Cancer Types and Imaging 101
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Questions and Answers

Which type of leukemia is primarily diagnosed in adults?

  • Chronic myeloid leukemia (CML) (correct)
  • Acute lymphocytic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL) (correct)
  • Acute myeloid leukemia (AML)

    • What is the primary population affected by hepatocellular carcinoma?

  • Children under 12 years old
  • Women of all ages
  • Men and individuals over age 65 (correct)
  • Persons diagnosed with thyroid cancer

    • What imaging procedure is recommended for thyroid cancer assessment?

  • CT scan of the abdomen and pelvis
  • Ultrasound focused on head and neck
  • Routine PET/CT from chest to pubic symphysis (correct)
  • Routine MRI from neck to pelvis

    • What type of lung cancer is specifically associated with solitary pulmonary nodule imaging approval?

    <p>Non-small cell lung cancer (NSCLC)</p> Signup and view all the answers

    Which imaging position is recommended for patients during lung cancer assessment?

    <p>Lying supine from neck to pelvis</p> Signup and view all the answers

    What receptors does 18F Fluroestradiol bind to for breast cancer imaging?

    <p>Estrogen receptors</p> Signup and view all the answers

    Which imaging agent is recommended for evaluating prostate cancer and metastasis?

    <p>18F Piflufolastat</p> Signup and view all the answers

    What is the recommended wait time after injecting GA-68 Gozetotide before performing a scan?

    <p>50-90 minutes</p> Signup and view all the answers

    Which term describes the method used to process 18F Florataucipir?

    <p>Nucleophilic radio-fluorination</p> Signup and view all the answers

    What is the primary use of 18F Florataucipir?

    <p>Alzheimer's disease evaluation</p> Signup and view all the answers

    What type of cancer is most commonly associated with the female reproductive organs?

    <p>Uterine cancer</p> Signup and view all the answers

    Which type of renal cancer is the most common?

    <p>Renal cell carcinoma</p> Signup and view all the answers

    Which cancer type is most closely linked to HPV infection and affects predominantly women younger than 55 years old?

    <p>Cervical cancer</p> Signup and view all the answers

    What age group is most commonly affected by prostate cancer?

    <p>Over 65 years</p> Signup and view all the answers

    What imaging technique is critical to ensure accuracy in detecting cancer spread in the pelvis and other organs?

    <p>PET imaging</p> Signup and view all the answers

    What is the peak time for the formation of metastases in melanoma after its initial diagnosis?

    <p>1 to 2 years</p> Signup and view all the answers

    Which imaging method is recommended for detecting sarcomas?

    <p>CT from base of skull to feet with arms down</p> Signup and view all the answers

    In imaging protocols for melanoma, what is the recommended patient positioning?

    <p>Arms down and prone</p> Signup and view all the answers

    What is the primary tumor type of prostate cancer?

    <p>Adenocarcinoma</p> Signup and view all the answers

    Which PET radiopharmaceutical is used to evaluate hypoxia?

    <p>18F-FMISO</p> Signup and view all the answers

    Which of the following cancers accounts for around 2 to 4% of all cancers in the U.S. and is more common in men than women?

    <p>Myeloma</p> Signup and view all the answers

    What is the mechanism by which 18F-FLT uptakes in cancer cells?

    <p>Affinity to thymidine kinase 1 (TK1)</p> Signup and view all the answers

    What factor is NOT used to classify myeloma into its stages?

    <p>Patient's age</p> Signup and view all the answers

    What characteristic is associated with neuroendocrine prostate cancer?

    <p>Spread earlier than adenocarcinoma</p> Signup and view all the answers

    What type of carcinoma is commonly associated with esophageal cancer?

    <p>Adenocarcinoma</p> Signup and view all the answers

    What imaging procedure is generally NOT covered for staging cervical cancer?

    <p>PET imaging</p> Signup and view all the answers

    Which of the following procedures involves using 18F-FDG?

    <p>Malignancy in oncology evaluations</p> Signup and view all the answers

    Which of the following is NOT a stage classification for esophageal cancer?

    <p>Stage IIIA</p> Signup and view all the answers

    What age demographic has a higher risk of developing sarcomas?

    <p>Males in adolescence</p> Signup and view all the answers

    What is the use of 18F-Fluciclovine in medical imaging?

    <p>Detection of small metastatic lymph nodes in prostate cancer</p> Signup and view all the answers

    What patient preparation is necessary before PET/CT imaging for gastric cancer?

    <p>Fasting for 4-6 hours</p> Signup and view all the answers

    How is melanoma generally recognized in terms of its pathology?

    <p>Begins in melanocytes</p> Signup and view all the answers

    Which radiopharmaceutical possesses a blood flow mechanism primarily used in cardiology?

    <p>82Rb-Chloride</p> Signup and view all the answers

    What is a crucial aspect of imaging for myeloma to include?

    <p>Coverage from the base of the brain to the popliteal fossa</p> Signup and view all the answers

    What process is involved in the production of 11C-Sodium acetate?

    <p>Irradiating purified water and ethanol</p> Signup and view all the answers

    What is the coverage status of metastatic cancer of unknown primary origin for initial treatment strategy?

