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Home , Cystography, Fluorodopa, Iobenguane, Ioflupane (123I)

12614-01_CH01-rev3.qxd 10/25/11 10:56 AM Page 1

CHAPTER 1 Radioisotopes

Distribution for Not

1 12614-01_CH01-rev3.qxd 10/25/11 10:56 AM Page 2

2 NUCLEAR PHARMACY QUICK REFERENCE b Inhalation IV IV IV IV PO IV PO IV IV IV IV IV IV Route ) a 60–100 mCi 20–30 mCi 10–20 mCi 10–15 mCi 12–40 mCi 1 µCi 10–80 µCi 0.5 µCi 10–15 mCi 4–6 mCi 10 mCi 8–10 mCi 5 mCi 5 mCi Various Typical Dosage (Adult In radiophar- 111 receptor imaging 2

Helicobacter pylori maceuticals Cardiac: Marker of oxidative metabolism Diagnosis of Labeling red blood cells (RBCs) for mea- suring RBC volume, survival, and splenic sequestration Diagnosis of pernicious anemia and defects of intestinal absorption utilization in brain, cardiac, and neoplastic disease neuronal decarboxylase activity in brain Bone imaging Hodgkin’s disease, lymphoma Acute inflammatory lesions Metastatic imaging in patients with biopsy- proven prostate cancer Radiolabeling various Cardiac: Blood volume measurement Brain: Benzodiazepine receptor imaging Neoplastic disease evaluation in Brain: Dopamine D Use Distribution for Carbon monoxide injection injection injection Sodium injection Urea Sodium chromate injection Cyanocobalamin capsules Fludeoxyglucose injection injection injection Gallium citrate injection Capromab pendetide injection Indium chloride sterile solution NotChemical Form and Dosage Form TABLE 1-1 Used in Nuclear Carbon C 11 Carbon C 11 Carbon C 11 Carbon C 11 Carbon C 11 Carbon C 14 Chromium Cr 51 Cobalt Co 57 Fluorine F 18 Fluorine F 18 Fluorine F 18 Gallium Ga 67 Indium In 111 Indium In 111 12614-01_CH01-rev3.qxd 10/25/11 10:56 AM Page 3

RADIOISOTOPES 3 (continued) IV Intrathecal IV IV IV PO PO IV IV IV IV IV PO ) c 2 5 mCi 3–5 mCi 400–600 µCi 2 mCi 0.14 mCi/kg (child) 10 mCi (adult) 5–10 µCi 30 µCi 5–50 µCi 0.5 mCi/1.7m 500 µCi 500 µCi 3 mCi (planar) 6 mCi (SPECT 5–10 µCi 50–100 µCi 100 µCi 2 mCi 5–33 mCi 150–200 mCi Y Zevalin (Biogen Idec) in 90 the treatment of non-Hodgkin’s lymphoma Striatal visualization (assist in the evaluation of adult patients with suspected Parkinsonian syndrome) (PS) Thyroid gland imaging Thyroid metastases (total body) , carcinoid tumors, non- secreting paragangliomas, Plasma volume determination Glomerular filtration rate (GFR) determination Blood volume/plasma volume determination Pheochromocytoma, carcinoid tumors, non- secreting paragangliomas, neuroblastoma Thyroid function Thyroid imaging (neck) Thyroid imaging (substernal) Thyroid metastases (total body) Hyperthyroidism Carcinoma Labeling autologous leukocytes Cisternography Neuroendocrine tumors Biodistribution imaging prior to therapeutic dosing with Distribution for

NotIndium oxine sterile solution Pentetate injection Pentetreotide injection injection Injection Sodium iodide capsules and solution injection Albumin injection Iothalamate sodium injection Albumin injection Iobenguane injection Sodium iodide capsules and solution Indium In 111 Indium In 111 Indium In 111 Indium In 111 I 123 Iodine I 123 Iodine I 123 Iodine I 125 Iodine I 125 Iodine I 131 Iodine I 131 Iodine I 131 12614-01_CH01-rev3.qxd 10/25/11 10:56 AM Page 4

