SIEMENS The New Measure of Performance.

From around the world. WE LISTENED TO YOU Lots of you. We looked at the whole picture. Through your eyes.

With purpose, we set our sights on a new standard in camera flexibility. IMAGING YOUR PATIENTS. Every one of them. For any nuclear procedure.

Using your vision, we expanded the clinical possibilities. At any energy. BEYOND SPECT. Well beyond.

We reached into a new dimension. And found the future. EMISSION TOMOGRAPHY

Siemens Medical Systems, Inc., Nuclear Medicine Group, 2501 North Barrington Road, Hoffman Estates, Illinois 60195-5203 U.S.A. North and South America 847.304.7700 •Canada 905.819.8000 •Europe 49.9131.84.6685 •Asia and Pacific Rim 81.3.5423.4066 E-mail: [email protected] •Web site: http://www.sms.siemens.com/nmg

Circle Reader Service No. 181 COMEToCAPINTEC, FORALLYOURLABORATORYNEEDS

FOR COMPLETE PACKAGEINFORMATION CONTACTUS ATTHE ADDRESSBELOW.

CAPINTEC. ONE STOPSHOPPING. ITJUSTMAKESSENSE! CAPINTEC, INC. 6 Arrow Rd. •Ramsey, NJ 07446 1-800-ASK-4-CRC •Fax: 201-825-4829

Circle Reader Service No. 23 A Look IntoThe Future...

AvailableTodayl

FDA 510(k) clearance to market granted 9/12/96. Industry í'/rst

The nrsl u hoir lioriy coincidence scan acquired un a gamma camera.

Positron Coincidence Detection

Once again, Picker International is on the leading edge of nuclear medicine imaging with the introduction of the new Positron Coincidence Detection (PCDâ„¢)imaging.

Available on the PRISMâ„¢2000XP. PCD is pioneering the use of PRISM XP multi-head cameras for imaging positron isotopes. By offering multiple crystal thicknesses, on-the-fly rebinning of data, unique scatter removal, and the fastest advanced image processing in nuclear medicine, PCD offers the best range of options for imaging positron-based Pharmaceuticals.

To find out more about all the advantages PCD gives you, call us today at 1-800-323-0550; e-mail us at [email protected]; or visit us on the Web at the Nuclear Medicine Modality Home Page, http://www.picker.com/nuclear/nuclear.html. PICKER MORETHANIMAGES.INSIGHT.

Circle Reader Service No. 151 Asymptomatic. Rising CEA. 2 years post-op for colorectal cancer. CT is equivocal.

Now there's a new way to determine resectability. NTRODUCINC

CEA-SCAIsr (Ärcitumomab)

SENSITIVE IMAGING TO HELP DRIVE MANAGEMENT DECISIONS

BETTER IDENTIFICATION OF EA-Scan is a new imaging agent that RESECTABLE/NON-RESECTABLE DISEASE enhances your pre-operative determination of colorectal cancer resectability. CEA-Scan is Comparison of surgical outcomes correctly indicated, in conjunction with standard diagnostic identified by CT vs CT plus CEA-Scan (n = 209) evaluations, for detection of the presence, 66% location and extent of recurrent and/or metastatic 75% (59/89) colorectal carcinoma involving the liver, extra- hepatic abdomen and pelvis in patients with a 47% (34/73) 50% histologically confirmed diagnosis of colorectal carcinoma.

Surgery confirms that CEA-Scan with CT can 25% help you make decisions concerning surgical resectability. Compared to CT alone, CEA-Scan 0% with CT: Resectable Non-Resectable •Identified 59/89 versus 42/89 patients with resectable disease, a 40% increase in detection rate IMPROVES SENSITIVITY •Identified 34/73 versus 14/73 patients with non-resectable disease, or more than twice as many Sensitivity and specificity of CEA-Scan vs standard diagnostic methods (SDM) •In patients with negative or equivocal CT (occult disease), reduced the number of false- SDM CEA-Scan negative patients from 59 to 23, a 60% decrease.1 SensitivitySpecificitylUI^I^^I^I57.9%(103/178)84.4%(27/32)P=0.006P=0.1271.3%(127/178)62.5%(20/32)

CEA-Scan has a 97% positive predictive value for lesions when concordant with CT (146 true- positive lesions versus 4 false-positives). SENSITIVE, SAME-DAY IMAGING

CEA-Scan enables improved colorectal cancer detection compared to standard diagnostic methods (SDM, 95% of which were CT).

• In general, CEA-Scan was more sensitive and less specific in the abdomen and pelvis than CT'

• However, direct comparisons of the performance characteristics of SDM to CEA-Scan are difficult to interpret, since the results of SDM were entry criteria for both Phase 3 protocols.