    <p>Covered by CMS</p> Signup and view all the answers

    What kind of images are typically acquired after injecting 18F-Flurpiridaz?

    <p>Images after a short rest period</p> Signup and view all the answers

    What type of cancer is primarily associated with seminomas and nonseminoma germ cell tumors?

    <p>Testicular cancer</p> Signup and view all the answers

    Which positioning is specified for imaging in lymphoma cases?

    <p>Supine with arms held above the head</p> Signup and view all the answers

    Which type of imaging is approved for breast cancer according to CMS?

    <p>FDG/PET imaging</p> Signup and view all the answers

    What age group is primarily affected by thymomas?

    <p>Adults aged 40-60</p> Signup and view all the answers

    What is a common imaging practice for the evaluation of breast cancer?

    <p>Arms held above the head during imaging</p> Signup and view all the answers

    Which of the following cancers was one of the first indications approved for PET imaging?

    <p>Lymphoma</p> Signup and view all the answers

    What is a significant risk factor for head and neck cancers?

    <p>Alcohol and tobacco use</p> Signup and view all the answers

    Which cancer type is characterized by tumors that are often slow-growing and treatable with radiation therapy?

    <p>Seminomas</p> Signup and view all the answers

    What is typically included in imaging for colorectal cancer?

    <p>Mid-neck to pelvis</p> Signup and view all the answers

    Which type of pancreatic cancer is specified for CMS approval under ICD-9 code 157?

    <p>Pancreatic CA</p> Signup and view all the answers

    Which age group is at higher risk for developing non-Hodgkin's lymphoma?

    <p>Adults</p> Signup and view all the answers

    What is the primary classification of breast cancer?

    <p>Ductal and lobular carcinoma</p> Signup and view all the answers

    What is the primary group affected by Hodgkin's lymphoma?

    <p>Adolescents and young adults</p> Signup and view all the answers

    How should patients be positioned during the imaging for thymomas?

    <p>Supine with arms over the head</p> Signup and view all the answers

    How many new cases of cancer are diagnosed each year in the United States?

    <p>1.6 million</p> Signup and view all the answers

    What significant advancement is mentioned regarding PET imaging in oncology?

    <p>It offers the best resolution compared to other nuclear medicine devices.</p> Signup and view all the answers

    What was one of the first clinical investigations for PET in the late 1970s?

    <p>Heart and brain evaluation</p> Signup and view all the answers

    In what decade did investigators begin to demonstrate the value of PET technology in cancer detection?

    <p>1980s</p> Signup and view all the answers

    Which feature enhances the confidence of identifying areas of hypermetabolism in PET imaging?

    <p>Computed tomography (CT) integration</p> Signup and view all the answers

    What did cost analyses indicate regarding PET technology in relation to unnecessary tests?

    <p>It offers significant potential savings by avoiding unnecessary tests.</p> Signup and view all the answers

    What is a key concern that remains despite advances in oncology?

    <p>Identifying recurrence of cancer</p> Signup and view all the answers

    Which of the following best describes the role of positron-emitting radionuclides in PET imaging?

    <p>They can be bound to organic atoms for cellular evaluation.</p> Signup and view all the answers

    What positioning may alleviate pressure on specific pain areas during imaging?

    <p>Prone or supine</p> Signup and view all the answers

    What is critical to manage for patient comfort when using immobilization devices during PET/CT imaging?

    <p>Anxiolytic or pain management medications</p> Signup and view all the answers

    Why is it important for patients to void before undergoing imaging?

    <p>To prevent discomfort during the procedure</p> Signup and view all the answers

    What arms positioning is commonly recommended for average patients during PET scans?

    <p>Above the head</p> Signup and view all the answers

    How can patient movement affect the quality of PET/CT images?

    <p>It can create motion artifacts</p> Signup and view all the answers

    For patients with specific malignant conditions, what may be necessary regarding arm positioning?

    <p>Arms to the sides</p> Signup and view all the answers

    What is advisable to avoid artifacts from patients with higher body weight during acquisitions?

    <p>Increased acquisition time and proper protocol adjustments</p> Signup and view all the answers

    Why is it recommended to acquire head and neck imaging in two parts?

    <p>To use higher resolution for small structures</p> Signup and view all the answers

    What is one of the main reasons for using overlapping data in large patients?

    <p>To reduce sensitivity changes and artifacts</p> Signup and view all the answers

    What does the acquisition mode for PET scans depend on?

    <p>Scanner's technical capabilities and parameters</p> Signup and view all the answers

    Why is patient cooperation emphasized during PET imaging procedures?

    <p>It is critical for achieving high-resolution images</p> Signup and view all the answers

    What is often necessary to check before starting a PET/CT scanning protocol?

    <p>Acquisition program settings and patient safety</p> Signup and view all the answers

    What is a common reason for falsely increased FDG uptake in PET imaging?

    <p>Presence of inflammation</p> Signup and view all the answers

    What normal variation is often observed in myocardial FDG imaging for fasting patients?

