MAA vs Colloid Particles in Nuclear Medicine
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Questions and Answers

What is the size range of MAA particles?

  • 10-90 Microns (correct)
  • 1-10 micrometers
  • 90-100 micrometers
  • 0.1-1 micrometers

    • What is the pH level of Colloid?

  • 5
  • 7-8
  • 8-9
  • 6-7 (correct)

    • What is the purpose of adding EDTA in the preparation of 99mTc-sulfur colloid?

  • To add acidity to the mixture
  • To remove by chelation any aluminum ion present in the Tc-99m eluate (correct)
  • To reduce TC04 with stannous chloride
  • To increase the temperature of the mixture

    • What is the temperature range used in the preparation of 99mTc-sulfur colloid?

    <p>95-100C</p> Signup and view all the answers

    What is the purpose of gelatin in the preparation of 99mTc-sulfur colloid?

    <p>To act as a protective colloid</p> Signup and view all the answers

    What are the commonly used phosphonate compounds for bone imaging?

    <p>MDP and HDP</p> Signup and view all the answers

    What is the labeling yield of 99mTc using the in vitro method?

    <p>80-90%</p> Signup and view all the answers

    What is the half-life of 99mTc?

    <p>6 hours</p> Signup and view all the answers

    What is the primary use of Theraspheres?

    <p>Radiation treatment of hepatocellular carcinoma</p> Signup and view all the answers

    What is the disadvantage of the in vitro method of 99mTc labeling?

    <p>Complexity in handling steps</p> Signup and view all the answers

    What is the radiolabel used for labeling monoclonal antibodies with the indirect method using a bifunctional chelating agent?

    <p>Tc-99m</p> Signup and view all the answers

    What is the recommended storage temperature for 99mTc-sulfur colloid?

    <p>Room temperature</p> Signup and view all the answers

    What is the purpose of adding stannous pyrophosphate in the in vivo method of 99mTc labeling?

    <p>To bind the 99mTc to the RBCs</p> Signup and view all the answers

    What is the purpose of polyethylene glycol (PEG) in the production of monoclonal antibodies?

    <p>To facilitate fusion of spleen cells with myeloma cells</p> Signup and view all the answers

    What is the primary purpose of SIR-Spheres?

    <p>Treatment of unresectable metastatic liver tumors from primary colorectal cancer</p> Signup and view all the answers

    What is the purpose of adding an acid citrate dextrose (ACD) solution to the platelet-rich plasma during 111In-labeling of platelets?

    <p>To prevent clotting</p> Signup and view all the answers

    What is the chelating agent used for labeling monoclonal antibodies with In-111?

    <p>DTPA</p> Signup and view all the answers

    What is the purpose of HAT medium in the production of monoclonal antibodies?

    <p>To allow only hybridoma cells to survive</p> Signup and view all the answers

    What is the mechanism of labeling of platelets with 111In?

    <p>The 111In-oxine complex is lipophilic and crosses the cell membrane, binding to intracellular components</p> Signup and view all the answers

    What is the purpose of adding stannous chloride to the 99mTc-HMPAO kit?

    <p>To reduce technetium</p> Signup and view all the answers

    What is the radiolabel used for palliation of pain due to bone metastasis?

    <p>Sr-89</p> Signup and view all the answers

    What is the charge of 99mTc-HMPAO?

    <p>Neutral (0)</p> Signup and view all the answers

    What is the method of labeling monoclonal antibodies with Tc-99m that involves incubating the antibody with stannous chloride, potassium phthalate, and potassium tartrate?

    <p>Pre-tinning Method</p> Signup and view all the answers

    What is the purpose of enzyme-linked immunosorbent assay (ELISA) in the production of monoclonal antibodies?

    <p>To screen for the production of the desired antibody</p> Signup and view all the answers

    What are the restrictions on the quality of 99mTcO-4 in the preparation of 99mTc-HMPAO?

    <p>Must not be older than 2 hours after elution from the generator and must be eluted from a generator that has been eluted in the past 24 hours</p> Signup and view all the answers

    What is the yield of the indirect method using bifunctional chelating agents for labeling monoclonal antibodies with Tc-99m?

    <p>90%</p> Signup and view all the answers

    What is the purpose of 111In-ibritumomab tiuxetan?

    <p>Used as an imaging agent to predict the distribution of the subsequental therapeutic dosage of Y90-ibritumomab within the body</p> Signup and view all the answers

    What are the two distinct features of fluorine labeling?

    <p>Use of electrophilic and nucleophilic fluorinating agents, and high specific activity</p> Signup and view all the answers

    Which of the following agents is used for detecting neuroendocrine tumors?

    <p>68Ga-DOTATATE (Netspot)</p> Signup and view all the answers

    What is the purpose of 90Y-TheraSpheres and 90Y-SIR-Spheres?

    <p>Used for treatment of liver cancer</p> Signup and view all the answers

    Which of the following agents is used for detecting Alzheimer's disease?

    <p>18F-Amyvid</p> Signup and view all the answers

    What is the role of the co-ligand in the radiolabeling process of the antibody-HYNIC conjugate?

    <p>To facilitate the binding of Tc99 to the HYNIC chelating agent</p> Signup and view all the answers

    What is the purpose of the purification step after radiolabeling the antibody-HYNIC conjugate?

    <p>To remove free Tc99 and unconjugated HYNIC</p> Signup and view all the answers

    What is the major difficulty in producing human monoclonal antibodies?

    <p>All of the above</p> Signup and view all the answers

    What is the role of the reducing agent in the direct method of 99mTc-labeling of antibodies?

    <p>To reduce TcO4- to a lower oxidation state</p> Signup and view all the answers

    What is the purpose of the stabilizing agents or ligands in the direct method of 99mTc-labeling of antibodies?

    <p>To stabilize the technetium-antibody complex</p> Signup and view all the answers

    What is the result of the HAMA response when using murine Mabs?

    <p>Immune response against the murine antibodies</p> Signup and view all the answers

    What is the mechanism of binding of Tc99 to the antibody in the direct method of 99mTc-labeling?

    <p>Through coordination with thiol groups</p> Signup and view all the answers

    What is the purpose of purification methods such as size-exclusion chromatography and ITLC after radiolabeling?

    <p>To remove impurities and unbound Tc99</p> Signup and view all the answers

    What is the primary difference in composition between MAA and colloid particles?

    <p>MAA is made from Human Serum Albumin, while colloid is composed of sulfur, antimony, or other elements</p> Signup and view all the answers

    A patient receives an injection of 5-mCi (185 MBq) 99mTc-MAA for lung imaging. How many particles did the patient receive?

    <p>750,000 particles</p> Signup and view all the answers

    What is the primary purpose of adding stannous chloride in the 99mTc-labeling of phosphonate compounds?

    <p>To reduce TC04</p> Signup and view all the answers

    What is the purpose of adding gelatin in the preparation of 99mTc-sulfur colloid?

    <p>To stabilize the colloid particles</p> Signup and view all the answers

    Which of the following radiopharmaceuticals is NOT used for the study of hepatobiliary function?

    <p>99mTc-Sulfur colloid</p> Signup and view all the answers

    What is the primary difference between MDP and HDP?

    <p>MDP and HDP are both used for bone imaging, but differ in their composition</p> Signup and view all the answers

    What is the primary role of EDTA in the preparation of 99mTc-sulfur colloid?

    <p>To chelate metal ions and prevent aggregation</p> Signup and view all the answers

    What is the primary purpose of using a kit in the 99mTc-labeling of phosphonate compounds?

    <p>To prepare a pre-mixed solution of phosphonate ligand, reducing agent, and stabilizers</p> Signup and view all the answers

    What is the primary advantage of using 99mTc over 51Cr for labeling RBCs?

    <p>Reduced radiation exposure</p> Signup and view all the answers

    What is the purpose of adding stannous pyrophosphate in the in vivo method of 99mTc labeling of RBCs?

    <p>To allow 99mTc to bind to RBCs</p> Signup and view all the answers

    What is the primary use of 51Cr-labeled RBCs?

    <p>To measure red cell mass and survival</p> Signup and view all the answers

    What is the recommended storage temperature for 99mTc-sulfur colloid?

    <p>Room temperature</p> Signup and view all the answers

    What is the primary advantage of using 51Cr over 99mTc for labeling RBCs?

    <p>Longer half-life</p> Signup and view all the answers

    What is the method of labeling RBCs with 99mTc that involves injecting stannous pyrophosphate and then 99mTc-pertechnetate?

    <p>In vivo method</p> Signup and view all the answers

    What is the purpose of adding ascorbic acid in the 51Cr labeling process?

    <p>To reduce untagged Cr+6 to Cr+3 and stop the reaction</p> Signup and view all the answers

    What is the primary disadvantage of the in vitro method of 99mTc labeling of RBCs?