4 NUCLEAR PHARMACY QUICK REFERENCE b IV IV IV IV Intraperi- toneal or intrapleural (Not for IV use) IV IV IV IV IV IV Route ) a 200 µCi (2 kidneys) 75 µCi (1 ) Patient-specific dosing; not >75 cGy whole body 10–20 mCi 30–100 mCi 10–20 mCi 1–8 mCi 30–60 mCi 1.0 mCi/kg 4 mCi 20 mCi 3 mCi Typical Dosage (Adult Recoverable renal function Treatment of refractory low-grade non- Hodgkin’s lymphoma Myocardial perfusion studies Cardiac perfusion Peritoneal and pleural effusions Polycythemia Myocardial perfusion studies Bone pain palliation in confirmed osteoblastic metastatic bone lesions Bone pain palliation in confirmed osteoblastic metastatic bone lesions Heart blood pool imaging Perfusion lung imaging Use Distribution for Iodohippurate sodium injection Ammonia injection Water injection Chromic phosphate suspension Sodium phosphate injection injection Lexidronam injection Strontium chloride injection Albumin injection Albumin aggregated injection NotChemical Form and Dosage Form TABLE 1-1 Radiopharmaceuticals Used in (Continued) Iodine I 131 Iodine I 131 Nitrogen N 13 Oxygen O 15 Phosphorus P 32 Phosphorus P 32 Rubidium Rb 82 Samarium Sm 153 Strontium Sr 89 Technetium Tc 99m Technetium Tc 99m Radionuclide 12614-01_CH01-rev3.qxd 10/25/11 10:56 AM Page 5

RADIOISOTOPES 5 (continued) IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV 20 mCi 20 mCi 5 mCi 20 mCi 10 mCi 20 mCi 10 mCi 5 mCi 20–30 mCi 5 mCi 1–3 mCi 1–3 mCi 20–30 mCi 3 mCi 3 mCi 10 mCi 15 mCi 15 mCi 8–40 mCi in patients with d confirmed Hepatobiliary imaging With or without methylene blue for regional cerebral perfusion in stroke Without methylene blue for leukocyte labeling Brain imaging Renal perfusion imaging Hepatobiliary imaging Bone imaging Kidney imaging Renogram—renal transplant Renogram—captopril Bone imaging GFR (quantitative) Renogram (diuretic) Renal perfusion imaging Infarct-avid scan GI bleed (intermittent) Myocardial perfusion and function, parathyroid imaging Recurrent or metastatic colorectal carcinoma Adjunct to CT/MRI Distribution for

NotArcitumomab Bicisate injection Disofenin injection Exametazime injection Gluceptate injection Mebrofenin injection Medronate injection Mertiatide injection Oxidronate injec tion Pentetate injection Pyrophosphate injection Red blood cells injection Sestamibi injection Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m 12614-01_CH01-rev3.qxd 10/25/11 10:56 AM Page 6

6 NUCLEAR PHARMACY QUICK REFERENCE b IV IV IV Urethral Eye drops IV IV IV IV Interstitial Intradermal PO IV PO PO IV IV IV Inhalation IV Route ) a 20 mCi 10 mCi 20 mCi 1 mCi 0.1 mCi 5 mCi 5 mCi 5 mCi 5 mCi 0.4–0.6 mCi 0.5–0.8 mCi 1 mCi 10 mCi 5 mCi 0.2 mCi 8–40 mCi 3–4 mCi 2 mCi 10–20 mCi 0.3–0.4 mCi/kg Typical Dosage (Adult tion Brain imaging Thyroid imaging Radionuclide ventriculogram Radionuclide cystography Dacryocystography Meckel’s diverticulum Renal scan—differential renal func Renal scan—cortical anatomy Liver–spleen scan Lymphoscintigraphy (breast) Lymphoscintigraphy (melanoma) Gastric emptying (scrambled egg) GI bleed (acute) Lung aspiration Gastroesophageal reflux Myocardial perfusion and function Myocardial perfusion imaging Parathyroid imaging Lung ventilation imaging Treatment of refractory low-grade non- Hodgkin’s lymphoma Use Distribution for magnetic resonance imaging. Sodium pertechnetate injection Succimer injection Sulfur colloid injection Tetrofosmin injection Thallous chloride injection Xenon Ibritumomab tiuxetan Chemical Form and Dosage Form

Not oral. single-photon emission computed . = computed tomography; MRI = intravenous; PO = = = TABLE 1-1 Radiopharmaceuticals Used in Nuclear Medicine (Continued) Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Technetium Tc 99m Thallium Tl 201 Xenon Xe 133 Yttrium Y 90 Radionuclide IV CT Except where otherwise noted. SPECT a b c d 12614-01_CH01-rev3.qxd 10/25/11 10:57 AM Page 7