    <p>Intense left ventricular activity</p> Signup and view all the answers

    What factor complicates thyroid evaluations in FDG PET imaging?

    <p>Variability of normal thyroid activity</p> Signup and view all the answers

    Which condition is usually suspected if there is intense symmetrical uptake in the thyroid gland?

    <p>Graves disease</p> Signup and view all the answers

    Which area is known to present diagnostic challenges due to muscular or brown fat activity?

    <p>Neck and shoulders</p> Signup and view all the answers

    What can increase FDG uptake in patients, possibly leading to misdiagnosis?

    <p>Muscular tension and exercise</p> Signup and view all the answers

    In which circumstance may additional imaging help resolve diagnostic uncertainties?

    <p>In cases of unilateral neck activity</p> Signup and view all the answers

    What are glucose clamp protocols used for in FDG PET imaging?

    <p>To maintain constant glucose levels</p> Signup and view all the answers

    How does FDG uptake vary in patients with a history of muscle grinding or chewing?

    <p>Prominent activity in muscle groups</p> Signup and view all the answers

    What normal variation occurs frequently in diabetic patients on FDG PET imaging?

    <p>Heterogeneous activity despite controlled glucose levels</p> Signup and view all the answers

    What was the first cancer for which Medicare approved FDG PET scan reimbursement in 1998?

    <p>Non-small-cell lung carcinoma</p> Signup and view all the answers

    Which of the following cancers was added to CMS coverage for FDG PET scans in 2002?

    <p>Head and neck cancer</p> Signup and view all the answers

    What should patients with diabetes mellitus do before undergoing an FDG PET scan?

    <p>Continue their regular snacks and insulin injections.</p> Signup and view all the answers

    What characteristic of cancer cells contributes to increased FDG uptake compared to normal cells?

    <p>Higher intracellular enzyme activity</p> Signup and view all the answers

    Which factor can lead to inadequate tissue activity in FDG PET scans for diabetic patients?

    <p>High peripheral blood glucose levels.</p> Signup and view all the answers

    What is a primary concern when using FDG PET as a screening tool for cancer?

    <p>False positives due to benign processes</p> Signup and view all the answers

    What happens to FDG once it enters the cancer cell?

    <p>It accumulates as FDG-6-P due to metabolic trapping</p> Signup and view all the answers

    What is the main reason for patients to fast for 4 to 6 hours before FDG administration?

    <p>To limit competition from nonradioactive glucose.</p> Signup and view all the answers

    Which enzyme is primarily responsible for the phosphorylation of glucose in the first step of glycolysis?

    <p>Hexokinase</p> Signup and view all the answers

    What condition may cause complications during FDG PET studies in hospitalized patients?

    <p>Being on a dextrose solution.</p> Signup and view all the answers

    In which year did CMS release a decision to cover FDG PET scans for solid tumors for subsequent treatment strategies?

    <p>2013</p> Signup and view all the answers

    What is the purpose of injecting a saline flush after FDG administration?

    <p>To reduce venous FDG uptake in the arm.</p> Signup and view all the answers

    Which of the following is TRUE about FDG PET imaging in cancer diagnostics?

    <p>It may confuse benign processes as malignancies.</p> Signup and view all the answers

    Which patient condition requires careful management before a PET/CT examination?

    <p>Insulin-dependent diabetes mellitus.</p> Signup and view all the answers

    What type of facility's increase has been necessary for expanding PET services?

    <p>Cyclotron facilities</p> Signup and view all the answers

    What is a recommended preparation for patients prior to undergoing FDG PET scans?

    <p>Bring all medications to the appointment.</p> Signup and view all the answers

    What should be ensured regarding the patient before FDG administration?

    <p>They can tolerate the procedure.</p> Signup and view all the answers

    What is a potential advantage of using FDG as a radiopharmaceutical?

    <p>It aids in visualizing cellular glucose metabolism.</p> Signup and view all the answers

    What is the advised approach for type I diabetic patients before an FDG PET scan?

    <p>Fast and not inject insulin unless necessary.</p> Signup and view all the answers

    Which cancer types were covered by Medicare for FDG PET scans immediately following lung cancer?

    <p>Lymphoma, colorectal cancer, melanoma</p> Signup and view all the answers

    Why is it advisable to advocate for preauthorization with private insurance for FDG PET scans?

    <p>Coverage rules may vary and complicate access.</p> Signup and view all the answers

    How long should a patient with diabetes avoid dextrose solutions before an FDG PET scan?

    <p>6 to 8 hours.</p> Signup and view all the answers

    What role do membrane transport proteins play in FDG uptake by cancerous cells?

    <p>They assist in the import of glucose and FDG.</p> Signup and view all the answers

    What activity should be avoided by patients 24 hours prior to an FDG PET scan?

    <p>Strenuous exercise.</p> Signup and view all the answers

    What are patients advised to do with their bladder before a PET imaging sequence?

    <p>Completely void just before imaging.</p> Signup and view all the answers

    What is the most common adult dose of FDG administered to reduce radiation exposure?

    <p>10 mCi</p> Signup and view all the answers

    What is a potential consequence of retention in the reservoirs and catheter line tips during imaging evaluation?

