Pulmonary Ventilation Techniques Quiz
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Questions and Answers

What does the acronym VQ stand for in nuclear medicine?

  • Ventilation and Quantification
  • Ventilation Quantitative
  • Ventilation and Perfusion (correct)
  • Vascular Quality

    • What is the primary purpose of conducting lung scans?

  • To rule out pulmonary embolism (correct)
  • To assess lung capacity
  • To monitor post-operative lung function
  • To evaluate for chronic obstructive pulmonary disease

    • Which statement is true about the performance of lung scans?

  • They should only be performed in outpatient settings.
  • They must be performed in a single step only.
  • They can be scheduled weeks in advance for any condition.
  • They are usually ordered as immediate emergency procedures. (correct)

    • How does a low probability VQ scan differ from a high probability VQ scan for pulmonary embolism?

    <p>High probability indicates a greater likelihood of PE.</p> Signup and view all the answers

    What technique is used for a quantitative lung scan as part of nuclear medicine?

    <p>Xenon 133 gas ventilation</p> Signup and view all the answers

    During a VQ scan, what specific symptoms might a patient typically exhibit?

    <p>Shortness of breath and chest pain</p> Signup and view all the answers

    What is one of the steps to be followed when performing a VQ scan?

    <p>Performing ventilation and perfusion together</p> Signup and view all the answers

    What distinguishes a quantitative lung scan from traditional lung scans?

    <p>Quantitative scans measure the blood flow in the lungs.</p> Signup and view all the answers

    What is the approximate number of small capillaries in the lungs?

    <p>280 billion</p> Signup and view all the answers

    What is the typical ratio of right lung uptake to left lung uptake?

    <p>55% to 45%</p> Signup and view all the answers

    What is a potential complication of injecting micro emboli into the lungs?

    <p>Blockage of capillaries</p> Signup and view all the answers

    What does the VQ consist of?

    <p>Ventilation and perfusion studies</p> Signup and view all the answers

    What might cause the left lung to show less uptake than the right lung?

    <p>Overlay of the heart</p> Signup and view all the answers

    Which of the following is NOT typically included in a VQ scan?

    <p>Conductivity measurement</p> Signup and view all the answers

    How many regions are commonly compared in lung segment analysis?

    <p>4 regions</p> Signup and view all the answers

    When comparing total counts in lung segments, what is measured?

    <p>Counts from each segment and both lungs combined</p> Signup and view all the answers

    What might affect uptake percentages in lung studies?

    <p>Heart position relative to the lungs</p> Signup and view all the answers

    What study is usually a standalone examination in lung diagnostics?

    <p>Lung quantification</p> Signup and view all the answers

    What is usually indicated by the presence of a triangular wedge during a lung perfusion study?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which lung condition may show clumpy areas due to particle deposition?

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

    In a ventilation study, what does normal ventilation with abnormal perfusion indicate?

    <p>Pulmonary embolism</p> Signup and view all the answers

    What might be a consequence of using a larger amount of the isotope in patients with pulmonary hypertension?

    <p>Increased risk of respiratory distress</p> Signup and view all the answers

    How do obstruction presentations in lung imaging typically manifest?

    <p>Bronchial branching missing or reduced</p> Signup and view all the answers

    What does accelerated clearance of aerosols in lung imaging suggest?

    <p>Chronic interstitial lung disease</p> Signup and view all the answers

    Why is the perfusion portion crucial in lung studies?

    <p>To identify blood flow issues such as clots</p> Signup and view all the answers

    Which of the following is a contraindication for lung perfusion studies?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    What is the significance of the ventilation study in diagnosing conditions like COPD?

    <p>It correlates with chest X-ray findings</p> Signup and view all the answers

    What is the risk of using too many particles in the perfusion study?

    <p>Potential lung obstruction</p> Signup and view all the answers

    What happens to ventilation findings when a patient has a significant perfusion issue?

    <p>Ventilation may still appear normal</p> Signup and view all the answers

    What can significantly alter the imaging time in a perfusion study?

    <p>Amount of isotope administered</p> Signup and view all the answers

    For evaluating particulate deposition, which lung disorders are typically observed?

    <p>Obstructive lung disorders</p> Signup and view all the answers

    What is the biological half-life of xenon as described?

