Nuclear Medicine: A Core Review

298 Pages·2015·17.584 MB·English

by  Chirayu Shah MD, Marques Bradshaw MD

Nuclear Medicine
A Core Review
EDITORS
Chirayu Shah, MD
Assistant Professor
Department of Radiology and Radiological Sciences
Vanderbilt University Medical Center
Physician in Medical Imaging
Tennessee Valley Healthcare System
Nashville, Tennessee
Marques Bradshaw, MD, MSCR
Assistant Professor of Radiology
Medical University of South Carolina
Charleston, South Carolina
Acquisitions Editor: Ryan Shaw
Product Development Editor: Lauren Pecarich
Production Project Manager: David Saltzberg
Senior Manufacturing Coordinator: Beth Welsh
Design Coordinator: Elaine Kasmer
Prepress Vendor: SPi Global
Copyright © 2016 by Wolters Kluwer
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Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services).
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Printed in China
Library of Congress Cataloging-in-Publication Data
Nuclear medicine (Shah)
Nuclear medicine : a core review / editors, Chirayu Shah, Marques Bradshaw.
p. ; cm. — (Core review series)
Includes bibliographical references and index.
ISBN 978-1-4963-0062-1
I. Shah, Chirayu, editor. II. Bradshaw, Marques, editor. III. Title. IV. Series: Core review series.
[DNLM: 1. Nuclear Medicine—Examination Questions. WN 18.2]
RC78.7.N83616.07'548076—dc23
2015028033
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LWW.com
To my parents, Yatin and Anjana Shah, whose unconditional love and support
allowed me to follow my dreams. They worked hard so that we didn't have to and put
our needs before theirs so that we could flourish.
To my wife, Payal Shah, for being there for me in my time of need, for her love and
support, and for allowing what appeared to be an eternity out of our personal time so
that one of my aspirations could come to fruition.
To our daughter, Kavya Shah, for coming into our lives and putting things in
perspective.
To my mentors, coworkers, and residents at the Vanderbilt University Medical Center
and The Nashville VA Hospital for their continued support and guidance.
—CHIRAYU SHAH

