NMTCB Positron Emission Tomography Specialty Examination Content Outline

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NMTCB Positron Emission TomographySpecialty ExaminationContent OutlineI.II.III.IV.Diagnostic Procedures ( 35%) [70 items]Instrumentation/Quality Control ( 30%) [60 items]Radiation Protection ( 10%) [20 items]Radiopharmaceuticals ( 25%) [50 items]I. DIAGNOSTIC PROCEDURES ( 35%) [70 items]A. Administration of Radiopharmaceuticals1. Dosage determinationa. Calculation of pediatric doseb. Calculation of radiopharmaceutical/pharmaceutical dosec. Volume determinationd. Units – calculations and conversione. Dose determination according to scan mode and equipment type2. Dose preparation and administrationa. Verify correct radiopharmaceutical for examb. Preparation for administrationc. Assay in dose calibratord. Radiopharmaceutical labelinge. Administration techniquef. Residual dose measurement3. Routes of administration4. Intravenous injection techniques5. Factors affecting biodistributiona. Cardiologyi. Serum glucose levelii. Serum insulin levelb. Neurologyi. Stimulationii. Surgical variantsiii. Radiation treatmentiv. Serum insulin/glucose levelsv. Psychotropic drugsvi. Ictal vs. inter‐ictal statec. Oncologyi. Serum insulin/glucose levelsPET Specialty Certification Exam 2021

ii. Exerciseiii. Chemotherapyiv. Radiation therapyv. Surgery/biopsyvi. Hemopoietinsvii. Muscle tensionviii. Hydrationix. Inflammatory diseasex. Infectious processesxi. SSRI medicationB. Administration of interventional pharmaceuticals, pharmaceuticals and contrast media1. Basic conceptsa. Indicationsb. Contraindicationsc. Adverse reactionsd. Medication interactionse. Dosing and route of administrationf. Pediatric considerations2. Emergency carea. CPRb. Emergency medicationsc. Diabetic complicationsd. Contrast reactionse. hypoglycemia3. Pharmaceuticalsa. Cardiologyi. Dobutamineii. Adenosineiii. Dipyridamoleiv. Regadenosoniv. Glucosev. Insulinvi. Hyperinsulinemic‐euglycemic clampvii. Heparinb. Neurologyi. Sedatives/Anxiolyticsii. Antiseizurec. Oncologyi. Diureticsii. IV/oral hydrationiii. Sedatives/ Anxiolyticsiv. Insulin4. Contrast mediaa. Oralb. Non‐ionicc. IonicC. Gated Procedures (Cardiac and Respiratory)1. Equipment2. Lead placement3. Sources of error2

a. Patientb. Equipmentc. UserD. Imaging Techniques:1. Cardiology:a. History and assessmentb. Indications and contraindicationsc. Patient preparation/instructionsi. pre‐arrivalii. pre‐injectioniii. post‐injectioniv. post‐procedure– discharge instructionsd. ECG’si. Patient preparation, electrode placementii. Rate calculationiii. Normal and abnormal rhythmse. Exercisef. Uptake periodg. Patient positioningi. Low dose scoutii. Transmissioniii. Anatomical markersh. Imaging techniquesi. Anatomy/physiology/clinical indicationsi. Myocardial Perfusion Imagingii. Myocardial Viabilityiii. Myocardial Sarcoidosis2. Neurology:a. History and assessmentb. Indications and contraindicationsc. Patient preparation/instructionsi. pre‐arrivalii. pre‐injectioniii. post‐injectioniv. post‐procedure– discharge instructionsd. Uptake timee. EEG monitoringi. Patient preparationii. Seizure activity patternsf. Patient positioningg. Imaging techniquesh. Anatomy/physiology/clinical indicationsi. Epileptic seizuresii. Dementiaiii. Tumoriv. Movement disorders3. Oncology:a. History and assessmentb. Indications and contraindicationsc. Patient preparation/instructionsi. pre‐arrival3

ii. pre‐injectioniii. post‐injectioniv. post‐procedure – discharge instructionsd. Uptake timee. Patient positioningi. Arms up/downii. Head first/feet firstf. Imaging techniquesg. Anatomy/physiology/clinical indicationsi. Colorectal cancerii. Head/Neck canceriii. Esophageal canceriv. Non‐Small Cell Lung cancerv. Single Pulmonary Nodule (SPN) evaluationvi. Breast cancervii. Melanomaviii. Lymphomaix. Thyroid cancerx. Prostate cancerxi. Other indications4. Acquisition modesa. 2Db. 3Dc. Time of Flightd. Emissione. Transmissioni. Measuredii. CTf. Single bed positioni. Post‐injection start timeii. Scan durationg. Dynamic imagingi. Framing ratesii. Injection sites/techniquesh. Whole body imagingi. Post‐injection start timeii. Number of bed positionsiii. Scan duration/bediv. Slice overlapII. Instrumentation/Quality Control ( 30%) [60 items]A. Survey Meter1. Operating principles2. Quality control3. Source selection4. Interpretation of QC resultsB. Dose calibrator1. Operating principles2. Quality control (accuracy, linearity, geometry, constancy)4

