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nucs
nucs
52
Medical
Post-Graduate
04/29/2013

Additional Medical Flashcards

 


 

Cards

Term
1
stop breastfeeding
1. technetium
1. fdg
1. indium
1. thallium
1. I 123
1. I 131
1. gallium
Definition
1. technetium, fdg: 1 d
1. indium, thallium, I 123: 3d (~1 wk)
1. gallium: if pt not willing to cease breastfeeding then stop for 4 wks.
1. I 131 cessation
exactly what requisites say
(1. can resume breast feeding after 4 half lives from face the case)
Term
2
major spill
1. I 131
1. indium
1. gallium
1. I 123
1. thallium
1. technetium
1. FDG
Definition
1. > 1 mCi I 131.
1. > 10 mCi indium, I 123, gallium,
1. > 100 mCi of technetium, thallium
1. > 15 mCi of FDG
-the only patient doses that make a major spill are gallium, indium, and I 131 and fdg pet
-this card has been confirmed with http://mpcphysics.com/documents/RadioactiveSpillWorkbook1007.pdf
Term
3
written directive required if
Definition
1. I 131 does more than 30 mCi
1. must be signed by an authorized user (board certified and minimum hours of training)
1. our written directive: signature to administer
Term
4
how to receive radioactive package
1. category I
1. category II
1. category III
1. wipe test: when report to rso?
1. when have to check packages?
Definition
1. put on gloves
1. if damaged, call the radiation safety officer
1. use survey meter at surface then 1 m.
1) category I white: < 0.5 mrem/hr
2) category II yellow: < 50 mrem/hr. at 1 m, < 1 mR/hr
3) category III yellow: < 200 mrem/hr. at 1 m, < 10 mR/hr
-if package substantially different from category then call RSO
1. perform wipe test
a. if > 6600 dpm/300 cm2: call rso
1. open package
1. check that package insert matches the product.
1. check product for damage
1. do wipe test
1. check material to discard for radioactivity using survey meter. if greater than background then place with radioactive waste. if < background then remove labels and place in regular trash.
1. maintain record of receipt.
1. if volatile (liquid I 131) then use fume hood (if on the paper on the inside will point up)
1. check packages
a. work hour: within 3 hours of receipt
a. non work hours: within 3h of start of next business day.
Term
5
how to use survey meter
Definition
1. make sure that battery working
1. switch on before going near source
1. check source cesium on the side
1. place on x 10 or x 100 setting then lower setting if nothing detected (try to detect higher levels first)
1. survey meter should be documented: name of surveyor, survey meter # and serial #, date.
1. should pass within 2 cm of area without getting contaminated.
Term
7
upper limit of Mo99
Definition
-0.15 uCi Mo99/mCi Tc
-check the amount of Mo99 by placing the elution into a special lead pig. only Mo99 can be detected through the special lead pig.
Term
8
maximum permissable aluminum
Definition
10 ug/ml max aluminum
test with indicator paper which turns red if too much aluminum
Term
9
what to do if minor spill or major spill
Definition
minor spill
1) Notify persons in the area that a spill has occurred
1) Cover the spill with absorbent paper
3) if clothing contaminated, remove and place in plastic bag
1) if person if contaminated, rinse region with lukewarm water and wash with soap
3) Wearing protective clothing, gloves, lab coat
4) Place the paper towels and anything contaminated in plastic bag that goes into radioactive waste
5) Place the bag into a radioactive waste container
6) Survey the area with a Geiger Muller counter
7) Report the incident to the RSO
-----------------------
major spill.
1) Notify all individuals in the vicinity and clear the area
2) Prevent the spread of the spill with paper towels
3) Shield the source if possible, use lead bricks or the thick acrylic plastic shields
4) Close access to the area. have sign.
5) Notify the RSO IMMEDIATELY and rso directs clean up
6) Decontaminate personnel by removing contaminated clothing and washing contaminated skin
Term
14
dose calibrator
1. what is it?
1. discriminate energy?
1. QC:
Definition
1. ionization chamber
1. cannot discriminate energy
1. QC:
a. daily: constancy (aka precision). cesium 137 should have less than 5 % variance
a. quarterly: linearity. watch the decay of Tc pertechnetate. checks from 10-200 mCi. should be within 10%
a. annually: accuracy. should agree within 10%
a. geometry: at installation and after repairs. compensated measurement due to different containers and dilutions
Term
15
well counter qc daily
Definition
well counter qc daily
1. energy peaking
1. background
1. constancy
Term
16
how to perform vq scan in pregnant patient
Definition
1. give only perfusion dose 1 mCi of Tc MAA
Term
17
when release after I 131 dose and instructions.
radiation to family members should be
Definition
1. if
a. < 30 mCi dose then can discharge after 15 min observation
a. inpatient stay if dose > 30 mCi I 131
a. if > 30 mCi then discharge when exposure rate at 1 m < 2 mrem/hr (our institution so that we don't have to give written instructions).
a. face case says: release without instructions if tede (total effective dose equivalent) < 1 mSv

