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330361

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Selective use of angiography after SPECT imaging as compared to direct angiography in patients with stable angina results in

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330362

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Which of the following filters is ALWAYS employed in the SPECT reconstruction using filtered back-projection

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Explanation

Ramp filter is an integral part of the reconstruction process. The other filters are all smoothing filters and their use is optional

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Which is a common reason for low specificity of SPECT MPI in relation to coronary angiography?

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330364

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A 49 yo M with h/o HTN and tobacco use presents to the ER with 6 week h/o intermittent chest pain. His baseline ekg shows LVH with repolarization changes. His cardiac enzymes on arrival and 6 hrs later are negative. What is the next most appropriate step

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Explanation

could be MPI or exercise stress but would need MPI if ETT pos

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An MPI using a 99mTc agent is acquired with the PHA calibrated for 201Tl. Which is correct regarding the image data

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Explanation

Data will have incorrect energy information, therefore can't be processed. (Unless data acquired in list mode, which is very uncommon)

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A 50 yo M with h/o HTN presents with intermittent chest discomfort for the past 2 days. Physical exam is normal and EKG shows LVH but no ischemic changes. Admission and 3-hr troponin are normal. He is scheduled for exercise MPI. Just when he is brought to the lab, he develops moderate intensity retrosternal pain similar to his initial chest discomfort. His vitals are stable and repeat EKG unchanged. Pain lasts 10 min and almost subsided but he is uncomfortable. The next best step is

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Explanation

Injection of isotope during or immediately after chest pain resolution for suspected ACS is called acute chest pain imaging. Normal scan has very high neg predictive value for ACS. Sensitivity decr substantially after 2 hrs of pain resolution. It does no

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The specificity of SPECT MPI is increased by

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Explanation

false positive studies due to attenuation artifacts reduce specificity. Thus attenuation correction improves it. Stress only imaging reduces protocol duration and radiation dose but has no effect on sensitivity or specificity. Tl-201 has a lower photon en

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Which of the following parameters indicates lowest risk of hard events in a patient with a normal scan

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Which of the following should be used for interpretation of SPECT images

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Explanation

linear scales should always be used in interpreting SPECT. the gradual changes in uptake are seen better than when using sigmoidal (nonlinear) scales. these may miss small defects. Grey scale is generally preferred but is depending on the comfort of the r

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Which of the following is a contraindication for vasodilator pharm stress testing in a patient with h/o CAD, SS s/p dual chamber PPM

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Explanation

Persistent hypotension is a contraindication for vasodilator stress. Other contraindications: bronchospasm, critical AS, unstable angina, recent MI <2 days ago, high deg AVB without PPM, uncontrolled arrhythmias

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How many min after start of dipyridamole infusion is radiotracer injected

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Explanation

Max vasodilation of dipyridiamole is 287 +/- 101 seconds so radiotracer should not be injected until 3-5 min after dipyridamole infusion is complete. The infusion occurs over 4 minutes

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How does increasing the cutoff frequency in SPECT image reconstruction impact image resolution

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Explanation

incr cutoff frequency increases the resolution of images. decr the cutoff frequency smooths (blurs) the images, which decr the resolution

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Based on observational data, in patients with stable CAD, which characteristics are likely to have better outcomes with revasc as compared to those receiving medical therapy

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Explanation

Data suggest patients with ischemia >10-15% of LV have better outcomes with revasc compared to medical therapy if ischemic burden is >10% or scar <10%

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For a single day rest and stress Mibi, the ratio of radiotracer injected is

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Explanation

To optimize balance btw radiation doses, time between rest and stress scans, a ratio of 1:3 gives adequate imaging while keeping ALARA dose. Normal rest dose 8-12 mCi, stress dose 24-36 mCi. Regardless of type of SPECT camera used

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How are sensitivity and specificity of MPI affected by post-test referral bias

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