    <p>Errors in chest wall evaluation</p> Signup and view all the answers

    What is a standard protocol for hydration before an FDG PET scan?

    <p>Remain well hydrated with water.</p> Signup and view all the answers

    Which imaging technique is commonly used for evaluating specific areas in oncology?

    <p>Limited-area scanning</p> Signup and view all the answers

    Which contrast media is commonly used to enhance radiographic visualization of low-contrast tissues?

    <p>Iodine</p> Signup and view all the answers

    What is the recommended procedure regarding the bladder immediately before imaging?

    <p>Void the bladder</p> Signup and view all the answers

    In the case of suspected cancer in the pelvis, which intervention is mentioned but may be counterproductive?

    <p>Placement of a urinary catheter</p> Signup and view all the answers

    What method is commonly employed to enhance the excretion of FDG?

    <p>Administration of diuretics</p> Signup and view all the answers

    Which scan type requires patients to be still for the entirety of the imaging sequence?

    <p>Dynamic imaging</p> Signup and view all the answers

    What is the recommended patient positioning during PET scans to minimize artifacts?

    <p>Supine with legs extended</p> Signup and view all the answers

    What key factor must be accounted for in imaging protocols regarding patient movements?

    <p>Likelihood of claustrophobia</p> Signup and view all the answers

    What is the purpose of incremental administration of oral contrast before imaging?

    <p>To increase radiographic visualization</p> Signup and view all the answers

    Which imaging procedure may involve a combination of PET with CT for optimal results?

    <p>PET/CT examination</p> Signup and view all the answers

    What is often done to improve tumor to soft tissue contrast over time during imaging?

    <p>Prolonged rest period post-injection</p> Signup and view all the answers

    What is the primary reason FDG accumulates in cancer cells?

    <p>Cancer cells use glucose differently from normal cells.</p> Signup and view all the answers

    What should patients do to ensure low peripheral blood glucose levels before an FDG PET scan?

    <p>Fast for 4 to 6 hours before the appointment.</p> Signup and view all the answers

    What is a potential effect of elevated peripheral blood glucose levels on FDG PET imaging?

    <p>Reduced contrast in the images.</p> Signup and view all the answers

    Which of the following situations requires additional consideration when preparing a patient for a PET scan?

    <p>If the patient had prior radiation therapy.</p> Signup and view all the answers

    What role does hexokinase play in FDG metabolism in cancer cells?

    <p>It transforms FDG into FDG-6-P at higher rates than in normal cells.</p> Signup and view all the answers

    What is the recommended action if a patient has elevated glucose levels before a PET scan?

    <p>Delay the scan until glucose levels normalize.</p> Signup and view all the answers

    How should communication be tailored for patients with language barriers before a PET scan?

    <p>Ensure that the facility has an interpreter if necessary.</p> Signup and view all the answers

    What is a key consideration during patient preparation to prevent FDG uptake in muscles?

    <p>Advise the patient against strenuous exercise for 24 hours.</p> Signup and view all the answers

    What precaution should be taken with diabetic patients before their PET scan?

    <p>Special protocols may need to be implemented.</p> Signup and view all the answers

    What effect does FDG-6-P have on cancer cells after uptake?

    <p>It becomes trapped in the cytosol and cannot be further metabolized.</p> Signup and view all the answers

    Why is patient positioning important during imaging?

    <p>To ensure a consistent breathing pattern for accurate measurements.</p> Signup and view all the answers

    What might be necessary if a patient cannot comply with procedural instructions due to hearing impairment?

    <p>Coordinate language assistance from family or professionals.</p> Signup and view all the answers

    What is a common misunderstanding regarding fasting periods before a PET scan?

    <p>Fasting ensures that the patient has low peripheral glucose levels.</p> Signup and view all the answers

    Why does the presence of inflammation around a gastrostomy tube show elevated FDG activity on a PET scan?

    <p>Inflammation increases the metabolic activity in nearby tissues.</p> Signup and view all the answers

    What is the recommended order for performing emission and transmission scans to minimize patient motion misalignments?

    <p>Transmission, Emission, Move, Transmission</p> Signup and view all the answers

    How does the CT scan in PET/CT scanners contribute to the imaging process?

    <p>It offers an attenuation-correction map with lower statistical noise.</p> Signup and view all the answers

    What duration is typically required for each transmission scan at a bed position using radioactive rod sources?

    <p>3 minutes</p> Signup and view all the answers

    What factor should be monitored throughout the PET/CT imaging to ensure patient safety and protocol adherence?

    <p>Patient compliance with imaging parameters</p> Signup and view all the answers

    What is usually the best practice for patient positioning when preparing for a PET/CT procedure?

    <p>Stabilize the patient's head and eliminate linen obstruction.</p> Signup and view all the answers

    What is the typical time interval recommended after injecting 18F-FDG before beginning imaging?

    <p>90 to 120 minutes</p> Signup and view all the answers

    Which organs demonstrate consistent intense activity in normal FDG distribution during PET imaging?