1. other directions
a. sleep alone 1 week
a. avoid prolonged contact with visitors for 3 d (< 6 feet away)
a. flush toilet twice, don't prepare food, use separate utensils, use own bathroom
a. avoid mucous membrane/ fluid contact
Term
18
travel after dose
1. fdg pet
1. technetium
1. thallium
1. I 131
Definition
1. fdg pet: detectable for 1 d
1. technetium: detectable 3 (or 4) d
1. thallium: detectable 1m
1. I 131: detectable 3m
-can write letter with date, patient's name, dose, when administered, 1/2 life, 24 hour contact
http://www.snm.org/index.cfm?PageID=5660
Term
19
annual nrc dose limit for
1. occupational worker
a. lens
a. skin
a. extremities
1. pregnant occupational worker
1. minor occupational worker
1. member of the public
Definition
1. if pregnant, an extra dosimeter can be worn around the abdomen.
1. if person might get 1/10th of the occupational limit of 5 rem/yr then should wear badge. if secretary is near patients who have been injected then she may need to wear a badge also. 1rem = 10mSv
1. nrc annual dose limit
a. occupational worker 5 rem/year=50 mSv/year
1) 15 rem/yr lens = 150 mSv/year
1) 50 rem/yr skin/extremities=500 mSv/year
a. general public 0.5 rem/yr= 5 mSv/year
a. occupational worker who has declared pregnancy 0.5 rem/pregnancy = 5 mSv/yr
a. minor occupational worker: 0.5 rem/year
1. member of the public
a. 0.1 rem/yr= 1 mSv/yr
a. < 2 mrem/hr on average
Term
20
radioactive waste disposal
Definition
1. if half life < 120 days then decay in storage
a. separate into containers with half life. when full, mark with date, initials, isotope and exposure rate.
a. store for 10 half lives.
a. discard in regular trash without labels if survey meter show activity < background
1. if half life > 120 d then RSO to manage
Term
21
survey meter
Definition
1. daily qc: battery, background, constancy,

1. survey meter daily
a. unrestricted area should be < 2 mrem/hr
a. restricted area can be > 5 mrem/hr at 30 cm. sign need to be posted in restricted area > 5 mrem/hr at 30 cm. warning about pregnant and breastfeeding patients

1. wipe test weekly: wipe 5 areas in each room over 300 cm2.
a. if any area is > 6600 dpm/300 cm2 then call rso.
-----------------------
a. if Tc 99m. < 200 dpm for unrestricted area and < 2,000 dpm for restricted area.
a. if I 131. < 2,000 dpm for unrestricted area and < 20,000 dpm for restricted area.
a. http://books.google.com/books?id=i6z49rvtl3UC&pg=PA318&dq=wipe+test+weekly+nuclear+medicine&hl=en&sa=X&ei=tLiYUcCIDKjTyAGpv4G4Ag&ved=0CEoQ6AEwAw#v=onepage&q=wipe%20test%20weekly%20nuclear%20medicine&f=false

http://books.google.com/books?id=NFo28VB5MtsC&pg=PA129&dq=wipe+test+weekly+nuclear+medicine&hl=en&sa=X&ei=tLiYUcCIDKjTyAGpv4G4Ag&ved=0CD8Q6AEwAQ#v=onepage&q=wipe%20test%20weekly%20nuclear%20medicine&f=false

(1. daily: survey meter. restricted and unrestricted areas should be < 2 x background. if restricted area has > 2 x background, decontaminate and repeat again)
Term
22
medical incident vs. medical event
Definition
1. wrong route
1. wrong dose > 20% error (10% illinois)
1. wrong pharmaceutical
1. wrong patient
1. unintended permanent non intentional damage as deemed by physician
and

