PRACTICAL APPLICATIONS Chapter 20 HW Done
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RADIOLOGY.AND NUCLEAR MEDICINE 869 Wyinr {arnia PRACTICAL APPLICATIONS CASE STUDY: MELANOMA FOLLOW-UP Rill Q P ) ¢ o o - % Bill Smith, a 51-year-old sales representative, was initially diagnosed with stage II1 melanoma 4 years ago 3-month follow-up CT 1 lswers to the questions are found on page 876 | | | E | { b He underwent surgery and received interferon treatment at that time. At his 3 1% k tieluation last year, Mr. Smith received bad news. The CT scan indicated a small 1-cm nodule that could 1 be 2 melanoma metastasis. To confirm the diagnosis, Mr. Smith underwent a PET scan. He was admitted to the nuclear medicine unit of the hospital on the morning of the scan He had been istructed to fast (no food or beverage 12 hours before the scan). The nuclear medicine physician had told him especially not to eat any type of sugar, which would compete with the radiopharmaceutical 18F-FDG j [radiolabeled fluorodeoxyglucose, "*F-FDG), a radioactive glucose molecule that travels to every cell in the P body B The PET scan began with an injection of a trace amount of 18F-FDG by the physician. Bill was asked 1} I lie still for about an hour in a dark, quiet room and to avoid talking to prevent the compound from i gncentrating in the tongue and vocal cords. The waiting time allowed the 18F-FDG to be ahsorbed and 1 wleased from normal tissue. After emptying his bladder, Bill reclined on a bed that moved slowly and i | quietly through a PET scanner, a large tube similar to a CT scanner. The radioactive glucose emits charged particles called positrons, which interact with electrons, producing gamma rays that are in turn detected by the scanner. Color-coded images indicate the intensity of metabolic activity throughout the body. Cancerous cells absorb more radioactive glucose than noncancerous cells. The malignant cells show up b brighter on the PET scan. € Bill's PET scan proved the CT wrong: His melanoma had not metastasized. He returned home quite P rilieved. Questions about the Case Study: Melanoma Follow-up I. In CT scanning: 2. A radioactive tracer is used b, Magnetic images reveal images in all three planes of the body ¢. A nuclear physician performs the ultrasound procedure d X-rays and a computer produce images in the axial plane P 2 In PET scanning: a, A radioactive tracer is used b. X-ray images reveal images in all three planes of the body ¢ A nuclear physician performs the ultrasound procedure d. Doppler ultrasound is used 3, Bill's case showed that: a CT scanning and PET scanning are equally effective in diagnosis of metastases b, PET scanning is useful in cancer diagnosis and staging ¢ Melanoma never progresses to stage IV d A diet high in glucose helps concentrate the radioactive 18F-FDG before the PET scan
- 870 RADIOLOGY AND NUCLEAR MEDICINE GENERAL HOSPITAL: NUCLEAR MEDICINE DEPARTMENT Available Radionuclides Radionuclide Radiopharmaceutical Xe-133 xenon gas Tc-99m albumin microspheres Sr-87m (strontium) solution Te-99m diphosphonate Tc-99m pertechnetate Tc-99m sulfur colloid Te-99m HIDA Tc-99m DTPA Tc-99m DMSA 1-123 sodium iodide 1-131 sodium iodide TI-201 (thallium) thallium chloride Te-99m sestamibi Ga-67 (gallium) gallium citrate DMSA, dimercaptosuccinic acid; DTPA, diethylenetriaminepentaacetic acid, HIDA, NH2,6-dimethyllimir PO, oral (Latin per os, by mouth) Questions about the General Hospital: Nuclear Medicine Department Administration Route inhaled v 1. Which radionuclide is used with sestamibi in an ETT of heart function? a. Thallium-201 b. Todine-131 ¢. Gallium-67 d. Technetium-99m 2. Which radionuclide would be used to diagnose disease in an endocrine gland? a. Ga-67 b. 1-123 c. Xe-123 d. Sr-87m Target Organ lungs lungs bone bone brain liver/spleen gallbladder kidney kidney thyroid thyroid heart heart tumors and abscesses acetic acd