RADIOISOTOPES 7 e (continued) 5.91 5.91 5.91 5.73 5.5 0.52 5.37 1.16 None None 0.18 1.0 0.8 4.0 4.0 4.0 4.0 9.0 7.0 4.0 0.4 None None 1.7 0.2 0.66 Half-Value(mm Pb) (R/mCi-hr/cm) Layer Dose Constant b and x-rays) 0.511 (200) 0.511 (200) None 0.511 (200) 0.511 (193) None 0.811 (99) 0.091 (7) 0.093 (16) 0.185 (49) 0.511 (178) Photon MeV (% Intensity) ( ␥ 0.320 (10) 0.122 (86) 0.093 (39) 0.136 (11) 0.185 (21) 0.300 (17) 0.394 (5) b (MeV) 0.2780.191 0.511 (35.2) mean + − 0.250 0.201 0.141 0.830 β β ␤ None None None

b,c Distribution in MeV 0.653 (17.6) 0.579 (38.5) max + − ␤ (% Intensity) β 0.377 (57) 0.468 (22) 0.562 (20) 1.899 (88) for β b Half-life 20.3 min9.97 min5700 yr 0.960 (100)122 sec 1.198 (100)109.8 min 0.156 (100) 0.386 14.26 days 1.732 (100) 0.633 (97) 0.492 1.710 (100) 0.049 0.735 70.9 days 0.695 12.7 hr 0.475 (15) 61.8 hr 0.168 (1) 67.7 min 0.822 (1) 27.7 days271.7 days None None 3.26 days None − β , a + +

Not β β + + − + + − − + β β β β β β β β Decay C N C O F P CrCoCo EC EC Cu EC, Cu EC, Ga EC Ga 11 TABLE 1-2 in Nuclear Medicine 13 14 15 18 32 51 57 58 64 67 67 68 Nuclide Mode 12614-01_CH01-rev3.qxd 10/25/11 10:57 AM Page 8

8 NUCLEAR PHARMACY QUICK REFERENCE e d 0.78 0.18 1.6 7.6 3.21 1.6 6.1 None None None d 0.17 6.5 8.0 0.019 0.23 0.05 7.0 None None None Half-Value(mm Pb) Gamma Ray (R/mCi-hr/cm) Layer Dose Constant b and x-rays) 0.1405 (89) 0.027 (70), x-rays None None 0.740 (12) 0.778 (4) None 0.027 (47), x-rays 0.511 (46) 0.603 (63) 0.723 (10) 1.691 (11) Photon MeV (% Intensity) 0.190 (68) 0.023 (69), x-rays 0.026 (13), x-rays 0.171 (91) 0.245 (94) 0.030–0.032 (15), x-rays 0.159 (83) ( ␥ 0.511 (191) 0.777 (15) b (MeV) mean None None 0.934 0.389 0.820 None ␤ None 1.48

b,c Distribution in MeV max ␤ (% Intensity) 2.28 (100) 1.215 (82) 2.137 (11) for3.38 (82) b 13.1 sec None 6.02 hr None 2.8 days None 13.22 hr None Half-life 76.4 sec 2.60 (13) 50.5 days64 hr 65.94 hr 1.4926 (100) 0.437 (16) 0.585 2.11E + 5 yr 0.294 (100) 0.085 4.18 days 1.534 (12) a +

Not β + − − − − β β β β β Decay Kr IT Tc IT In EC II EC EC, Rb Sr Y Mo Tc TABLE 1-2 Radionuclides in Nuclear Medicine (Continued) 82 81m 89 90 99 99m 99 111 123 124 Nuclide Mode 12614-01_CH01-rev3.qxd 10/25/11 10:57 AM Page 9

