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GI - HIDA

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CAMRT Nuclear Medicine Technology (Clinical) Quiz on GI - HIDA, created by Siobhan Pett on 02/07/2020.
Siobhan Pett
Quiz by Siobhan Pett, updated more than 1 year ago
Siobhan Pett
Created by Siobhan Pett almost 5 years ago
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Resource summary

Question 1

Question
Significantly increased serum bilirubin levels will most likely cause which of the following to be visualized on hepatobiliary images?
Answer
  • kidneys
  • colon
  • lungs
  • pancreas
  • spleen

Question 2

Question
In preparation for hepatobiliary imaging, patients are required to fast to:
Answer
  • prevent renal uptake of the tracer
  • enhance liver uptake of the tracer
  • minimize the risk of radioactive emesis
  • avoid stimulating the gallbladder
  • avoid gastric interference

Question 3

Question
During hepatobiliary imaging, which structure will NOT be visualized if cyctic duct obstruction is present?
Answer
  • gallbladder
  • common bile duct
  • stomach
  • small intestine
  • common hepatic duct

Question 4

Question
In a normal hepatobiliary study, which of the following structures will NOT be visualized?
Answer
  • liver
  • common bile duct
  • spleen
  • gallbladder
  • intestines

Question 5

Question
In a normal hepatobiliary study, excretion of the tracer into the intestine should occur a maximum of how long after tracer administration?
Answer
  • 20-30 min
  • 35-40 min
  • 45-60 min
  • 1-2 hr
  • 2-3 hr

Question 6

Question
Which of the following agents would be used to perform a gallbladder ejection fraction?
Answer
  • morphine and 99mTc-lidofenin
  • sincalide and 99mTc-sulphur colloid
  • sincalide and 99mTc-disofenin
  • morphine and 99mTc-mertiatide
  • sincalide and 99mTc-medronate

Question 7

Question
If the gallbladder is not visualized within 60 minutes during hepatobiliary imaging, which of the following may be administered?
Answer
  • cimetidine
  • morphine
  • dobutamine
  • furosemide
  • adenosine

Question 8

Question
Morphine is administered during hepatobiliary imaging to cause the:
Answer
  • cystic duct to open
  • gallbladder to empty completely
  • sphincter of Oddi to contract
  • tracer to be diverted to the common bile duct
  • tracer to be diverted into the spleen

Question 9

Question
Consumption of a fatty meal may have the same effect on the hepatobiliary system as which of the following compounds?
Answer
  • cimetidine
  • furosemide
  • morphine
  • sincalide
  • aspirin

Question 10

Question
A synthetic form of cholecystokinin is:
Answer
  • glucagon
  • cimetidine
  • pentagastrin
  • sincalide
  • mebrofenin

Question 11

Question
If 0.02 mcg/kg of cholecystokinin is needed for a hepatobiliary study, what volume needs to be drawn for a 175 lb patient with a solution of 10 mcg/mL available to draw from?
Answer
  • 0.115 mL
  • 0.129 mL
  • 0.134 mL
  • 0.149 mL
  • 0.159 mL

Question 12

Question
If CCK is administered prior to the IDA study when should IDA be administered?
Answer
  • immediately after the CCK
  • within 30 minutes of the CCK
  • 60 minutes after the CCK
  • 15 minutes before the CCK
  • CCK should never be administered prior to the IDA

Question 13

Question
What would be the purpose of administering Phenobarbital during an IDA study?
Answer
  • to provide the patient with mild sedation
  • to stimulate gallbladder contraction
  • to increase liver excretion of IDA
  • to shorten the length of the study
  • to improve gallbladder visualization in neonates

Question 14

Question
When may a second dose of 99mTc-disofenin be given?
Answer
  • if the patient is very large
  • in the presence of liver failure
  • if the gallbladder is full
  • if the exam is lasting a long time
  • if the patient has elevated bilirubin levels

Question 15

Question
What procedure would be appropriate for an IDA study?
Answer
  • anterior images of the abdomen every 10 minutes for 60 minutes
  • anterior and posterior images of the abdomen every 15 minutes for 1 hour
  • 500k static images of the anterior, posterior, lateral and obliques of the abdomen
  • SPECT imaging of the abdomen
  • 1 minute per frame dynamic images for 15 minutes

Question 16

Question
The radiologist asks you to perform a left anterior oblique view following the 60 minute dynamic IDA study. What is the purpose of this view?
Answer
  • To distinguish between gallbladder and bowel and/or duct
  • To distinguish between gallbladder and renal pelvis
  • To determine the gallbladder ejection fraction
  • These views are not used in an IDA study
  • To distinguish between liver and gallbladder