ADVANCED TECHNOLOGY underwent abdominoper- CEA-Scan offers the advantages of Fab' fragment design. incal resection in 1987. Presented 5 years post-op with negative CT mid rising CEA. • Short biological half-life ( 13±4hours) and rapid blood clearance improve tumor-to-background ratios2

• Minimal liver metabolism allows hepatic imaging

• Small fragment size enhances renal clearance

• Fragment technology provides lower immunogenicity ESTABLISHED SAFETY PROFILE T- >» Over 400 patients who have received CEA-Scan have been evaluated for human anti-mouse antibody (HAMA).

• < 1% showed an elevation of HAMA levels .

• Limited data are available regarding the safety of re-administration

In the patients studied with CEA-Scan, one patient each developed the following minor self-limiting adverse effects: transient eosinophilia, CEA-Scan abdominal SPECT nausea, bursitis, urticaria, generalized itching, headache, upset stomach image indicating tumor uptake (T, arrow). Surgery confirmed and fever. Out of a total of over 500 patients receiving the product to the positive CEA-Scan image. date, there has been a single report of an apparent grand mal epileptic seizure in a severely hypertensive patient that was "possibly related" to CEA-Scan infusion.

HELPING You MAKE DECISIONS ABOUT TUMOR RESECTABILITY

Manufacturedby: Distributed by: LLINCKRODT HMMUNOMEDICS, INC. MEDICAL

Please see adjacent page for brief summary of prescribing infonnation

References: 1. MollaiFLJr.,PinskyCM,HammershaimbL.etal.ClinicalutilityofexternalimmunoscintigraphywiththeIMMU-4lechnelium-99m-Fab'anlibodyIragmentinpatientsundergoingsurgerylorcarcinomaolthecolonandrectum Resultsolapivotal.PhaseIIItrial.J ClinOncol.1996:14:2295-2305. 2. TemperoM.BrandR.HoldemanK,MatamorosA.Newimagingtechniquesincolorectalcancer.SeminOncol.1995;22(5):448-471. CEA SCAN affect the future use ol other murine-based products, including CEA-Scan1.and they should be advised to dis cuss prior use ol murine-based antibody products with their physicians, (see Heterologous Protein (Arcitumomab) Administration) For the Preparation of Technetium Tc 99m Arcitumomab. Heterologous Protein Administration Sterile. Non-Pyrogenic, Lyophilized Powder for Intravenous Use Only. The presence of HAMA and human anti-mouse fragment antibodies have been reported in patients before and after receiving CEA-Scan*(<1% of patients develop HAMA to the antibody fragment). While hypersensitivity reactions to CEA-Scan*have not been observed to date, it is possible that such reactions could occur, resulting DESCRIPTION CEA-Scan is a radiodiagnostic agent consisting of a murine monoclonal antibody Fab' fragment, arcitumomab. in anapnylactic shock, serum sickness or death. In addition, patients who have previously received murine formulated to be labeled with ""Technetium [""Tel.' The active component, arcitumomab, is a Fab' fragment monoclonal antibody products are more likely to have HAMA. When considering the use of the CEA-Scan*in generated from IMMU-4, a murine IgGj monoclonal antibody produced in murine ascitic fluid supplied to patients who have previously received murine antibody-based products, physicians should be aware of the Immunomedics, Inc., by Charles River Laboratories. IMMU-4 is purified from the ascitic fluid and is digested potential lor HAMA to increase the risk ol allergic reactions and to alter clearanceand biodistribution. The with pepsin to produce F(ab'|i fragments and subsequently reduced to produce the 50,000-dalton arcitu quality or sensitivity of the imaging study may then be compromised. momab. Eachvial contains the non-radioactive materials necessary to prepare one patient dose. CEA-Scan* Drug/Laboratory Test Interactions is a sterile, lyophilized formulation, containing 1.25 mg of arcitumomab and 0.29 mg stannous chloride per The presence of HAMA in serum may interfere with two-site murine antibody-based immunoassays. such as vial, with potassium sodium tartrate tetrahydrate. sodium acetate trihydrate. sodium chloride, acetic acid, glacial, hydrochloric acid, and sucrose. The imaging agent, technetium Tc 99m CEA-Scan', technetium Tc 99m assays lor CEAand CA-125. II HAMA is known or suspected to be present, the clinical laboratory should be arcitumomab, is formed by reconstitution of the contents of the CEA-Scan"vial with 30 mCi of [Tel sodium notified that interference may occur. pertechnetate in 1 ml of Sodium Chloride for Injection, USP. The resulting solution is pH 5-7 and lor intra CEA-Scan' may interfere with serum assays for assessment of serum levels of CEA. Therefore, any determina venous use only. Following administration, the labeled antibody can be visualized by common nuclear medi tion of serum CEAshould be made prior to injection with CEA-Scan*. Assays for serum CEAshould not be cine instrumentation. performed within 7 days after injection of CEA-Scan*.

