Radiopharmaceutical Kits Part I Flashcards
Describe 99m-Tc diphosphonates (MDP and HDP)
- Chemical names: Medronate, methylene diphosphonic acid and oxidronate
Contents: - Nitrogen-sealed
- medroic acid/oxidronate
- stannous chloride
- PABA, ascorbic acid or gentisic acid
- Target organ: Bone surface
- Critical organ: Bone surface and urinary bladder wall
MDP preparation
- add 2-18.5 GBq of 99m-TcO4 in a volume of 1-10 mL
- Agitate vial 1-2 minutes, let stand 5 min
- store at 2-30 celsius
- pH 6.5-7.5
- 6-12 hr expiry
HDP preparation
- Add 3-6 mL of 99m-Tc O4
- Agitate vial 1-2 min and let stand 15 min
- store at 15-30 celsius
- pH 4.0-5.5
- expires at 8 hrs
QC done on diphosphonates
- 2 strip ITLC
- Radiochemical purity >/= 90%
Describe 99m-Tc DTPA
- Pentetate
Contents: - nitrogen sealed
- DTPA
- stannous chloride
- PABA, calcium chloride
- Uses: GFR, Renal perfusion, CSF leaks, Lung vent, Brain death
- Target organ: Kidneys
- Critical organs: Bladder wall
DTPA prep
- Add 0.11-18.5 GBq of 99m-Tc O4 in a volume of 1-10ml
- agitate viaal, let stand 5-15 min\
- pH 3.8-7.5
- Store at 2-25 celsius
- expires at 6-12 hrs
DTPA QC
- 2 Strip ITLC
- Radiochemical purity greater than or equal to 90%
Describe 99m-Tc MAG3
contents:
- Argon-sealed
- betiatide
- stannous chloride
- sodium tartrate, lactose monohydrate
- Target organ: kidneys
- Critical organ: bladder wall
- Clinical use: Renal perfusion
Describe MAG 3 prep
- Insert venting needle provided into the kit vial
- add 740-3700 MBq of 99m-Tc O4 to the vial
- remove 2ml of argon gas from the vial
- add saline as needed to a total kit volume of 4-10 ml
- agitate vial and within 5 min, boilin water for 10 min; cool 15 min
- pH 5.0-6.0
- store at 15-30 celsius
- expires within 6 hours
MAG3 QC
- Waters sep-pak cartridges
- radiochemical purity greater than 90%
Describe DMSA
- AKA succimer
Contents: - Nitrogen sealed
- DMSA
- Stannous chloride
- Ascorbic acid, inositol
- Clinical uses: evaluation of renal parenchyma
- target organ: renal cortex
- Critical organs: renal cortex and bladder wall
DMSA prep
- add 270-1500 MBq of 99m-Tc O4 to kit vial
- agitate vial and let stand for 10 min
- pH: 2 to 3
- Store at 208 degrees before and after reconstruction
- protected from light
- expires in 4 hrs
DMSA QC
- 1 strip ITLC acetone
- Radiochemical purity greater then or equal to 85%
Describe DISIDA and BRIDA Kits
- hepatolite and choletec
- DISIDA: Nitrogen-sealed, disofenin, sstannous chloride
- BRIDA: Nitrogen-sealed, mebrofenin, stannous flouride, methyl paraben
- Uses: Hepatobiliary imaging
- Target organ: Hepatobiliary system
- Critical organ: Upper large intestine
DISIDA Prep
- add 370-3700 MBq of 99m-Tc O4 in a total of 4-5 ml
- agitate, let stand 4 min
- sitrogen sealed
- pH 4 to 5
- store at 20-25 celsius
- expireswithin 6 hrs
BRIDA prep
- Add up to 3700 MBq of pertechnetate to kit vial in a total of 1-5 ml
- agitate, let stand 15 min
- nitrogen-sealed
- 4.2 to 5.7 pH
- store at 20-25 celsius
- expires within 6-18 hours
DISIDA and BRIDA QC
- 2 strip ITLC
- Radiochemical purity of 90%
Describe a 99m-Tc Sulfur colloid kit
Contents:
- Reaction vial: anhydrous sodium thiosulfate (sulfur source), disodium edetate (Al3 chelator), gelatin (protective colloid/pH stabilizer)
- solution a vial: HCL acid
- Solution b vial: sodium biphosphate and NaOH (base-buffer)
- uses: Lymphoscintigraphy, GI bleeds, bone marrow, liver/spleen, gastric emptying
- target organ: Depends on study being performed
- Critical organ:Liver (Intravenous injection); Upper intestine (oral)
Sulfur colloid prep
- Add 1-3ml of pertechnetate to the vial, max activity 1800MBq/ml
- add 1.5ml of vial a to the reaction vial
- agitate vial and boil for 5 min; cool for 3 min
- add 1.5ml of vial b to the reaction vial
- pH 4.5 to 7.5
- store 15-30 celsius
- expires within 6 hrs
- filtered through a 0.1-0.2 Um millipore filter for lymphoscintigraphy
Sulfur colloid QC
- 1 strip ITLC
- Radiochemical purity
- cloudy in appearance
- particle size 0.1-1um
Preparation considerations for sulfur colloid
- The precense of Al 3+ can interfere with colloid formationby flocculation
- evident in presence of phosphate buffer
- aggregation causes larger particles to be trapped within the pulmonary capillaries
- eluate should not be used if it contains more than 10 ug/ml of Al3+
- Agitate vial to ensure even distribution of particle prior to dispensing a dose and injecting a patient
Describe MAA
contents: Stannous albumin (aggregated human albumin heated with stannous chloride)
- uses: pulmonary perfusion, DVT diagnosis, First pass angiography, shunt patency
- Target organ:Lungs or other depending on the clinical study
- Critical organ: lungs or other depending on clinical study/route
MAA prep
- add 740-2220 MBq of pertechnetate to reaction vial in a volume of 5-10 ml
- 4-8 million particles in one vial
- 200-700k particles per 148 MBq (# particles per patient dose)
- Agitate vial and let stand 5-15 min
- 3.8 to 8 pH
- store at 2-8 celsius after reconsitution
- expires within 6-8 hrs
MAA QC
- 1 strip ITLC
- 90% radiochemical purity
- cloudy/milky appearance
- particle sizing: 10-90um (none>150 um)
MAA contraindications
- Absolute: Patients with severe pulmonary hypertension
- Relative: Patients with known or suspected R-L shunt, pneumonectomy, lobectomy, pediatric or pregnant patient
- use freshly labelled MAA and reduce the # particles in the injection by using 1/3 the normal dose (74 MBq)
- dilution of MAA also reduces the number of particles (~100-200K)
MAA considerations
- Do not pull blood back into syringe
- when injecting, if blood is pulled back into the syringe and injected, it may cause hot spots on the lungs, false positive results
- agitate vial before dispensing dose
- agitate syringe before injecting
- inject supine
- avoid use of IV: dont use ports, PICC etc.,
- If the MAA particles are too small, they will accumulate in the liver and spleen