RADIOLOGY AND NUCLEAR MEDICINE 871 Remember to check your answers carefully with the Answers to Exercises, page 875. o Complete the medical terms based on the definitions and word parts given. Wy e — S—— 1. Obstructing the passage of x-rays: radio _{ 2. Permitting the passage of x-rays: radio _\Jlgw\¥= e 3. Aids physicians in performing ultrasound procedures: ___ Sonv grapher 4. Transformation of stable substances into charged particles: __ _lon _ization 5. Radioactive drug administered for diagnostic purposes: radio \L\ 22> 6. Radioactive chemical that gives off energy in the form of radiation: radio nwe. S o 7. A physician who specializes in diagnostic radiology: radi 0\oiy S 8. Study of the uses of radioactive substances in the diagnosis of disease: ___’ uy medicine o Match the special diagnostic techniques below with their definitions. computed tomography _ magnetic resonance imaging contrast studies- ultrasonography . interventional radiology 1. Radiopaque substances are given and conventional x-rays taken Condans Gx BN 2. Use of echoes of high-frequency sound waves to diagnose disease __\ XU (A . 3. A magnetic field and radio waves are used to form images of the body _\M\¢ DXL (SN, . 4. X-ray pictures are taken circularly around an area of the body, and a computer synthesizes the information into composite images _()Wpux ¢t Ay laahy . —mmw%, ¢ Therapeutic procedures are performed by a radiologist under the guidance of CT, MRI, or 3] ultrasonography _ \\NXUAMAOG (LY NN o Match the diagnostic x-ray test in Column | with the part of the body that is imaged in Column Il COLUMN | COLUMN 1l 1. myelography i A. spinal cord 2. retrograde pyelography _%_ 2 ::(t:t;s\.ifijc;;llInpmn . 3. angiography _(,‘ )) esophagus, stomach, and small intestine L saceriiyeies ):)_ -; :::\I\:Ir&d;rtj:-'tlnlmmul tract S 6. bile vessels (ducts) . 5. cholangiography 6. barium enema X 7. hysterosalpingography ) K OO\ o
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872 RADIOLOGY AND NUCLEAR MEDICINE Match the x-ray views or positions in Column | with their meanings in Column I Write the letter of the answer in the space provided. COLUMN | COLUMN I 1. PA o _A. on the side P ' A7 turned inward e = = -C. movement away from the midline 3. prone i Y -D. lying on the belly E. x-ray tube positioned on an angle A. AP LS A. bending a part [ o . 5. lateral g -G. straightening a limb ———n H. lying on the back . lying down on the side -+, lying down; prone or supine . - - lateral decubitus . K. anteroposterior view (front to back) Y 6. oblique 7 L. turning outward M. posteroanterior view (back to front) -N. movement toward the midline 8. adduction 9. inversion 10. abduction [ 11. recumbent v < 12. eversion 13. flexion 4 }.‘1 14. extension & o Give the meanings of the following medical terms. 1. invitro _) oW, ¢ W 07 ALS \ \ 2. in vivo w\\\v\n [TV OF (ARG 1 / \V . radiopharmaceutical YO0t e dyum XWX 6 Goua LU0 MO o Vnadim Parn \ 0 X . uptake W, i\e, oy SV 2 3 4. tracer studies y(\o (MR ShaSMuna 0fe (v aeed. s Nvo S AT TR Wl o 6 . perfusion lung scan \\\\,\\ o e \\;\._ Mo Wsods of W \owk s Uonnak ventilation lun, LSS g N d ( > g scan (‘V\\MV\M DAY IR (RN GLAS RN (PR 1 V2 O SN ) - 2 8. bone scan \Whpade Smeadinue o W\ Ves 9. thyroid scan Sner g\, Mo tétew s gOwle in \’\\L \\Nr«\\t n Ny 10. technetium Tc99m sestamibi scan \"<“ K D \WugOs i,-),— St
¥ 2. SPECT \/\ 3. PACS ‘,YL\, v o) L omtpund M,,‘g fetal size and development RADIOLOGY AND NUCLEAR MEDICINE 873 o Give the meanings of the following terms. 1. gamma camera mu/u‘l_(ul Yy s emidh ] ll 1111 W Seb5fdnce . 2. positron emission tomography (PET) fadoec/ive 71‘2,/4 f0 (s fheed o0 beode co 3. radioisotope [ " Qhinlide. gdise ofZ 12 ot ftom — DR / > - 9 > A / 4. transducer /uuu._ toat sends o d vecouns Ulhdisom) Sobels 5: vchncurdmumphyé_/fi Sownd. /X Lsed I{Az‘fi bh impge aé M [R&AL 6. lymphoscintigraphy /ZC/e4r Jledignu taging g 24 Ypiphs b Sys 7 / 4 ‘h 7. radioactive iodine uptake test /2.1 M/ b cogltr // el & ‘/,.A yays 8. PET-CT scan (usdypatia o (EL and (T scan b she Loll shrithrin funciion o //L‘ So0d Give the meanings of the following word parts. 1. -gram _) Ll {J 5. pharmaceut/o Wus 7’ » by / 2. ultra- '//“"‘(N'\ l 6. son/o Sovhd o 3. vitr/o A,w/{- Ss 7. therapeutio _ /724 Mvrens” 4. vivio fe Give the meanings of the abbreviations in Column |, and then select the best association for each from Column II. COLUMN | COLUMN 1I 1. MRI “\.