INDICATIONS No data are available on possible drug interactions. Do not mix or administer CEA-Scan*with other products. CEA-Scan' (Arcitumomab) is indicated, in conjunction with standard diagnostic evaluations (e.g.. additional Sufficient time should be allowed for clearance and radioactive decay betöreand after the use of this product imaging evaluation), lor detection of the presence,location and extent ol recurrent and/or metastatic colorectal and other products using radionuclides. carcinoma involving the liver, extrahepatic abdomen and pelvis in patients with a histologically confirmed diag nosis of colorectal carcinoma. CEA-Scan*provides additional Information in patients with no evidence of dis Carcinogenesls, Mutagenesis. Impairment ol Fertility No long-term animal studies have been performed to evaluatethe carcinogenic or mutagenic potential of ease by standard diagnostic modalities (SDM) in whom recurrence or metastasis is suspected based upon ele Technetium Tc 99m arcitumomab or to determine its effects on fertility in males or females. vated or rising serum CEA,and in patients with evidence of metastatic or recurrent disease on SOM. A retro Pregnancy- CategoryC spective analysis suggests that these data can be useful in the evaluation of patients in whom surgical inter Animal reproduction studies have not been conducted with CEA-Scan*. It is also not known whether it can vention (biopsy, exploratory laparotomy and surgical resection) is under consideration. cause letal harm or affect reproductive capacity when administered to a pregnant woman. CEA-Scan*should CEA-Scan" is not indicated tor the differential diagnosis of suspected colorectal carcinoma or as a screening tool for colorectal cancer. CEA-Scan' is not intended for readministration or for assessment ot response to be used during pregnancy only if. in the opinion of the physician, the information to be gained justifies the potential risk to the fetus. Examinations using a radiopharmaceutical in a woman of child-bearing capability treatment, (see PRECAUTIONS) should be performed during the first 8-10 days following the onset of menses, if possible. CONTRAIN., CATIONS CEA-Scan' should not be administered to patients who are hypersensitive to products of murine origin or to Lactation Before administering a radioactive medicinal product to a mother who is breast feeding, consideration should Technetium (Tc-99m.) be given whether the investigation could be reasonably delayed until the mother has ceased breast leeding. If WARNINGS the use ol the product is deemed to be clinically indicated, breast feeding should be interrupted, the expressed Anaphylactic and other hypersensitivity reactions can occur following administration of mouse protein to milk discarded, and formula feedings substituted for breast feeding. patients. Although serious reactions of this type have not been observed in clinical trials after CEA-Scan* PediatrieUse administration, medications for the treatment of hypersensitivity reactions, e.g.. epinephrine. antihistamines Safety and diagnostic accuracy in persons under 21 years of age have not been established. and corticosteroids, should be available for immediate use in the event of an allergic reaction during adminis ADVERSE REACTIONS tration of this agent. In the patients studied with CEA-Scan*.one patient each developed the following minor self-limiting adverse PRECAUTIONS effects: transient eosinophilia. nausea,bursitis, urticaria, generalized itching, headache,upset stomach and General fever. Out of a total of over 500 patients receiving the product to date, there has been a single report of an CEA-Scan*is to be interpreted in conjunction with standard diagnostic modalities. A negative or positive CEA- apparent grand mal epileptic seizure in a severely hypertensive patient that was "possibly related" to CEA- Scan by itself should not be utilized in the diagnostic evaluation of colorectal cancer. Discordant results are Scan' infusion. substantially less predictive than concordant results. Over 400 patients who have received CEA-Scan*have been evaluated for HAMA by Immunomedics using CEA-Scan*should not be used as a screening test for colorectal cancer. ELISA methodology. Fewerthan 1% of the patients showed an elevation of HAMA levels to fragment after Limited data are available regarding the safety of readministration. There are no data to support the efficacy of being injected with CEA-Scan'. If the physician suspects HAMA based on an adverse reaction or altered CEA-Scan* readministration. CEA-Scan' should be used only once in each patient. biodistribution pattern, and deems that a HAMA assay is clinically warranted, he/she should telephone The components of CEA-Scan*are sterile and non-pyrogenic. It is essential to follow preparation directions Immunomedics, Inc., at 800 327-7211, between 8:30 a.m. and 5:00 p.m. Eastern Standard Time, for informa carefully and to adhere