    <p>Complexity in labeling process</p> Signup and view all the answers

    What is the primary disadvantage of using 51Cr for labeling RBCs?

    <p>Less ideal imaging</p> Signup and view all the answers

    What is the recommended storage temperature for 57Co-cyanocobalamin?

    <p>5 degrees Celsius</p> Signup and view all the answers

    What is the primary purpose of Theraspheres and SIR-Spheres?

    <p>Treating liver tumors</p> Signup and view all the answers

    What is the purpose of polyethylene glycol (PEG) in the production of monoclonal antibodies?

    <p>To fuse spleen cells with myeloma cells</p> Signup and view all the answers

    What is the mechanism of labeling of monoclonal antibodies with Tc-99m using the indirect method?

    <p>Tc-99m binds to a bifunctional chelating agent which is conjugated to the antibody</p> Signup and view all the answers

    What is the purpose of HAT medium in the production of monoclonal antibodies?

    <p>To select for hybridoma cells that produce the desired antibody</p> Signup and view all the answers

    What is the radiolabel used for palliation of pain due to bone metastasis?

    <p>Strontium-89</p> Signup and view all the answers

    What is the yield of the indirect method using bifunctional chelating agents for labeling monoclonal antibodies with Tc-99m?

    <p>90%</p> Signup and view all the answers

    What is the purpose of the purification step after radiolabeling the antibody-HYNIC conjugate?

    <p>To purify the radiolabeled antibody</p> Signup and view all the answers

    What is the mechanism of labeling of monoclonal antibodies with In-111 using DTPA as a chelating agent?

    <p>In-111 binds to DTPA which is conjugated to the antibody</p> Signup and view all the answers

    What is the role of the co-ligand in the radiolabeling process of the antibody-HYNIC conjugate?

    <p>To facilitate the binding of the radiometal to the HYNIC</p> Signup and view all the answers

    What is the primary purpose of enzyme-linked immunosorbent assay (ELISA) in the production of monoclonal antibodies?

    <p>To screen for hybridoma cells that produce the desired antibody</p> Signup and view all the answers

    What is the purpose of adding an acid citrate dextrose (ACD) solution to the platelet-rich plasma during 111In-labeling of platelets?

    <p>To prevent clotting of the platelets</p> Signup and view all the answers

    What is the mechanism of labeling of platelets with 111In?

    <p>The 111In-oxine complex is lipophilic, allowing it to cross the cell membrane, and then binds to intracellular components</p> Signup and view all the answers

    What is the purpose of gentisic acid in the 99mTc-HMPAO kit?

    <p>To act as a stabilizer to prevent oxidation</p> Signup and view all the answers

    What is the charge of the 99mTc-HMPAO radiopharmaceutical?

    <p>Neutral (0)</p> Signup and view all the answers

    What is the purpose of 111In-ibritumomab tiuxetan?

    <p>To image the distribution of the subsequential therapeutic dosage of Y90-ibritumomab within the body</p> Signup and view all the answers

    What is the restriction on the quality of 99mTcO-4 in the preparation of 99mTc-HMPAO?

    <p>It must not be older than 2 hours after elution from the generator</p> Signup and view all the answers

    What is the purpose of 90Y-TheraSpheres and 90Y-SIR-Spheres?

    <p>To treat liver cancer and metastatic liver disease</p> Signup and view all the answers

    What are the two distinct features of fluorine labeling?

    <p>High specific activity and radiochemical purity, and use of electrophilic and nucleophilic fluorinating agents</p> Signup and view all the answers

    What is the agent used for detecting neuroendocrine tumors?

    <p>68Ga-DOTATATE (Netspot)</p> Signup and view all the answers

    What are the agents used for detecting Alzheimer's disease?

    <p>F18-Florbetapir-Amyvid, F18-Flutemetamol-Vizamyl, and F18-Florbetaben-Neuraceq</p> Signup and view all the answers

    What is the primary function of the co-ligand in the radiolabeling process of the antibody-HYNIC conjugate?

    <p>To facilitate the binding of technetium to the HYNIC chelating agent</p> Signup and view all the answers

    What is the major difficulty in producing human monoclonal antibodies?

    <p>All of the above</p> Signup and view all the answers

    What is the result of the HAMA response when using murine Mabs?

    <p>Formation of immune complexes with human antibodies</p> Signup and view all the answers

    What is the mechanism of binding of Tc99 to the antibody in the direct method of 99mTc-labeling?

    <p>Through coordination with functional groups on the antibody</p> Signup and view all the answers

    What is the role of the reducing agent in the direct method of 99mTc-labeling of antibodies?

    <p>To reduce the technetium species</p> Signup and view all the answers

    What is the purpose of the stabilizing agents or ligands in the direct method of 99mTc-labeling of antibodies?

    <p>To stabilize the technetium-antibody complex</p> Signup and view all the answers

    What is the purpose of purification methods such as size-exclusion chromatography and ITLC after radiolabeling?

    <p>To remove free technetium and unconjugated HYNIC</p> Signup and view all the answers

    What is the mechanism of 99mTc-labeling of antibodies by the indirect method?

    <p>Through binding to a bifunctional chelating agent</p> Signup and view all the answers

    What information should be included in the record of the reconstituted 99mTc-labeled radiopharmaceutical?

    <p>Total activity, Concentration, Time of calibration, Expiration, and Name</p> Signup and view all the answers

    What is the primary purpose of USP General Chapter 823 for compounding radiopharmaceuticals?

    <p>To set standards for compounding PET radiopharmaceuticals</p> Signup and view all the answers

    What is the particle limit for ISO Class 5?

    <p>3520</p> Signup and view all the answers

    What is the main difference between ISO Class 5 and ISO Class 7 environments?

    <p>The number of particles in the air per cubic meter</p> Signup and view all the answers

    What is the purpose of USP General Chapter 825 for compounding radiopharmaceuticals?

    <p>To set standards for compounding radiopharmaceuticals specifically</p> Signup and view all the answers

    What is the primary focus of USP Chapter 825?

    <p>Balancing radiation safety with aseptic handling practices</p> Signup and view all the answers

    What is the purpose of International Organization Standardization (ISO) classifications in radiopharmaceutical compounding?

    <p>To determine the environments in which radiopharmaceuticals can be processed</p> Signup and view all the answers

    In which ISO class facility are tech-based radiopharmaceuticals typically done?

    <p>Class 5 inside a Class 8 facility</p> Signup and view all the answers

    What is the importance of compounding areas being cleaned and disinfected on a regular basis according to USP General Chapter 823?

    <p>To prevent contamination of the radiopharmaceuticals</p> Signup and view all the answers

    Which of the following is NOT addressed in USP Chapter 825?

    <p>Compounding of PET Radiopharmaceuticals</p> Signup and view all the answers

    What is the ISO class typically used for RBCs and In-111 Labeled leukocytes?

    <p>Class 7</p> Signup and view all the answers

    What is the primary focus of USP Chapter 823?

    <p>Compounding of PET Radiopharmaceuticals</p> Signup and view all the answers

    ISO Class 7 Particle limit is 35200.

    <p>False</p> Signup and view all the answers

    Tech-based Radiopharmaceuticals are done in a class 7 facility.

    <p>False</p> Signup and view all the answers

    RBCs are in class 5 and In-111 Labeled leukocytes are in class 6.

    <p>False</p> Signup and view all the answers

    USP Chapter 823 is about the Compounding of Radiopharmaceuticals.

    <p>False</p> Signup and view all the answers

    USP Chapter 825 addresses the failure of USP Chapter 823 to include radiation safety considerations.

    <p>False</p> Signup and view all the answers

    ISO Class 8 Particle limit is 35200.

    <p>False</p> Signup and view all the answers

    The record of the reconstituted 99mTc-labeled radiopharmaceutical should include the Nuclear pharmacy control number, but not the concentration.

    <p>False</p> Signup and view all the answers

    USP General Chapter 823 is a set of standards for compounding PET radiopharmaceuticals.

    <p>True</p> Signup and view all the answers

    ISO Class 5 environment is required for compounding 99mTc products and tagged RBCs and WBCs.

    <p>False</p> Signup and view all the answers

    ISO classification is used to determine the maximum number of particles in the air per cubic meter for pharmaceutical environments.

    <p>True</p> Signup and view all the answers

    Compounded pharmaceuticals are assigned a Beyond Use Date which is the date or time before compounding where the drug cannot be used and must be discarded.

    <p>True</p> Signup and view all the answers

    USP General Chapter 825 is a set of standards for compounding radiopharmaceuticals, but it does not include standards for PET radiopharmaceuticals.

    <p>False</p> Signup and view all the answers

    What information should be included in the record of the reconstituted 99mTc-labeled radiopharmaceutical?

