Radiopharmaceutical Kits Part II Flashcards
Describle Sestamibi
- cardiolite or miraluma
contains: - tetrakis, copper tetrafluoroborate
- stannous chloride
- l-cysteine hydrochloride
- sodium citrate, l-cysteine hydrochloride, mannitol
- uses: mpi, breast imaging, and parathyroid scans
- target organ: heart, breat tissue, parathyroid
- critical organs: upper large intestine
MIBI prep
- add 1-3 ml of 99m-Tc O4 to the reaction vial (925-5550 MBq)
- shake vigorously, boil for ten min, cool for 15
- ph at 5-6
- store at 15-25 celsius
- expires within 6 hours
MIBI QC
- Plastic TLC plate or Sep pak
- radiochemical purity over 90%
Describe the myoview kit
- Tetrofosmin
contains: - tetrofosmin
- stannous chloride
- sodium D-gluconate
- disodium sulfosalicylate
- sodium hydrogen carbonate
- nitrogen seaaled
- uses: mpi
- target organ: heart
- critical organs: gallbladder wall
Myoview prep
- Insert a venting needle into the reaction vial
- add 4-8 ml of pertechnetate (concentration must not exceed 30mCi/ml)
- withdraw 2ml of nitrogen gas from vial before removing the needle
- agitate and let stand 15 min
- pH 7.5-9
- store at 2-8 celsius prior to reconstitution
- store at 2-25 celsius post reconstitution, protect fromlight
- expires within 8-12 hours
Myoview QC
- 1 strip ITLC
- Radiochemical purity greater than 90%
What is HMPAO
- exametazime,ceretec
contents: Nitrogen sealed - Vial 1: exametazime, stannous chloride, sodium chloride
- vial 2: methylene blue stabilizer and phosphate buffer OR Cobalt stabilizer
- Stabilizer used for brain imaging; non-stabilized for WBC imaging
- Depends on manufacturer
- clinical uses: Brain imaging, WBC labeling
- target organ: Brain imaging: brain/WBC labeling
- critical organ: brain imaging: kidneys/ WBC labeling: spleen
- must use fresh eluate, no more than 30min (brain) or 2 hours (WBC) old; generator must be milked in the last 24 hours)
HMPAO prep w/ methylene blue/phosphate buffer
- Add 0.5 ml of methylene blue to phosphate buffer vial, swirl and withdraw 2 ml of this solution.
- Add 5 ml of 99mTcO4- to the reaction vial (0.37-2.0 GBq).
- Agitate vial and within 2 minutes, add the 2 ml of stabilizer/buffer solution.
- Patient dose must be filtered through a 0.2 um filter at time of injection.
- pH 6.5 – 7.5
- Store at 20-25 C
- Expiry: 4 hours
HMPAO prep w/ cobalt stabilizer
- Add 0.37 – 1.11 GBq of 99mTcO4- to the reaction vial
- Within 1-5 min add 2 ml of Cobalt Stabilizer and agitate the vial
- pH 6.5 – 7.5
- Store at 20-25 degrees
- Expiry: 5 hours.
HMPAO without stabilizer prep
- Stabilizer is not needed when Ceretec is used for WBC Labeling
- Add 5 ml of 99mTcO4- to the reaction vial (~1 GBq)
- Agitate vial
- Perform in-vitro labeling of leukocytes according to product monograph
- pH 9.0 – 9.8
- Store at 15-25oC
- Expiry: 30 min
HMPAO QC
○ 3 Strip ITLC (Instant Thin Layer Chromatography)
○ Radiochemical Purity ≥ 80%
○ Colour:
■ Blue (if using methylene blue stabilizer)
■ Amber (if using cobalt stabilizer)
■ Blood product (if used for leukocyte labeling)
○ WBC Tagging Efficiency ~55%
Describe ECD kits
● Chemical Name: Ethyl cysteinate dimer, Bicisate, Neurolite ®
● Kit Contents:
○ Nitrogen-sealed
○ Vial 1 (Reaction Vial): Bicisate dihydrochloride, edetate disodium, stannous
chloride, Mannitol
○ Vial 2 (Buffer Solution): Sodium phosphate & H2O
● Clinical Uses: Brain Imaging
● Target Organ: Brain
● Critical Organs: Bladder Wall
Describe ECD prep
○ Add 1.85 – 3.7 GBq of 99mTcO4- in 2 mL to Vial 2.
