Certificate of Fellowship of the European Board of Nuclear Medicine

Which description best matches the current official identity of exam ID eu-ebnm-exam?

• AA generic European nuclear medicine technologist licensing examination
• BThe UEMS/EBNM Certificate of Fellowship of the European Board of Nuclear Medicine (FEBNM)
• CA national board examination limited to one European Union member state
• DA continuing medical education quiz without a fellowship certificate outcome

A candidate is planning travel for the 2026 FEBNM examination. Which plan matches the official arrangement?

• ARemote MCQ on October 15, 2026 and remote oral on October 17, 2026
• BOnsite written essay exam on October 17, 2026 and oral exam in a separate city in Novembe…
• COne combined practical examination on June 7, 2026 at Austria Center Vienna
• DOnsite online MCQ on October 16, 2026 and onsite in-person oral on October 16 and 17, 202…

Which application timing statement is correct for the 2026 FEBNM examination?

• AThe regular application deadline is May 03, 2026, with a late deadline of June 07, 2026 i…
• BThe regular application deadline is June 07, 2026, and late applications are accepted unt…
• CApplications close on October 17, 2026 after the oral examination begins.
• DThere is no application deadline because registration occurs only onsite.

A physician passed the MCQ part in 2024 and applies in 2026 for the oral part only. Which fee category matches the official 2026 fee structure?

• AMCQ only, EUR 250
• BMCQ plus Oral, EUR 600
• COral only after MCQ passed in 2025-2023, EUR 350
• DOral retake second try, EUR 200

A candidate passed the FEBNM MCQ more than 3 years before the planned oral examination. What is the official consequence?

• AThe oral examination can still be taken without restriction because MCQ success never exp…
• BThe candidate may take only a shorter oral examination.
• CThe candidate must redo the MCQ because both parts must be completed within 3 years.
• DThe candidate is permanently excluded from future FEBNM examinations.

Which application package most closely matches the official FEBNM requirements?

• ACountry/date of Nuclear Medicine national board certificate or equivalence documents, CV,…
• BCurriculum vitae only, because procedure numbers are assessed at the oral examination
• CProof of attendance at EANM'26 only, with no requirement for certificates or procedure do…
• DA log of 300 diagnostic procedures and 10 therapies, with no supporting certificates

During planar imaging of I-131 with a gamma camera fitted with a low-energy high-resolution collimator, the image shows severe septal penetration and star-like artifacts. What is the best technical correction?

• ANarrow the Tc-99m photopeak window to 5 percent.
• BMove the patient farther from the collimator to improve resolution.
• CAcquire fewer counts to reduce septal penetration.
• DUse a high-energy collimator appropriate for the photon energy.

A Tc-99m acquisition uses a 140 keV photopeak window. What is the main reason scattered photons are preferentially detected below the photopeak?

• APair production in the crystal converts 140 keV photons into 511 keV photons.
• BCompton scattering in the patient reduces photon energy before detection.
• CThe photomultiplier tubes amplify only low-energy photons.
• DThe collimator increases photon energy by absorbing septal electrons.

For a parallel-hole collimator, which statement about resolution and sensitivity is most accurate?

• ASpatial resolution improves as the source moves farther from the collimator face.
• BSpatial resolution worsens as source-to-collimator distance increases, while sensitivity…
• CSensitivity becomes zero at distances greater than one focal length.
• DIncreasing hole diameter improves resolution without changing sensitivity.

A SPECT study reconstructed from a camera with an uncorrected center-of-rotation error is most likely to show which artifact?

• AUniform global increase in measured activity concentration only
• BComplete absence of attenuation in all projections
• CA pure low-energy tail on the energy spectrum without spatial distortion
• DRing, crescent, or duplicated-edge artifacts in transaxial slices

Why is a gamma camera uniformity flood test important before clinical SPECT imaging?

• ANonuniform detector response can be amplified by reconstruction into ring artifacts.
• BIt directly measures patient renal clearance.
• CIt replaces the need for energy peaking.
• DIt calibrates the CT tube current for attenuation correction.