    <p>30 seconds</p> Signup and view all the answers

    Why is patient positioning crucial before administering the ventilation process?

    <p>To guarantee the lungs are visible within the camera's field of view</p> Signup and view all the answers

    What should be the expected appearance of the left lung during a normal ventilation scan?

    <p>A shadow from the heart creating a rounded appearance</p> Signup and view all the answers

    What is the characteristic gamma energy level for xenon used in lung scans?

    <p>81 KeV</p> Signup and view all the answers

    Which position is ideally preferred for the patient during the scanning process?

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

    What is the primary purpose of using a lead shielded container in this procedure?

    <p>To prevent radiation exposure</p> Signup and view all the answers

    What is a common result indicative of an abnormal ventilation scan?

    <p>Decreased activity in certain areas</p> Signup and view all the answers

    How long should radioactive materials typically be stored before disposal?

    <p>Ten half-lives</p> Signup and view all the answers

    How long should the mask remain on during the xenon lung scan?

    <p>1 minute</p> Signup and view all the answers

    What imaging orientation is not typically performed during ventilation imaging?

    <p>Upside down</p> Signup and view all the answers

    In the context of nuclear medicine, what does a physical half-life of 5.3 days imply?

    <p>Long-term radiation exposure risk</p> Signup and view all the answers

    What occurs during the 'wash out' phase of the lung scan?

    <p>The lungs begin to empty</p> Signup and view all the answers

    What could cause decreased activity in the lungs during imaging?

    <p>Poor venting of the lung</p> Signup and view all the answers

    Why is it preferable to conduct ventilation imaging before perfusion imaging?

    <p>Counts in the lungs are lower for ventilation</p> Signup and view all the answers

    What ensures effective visualization during a lung scan?

    <p>Clear instructions to the patient</p> Signup and view all the answers

    What issue might arise if a patient swallows a lot of contaminated saliva during the procedure?

    <p>Interference with image quality</p> Signup and view all the answers

    What does a ventilation scan typically show in cases of pulmonary embolism?

    <p>Normal ventilation and abnormal perfusion</p> Signup and view all the answers

    What is a common visual artifact found in the imaging process?

    <p>Stomach uptake</p> Signup and view all the answers

    What is one common challenge faced during the xenon administration process?

    <p>Gas escaping due to improper mask fit</p> Signup and view all the answers

    What technological device is utilized to survey radioactive materials before disposal?

    <p>GM survey meter</p> Signup and view all the answers

    What range of activity in the lungs should be expected during a normal xenon scan?

    <p>Uniform and symmetric wash in and wash out</p> Signup and view all the answers

    What happens if the oxygen flow is inadequate during the ventilation process?

    <p>The majority of the isotope escapes</p> Signup and view all the answers

    What is the role of the isotope marked on the patient during preparation?

    <p>To outline the correct positioning for imaging</p> Signup and view all the answers

    What is considered low gamma energy according to the information provided?

    <p>Below 150 Kev</p> Signup and view all the answers

    Which of the following might be visualized in addition to the lungs during imaging?

    <p>Trachea and bronchi</p> Signup and view all the answers

    What effect do ventilation and perfusion studies typically aim to highlight?

    <p>Mismatch areas</p> Signup and view all the answers

    What is an acceptable practice in nuclear medicine regarding image presentation?

    <p>Masking out unnecessary areas</p> Signup and view all the answers

    During the imaging process, what is an important step to minimize unwanted results?

    <p>Asking the patient to expel saliva</p> Signup and view all the answers

    What condition may cause a significant decrease in ventilation and slight decrease in perfusion?

    <p>Bacterial pneumonia</p> Signup and view all the answers

    What indicates fatty liver prevalent in certain individuals?

    <p>High liver retention with isotopes</p> Signup and view all the answers

    What may be indicated if one lung shows poor presentation in imaging?

    <p>Partial airway obstruction</p> Signup and view all the answers

    Which isotopes are commonly designed to target the lungs?

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

    How long is the biological half-life of xenon in ventilation imaging?

    <p>30 seconds</p> Signup and view all the answers

    What is the typical dose range for aerosol used in lung studies?

    <p>25 to 40 milliliters</p> Signup and view all the answers

    What is a recommended patient position during aerosol ventilation?

