Practice Test #2: Difficulty Level—Moderate



  1. 1.
    Peak myocardial concentration of thallium occurs within:
    1. A.

      5 min of injection

    2. B.

      10 min of injection

    3. C.

      20 min of injection

    4. D.

      40 min of injection

  2. 2.
    The most common configuration for cardiac transmission imaging, uses a scanning line source of:
    1. A.


    2. B.


    3. C.


    4. D.


  3. 3.
    Which of the following protocols offers the potential of acquiring Tl-2011myocardial redistribution images?
    1. A.

      A single-day study low dose rest and high dose stress

    2. B.

      A 2-day study high dose rest and high dose stress

    3. C.

      A dual-isotope technique

    4. D.

      A single-day study high dose rest and low dose stress

  4. 4.
    Which of the following statements correctly describes cardiac F-18 FDG uptake?
    1. A.

      Insulin inhibits cardiac F-18 FDG uptake; free fatty acids stimulate F-18 FDG accumulation

    2. B.

      Insulin and free fatty acids inhibit F-18 FDG accumulation

    3. C.

      Insulin stimulates cardiac F-18 FDG uptake; free fatty acids inhibit F-18 FDG accumulation

    4. D.

      Insulin and free fatty acids...


Myocardial Perfusion Myocardial Blood Flow Coronary Flow Reserve Left Bundle Branch Block Linear Energy Transfer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Suggested Readings

