Last chance

Cisternogram imaging times

immediate, 4, 24 hours

MIBG

15 min, 4 hours

DMSA uptake

3 hours

HMPAO imaging

30 min - 4 hours

WBC image times

4 and 24 hours

In111 Octreotide

4 and 24 hours

Regadenson dose

0.4 mg in 5 mL bolus

Adenosine dose

140 ug/kg/min for 6 mins

Dipyridamole dose

0.56 mg/kg intravenously over a 4-minute period.

Dobutamine dose

15-40 ug/kg/min every 3 mins

Sr89 chloride metastron dose

40–60 µCi/kg

Ra-223 Radium dichloride (Xofigo®)

55 kBq/kg every 4 weeks × 6

Lu-177 Vipivotide tetraxetan (Pluvicto®)

200 mCi every 6 weeks × 6

Lu-177 dotatate (Lutathera®)

200 mCi every 8 weeks × 4

F-18 FDG mol

Facilitated diffusion via GLUT transporters, phosphorylated by hexokinase

Radpharm for Neuroendocrine tumor imaging, carcinoid, islet cell tumors

In 111 pentetreotide (Octreoscan®)

radpharm for Pheochromocytoma, paraganglioma, neuroblastoma

I 123 iobenguane (MIBG)

MAG3

tubular secretion = Obstruction

UPJ obstruction, Dynamic, Immediate, Lasix

DTPA

glomerular filtration = GFR = Dynamic

Immediate

DMSA

cortical binding. DMSA → wait → cortical images

Scarring, pyelonephritis, Cortical defects, Static, 2–4 hr

Lympho sulfur colloid size

0.1 um

Sentinel node SC size

0.2

Meckels rad pharm

10 mCi pertechnetate

Lutathera adjunct

amino acids 4 hours, antiemetic 30 mins prior

Dat Dose

3-5 mCi I123 ioflupane

Liver-spleen dose

5-10 mCi Tc99m Sulfur Colloid IV bolus RAC

HIDA Dose

3-5 mCi Tc-IDA

GI bleed radpharms

15-30 mCi RBCs for intermittent, 10 mCi SC for active

Common thyroid cancer

pap and folic

Grave’s disease

Autoimmune disorder, Diffuse toxic goiter

Plummer’s disease

Solitary toxic nodule

Hasimoto’s

HYPO, don’t image

Antithyroid meds

o   Methimazole

o   Tapazole

Rb82 chloride imaging cardiac pet

Potassium analog, active transport

30-60 mCi, 50 mL/min rate

Image during infusion and for 7 mins after

Wait 10 mins between rest and stress.

Three minutes after administration of the pharmacologic stress agent, infuse the second dose of Rubidium Rb-82 chloride and complete the stress image acquisition.

MIBG prep

SSKI

MUGA prep

Reduce Tc99m, 15-30 mCi, in vitro preferred

V-tach

V-fib

Myocardial perfusion Th201

o Redistributes over time – hibernating tissue

o Can be used for viability study

o Stress with 3 mCi, image immediately, 4 hr delay for redistribution. 1 mCi rest injection and image

o Rest Only Thallium following cardiac event (48+ hrs): 4 mCi, 5 min anterior static, SPECT, 4-6 hour delayed SPECT (24, 48 hr)

Adrenal Radpharm

10 mCi I123-MIBG IV, over 5 mins

Direct Cystogram

1-5 mCi Tc-99m pertechnetate or Tc-99m sulfur colloid

Indirect cystogram

5-10 mCi Tc-99m DTPA or Tc-99m MAG3

GFR dose

5-15 mCi Tc99m DTPA IV blus

Amyvid

10 mCI

Vizamyl

5 mCi

Neuraceq

8.1 mCi

Fluorodopa

5 mCi

Tauvid

10 mCi

Cerianna

6 mCi

Ga68 Gozetatide

5 mCi

Ultratag

o   Collect 1-3mLof whole blood (with anticoagulant: ACD or heparin)

o   Add Syringe #1 – Sodium Hypochlorite BASE

o   Add Syringe #2 – Citric Acid    ACID

o   Add FRESH Tc-99m   (Max 100mCi/3mL)

o   Allow to react for 20min

o   Re-administer labeled RBCs within 30min

Co57

270 days

Cs137

30 years

Therapy T1/2

Sm - 47 hours

Y - 64 hours

Lu - 6.7 days

I131 - 8 days

Ra223 - 11 days

P 14.3 days

Sr - 50 days

MAG3 under

argon gas

Make SC kit

Add 1-3mL Tc-99m

Add 1.5mL Acid (Syringe #1-Hydrochloric acid)

Boil for 5min

Cool for 3min

Add 1.5mL Base (Syringe #2-Sodium biphosphate anhydrous and Sodium hydroxide)

Most kits have bound purities

at bottom

Mo/Tc

Transient

Caution Areas

 >0.05mSv in 1 hour

 >1mSv in 1 hour

>5Gy in 1 hour

Package limits

o   Surface exposure rate > 200 mrem/hr (2 mSv/hr)

o   Exposure rate at 1 meter > 10 mrem/hr (0.1 mSv/hr)

o   Removable contamination > 22 dpm/cm2 over 300 cm2

DOT

1: White 1 - < 0.5 mR/hr surface and 0 at 1 m.

2: Yellow 2 - 0.5 - 50 mR/hr surface and < 1 mR/hr at 1 m.

3: Yellow 3 - 50 – 200 mR/hr surface and < 10 mR/hr at 1 m

Which instrument should be used

o Contamination? → GM survey meter

o Exposure rate? → Portable ionization chamber

o Wipe test? → Well counter

o Measure dose activity? → Dose calibrator

Compton Scatter

o Medium-energy photon ejects an outer shell electron with lower binding energy

o Lower-energy scattered photon is emitted

Classic scatter

o Photon is momentarily absorbed by shell electron or the atom

o Reemitted in a slightly different direction

Photoelectric absorption

o   Incident photons energy is absorbed by atom, resulting in ejection of an electron from an inner shell (photoelectron).

o   Inner shell electron absorbs incident photon and is ejected, giving a Characteristic x-ray or Auger electrons

Beta -

Neutron rich

Beta + (positron)

Proton rich

Isotopes

H1 and H2

Isotones

B12 and C13