RADIOISOTOPES 9 1.43 4.7 0.51 3.32 0.46 0.2 2.27 0.017 6.0 0.1 2.5 2.4 0.032 (6), x-rays 0.041 (48), x-rays 0.031–0.032 (24), x-rays 0.035 (7) 0.135 (2.6) 0.167 (10) 0.027 (114), x-rays 0.069–0.082 (75), x-rays 0.006 0.030 (5), x-rays 0.031–0.036 (49), x-rays 0.035 0.137 (9) 0.081 (38) 0.662 (85) 0.047 (9), x-rays 0.103 (29) 0.080 (3) 0.364 (82) 0.637 (7) 0.187 0.224 None None 0.182 0.100 Distribution0.347 1.175 (5) 0.704 (49) 0.808 (18) 1.070 (71) 0.339 (7) 0.606 (90) for 59.4 days None 3.04 days None 8.02 days 0.248 (2) 5.24 days30.08 yr 0.346 46.5 hr 0.514 (95) 3.72 days 0.635 (31) 0.932 (22) Not isomeric transition. − − − − − β β β β β electron capture, IT = is the endpoint energy for decay. roentgen. II EC Xe Cs Sm Re Tl EC = = 125 131 133 137 153 186 201 max Values obtained from National Nuclear Data Center, Brookhaven Laboratory (www.nndc.bnl.gov/chart/reCenter.jsp?z = 39&n 51). Source: http://hpschapters.org/northcarolina/NSDS/124IPDF.pdf. EC β R a b c d e 12614-01_CH01-rev3.qxd 10/25/11 10:57 AM Page 10

10 NUCLEAR PHARMACY QUICK REFERENCE 0.9% NaCl 0.9% NaCl 0.1 M HCl Water Air/oxygen Solvent extraction 0.05 M HCl Eluant Sr solution Column Type Aluminum oxide Stannic oxide Stannic oxide Cation exchange resin Zirconium oxide 90 (6.01 hr) 4 (1.7 hr) (67.7 min) 3 3 (64 hr) TcO 3 InCl 99m Kr gas (13.1 sec) RbCl (76.4 sec) GaCl YCl 82 68 81m 90 113m Na Daughter Product (half-life) Distribution for Beta minus Electron capture Electron capture Electron capture Beta minus Electron capture Not Parent Decay Mode Sn (115.09 days) Mo (65.94 hr) Sr (25.55 days) Ge (271 days) Rb (4.57 hr) Sr (28.9 yr) TABLE 1-3 Radionuclide Generator Systems Parent (half-life) 99 82 68 81 90 113 12614-01_CH01-rev3.qxd 10/25/11 10:57 AM Page 11

RADIOISOTOPES 11

99 Mo (T½ 66 hours) β– (86%) 99m Tc (T½ 6 hours)

Emax β– (14%) 1.357 MeV γ 0.140 MeV (88%)

99 5 Tc (T½ 2.1 × 10 yr)

FIGURE 1-1 Simplified decay scheme for 99Mo.

1.0 99Mo Decay

0.5

99mTc Ingrowth Activity Distribution 0.2

99m Tc Elutionfor 0.1 10 20 30 40 50 60 70 Hours

FIGURE 1-2 Decay of 99Mo and ingrowth and elution of 99mTc Notactivity over time in a 99mTc generator. 12614-01_CH01-rev3.qxd 10/25/11 10:57 AM Page 12

12 NUCLEAR PHARMACY QUICK REFERENCE

TABLE 1-4 Expiration Times for 99mTc-Sodium Pertechnetate after Generator Elution

Initial Ratio Initial Ratio (microcuries of Expiration (microcuries of Expiration 99Mo/millicurie Time 99Mo/millicurie Time of 99mTc) (hr) of 99mTc) (hr) 0.135 1 0.072 7 0.122 2 0.065 8 0.109 3 0.058 9 0.098 4 0.052 10 0.089 5 0.047 11 0.080 6 0.042 12

Source: Ponto JA. Expiration times for Tc-99m. J Nucl Med Technol. 1981;9:40. .

TABLE 1-5 Relationship between 99mTc and 99Mo in the Generator at Various Times after Elution

Time Ratio Curies 99Mo × = Curies 99mTca (hr) 99mTc:99Mo 0 1.000 — 0 1 0.990 0.094 0.093 2 0.979 0.179 0.175 3 0.969Distribution 0.255 0.247 4 0.959 0.324 0.311 5 0.949 0.386 0.366 6 0.940 0.441 0.414 12for 0.883 0.677 0.598 18 0.829 0.803 0.666 24 0.779 0.870 0.678 36 0.688 0.924 0.636 48 0.607 0.940 0.571 60 0.533 0.944 0.506 Not72 0.473 0.946 0.448 78 0.445 0.946 0.421

a Actual 99mTc present based on 86.05% 99Mo decay to 99mTc.