    <p>Total activity, Concentration, Time of calibration, Expiration, Name, Nuclear pharmacy control number</p> Signup and view all the answers

    What are the key features of USP General Chapter for compounding radiopharmaceuticals?

    <p>A set of standards for Compounding Sterile Preparations (CSP), CSPs include anything that could potentially cause drugs to lose sterility and/or become pyrogenic, Compounding areas must be cleaned and disinfected on a regular basis, Compounded pharmaceuticals are assigned a Beyond Use Date</p> Signup and view all the answers

    What is the significance of ISO classification in radiopharmaceutical compounding?

    <p>ISO classification determines the maximum number of particles in the air per cubic meter, which is used to determine the environments in which radiopharmaceuticals can be processed</p> Signup and view all the answers

    What are the requirements for compounding 99mTc products according to ISO classification?

    <p>99mTc products must be compounded in a ISO Class 5 environment inside of a ISO Class 8 or cleaner environment</p> Signup and view all the answers

    What is the significance of USP 825 in radiopharmaceutical compounding?

    <p>USP 825 is a new standard specifically for radiopharmaceuticals, providing guidelines for compounding and ensuring the quality and safety of radiopharmaceuticals</p> Signup and view all the answers

    What is the importance of assigning a Beyond Use Date in radiopharmaceutical compounding?

    <p>The Beyond Use Date is the date or time after compounding where the drug cannot be used and must be discarded, ensuring the quality and safety of the radiopharmaceutical</p> Signup and view all the answers

    What is the primary advantage of using 99mTc over 51Cr for labeling RBCs?

    <p>High-quality imaging with reduced radiation exposure due to its short half-life.</p> Signup and view all the answers

    What is the purpose of adding stannous chloride in the In Vitro Method of 99mTc labeling of RBCs?

    <p>To reduce the 99mTc-pertechnetate.</p> Signup and view all the answers

    What is the mechanism of labeling of platelets with 111In?

    <p>The 111In-oxine complex is lipophilic, allowing it to cross the cell membrane.</p> Signup and view all the answers

    What is the disadvantage of the Modified In Vivo/In Vitro Method of 99mTc labeling of RBCs?

    <p>Patient discomfort due to multiple injections.</p> Signup and view all the answers

    What is the advantage of using 51Cr over 99mTc for labeling RBCs?

    <p>Longer half-life, allowing for prolonged studies of RBC survival and sequestration.</p> Signup and view all the answers

    What is the purpose of adding ascorbic acid in the 51Cr labeling process?

    <p>To reduce untagged Cr+6 to Cr+3 and to stop the reaction.</p> Signup and view all the answers

    What is the recommended storage temperature for Tc-99m sulfur colloid?

    <p>Room temperature, and dispensed within 6-12 hours.</p> Signup and view all the answers

    What is the purpose of adding ACD (Acid Citrate Dextrose) solution to the platelet-rich plasma during 111In-labeling of platelets?

    <p>To prevent clotting.</p> Signup and view all the answers

    What is the labeling yield of 99mTc using the In Vitro Method?

    <p>97%.</p> Signup and view all the answers

    What is the primary use of 51Cr labeling?

    <p>Measurement of red cell mass and its survival, and imaging of the spleen.</p> Signup and view all the answers

    What are the differences between the radiopharmaceutical preparation in USP Chapter 825 and USP Chapter 823?

    <p>USP Chapter 825 emphasizes the importance of following good radiation safety practices, balancing with aseptic handling practices, and addresses the failure of USP to include radiation safety considerations. USP Chapter 823 is specifically about the compounding of PET radiopharmaceuticals.</p> Signup and view all the answers

    What is the significance of the particle size of MAA compared to colloid in radiopharmaceutical applications?

    <p>The larger particle size of MAA (10-90 microns) restricts its use to lung perfusion, whereas the smaller particle size of colloid (0.1-1 micrometers) allows it to be used for liver and spleen, bone marrow, and gastric emptying studies.</p> Signup and view all the answers

    Describe the role of stannous chloride in the preparation of 99mTc-labeled phosphonate compounds.

    <p>Stannous chloride is used as a reducing agent to reduce TcO4- and combine it with the phosphonate ligand, resulting in the formation of a stable complex.</p> Signup and view all the answers

    What is the significance of the half-life of 99mTc and 131I in radiopharmaceutical applications?

    <p>The short half-life of 99mTc (6 hours) allows for rapid imaging and diagnosis, while the longer half-life of 131I (8.1 days) makes it suitable for therapy and longer-term studies.</p> Signup and view all the answers

    Compare and contrast the in vivo and in vitro methods of labeling RBCs with 99mTc.

    <p>The in vivo method involves injecting stannous pyrophosphate and then 99mTc-pertechnetate, which binds to the RBCs, whereas the in vitro method involves incubating RBCs with stannous chloride and 99mTc-pertechnetate. The in vivo method is more convenient but has a lower labeling efficiency, whereas the in vitro method has a higher labeling efficiency but is more time-consuming.</p> Signup and view all the answers

    What is the purpose of gelatin and EDTA in the preparation of 99mTc-sulfur colloid?

    <p>Gelatin acts as a protective colloid, stabilizing the sulfur colloid particles, while EDTA chelates any metal ions that might be present, preventing aggregation of the colloid particles.</p> Signup and view all the answers

    Describe the differences between TC-99m DISIDA and TC-99m Mebrofenin in hepatobiliary function studies.

    <p>Both are used for hepatobiliary function studies, but TC-99m DISIDA is preferred for its improved imaging quality, while TC-99m Mebrofenin has a higher labeling yield and longer shelf life.</p> Signup and view all the answers

    What is the significance of ISO Class 5 and 8 facilities in the preparation of radiopharmaceuticals?

    <p>ISO Class 5 facilities are used for the preparation of tech-based radiopharmaceuticals, such as those used in PET imaging, while ISO Class 8 facilities are used for the preparation of radiopharmaceuticals that require a higher level of radiation safety, such as those used in therapy.</p> Signup and view all the answers

    Compare and contrast the use of 99mTc and 51Cr in labeling RBCs.

    <p>99mTc is preferred for its shorter half-life, better imaging quality, and ease of labeling, while 51Cr is preferred for its longer half-life, allowing for longer-term studies, but has a more complex labeling process.</p> Signup and view all the answers

    What is the significance of radiation safety considerations in the preparation and handling of radiopharmaceuticals?

    <p>Radiation safety considerations are crucial to minimize the risks of radiation exposure to patients, healthcare workers, and the environment, ensuring safe and effective use of radiopharmaceuticals.</p> Signup and view all the answers

    What is the mechanism of labeling of leukocytes with 111In-oxine?

    <p>The 111In-oxine complex crosses the cell membrane of leukocytes. Once inside, the oxine is released, and the indium binds to intracellular components, ensuring stable labeling.</p> Signup and view all the answers

    How is the 99mTc-HMPAO kit stabilized?

    <p>The 99mTc-HMPAO kit is stabilized by including a reducing agent (stannous chloride) to maintain the reduced state of technetium, lyophilizing the components to prevent degradation, adjusting the pH to a lower level using phosphate buffer, and adding stabilizers like gentisic acid to prevent oxidation.</p> Signup and view all the answers

    What is the purpose of 111In-ibritumomab tiuxetan?

    <p>111In-ibritumomab tiuxetan is used as an imaging agent to predict the distribution of the subsequent therapeutic dosage of Y90-ibritumomab within the body.</p> Signup and view all the answers

    What are the restrictions on the quality of 99mTcO-4 in the preparation of 99mTc-HMPAO?

    <p>TCO4- must not be older than 2 hours after elution from the generator and must be eluted from a generator that has been eluted in the past 24 hours.</p> Signup and view all the answers

    What is the purpose of 90Y-TheraSpheres and 90Y-SIR-Spheres?

    <p>90Y-TheraSpheres are used for radiation treatment of hepatocellular carcinoma, while 90Y-SIR-Spheres are used for the treatment of unresectable metastatic liver tumors from primary colorectal cancer.</p> Signup and view all the answers

    What are the agents used for detecting Alzheimer's disease?

    <p>F18-Florbetapir (Amyvid), F18-Flutemetamol (Vizamyl), and F18-Florbetaben (Neuraceq) are used for detecting Alzheimer's disease.</p> Signup and view all the answers

    What are the two distinct features of fluorine labeling?

    <p>The two distinct features of fluorine labeling are the use of electrophilic and nucleophilic fluorinating agents, and high specific activity and radiochemical purity.</p> Signup and view all the answers

    What is the role of methylene blue in the stabilization of 99mTc-HMPAO?

    <p>Methylene blue is a scavenger for free radicals and helps to prevent oxidation of the 99mTc-HMPAO complex.</p> Signup and view all the answers

    What is the purpose of phosphate buffer in the preparation of 99mTc-HMPAO?

