Nuclear Cardiology Study Guide

Nuclear Cardiology Study Guide

Andrzej Moniuszko B. Adrian Kesala Nuclear Cardiology Study Guide A Technologist s Review for Passing Specialty Certification Exams

Andrzej Moniuszko, MD Department of Radiology Presence Resurrection Medical Center Chicago, IL, USA B. Adrian Kesala, MD Department of Radiology Staff Radiologist Presence Resurrection Medical Center Chicago, IL, USA ISBN 978-1-4614-8644-2 ISBN 978-1-4614-8645-9 (ebook) DOI 10.1007/978-1-4614-8645-9 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013947921 Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms 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 specifically 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 specific 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 current and past coworkers from the Nuclear Medicine Department at Presence Health in Chicago Sandra Jennings, Kathleen Tiffi n, Anjum Ahmed, Marilyn Biel, Michele Strom, Nisha Varghese, Komal Desai, Sharon Nyczak, and Brett Nemer for the willingness to share knowledge and experience. Andrzej Moniuszko, CNMT, ARRT (N), NCT, PET This work is dedicated to my wife Larissa B. Adrian Kesala, MD

Preface Nuclear Cardiology Study Guide is the third publication in the series of nuclear medicine guides written in question and answer format. All three books Nuclear Medicine Technology, PET and PET /CT, and Nuclear Cardiology collectively provide comprehensive knowledge and cover a broad spectrum of problems involving the application of radioactive substances in the diagnosis and treatment of disease. This book is designed for technologists, practitioners, students, and trainees in medical imaging to serve as a practical tool to study multiple aspects of nuclear cardiology. It was written and reviewed by individuals who have a wide range of nuclear medicine expertise: a practicing nuclear medicine physician, a nuclear medicine college teacher, and an experienced nuclear medicine technologist. A broad assembly of authors and contributors, with different nuclear medicine experiences, provides an array of problems that technologists and practitioners 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 deepen knowledge of nuclear cardiology. It is said that a picture is worth a 1,000 words. Our book includes a variety of images, graphics, and diagrams. It is our hope that these illustrations will help the reader to get to the bottom of the problem and come up with the right solution quickly. The book is divided into four chapters and three appendices. We kick off the book with a chapter on test-taking strategies, which is designed to equip readers with practical tools and methods to successfully navigate through the multiplechoice exam. It was written by a recent Master of Business Administration graduate, a GED Chief Examiner, and an instructor with a Master of Arts in philosophy; their knowledge and hands-on experience provide readers with valuable insider tips. Chapters 2, 3, and 4 contain the test problems. Each test includes multiple-choice questions, with a total of more than 600 problems. The chapters are organized in three levels of complexity, from the easiest to the most difficult. Generally, tagging vii

viii Preface questions as easy or difficult is a tricky matter and highly subjective. Nevertheless, for learning purposes, the proposed classification is beneficial for readers. Each chapter is a separate entity with answers and short explanations included. This approach works like building blocks, in which the completion of the first test will prepare the reader to progress to the second test, and so on. Appendices A and B offer a list of commonly used abbreviations and a glossary of terms which are encountered in everyday nuclear medicine practice and beyond. The abbreviations and the glossary can appear as either too short or simply too long. Some readers will find the included terms as unnecessary ; some readers will not find the abbreviation for which they are looking. One size never fits 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 add or modify as 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 and glossary before the examinations can be very helpful and highly suggested. Appendix C offers a list of updated, useful Web sites to refresh knowledge or to learn new skills. The collection of problems in this book mirrors the exam content as provided by National Medicine Technology Certification Board (NMTCB). The questions cover topics in 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 readers to go through these questions carefully and answer diligently you will be surprised how much you already know and how much you still can learn. Both factors serve as great motivators. Learning should be fun, entertaining, and contagious. Nuclear medicine is a challenging and rapidly evolving field of medicine, and the only way to keep pace with its development is through continuous learning. Nuclear cardiology procedures that were popular in the 1970s are no longer performed, and many new radiotracers and procedures have since been successfully introduced. The integration of molecular imaging not only demonstrates a significant paradigm shift for the specialty but guarantees that nuclear medicine will be a major part of medical practice for the conceivable future. Be a part of this exciting journey. Make learning fun, and make it a habit this is the kind of addiction you can afford. The benefits are overwhelming. You can receive the 24 continuing education credit hours, keep your professional license, and, some would say most importantly meet your superiors expectations. 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. Again, it is beyond the scope of words to express my appreciation to Prof. Joanne Metler, Coordinator of Nuclear Medicine Technology Program, College of DuPage, IL, for her patience in reviewing the manuscript. Her insight, helpful criticism, suggestions, and insistence on clarity, accuracy, and consistency deserve nothing but my sincere gratitude. I was fortunate enough to be her student, and