to strict aseptic procedures during preparation of CEA-Scan*(""Te]. The contents of tion on procedures to be followed for submission ol patient serum lor assessment ol HAMA directed against the vial are intended only for use in the preparation of CEA-Scan*|""Tc] and are not to be administered directly mouse monoclonal antibody fragments. to patients. OVERDOSAGE The contents of the vial before preparation are not radioactive. However,after "*Tc-pertechnetate is added, Intravenous infusion of intact IgG and F(ab> of IMMU-4 in doses of up to 25 mg or arcitumomab at doses up to 10 mg have not shown any serious adverse reaction. adequate shielding ol the preparation must be maintained. Appropriate safety measures should be used to minimize radiation exposure to clinical personnel and patients, consistent with proper patient management. HOW SUPPLIED Packagecontaining one (1) vial, with a single-use dose of 1.25 mg lyophilized arcitumomab. The product Radiopharmaceuticals should be used only by physicians who are qualified by training and experiencein the should not be used beyond the expiration date printed on the label. safe use and handling of radionuclides. Imaging Interpretation REFERENCES 1. Hansen HJ. Jones AL, Sharkey RM, GrebenauR, BlazejewskiN, Kunz A, Buckley MJ, Newman ES,Ostella f, fieneal Goldenberg DM. Preclinical evaluation of an 'instant' ""Tc-labeling kit lor antibody imaging. CancerRes. There are limited data to determine the imaging characteristics and efficacy of the CEA-Scan*(Arcitumomab) in detection of lesions outside ol the abdominopelvic cavity.'1 1990:50:794-798. 2. Data on Fileat Immunomedics, Inc. Areas ol potential false-positive readings, particularly with planar imaging, may be observed near the major 3. Moftat FL. Pinsky CM. Hammershaimb L. Petrelli NJ. Part YZ. Whaley FS. Goldenberg DM, and the bloodpool organs (heart, major vessels, etc.) at very early imaging times, near the sites of antibody fragment Immunomedics Study Group. Clinical utility of external immunoscintigraphy with the IMMU-4 technetium- metabolism (kidneys and urinary bladder), and in the intestines and gallbladder. Late imaging may also aid in 99m-Fab' antibody fragment in patients undergoing surgery for carcinoma of the colon and rectum. Results the evaluation of suspected normal bowel activity. of a pivotal, PhaseIII trial. J Clin Oncol 1996:14:2295-2305. With regard to imaging of tumor near the kidneys or urinary bladder, it is advisable to have the patient void 4. Behr T, BeckerW, Hanappel E, Goldenberg DM, Wolf F. Targeting of liver métastasesof colorectal cancer with IgG, F(ab');, and Fab' anti-carcinoembryonic antigen antibodies labeled with ""Tc: the role of urine prior to acquisition of imaging data to decrease bladder activity. Careful SPECTimaging near the kidneys and bladder has been helpful. metabolism and kinetics. CancerRes. 1995;55:5777s-5785s. Porta Heoalis Reoion Precise localization of lesions in the region of the porta hepatis has been difficult. Lesions within the porta Immunomedics,Inc. hepatis region may be present within the liver or the portal nodes. At the time of surgical exploration, such 300AmericanRoad lesions (which if nodal would preclude resection ol hepatic métastases)should be explored first. MorrisPlains,NJ07950 False-Positive Lesions There were 52 false-positive lesions observed in 41 patients from a total of 209 surgically explored subjects in the two pivotal trials. Thirty-live ot these lesions were in occult disease patients. 01 the 52 false-positive lesions. 11 were observed in the liver. 17 in the extra-hepatic abdomen, and 24 in the pelvis. A pathological Manufactured by: Distributed by. correlate to the lesions was infrequently documented: these included granulomas in the liver (1 instance), adhesions with or without suture granulomas (4 cases), surgical incision site (1 case). Descriptions of false- ALLINCKRODT positive lesions within the abdomen were suggestive of colonie activity in several cases. ^IMMUNOMEDICS, INC. MEDICAL Hot. Rimmed, and Cold Lesions Only hot or rimmed lesions should be considered as positive for tumor. Lesions that are rimmed or cold usu ally fill in as hot or rimmed, respectively, with time." Often, large lesions, due to poor vascularization or cen tral necrosis, will appear to be cold. Information lor Patients Murine monoclonal antibodies are foreign proteins, and their administration can inbuce human anti-mouse antibodies (HAMA). While limited data exist concerning the clinical significance ol HAMA the presence of HAMA may interfere with murine antibody-based immunoassays (e.g., serum CEAassays), could compromise the efficacy of in vitro or in vivo diagnostic or therapeutic murine antibody-based agents, and may increase the risk of adverse reactions. For these reasons, patients should be informed that the use ol this product could ©1996Mallinckrodt Medical, Inc. MI22622 9/96 Printed in U.S.A.