    <p>The phosphate buffer is used to adjust the pH to a lower level, which helps to stabilize the 99mTc-HMPAO complex.</p> Signup and view all the answers

    What is the mechanism of labeling of monoclonal antibodies with 111In and 99mTc?

    <p>The mechanism of labeling of monoclonal antibodies with 111In and 99mTc involves the use of a bifunctional chelating agent, which binds to the antibody and the radiolabel, forming a stable complex.</p> Signup and view all the answers

    What is the primary purpose of HAT medium in the production of monoclonal antibodies?

    <p>To allow only the hybridoma cells to survive while unfused spleen cells and myeloma cells die.</p> Signup and view all the answers

    What is the mechanism of labeling of monoclonal antibodies with Tc-99m using the direct method?

    <p>The antibody is reduced using a reducing agent such as stannous chloride, and the reduced technetium species can directly bind to the antibody.</p> Signup and view all the answers

    What is the primary difference between the direct and indirect methods of labeling monoclonal antibodies with Tc-99m?

    <p>The direct method involves reducing the technetium species and then allowing it to bind to the antibody, while the indirect method uses a bifunctional chelating agent to bind to the antibody and then the technetium.</p> Signup and view all the answers

    What is the purpose of the purification step after radiolabeling the antibody-HYNIC conjugate?

    <p>To remove free Tc-99m and unconjugated HYNIC, and to assess the purity and radiochemical stability of the radiolabeled antibody.</p> Signup and view all the answers

    What is the primary difficulty in producing human monoclonal antibodies?

    <p>The human anti-murine antibody (HAMA) response when using murine monoclonal antibodies, lack of appropriate human myeloma fusion partners, difficulty obtaining sensitized B lymphocytes, limited success with heteromyelomas, and impossibility of immunizing humans with specific antigens to produce immune B lymphocytes.</p> Signup and view all the answers

    What is the purpose of the bifunctional chelating agent in the indirect method of labeling monoclonal antibodies with Tc-99m?

    <p>To bind to the antibody on one side and to the technetium on the other side, allowing the technetium to be labeled to the antibody.</p> Signup and view all the answers

    What is the role of the co-ligand in the radiolabeling process of the antibody-HYNIC conjugate?

    <p>To facilitate the binding of the technetium to the HYNIC chelating agent.</p> Signup and view all the answers

    What is the result of the HAMA response when using murine monoclonal antibodies?

    <p>The human immune system recognizes the murine monoclonal antibody as foreign and produces an immune response against it, reducing its effectiveness.</p> Signup and view all the answers

    What is the purpose of enzyme-linked immunosorbent assay (ELISA) in the production of monoclonal antibodies?

    <p>To screen for the production of the desired antibody by the hybridoma cells.</p> Signup and view all the answers

    What is the primary advantage of using the indirect method of labeling monoclonal antibodies with Tc-99m?

    <p>It allows for a higher yield of labeled antibodies compared to the direct method.</p> Signup and view all the answers

    The record of the reconstituted 99mTc-labeled radiopharmaceutical should include the ______ activity.

    <p>total</p> Signup and view all the answers

    According to USP General Chapter for compounding radiopharmaceuticals, compounded pharmaceuticals are assigned a ______ which is the date or time after compounding where the drug cannot be used and must be discarded.

    <p>beyond use date</p> Signup and view all the answers

    New standards specifically for radiopharmaceuticals have been recommended, known as ______.

    <p>USP 825</p> Signup and view all the answers

    99mTc products must be compounded in a ______ environment inside of a cleaner environment.

    <p>ISO Class 5</p> Signup and view all the answers

    Tagged RBCs and WBCs are compounded in an ______ area.

    <p>ISO Class 7</p> Signup and view all the answers

    ISO classification is used to determine the maximum number of ______ in the air per cubic meter.

    <p>particles</p> Signup and view all the answers

    Tech based Radiopharmaceuticals are done in ______ inside of a class ______ facility

    <p>class 5, class 8</p> Signup and view all the answers

    RBCs are in ______ and In-111 Labeled leukocytes is ______

    <p>class 7, class 7</p> Signup and view all the answers

    USP Chapter ______ addresses the failure of USP to include radiation safety considerations

    <p>825</p> Signup and view all the answers

    USP Chapter ______ is about the Compounding of PET Radiopharmaceuticals

    <p>823</p> Signup and view all the answers

    The patient received ______ particles if injected with 3-mCi (111 MBq) 99mTc-MAA for lung imaging

    <p>300,000</p> Signup and view all the answers

    The most useful phosphonate compounds for bone imaging are ______ and ______

    <p>MDP, HDP</p> Signup and view all the answers

    The usual expiratory period for ______ is ______ days

    <p>131I-labeled compounds, 8.1</p> Signup and view all the answers

    Labeling RBCs with ______ involves injecting the patient with stannous pyrophosphate

    <p>99mTc</p> Signup and view all the answers

    The basic principle of ______ preparation is to add an acid to a mixture of Tc99mO4- and sodium thiosulfate

    <p>99mTc-sulfur colloid</p> Signup and view all the answers

    The In Vitro method of labeling RBCs with 99mTc involves ______ of the blood sample to reduce the 99mTc-pertechnetate.

    <p>add</p> Signup and view all the answers

    The important radiopharmaceuticals used for the study of hepatobiliary function are ______ and ______

    <p>TC-99m DISIDA, TC-99m Mebrofenin</p> Signup and view all the answers

    The 99mTc-HMPAO kit is stabilized by including a _______________ agent (stannous chloride) to maintain the reduced state of technetium.

    <p>reducing</p> Signup and view all the answers

    The 99mTc-HMPAO kit is stabilized by lyophilizing the components to prevent _______________.

    <p>degradation</p> Signup and view all the answers

    The modified In Vivo/In Vitro method of labeling RBCs involves injecting ______ into the patient and waiting for 20 minutes.

    <p>PYP</p> Signup and view all the answers

    The 99mTc-HMPAO kit is stabilized by adding _______________ like gentisic acid to prevent oxidation.

    <p>stabilizers</p> Signup and view all the answers

    The In Vitro method of labeling RBCs with 51Cr involves adding ______ to the blood sample to prevent clotting.

    <p>ACD</p> Signup and view all the answers

    The charge of the 99mTc-HMPAO is _______________.

    <p>neutral</p> Signup and view all the answers

    The method of labeling platelets with 111In involves adding ______ to the platelet-rich plasma to facilitate the uptake of 111In.

    <p>indium-111 oxine</p> Signup and view all the answers

    The fused cells are cultured in a selective medium called _______________ that allows only the hybridoma cells to survive.

    <p>HAT</p> Signup and view all the answers

    The mechanism of labeling of platelets with 111In involves the ______ complex crossing the cell membrane.

    <p>111In-oxine</p> Signup and view all the answers

    The 99mTcO-4 must not be older than _______________ hours after elution from the generator.

    <p>2</p> Signup and view all the answers

    The recommended storage temperature for 99mTc-sulfur colloid is ______.

    <p>room temperature</p> Signup and view all the answers

    The antibodies are purified using techniques such as _______________ affinity chromatography.

    <p>protein A/G</p> Signup and view all the answers

    111In-ibritumomab tiuxetan is used as an _______________ agent to predict the distribution of the subsequential therapeutic dosage of Y90-ibritumomab within the body.

    <p>imaging</p> Signup and view all the answers

    The monoclonal hybridoma cells are cultured, and the antibodies are harvested from the culture _______________ or ascitic fluid of mice injected with the hybridoma cells.

    <p>supernatant</p> Signup and view all the answers

    F18-Florbetapir is used for detecting _______________ disease.

    <p>Alzheimer's</p> Signup and view all the answers

    The recommended storage temperature for 57Co-cyanocobalamin is ______.

    <p>5 degrees Celsius</p> Signup and view all the answers

    68Ga-DOTATATE is used for detecting _______________ tumors.

    <p>neuroendocrine</p> Signup and view all the answers

    The antibodies are collected and purified, ready to use and match up with/ _______________ antigen in body perfectly.

    <p>target</p> Signup and view all the answers

    Labeling can be done via Direct, indirect, and Indirect method using a _______________ chelating agent.

    <p>bifunctional</p> Signup and view all the answers

    90Y-TheraSpheres are used for the radiation treatment of _______________ carcinoma.

    <p>hepatocellular</p> Signup and view all the answers

    The labeling yield of 111In using the method of labeling platelets is ______ %.

    <p>not specified</p> Signup and view all the answers

    The chelating agent, such as DTPA, is conjugated to the _______________ antibody.

    <p>monoclonal</p> Signup and view all the answers

    The difficulty in making human monoclonal antibodies is due to the lack of appropriate human _______________ fusion partners.

