Definition

1. Fixed defects: Defects that shows no significant changes in activity between post stress or rest
images.
2. Cross-react rate: It reflexes the specificity of the antibody.
3. Renography: Simply a time-activity curve using renogram equipment after the bolus
intravenous injection of a radio-pharmaceutical. It provides a graphic representation of the
renal function and the conditions of upper urinary tract.
4. Phase inversion: The kidney image appear and disappear lately. Normal kidney will increase
activity firstly, decreased lately and abnormal will decreased firstly and increased lately.
5. 201TI redistribution: Myocardial uptake and blood clearance of 201Tl are rapid, and imaging can
be started 5-10 minutes after intravenous injection, called “early distribution”. But normal
myocardial cells clear 201Tl are faster than ischemia myocardial cells, after 3-4 hours, there is no
difference between the normal cells and abnormal cells, called “201Tl redistribution”.
6. Three-phases bone imaging: A method that utilize images of three phase (blood flow images,
blood pool images and static bone images) to illustrate the blood flow, blood pool and
metabolism of regional bones after once intravenous administration of 99mTc-MDP.
7. TRAb: An important abnormal autoimmune antibody, which may act important roles in the
occurrence, development, reoccurrence and the prognosis of Graves’ disease.
8. Thyroid cold-nodule: The relative amount of radioactivity in nodule is less or no compared with
the normal thyroid tissue. Clinical significance: Incidence of malignant about 20.3%, other
possibility are benign disease (ex: cyst, hemorrhage, etc).
9. Flare reaction: Temporary increased of pain. A side effect of early reaction from bone
metastasis.
10. Bone superscan : images show markedly abnormal increased uptake of 99m Tc-MDP distributed
throughout the skeleton, and the images of kidneys and bladder were absent or shown
unclearly. it indicates widespread bony disease, mainly in patients with diffuse osseous
metastases of carcinoma or metabolic bone disease(ex : hyperparathyroidism)
11. Crossed cerebellar diaschisis: Reduced metabolism and blood flow in the cerebral hemisphere
contralateral to a cerebral lesion.
12. DTC: Differentiated Thyroid carcinoma. Papillary, follicular, mixed papillary-follicular thyroid
carcinoma. Etiology: prior exposure to radiation, dietary factors, genetic, immunity. Clinical
features: solitary thyroid nodule in cervical triangle to be discovered by accident or on routing
PE, painless and moving during deglutition. Treatment: surgery, 131I Therapy, thyroid hormone.
13. Bq: It also called Becquerel. It means one disintegration per second. It is the smallest unit of
radioactivity.
14. Separate phenomenon: In the acute period of subacute thyroiditis, the percentage of RAIU
usually is decreased, on the other hand, the levers of serum T3 and T4 are increased obviously,
we call this representation “Separate phenomenon”.
15. Affinity constant K: It reflexes the ability of antibody of binding with its antigen.
16. Ci: A curie is defined as the quantity of any radionuclide which undergoes 3.7×1010
disintegrations per second. The curie is the basic unit of radioactivity.
17. Reversible defects: Defect that appears at stress and disappear during rest
18. Thyroid hot nodule: The radioactivity was focally increased comparing with the surrounding
thyroid tissue. Clinical significance: almost hot nodules are toward benign disease (ex:
autonomous hyperfunctioning adenomal), the incidence of malignant is less than 1%.
19. rCBF: To use radiopharmaceutical which can pass through BBB. amount of pharmaceutical
entering cerebral tissue depends on the quantity of cerebral blood flow and cerebral function.
20. Physical half-life: The period of time that elapses while a radionuclides decays to its half original
activity. 221Radium: T1/2 : 30 sec.
21. Thyroid warm nodule: Appearance: relative amount of radioactivity in nodule is equal to
surrounding soft tissue. Clinical significance: indicating its function is normal, incidence of
malignant is 5.3%.

Long Questions
1. Describe the clinical application of RAIU test.
A. To evaluate the function of thyroid.

hyperthyroidism The value of RAIU and peak value appear earlierly (befor 24h)

hypothyroidism The value of RAIU

RAIU should not be used to evaluate the thyroid function along, and should be combined
with other tests.
B. To diagnose subacute thyroiditis.
In the acute period of subacute thyroiditis ,the percentage of RAIU usually is decreased,on
the other hand, he levers of serum T3 and T4 are increased obviously ,we call this
representation “Separate phenomenon”.
C. To calculate the dose of 131I administration to the patients with hyperthyroidism who
prepare to accept 131I therapy.
D. As a preparation for other tests, such as perchlorate washout test, TH suppression test, et al.

2. Please explain the definition and content of Nuclear Medicine.

• Nuclear Medicine is a medical speciality. It uses very small amount of radioactive materials
to diagnose and treat disease by using safe non-invasive techniques.
• Contents of Nuclear Medicine:
a. Nuclear Medicine on Diagnosis.
- In Vivo Nuclear Medicine: imaging and non-imaging.
- In Vitro Nuclear Medicine.
b. Nuclear Medicine on Therapy.
3. How to identifying the properties of thyroid cold nodule with nuclear medicine methods.
• Applying tumor-locating imaging agents (such as 67Ga, 201Tl, 99mTc -MIBI, 99mTc -DMSA).
• Static imaging combining with dynamic imaging.