○ Add 3 ml of 0.9% saline into Vial 1 to dissolve contents; gently invert vial
○ Within 30 secs, withdraw 1 ml of Vial 1 and inject it into Vial 2
○ Gently agitate vial and let stand for 30 min
○ pH 7.2 – 8.0
○ Store at 15-30oC, protect from light
○ Expiry: 6 hrs
Describe ECD QC
○ 1 Strip ITLC (Instant Thin Layer Chromatography)
○ Radiochemical Purity ≥ 90%
Describe requirements to label RBCs:
- RBCs
- 99m-Tc O4
- stannous ion
- pertechnetate will cross erythrocyte membrane, then reduced to lower oxidation state by stannous to stay inside the RBC and allow blood pool imaging
Methods of labelling
1) in-vivo
2) modified in-vivo/in-vitro
3) in-vitro
99m-Tc ultratag kit
● Chemical Name: N/A → Tagged RBCs/Blood Pool Imaging Agent
● Kit Contents:
○ Argon-sealed
○ Syringe 1: Sodium hypochlorite
○ Syringe 2: Citric acid, sodium citrate, dextrose
○ Reaction Vial: Stannous chloride
● Clinical Uses: Localizing GI bleeds, hemangiomas of the liver, and wall motion studies
(Cardiac)
● Target Organ: Blood Pool
● Critical Organs: Spleen
Describe ultratag prep (in-vitro RBC labeling)
- Collect 1-3 ml of blood froma patient in a syringe containing 0.15ml of ACD/Heparin per 1ml of blood; gently mix the syringe
- add anticoagulated blood to the reaction vial; invert the vial to mix
- add the contents of syringe 1 and gently mix
- add contents of syringe 2 to vial and gently mix
- add 370-3700 MBq of fresh eluate in amax 3ml vol to reaction vial, and incubate 20 min
- pH 7.1-7.2
- protect syring 1 fromlight
- store at 20-25 degreess
- expires within 30 min
Describe ultratag QC
● Quality Control:
○ 99mTcO4- (eluate) QC is performed.
○ No specific QC required
■ Optional: can calculate the RBC labeling efficiency by centrifuging the blood and separating RBCs from plasma
Ultratag considerations
○ Labeled RBCs can be re-injected through the patient’s IV
○ Ensure you re-inject the correct patient (blood product)!
○ Excellent tagging efficiency and image quality (bariatric patients)
○ GI Bleeds: Ability to detect intermittent bleeding (compared to 99mTc-SC that
requires the patient be actively bleeding at injection time)
Describe PYP
● Chemical Name: Pyrophosphate, Technescan PYP ®
● Kit Contents:
○ Nitrogen-sealed
○ Sodium pyrophosphate
○ Stannous chloride
● Clinical Uses:
○ ‘Hot PYP’ - Cardiac Imaging (Myocardial Infarct), bone imaging
○ ‘Cold PYP’ – RBC labeling for Blood Pool Imaging (WMS, GI Bleed)
● Target Organ: Heart or bone (Hot PYP), Blood Pool (Cold PYP)
● Critical Organs: Bladder wall, kidneys (Hot PYP), Blood Pool (Cold PYP)
Describe hot PYP prep
○ Allow vial to warm to room temp
○ Add 1-10 ml 99mTcO4- (max: 3.7 GBq) to the reaction vial
○ Agitate and let stand 10 min
Describe cold PYP prep
○ Note: In-Vivo or modified can be used)
○ Allow vial to warm to room temp and add 3 ml of 0.9% saline to the reaction vial
○ Agitate and let stand 10 min.
○ pH 5.3 – 5.7
○ Store at 20-25oC
○ Expiry: 6 hrs
Describe PYP QC
- only done on hot PYP
- ○ 2 Strip ITLC (Instant Thin Layer Chromatography)
○ Radiochemical Purity ≥ 90%
Describe gluceptate
● Chemical Name: Glucoheptonate, GH, Glucoscan ®
● Kit Contents:
○ Nitrogen-sealed
○ Calcium gluceptate
○ Stannous chloride
○ Other: Ascorbic acid
● Clinical Uses:
○ ‘Hot GH’ – Brain and Renal Imaging
○ ‘Cold GH’ – RBC labeling for Cardiac Blood Pool Imaging (WMS)
● Target Organ: Brain & Kidneys (Hot GH), Blood Pool (‘Cold’ GH)
● Critical Organs: Bladder wall, kidneys (Hot & ‘Cold’ GH)
Describe hot gluceptate prep
○ Add 2-10 ml of 99mTcO4-(max activity of 11 GBq) to the reaction vial. Agitate and let stand 15 min
○ Expiry: 6 hrs
Describe cold gluceptate prep
○ Note: In-Vivo or modified can be used
○ Allow vial to warm to room temp and add 3 ml of 0.9% saline to the reaction vial
○ Agitate and let stand 10 min
○ pH 6.2 – 6.5
○ Store at 2-8oC after reconstitution (Fridge)
○ Expiry: 8 hrs
Describe gluceptate QC
○ 2 Strip ITLC (Instant Thin Layer Chromatography)
○ Radiochemical Purity: ≥ 90%
