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Nuclear Medicine Board Review
Questions and Answers for Self-Assessment
Second Edition
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Nuclear Medicine Board Review
Questions and Answers for Self-Assessment
Second Edition
C. Richard Goldfarb, M.D.
Associate Professor ofNuclear Medicine
Albert Einstein College ofMedicine
Bronx, New York
Chief, Division ofNuclear Medicine
Beth Israel Medical Center
New York, New York
Steven R. Parmett, M.D.
Assistant Professor ofRadiology
Mount Sinai Medical Center
New York, New York
Lionel S. Zuckier, M.D.
Associate Professor ofNuclear Medicine
Albert Einstein College ofMedicine
Bronx, New York
Fukiat Ongseng, M.D.
Assistant Professor ofRadiology
Albert Einstein College ofMedicine
Attending Radiologist
Beth Israel Medical Center
New York, New York
Maroun Karam, M.D.
Associate Professor ofRadiology
Director ofNuclear Medicine
Albany Medical College
Albany, New York
Jeffrey A. Cooper, M.D.
Clinical Professor ofRadiology
University ofPittsburgh
Pittsburgh, Pennsylvania
Thieme
New York • Stuttgart
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To our editor, J. Owen Zurhellen, for patiently, persistently, and proficiently fielding our faults and
foibles
To my supportive residents (at home and work) for their frequent wise counsel and their 24/7
endurance
C. Richard Goldfarb
To my father, Leon Parmett, with love and admiration; and to my wife, Ofra, and my children,
Zecharya, Avraham, Yonatan, and Rachel, with love and appreciation
Steven R. Parmett
To Benny: missed you on the first edition
Lionel S. Zuckier
To my wife Hidemi and the joy ofour lives, Lisa and Marie
Fukiat Ongseng
To my late parents, Saïd and Ninette, who sacrificed much in order to provide me with the best
education
Maroun Karam
To my friends
Jeffrey A. Cooper
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Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
I. The Basics of Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
1. Radionuclides and Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
2. Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
3. Quality Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
II. Single-Photon Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
4. Musculoskeletal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
5. Cardiac . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
6. Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
7. Thyroid and Endocrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
8. Gastrointestinal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
9. Genitourinary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
10. Infection, Inflammation, and Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
11. Pulmonary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
III. Positron Emission Tomography (PET) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
12. PET Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
13. Breast and Cutaneous Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
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14. Gastrointestinal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
15. Pulmonary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
16. Genitourinary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
17. Lymphomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138
18. Head and Neck Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
19. Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
20. Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
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Preface
Nuclear medicine has evolved exponentially monoclonal antibodies, in neuroendocrine
since the first edition of Nuclear Medicine tumors using radiolabeled receptor agents,
Board Reviewwas published in 1998. In that and in palliation ofskeletal metastases using
same year, the Health Care Financing bone-seeking radiolabeled tracers. To incor-
Administration (HCFA) approved Medicare porate all this burgeoning new material, we
reimbursement for fluorine 18 (F-18) fluo- have added several chapters to this second
rodeoxyglucose positron emission tomog- edition and revised many questions and
raphy (FDG PET) evaluation of solitary answers.
pulmonary nodules. Approval of reimburse- This book is not intended solely for certifi-
ment for staging of colorectal cancer, cation seekers; all who strive to keep current
melanoma, and lymphoma soon followed. in nuclear medicine should find the contents
The new millennium marked the recognition stimulating and satisfying. The detailed divi-
ofFDG PET as a diagnostic reference standard sion oftopics is designed to facilitate use for
in oncology. The HCFA broadened PET cover- those interested in focusing on a subspe-
age to diagnosis, staging, and restaging of cialty. The handy quiz arrangement provides
breast cancer, lung cancer, colorectal cancer, opportunity for immediate gratification;
lymphoma, melanoma, esophageal cancer, simply uncover the answer column on the
and head and neck cancer. The proliferation right as you respond to the questions on the
of FDG PET imaging and the emergence of left. Successful navigation of these exercises
PET/computed tomography (CT) has fueled a may not guarantee a “pass” for board exam
demand for continuing medical education in takers, but we are confident that time and
clinical PET. Meanwhile, single-photon effort will be rewarded by added knowledge
nuclear medicine has continued to expand, and increased confidence. This second edi-
with the growing acceptance of scintimam- tion is more user-friendly for those practicing
mography to diagnose breast cancer, and worldwide because we have been careful to
radionuclide sentinel node localization to cite International System (SI) metric units in
stage breast and other cancers. The incidence addition to the system of rads, curies, etc.,
of thyroid cancer has risen significantly in that remains popular with many in the
the United States, and therapeutic and diag- United States. We have retained the first edi-
nostic algorithms have been substantially tion’s convenient question-and-answer for-
modified in the past few years. Radionuclide mat, designed to speed the grasping of, and
therapy grows slowly, though surely, expand- enhance retention of, relevant information.
ing its role in lymphoma using radiolabeled We wish you success in your quest!
