether a newly diagnosed lung can- metastases
cer patient has liver metastases
c) evaluating response to chemotherapy in a patient
with lymphoma
d) determining whether a newly diagnosed lunch can-
cer has brain metastases
350. Which is not a MAIN risk factor for giving intravenous a) sickle cell ane-
contrast? mia
a) sickle cell anemia
b) asthma
c) allergy
d) renal insufficiency
59 / 59

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PET/CT

Study online at https://quizlet.com/_bs73il

1. 4 things you need to know before getting started 1. Correct patient

2. What are the 4 main components of a PET/CT scan? 1. FDG amount

4. 3 Options based on PATIENT SIZE (FDG Amount) 1. Same dose,

5. FDG is injected... Intravenously (IV)

6. Choice of injection site depends on... (3 things) 1. Quality of pa-

7. 3 things to consider during uptake period 1. Patient should

8. Considerations for uptake time period (3) 1. 2hr half

(45-60 min uptake

9. Imaging protocol is chosen on the___________ clinical question

11. head to toe imaging protocol is used for melanoma, multi-

12. brain imaging is used for recurrent brain tu-

13. Why are brain mets difficult to see? high level of

15. arms up or down imaging protocol depends on

17. The CT portion time span 20-60 seconds

19. 2 Reasons CT is important! 1. Fusion

20. CT Basics: Define X-ray Tube evacuated con-

21. CT basics: Define Anode The Target--> the

22. CT Basics: Define Cathode The Source-->

23. kVp (kilovolt peak) the peak voltage

24. mA (milliampere) the unit of electric

25. pitch the ratio of table

26. voltage and current the 2 primary set-

27. mAs current per sec-

28. Energy variation for PET/CT 80-140kVp

29. kVp selection depends on 2 things 1. patient size

30. limited set of energies usually available for CT scan- 80,100,120,140

31. higher energy photons are needed to penetrate large kVp

32. kVp setting defines the fraction of

33. As energy of photons increase (3) 1. more photons

34. 3 Advantages to using a higher kVp 1.greater penetra-

35. 2 Disadvantages of using a higher kVp 1. higher dose to

36. CT Current Variation (4) 1. there is a pro-

37. As current increases (3) 1. decrease in im-

38. CT Voltage and Current Relationship Rule Rule is that a de-

39. CT can be enhanced with (3) 1. oral contrast

40. Oral Contrast distends GI tract

41. IV Contrast differentiates soft

43. Positive Oral Contrast distends and

44. Neutral Oral Contrast also called wa-

45. Oral Contrast Unit Hounsfield

46. CT without contrast parenchyma,

47. CT with contrast more accurate

48. Parenchyma the functional

49. Stroma the structural tis-

50. Before giving IV CT contrast 1. must review the

51. GFR> 60 normal

52. GFR 45-60 patient may be hy-

53. GFR <45 most likely will not

54. GFR Glomerular Filtra-

55. GFR for Diabetic patients >70

56. The approach to patients about to undergo a con- 1. to assure that

57. Main Risk Factors to Consider for Constrast allergy, asthma,

58. Other Risk Factors to Consider anxiety, multiple

59. Premeditation for Allergic and At-Risk Patients Corticosteroid and

61. 2 Possible Problems with Contrast Injection Extravastion and

62. Mild Reactions Signs and symp-

63. Moderate Reactions Signs and symp-

64. Severe Reactions Signs and symp-

65. Reasons why CT scans might be over-ordered by Financial incen-

67. CT is regulated by who? FDA

68. PET/CT is regulated by who? FDA (x-ray)