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

    What is the significant advantage of using DTA aerosol over xenon for imaging?

    <p>Longer stay in lungs</p> Signup and view all the answers

    What body part is most commonly targeted by isotopes during lung studies?

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

    What should be avoided during the inhalation procedure of aerosol?

    <p>Exhaling through the nose</p> Signup and view all the answers

    How does oxygen contribute to the aerosolization process during imaging?

    <p>It helps mix with the DTA to create a mist</p> Signup and view all the answers

    In patients with certain lung conditions, what is an important logistical consideration?

    <p>Ensure they remain upright during scanning</p> Signup and view all the answers

    What can high liver uptake during lung studies signify?

    <p>Fatty liver disease</p> Signup and view all the answers

    What is a common weight limit for tables used in lung scans?

    <p>350 to 400 pounds</p> Signup and view all the answers

    What might a reverse mismatch in lung scans indicate?

    <p>Pneumonia or atelectasis</p> Signup and view all the answers

    During a lung scan, how does scanning in an upright position affect the process?

    <p>It takes longer but can still produce good images.</p> Signup and view all the answers

    What is the primary benefit of administering a lower dose of particles to a patient?

    <p>It benefits the patient by minimizing exposure.</p> Signup and view all the answers

    What type of lung defect is characterized by wedge-shaped areas in the lungs?

    <p>Pulmonary embolism</p> Signup and view all the answers

    In which scenario should a chest X-ray be performed within one hour?

    <p>When the patient exhibits severe symptoms.</p> Signup and view all the answers

    What is the most common reason patients visit a nuclear medicine technologist?

    <p>Chest pain or shortness of breath</p> Signup and view all the answers

    What is the likelihood of pulmonary embolism at the low probability level?

    <p>10 to 19%</p> Signup and view all the answers

    What is the preferred method of injection for the radiopharmaceutical?

    <p>Straight stick injection.</p> Signup and view all the answers

    How many large mismatch segmental perfusion defects indicate a high probability of pulmonary embolism?

    <p>Two or more</p> Signup and view all the answers

    What procedure is commonly performed in conjunction with a lung scan?

    <p>Chest X-ray</p> Signup and view all the answers

    What is the consequence of injecting the radiopharmaceutical through tubing?

    <p>Potential loss of dosage due to stickiness.</p> Signup and view all the answers

    In what situations might a lung scan still be performed despite advancements in CT technology?

    <p>For highly claustrophobic or allergic patients</p> Signup and view all the answers

    What typically correlates with high probability of pulmonary embolism in lung scans?

    <p>Two large mismatch segmental defects</p> Signup and view all the answers

    What is indicated by a striped sign in lung imaging?

    <p>Possible emphysema or COPD</p> Signup and view all the answers

    What is the typical dose range for TEC Museum 99 M macro aggregated albumin?

    <p>2 to 6 milliliters.</p> Signup and view all the answers

    Why is it critical to use a negatively pressurized room when administering xenon gas?

    <p>To prevent xenon contamination in the external environment</p> Signup and view all the answers

    What is a significant risk associated with the longer half-life of xenon gas?

    <p>Increased contamination of the procedure room</p> Signup and view all the answers

    What is the role of the physician when interpreting lung scan data?

    <p>Making the final diagnosis</p> Signup and view all the answers

    Why should patients be maintained in a supine position during the perfusion study?

    <p>To ensure uniform distribution of the radiopharmaceutical.</p> Signup and view all the answers

    What percentage of the population is affected by subsegment defects?

    <p>7%</p> Signup and view all the answers

    What could happen if blood is drawn into the syringe before injecting the radiopharmaceutical?

    <p>Formation of blood clots in the syringe.</p> Signup and view all the answers

    Which component helps contain excess xenon during the procedure?

    <p>Xenon charcoal trap</p> Signup and view all the answers

    What result is considered normal after administering the radiopharmaceutical?

    <p>Homogeneous uptake throughout the lungs.</p> Signup and view all the answers

    What characterizes intermediate probability for pulmonary embolism?

    <p>20 to 79% likelihood</p> Signup and view all the answers

    What should a patient do during the 'wash in' phase when ventilation with xenon gas is initiated?

    <p>Take a deep breath and hold it</p> Signup and view all the answers

    Which lung condition correlates with a negative chest x-ray and matched ventilation defects?