    <p>Brain and liver</p> Signup and view all the answers

    How does immobilization contribute to the PET/CT imaging process for radiation therapy candidates?

    <p>It mimics the treatment position to ensure accurate targeting.</p> Signup and view all the answers

    What should be done if a patient's blood glucose level is greater than 200 mg/dl before FDG injection?

    <p>Delay the imaging until the level is normalized</p> Signup and view all the answers

    What is typically the first step in the PET/CT procedure for oncology?

    <p>Verify patient identification and procedure order</p> Signup and view all the answers

    What is the consequence of patient movement during PET imaging?

    <p>Misalignment of scans and artifacts in images</p> Signup and view all the answers

    What method is used to reconstruct images after PET acquisition?

    <p>Statistical noise correction</p> Signup and view all the answers

    What must be done to the patient prior to injecting FDG?

    <p>Ask them to void to avoid contamination</p> Signup and view all the answers

    During a PET/CT procedure, which parameter relates to the timing of the imaging sequence?

    <p>Interval after FDG injection before imaging begins</p> Signup and view all the answers

    What is estimated to be the total number of new cancer cases diagnosed in the United States each year?

    <p>1.6 million</p> Signup and view all the answers

    Which imaging technology represents one of the most effective diagnostic tools in nuclear medicine?

    <p>Positron Emission Tomography (PET)</p> Signup and view all the answers

    What significant benefit has been demonstrated through the use of PET technology in medical imaging?

    <p>Increased resolution of images</p> Signup and view all the answers

    During what decade did PET technology begin to show value in cancer detection?

    <p>1980s</p> Signup and view all the answers

    Which of the following has significantly improved confidence in identifying areas of hypermetabolism in PET imaging?

    <p>Incorporation of computed tomography</p> Signup and view all the answers

    What aspect of oncology continues to face significant questions despite advancements in research and treatment?

    <p>Cancer staging and grading</p> Signup and view all the answers

    What was one of the primary focuses of initial PET development in the late 1970s?

    <p>Cardiac evaluations</p> Signup and view all the answers

    The increased use of PET technology has provided significant savings by avoiding which of the following?

    <p>Surgical interventions</p> Signup and view all the answers

    What is the typical dose range for injected FDG in adults during imaging?

    <p>5 to 20 mCi</p> Signup and view all the answers

    Which imaging technique is often used when a solitary pulmonary nodule is detected?

    <p>Limited-area imaging</p> Signup and view all the answers

    What is the primary purpose of administering a three-way stopcock in FDG injection?

    <p>To allow flush with saline post-injection</p> Signup and view all the answers

    In what scenario might urinary catheters be used during PET scanning?

    <p>To enhance imaging of the bladder</p> Signup and view all the answers

    What is the recommended wait time after injecting FDG before imaging?

    <p>60 to 90 minutes</p> Signup and view all the answers

    What is the effect of contrast media on the heart and renal system?

    <p>It can create adverse reactions</p> Signup and view all the answers

    Which imaging method is typically used to achieve better lesion detection?

    <p>Longer update times</p> Signup and view all the answers

    What positioning is recommended to alleviate pressure during imaging?

    <p>Prone position</p> Signup and view all the answers

    What should be checked before commencing a PET scan on a potentially claustrophobic patient?

    <p>The need for sedatives</p> Signup and view all the answers

    What is the purpose of dual time point imaging in PET scans?

    <p>To differentiate between benign and malignant tissues</p> Signup and view all the answers

    What range of body weight is used to calculate pediatric doses of FDG?

    <p>0.10 to 0.14 mCi/kg</p> Signup and view all the answers

    Why is patient cooperation critical during a PET scan?

    <p>To ensure high-resolution images</p> Signup and view all the answers

    What is a recommended action for patients before the imaging procedure?

    <p>Void their bladder</p> Signup and view all the answers

    Which protocol is essential for managing patients with significantly low or high glucose levels?

    <p>Policies for hypoglycemia management</p> Signup and view all the answers

    What role do immobilization devices play in PET/CT imaging?

    <p>They prevent fluctuations in patient position</p> Signup and view all the answers

    What can cause errors in the evaluation of the chest wall during imaging?

    <p>Retention in catheter lines</p> Signup and view all the answers

    What factor can significantly impact imaging quality in heavier patients?

    <p>Table sagging</p> Signup and view all the answers

    When undergoing PET imaging, why is it beneficial to void the bladder immediately before the procedure?

    <p>To avoid reconstruction artifacts</p> Signup and view all the answers

    Which imaging technique requires continuous imaging in a single position?

    <p>Dynamic imaging</p> Signup and view all the answers

    Which scanning protocol is commonly recommended for typical patients during PET scans?

    <p>Arms raised above the head</p> Signup and view all the answers

    What imaging method is recommended for gaining a comprehensive view of suspected malignancies throughout the entire body?

    <p>Total-body imaging</p> Signup and view all the answers

    What is the minimum imaging matrix recommended for PET scanners?

    <p>128 × 128</p> Signup and view all the answers

    What should be done to ensure patient safety before the scanning protocol begins?