Which statement correctly describes PET coincidence imaging?

• APET detects a single 140 keV photon after mechanical collimation.
• BThe positron itself travels through the detector crystal and is counted directly.
• CA positron annihilation usually produces two 511 keV photons emitted approximately 180 de…
• DCoincidence detection requires a lead parallel-hole collimator for every detector block.

What does time-of-flight PET primarily improve?

• AIt eliminates the need for attenuation correction in obese patients.
• BIt changes the annihilation photon energy from 511 keV to 140 keV.
• CIt estimates the annihilation position along the line of response from the arrival-time d…
• DIt prevents all respiratory motion artifacts.

In PET, which approach is commonly used to estimate random coincidences?

• ADelayed coincidence window sampling
• BDaily intrinsic flood uniformity with Co-57 only
• CMeasuring the patient height in centimeters
• DTurning off attenuation correction

A PET/CT shows an apparent focal FDG defect at the dome of the liver only on attenuation-corrected images. Review shows CT and PET misregistration from respiration. What is the most likely explanation?

• AThe lesion must be non-FDG-avid malignancy because it disappears without attenuation corr…
• BRandom coincidences are always higher in the liver dome than elsewhere.
• CThe PET detector normalization file cannot affect attenuation-corrected images.
• DIncorrect attenuation map alignment created a correction artifact.

A small pulmonary nodule is clearly seen on CT but has an underestimated SUV on FDG PET because its diameter is below about two to three times the PET spatial resolution. What effect best explains this?

• ABremsstrahlung contamination
• BPartial-volume effect
• CMolybdenum breakthrough
• DPhotopeak window drift

A very high-activity first-pass radionuclide acquisition shows count losses and distorted count-rate curves. Which detector phenomenon is the most likely cause?

• AImproved Poisson statistics at high activity
• BDead-time losses and pulse pile-up at high count rates
• CIncreased collimator focal length
• DComplete removal of scattered photons by the pulse-height analyzer

A dose calibrator constancy check with a long-lived reference source reads 8 percent lower than expected. What is the most appropriate response before administering patient doses?

• AIgnore the result because constancy checks are unrelated to administered activity.
• BDouble all measured patient activities to compensate.
• CUse the gamma camera image counts to certify the syringe activity without further action.
• DInvestigate and resolve the QC failure according to local procedures before relying on th…

What is the purpose of checking Mo-99 breakthrough in eluate from a Tc-99m generator?

• ATo verify radionuclidic purity and avoid administering excessive long-lived parent radion…
• BTo determine whether the patient is pregnant.
• CTo measure free pertechnetate radiochemical impurity only.
• DTo confirm that the gamma camera center of rotation is correct.

A Tc-99m bone scan shows unexpected gastric and thyroid activity, raising concern for free pertechnetate. Which QC concept is most directly implicated?

• APET detector normalization
• BCT tube warm-up calibration
• CRadiochemical purity of the labeled preparation
• DParallel-hole collimator focal distance

Which unit pairing is correct in radiation dosimetry?

• AAbsorbed dose is measured in becquerel, while activity is measured in gray.
• BEffective dose is measured in counts per second, while absorbed dose is measured in hertz.
• CAbsorbed dose is measured in gray, while equivalent and effective dose are measured in si…
• DEquivalent dose and administered activity are both measured in millisievert.

A staff member must handle a syringe containing a high-energy gamma-emitting radiopharmaceutical. Which practice best applies ALARA principles?

• AUse appropriate shielding and tools, maximize distance when practical, and minimize handl…
• BHold the unshielded syringe close to the torso to improve control.
• CIncrease handling time so the exposure rate can be measured more accurately by the body b…
• DUse thin paper as the main shield for high-energy photons.

Which shielding principle is most appropriate for a pure or high-energy beta emitter such as Y-90?