To my parents, Joyce and James Bradshaw, who sacrificed and worked long hours so
that I could achieve my dreams. To my family who always supported me and
encouraged me to continuing striving to be the best that I could be.
To my wife, Francesca Bradshaw, who loves me just because, who is always my rock,
who makes sure things are taken care of at home, while I strive to be the best clinician
educator that I can be.
To my children, Mckinley, Sydney, and Ethan, who allow me to just be dad, part-time
superhero, and full-time playmate. For never complaining when daddy has to go to
work.
To all of those who helped me along the way, be it getting into medical school, getting
into residency, teaching me how to do research, giving me career advice, keeping me
grounded, or merely being a friend in a time of need. I say thank you.
—MARQUES BRADSHAW
C O N T R I B U T O R S
Twyla Bartel, DO, MBA, FACNM
Associate Professor
Diagnostic Radiology
UAMS
Little Rock, Arkansas
Adam J. Bobbey, MD
Pediatric Radiology Fellow
Department of Radiology
Monroe Carell Jr. Children's Hospital at Vanderbilt
Nashville, Tennessee
Ishani Dalal, MD, MBBS
Senior Staff
Department of Radiology
Henry Ford Hospital
Detroit, Michigan
Jonathan David Perry, MD
Resident Physician
Department of Radiology
Medical University of South Carolina
Charleston, South Carolina
S E R I E S F O R E WO R D
Nuclear Medicine: A Core Review is the sixth book added to the Core Review Series. This book
covers the most important aspects of nuclear medicine in a manner that I am confident will serve as a
useful guide for residents to assess their knowledge and review the material in a question style format
that is similar to the ABR Core examination.
Dr. Chirayu Shah and Dr. Marques Bardshaw have succeeded in producing a book that
exemplifies the philosophy and goals of the Core Review Series. They have done an excellent job in
covering key topics and providing quality images. Please note that the review of the regulatory and
radiation physics aspects of the Radioisotope Safety Exam (RISE) will be covered in the Radiology
Physics and Safety volume of the Core Review Series. The multiple-choice questions have been
divided logically into chapters so as to make it easy for learners to work on particular topics as
needed. Each question has a corresponding answer with an explanation of not only why a particular
option is correct but also why the other options are incorrect. There are also suggested reading
provided for each question for those who want to delve more deeply into a specific subject. This
format is also useful for radiologists preparing for Maintenance of Certification (MOC).
The intent of the Core Review Series is to provide the resident, fellow, or practicing physician a
review of the important conceptual, factual, and practical aspects of a subject by providing
approximately 300 multiple-choice questions, in a format similar to the ABR Core examination. The
Core Review Series is not intended to be exhaustive but to provide material likely to be tested on the
ABR Core exam and that would be required in clinical practice.
As series editor of the Core Review Series, I have had the pleasure to work with many
outstanding individuals across the country who contributed to the series. This series represents
countless hours of work and involvement by many, and it would not have come together without their
participation.
Dr. Chirayu Shah, Dr. Marques Bradshaw, and their contributors are to be congratulated on doing
an outstanding job. I believe Nuclear Medicine: A Core Review will serve as an excellent resource
for residents during their board preparation and a valuable reference for fellows and practicing
radiologists.
Biren A. Shah, MD, FACR
Series Editor
P R E F A C E
The changing format of the certification process for the American Board of Radiology has altered the
way residents prepare for the exam. The most significant change has come in the form of the Core
Exam, an initial qualifying exam now taken 36 months after beginning the radiology residency
training. It is an image-rich computer-based exam designed to assess resident's comprehensive
understanding of disease processes, the physics behind image acquisition/manipulation, quality
control, and safety. Learners are now faced with the task of choosing the best multiple-choice
answers rather than proving to an oral examiner that they are an intelligent, safe radiologist. There
continues to be a paucity of reliable study materials designed with this Core Exam in mind. We hope
that this book will serve as a useful tool for residents as they not only prepare to take their boards but
also prepare to achieve their career goals.
Sometimes focus on an intermediate goal can make us lose sight of the ultimate goal. The ultimate
goal of every radiology resident should be to become the best radiologist possible. Unfortunately, this
aim is often clouded by pressure to pass the Boards. However, if there is an appropriate focus on the
ultimate goal, achieving that intermediate goal becomes less of an obstacle. With this in mind, we
have created a text containing 300 selective ABR Core Exam styled questions covering basic
concepts in Nuclear Medicine with which a resident would be expected to be familiar. The questions
are supplemented with detailed explanations of the findings and diagnosis as well as differential
diagnosis. References are provided for each question for those wishing to delve more deeply into a
specific subject. This format is also practical for radiologists preparing for Maintenance of
Certification. Within the confines of three hundred questions limit, we have tried to ensure that the
major topics were addressed. Our hope is that the pearls provided in the explanations/discussions
will not only help residents with the Core Exam but will also prove helpful in day to day practice.
Multiple colleagues have contributed to this publication. The quality and timely completion of
this book would not have been possible without the efforts of each of these intelligent, talented, and
committed individuals who took time from their busy lives to research, write, and submit material in
a timely manner. To all who helped, we offer our heartfelt thanks. Additionally, we would like to
extend thanks to the staff at LWW for this opportunity and for their guidance along the way. Finally,
we are truly grateful to our families who have encouraged us through this long process and supported
us each step along the way.
Chirayu Shah, MD
Marques Bradshaw, MD, MSCR
A C K N O W L E D G M E N T S
We would like to extend our heartfelt appreciation to Dr. Biren Shah for his guidance and support
throughout the process. We would also like to thank Dr. William H. Martin for sharing his precious
teaching files with us. This book would not have been as robust without his help. We would like to
thank Lauren Pecarich and Ryan Shaw at Lippincott for their help and support in timely completion
and publication of this book. We would also like to thank other staff members at Wolters Kluwer and
SPi Global who were integral in getting this book from the digital word document format to the final
finished product in less than 6 months, an impressive endeavor realizing how many pieces had to fall
in place.
C O N T E N T S
Contributors
Series Foreword
Preface
Acknowledgments

1 Radiopharmaceuticals
2 Endocrine System
3 Musculoskeletal System
4 Head and Neck
5 Nuclear Cardiology
6 Vascular and Lymphatics
7 Pulmonary System
8 Gastrointestinal System
9 Genitourinary System
10 Pediatric Nuclear Medicine
11 Other Oncology
12 Physics, Artifacts, NRC, Quality Control, and Safety
Index
1 Radiopharmaceuticals
QUESTIONS
1 Which one of the following photon energies is associated with this radiopharmaceutical?
A. 69 to 83 keV (Hg x-rays)
B. 140 keV
C. 159 keV
D. 93, 185, 300, and 395 keV
E. 171 and 240 keV
F. 364 keV
2 What is the physical half-life of the following radiopharmaceutical?