    <p>myeloma</p> Signup and view all the answers

    The mechanism of 99mTc-labeling of antibodies by the direct method involves _______________ of TcO4-.

    <p>reduction</p> Signup and view all the answers

    The radiolabeled antibody is purified to remove free _______________ and unconjugated HYNIC.

    <p>Tc99</p> Signup and view all the answers

    The purity and radiochemical stability are assessed using methods such as size-exclusion _______________ and instant thin-layer chromatography (ITLC).

    <p>chromatography</p> Signup and view all the answers

    Which radiopharmaceutical requires heating during the preparation process?

    <p>99mTc-Macroaggregated Albumin (MAA)</p> Signup and view all the answers

    What is the common use of 99mTc-Phosphonate?

    <p>Bone imaging</p> Signup and view all the answers

    What is the storage temperature for 99mTc-Phosphonate before labeling?

    <p>15-30°C</p> Signup and view all the answers

    Which radiopharmaceutical is used for lymphoscintigraphy?

    <p>Filtered 99mTc-Sulfur Colloid</p> Signup and view all the answers

    What is the common pH range for 99mTc-Sulfur Colloid?

    <p>6-7</p> Signup and view all the answers

    What is the half-life of all the mentioned radiopharmaceuticals?

    <p>6 hours</p> Signup and view all the answers

    What is the half-life of F-18-Flutemetamol?

    <p>109.7 mins</p> Signup and view all the answers

    What is the energy emitted by Y90-TheraSphere?

    <p>0.936 MeV</p> Signup and view all the answers

    What is the pH range of 111In-Oxine?

    <p>6.5 to 7.5</p> Signup and view all the answers

    What is the half-life of Ra-223-Radium Chloride?

    <p>11.4 days</p> Signup and view all the answers

    What is the energy emitted by Ga-68- and Lu-177-Labeled DOTATOC and DOTATATE?

    <p>0.511MeV</p> Signup and view all the answers

    What is the storage temperature of F-18-Florbetaben?

    <p>24°C</p> Signup and view all the answers

    What is the half-life of C-11-Choline?

    <p>20.3 mins</p> Signup and view all the answers

    What is the pH range of Tc-99m leukocytes?

    <p>6.5 to 7</p> Signup and view all the answers

    What is the energy emitted by Y90-SIR-Sphere?

    <p>0.936 MeV</p> Signup and view all the answers

    What is the half-life of 51Cr-Labeled Red Blood Cells?

    <p>27.7 days</p> Signup and view all the answers

    What is the common energy of the radiopharmaceuticals mentioned?

    <p>140 KeV</p> Signup and view all the answers

    Which radiopharmaceutical is used for brain perfusion imaging and has a pH range of 9-9.8?

    <p>99mTc-HMPAO</p> Signup and view all the answers

    Which radiopharmaceutical is used for myocardial perfusion abnormalities and has a pH of 5.5?

    <p>99mTc-Sestamibi</p> Signup and view all the answers

    What is the storage parameter for 99mTc-Labeled Red Blood Cells?

    <p>Room temperature</p> Signup and view all the answers

    Which radiopharmaceutical is used for renal flow study and has a pH of 7.5?

    <p>99mTc-Pentetate</p> Signup and view all the answers

    Which radiopharmaceutical requires heating during preparation?

    <p>99mTc-DMSA</p> Signup and view all the answers

    Which radiopharmaceutical is used for inflammation scintigraphy and has a cloudy color?

    <p>99mTc-Albmun Colloid</p> Signup and view all the answers

    Which radiopharmaceutical is used for lymphoscintigraphy and has a pH of 7.5?

    <p>99mTc-Tilmanocept</p> Signup and view all the answers

    Which radiopharmaceutical is used for ventilation scintigraphy of the lungs?

    <p>99mTc-Technegas</p> Signup and view all the answers

    Which radiopharmaceutical is used for bone marrow imaging and has a pH range of 6-7?

    <p>99mTc-Albmun Colloid</p> Signup and view all the answers

    What is the energy level of 131I-Sodium Iodide?

    <p>364 keV</p> Signup and view all the answers

    What is the half-life of 123I-Ioflupane (DaTscan)?

    <p>13.2 hrs</p> Signup and view all the answers

    What is the pH level of 125I-Albumin Serum Albumin (RISA)?

    <p>7.5-9</p> Signup and view all the answers

    What is the storage parameter of 123I-Metaiodobenzylguanidine (AdreView)?

    <p>-200*C to -10 C</p> Signup and view all the answers

    What is the energy level of 111In-DTPA (Pentetate) Indium Disodium?

    <p>173 keV, 247 keV</p> Signup and view all the answers

    What is the half-life of 201Tl-Thallous Chloride?

    <p>72.91 hours</p> Signup and view all the answers

    What is the common use of 67Ga-Citrate?

    <p>Oncology, neuroendocrine tumors, Hodgkin's disease, lymphomas</p> Signup and view all the answers

    What is the energy level of 153Sm-Ethylenediaminetetramethylene Phosphonic Acid (Quadramet)?

    <p>103-keV</p> Signup and view all the answers

    What is the storage parameter of 57Co-Cyanocobalamin?

    <p>5°C in the dark</p> Signup and view all the answers

    What is the half-life of 89Sr-Strontium Chloride (Metastron)?

    <p>50.6 days</p> Signup and view all the answers

    What is the half-life of In-111-ibritumomab tiuxetan?

    <p>2.8 days</p> Signup and view all the answers

    What is the energy of 18F-FDG?

    <p>511 KeV</p> Signup and view all the answers

    What is the pH range of Tc-99m Sulesomab (LeukoScan)?

    <p>4.5-5.5</p> Signup and view all the answers

    What is the storage temperature for Tc-99m MAG3 (mertiatide)?

    <p>15-30°C</p> Signup and view all the answers

    What is the half-life of 67Ga Gallium Citrate?

    <p>78.2 hours</p> Signup and view all the answers

    What is the energy of Tc-99m Sestamibi (Miraluma)?

    <p>140 KeV</p> Signup and view all the answers

    What is the half-life of F18 sodium fluoride?

    <p>110 minutes</p> Signup and view all the answers

    What is the energy of N-13-Ammonia?

    <p>1.1198 MeV</p> Signup and view all the answers

    Study Notes

    Difference between MAA and Colloid Particles

    • MAA particles: 10-90 microns in size, made from Human Serum Albumin, used for lung perfusion, and have a pH level of 5
    • Colloid particles: 0.1-1 micrometers in size, made from sulfur, antimony, or other elements, used for liver, spleen, and bone marrow imaging, and have a pH level of 6-7

    MAA Particles in Lung Imaging

    • 20 millicurie (740 MBq) 99mTc-MAA contains 2 million MAA particles
    • If a patient is injected with 3-mCi (111 MBq) 99mTc-MAA, they will receive 300,000 particles

    Phosphonate Compounds for Bone Imaging

    • Useful phosphonate compounds: MDP, HDP
    • Method of 99mTc-labeling: use a kit, reduce TC04 with stannous chloride, and combine with MDP or HDP

    99mTc-Sulfur Colloid Preparation

    • Basic principle: add acid to a mixture of Tc99mO4- and sodium thiosulfate, then heat at 95-100°C in a water bath for 5-10 minutes
    • Additions: gelatin as a protective colloid, EDTA to remove aluminum ions present in the Tc-99m eluate

    Radiopharmaceuticals for Hepatobiliary Function

    • Preferred radiopharmaceuticals: TC-99m DISIDA, TC-99m Mebrofenin
    • Labeling method: use a kit, add TCo4- to the kit, and mix well
    • Labeling yield: >95% with a shelf life of 6 hours

    Expiratory Periods for Radiolabeled Compounds

    • 131I-labeled compounds: 8.1 days
    • 99mTc-labeled compounds: 6 hours

    Labeling RBCs with 99mTc and 51Cr

    • Labeling RBCs with 99mTc:
      • In Vivo Method: inject stannous pyrophosphate, then inject 99mTc-pertechnetate, labeling efficiency: 80-90%
      • In Vitro Method: add stannous chloride to blood sample, reduce 99mTc-pertechnetate, labeling efficiency: 97%
      • Modified In Vivo Method: 95% labeling efficiency
      • Merits: short half-life, high gamma photon energy, rapid availability
      • Disadvantages: complexity, patient discomfort
    • Labeling RBCs with 51Cr:
      • In Vitro Method: add Cr-51 sodium chromate to blood sample, incubate, labeling efficiency: 80-90%
      • Merits: longer half-life, stable labeling
      • Disadvantages: higher radiation dose, less ideal imaging

    Storage Temperature for Radiopharmaceuticals

    • 99mTc-sulfur colloid: room temperature, dispense within 6-12 hours
    • 57Co-cyanocobalamin: 5°C