\L\&(M\F\\ {15000n L, \fgq,\fi \/\ A. X-ray examination of the kidney after injection Yoy of contrast \l \} L W—*‘M}““Bl Diagnostic procedure frequently used to assess . X-ray examination of the esophagus, stomach, 4. UGL v [ ADNDNACTNTN and intestines D. X-ray of blood vessels made by taking two o \( i ) 5. CXR *fl-\%x—j"—f— A— images (with and without contrast) and 6. DSA \\u\k A\ AV TR ) subtracting the digitized data for one from the v o data for the other 7. RP (e oiyiny (Y E. Radioisotope used in nuclear medicine (tracer N\ \ N\ studies) 8. LAT § S ). S N o ; A N F. Radioactive substances and a computer used to 9. U/S VRS0, Q) create 3D images ; \ \ - Diagnostic procedure produces magnetic 10, Te-99m\WAKORA. N P = 2 tmi s i resonance images of all three planes of the body and visualizes soft tissue in the nervous and musculoskeletal systems H. Replacement of traditional films with digital equivalents I. X-ray view from the side J. Diagnostic procedure (x-rays are used) necessary to investigate thoracic disease
874 RADIOLOGY AND NUCLEAR MEDICINE o Circle the correct boldface terms to complete the sentences. L. (3] w ~3 . After a head-on automobile collision, Sam was taken to the emergency dep: Mr. Jones was scheduled for ultrasound-guided thoracentesis. He was sent to the (interventional radiology, radiation oncology, nuclear medicine) department for the procedure . In order to better visualize Mr. Smith’s small intestine, Dr. Wong ordered a (perfusion study, SBFT, hysterosalpingography). She hoped to determine why he was having abdominal pain and diarrhea. tment 1n an unconscious state. The paramedics suspected head trauma, and the doctors ordered an emergency (PET scan, U/S, CT scan) of his head. . In light of Sue’s symptoms of fever, cough, and malaise, the doctors thought that the consolidated, hazy (radioisotope, radiolucent, radiopaque) area on the chest x-ray represented a pneumonia. . Fred, a lung cancer patient, experienced a seizure recently. His oncologist ordered a brain (ultrasound, pulmonary angiogram, MRI), which showed a tumor involving the left frontal lob of the brain. Fred was treated with Gamma Knife irradiation, and the tumor decreased in siz He has had no further seizures. Tom recently developed a cough and fever. A chest x-ray and (CT, myelogram, IVP) of the cf show that a (pelvic, spinal, mediastinal) mass is present. (Mediastinoscopy, Cystoscopy, Lumbar puncture) and biopsy of the mass reveal Hodgkin disease on histopathologic examination. He is treated with chemotherapy, and his symptoms disappear. A repeat x-ray shows that the mass has decreased remarkably, and a (SPECT, MRI, PET) scan shows no uptake of *F-FDG in the chest, indicating that the mass is fibrosis and not tumor. . Paola, a 50-year-old woman with diabetes, experiences chest pain during a stress test, and her (U/S, ECG, EEG) shows evidence of ischemia. A (contrast agent, transducer, radiopharmaceutical) called technetium Tc99m sestamibi (Cardiolite) is injected intravenous and uptake is assessed with a (probe, CT scanner, gamma camera), which shows an area of poor perfusion in the left ventricle. . Sally has a routine pelvic examination, and her (neurologist, gynecologist, urologist) detects irregular area of enlargement in the anterior wall of the uterus. A pelvic (angiogram, U/S study PET scan) is performed, which demonstrates the presence of fibroids in the uterine wall. Tt examination involves placing a gel over her abdominopelvic area and applying a (ultrasound transducer, radionuclide, MRI scanner) to send/receive sound vibrations to/from the pelvic region. . Sally was having palpitations in the early evening. An ECG revealed possible left ventricula hypertrophy. Her physician ordered an (ECHO, EUS, UGI) to rule out valvular heart disease . Joe, a 75-year-old man with a long smoking history, noticed blood in his sputum. His prir care physician ordered a/an (abdominal CT, chest CT, ultrasound of his heart) for further evaluation.
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