3. Frequency of quality checks4. Source selection5. Interpretation of resultsC. Well Counter1. Operating principles2. Quality control (constancy, energy FWHM, chi‐square)3. Frequency of quality checks4. Source selection5. Interpretation of resultsD. Scintillation Detector Systems1. Principles of scintillation detection2. Detector materialsa. BGOb. LSOc. GSOd. NaI3. System typesa. Dedicated PETi. Full ringii. Partial ringiii. Detector panelsb. Integrated PET/CT4. Quality controla. Normalizationb. Blank scanc. Gains (Singles)d. Calibration factors for quantificatione. Scanner failure/recognition of instrumentation artifactsi. Detector failureii. High voltage driftiii. Energy driftiv. Gain driftv. Power supply drift/failurevi. Temperature drift (cooling system failure)vii. Coincidence timing malfunctionviii. Transmission source malfunctionix. Septa mis‐positioning/alignmentx. Imaging table failure5. System performancea. Scatter fractionb. Randoms fractionc. Noise equivalent count rate (NEC)d. NEMA standards and testingE. Theory of Operation1. Principles of Coincidence Detectiona. Truesb. Randomsc. Scatterd. Lines of response (LORs)5

e. Delayed eventf. Coincidence timing window2. Image Formation and Reconstructiona. Sinogramsi. 2Dii. 3Diii. Fourier rebinningiv. Filtered back projection (FBP)v. Iterative reconstructiona Ordered subset expectation maximization (OSEM)b Maximum likelihood expectation maximization (MLEM)b. Image filters/cutoff frequencies3. Data processing/correctionsa. Normalizationb. Decay correctionc. Attenuation correctioni. Calculatedii. Measurediii. Segmentediv. No attenuation correctiond. Random correctione. Scatter correctionF. Data Analysis1. Quantitative analysisa. Region of interestb. Time activity curvesc. Standardized Uptake Value (SUV)i. Methods of calculationii. Sources of errord. Metabolic flow rate measurement and analysise. R to L count profiles and histogramf. Cardiac polar mappingg. Other2. Image reconstruction variantsG. Basic Principles of Image Fusion/Image Registration1. Manual2. Mechanical3. Automateda. Rigidb. DeformableH. Image Artifacts1. Pre‐procedurea. Medicationsb. Prostheticsc. Therapeutic effectsd. Exercise2. Injection/uptakea. Muscle tensionb. Injection sites/tubing6

c. Radioactive contaminationd. Environment (temperature, noise)3. Scanning Procedurea. Patient motionb. Transmission/emission (misalignment)c. Bed position overlapd. Urinary catheter linese. IV linesf. High Z materialg. Filter/cutoff selectionh. Partial volume effecti. Attenuation correctionj. CTi. Contrastii. Attenuation correctionIII. RADIATION PROTECTION ( 10%) [20 items]A. Personal protection/monitoring1. Basic concepts (ALARA)2. Personnel protectiona. Timeb. Distancec. Shieldingi. Patient doseii. Dose calibratoriii. Scanning roomiv. Waiting roomv. Control roomvi. Patient holding roomvii. Waste3. Personnel monitoring devices (body/extremity)4. Regulatory requirements including appropriate signageB. Area/facilities monitoring1. Basic concepts2. Survey equipment3. Radiation surveys4. Regulatory requirementsC. Packaging and storage of radioactive materials1. Inspection of incoming/outgoing materials2. Storage of radiopharmaceuticalsD. Records1. Shipping of radioactive materials2. Receipt of radioactive materials3. Administration of radioactive materials4. Storage of radioactive materials5. Disposal of radioactive materials6. Radiation surveys7