    Labeling Platelets and Leukocytes with 111In

    • Labeling platelets:
      • Incubate platelets with 111In-oxine
      • Mechanism: 111In-oxine complex crosses cell membrane, binds to intracellular components
    • Labeling leukocytes:
      • Incubate leukocytes with 111In-oxine
      • Mechanism: similar to platelet labeling

    99mTc-HMPAO Kit Stabilization

    • Methods: reducing agent, lyophilization, pH adjustment, addition of stabilizers and chelating agents

    Charge of 99mTc-Radiopharmaceuticals

    • 99mTc-HMPAO: neutral
    • 99mTc-MAG3: negative
    • 99mTc-sestamibi: positive
    • 99mTc-tetrofosmin: positive

    Restrictions on 99mTcO4- Quality

    • Must not be older than 2 hours after elution from the generator
    • Must be eluted from a generator that has been eluted in the past 24 hours

    Uses of 111In- and 90Y-Ibritumomab Tiuxetan

    • 111In: imaging agent to predict distribution of Y90-ibritumomab
    • 90Y: treatment of relapsed or refractory low-grade, follicular, or CD20 transformed non-Hodgkin's lymphoma

    Features of Fluorine Labeling

    • Use of electrophilic and nucleophilic fluorinating agents
    • High specific activity and radiochemical purity

    Agents for Detection of Alzheimer's Disease

    • F18-Florbetapir (Amyvid)
    • F18-Flutemetamol (Vizamyl)
    • F18-Florbetaben (Neuraceq)

    Agents for Detection of Neuroendocrine Tumors

    • 68Ga-DOTATATE (Netspot)

    Agents for Pain Palliation

    • Strontium-89 (Strontium Chloride-Metastron)
    • Samarium-153 (Sm-153-EDTMP-Quadramet)

    Production of Monoclonal Antibodies

    • Method: mouse vaccination, spleen cell harvest, fusion with myeloma cells, selection, and cloning
    • Labeling with 111In and 99mTc: use of chelating agents, bifunctional chelates, and radiolabeling

    Difficulties in Making Human Monoclonal Antibodies

    • Human anti-murine antibody (HAMA) response
    • Lack of appropriate human myeloma fusion partners
    • Difficulty obtaining sensitized B lymphocytes
    • Limited success with heteromyelomas
    • Impossibility of immunizing humans with specific antigens

    Mechanism of 99mTc-Labeling of Antibodies by Direct Method

    • Reduce TCO4- using a reducing agent
    • Bind reduced technetium to the antibody
    • Stabilize the technetium-antibody complex with additional agents
    • Purify the radiolabeled antibody

    MAA and Colloid Particles

    • MAA (Macroaggregated Albumin) particles are larger, with a size range of 10-90 microns
    • Colloid particles are smaller, with a size range of 0.1-1 micrometers
    • MAA is composed of Human Serum Albumin, while colloid particles are typically made from sulfur, antimony, or other elements
    • MAA is used for lung perfusion, while colloid particles are used for liver, spleen, and bone marrow imaging

    Radiopharmaceuticals

    • 20 millicurie (740 MBq) 99mTc-MAA contains approximately 2 million MAA particles
    • If a patient is injected with 3-mCi (111 MBq) 99mTc-MAA, they will receive approximately 300,000 particles

    Bone Imaging

    • MDP (Methylene Diphosphonate) and HDP (Hydroxymethylene Diphosphonate) are phosphonate compounds used for bone imaging
    • These compounds are labeled with 99mTc using a kit that includes a phosphonate ligand, reducing agent, and stabilizers
    • Labeling is achieved by reducing TC04 with stannous chloride and combining it with MDP or HDP

    Sulfur Colloid Preparations

    • The basic principle of 99mTc-sulfur colloid preparation involves adding an acid to a mixture of Tc99mO4- and sodium thiosulfate, then heating at 95-100°C for 5-10 minutes
    • Gelatin is added as a protective colloid, and EDTA is used to remove any aluminum ions present in the Tc-99m eluate

    Hepatobiliary Function

    • TC-99m DISIDA (Preferred) and TC-99m Mebrofenin (Preferred) are radiopharmaceuticals used for the study of hepatobiliary function
    • These agents are prepared using a kit that includes the IDA derivative and stannous chloride or fluoride dihydrate as the reducing agent
    • Labeling is accomplished by adding TCo4- to the kit and mixing well

    Expiratory Periods

    • The expiratory period for 131I-labeled compounds is 8.1 days
    • The expiratory period for 99mTc-labeled compounds is 6 hours

    Labeling RBCs

    • 99mTc can be used to label RBCs (Red Blood Cells) using in vivo, in vitro, or modified in vivo methods
    • The in vivo method involves injecting the patient with stannous pyrophosphate, followed by 99mTc-pertechnetate
    • The in vitro method involves labeling RBCs with 99mTc-pertechnetate and stannous chloride, then washing and re-injecting the labeled cells
    • The modified in vivo method involves using a butterfly infusion set and a mixture of pertechnetate and heparinized saline

    Labeling RBCs with 51Cr

    • 51Cr can be used to label RBCs using an in vitro method
    • The method involves adding Cr-51 sodium chromate to a blood sample, incubating, and then washing and re-suspending the labeled cells
    • The labeling yield is approximately 80-90%

    Storage of Radiopharmaceuticals

    • 99mTc-sulfur colloid should be stored at room temperature and used within 6-12 hours
    • 57Co-cyanocobalamin should be stored at 5°C

    Labeling Platelets and Leukocytes

    • 111In can be used to label platelets and leukocytes
    • The method involves labeling the cells with 111In-oxine, which is a lipophilic complex that crosses the cell membrane
    • The labeling yield is approximately 80-90%

    99mTc-HMPAO Kit

    • The 99mTc-HMPAO kit is stabilized by including a reducing agent, lyophilizing the components, adjusting the pH, and adding stabilizers
    • The kit is used to prepare 99mTc-HMPAO, a radiopharmaceutical used for cerebral perfusion imaging

    Charge of 99mTc-Radiopharmaceuticals

    • 99mTc-HMPAO has a neutral charge
    • 99mTc-MAG3 has a negative charge
    • 99mTc-sestamibi and 99mTc-tetrofosmin have a positive charge

    Quality of 99mTcO-4

    • The quality of 99mTcO-4 is restricted to elution from the generator within 2 hours and from a generator that has been eluted within the past 24 hours

    111In- and 90Y-Ibritumomab Tiuxetan

    • 111In-ibritumomab tiuxetan is used as an imaging agent to predict the distribution of the subsequent therapeutic dosage of 90Y-ibritumomab
    • 90Y-ibritumomab tiuxetan is used for the treatment of relapsed or refractory low-grade, follicular, or CD20 transformed non-Hodgkin's lymphoma

    Fluorine Labeling

    • Fluorine labeling involves the use of electrophilic and nucleophilic fluorinating agents
    • The process yields high specific activity and radiochemical purity

    Agents for Detection of Alzheimer's Disease

    • F18-florbetapir (Amyvid) is used for the detection of Alzheimer's disease
    • F18-flutemetamol (Vizamyl) is used for the detection of Alzheimer's disease
    • F18-florbetaben (Neuraceq) is used for the detection of Alzheimer's disease

    68Ga-DOTATATE (Netspot)

    • 68Ga-DOTATATE (Netspot) is used for the detection of neuroendocrine tumors

    90Y-TheraSpheres and 90Y-SIR-Spheres

    • 90Y-TheraSpheres are used for the radiation treatment of hepatocellular carcinoma
    • 90Y-SIR-Spheres are used for the treatment of unresectable metastatic liver tumors from primary colorectal cancer

    Agents for Palliation of Pain

    • Strontium-89 (Strontium Chloride-Metastron) is used for pain relief
    • Samarium-153 (Sm-153-EDTMP-Quadramet) is used for pain relief

    Monoclonal Antibody Production

    • Monoclonal antibodies are produced by immunizing a mouse with an antigen, then fusing the spleen cells with myeloma cells
    • The hybridoma cells are cultured, and the antibodies are harvested from the culture supernatant or ascitic fluid
    • The antibodies are purified using techniques such as protein A/G affinity chromatography

    Labeling Monoclonal Antibodies

    • Monoclonal antibodies can be labeled with 111In or 99mTc
    • The labeling process involves conjugating the antibody with a chelating agent, then radiolabeling with the desired isotope
    • The radiolabeled antibody is then purified to remove any impurities

    Difficulties in Making Human Monoclonal Antibodies

    • Human anti-murine antibody (HAMA) response may occur when using murine Mabs
    • Lack of appropriate human myeloma fusion partners
    • Difficulty obtaining sensitized B lymphocytes
    • Limited success with heteromyelomas
    • Impossibility of immunizing humans with specific antigens to produce immune B lymphocytes

    Mechanism of 99mTc-Labeling of Antibodies

    • The direct method of 99mTc-labeling involves reducing TCO4- with a reducing agent, then binding the reduced technetium to the antibody
    • The indirect method involves using a bifunctional chelating agent to link the antibody to the technetium

    Record of Reconstituted 99mTc-Labeled Radiopharmaceutical

    • The record should include: total activity, concentration, time of calibration, expiration, name, and nuclear pharmacy control number.