Circle Reader Service No. 110 Introducing a view from the heart. MY,VIEW TechnetiunTc99mTetrofosminforInjection A clear view. t Technetium - labeled f Rapid and sustained myocardiaJ uptake, with images available from 15 minutes to 4 hours post-injection f Rapid CI clearance A convenient view. t Room temperature preparation, and 8 hour reconstituted shelf-life f No redistribution iul Available in unit dose An efficient view. f Flexible scheduling f Assessment of myocardial perfusion and ventricular function with a single injection t Sensitive and reliable detection of coronary disease A patient's view.

S Low-radiation exposure compared to other myocardial perfusion agents t Less than 1% of patients experienced side effects in clinical trials of 7(H adults.

Wmersham HEALTHCARE

See brief summary of prescribing information on following page Brief Summary Pregnancy Category C Animal reproduction studies have not been conducted with Myoview. It is not known whether Myoview can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Therefore, Myoview should not be administered to a pregnant woman unless the potential MY, VIEW benefit justifies the potential risk to the fetus. Nursing Mothers KitforthePreparationofTechnetiumTc99mTetrofosminforinjection Technetium Tc99m Pertechnetate can be excreted in human milk. Therefore, formula should be Diagnostic radiopharmaceutical For intravenous use only substituted for breast milk until the technetium has cleared from the body of the nursing woman. Code N166A Pediatrie Use Safety and effectiveness in pediatrie patients have not been established. DESCRIPTION The Medi-Physics Myoview"* kit is supplied as a pack of five vials for use in the preparation of a ADVERSE REACTIONS technetium Tc99m tetrofosmin intravenous injection to be used for the scintigraphic delineation of Adverse events were evaluated in clinical trials of 764 adults (511men and 253 women) with a mean regions of reversible myocardial ischemia in the presence or absence of infarcted myocardium. Each age of 58.7 years (range 26-94 years). The subjects received a mean dose of 7.67 mCi on the first vial contains a pre-dispensed, sterile, non-pyrogenic. lyophilized mixture of 0.23 mg tetrofosmin [6,9- injection and 22.4 mCi on the second injection of Myoview. bis(2-ethoxyethyl)-3,12-dioxa-6,9-diphospha-tetradecane], 30 ug stannous chloride dihydrate (minimum stannous tin 5.0 ug; maximum total stannous and stannic tin 15.8 ug), 0.32 mg disodium Deaths did not occur during the clinical study period of 2 days. Six cardiac deaths occurred 3 days sulphosalicylate and 1.0 mg sodium D-gluconate, and 1.8 mg sodium hydrogen carbonate. The to 6 months after injection and were thought to be related to the underlying disease or cardiac lyophilized powder is sealed under a nitrogen atmosphere with a rubber closure. The product surgery. After Myoview injection, serious episodes of angina occurred in 3 patients. Overall cardiac contains no antimicrobial preservative. adverse events occurred in 5/764 (less than 1 %) of patients after Myoview injection. Caution: Federal (USA) law prohibits dispensing without a prescription The following events were noted in less than 1 % of patients: Cardiovascular: angina, hypertension, Torsades de Pointes CLINICAL PHARMACOLOGY Gastrointestinal: vomiting, abdominal discomfort General Hypersensitivity: cutaneous allergy, hypotension, dyspnea When technetium Tc99m pertechnetate is added to tetrofosmin in the presence of stannous Special Senses: metallic taste, burning of the mouth, smelling something reductant. a lipophilic. cationic technetium Tc99m complex is formed. Tc99m tetrofosmin. This There was a low incidence (less than 4%) of a transient and clinically insignificant rise in white blood complex is the active ingredient in the reconstituted drug product, on whose biodistribution and cell counts following administration of the agent. pharmacokinetic properties the indications for use depend. Clinical Trials DOSAGE AND ADMINISTRATION A total of 252 patients with ischemie heart disease or atypical chest pain who had a reason for For exercise and rest imaging, Myoview is administered in two doses. exercise stress imaging were studied in two open-label, multi center, clinical trials of Tc99m tetrofosmin (study a and study b). Of these 252 patients there were 212 (83%) males and 40 (17%) •The first dose of 5-8 mCi (185-296 MBq) is given at peak exercise. females with a mean age of 60.5 years (range 33.7 to 82.4 years). At peak exercise, maximum heart •The second dose of 15-24 mCi (555-888 MBq) is given approximately 4 hours later, at rest. rate achieved and peak systolic blood pressure were comparable after Myoview and thallium-201 exercise studies. Imaging may begin 15 minutes following administration of the agent. All patients had exercise and rest planar imaging with Myoview and thallium-201; 191 (76%) patients Dose adjustment has not been established in renally or liver impaired, pediatrie or geriatric patients. also had SPECT imaging. The Myoview and thallium-201 images were separated by a mean of 5.1 days (1-14 days before or 2-14 days after Myoview). For Myoview imaging, each patient received RADIATION DOSIMETRY 185-296 MBq (5-8 mCi) Tc99m tetrofosmin at peak exercise and 555-888 MBq (15-24 mCi) Tc99m Based on human data, the absorbed radiation doses to an average human adult (70 kg) from tetrofosminat rest approximately4 hours later. For thallium-201imaging,patientsreceivedthallium-201 intravenous injections of the agent under exercise and resting conditions are listed in Table 1. The 55.5-74 MBq (1.5-2.0 mCi) at peak exercise. values are listed in descending order as rad/mCi and uGy/MBq and assume urinary bladder emptying at 3.5 hours. The ¡mageswere evaluated for the quality of the image (excellent, good or poor) and the diagnosis (with scores of 0 = normal, 1 = ischemia, 2 = infarcì,3 = mixed infarcìand ischemia). The primary Table 1 outcome variable was the percentage of correct diagnoses in comparison to the final clinical Estimated Absorted Radiation Dose (TechnetiumTc99mTetrofosmin Injection) diagnosis. All planar images were blindly read; SPECT images were evaluated by the unblinded investigator. A subset of 181/252 (71%) patients had coronary angiography comparisons to the planar images of Myoview or thallium-201. doseExerciserad/mCi0.1230.0750.0580.0570.0450.0390.0300.0290.0270.0230.0190.0170.0160.0160.0150.01500150.0130.0130.0120.0120.0100.0080.0080.008uGy/MBq33.220.115.615.312.110.48.047.887.346.235.004.604.344.324.144.144.123.523.413.223.112.722.272.22222Restrad/mCi0.1800.1130.0710.0820.0630.0460.0430.0350.0310.0210.0180.0170.0220.0150.0150.0150.0140.0120.0110.0150.0090.0080.0080.0070.007uGy/MBq48.630.419.322.217.012.511.69.558.365.584.984.635.834.113.933.973.823.323.054.152.542.152.081.911.83radiation