-medical event >
1. 5 rem (50 mSv) whole body dose , 50 rem (500 mSv) organ / tissue.
1. need to notify nrc/state regulatory commission and physician/patient within 24 hours.
1. notify in writing nrc within 15 days
1. maintain records for 10 years
-----------
medical incident: if <
1. whole body dose adult < 5 rem (50 mSv)
1. organ dose < 50 rem (500 mSv)
Term
26
in vitro ultratag kit
Definition
In Vitro (Ultratag) 98% labeling
• Add 1-3 ml of blood (heparin as an anticoagulant) to regent vial (Stannous chloride ).
• Add syringe 1 (Na Hypochlorite)
• Add syringe 2 (Citric acid, sodium citrate and dextrose)
• Add 10-100 mCi of Tc99 pertechnetate to vial.
allow to react for 20 min.
Term
28
gamma/spect qc: daily, weekly, quarterly
Definition
1. daily: energy peaking, uniformity
1. weekly: spatial resolution and linearity with 4 bar phantom and center of rotation
1. quarterly: tomographic uniformity and overall system performance (Jaszczak phantom)
Term
30
hot sink allows
Definition
1 Ci per year
Term
31
what cannot be found on wipe test
Definition
xe 133
Term
32
if found out 5 wks pregnant 3 hours after dose
Definition
give iv fluids and frequent voiding
1. giving sski doesn't work to block fetal thyroid as fetal thyroid doesn't take up iodine prior to 10-12 weeks
1. everything absorbed in 1st 1-2 hours so inducing vomiting won't help.
Term
33
contrast extravasation
Definition
1. elevate arm above heart
1. warm or cold compresses
1. observe. release if improving or no other new signs occur. if discharge, instruct patient about getting evaluation if paresthesias.
1. get surgery consult if worried about compartment syndrome like paresthesia, poor capillary refill, skin blistering or ulceration.
Term
34
urticaria
Definition
1. benadryl 50 mg PO/IM/IV
1. if severe or widely disseminated: epinephrine (1:1,000) 0.1 mg (0.1cc) sq
Term
35
facial or laryngeal edema
Definition
1. 10L via mask
1. epinephrine (1:10,000) 0.1 mg (1cc). repeat up to 1 mg.
1. call cardiopulmonary response team
Term
36
bronchospasm
Definition
1. 10L via mask
1. albuterol 2 puffs. repeat as necessary.
1. epinephrine (1:10,000) 0.1 mg (1cc). repeat up to 1 mg
1. call cardiopulmonary response team if needed.
Term
37
hypotension with tachycardia
Definition
1. 10L via mask
1. elevate legs 60 degrees or more (preferred) or trendelenburg position
1. monitor:ekg, pOx, vital signs
1. IV Normal saline
--------
1. if poorly responsive, epinephrine (1:10,000) 0.1 mg (1cc). repeat up to 1 mg. q 3-5 min.
1. if still poorly responsive, call cardiopulmonary resuscitation.
Term
38
hypotension with bradycardia
Definition
1. 10 L/min via mask
1. elevate legs 60 degrees or more (preferred) or trendelenberg position
1. monitor ekg, pOx, vital signs
1. IV normal saline
-----------
1. give atropine 1 mg slow IV push q 3-5 min. repeat up to 3 mg.
1. can also place transcutaneous pacer.
Term
39
severe hypertension
Definition
1. 10 L/min via mask
1. monitor ekg, pOx, vital signs
---------
1. ntg 0.4 mg SL. may repeat x 3.
1. if no response: consider labetalol 20 mg IV then repeat q 10 min up to 300 mg.
1. can use phentolamine 5 mg IV for pheochromocytoma
1. transfer to ER or ICU
Term
49
seizures
Definition
1. 10 L/min via mask
-----------
1. versed 1 mg IV or valium 5 mg IV
1. if longer effect needed, consider dilantin (15 mg/kg) at 50 mg/min
1. monitor for respiratory depression
1. consider cardiopulmonary response team for intubation if needed.
Term
41
pulmonary edema
Definition
1. 10 L/min via mask
1. elevate torso
----------
1. give lasix 40 mg IV slow push
1. consider morphine 1mg IV
1. transfer to icu or er
Term
42
common radionuclides, half life and kev
Tc, fdg, I 123, thallium, indium, gallium, I 131, cobalt
Definition
Tc 140 kev 6h
F18 511 kev 110 min
I 123 ~150 (159) kev, 1/2 day
thallium 3d, ~100, 200 (70, 167) kev
indium 111 3d. 100, 200 (173, 247) kev
gallium 3d, 100, 200, 300 (93, 185, 300) kev
I 131 8d ~ 350 (364) kev
cobalt 122 kev. 270 d
Term
44
monitoring packages received
Definition
-3h during work or within 3h of start of business day if not during work hours
-wipe test < 6600 dpm/300 cm2
Term
3740
collimators and when to use them
1. high energy
1. medium energy
1. low energy
1. pinhole
Definition
1. high energy: I 131
1. medium energy: gallium, indium
1. low: technetium, thallium
1. pinhole: thyroid, pediatrics (e.g. hips)
1. resolution depends upon size of the apertures of the collimators among other things as per internet
Term
45
contrast reaction prophylaxis
Definition
1. PO: prednisone 50 mg 13, 7, 1 hour prior to exam. benadryl 50 mg 1 hour prior
1. IV: hydrocortisone 200 mg IV q 4 hours until exam. benadryl 50 mg IV 1 hour prior to exam
Term
bones
Definition
Tc 99 MDP bone scan 20 mCi at 3h
Term
bones and hot liver
Definition
a. Tc sulfur colloid (3 mCi at 10 min for liver-spleen study,

