2016 AAPM Annual Meeting
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Session Title: Challenges and Opportunities for Nuclear Medicine Theranostics
Question 1: What is the two main dose limiting organs from radionuclide therapies?
Reference:Nuclear Medicine Physics, An Handbook for Teachers and Students, Eds. Bailey DL, Humm JL, Todd-Pokropek A and van Aswegen A. IAEA Publications, Vienna 2014.
Choice A:G.I. tract and kidney.
Choice B:Gonads and liver.
Choice C:Bone marrow and kidney.
Choice D:Kidney and liver.
Choice E:Bone marrow and breast.
Question 2: What is the typical administered activity of 223Ra to a patient with castrate resistant prostate cancer metastatic to bone?
Reference:Carrasquillo JA, O'Donoghue JA, Pandit-Taskar N, Humm JL, Rathkopf DE, Slovin SF, Williamson MJ, Lacuna K, Aksnes AK, Larson SM, Scher HI, Morris MJ., Phase I pharmacokinetic and biodistribution study with escalating doses of 223Ra-dichloride in men with castration-resistant metastatic prostate cancer. Eur J Nucl Med Mol Imaging. 2013; 40 (9):1384-93.
Choice A:3.7 MBq (100 μCi)
Choice B:37 MBq (1 mCi)
Choice C:370 MBq (10 mCi)
Choice D:3.7 GBq (100 mCi)
Choice E:37 GBq (1 Ci)
Question 3: A radiolabeled IgG antibody injected i.v. can achieve tumor to blood ratios of in excel of 100. So why is the ratio of the radiation dose tumor to blood much lower e.g. 5?
Reference:Nuclear Medicine Physics, An Handbook for Teachers and Students, Eds. Bailey DL, Humm JL, Todd-Pokropek A and van Aswegen A. IAEA Publications, Vienna 2014.
Choice A:The radiolabeled antibody binds to the tumor but rapidly clears.
Choice B:The tumor uptake and the clearance from blood are both slow.
Choice C:The radiolabeled antibody metabolizes and releases the radionuclide back into the blood.
Choice D:The antibody binds to the blood vessels.
Choice E:The marrow is very leaky and therefore there is always more uptake in marrow than tumor.
Question 4: Why is zirconium-89 a good radionuclide for imaging tumor specific antibodies?
Reference:: Rice, SL, Roney CA, Daumar, P and Lewis JS, The Next Generation of Positron Emission Tomography Radiopharmaceuticals in Oncology, Semin Nucl Med. 2011 Jul; 41(4): 265–282.
Choice A:It produces low energy emissions that result in a very low dose to the patient.
Choice B:It has a very short half-life of only 4 hours.
Choice C:It is an inert metal, which immediately leaves the body if detached from the antibody.
Choice D:It is an ideal radionuclide for quantitative SPECT imaging .
Choice E:It is a long lived PET radionuclide suitable for imaging several days post radiolabeled antibody injection.
Question 5: What are the major drawbacks of alpha particle therapies?
Reference:Sgouros G, Roeske JC, McDevitt MR, Palm S, Allen BJ, Fisher DR, Brill AB, Song H, Howell RW, Akabani G; MIRD Pamphlet No. 22 (abridged): radiobiology and dosimetry of alpha-particle emitters for targeted radionuclide therapy. J Nucl Med. 2010 Feb;51(2):311-28.
Choice A:The emission ranges of alpha particle are < 100 micrometers
Choice B:There are very few alpha emitters suitable for radionuclide therapies
Choice C:Alpha emitters are very dangerous if ingested
Choice D:Alpha emitters often have radioactive progeny
Choice E:All of the above
Question 6: What is the most common theranostic isotopes used in Neuroendocrine cancers?
Reference:: Clemens Kratochwil,Frederik L. Giesel, Melsa Stefanova,Martina Benešová,Marcus Bronzel,  Ali Afshar-Oromieh,Walter Mier,Matthias Eder, Klaus Kopka and  Uwe Haberkorn . PSMA-targeted radionuclide therapy of metastatic castration-resistant prostate cancer with Lu-177 labeled PSMA-617 J Nucl Med March 16, 2016  [52]
Choice A:Ga-68
Choice B:Y-90
Choice C:Lu-177
Choice D:All of the above.
Question 7: Which of the following is the most promising ligand used in prostate cancer:
Reference:Clemens Kratochwil,Frederik L. Giesel, Melsa Stefanova,Martina Benešová,Marcus Bronzel,  Ali Afshar-Oromieh,Walter Mier,Matthias Eder, Klaus Kopka and  Uwe Haberkorn . PSMA-targeted radionuclide therapy of metastatic castration-resistant prostate cancer with Lu-177 labeled PSMA-617 J Nucl Med March 16, 2016  [52]
Choice A:PSA
Choice B:Prostate Antibody
Choice C:Prostate Specific Membrane Antigen (PSMA)
Choice D:PSMA inhibitor
Question 8: The following isotopes can be used as therapeutics EXCEPT:
Reference:Clemens Kratochwil,Frederik L. Giesel, Melsa Stefanova,Martina Benešová,Marcus Bronzel,  Ali Afshar-Oromieh,Walter Mier,Matthias Eder, Klaus Kopka and  Uwe Haberkorn . PSMA-targeted radionuclide therapy of metastatic castration-resistant prostate cancer with Lu-177 labeled PSMA-617 J Nucl Med March 16, 2016  [52]
Choice A:Pb203
Choice B:Pb212
Choice C:Lu-177
Choice D:Y-90
Question 9: What is/are the advantage(s) of Ga-68 DOTATATE PET/CT to Octreoscan for diagnosis of neuroendocrine cancers:
Reference:Clemens Kratochwil,Frederik L. Giesel, Melsa Stefanova,Martina Benešová,Marcus Bronzel,  Ali Afshar-Oromieh,Walter Mier,Matthias Eder, Klaus Kopka and  Uwe Haberkorn . PSMA-targeted radionuclide therapy of metastatic castration-resistant prostate cancer with Lu-177 labeled PSMA-617 J Nucl Med March 16, 2016  [52]
Choice A:PET/CT is done faster than Octreoscan.
Choice B:Quantification capability and higher spatial resolution.
Choice C:Less radiation than Octreoscan.
Choice D:All of the above.
Question 10: Which organ gets the highest radiation per gram of tissue in Lu-177 PSMA therapy:
Reference:Clemens Kratochwil,Frederik L. Giesel, Melsa Stefanova,Martina Benešová,Marcus Bronzel,  Ali Afshar-Oromieh,Walter Mier,Matthias Eder, Klaus Kopka and  Uwe Haberkorn . PSMA-targeted radionuclide therapy of metastatic castration-resistant prostate cancer with Lu-177 labeled PSMA-617 J Nucl Med March 16, 2016  [52]
Choice A:Bone marrow
Choice B:Kidneys
Choice C:Salivary gland
Choice D:Liver
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