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PET and PET/CT Study Guide Andrzej Moniuszko Adam Sciuk ● PET and PET/CT Study Guide A Review for Passing the PET Specialty Exam Andrzej Moniuszko Adam Sciuk Department of Nuclear Medicine Department of Radiology Resurrection Medical Center Resurrection Medical Center Chicago , IL , USA Chicago , IL , USA ISBN 978-1-4614-2286-0 ISBN 978-1-4614-2287-7 (eBook) DOI 10.1007/978-1-4614-2287-7 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2012947031 © Springer Science+Business Media, LLC 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) I would like to dedicate this work to my brother Jerzy, my sister-in-law Teresa, and my dear nieces Jola, Violetka, and Margie for all their help and indefatigable support at the beginning of my new medical journey. Andrzej Moniuszko To my lovely wife Kasia, son Jakub, and daughter Ola for their love, support, and inspiration. Adam Sciuk Preface The P ET and PET/CT Study Guide is designed for technologists, practitioners, and trainees in medical imaging to serve as a practical tool to study multiple aspects of PET and PET/CT. The book was written and reviewed by individuals from a wide spectrum of nuclear medicine expertise: an experienced nuclear medicine technologist, a new graduate of nuclear medicine technology program, a practicing nuclear medicine physician, and a nuclear medicine college teacher. A broad assembly of authors and contributors, with different nuclear medicine experiences, provides an array of problems that technologists, practitioners, and trainees can, and will, encounter in everyday practice. Some of the questions are easy, and some of them are not. In either case, the book is not designed to test the reader’s knowledge. Rather, it should be viewed as tool to learn and build the skills necessary in utilizing this compelling modality in daily practice. It is said that a picture is worth a thou- sand words. Our book includes more than 75 images, graphics, and diagrams. It is our goal for these illustrations to help readers get to the bottom of the problem and to come up with the right solution quickly. The book is divided into fi ve chapters and an appendix. We kick things off with a chapter on test taking strategies, which is designed to equip readers with practical tools and methods to successfully navigate through the multiple-choice exam. It was written by a recent graduate and the hands-on experience provides readers with valuable insider tips. Chapters 2–5 contain the test problems. Each test includes multiple-choice questions with a total number of 650 problems; chapters are organized into levels of complexity, from the easiest to the most dif fi cult. Generally, tagging questions as easy or dif fi cult is a tricky matter, and highly subjective. Nevertheless, for learning purposes, the proposed classi fi cation will be bene fi cial to readers. Each chapter is a separate entity with answers and optional short explanations included. This will work like building blocks, where the comple- tion of the fi rst test will prepare the reader to progress to the second test, and so on. Appendix A consists of the critical formulas, numbers, and normal range values for some of the quantitative nuclear medicine procedures. It is suggested, for those vii viii Preface preparing for the licensee examination, to commit these to memory; for others, it is for reference purposes only. Appendix B offers a list of commonly used abbreviations that are encountered in everyday nuclear medicine practice, and beyond. The list can appear as too short or simply too long. Some readers will fi nd the included terms as “unnecessary”; some readers will not fi nd the abbreviation they are looking for. One size never fi ts all, and thus the subjective choices, as is our selection, are not perfect. Use it to your advantage. There is enough space between the lines, and in the margins, to modify to your own preferences. Understanding the acronyms will pay off in the long run; simply being able to decode it, will be short-lived. Therefore, a thorough review of the abbreviations before the examinations can be very helpful, and highly suggested. Appendix C presents a glossary of frequently used terms in nuclear medicine, and again, we strongly advise a thorough review of the terms. Appendix D is comprised of web site addresses that offer priceless and free information on many topics related to the nuclear medicine fi eld. The present collection of problems mirrors the exam content as provided by NMTCB. The questions cover radiation safety, radionuclides, and instrumentation to name a few. The reader should never be discouraged when the type of “never heard of” or “it is over my head” problem is encountered. We advise students to go through these questions carefully, and answer diligently—you will be surprised how much you already know and how much you can still learn. Both factors serve as great motivators. Learning should be fun, entertaining, and contagious. Positron emission tomography is a powerful, challenging, and rapidly evolving fi eld of medicine and the only way to keep pace with its development is through continuous learning. Make it fun, and make it a habit—this is the kind of addiction that you can afford. The bene fi ts are overwhelming. You can receive the 24 continuing education credit hours and keep your professional license. You can read, you can study, you can investigate, and you can challenge yourself and others. Best of all you can exceed…your own expectations. The choice is yours. We want to thank Prof. Joanne Metler, Coordinator of Nuclear Medicine Technology Program, College of DuPage, IL, for her patience in reviewing our manuscript. Her dedication, helpful criticism, and detailed oriented effort deserve nothing but our sincere appreciation. It is beyond the scope of words to express our appreciation for the opportunity of knowledge and her enthusiasm, suggestions, inspiration, and encouragement to write this book. Thank you for being with us through every chapter of our book. We would also like to thank Mrs. Sabina Moniuszko for devotion and intractable eagerness when preparing diagrams and drawings we used in this book, to Dharmesh Patel for authoring math questions, and to Mr. George Chang, PACS coordinator, Resurrection Medical Center, for his priceless help in preparing clinical images. About the Authors Andrzej Moniuszko received an MD degree in 1977 from Medical University in Bialystok, Poland. In 1995 he moved to the US and two years later passed all exams required by the United States Medical Licensing Examination (USMLE). He completed a Nuclear Medicine Technology Program in College of DuPage, Glen Ellyn, IL and now works as a Nuclear Medicine Technologist in Resurrection Medical Center, Chicago, IL and holds CNMT, ARRT (N), PET and NCT certi fi cations. The dualistic nature of nuclear medicine, which combines interdisciplinary, state-of-the-art diagnostic imaging with the softer side of taking care of patients and helping people, perfectly fi ts Andrzej’s (Andy’s) personality. During the many years of his medical experience he has viewed revolutions of treatment regimens and transformations of imaging protocols. Through these changes he has learned that the only things that have not changed over time are the patients’ fears, worries, and concerns, all of which he calls a lesson in humbleness. Adam Sciuk is a polish-born physician who received his initial medical training at the Military Medical Academy in Poland. After fi nishing his internship he emi- grated to United States and completed Diagnostic Radiology residency program at the Louisiana State University in Shreveport. Throughout his residency he partici- pated in several clinical research projects, some of which resulted in presentations on the national level. For his achievements he was awarded with the Roentgen Resident/Fellow Research Award. Dr. Sciuk has also completed fellowships in Nuclear Medicine and Diagnostic Magnetic Resonance Imaging at the University of Wisconsin in Madison, where he focused on Positron Emission Tomography, its applications in oncology imaging, and correlation with whole body diffusion imaging. Dr. Sciuk is currently an attending radiologist at Resurrection Medical Center in Chicago where he combines clinical work with his research passion. ix