    <p>Verify that no body parts will be pinched by the table</p> Signup and view all the answers

    What acquisition mode might be used in PET imaging depending on scanner capabilities?

    <p>Two-dimensional (2D)</p> Signup and view all the answers

    Why might the arms be positioned at the sides during head and neck imaging?

    <p>To obtain better visualization of small anatomic structures</p> Signup and view all the answers

    How can larger patients affect PET imaging acquisition times?

    <p>Acquisition times should be increased appropriately</p> Signup and view all the answers

    What should be adjusted in the CT parameters when scanning the head and neck region?

    <p>Use a zoom feature</p> Signup and view all the answers

    What issue can arise from motion artifacts during the CT and PET acquisitions?

    <p>Distortion in PET/CT interpretation</p> Signup and view all the answers

    What is a common reason for increased FDG uptake in diabetic patients during myocardial PET imaging?

    <p>Exercise and muscular tension</p> Signup and view all the answers

    Which pattern of FDG uptake in the thyroid is commonly associated with autoimmune disorders?

    <p>Intense symmetrical uptake</p> Signup and view all the answers

    What is a significant factor that can complicate FDG imaging results in the neck and shoulder regions?

    <p>Exercise-induced muscle tension</p> Signup and view all the answers

    Which of the following describes a normal variation of FDG accumulation around the mouth?

    <p>Prominence in the muscles of mastication</p> Signup and view all the answers

    What imaging studies are essential for confirming the presence or absence of a malignancy in cases of notable FDG uptake?

    <p>Biopsy and additional imaging</p> Signup and view all the answers

    What factor must be considered to achieve accurate results during myocardial PET imaging in fasting patients?

    <p>Blood glucose maintenance</p> Signup and view all the answers

    Why is activity in the supraclavicular region potentially misleading in FDG PET imaging?

    <p>It can resemble metastatic lymphadenopathy</p> Signup and view all the answers

    What normal variation may occur in the hearts of fasting patients during FDG PET scans?

    <p>Intense left ventricular activity</p> Signup and view all the answers

    Which condition is suggested by intense focal uptake of FDG in the thyroid?

    <p>Thyroid carcinoma</p> Signup and view all the answers

    What common imaging study complements PET imaging for accurate diagnosis in ambiguous cases of FDG uptake?

    <p>Sonography</p> Signup and view all the answers

    What is an important dietary recommendation for patients before fasting for FDG administration?

    <p>Maintain hydration</p> Signup and view all the answers

    Which factor may lead to inadequate tissue activity in patients with diabetes during FDG PET scans?

    <p>High peripheral blood glucose levels</p> Signup and view all the answers

    What is the recommended fasting period before the administration of FDG?

    <p>4 to 6 hours</p> Signup and view all the answers

    When preparing a diabetic patient for an FDG PET scan, what should be avoided in terms of insulin administration for type I patients?

    <p>Injecting insulin before the appointment</p> Signup and view all the answers

    What is the primary reason for assessing whether a patient is an inpatient or outpatient before a PET scan?

    <p>To manage fluid intake and diet</p> Signup and view all the answers

    What should be done with IV lines used for FDG injection if iodinated contrast will also be administered?

    <p>Use a compatible size catheter for both FDG and contrast</p> Signup and view all the answers

    Which of the following is not advisable for inpatient preparation before a FDG PET scan?

    <p>Administering dextrose solution</p> Signup and view all the answers

    What effect does ingestion of high carbohydrates have on FDG PET imaging results?

    <p>Causes competition for binding sites</p> Signup and view all the answers

    What is the impact of muscle exercise on FDG uptake?

    <p>Causes mild to intense uptake</p> Signup and view all the answers

    What additional steps should breast-feeding mothers take before FDG administration?

    <p>Pump enough milk for the next few days</p> Signup and view all the answers

    How long after FDG administration is localization typically recommended?

    <p>60 to 90 minutes</p> Signup and view all the answers

    What should be monitored in patients with diabetes during the preparation for FDG imaging?

    <p>Blood glucose levels and medication use</p> Signup and view all the answers

    In cases of patients undergoing PET scans, what should be documented accurately to prepare for their appointment?

    <p>Comprehensive medication list</p> Signup and view all the answers

    What is a key advantage of FDG in cancer imaging?

    <p>FDG cannot be metabolized and remains trapped in cancer cells.</p> Signup and view all the answers

    What preparation should a patient undergo before an FDG PET scan?

    <p>Fast for 4 to 6 hours before the appointment.</p> Signup and view all the answers

    What is a reason that FDG PET scans may yield inconclusive results in some cases?

    <p>Tumors may remain hidden within the normal imaging background.</p> Signup and view all the answers

    Which characteristic enables cancer cells to take up FDG more effectively than normal cells?

    <p>Cancer cells possess more glucose transport proteins.</p> Signup and view all the answers

    What patient factors should be assessed before an FDG PET scan?

    <p>Height, weight, fasting state, and diabetes history should be confirmed.</p> Signup and view all the answers

    What can occur if a patient has elevated blood glucose levels before an FDG PET scan?