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

    During which phase is dynamic imaging taken while using xenon gas for lung scans?

    <p>Equilibrium phase</p> Signup and view all the answers

    What should be done if intravenous administration is the only option for injection?

    <p>Ensure to flush the tubing thoroughly after injection.</p> Signup and view all the answers

    How long does the entire process of the xenon lung scan typically take?

    <p>60 seconds</p> Signup and view all the answers

    What might be the impact of a patient's claustrophobia during lung scanning?

    <p>Upright scanning may be necessary.</p> Signup and view all the answers

    What is the primary imaging concern if a patient has a pulmonary embolism?

    <p>Difficulty in diagnosing due to hot clots.</p> Signup and view all the answers

    What is a disadvantage of using xenon gas for lung imaging compared to CT scans?

    <p>Longer imaging time</p> Signup and view all the answers

    What defines a normal result in the context of pulmonary embolism assessment?

    <p>No perfusion defects with normal chest x-ray</p> Signup and view all the answers

    How should the patient be positioned following the injection to promote proper blood flow?

    <p>Supine with arms lifted.</p> Signup and view all the answers

    What is the main purpose of ventilation in nuclear medicine lung scans?

    <p>To assess airflow in the lungs</p> Signup and view all the answers

    What is the primary purpose of asking patients to take deep breaths before injection?

    <p>To enhance airflow and aid distribution in the lungs.</p> Signup and view all the answers

    Which type of imaging is typically performed in conjunction with the ventilation portion?

    <p>Perfusion imaging.</p> Signup and view all the answers

    Which patient population may not be suitable for a CT scan for lung imaging?

    <p>Patients with claustrophobia</p> Signup and view all the answers

    What flow rate is commonly set for delivering xenon gas during lung imaging?

    <p>12 liters per minute</p> Signup and view all the answers

    What imaging method has largely replaced lung scans for diagnosing pulmonary embolism?

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

    What is the primary treatment for a patient diagnosed with a pulmonary embolism?

    <p>Blood thinners and rest</p> Signup and view all the answers

    Why might a physician be cautious in diagnosing a pulmonary embolism?

    <p>To prevent misdiagnosis and subsequent liability</p> Signup and view all the answers

    What does a quantitative lung scan primarily evaluate?

    <p>Blood flow percentage in lung segments</p> Signup and view all the answers

    In the case of a quantitative lung scan, why is the posterior perfusion view considered most important?

    <p>It minimizes the effects of gravity on blood flow measurements</p> Signup and view all the answers

    What is necessary to make a proper diagnosis using imaging for pulmonary embolism?

    <p>A chest x-ray</p> Signup and view all the answers

    What is the minimum number of particles needed for effective imaging in a quantitative lung scan?

    <p>75,000 particles</p> Signup and view all the answers

    Which condition makes results from a quantitative lung study indeterminate?

    <p>Greater than 75% of the lung zone having obstructive lung disease</p> Signup and view all the answers

    What imaging technique is most commonly used for assessing airflow in the lungs?

    <p>Ventilation scan</p> Signup and view all the answers

    Why do patients need to remove items like jewelry during a quantitative lung scan?

    <p>To prevent artifacts in imaging results</p> Signup and view all the answers

    What would indicate a normal ventilation scan?

    <p>Clear triangular wedges in the perfusion</p> Signup and view all the answers

    What is the typical post-treatment requirement for patients treated with blood thinners for pulmonary embolism?

    <p>Continued blood thinner use after discharge</p> Signup and view all the answers

    What should the positioning of patients be during the injection for a quantitative lung scan?

    <p>Supine to prevent gravitational effects</p> Signup and view all the answers

    Which of the following lung scan views are usually included in a complete assessment?

    <p>Lateral, anterior, and posterior views</p> Signup and view all the answers

    Which imaging result indicates areas of concern for lung perfusion?

    <p>Triangular wedges indicating abnormalities</p> Signup and view all the answers

    Study Notes

    Learning Objectives

    • Differentiate Xenon 133 gas ventilation from ISM 99m DTA aerosol ventilation techniques.
    • Describe the perfusion lung scan process for pulmonary embolism (PE).
    • Explain the combined ventilation and perfusion process for VQ scans.
    • Differentiate between low and high probability VQ scans for PE.
    • Describe the process for a quantitative lung scan.