• AUse only thick lead directly against the beta source because lead eliminates bremsstrahlu…
• BNo shielding is needed because beta particles cannot irradiate skin.
• CUse a Tc-99m low-energy collimator as personal shielding.
• DUse low-Z shielding such as acrylic close to the beta source to reduce bremsstrahlung pro…

Before an elective diagnostic nuclear medicine study, a patient says she may be pregnant. What is the most appropriate next step?

• AProceed unchanged because diagnostic administered activities can never irradiate the embr…
• BClarify pregnancy status and clinical justification, consider alternatives or postponemen…
• CCancel all future nuclear medicine procedures permanently.
• DAdminister extra activity to shorten imaging time and reduce fetal dose.

During injection of a therapeutic radiopharmaceutical, suspected extravasation occurs at the intravenous site. What is the best immediate management principle?

• AIgnore the event if the planned systemic activity was assayed correctly before injection.
• BStop or pause administration as appropriate, assess the site, limit local dose when possi…
• CApply no documentation because extravasation affects image quality only and never tissue…
• DFlush forcefully without assessment so the entire residual activity enters the tissue.

A 58-year-old man with newly diagnosed non-small cell lung cancer undergoes FDG PET/CT for staging. The primary right upper lobe tumour is intensely FDG-avid, and there is a small FDG-avid left adrenal nodule with CT attenuation of 8 HU on non-contrast images. What is the most appropriate interpretation?

• ATreat the adrenal focus as definite metastatic disease because it is FDG-avid
• BIgnore the adrenal finding because adrenal metastases are never solitary in lung cancer
• CClassify the examination as non-diagnostic because FDG PET/CT cannot assess adrenal lesio…
• DConsider the adrenal lesion likely benign adenoma, integrating low CT attenuation despite…

A patient with diffuse large B-cell lymphoma has interim FDG PET/CT after two cycles of immunochemotherapy. Residual mediastinal uptake is visually greater than mediastinal blood pool but lower than normal liver uptake, with no new lesions. Using the Deauville 5-point scale, what score best applies?

• ADeauville 3
• BDeauville 1
• CDeauville 2
• DDeauville 5

A 66-year-old man with biochemical recurrence after prostatectomy has a PSA of 0.35 ng/mL and a negative conventional CT and bone scan. Which imaging test is generally most appropriate to localize recurrent disease?

• AFDG PET/CT
• BIodine-123 MIBG scintigraphy
• CPSMA PET/CT
• DTechnetium-99m sestamibi parathyroid SPECT/CT

A 72-year-old man with metastatic castration-resistant prostate cancer is being evaluated for lutetium-177 PSMA radioligand therapy. PSMA PET/CT shows intense uptake in most bone and nodal metastases, but one enlarging liver lesion is PSMA-negative and FDG-positive. What is the main clinical implication?

• AThe liver lesion confirms ideal eligibility because FDG uptake predicts PSMA therapy resp…
• BPSMA radioligand therapy is contraindicated whenever any liver metastasis is present, reg…
• CDiscordant PSMA-negative viable disease suggests a higher risk of poor response and shoul…
• DThe FDG PET finding is irrelevant because only bone lesions determine treatment eligibili…

A patient with metastatic well-differentiated ileal neuroendocrine tumour is considered for peptide receptor radionuclide therapy. Which imaging pattern most strongly supports suitability for lutetium-177 DOTATATE therapy?

• ASomatostatin receptor PET uptake in lesions clearly above normal liver uptake
• BAbsent somatostatin receptor uptake but intense FDG uptake in all lesions
• COnly physiologic splenic and pituitary uptake without tumour uptake
• DDiffuse thyroid uptake on radioiodine scan

On gallium-68 DOTATATE PET/CT for a suspected pancreatic neuroendocrine tumour, a small focus of intense uptake is seen in the pancreatic uncinate process without a definite CT mass. What is the most appropriate next step in interpretation?

