Term
1
stop breastfeeding
1. technetium
1. fdg
1. indium
1. thallium
1. I 123
1. I 131
1. gallium |
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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) |
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Term
2
major spill
1. I 131
1. indium
1. gallium
1. I 123
1. thallium
1. technetium
1. FDG |
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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 |
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Term
3
written directive required if |
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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 |
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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? |
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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. |
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Term
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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. |
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Term
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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. |
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Term
8
maximum permissable aluminum |
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Definition
10 ug/ml max aluminum
test with indicator paper which turns red if too much aluminum |
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Term
9
what to do if minor spill or major spill |
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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 |
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Term
14
dose calibrator
1. what is it?
1. discriminate energy?
1. QC: |
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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 |
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Term
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Definition
well counter qc daily
1. energy peaking
1. background
1. constancy |
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Term
16
how to perform vq scan in pregnant patient |
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Definition
| 1. give only perfusion dose 1 mCi of Tc MAA |
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Term
17
when release after I 131 dose and instructions.
radiation to family members should be |
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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 |
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Term
18
travel after dose
1. fdg pet
1. technetium
1. thallium
1. I 131 |
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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 |
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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 |
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Term
20
radioactive waste disposal |
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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 |
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Term
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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) |
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Term
22
medical incident vs. medical event |
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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) |
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Term
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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. |
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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) |
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Term
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Definition
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Term
31
what cannot be found on wipe test |
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Definition
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Term
32
if found out 5 wks pregnant 3 hours after dose |
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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. |
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Term
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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. |
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Term
|
Definition
1. benadryl 50 mg PO/IM/IV
1. if severe or widely disseminated: epinephrine (1:1,000) 0.1 mg (0.1cc) sq |
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Term
35
facial or laryngeal edema |
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Definition
1. 10L via mask
1. epinephrine (1:10,000) 0.1 mg (1cc). repeat up to 1 mg.
1. call cardiopulmonary response team |
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Term
|
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. |
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Term
37
hypotension with tachycardia |
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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. |
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Term
38
hypotension with bradycardia |
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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. |
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Term
|
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 |
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Term
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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. |
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Term
|
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 |
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Term
42
common radionuclides, half life and kev
Tc, fdg, I 123, thallium, indium, gallium, I 131, cobalt |
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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 |
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Term
44
monitoring packages received |
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Definition
-3h during work or within 3h of start of business day if not during work hours
-wipe test < 6600 dpm/300 cm2 |
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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 |
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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 |
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Term
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Definition
| Tc 99 MDP bone scan 20 mCi at 3h |
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Term
|
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. |
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Term
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Definition
| bones and hot spleen: Indium 111 labeled wbc (500 uCi 24h) or Tc labelled wbc (10 mCi 2h). |
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Term
|
Definition
| gallium 67 citrate: 5 mCi, 48 h. |
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|
Term
1. liver and heart and salivary gland (parotid)
1. bowel, thyroid, lungs, uterus/prostate |
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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. |
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Term
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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. |
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Term
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Definition
Tc sestamibi:
a. for parathyroid 20 mCi 20 min and 2h.
b. for cardiac 10 mCi at rest and 30 mCi at stress. |
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Term
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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. |
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Term
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Definition
| Tc labeled rbc 20 mCi, dynamic. ultratag kit |
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Term
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Definition
| 5 mCi Tc mebrofenin. wait 1h and can give morphine (0.04 mg/kg like around 2mg) then wait 30 min more |
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Term
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Definition
prostascint
5 mCi of Indium 111 cabromab pendetide (prostascint) 4d (need to give 2 mCi of Tc labeled rbc b4 scan) |
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Term
|
Definition
| Indium 111 octreoscan 4 mCi 4h and 24h |
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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 |
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Term
|
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) |
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Term
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Definition
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Term
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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 |
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Term
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Definition
| cck 0.02 ug/kg over 30 min then get EF |
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