Infection and inflammation

Adrenal G: Adrenal medullar RP

MIBG labeled to I-123 (diagnosis) and I-131(treatment)

patient prep for adrenal G: adrenal medulla

lugol solution or 400 mg potassium perchlorate

What do you do for a adrenal G study

Inject the RP slowly (5 min)

Blood pressure and ECG monitoring is required

What does adrenal G identify

location of neuroendocrine tumors and metastases (Neuroblastoma, Pheochromcytoma, paraganglioma)

how long do you wait to image for Adrenal G

24 to 72 hours

somatostatin receptor imaging

proteins located on the surface of normal and tumor cells that bind the hormone somatostatin (naturally occurringhormone that inhibits the release of many other hormones and slows cellular activity)

where are neuroendocrine tumors found

pituitary, thryroid, and pancretic islet cells

what is the pt prep for a somatostatin receptor imaging

make sure the pt is well hydrated 1 day prior and after injection

when do you image for somatostatin receptor imaging

4 and 24 hours (can carry out 48 delays)

new method for somatosatin receptor imaging

4-5 mCi of Ga-67 DOTATATE PET/CT (image 60min post injection)

followed by Lu-177 DOTATATE

Monoclonal antibody imaging (MoAbs)

molecular imaging technique that uses radiolabeled monoclonal antibodies to target specific antigens expressed on tumor cells

antibody binds to specific protein (antigen) on the surface of cell

what does and what is special about the antibody from monoclonal antibody imaging

is a laboratory produced protein (mouse monoclonal antibody)

it is designed to recognize and bind to 1 specific antigen

Rituzimab

Zr-89

lymphoma

carcinoembryonic antigen (CEA)

In-111 or Tc-99m can be labeled to arcitumomab

colorectal CA

ProstaScint

In-111 capromabpendetide

prostate CA

OncoScint

In-111 satumab pendetide

ovarian and colon CA

RP and Doses for monoclonal antibody imaging

In-111: 5 mCi

Tc-99m: 20 mCi

Zr-89: 1-2 mCi

pt prep for monoclonal antibody imaging

none

HAMA (human anit mouse antibody) needed if prevoisly had this scan before

scan time for monoclonal antibody imaging

4 and 24 hours

delays up to 48hr

SPECT at 24hr

a postive antibody is followed by therapy

Gallium-67 citrate

binds to proteins within the WBC and attracted by inflammation leukocytes and low molecular weight molecules of bacteria

RP of Ga-67 citrate

8-10 mCi (tumor)

pt prep for Ga-67

none

if accumulation is bowel/feces bowel cleansing may be required

scan time for Ga-67 citrate

48 hours for tumors

optional 72 and 96 hour

TI-201 chloride

detects and localizes certain neoplasms

Dose for TI-201

2-5 mCi

pt prep for TI-201

none

scan time for TI-201

2-4 hours post

if any activity outside normal areas = neoplasm

lymphoma

Y-90 ibritumomab tiuxetan (Zevalin) is a radioimmunotheray used to treat postivie B cell Non-Hodgkin lymphoma

ibritumomab

monoclonal antibody that targets CD20 antigen receptor on the B cell

tiuxetan

chelating agent that securely ataches the RN to the antibody

yttrium-90

theraputic beta emtting RN

what would be the indications for lymphoma study

treatment of pt with relasped/refractory low grade, follicular/transformed B-cell non-hodgkins lymphoma

what would be some contradictions for a lymphoma study

reciveing bone marrow transplants, radioimmunotherap, know type 1 hypersensitivity/anaphylatic reactions to murine protinets (MoAbs), leukemia, HIV, AIDS, platelet counts < 100,000mm³, neutrophil counts < 1500 cells/ml, > 25% lymphoma bone marrow. biodistrubutionb seen on In-111 Zevalin images

what are the RP’s for lymphoma

diagnostic: In-111 Zevalin (no longer required)

theraputic: Y-90 Zevalin: 0.3 mCi with platelet count 100,000 to 149,000

0.4 mCi with platelet count >150,000

Y-90 dose shouldn’t exceed 32 mCi

procedure for lymphoma

pt recives rituximab (cold ibiritumomab) 4 hours before In-111 Zevalin

after injected pt with 5 mCi In-111 Zevalin (10 min injection)

scan time for lymphoma

48-72 hours

7-10 days following In-111, administer Y-90 Zevalin (10 min injection)

nurse monitor vitals for 1 hours every 15 minutes

lymphoscintigraphy

elective lymph node dissection (ELND) or axillary lymph node dissection (ALND)

can determine drainage pathwats of lymoph nodes from malignant neoplasms

the primary site for metastasis

sentinel node (1st lymph node)

RP for lymphoscinigraphy

radiocolloid 0.1-0.5ml, modified Tc-99m SC usualy injected at tumor site

scan times for lymphoscintigraphy

immediate dynamic images

30-60min delays (mapping)

Tc-99m Sestamibi indications

used to detect breast and parathyroid tumors

MIBG used for

breast and parathryoid

if there is any accumulation in the parathryoid then something is wrong (abnormal)

RP dose for Tc-99m Sestimibi & pt prep

20-30 mCi

no pt prep

Tc-99m Sestimibi procedure

inject in opposting breast

lay pt prone (seperates breast from other organs)

scan times for Tc-99m Sestimibi

10-20 min post inejction

delayed images go out to 2hr

infection and inflammation RP

Ga-67 Citrate

radiolabled WBC: In-111 Oxine and Tc-99m HMPAO

what does Ga-67 do

bind to plasma proteins in the blood, still binds to WBC

infection and inflammation have higher amount of WBC

indications for a infection and inflammation study

rule out and confirn inflammation and infection

location of inflammed and infected

fever of unknown origin

pt prep for infection and inflammation

optional bowel cleansing

RP dose for infection and inflammation

4-6 mCi lower doses are used for infection/inflammation

True

after 24hr Ga-67 is excreted by intestines

kidney uptake in an infection and inflammation study after the first 24hr is not normal T/F

scan time for a infection and inflammation study

6, 24, and 48 if nesscessary

infection nd inflamatiory accumulate faster than tumors

procedure for a infection and inflmmation study (simple approach to labeling)

take 50-60ml of the pt blood

sepertate teh WBC

lable it with 500uci In-111 or 20mCi Tc-99m

reinject with a 20 gague

image

radiolabled WBC RP and doses

In-111 Oxine (500uCi)

Tc-99m HMPAO (10 mCi)

differences in In-111 and Tc-99m for radiolabled WBC

In-111: longer T1/2 (can image 96hr), normal uptake (liver, spleen, some bone marrow, NO GI or Kidney uptake), earlier results, higher amount to infected area, higher dose to pt, difficult to make

Tc-99m: higher dose, faster uptake, only image to 24hr, normal uptake (GI tract, kidneys, bone marrow), cheaper

pt prep for Radiolabled

none

scan times for radiolabled WBC

In-111: 6, 24, 48 (if necessary)

Tc-99m: 30min, 4 and 24 hours