    Ventilation Scan

    • VQ scan assesses ventilation and perfusion (blood flow).
    • "VQ" originally had quantitative data for perfusion; now separate.
    • Primary purpose: rule out PE, often a medical emergency.
    • Performed as a stat procedure; sometimes scheduled.

    Ventilation Methods

    • Xenon Gas:
      • Used in a negatively pressurized room with exhaust to prevent contamination.
      • Gas can escape easily.
      • Administered via mask; 10-20 millicuries (mCi).
      • Room walls and surfaces can be contaminated due to escaping gas.
      • Long physical half-life (5.3 days); short biological half-life (30 seconds) impacts contamination risks.
      • Charcoal filter traps escaping gas.
      • Tight patient seal required to prevent contamination.
      • Gas flow is generally 12 liters per minute.
      • Patient takes deep breath for initial Xenon uptake.
      • Dynamic images during wash-in, equilibrium, and wash-out phases.
      • Scan takes approximately 60 seconds.
      • Proper patient positioning vital for lung visibility. Markers used on top of shoulders, left and right, and slightly below lungs.
    • DTA Aerosol:
      • Higher energy (140 keV) than Xenon.
      • Liquid radiopharmaceutical vaporized into an aerosol.
      • Administered via tight-seal mask and oxygen flow (10-12 liters/minute).
      • Typically lasts 5 minutes, allowing for re-administration if needed.
      • Patient can be positioned upright or supine; upright for better view, sometimes useful for larger patients.

    Perfusion Scan

    • Injects TEC-99m-macroaggregated albumin (MRA; radiopharmaceutical) into vein.
    • Straight stick injection preferred to avoid tubing contamination.
    • Administered 2-6 millicuries (mCi).
    • Patient placed in supine position.
    • Requires 75,000-700,000 particles for optimal viewing, avoiding clots when possible.
    • Images acquired for each acquisition view (anterior, posterior, lateral, oblique).
    • Acquisition views are matched with corresponding ventilation view.
    • Important to have patient take deep breaths and cough to distribute the isotope through the lungs.

    Quantitative Lung Scan

    • Measures lung function.
    • Usually a perfusion-only scan.
    • Injects MRA radiopharmaceutical.
    • Patient in supine position (to prevent gravity effects).
    • Regions of interest (ROIs) drawn on images.
    • Software quantifies relative blood flow to different lung segments.
    • Normal ratio: Approximately 55% right lung, 45% left lung (left lung often slightly lower due to heart overlay).

    Results Interpretation (for all scans)

    • Normal Results: Uniform blood flow and vent activity throughout lungs.
    • Abnormal Results (Ventilation): In cases of pulmonary embolism, ventilation should be normal; perfusion will show abnormalities. (low flow areas)
    • Abnormal Results (Perfusion): Triangular-shaped defects (wedges), decreased blood flow. These indicate likely PE.
    • Other Results:
      • COPD/Emphysema: patchy uptake, clumping.
      • Bacterial pneumonia: ventilation and perfusion decreased.
      • Fatty liver (alcoholism, obesity): isotope uptake in liver.
      • Collapsed lung: missing or very weak vent activity on one side.
      • Bronchial obstruction, less ventilation distal to the obstruction.

    Diagnosis Probability

    • Low (0-10%), moderate (20-79%) or high (>80% probability): Based on extent/location of perfusion defects in combination with other radiographic evidence (X-ray, etc.).

    Importance of Correlation

    • Ventilation and perfusion scans must be interpreted together with a chest X-ray. Chest X-ray is extremely important for correlation

    Additional Precautions for All Scans

    • Maintain tight seals.
    • Ensure patient's head and lungs remain in the proper position during scans for ventilation and perfusion.
    • Shield radiopharmaceuticals appropriately.
    • Follow departmental protocols for isotope disposal.

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    Description

    This quiz focuses on various ventilation techniques used in pulmonary assessment, including the differences between Xenon 133 gas and ISM 99m DTA aerosol ventilation. It covers the perfusion lung scan process for pulmonary embolism, as well as the combined ventilation and perfusion processes for VQ scans. Enhance your understanding of the complexities of lung scans and their clinical applications.

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