INDICATIONS AND USAGE Myoview is indicated for scintigraphic imaging of the myocardium following separate administrations OrganGallTarget under exercise and resting conditions. It is useful in the delineation of regions of reversible myocardial ischemia in the presence or absence of infarcted myocardium. wallUpperbladder intestineBladderlarge CONTRAINDICATIONS wallLower None known. intestineSmalllarge WARNINGS intestineKidneySalivary In studying patients with known or suspected coronary artery disease, care should be taken to ensure continuous cardiac monitoring and the availability of emergency cardiac treatment. glandsOvariesUterusBone PRECAUTIONS General surfacePancreasStomachThyroidAdrenalsHeart To minimize radiation dose to the bladder, the patient should be encouraged to void when the examination is completed and as often thereafter as possible. Adequate hydration should be encouraged to permit frequent voiding.

The contents of the Myoview vial are intended only for use in the preparation of technetium wallRed Tc99m tetrofosmin injection and are NOT to be administered directly to the patient. marrowSpleenMuscleTestesLiverThymusBrainLungsSkinBreastsAbsorbed As with all injectable drug products, allergic reactions and anaphylaxis may occur.

Sometimes Tc99m labeled myocardial imaging agents may produce planar and SPECT images with different imaging information.

TechnetiumTc99m tetrofosmin injection, like other radioactive drugs must be handled with care and appropriate safety measures should be used to minimize radiation exposure to clinical personnel. Care should also be taken to minimize radiation exposure to the patient consistent with proper patient management.

Radiopharmaceuticals should be used by or under the control of physicians who are qualified by specific training and experience in the safe use and handling of radionuclides, and whose experience and training have been approved by the appropriate governmental agency authorized to license the Dose calculations were performed using the standard MIRO method (MIRD Pamphlet No.1 (rev). use of radionuclides. Society of Nuclear Medicine, 1976. Effective dose equivalents (EDE) were calculated in accordance with ICRP 53 (Ann. ICRP 18 (1-4). 1988) and gave values of 8.61 x 10' mSv/MBq and 1.12 x 10' Drug Interactions: Drug interactions were not noted and were not studied in clinical studies in which mSv/MBq after exercise and rest respectively. Myoview was administered to patients receiving concomitant medication. Drugs such as beta blockers, calcium blockers and nitrates may influence myocardial function and blood flow.The effects Manufacturedby AmershamInternationalpic - Amersham,UnitedKingdom of such drugs on imaging results are not known. PatentNo.5,045,302(r) Carcinogenesis, Mutagenesis, Impairment of Fertility Distributedby: Medi-Physics,Inc.,Amersham Healthcare Studies have not been conducted to evaluate carcinogenic potential or effects on fertility.Tetrofosmin 2636S. ClearbrookDr.,ArlingtonHeights.IL60005 sulphosalicylate was not mutagenic in vitro in the Ames test, mouse lymphoma, or human 1-800-633-4123 (TollFree) lymphocyte tests, nor was it clastogenic in vivo in the mouse micronucleus test. February,1996 Amershamand Myovieware trademarksof Amersham Internationalpic 43-1011 F>lmersham HEALTHCARE Circle Reader Service Number 10 Get an angle on the future...