    USP General Chapter for Compounding Radiopharmaceuticals

    • The chapter provides a set of standards for Compounding Sterile Preparations (CSP).
    • CSPs include anything that could potentially cause drugs to lose sterility and/or become pyrogenic.
    • Compounding areas must be cleaned and disinfected on a regular basis.
    • Compounded pharmaceuticals are assigned a Beyond Use Date, which is the date or time after compounding where the drug cannot be used and must be discarded.
    • USP 823 provides standards for compounding PET radiopharmaceuticals.
    • USP 825 provides new standards specifically for radiopharmaceuticals.
    • International Organization Standardization (ISO) has different air quality standards assigned to different pharmaceuticals.

    ISO Classification

    • ISO classification determines the environments in which radiopharmaceuticals can be processed.
    • Particle limits per cubic meter are:
      • ISO Class 3: 35.2
      • ISO Class 4: 352
      • ISO Class 5: 3520
      • ISO Class 6: 35200
      • ISO Class 7: 352000
      • ISO Class 8: 3520000
    • Tech-based radiopharmaceuticals are compounded in ISO Class 5 inside a ISO Class 8 facility.
    • RBCs are compounded in ISO Class 7.
    • In-111 Labeled leukocytes are compounded in ISO Class 7.

    USP Chapter 825

    • This chapter emphasizes the importance of following good radiation safety practices while being attentive to the time element for the clinical use of radiopharmaceuticals.
    • It balances radiation safety with aseptic handling practices.
    • USP Chapter 825 addresses the failure of USP 823 to include radiation safety considerations.
    • Specific guidelines include:
      • Placement of absorbent pads in hoods.
      • Handling of sharps during radiopharmaceutical compounding.
      • Positioning of radiation measuring instrumentation needed during compounding activities in hoods.

    USP Chapter 823

    • This chapter is about the Compounding of PET Radiopharmaceuticals.

    Record of Reconstituted 99mTc-Labeled Radiopharmaceutical

    • The record should include: total activity, concentration, time of calibration, expiration, name, and nuclear pharmacy control number.

    USP General Chapter for Compounding Radiopharmaceuticals

    • The chapter provides a set of standards for Compounding Sterile Preparations (CSP).
    • CSPs include anything that could potentially cause drugs to lose sterility and/or become pyrogenic.
    • Compounding areas must be cleaned and disinfected on a regular basis.
    • Compounded pharmaceuticals are assigned a Beyond Use Date, which is the date or time after compounding where the drug cannot be used and must be discarded.
    • USP 823 provides standards for compounding PET radiopharmaceuticals.
    • USP 825 provides new standards specifically for radiopharmaceuticals.
    • International Organization Standardization (ISO) has different air quality standards assigned to different pharmaceuticals.

    ISO Classification

    • ISO classification determines the environments in which radiopharmaceuticals can be processed.
    • Particle limits per cubic meter are:
      • ISO Class 3: 35.2
      • ISO Class 4: 352
      • ISO Class 5: 3520
      • ISO Class 6: 35200
      • ISO Class 7: 352000
      • ISO Class 8: 3520000
    • Tech-based radiopharmaceuticals are compounded in ISO Class 5 inside a ISO Class 8 facility.
    • RBCs are compounded in ISO Class 7.
    • In-111 Labeled leukocytes are compounded in ISO Class 7.

    USP Chapter 825

    • This chapter emphasizes the importance of following good radiation safety practices while being attentive to the time element for the clinical use of radiopharmaceuticals.
    • It balances radiation safety with aseptic handling practices.
    • USP Chapter 825 addresses the failure of USP 823 to include radiation safety considerations.
    • Specific guidelines include:
      • Placement of absorbent pads in hoods.
      • Handling of sharps during radiopharmaceutical compounding.
      • Positioning of radiation measuring instrumentation needed during compounding activities in hoods.

    USP Chapter 823

    • This chapter is about the Compounding of PET Radiopharmaceuticals.

    Record of Reconstituted 99mTc-Labeled Radiopharmaceutical

    • The record of reconstituted 99mTc-labeled radiopharmaceutical should include: + Total activity + Concentration + Time of calibration + Expiration + Name + Nuclear pharmacy control number

    USP General Chapter for Compounding Radiopharmaceuticals

    • USP Chapter 825 is a set of standards for compounding sterile preparations (CSP) • CSPs include anything that could potentially cause drugs to lose sterility and/or become pyrogenic • Compounding areas must be cleaned and disinfected regularly • Compounded pharmaceuticals are assigned a Beyond Use Date (BUD) which is the date or time after compounding where the drug cannot be used and must be discarded

    ISO Classification

    • ISO classification determines the environments in which radiopharmaceuticals can be processed • ISO Class 3: Particle limit of 35.2 per cubic meter • ISO Class 4: Particle limit of 352 per cubic meter • ISO Class 5: Particle limit of 3520 per cubic meter • ISO Class 6: Particle limit of 35200 per cubic meter • ISO Class 7: Particle limit of 352000 per cubic meter • ISO Class 8: Particle limit of 3520000 per cubic meter • Tech-based radiopharmaceuticals are done in Class 5 inside a Class 8 facility • RBCs are compounded in Class 7, and In-111 labeled leukocytes are compounded in Class 7

    Radiopharmaceuticals

    • MAA and colloid particles differ in: + Size: MAA (10-90 microns) vs. colloid (0.1-1 micrometers) + Composition: MAA (human serum albumin) vs. colloid (sulfur, antimony, or other elements) + Uses: MAA (lung perfusion) vs. colloid (liver and spleen, bone marrow, gastric emptying) + pH level: MAA (5) vs. colloid (6-7) • 20 millicurie (740 MBq) 99mTc-MAA contains 2 million MAA particles

    Phosphonate Compounds

    • Most useful phosphonate compounds for bone imaging: MDP and HDP • Method of 99mTc-labeling: Use a kit with pre-prepared phosphonate ligand, reducing agent, and stabilizers • Reduce TcO4- with stannous chloride and combine with MDP or HDP

    Sulfur Colloid Preparation

    • Basic principle: Add acid to a mixture of Tc99mO4- and sodium thiosulfate, and then heat at 95-100°C in a water bath for 5-10 minutes • Gelatin is added as a protective colloid and EDTA to remove any aluminum ion present in the Tc-99m eluate

    Radiopharmaceuticals for Hepatobiliary Function

    • Important radiopharmaceuticals: TC-99m DISIDA, TC-99m Mebrofenin, and TC-99m labeled IDAs • Method of preparation: Add TcO4- to the kit containing the IDA derivative and stannous chloride or fluoride dihydrate as the reducing agent

    Expiratory Periods

    • 131I-labeled compounds: 8.1 days • 99mTc-labeled compounds: 6 hours

    Labeling RBCs and Leukocytes

    • Methods of labeling RBCs with 99mTc: In Vivo, In Vitro, and Modified In Vivo/In Vitro • Method of labeling RBCs with 51Cr: In Vitro • Methods of labeling platelets and leukocytes with 111In • Merits and disadvantages of 99mTc and 51Cr labeling

    Storage and Handling

    • Recommended storage temperatures: + 99mTc-sulfur colloid: room temperature, dispensed within 6-12 hours + 57Co-cyanocobalamin: 5°C • Methods of labeling platelets and leukocytes with 111In

    99mTc-HMPAO Kit

    • Stabilized by: + Reducing agent (stannous chloride) to maintain the reduced state of technetium + Lyophilizing (freeze-drying) the components to prevent degradation + Adjusting the pH to a lower level using phosphate buffer + Adding stabilizers like gentisic acid to prevent oxidation

    Charge of Radiopharmaceuticals

    • 99mTc-HMPAO: Neutral (no charge) • 99mTc-MAG3: Negative (anion) • 99mTc-sestamibi: Positive (cation) • 99mTc-tetrofosmin: Positive (cation)

    Quality of 99mTcO4-

    • Restrictions on the quality of 99mTcO4- in the preparation of 99mTc-HMPAO: + Not older than 2 hours after elution from the generator + Must be eluted from a generator that has been eluted in the past 24 hours