  1. ACC/AHA/ASNC Guidelines for the clinical use of cardiac radionuclide imaging—executive summary.
  2. Akinpelu D ed. Treadmill stress testing Accessed Oct 11 2012
  3. Armstrong WF, Ryan T. Stress echocardiography from 1979 to present. J Am Soc Echocardiogr. 2008;21:22.PubMedCrossRefGoogle Scholar
  4. ASNC. Pharmacologic and exercise stress tests.
  5. Baggish LA, Boucher AC. Radiopharmaceutical agents for myocardial perfusion imaging. Circulation. 2008;118:1668–74.PubMedCrossRefGoogle Scholar
  6. Banerjee A, Newman DR, Van den Bruel A, Heneghan C. Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies. Int J Clin Pract. 2012;66(5):477–92.PubMedCrossRefGoogle Scholar
  7. Bengel MF, Higuchi T, et al. Cardiac positron emission tomography. J Am Coll Cardiol. 2009;54:1–15.PubMedCrossRefGoogle Scholar
  8. Berman DS, Hachamovitch R, Shaw LJ, et al. Roles of nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance: Noninvasive risk stratification and a conceptual framework for the selection of noninvasive imaging tests in patients with known or suspected coronary artery disease. J Nucl Med. 2006;47:1107.PubMedGoogle Scholar
  9. Bonow RO, Mann LD, Zipes PD, et al. Braunwald’s heart disease – a textbook of cardiovascular medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011.Google Scholar
  10. Brindis RG, Douglas PS, Hendel RC, et al. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol. 2005;46:1587.PubMedCrossRefGoogle Scholar
  11. Burrell S, MacDonald A. Artifacts and pitfalls in myocardial perfusion imaging. J Nucl Med Technol. 2006;34:193–211.PubMedGoogle Scholar
  12. Cerqueira MD, Allman KC, Ficaro EP, et al. Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol. 2010;17:709.PubMedCrossRefGoogle Scholar
  13. Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation. 2002;105:539.PubMedCrossRefGoogle Scholar
  14. Chaitman BR. Should early acceleration of heart rate during exercise be used to risk stratify patients with suspected or established coronary artery disease? Circulation. 2007;115:430.PubMedCrossRefGoogle Scholar
  15. Chamarthy M, Travin IM. Altered biodistribution and incidental findings on myocardial perfusion imaging. Semin Nucl Med. 2010;40:257–70.PubMedCrossRefGoogle Scholar
  16. Chen J, Henneman MM, Trimble MA, et al. Assessment of left ventricular mechanical dyssynchrony by phase analysis of ECG-gated SPECT myocardial perfusion imaging. J Nucl Cardiol. 2008;15:127–36.PubMedCrossRefGoogle Scholar
  17. Christian PE, Bernier DR, Langan JK. Nuclear medicine and PET. Technology and techniques. 5th ed. St. Louis, MO: Mosby; 2004.Google Scholar
  18. Coakley AJ, Kettle AG, Wells CP, et al. 99mTcsestamibi: a new agent for parathyroid imaging. Nucl Med Commun. 1989;10:791–4.PubMedCrossRefGoogle Scholar
  19. Cooper JA, Neumann PH, McCandless BK. Effect of patient motion on tomographic myocardial perfusion imaging. J Nucl Med. 1992;33:1566–71.PubMedGoogle Scholar
  20. Des Prez RD, et al. ASNC Clinical Update: stress-only myocardial perfusion imaging. J Nucl Cardiol. 2009;39:999–1004.Google Scholar
  21. DePuey EG. Advances in SPECT camera software and hardware: currently available and new on the horizon. J Nucl Cardiol. 2012 Jun;19(3):551–81.CrossRefGoogle Scholar
  22. Dilsizian V, Narula J, Braunwald E, Dilsizian V, Narula J, Braunwald E, editors. Atlas of nuclear cardiology. 3rd ed. Philadelphia, PA: Current Medicine; 2009.Google Scholar
  23. Dorbala S, Hachamovitch R, Curillova Z, et al. Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging. 2009;2:846–54.PubMedCrossRefGoogle Scholar
  24. Early PJ, Sodee BD. Principles and practice of nuclear medicine. 2nd ed. St. Louis, MO: Mosby; 1995.Google Scholar
  25. Fam NP, Verma S, Kutryk M, et al. Clinician guide to angiogenesis. Circulation. 2003;108: 2613–8.PubMedCrossRefGoogle Scholar
  26. Fang CJ, Aranki S. Diagnosis and management of ischemic cardiomyopathy
  27. Ficaro EP, Hansen CL, American Society of Nuclear Cardiology: Imaging Guidelines for Nuclear Cardiology Procedures. Available at:
  28. Ficaro EP, Kritzman JN, Corbett JR. Effect of valve plane constraint on LV ejection fractions from gated perfusion SPECT [abstract]. J Nucl Cardiol. 2003;10:S23.Google Scholar
  29. Fox KAA, Birkhead J, Wilcox R, Knight C, Barth J. British Cardiac Society Working Group on the definition of myocardial infarction. Heart. 2004;90:603–9.PubMedCrossRefGoogle Scholar
  30. Froelicher VF, Myers J. Exercise and the heart. 5th ed. Philadelphia, PA: WB Saunders; 2006.Google Scholar