    <p>Reduced tumor visibility due to competing glucose uptake.</p> Signup and view all the answers

    How should a patient be positioned during brain imaging for a PET scan?

    <p>Reclined with closed eyes in a dark and quiet room.</p> Signup and view all the answers

    What factor does NOT affect the image quality in FDG PET scanning?

    <p>Use of the correct glucose transporter proteins.</p> Signup and view all the answers

    What can happen if insulin is administered within 2 hours of FDG injection?

    <p>It reduces tumor FDG uptake, lowering image contrast.</p> Signup and view all the answers

    What could potentially enhance patient cooperation during PET imaging?

    <p>Ensuring clear communication and understanding of the process.</p> Signup and view all the answers

    What is one of the main disadvantages of using FDG as a PET imaging agent?

    <p>It may not effectively distinguish between tumors and normal tissues.</p> Signup and view all the answers

    What is the purpose of interlacing emission and transmission scans in PET imaging?

    <p>To facilitate simultaneous data acquisition and reduce patient motion.</p> Signup and view all the answers

    What role do hexokinase enzymes play in cancer cell FDG metabolism?

    <p>They transform FDG into FDG-6-P more rapidly than in normal cells.</p> Signup and view all the answers

    What is the typical duration of a transmission scan at each bed position?

    <p>3 minutes</p> Signup and view all the answers

    In what year did CMS first approve reimbursement for FDG PET scans in patients with solitary pulmonary nodules or non–small-cell lung carcinoma?

    <p>1998</p> Signup and view all the answers

    How do PET/CT scanners differ from traditional PET scanners in terms of transmission scans?

    <p>They generate attenuation-correction maps using CT scans.</p> Signup and view all the answers

    What is a necessary step to verify before starting a PET/CT procedure?

    <p>Confirm the patient's identification using two unique identifiers.</p> Signup and view all the answers

    Which cancers were covered by Medicare after their initial approval for FDG PET scans in 1999?

    <p>Melanoma and Lymphoma</p> Signup and view all the answers

    Why is it recommended to wait approximately 90 to 120 minutes after the injection of FDG before imaging?

    <p>To achieve a better ratio of tumor to soft tissue concentration.</p> Signup and view all the answers

    What is the first intracellular enzyme involved in the breakdown of glucose?

    <p>Hexokinase</p> Signup and view all the answers

    What is the primary reason that FDG cannot be transformed into fructose-6-phosphate?

    <p>Its chemical structure prohibits enzymatic breakdown</p> Signup and view all the answers

    What should be done if a patient's blood glucose level exceeds 200 mg/dl before a PET scan?

    <p>Do not administer FDG and postpone the procedure.</p> Signup and view all the answers

    Which factor is essential for determining the success of the PET/CT imaging procedure?

    <p>Compliance with necessary imaging parameters.</p> Signup and view all the answers

    What factor is primarily increased in malignant tumors that makes FDG PET imaging effective?

    <p>Higher levels of specific membrane transport proteins</p> Signup and view all the answers

    Which circumstance may lead to false positives in FDG PET scans?

    <p>Inflammation and infections</p> Signup and view all the answers

    Why might immobilization devices be used during a PET/CT examination?

    <p>To mimic the treatment position in radiation therapy.</p> Signup and view all the answers

    What does the CT scan provide during a PET/CT procedure in comparison to using radioactive sources for transmission scans?

    <p>Faster image acquisition time.</p> Signup and view all the answers

    What happens to FDG-6-P once it has entered the cytosol of a cell?

    <p>It accumulates within the cell.</p> Signup and view all the answers

    In normal FDG distribution, which organ is known to have moderate activity?

    <p>Liver</p> Signup and view all the answers

    What is the significance of FDG PET scans expanding in various cancer treatment centers?

    <p>Increased access to imaging tools for patients and physicians</p> Signup and view all the answers

    What happens to the soft tissue concentration of FDG over time following its injection?

    <p>It decreases gradually.</p> Signup and view all the answers

    Which of the following is a limitation identified in the use of FDG PET for cancer screening?

    <p>It may detect noncancerous conditions that mimic cancers.</p> Signup and view all the answers

    What method allows FDG to enter cells for imaging applications?

    <p>Facilitated diffusion through membrane proteins</p> Signup and view all the answers

    Which method facilitates the best understanding of variations in FDG localization?

    <p>Becoming familiar with hundreds of FDG PET studies.</p> Signup and view all the answers

    Which type of cancer was not initially approved for FDG PET scan reimbursement in 2002?

    <p>Thyroid carcinoma</p> Signup and view all the answers

    What aspect of tumor biology correlates with increased intracellular FDG uptake?

    <p>Higher viability and more aggressive tumors</p> Signup and view all the answers

    What is a critical aspect for patients regarding FDG PET imaging coverage by insurance?

    <p>It is subject to evaluation for preauthorization.</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with increased FDG uptake?

    <p>Stable chronic conditions</p> Signup and view all the answers

    Study Notes

    Cancer Types and Imaging

    • Leukemia: Cancers originating in blood cells. Subtypes include Chronic Lymphocytic Leukemia (CLL), Chronic Myeloid Leukemia (CML), Acute Lymphocytic Leukemia (ALL), and Acute Myeloid Leukemia (AML). CLL and CML primarily affect adults, while ALL and AML can affect both adults and children.