    Monoclonal Antibodies

    • Methods of production: + Vaccination of a mouse with the antigen of interest + Fusion of spleen cells with myeloma cells + Hybridoma cells are cultured, and the antibodies are harvested + Purification of the antibodies • Labeling with 111In and 99mTc + Methods of labeling: Direct, indirect, and indirect using a bifunctional chelating agent + Chelating agents: DTPA, GYK-DTPA, SCN-Bz-DTPA, DOTA + Purification of the radiolabeled antibody

    Difficulties in Making Human Monoclonal Antibodies

    • Human anti-murine antibody (HAMA) response • Lack of appropriate human myeloma fusion partners • Difficulty obtaining sensitized B lymphocytes • Limited success with heteromyelomas • Impossibility of immunizing humans with specific antigens

    Record of Reconstituted 99mTc-Labeled Radiopharmaceutical

    • The record of reconstituted 99mTc-labeled radiopharmaceutical should include: + Total activity + Concentration + Time of calibration + Expiration + Name + Nuclear pharmacy control number

    USP General Chapter for Compounding Radiopharmaceuticals

    • USP Chapter 825 is a set of standards for compounding sterile preparations (CSP) • CSPs include anything that could potentially cause drugs to lose sterility and/or become pyrogenic • Compounding areas must be cleaned and disinfected regularly • Compounded pharmaceuticals are assigned a Beyond Use Date (BUD) which is the date or time after compounding where the drug cannot be used and must be discarded

    ISO Classification

    • ISO classification determines the environments in which radiopharmaceuticals can be processed • ISO Class 3: Particle limit of 35.2 per cubic meter • ISO Class 4: Particle limit of 352 per cubic meter • ISO Class 5: Particle limit of 3520 per cubic meter • ISO Class 6: Particle limit of 35200 per cubic meter • ISO Class 7: Particle limit of 352000 per cubic meter • ISO Class 8: Particle limit of 3520000 per cubic meter • Tech-based radiopharmaceuticals are done in Class 5 inside a Class 8 facility • RBCs are compounded in Class 7, and In-111 labeled leukocytes are compounded in Class 7

    Radiopharmaceuticals

    • MAA and colloid particles differ in: + Size: MAA (10-90 microns) vs. colloid (0.1-1 micrometers) + Composition: MAA (human serum albumin) vs. colloid (sulfur, antimony, or other elements) + Uses: MAA (lung perfusion) vs. colloid (liver and spleen, bone marrow, gastric emptying) + pH level: MAA (5) vs. colloid (6-7) • 20 millicurie (740 MBq) 99mTc-MAA contains 2 million MAA particles

    Phosphonate Compounds

    • Most useful phosphonate compounds for bone imaging: MDP and HDP • Method of 99mTc-labeling: Use a kit with pre-prepared phosphonate ligand, reducing agent, and stabilizers • Reduce TcO4- with stannous chloride and combine with MDP or HDP

    Sulfur Colloid Preparation

    • Basic principle: Add acid to a mixture of Tc99mO4- and sodium thiosulfate, and then heat at 95-100°C in a water bath for 5-10 minutes • Gelatin is added as a protective colloid and EDTA to remove any aluminum ion present in the Tc-99m eluate

    Radiopharmaceuticals for Hepatobiliary Function

    • Important radiopharmaceuticals: TC-99m DISIDA, TC-99m Mebrofenin, and TC-99m labeled IDAs • Method of preparation: Add TcO4- to the kit containing the IDA derivative and stannous chloride or fluoride dihydrate as the reducing agent

    Expiratory Periods

    • 131I-labeled compounds: 8.1 days • 99mTc-labeled compounds: 6 hours

    Labeling RBCs and Leukocytes

    • Methods of labeling RBCs with 99mTc: In Vivo, In Vitro, and Modified In Vivo/In Vitro • Method of labeling RBCs with 51Cr: In Vitro • Methods of labeling platelets and leukocytes with 111In • Merits and disadvantages of 99mTc and 51Cr labeling

    Storage and Handling

    • Recommended storage temperatures: + 99mTc-sulfur colloid: room temperature, dispensed within 6-12 hours + 57Co-cyanocobalamin: 5°C • Methods of labeling platelets and leukocytes with 111In

    99mTc-HMPAO Kit

    • Stabilized by: + Reducing agent (stannous chloride) to maintain the reduced state of technetium + Lyophilizing (freeze-drying) the components to prevent degradation + Adjusting the pH to a lower level using phosphate buffer + Adding stabilizers like gentisic acid to prevent oxidation

    Charge of Radiopharmaceuticals

    • 99mTc-HMPAO: Neutral (no charge) • 99mTc-MAG3: Negative (anion) • 99mTc-sestamibi: Positive (cation) • 99mTc-tetrofosmin: Positive (cation)

    Quality of 99mTcO4-

    • Restrictions on the quality of 99mTcO4- in the preparation of 99mTc-HMPAO: + Not older than 2 hours after elution from the generator + Must be eluted from a generator that has been eluted in the past 24 hours

    Monoclonal Antibodies

    • Methods of production: + Vaccination of a mouse with the antigen of interest + Fusion of spleen cells with myeloma cells + Hybridoma cells are cultured, and the antibodies are harvested + Purification of the antibodies • Labeling with 111In and 99mTc + Methods of labeling: Direct, indirect, and indirect using a bifunctional chelating agent + Chelating agents: DTPA, GYK-DTPA, SCN-Bz-DTPA, DOTA + Purification of the radiolabeled antibody

    Difficulties in Making Human Monoclonal Antibodies

    • Human anti-murine antibody (HAMA) response • Lack of appropriate human myeloma fusion partners • Difficulty obtaining sensitized B lymphocytes • Limited success with heteromyelomas • Impossibility of immunizing humans with specific antigens

    99mTc-Labelled Radiopharmaceuticals

    • 99mTc-Macroaggregated Albumin (MAA)
      • Energies: 140 KeV
      • Half-life: 6 hours
      • Storage parameters: kits stored at 2-8°C before labeling with 99mTc, preparations good for 6-8 h at 2-8°C after formulation
      • Color: cloudy
      • Common uses: lung perfusion imaging, venography to detect deep vein thrombi in lower extremities
      • pH: 5
      • Needs to be heated: yes
    • 99mTc-Phosphonate
      • Energies: 140 KeV
      • Half-life: 6 hours
      • Storage parameters: 15-30°C both before and after labeling (MDP: 6 hrs, HDP: 8 hrs)
      • Color: clear
      • Common uses: bone imaging (MDP and HDP)
      • pH: 7.5
      • Needs to be heated: no
    • 99mTc-Pyrophosphate (PYP)
      • Energies: 140 KeV
      • Half-life: 6 hours
      • pH: 7.5
      • Common uses: myocardial infarct imaging, also used in red blood cell labeling for use in gated blood pool and gastrointestinal blood loss studies
      • Needs to be heated: no ...

    Other Radiopharmaceuticals

    • 111In-DTPA (Pentetate) Indium Disodium
      • Energies: 173 keV, 247 keV
      • Half-life: 2.8 days
      • Storage: Store vial in its lead shield at a temperature of 5-30°C. Do not freeze
      • Color: pure white
      • Common uses: cisternography
      • pH: 5
      • Needs to be heated: yes
    • 133Xe Gas-Xenon 133
      • Energies: 81 keV
      • Half-life: 5.3 days
      • Storage: storage temperature for the gas is 15-30°C, and the shelf-life of 133Xe is 14 days after calibration
      • Color: purplish
      • Common uses: ventilation studies of the lungs and also for the assessment of cerebral blood flow
      • pH: N/A
      • Needs to be heated: no ...

    Yttrium-90 and Strontium-89 Radiopharmaceuticals

    • 90Y-Strontium Chloride (Metastron)
      • Energies: 1.46 Mev, 0.58 Mev, 901 keV
      • Half-life: 50.6 days
      • Storage: stored at 15-25°C and should be used within 28 days after calibration
      • Color: red
      • Common uses: relief of pain in patients with skeletal metastases
      • pH: 4 to 7.5
      • Needs to be heated: no ...

    Gallium-68 and Lutetium-177 Radiopharmaceuticals

    • Ga-68- and Lu-177-Labeled DOTATOC and DOTATATE
      • Energies: 0.511MeV (annihilation)
      • Half-life: 68Ga: 68 min, 177Lu: 6.65 d
      • pH: 4-5
      • Common uses: treatment of NETs ...

    Other Radiopharmaceuticals

    • 18F - FDG
      • Energies: 511 KeV
      • Half-life: 110 min
      • Storage: room temperature
      • Color: clear
      • pH: 7
      • Common uses: metabolism studies in the brain and heart, early detection of epilepsy and various tumors
      • Needs to be heated: yes ...

    Note: All radiopharmaceuticals have been categorized based on their properties and common uses.

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    Compare and contrast MAA and colloid particles in terms of their size, composition, uses, and pH level in nuclear medicine applications.

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