b. Tc sulfur colloid 10 mCi at 3 min for bleeding study and at 2h for bone marrow study

c. Tc sulfur colloid 100 uCi in each of the 4-6 tuberculin syringes for lymphoscintigraphy

d. 1 mCi in (age+2) x 30 cc for reflux)

e. Tc 99 sulfur colloid can also be used for gastric emptying study. 1 mCi.
Term
bones and hot spleen
Definition
bones and hot spleen: Indium 111 labeled wbc (500 uCi 24h) or Tc labelled wbc (10 mCi 2h).
Term
lacrimal gland
Definition
gallium 67 citrate: 5 mCi, 48 h.
Term
1. liver and heart and salivary gland (parotid)
1. bowel, thyroid, lungs, uterus/prostate
Definition
I 123 MIBG (I 123 10 mCi at 2 d (can use I 131 1 mCi for treatment). need to pre treat with Lugol's solution.
Term
Tc pertechnetate
Definition
Tc pertechnetate:

a. 5 mCi for thyroid 20 min

b. 10 mCi for Meckel's in adults dynamic

c. scrotal scintigraphy 10 mCi flow and blood pool.
Term
Tc sestamibi
Definition
Tc sestamibi:

a. for parathyroid 20 mCi 20 min and 2h.

b. for cardiac 10 mCi at rest and 30 mCi at stress.
Term
I 131
Definition
a. 2 mCi diagnostic at 2d

b. ablative therapy. 100 mCi for thyroid cancer, 150 mCi for lymph node positive, 200 mCi for mets to lung, 250 mCi for mets to bone. image 6d.

c. grave's 10 mCi (100 uCi/g/RAIU)

d. toxic adenoma 30 mCi.
Term
Tc labeled rbc
Definition
Tc labeled rbc 20 mCi, dynamic. ultratag kit
Term
hepatobiliary scan
Definition
5 mCi Tc mebrofenin. wait 1h and can give morphine (0.04 mg/kg like around 2mg) then wait 30 min more
Term
bone and very hot liver
Definition
prostascint
5 mCi of Indium 111 cabromab pendetide (prostascint) 4d (need to give 2 mCi of Tc labeled rbc b4 scan)
Term
hot spleen and kidney
Definition
Indium 111 octreoscan 4 mCi 4h and 24h
Term
SPECT cerebral perfusion imaging
Definition
SPECT cerebral perfusion imaging:

a. Tc HMPAO (ceretec) or Tc ECD (neurolite) 20 mCi at 20 min

b. PET imaging: 10 mCi of FDG, image after 45-60 min
Term
MAG
Definition
1. Tc MAG 3 (tubular) agent 10 mCi
1. (don't use Tc DTPA 10 mCi, which is GFR agent and only used for to calculate GFR)
Term
DMSA
Definition
Tc DMSA 3 mCi in 3h
Term
VQ scan
Definition
a. if not on vent: 1st: Xe 133 20 mCi then 2nd: Tc MAA 5 mCi.

b. if on vent: 1st: Tc MAA 5 mCi then 2nd Tc DTPA 30 mCi
Term
cck dose
Definition
cck 0.02 ug/kg over 30 min then get EF
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