  31. Frohlich ED. Rypin’s basic sciences review. 18th ed. Philadelphia, PA: J. B. Lippincott Company; 2001.Google Scholar
  32. Fuster V, O’Rourke RA, Walsh RA, Poole WP. Hurst’s the heart. 12th ed. New York: McGraw Hill; 2007.Google Scholar
  33. Germano G. Technical aspects of myocardial SPECT imaging. J Nucl Med. 2001;42:1499–507.PubMedGoogle Scholar
  34. Germano G, Berman SD. Clinical gated cardiac SPECT. 2nd ed. Malden, MA: Blackwell Publishing; 2006.CrossRefGoogle Scholar
  35. Gheorghiade M, Sopko G, De Luca L, et al. Navigating the crossroads of coronary artery disease and heart failure. Circulation. 2006;114:1202.PubMedCrossRefGoogle Scholar
  36. Ghosh N, Rimoldi EO, Beanlands SBR, et al. Assessment of myocardial ischaemia and viability: role of positron emission tomography. Eur Heart J. 2010;31:2984–95.PubMedCrossRefGoogle Scholar
  37. Gibbons JR. Imaging techniques. Myocardial perfusion imaging. Heart. 2000;83:355–60.PubMedCrossRefGoogle Scholar
  38. Goldberger LA. Clinical electrocardiography: a simplified approach. 7th ed. St. Louis, MO: Mosby Elsevier; 2006.Google Scholar
  39. Goldman L, Schafer IA, editors. Goldman: Goldman's Cecil medicine. 24th ed. Philadelphia, PA: Saunders, an imprint of Elsevier; 2012.Google Scholar
  40. Heller VG, Hendel CR. Nuclear cardiology: practical applications. 2nd ed. New York: McGraw-Hill; 2011.Google Scholar
  41. Heller VG, Lundbye BJ, Kapetanopoulos A. Vasodilator stress radionuclide myocardial perfusion imaging: testing methodologies and safety.
  42. Hendel CR, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate use criteria for cardiac radionuclide imaging. J Am Coll Cardiol. 2009;53(23):2201–29.PubMedCrossRefGoogle Scholar
  43. Hill J, Timmis A. ABC of clinical electrocardiography. Exercise tolerance testing.
  44. Ho BV, Reddy PG. Cardiovascular imaging. 1st ed. St. Louis, Mo: Saunders; 2011.Google Scholar
  45. Holly AT, Abbott GB, Al-Mallah M, et al. ASNC imaging guidelines for nuclear cardiology procedures. Single photon-emission computed tomography. J Nucl Cardiol. 2010;17:1071–3581.CrossRefGoogle Scholar
  46. Husain SS. Myocardial perfusion imaging protocols: is there an ideal protocol? J Nucl Med Technol. 2007;35:3–9.PubMedGoogle Scholar
  47. ICRP 1991 The 1990 recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann ICRP21. Pergamon, Oxford.Google Scholar
  48. Iskandar A et al. Gender differences in the diagnostic accuracy of SPECT myocardial perfusion imaging: a bivariate meta-analysis. ASNC 2012Google Scholar
  49. Iskandrian EA, Garcia VE. Atlas of nuclear cardiology: imaging companion to Braunwald's heart disease. Philadelphia, PA: Elsevier Saunders; 2012.Google Scholar
  50. Iskandrian AE, Verani MS, et al. Nuclear cardiac imaging and principles applications. 3rd ed. New York: Oxford University Press; 2003.Google Scholar
  51. Khalil MM, editor. Basic sciences of nuclear medicine. Berlin: Springer; 2011.Google Scholar
  52. Kinahan PE, Townsend DW, Beyer T, et al. Attenuation correction for a combined 3D PET/CT scanner. Med Phys. 1998;25:2046–53.PubMedCrossRefGoogle Scholar
  53. Klabunde ER. Cardiovascular physiology concepts.
  54. Koller D. Assessing diagnostic performance in nuclear cardiology. J Nucl Cardiol. 2002;9:114–23.PubMedCrossRefGoogle Scholar
  55. Kumar V, et al. Robbins & Cotran pathologic basis of disease. 8th ed. Philadelphia, PA: Saunders; 2009.Google Scholar
  56. Lauer SM. Heart rate response in stress testing: clinical implications. ACC CURRENT JOURNAL REVIEW Sep/Oct 2001.Google Scholar
  57. Lenneman A, Ooi HH et al. Cardiogenic shock. Accessed May 21 2012.
  58. Lin CE, Alavi A. PET and PET/CT. A clinical guide. 2nd ed. New York, NY: Thieme; 2009.Google Scholar
  59. Lombardi MH. Radiation safety in nuclear medicine. Boca Raton, FL: CRC Press LLC; 1999.Google Scholar
  60. Lu E, Wagner WR, Schellenberger U, et al. Targeted in vivo labeling of receptors for vascular endothelial growth factor: approach to identification of ischemic tissue. Circulation. 2003;108:97–103.PubMedCrossRefGoogle Scholar
  61. Manglos SH, Thomas FD, Gagne GM, Hellwig BJ. Phantom study of breast tissue attenuation in myocardial imaging. J Nucl Med. 1993;34:992.PubMedGoogle Scholar
  62. MacDonald A, Burrell AS. Infrequently performed studies in nuclear medicine: part 1. J Nucl Med Technol. 2008;36:132–43.PubMedCrossRefGoogle Scholar
  63. Mark DB, Hlatky MA, Harrell Jr FE, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987;106:793–800.PubMedCrossRefGoogle Scholar