All-Digital, High-Energy Imaging —I-Duljr'lJ.ird. ir'^-I' '/O_tuXÜÕ;ÕJ'Õ! O Leading in High-Energy Imaging a TransACT™: Transmission Attenuation Corrected Tomography

Robotic Design, Convertible Geometry a EleGantry™: Truly open, variable-angle (180°/90°)detector geometry a OptiTrack™: Real-time fully automatic body-contoured scanning Q Evolving-Images™ with Slip-Ring technology

Double-efficiency Double double-efficiency Double double-efficiency Whole-Body scan, featuring right-angle cardiac K£>/»//.'£•,'•/•/r sitjierior lesion detectability tomography: simultaneous with OptiTrack real-time dual-isotope FDG/MIBI body contouring. SPECT. <\otfoi-sale in U.S.) Pending 501 (k)

CircleReaderServiceNumber42 Elscint ElscintU.S.A.:(201)342-2020:1-800-ELSCINT TheSocietyof NuclearMedicine InvitesYoutoAttend the 44th AnnualMeetinginSanAntonio, Texas,June /-5, 1997.

\l;irk \oiir calendar mm! The Annual Meeting Preview \\ill lie mailed to you in .l;inn;ir>. 1997. H'yin have <|iieslions. please coniaci Ihe S\\l Department: SOCIETY OF \leelin« Senices. (7(i:i) 70ÌÌ-9000\-229 NUCLEAR or la\ (703) 709-927-4. S\\ls home |)a«e:htt|)./A\\\\\.SN\I.OK(; MEDICINE RIMESTAR Technology, Inc. FormerlyNuclearMedicineConsultingFirm,Inc.

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Circle Reader Service No. 153 Advertisement

ADAC ADAC LABORATORIES

Clinical Development Grants in NUCLEAR MEDICINE

ADAC Laboratories announces the continuing support of development grants to Clinical Nuclear Medicine. Previously, grants were awarded to

95/96 96/97 Northwestern University, Chicago Institute of Clinical PET Cedars Sinai, Los Angeles University of Texas Medical Branch at Galvest Emory University, Atlanta Notre Dame Hospital, Canada

Several grants ranging from $5000 to $50,000 will be awarded for 1997/98. Funds can be used for equipment and personnel support for a 12 month project.

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For application forms and information please write to: Advanced Clinical Research Program ADAC Laboratories 540 Alder Drive Milpitas, CA 95035

Application Deadline: March 31, 1997

Funding Announcements: SNM - 1997

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Leadership • Technology BETTER HEALTH CARE Circle Reader Service No. 1 WHAT AN ANTHROPOMORPHIC BRAIN PHANTOM SHOULD BE ?

Visit SNM home page at http://www.snm.org

JB003 and JB005 three dimensional rCBF brain phantoms designed by Braeckeveldl J., Neurologist distributed b\ N.V. NUCLEMED S.A. Weststraat 46 B2, B-8800 Roeselare, BELGIUM phone 32-51-22.17.46 - fax 32-51-22.28.36 E-Mail address : [email protected]

Circle Reader Service No. 133

Computer and Instrumentation Council Presents... UATAMANAGEMENTIN NUCLEARMEDICINE

LOCATION AND DATES Palm Springs Riviera Resort and Racquet Club Monday, February 10, through Tuesday, February 11, 1997

Call SNM Department: Meeting Services 703-708-9000

1/14/97Physicians/ScientistsMembersNonmembersSBefore 1/14/97On/ After

00$2185. 15.00$230.00$260.00TechnologistsMembersNonmembersStudents$90.00$120.00$70.00$120.00$150.00$70.00 INTRODUCING THE MOST UP-TO-DATE SELF- ASSESSMENT PROGRAM ON INSTRUMENTATION

Nuclear Medicine Self-Study Program II: Instrumentation is the most current and comprehensive self-assessment program on this vital topic available today. T With more than 35 pages devoted to questions, answers and critiques, this pro gram is an essential tool for reviewing and upgrading your skills or preparing NUCLEAR MEDICINE: for board certification.

Topics Include— •Nonimaging Instrumentation Quality Control for Anger Cameras •Anger Scintillation Cameras Emission Computed Tomographie •Multiple-Element Scintillation Imaging Camera Nuclear Medicine Computers, •Effect of Camera Performance •SUM», Acquisition and Processing Software •My.linle-ChoiceHutstiuni on Clinical Imaging and System Management •AnswersandCritiqueslor Multiple-ChoiceQuestions •Relerencis Self-Study Program II is the second book in the series from SNM. Self-Study Program III: For more information Cardiovascular Nuclear Medicine available on SNM books, spring 1997. Watch for Self-Study Program visit our web site at VI: Oncology topic booklets coming soon. http:// www. snm.org Call toll-free to order your copy today! $45.00 SNM members / $63.00 nonmembers. Matthews Medical Books 800-633-2665 (outside U.S. 314-432-1401)

