IAEA RADIOISOTOPES AND RADIOPHARMACEUTICALS SERIES No. 1 This publication provides a broad overview of the current status and future prospects of technetium-99m (99mTc) radiopharmaceuticals, including a description of the most Radiopharmaceuticals: Status and Trends Technetium-99m advanced chemical techniques for labelling biomolecules and synthesizing suitable multifunctional ligands. It also reviews the most recent applications of 99mTc agents for monitoring different biological processes. Various subfields of clinical relevance are identified where 99mTc radiopharmaceuticals will continue to have a significant impact on nuclear medicine, such as cardiology, oncology, neurology, infection/inflammation, and gene expression. Technetium-99m Radiopharmaceuticals: Status and Trends INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA ISBN 978–92–0–103509–7 ISSN 2077–6462 Atoms for Peace Atoms for Peace 09-11441_P1405_cover.indd 1 2010-01-14 11:02:13 RELATED PUBLICATIONS IAEA RADIOISOTOPES AND RADIOPHARMACEUTICALS SERIES PUBLICATIONS CYCLOTRON PRODUCED RADIONUCLIDES: GUIDELINES FOR SETTING UP A FACILITY One of the main objectives of the IAEA Radioisotope Production and Radiation Technology Technical Reports Series No. 471 programme is to enhance the expertise and capability of IAEA Member States in deploying STI/DOC/010/471 (213 pp.; 2009) emerging radioisotope products and generators for medical and industrial applications in order to ISBN 978–92–0–103109–9 Price: €45.00 meet national needs as well as to assimilate new developments in radiopharmaceuticals for diagnostic and therapeutic applications. This will ensure local availability of these applications THERAPEUTIC RADIONUCLIDE GENERATORS: within a framework of quality assurance. 90SR/90Y AND 188W/188RE GENERATORS Publications in the IAEA Radioisotopes and Radiopharmaceuticals Series provide information in the areas of: reactor and accelerator produced radioisotopes, generators and sealed Technical Reports Series No. 470 sources development/production for medical and industrial uses; radiopharmaceutical sciences, STI/DOC/010/470 (233 pp.; 2009) including radiochemistry, radiotracer development, production methods and quality assurance/ ISBN 978–92–0–111408–2 Price: €45.00 quality control (QA/QC). The publications have a broad readership and are aimed at meeting the needs of scientists, engineers, researchers, teachers and students, laboratory professionals, and CYCLOTRON PRODUCED RADIONUCLIDES: instructors. International experts assist the IAEA Secretariat in drafting and reviewing these PHYSICAL CHARACTERISTICS AND PRODUCTION METHODS publications. Some of the publications in this series may also be endorsed or co-sponsored by Technical Reports Series No. 468 international organizations and professional societies active in the relevant fields. STI/DOC/010/468 (279 pp.; 2009) There are two categories of publications: the IAEA Radioisotopes and Radiopharmaceuticals Series and IAEA Radioisotopes and Radiopharmaceuticals Reports. ISBN 978–92–0–106908–5 Price: €52.00 IAEA RADIOISOTOPES AND RADIOPHARMACEUTICALS SERIES TECHNETIUM RADIOPHARMACEUTICALS: Publications in this category present guidance information or methodologies and analyses of MANUFACTURE OF KITS long term validity, for example protocols, guidelines, codes, standards, quality assurance manuals, Technical Reports Series No. 466 best practices and high level technological and educational material. STI/DOC/010/466 (202 pp.; 2008) ISBN 978–92–0–100408–6 Price: €50.00 IAEA RADIOISOTOPES AND RADIOPHARMACEUTICALS REPORTS In this category, publications complement information published in the IAEA Radioisotopes CYCLOTRON PRODUCED RADIONUCLIDES: and Radiopharmaceuticals Series in areas of the: development and production of radioisotopes and generators for medical and industrial applications; and development, production and QA/QC of PRINCIPLES AND PRACTICE diagnostic and therapeutic radiopharmaceuticals. These publications include reports on current Technical Reports Series No. 465 issues and activities such as technical meetings, the results of IAEA coordinated research projects, STI/DOC/010/465 (230 pp.; 2008) interim reports on IAEA projects, and educational material compiled for IAEA training courses ISBN 978–92–0–100208–2 Price: €45.00 dealing with radioisotope