• AReport definite pancreatic neuroendocrine tumour because any uncinate uptake is malignant
• BDiagnose autoimmune pancreatitis because DOTATATE uptake is specific for inflammation
• CRecommend immediate PRRT based only on this focus
• DRecognize physiologic uncinate process uptake as a known pitfall and correlate with MRI o…

A 45-year-old woman with stage II breast cancer undergoes FDG PET/CT. There is symmetric, mild-to-moderate FDG uptake in both axillary nodal basins shortly after bilateral influenza vaccination, with no suspicious nodal enlargement and no uptake in distant sites. What is the best interpretation?

• ABilateral axillary metastases are confirmed because breast cancer commonly spreads symmet…
• BThe uptake is most consistent with reactive vaccine-related nodal activation in the appro…
• CThe scan proves complete absence of nodal disease because reactive nodes exclude metastas…
• DThe study must be repeated immediately with therapeutic radioiodine

A patient with colorectal cancer has rising CEA after liver metastasectomy. Contrast-enhanced CT is equivocal near the resection margin because of postoperative change. Which role of FDG PET/CT is most appropriate?

• AIt should be avoided because colorectal metastases never accumulate FDG
• BIt can help distinguish metabolically active recurrent tumour from postoperative scar and…
• CIt is useful only for detecting osteoblastic bone metastases, not liver recurrence
• DIt replaces histology for determining RAS mutation status

A patient treated with chemotherapy for Hodgkin lymphoma has end-of-treatment FDG PET/CT. A residual anterior mediastinal mass has uptake equal to mediastinal blood pool and markedly below liver, with no other lesions. What is the most appropriate response classification using Lugano/Deauville principles?

• AProgressive metabolic disease
• BPartial metabolic response with mandatory biopsy in all cases
• CStable metabolic disease because a residual mass remains
• DComplete metabolic response

A woman with differentiated thyroid carcinoma has total thyroidectomy followed by radioiodine ablation. Six months later thyroglobulin is rising, neck ultrasound is negative, and diagnostic radioiodine whole-body scan is negative. Which imaging test is most appropriate to look for dedifferentiated disease?

• AFDG PET/CT
• BGallium-68 DOTATATE PET/CT
• CTechnetium-99m MAG3 renography
• DIodine-123 MIBG scintigraphy

Before high-activity radioiodine therapy for differentiated thyroid cancer, which instruction is most relevant for improving radioiodine uptake in residual thyroid tissue or iodine-avid metastases?

• AAdminister iodinated CT contrast immediately before therapy to increase iodine trapping
• BBegin high-dose corticosteroids in every patient to enhance sodium-iodide symporter expre…
• CMaintain a low-iodine diet and ensure adequate TSH stimulation by withdrawal or recombina…
• DAvoid measuring pregnancy status because radioiodine is not systemically absorbed

A man with metastatic prostate cancer has a bone scan showing multiple new sclerotic lesions 10 weeks after starting effective androgen receptor pathway therapy, while PSA has fallen substantially and symptoms have improved. What is the most appropriate interpretation?

• ADefinite progression requiring immediate discontinuation of effective treatment
• BComplete response because sclerosis always means inactive disease
• CPossible bone flare; correlate with clinical and biochemical response and consider confir…
• DThe bone scan is invalid because prostate metastases are never osteoblastic

During sentinel lymph node mapping for early breast cancer, radiotracer injection is performed around the tumour. Planar images show an axillary focus and faint uptake near the injection site. What is the key purpose of SPECT/CT in this setting?

• ATo provide precise anatomic localization of sentinel nodes and distinguish nodal uptake f…
• BTo replace the surgeon's intraoperative probe in all cases
• CTo determine oestrogen receptor status from nodal uptake intensity
• DTo deliver therapeutic radiation to the sentinel node

A patient with melanoma undergoes lymphoscintigraphy for sentinel node biopsy. Drainage is seen to an interval node between the primary lesion and the expected nodal basin. How should this be handled?