The1997examinationwillbegivenSunday, June1,1997inSanAntonio,Texas inconjunctionwiththe44thAnnualMeetingofthe SocietyofNuclearMedicine. The examination is written and consists of two parts — TheAmerican Part One (3.5 hours) assesses knowledge of basic aspects of Nuclear Boardof Medicine Science. Part Two (2.5 hours) examines in depth the knowledge of a ScienceIn predetermined subspecialty area of the candidate's choice including: •Nuclear Medicine Physics and Instrumentation Nuclear •Nuclear Pharmaceutical Science and Radiochemistry Medicine •Radiation Protection Completed Applications must be postmarked by March 14,1997. 1997 The examination fee is $450 ($400 refundable if you do not qualify). Certification For applications and more information, please contact: Joanna Wilson, Associate Coordinator Examination American Board of Science in Nuclear Medicine c/o The Society of Nuclear Medicine 1850 Samuel Morse Drive, Reston, Virginia 20190-5316 Tel: (703) 708-9000, ext. 250 •Fax: (703) 708-9015 SNM 44™ANNUAL MEETING Critical Dates

Item Due Date

ABSTRACT FORMS Scientific Papers October IssueJNM . 1/9/97 Scientific Exhibits October IssueJNM . 1/9/97 REGISTRATION FORM Contact: 4/28/97 HOUSING FORM Dept. Meeting Services . 5/2/97

DON'T FORGET THE MID-WINTER MEETING IS IN PALM SPRINGS, CALIFORNIA

DATE: February 5-11, 1997

LOCATION: The Palm Springs Riviera Resort and Racquet Club

EDUCATION PROGRAM SPONSOR: The Computer and Instrumentation Council

SPONSOREDBY: THECOUNCILOFMEDICALSPECIALTYSOCIETIESAND THEAMERICANACADEMYOFOTOLARYNGOLOGY— HEADANDNECKSURGERYFOUNDATION CONTEMPORARYHEALTHCAREANDTHEETHICOFMEDICINE: WHATIs APHYSICIANTo Do? April 13-15,1997 Practitioners, ethicists, medical policy The Drake Hotel—Chicago, IL makers, and representatives of managed care are invited to meet together to re-exam Confirmed Speakers: Saul Bellow, Roger Ì.Bulger, MD, Christine K. Cassel, ine the ethic of medicine as a profession and MD, J. Lee Dockery, MD, John M. Eisenberg, MD, to consider challenges to ethical practice that Jeremy Lazarus, MD, George D. Lundberg, MD, Mary H. physicians may encounter as a result of the McGrath, MD, MPH, Martin F. McKneally, MD, PhD, Lynn Peterson, MD, Edmund D. Pellegrino, MD, rapid changes in the organization and financ Raymond Scalettar, MD, and John Santa, MD ing of healthcare. CME Credit The American Academy of Otolaryngology—Head and Neck Surgery Foundation For more information or to request (AAO-HNSF) is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. registration materials, The AAO-HNSF designates this educational activity for a maximum of 13 hours in cate call (847) 295-3456 or FAX (847)295-3759. gory 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Classified Advertising

Position Available Post Doctprial Fellowship Looking for a post doctoria! fellowship to wok on recep PLACEYOURCLASSIFIED tor imaging using PET in nuclear medicine. Mail or fax CV inquires to: J. James Frost, MD, PhD, Johns Hop kins University School of Medicine, Nelson, B1-130.600 N. Wolfe St.. Baltimore. MD2I287. Fax: 410-614-2972. ADVERTISEMENTINTHEJNMAND Positions Wanted ABNM certified, young physician with expertise in all clinical aspects of nuclear medicine seeks a temporary REACHMORETHAN15,000 or permanent, part-time or full-time employment in a Vet erans administration hospital beginning immediately. Phone:210-616-5311. NUCLEARMEDICINE PROFESSIONALSEACHMONTH. Visit SNM homepageat DEADLINEFORTHE LI http://www.snm.org FEBRUARY1997 ISSUE: 1/6/1997

DEPARTMENT OF NUCLEAR MEDICINE Faculty of Medicine Kuwait University Qualified nuclear medicine physicists are invited to apply for the ranks of Assistant, Associate and Full Professor positions at Kuwait University. Duties include teaching, research and patient care. An attractive salary package including housing allowance, 60 days annual leave, school allowance for children under the age of 18 years and annual family round trip airline tickets are provided. Applications may be obtained from: Embassy of the State of Kuwait Kuwait University Office 3500 International Drive, NW Washington, DC 20008 U.S.A Tel.: 202-363-8055 Applicants should send application, a copy of their C.V. and copies of qualifications to: Abdelhamid H. Elgazzar, MD Acting Chairman, Department of Radiology Faculty of Medicine Kuwait University P.O. Box 24923 13110 Safat, KUWAIT Fax: 963-533-8936 M CAT The Reality Modular Coded Aperture Technology (W.I.P.)

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Circle Reader Service No. 62