and radiopharmaceutical related subjects. In some cases, these reports may provide supporting material relating to publications issued in the IAEA Radioisotopes and COMPARATIVE EVALUATION OF THERAPEUTIC Radiopharmaceuticals Series. RADIOPHARMACEUTICALS All of these publications can be downloaded cost free from the IAEA web site: Technical Reports Series No. 458 STI/DOC/010/458 (310 pp.; 2007) http://www.iaea.org/Publications/index.html ISBN 92–0–115106–3 Price: €56.00 Further information is available from: LABELLING OF SMALL BIOMOLECULES USING NOVEL TECHNETIUM-99M CORES Sales and Distribution Unit International Atomic Energy Agency Technical Reports Series No. 459 Vienna International Centre STI/DOC/010/459 (312 pp.; 2007) PO Box 100 ISBN 92–0–101607–7 Price: €70.00 1400 Vienna, Austria TRENDS IN RADIOPHARMACEUTICALS (2 volumes) Readers are invited to provide feedback to the IAEA on these publications. Information may STI/PUB/1294 (Vol. 1: 408 pp.; Vol. 2: 464 pp.; 2007) be provided through the IAEA web site, by mail at the address given above, or by email to: ISBN 92–0–101707–3 Price: €120.00 [email protected] www.iaea.org/books 09-11441_P1405_cover.indd 2 2010-01-14 11:02:14 TECHNETIUM-99m RADIOPHARMACEUTICALS: STATUS AND TRENDS The following States are Members of the International Atomic Energy Agency: AFGHANISTAN GHANA NORWAY ALBANIA GREECE OMAN ALGERIA GUATEMALA PAKISTAN ANGOLA HAITI PALAU ARGENTINA HOLY SEE PANAMA ARMENIA HONDURAS PARAGUAY AUSTRALIA HUNGARY PERU AUSTRIA ICELAND PHILIPPINES AZERBAIJAN INDIA POLAND BAHRAIN INDONESIA PORTUGAL BANGLADESH IRAN, ISLAMIC REPUBLIC OF QATAR BELARUS IRAQ REPUBLIC OF MOLDOVA BELGIUM IRELAND ROMANIA BELIZE ISRAEL RUSSIAN FEDERATION BENIN ITALY BOLIVIA JAMAICA SAUDI ARABIA BOSNIA AND HERZEGOVINA JAPAN SENEGAL BOTSWANA JORDAN SERBIA BRAZIL KAZAKHSTAN SEYCHELLES BULGARIA KENYA SIERRA LEONE BURKINA FASO KOREA, REPUBLIC OF SINGAPORE BURUNDI KUWAIT SLOVAKIA CAMBODIA KYRGYZSTAN SLOVENIA CAMEROON LATVIA SOUTH AFRICA CANADA LEBANON SPAIN CENTRAL AFRICAN LESOTHO SRI LANKA REPUBLIC LIBERIA SUDAN CHAD LIBYAN ARAB JAMAHIRIYA SWEDEN CHILE LIECHTENSTEIN SWITZERLAND CHINA LITHUANIA SYRIAN ARAB REPUBLIC COLOMBIA LUXEMBOURG TAJIKISTAN CONGO MADAGASCAR THAILAND COSTA RICA MALAWI THE FORMER YUGOSLAV CÔTE D’IVOIRE MALAYSIA REPUBLIC OF MACEDONIA CROATIA MALI TUNISIA CUBA MALTA TURKEY CYPRUS MARSHALL ISLANDS UGANDA CZECH REPUBLIC MAURITANIA UKRAINE DEMOCRATIC REPUBLIC MAURITIUS UNITED ARAB EMIRATES OF THE CONGO MEXICO DENMARK MONACO UNITED KINGDOM OF DOMINICAN REPUBLIC MONGOLIA GREAT BRITAIN AND ECUADOR MONTENEGRO NORTHERN IRELAND EGYPT MOROCCO UNITED REPUBLIC EL SALVADOR MOZAMBIQUE OF TANZANIA ERITREA MYANMAR UNITED STATES OF AMERICA ESTONIA NAMIBIA URUGUAY ETHIOPIA NEPAL UZBEKISTAN FINLAND NETHERLANDS VENEZUELA FRANCE NEW ZEALAND VIETNAM GABON NICARAGUA YEMEN GEORGIA NIGER ZAMBIA GERMANY NIGERIA ZIMBABWE The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world’’. IAEA RADIOISOTOPES AND RADIOPHARMACEUTICALS SERIES No. 1 TECHNETIUM-99m RADIOPHARMACEUTICALS: STATUS AND TRENDS INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2009 COPYRIGHT NOTICE All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at: Sales and Promotion, Publishing Section International Atomic Energy Agency Vienna International Centre PO Box 100 1400 Vienna, Austria fax: +43 1 2600 29302 tel.: +43 1 2600 22417 email: [email protected] http://www.iaea.org/books © IAEA, 2009 Printed by the IAEA in Austria December 2009 STI/PUB/1405 IAEA Library Cataloguing in Publication Data Technetium-99m radiopharmaceuticals : status and trends. — Vienna : International Atomic Energy Agency, 2009. p. ; 24 cm. — (IAEA radioisotopes and radiopharmaceuticals series, ISSN 2077-6462 ; no. 1) STI/PUB/1405 ISBN 978–92–0–103509–7 Includes bibliographical references. 1. Technetium — Isotopes – Diagnostic use. 2. Radiopharmaceuticals. I. International Atomic Energy Agency. II. Series. IAEAL 09–00617 FOREWORD Technetium-99m radiopharmaceuticals are applied in morphological and dynamic imaging of many organs in the body, to diagnose various diseases. It is estimated that about 25 million diagnostic investigations are performed annually using this single isotope. It is expected that current applications using 99mTc radiopharmaceuticals in renal, hepatic, hepatobiliary, bone, cardiac