    • Thyroid Cancer: Common in women, including subtypes like papillary, follicular, Hurthle cell, medullary, and anaplastic. Approved for PET imaging since late 2003, similar imaging protocols are used as for head and neck cancers.

    • Lung Cancer: Includes Non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), squamous cell carcinoma, adenocarcinoma, large cell carcinoma, BAC. NSCLC is approved for solitary pulmonary nodule imaging since 1998. Imaging typically encompasses the neck to pelvis.

    • Hepatocellular Carcinoma: Cancer starting in the liver, affecting mainly men and those over 65. PET imaging can aid in staging and evaluating disease spread. Alphafetoprotein (AFP) blood tests can be used to assess disease.

    • Colorectal Cancer: Cancer in the colon/rectum. Approved for PET imaging in 1999 for staging, restaging, and diagnosis as well as reimbursement in 2009. Important to image rectum, lymph nodes for accurate evaluation.

    • Testicular Cancer: Rare but common solid tumor in young males (15-40). Includes seminomas (50%) and nonseminomas (50%). Seminomas are slow-growing, treatable with radiation; nonseminomas are faster-growing. FDG PET may help in staging and treatment response evaluations but large studies are limited compared to other cancer subtypes.

    • Lymphoma: Cancer in lymphatic system (lymphocytes, vessels, nodes). Includes Hodgkin lymphoma (primarily adolescents/young adults) and non-Hodgkin lymphoma (primarily adults). Approved for PET since 1999 for improved treatment evaluations. Lymph node involvement is critical to image.

    • Head and Neck Cancer: Affecting oral cavity, sinuses, larynx, etc. Often squamous cell carcinomas. Associated risk factors include tobacco and alcohol use. Approved for PET imaging in 2001 for diagnosis, staging, and treatment planning. Double scan protocol exists for comprehensive examination.

    • Thymomas: Rare thymic tumors (90% of thymic tumors are thymomas). Mostly affecting adults aged 40-60. PET may be used for staging and recurrence evaluation, but is optional for some initial assessment.

    • Breast Cancer: Cancer in breast cells, most frequently affecting females. Ductal and lobular subtypes exist. FDG/PET imaging approved in 2002. Imaging is performed with arms raised.

    • Pancreatic Cancer: Cancer in pancreas ducts. PET approved under CMS NCD and imaging includes neck to pelvis with arms held above the head.

    • Gynecological Cancers: Includes uterine (endometrial) cancer, often adenocarcinomas, and cervical cancer (often slow-growing, HPV-linked). PET coverage varies by cancer type, important to encompass all lymph nodes and organs within field of view, with arms raised.

    • Melanoma: Skin cancer that can arise in pigmented tissues. Diagnosed in stages 0-IV. FDG/PET imaging generally approved for general staging and treatment response evaluation, but some indications, such as in regional lymph nodes, remain uncovered. Total body imaging is crucial.

    • Myeloma: Cancer in bone marrow, diagnosed based on M protein levels, bony lesions, hemoglobin, and calcium. More frequent in men and rarely affecting under 50 year-olds

    • Unknown Primary Tumor (UPT/CUP): Metastatic cancer with unknown origin. CMS approval covers initial staging, typically with imaging from skull base to mid-thigh with arms raised.

    • Esophageal Cancer: Cancer of the esophagus, with squamous cell carcinoma and adenocarcinoma being common subtypes. Approved for PET imaging since 2001 and staging is important. Patients should fast and have blood glucose checked before imaging. Imaging is best done with arms above the patient's head.

    • Gastric Cancer: Stomach cancer, typically adenocarcinomas. It is important to evaluate for distant metastasis using PET imaging. Patients should fast and have blood glucose checked before imaging. Imaging is best done with arms above the patient's head.

    • Renal Cancer: Kidney cancer, most frequently renal cell carcinoma. Staging is an important use of PET imaging for this malignancy, ideally performed with arms held overhead.

    • Prostate Cancer: Prostate cancer, predominantly adenocarcinomas. PET imaging is less often covered for diagnosis but is useful for evaluating recurrence or metastatic spread. Recent agents may become important later.

    • Sarcoma: Cancer of connective tissues (bone, muscle, fat). Imaging from head to feet, arms by side.

    PET Radiopharmaceuticals

    • Numerous radiopharmaceuticals exist that target specific metabolic or biological processes.
    • Specific examples include: 18F-FLT, 18F-FMISO, 13NH3, 15O2, 82Rb-Chloride, 18F-Amyloid Florbetapir (Amyvid™) etc.
    • Each radiopharmaceutical has its specifics in terms of clinical applications, uptake mechanisms, production, procedure, and imaging parameters.

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    Test your knowledge on various types of cancers, including leukemia, thyroid, lung, and hepatocellular carcinoma. This quiz covers characteristics, demographics, and imaging protocols associated with each cancer type. Challenge yourself and learn about the critical role of imaging in cancer diagnosis and management.

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