• AIt should be ignored because only nodes in standard basins can be sentinel nodes
• BIt proves systemic metastatic disease and makes surgery futile
• CIt represents physiologic renal excretion of nanocolloid
• DIt should be reported and marked as a potential sentinel node because interval nodes may…

A patient with non-small cell lung cancer has FDG PET/CT 4 weeks after completion of chemoradiotherapy. There is diffuse FDG uptake in the irradiated lung field with geographic margins corresponding to the radiation portal. What is the most likely explanation?

• ADiffuse pulmonary metastases confined exactly to the radiation field
• BRadiation pneumonitis or post-radiation inflammatory change
• CNormal physiologic lung uptake
• DA technical artefact that makes the entire PET acquisition uninterpretable

A 61-year-old woman with invasive lobular breast cancer and suspected metastatic relapse has equivocal low-grade FDG uptake in sclerotic bone lesions on PET/CT. Which statement is most accurate?

• ALow FDG uptake excludes metastases in all breast cancer subtypes
• BLobular breast cancer metastases may be relatively low FDG-avid, so correlation with CT,…
• CSclerotic bone lesions are always benign bone islands if FDG uptake is mild
• DFDG PET/CT is pathognomonic for lobular histology

A patient with metastatic colorectal cancer starts granulocyte colony-stimulating factor after chemotherapy. FDG PET/CT performed a few days later shows diffusely increased marrow and splenic uptake, reducing lesion conspicuity. What is the best conclusion?

• ADiffuse marrow uptake proves disseminated marrow metastases in all cases
• BSplenic uptake excludes chemotherapy effect and indicates lymphoma transformation
• CThe scan is ideal for response assessment because G-CSF suppresses physiologic uptake
• DThe pattern is typical after G-CSF and can limit assessment for marrow or small lesions

A man with well-differentiated grade 1 small-bowel neuroendocrine tumour has extensive liver metastases. DOTATATE PET/CT shows high receptor expression. FDG PET/CT is negative. What does this combined pattern most strongly suggest?

• AA biology consistent with well-differentiated, receptor-positive disease that may be suit…
• BA contraindication to PRRT because FDG negativity means absent viable tumour
• CTransformation to high-grade neuroendocrine carcinoma
• DA false-positive DOTATATE scan because all liver metastases must be FDG-avid

A patient receiving lutetium-177 DOTATATE PRRT develops progressive thrombocytopenia before the next planned cycle. Which management principle is most appropriate?

• AProceed on schedule because PRRT has no marrow toxicity
• BGive additional unlabeled somatostatin analogue during the infusion to reverse marrow irr…
• CAssess hematologic toxicity and consider delaying, reducing, or discontinuing treatment a…
• DSwitch immediately to radioiodine therapy because it has the same target

A man undergoing lutetium-177 PSMA therapy reports xerostomia after prior cycles. Which organ uptake best explains this toxicity risk?

• APhysiologic gallbladder uptake
• BCerebral cortical glucose uptake
• CSalivary and lacrimal gland PSMA-ligand uptake
• DThyroidal radioiodine uptake

A patient with differentiated thyroid cancer has a post-therapy iodine-131 scan showing intense uptake in the thyroid bed and additional focal uptake in the lower anterior neck. SPECT/CT localizes the lower focus to the oesophageal lumen. What is the best interpretation?

• ALikely swallowed radioiodine activity in the oesophagus rather than nodal metastasis
• BDefinite metastatic lymph node because any neck focus outside the bed is malignant
• CPhysiologic parathyroid uptake of iodine-131
• DA camera flood-field artefact requiring cancellation of the report

A patient with lymphoma has a new isolated FDG-avid pulmonary opacity on interim PET/CT during treatment, with CT appearance of consolidation and recent fever. Other lymphoma sites have resolved. What is the most appropriate interpretation?

• AClassify as Deauville 5 progression in all cases because any new FDG focus is lymphoma
• BIgnore the lung finding because FDG PET cannot show infection
• CDiagnose pulmonary embolism because FDG uptake in lung consolidation is specific
• DConsider infection or inflammation as a likely cause and avoid automatically assigning ly…