E. Radioactive decontamination1. Area2. PersonnelF. Disposal of Radioactive Waste1. Release to environment2. Decay to storage3. Incineration4. Transfer to authorized recipientG. Medical Events1. Definitions2. Reporting and notificationIV. RADIOPHARMACEUTICALS ( 25%) [50 items]A. Radiopharmaceutical Characteristics1. Method of localization2. Radiopharmaceutical kinetics3. Radiopharmaceutical dosimetry4. Radiopharmaceutical biodistribution and normal variantsB. Physical properties of radioactive materials1. Types of emissions2. Energies3. Decay rate and half‐lifeC. Positron radionuclide principles1. Positron decay2. Positron energy3. Annihilation reaction4. Bremsstrahlung radiation5. Decay factors6. Exposure rates7. Half value layerD. Radionuclide production1. Cyclotrona. Principles of operationb. Targetry2. Generators – Ge-68/Ga-68, Sr-82/Rb-82a. Principles of operationb. Elutionc. Quality controlE. Synthesis of radiopharmaceuticals1. Basic chemistry2. Synthesis modulesF. Quality control of radiopharmaceuticals/radiochemicals/chemicals8

1. Purity2. Identity3. Sterility4. Apyrogenicity5. pH6. StabilityPROCEDURES LISTCardiologyCommon indications, including but not limited to:1. Rest/stress perfusion2. ViabilityNeurologyCommon indications, including but not limited to:1. Alzheimer2. Epileptic seizuresOther indications3. Dementia4. Brain tumor5. Movement disorderOncologyCommon indications, including but not limited to:1. Colon cancer2. Cervical cancer3. Head/Neck cancer4. Non‐small cell lung cancer5. Solitary pulmonary nodule (SPN) evaluation6. Breast cancer7. Melanoma8. Lymphoma9. Thyroid cancerOther indications:10. Ovarian cancer11. Pancreatic cancer12. Sarcomas13. Prostate14. Neuroendocrine tumorOther1. F‐18 sodium fluoride ‐ skeletal imaging2. F‐18 FDG inflammation/infection imagingDIAGNOSTIC RADIOPHARMACEUTICALS1. C‐11 acetate2. C‐11 Choline3. C‐11 Palmitate4. F-18 flortaucipir5. F-18 fluoroestradiol6. F‐18 fluorodeoxyglucose (FDG)7. F‐18 fluorodopa (F‐Dopa)8. F‐18 sodium fluoride9

9. F‐18 fluorothymidine (FLT)10. F‐18 fluoromisonidazole (FMISO)11. N‐13 ammonia12. O‐15 O213. O‐15 water14. Rb‐82 chloride15. F‐18 sodium fluoride16. F‐18 florbetapir17. F‐18 flurpiridaz18. F‐18 choline19. Ge‐6820. Ga‐68 dotatoc21. Ga‐68 dotanoc22. Ga‐68 dotatate23. I‐12424. Cu‐6425. Cu-64 dotatate26. C‐11 choline27. F‐18 flutemetamol28. F‐18 florbetaben29. F-18 fluciclovine30. PSMAMISCELLANEOUS PHARMACEUTICALS1. Acetylsalicylic acid2. Anticoagulants3. Antiarrhythmics4. Calcium channel blockers5. ACE inhibitors6. Cholesterol‐lowering drugs7. Digoxin8. Nitrates9. Beta blockers10. Caffeine11. Growth stimulation hormone factor12. Hematopoetins13. Diabetic medications14. Steroids15. GlucoseINTERVENTIONAL PHARMACEUTICALS1. Adenosine2. Dipyridamole3. Diuretics4. Aminophylline5. Dobutamine6. Theophylline7. Furosemide8. Insulin9. Glucose10. Sedatives/Anxiolytics10

11. Regadenoson12. Calcium channel blockers13. HeparinCONTRAST MEDIA1. Oral2. Non‐ionic3. IonicEQUIPMENT LIST1. Dedicated PET scanner and integrated PET/CT scanner2. Dose calibrator3. Well counter4. Survey meter5. Glucose meter6. ECG monitor7. Gate box/trigger8. Defibrillator, emergency cart access9. O2 saturation monitor10. Intravenous infusion pump11. EEG monitor12. Radiopharmaceutical generator13. Dose delivery systemUpdated December 202011

C. Positron radionuclide principles 1. Positron decay 2. Positron energy 3. Annihilation reaction 4. Bremsstrahlung radiation 5. Decay factors 6. Exposure rates 7. Half value layer D. Radionuclide production 1. Cyclotron a. Principles of operation b. Targetry 2. Generators - Ge-68/Ga-68, Sr-82/Rb-82 a. Principles of operation b. Elution c .

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