4. Make an evaluation of bone scan in the clinical practice (including its advantages and
disadvantages).
 It can not only display the anatomic structure, but also reflect the blood flow and
metabolism of skeleton. We called it functional imaging (which is in favor of earlier
diagnosing many bony disease, such as metastases, osteomyelitis, et al).
 A sensitive methods, which is more sensitive than radiography. Metastases show up on
bone scan 6 months or so before they show on a plain radiograph.
 It can obtain the images of whole-body skeleton at once time.
 It’s disadvantage is nonspecific.

5. Please explain the reason why patients with DTC need 131I treartment.
 Administration of 150 – 200 mCi of Iodine 131 can be use to eradicate metastasis lesions of
DTC.
 Iodine – 131 may be administrated 5 ~ 10 times.
 Whole body Iodine – 131 scans in search of metastasis are generally repeated at 6 mo or
annual intervals, followed by repeat therapy doses of Iodine-131 when warranted.

6. How to do the RAIU test?

 Administrate radioactive iodine to the fasting patient by oral.
 Made a standard, which is equal to the administrated dose.
 Measure the radioactivity of the thyroid, standard, and background at 6, 24 hours after oral
administration respectively.
 Calculate the percentage of radioactive iodine uptake (RAIU) of thyroid as the follow
formula.
The counts of thyroid - the counts of background
RAIU(%)= ------------------------------------------------------------- x 100%
The counts of standard - the counts of background

7. How to explain the result of myocardial perfusion imaging?

Interpretation of the Findings-SPECT.
Stress Rest Interpretation
No defects No defects Normal
Defect No defects Ischemia ( Stress- induced
ischemia)
Defect Defect Scar/ hibernating
 Defect location: anterior, posterior, lateral or septal wall.
Size: small, medium, large.
Severity: mild, moderate, absent.
Degree of reversibility at rest: completely reversible, partially reversible, irreversible.
Regional wall motion, EDV, ESV, EF.

8. Please explain the definition of rCBF and tell the advantages of rCBF Tomography for
detecting acute cerebral infarction comparing with CT and MRI.

9. Please explain the advantages and disadvantages of three different therapeutic approaches
which use to treat Graves disease.
a. ATDs (AntiThyroid Drugs).
Advantage: Long term ATD therapy may lead to remission in some pts. The incidence of
hypothyroidism in ATDs is lower than 131I-therapy.
Disadvantage: The duration therapy usually need 6 months – 2 years or more than 2 years.
There are some adverse reactions to ATDs, even appear serious reaction. The relapse rate
with ATD are high.
b. 131I-therapy.
Advantage: Very safe, 80% patients cured at once, no reaction after treatment.
Disadvatage: 20% patients may have permanent hypothyroidisim.
c. Surgery.
Advantage: Patients with very large goiter can be treated with thyroidectomy.
Disadvatage: Hypothyroidism and injury of recurrent laryngeal nerve.

10. How many types of abnormal renogram are there? What are they? Please describe the curve
of each type (using graphs) and tell the clinical application of them (illustrating with at least
one example).
• Persistent rising.
- a: normal.
- b: persistent rising.
- c: no decline.
- Clinical application: urinary obstruction.
• Prolongation at a high level.
- a: normal.
- b: straightline.
- No demarcation between b and c.
- Clinical applications:
 Long-standing urinary obstruction causing renal function damage.
 Urinary obstruction after renal function damage for a long time.
• Parabolic curve.
- a: normal/slight low.
- b: gradual rising.
- c: gradual decline.
- Clinical applications:
 Acute incomplete obstruction of upper urinary tract: hydronephrosis，
renal ischemia.
 Moderate impairment of renal function: significant renal damage.
• Prolongation at a low level.
- a: low.
- b: straightline.
- No demarcation between b and c .
- Clinical applications:
Significant renal damage: acute renal failure and chronic complete obstruction of upper
urinary tract with bad hydronephrosis.
• Progressive decrease at a low level.
- a: low.
- No b and c.
- Gradual decline after a appearing.
- Clinical applications:
 No function or poor function.
 Renal agenesis.
 Nephrectomy.
• Staircase decline.
- a: normal.
- b: normal.
- c: decline as irregular stair.
- Clinical applications:
Spasm of upper urinary tract: pain, mental tension and urinary tract
infection
• Unilateral small renogram.
- One side: normal.
- Suffering side: a near-normal shape.
- But the peak activity obvious decreased.
- Clinical applications:
Significant difference of function between the two kidneys:
 Stenosis of renal artery at one side.
 Congenital renal aplasia.
11. Please explain the difference between RIA and IRMA method.

RIA IRMA

Competitive Binding Assay Non-competitive Binding Assay

To use labelled antigens To use labelled antibodies

Three basic reagents Two basic reagents

The amount of antibodies is limited The amount of antibodies is excess

With the increased amount of Ag, the amount of With the increased amount of Ag, the amount
*AgAb is decreased. of Ag*Ab is increased.

To reach to the equilibrium more slowly To reach to the equilibrium more quickly

A high sensitivity A higher sensitivity

Which one is used in thyroid imaging?

a. gamma-ray b. beta-ray c. alpha-ray d. gamma n beta-ray.

Which imaging agent is most used in myocardial perfusion imaging?

a. 99mTc-MIBI b. 99mTc-MDP c. 99mTc-RBC d. 99mTc-PYP