Preface ix I will always appreciate both her deep knowledge of nuclear medicine and her wonderful generosity of spirit. Hope your retirement is everything you expect it to be and much more. We would also like to thank George Chang, PACS Coordinator, Presence Health, and Todd Monis, Director of Cardiac and Interventional Services, Presence Health, for their instrumental help in preparing clinical images used in this book. Chicago, IL, USA Andrzej Moniuszko, CNMT, ARRT (N), NCT, PET B. Adrian Kesala, MD

About the Authors Andrzej Moniuszko, Nuclear Medicine Technologist Andrzej Moniuszko received an MD degree in 1977 from Medical University in Bialystok, Poland. In 1995 he moved to the USA and two years later passed all exams required by the United States Medical Licensing Examination (USMLE). Given that he was not accepted to the Residency program of his choice and with the goal of furthering his medical career, he completed a Nuclear Medicine Technology Program in College of DuPage, Glen Ellyn, IL. He works as a Nuclear Medicine Technologist in Presence Resurrection Medical Center, Chicago, IL, and holds CNMT, ARRT (N), PET, and NCT certification. B. Adrian Kesala, M D Medical Degree: University of Navarra in Spain; Residencies in Diagnostic Radiology, and Nuclear Medicine at Northwestern University, Chicago. Board certification: American Board of Radiology, American Board of Nuclear Medicine, and Certification of Special Competence in Nuclear Radiology. Former Assistant Professor of Radiology Northwestern University; Senior Attending in Radiology and Director of Nuclear Medicine at Presence Resurrection Medical Center, Chicago. xi

Contents 1 Tackling the Multiple-Choice Test... 1 Dealing with the Test Anxiety... 3 References... 4 2 Practice Test #1: Difficulty Level Easy... 5 Questions... 5 Answers... 44 References and Suggested Readings... 74 3 Practice Test #2: Difficulty Level Moderate... 79 Questions... 79 Answers... 120 References and Suggested Readings... 152 4 Practice Test #3: Difficulty Level Hard... 157 Questions... 157 Answers... 198 References and Suggested Readings... 229 Appendix A: Commonly Used Abbreviations and Symbols in Nuclear Medicine... 235 Appendix B: Glossary of Cardiology Terms... 247 Appendix C: Useful Websites... 269 Index... 273 xiii

Contributors Beata M. Boies, MA DeKalb Community Unit School District, DeKalb, IL, USA Josh J. Boies, BS GED Chief Examiner, Geneva, IL, USA Daryll M. Dickson, RT Cath Lab, Presence Resurrection Medical Center, Chicago, IL, USA B. Adrian Kesala, MD Department of Radiology, Presence Resurrection Medical Center, Chicago, IL, USA Natalia Massingill Cardiology, Presence Resurrection Medical Center, Chicago, IL, USA Andrzej Moniuszko, CNMT, ARRT (N), PET, NCT Department of Radiology, Presence Resurrection Medical Center, Chicago, IL, USA Marta L. Moniuszko, MBA Aon Hewitt, Lincolnshire, IL, USA Sabina J. Moniuszko, PTA Department of Physical Therapy, Claremont Hanover Park, Hanover Park, IL, USA Purvish Patel, RT Department of Radiology, Presence Resurrection Medical Center, Chicago, IL, USA xv