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Section 3: Other Nuclear Cardiology Procedures

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Injection of which of the following radiopharmaceuticals can be utilized for both gated SPECT radionuclide angiography and first-pass radionuclide angiography?

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a. technetium-99m–diethylenetriamine pentaacetic acid.

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b. technetium-99m-–methylene diphosphonate.

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c. technetium-99m-–human serum albumin.

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d. technetium-99m-–pertechnetate.

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c. Radiolabeled human serum albumin (HSA) can be bolused and remains in the blood pool for equilibrium imaging. DTPA (renal agent) and methylene diphosphonate (MDP; bone agent) do not remain in the blood pool. Once the patient has received stannous pyrophosphate to reduce the hemoglobin within erythrocytes, injection of sodium pertechnetate (with or without first-pass imaging) results in red cell labeling appropriate for gated equilibrium SPECT or planar imaging, but not pertechnetate alone.

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Which of the following gamma camera characteristics are most appropriate for optimal performance of first-pass radionuclide angiography rather than gated equilibrium radionuclide angiography?

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a. frame acquisition speed as low as 0.1 s.

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b. count-rate linearity up to 100,000 counts/s.

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c. pixel size of 3 mm or less in the imaging matrix.

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d. high-sensitivity collimation.

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d. First-pass imaging requires a high-count rate without significant dead-time loss due to pulse pileup, preferably a maximum count of >500,000 counts/s, and <10% loss at 250,000 counts/s. This typically requires the trade-off of higher system sensitivity at a sacrifice of spatial resolution. Minimum frame time should be at least 0.02 s, or 50 frames/s, to ensure adequate quantitation of ejection fraction and resting diastolic function.

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Which of the following radiopharmaceuticals would be best for evaluation of both ejection fraction and osseous metastases in a patient undergoing chemotherapy?

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a. technetium-99m–diethylenetriamine pentaacetic acid.

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b. technetium-99m sestamibi.

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c. technetium-99m–methylene diphosphonate.

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d. technetium-99m tetrofosmin.

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c. Although the mitochondrial upregulation in malignant cells may attract the positively charged ionic tracers, sestamibi and tetrofosmin, the signal-to-noise ratio for the periosteal reaction to bony metastases imaged with Tc-99m–MDP is much higher.

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Which of the following ventricular function techniques is best for evaluation of right ventricular ejection fraction?

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a. two-dimensional echocardiography.

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b. gated SPECT myocardial perfusion imaging.

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c. first-pass radionuclide angiography.

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d. planar gated equilibrium radionuclide angiography.

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c. Echocardiography results in only partial right ventricular imaging. The degree of right ventricular uptake with SPECT myocardial perfusion imaging is highly variable. Planar gated equilibrium blood pool imaging results in anatomic chamber overlap in every view. Of these ...

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