Question 17

Question
You notice an increased amount of renal excretion during a IDA study on a patient known to have poor hepatic function. What static view would best separate the renal pelvis from the gallbladder?
Answer
  • right lateral
  • left lateral
  • left anterior oblique
  • left posterior oblique
  • right posterior oblique

Question 18

Question
All of the following may result in a false positive interpretation for acute cholecystitis EXCEPT:
Answer
  • failure to fast for at least 4 hours
  • alcoholism
  • chronic cholecystitis
  • cholangiocarcinoma of the cystic duct
  • accessory cystic duct

Question 19

Question
When administering Sincalide, you inject the pharmaceutical over 30 seconds instead of a slow infusion over 60 minutes. This may cause the patient to experience:
Answer
  • abdominal discomfort
  • a falsely high ejection fraction
  • no adverse effects
  • jaundice
  • increased urinary excretion of the tracer

Question 20

Question
Which of the following is/are indications for determination of the gallbladder ejection fraction with Sincalide? i. chronic cholecystitis ii. acute cholecystitis iii. bile leaks iv. biliary dyskinesis
Answer
  • ii only
  • i and iv
  • i, ii, and iv
  • i, ii, iii, and iv

Question 21

Question
What is the purpose of morphine administration during an IDA study?
Answer
  • relieve the patient's symptoms
  • shorten the study time
  • contract the gallbladder
  • determine the gallbladder ejection fraction
  • differentiate biliary atresia from neonatal hepatitis

Question 22

Question
Which statement is correct in describing the normal result in an IDA study?
Answer
  • maximum liver uptake at 10 minutes
  • gallbladder visualization within 5 minutes
  • bowel activity should appear in 15-20 minutes
  • gallbladder ejection fraction of 20%

Question 23

Question
An alternate imaging modality is required to distinguish _______________ as they have the same presentation on a hepatobiliary scan.
Answer
  • acute acalculous cholecystitis and chronic cholecystitis
  • biliary atresia and neonatal hepatitis
  • acute high grade biliary obstruction and hepatitis
  • acute cholecystitis and chronic cholecystitis
  • complete biliary obstruction and partial biliary obstruction

Question 24

Question
A patient is in the nuclear medicine department for a hepatobiliary scan post-cholecystectomy. What additional atypical views may be protocoled for this patient?
Answer
  • lateral views over the pelvis
  • RAO over the abdomen
  • anterior and posterior views over the abdomen
  • lateral views over the chest

Question 25

Question
A 24 year old female patient reported to the emergency department with right upper quadrant pain this morning and a IDA scan was ordered. These are her images. What is the most likely diagnosis?
Image:
Hida1 (binary/octet-stream)
Answer
  • acute cholecystitis
  • normal study
  • chronic cholecystitis
  • biliary obstruction
  • bile leak

Question 26

Question
A 56 year old female patient had a cholecystectomy yesterday. The following images were obtained today. What should you do next?
Image:
Hida2 (binary/octet-stream)
Answer
  • administer 0.02ug/kg Sincalide via slow infusion for 60 minutes while obtaining a 60 minute dynamic
  • administer 0.04mg/kg morphine over 3 minutes and image for an additional 30 minutes
  • submit the images for reporting and allow the patient to leave the department
  • have the radiologist review the images immediately while keeping the patient in the department
  • allow the patient to leave and come back for more images in another 3 hours

Question 27

Question
What is the diagnosis?
Image:
Hida3 (binary/octet-stream)
Answer
  • bile leak
  • free pertechnetate from poor radiopharmaceutical labelling
  • biliary atresia
  • choledochal cyst
  • hepatitis

Question 28

Question
How will the GBEF compare when done with CCK versus Ensure drink?
Answer
  • the GBEF may be slightly lower with Ensure
  • the GBEF may be slightly higher with Ensure
  • There would be no difference in GBEF
  • Ensure is not used for GBEF

Question 29

Question
When calculating the gallbladder ejection fraction you forget to draw a background region of interest. What would be the effect on the ejection fraction?
Answer
  • it would be overestimated
  • it would be underestimated
  • it would have no effect
  • the effect is unpredictable

Question 30

Question
The following results were obtained from the regions of interest drawn on pre- and post-Sincalide IDA images: Pre-sincalide: 156325 counts Post-sincalide: 91254 counts Background: 2345 counts The resulting ejection fraction may be reported as:
Answer
  • unequivocally normal
  • abnormal
  • equivocal
  • indeterminate

Question 31

Question
How will GB appear during a hepatobiliary scan (its anatomical position) if the image was taken from the RT lateral position?
Answer
  • Anterior and to the viewer’s right
  • Anterior and to the viewer’s left
  • Posterior and to the patient’s right
  • Posterior and to the patient’s left
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