  64. Miyamoto IM, Vernotico LS, Majmundar H, Thomas SG. Pharmacologic stress myocardial perfusion imaging: A practical approach. J Nucl Cardiol. 2007;14:250–5.PubMedCrossRefGoogle Scholar
  65. Morrison RA, Sinusas JA. New molecular imaging targets to characterize myocardial biology. Cardiol Clin. 2009;27:329–44.PubMedCrossRefGoogle Scholar
  66. Papaioannou IG, Heller VG. Exercise radionuclide myocardial perfusion imaging in the diagnosis and prognosis of coronary heart disease.
  67. Parker RP, Smith PHS, Taylor DM. Basic science of nuclear medicine. 2nd ed. Edinburgh: Churchill Livingstone; 1984.Google Scholar
  68. Paul KI, Nabi AH. Gated myocardial perfusion SPECT: basic principles, technical aspects, and clinical applications. J Nucl Med Technol. 2004;32:179–87.PubMedGoogle Scholar
  69. Pichler BJ, Wehrl HF, Judenhofer MS. Latest advances in molecular imaging instrumentation. J Nucl Med. 2008;49 Suppl 2:5S–23S.PubMedCrossRefGoogle Scholar
  70. Rahmima A, Zaidib HA. PET versus SPECT: strengths, limitations and challenges. Nucl Med Commun. 2008;29(3):193–207.CrossRefGoogle Scholar
  71. Saladin SK. Anatomy and physiology: the unity of form and function. 5th ed. New York: McGraw-Hill Higher Education; 2009.Google Scholar
  72. Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 1999;33:1756–824.PubMedCrossRefGoogle Scholar
  73. Schelbert RH. Quantification of myocardial blood flow: what is the clinical Role? Cardiol Clin. 2009;27:277–89.PubMedCrossRefGoogle Scholar
  74. Schinkel FLA, Poldermans D, Elhendy A, Bax JJ. Assessment of myocardial viability in patients with heart failure. J Nucl Med. 2007;48:1135–46.PubMedCrossRefGoogle Scholar
  75. Schlosser T, Pagonidis K, Herborn UC, et al. Assessment of left ventricular parameters using 16-MDCT: results. Am J Roentgenol. 2005;184(3):765–73.CrossRefGoogle Scholar
  76. Sica TG.Bias in research studies. Radiology. Vol.238 (3), 2006Google Scholar
  77. The Society of Nuclear Medicine, the American Heart Association, the American College of Cardiology. Standardization of cardiac tomographic imaging. J Nucl Med. 1992;33(7): 1434–5.Google Scholar
  78. Statkiewicz-Sherer MA, Ritenour ER, Visconti PJ. Radiation protection in medical radiography. 6th ed. Maryland Heights, MO: Mosby; 2011.Google Scholar
  79. Strauss WH, Grewal KR, Pandit-Taskar N. Molecular imaging in nuclear cardiology. Semin. 2004;XXXIV(1):47–55.Google Scholar
  80. Strickberger SA, et al. AHA/ACCF scientific statement on the evaluation of syncope. Circulation. 2006;113:316–27.PubMedCrossRefGoogle Scholar
  81. Takalkar A, Agarwal A, Adams S, et al. Cardiac Assessment with PET. PET Clin. 2011;6:313–26.CrossRefGoogle Scholar
  82. Takalkar A, ChenW, Desjardins B et al. Cardiovascular imaging with PET CT and MR imaging. PET Clin 2008; 3(3)Google Scholar
  83. Thompson K, Saab G, Birnie D, Chow BJ, et al. Is septal glucose metabolism altered in patients with left bundle branch block and ischemic cardiomyopathy? J Nucl Med. 2006;47:1763–8.PubMedGoogle Scholar
  84. Treves ST, Blume ED, Armsby L, Newburger JW, Kurac A. Cardiovascular system. In: Treves ST, editor. Pediatric nuclear medicine/PET. 3rd ed. New York, NY: Springer; 2007. p. 128–61.CrossRefGoogle Scholar
  85. Van Train KF, Garcia EV, Maddahi J, et al. Multicenter trial validation for quantitative analysis of same-day rest-stress technetium-99m-sestamibi myocardial tomograms. J Nucl Med. 1994;35:609–18.PubMedGoogle Scholar
  86. Weiner AD. Stress testing to determine prognosis and management of patients with known or suspected coronary heart disease.
  87. Weissleder R, Wittenberg J, Harisinghani GM, Chen WJ. Primer of diagnostic imaging. 5th ed. St. Louis, MO: Elsevier Mosby; 2011.Google Scholar
  88. Wheat J, Currie G. Incidence and characterisation of patient motion in myocardial perfusion SPECT imaging: part 1. J Nucl Med Technol. 2004;32(2):60–5.PubMedGoogle Scholar
  89. Zaidi H, Hasegawa B. Determination of the attenuation map in emission tomography. J Nucl Med. 2003;44:291.PubMedGoogle Scholar
  90. Zaret BL, Beller GA. Clinical nuclear cardiology: state of the art and future directions. 3rd ed. Philadelphia, PA: Mosby; 2005.Google Scholar
  91. Zubal GI, Wisniewski G. Understanding Fourier space and filter selection. J Nucl Cardiol. 1997;4:234–43.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of RadiologyStaff Radiologist, Presence Resurrection Medical CenterChicago, Cook CountyUSA

Personalised recommendations