Nuclear Medicine Board Review Gas Ventilation solution Xe 133 81 KeV 5 3 half life reactor produced dose 10 20 mCi imaging posterior position negative pressure room required single breath during inhalation uses activated charcoal trap to accumulate the exhaled xenon gas until decayed to background wash in equilibrium collected while the xenon distributes through aerated portions of the lung wash out while radioactivity is cleared from lungs Sr 89 Chloride solution Strontium Chloride Metastron 1 46 MeV max 58 Mev mean half life 50 5 days 40 60 uci kg IV for skeletal mets depresses bone marrow shouldn t be used if leukocyte count below 2400 ul or platelet below 60 o00 ul excretion urinary I 131 Tositumomab solution Bexxar half life 8 04 days 606 3 KeV max energy treatment of patients with NHL before treatment patient must receive 650 mg acetaminophen and 50mg diphydramine orally thyroid uptake should be minimized with SSKI activity initially seen in blood pool liver and spleen later times activity in liver spleen thyroid bladder and tumor sites Y 90 ibritumomab tiuxtetan solution Zevalin half life 2 67 days 2 281 MeV treatment of patients with NHL disseminated follicular B Cell monoclonal antibody against lymphoma antigens max dose 32 mci platelets must be at least 100 000 mm3 Sm 153 EDTMP solution ethylenediaminetetra methylene phosphonic before treatment patient must receive 650 mg imaging acetaminophen and 50mg diphydramine orally for patients with more metabolically activate metastases from prostate or breast cancer as well as those from osteogenic sarcoma Quadramet half life 46 7 hours 0 81 MeV maximum concentrates in bone marrow 1 0mci kg urinary excretion 2400 3000 ul leukocyte 2000 ul granuolyte half life 8 06 days 8 04 days Bone therapy blood requirements solution 60 000 100 000 ul platelet I 131 MIBG solution metaiodobenzylguanidine localization treatment of primary or metastatic pheochromocytomas neuroblastoma kidney urinary excretion I 131 Sodium Iodide solution half life 8 06 days used to treat hyperthyroidism thyroid carcinoma 10 15 mCi for graves 20 30 mCi for nodular goiters special release precautions Blood Brain Barrier Imaging solution Tc99m Pertechnetate least desirable accumulated in choroid plexus 15 30mCi premed with KCLO4 preferred Tc99m Pentetate DTPA planar cleared by kidneys Dynamic imaging cerebral blood flow static blood pool delayed statics 3 30 min after 6 sec after tracer rt and lt carotid and anterior cerebral abnormal increased localization of RP brain death tracer distribution in carotids abscense of perfusion Brain Perfusion solution Tc99m exametazime HMPAO ceretec Tc99m Biscisate ECD neurolite Lipid soluble crosses BBB SPECT 10 20mCi dimly lit room for injection approx 45 min post inject imaging with ECD and 90 min for HMPAO looking for photogenic defects no tracer Planar Imaging for Cerebral Brain Death solution 1 3 post injection Tc99m HMPAO Ceretec Total abscense of tracer brain death Cisternography CSF Leak Shunt Patency solution In 111 DTPA intrathecially for cisternography for hydrocephalus CSF leaks ventricular shunt patency CSF Leak pledges in ear nose Removed 2 hours and counted shunt injected directly into shunt want no uptake Image 4 6 hour 24 48 and 72 if needed Brain PET Brain PET CT solution F18 FDG most widely used 10 20mCi normal tracer uptake in gray matter active brain tissue relatively intense uptake inactive areas lesser degrees of uptake Renal Function solution Renogram Tc99m mertiatide pentetate patient must be well hydrated posterior position patient should void prior to study Renal Perfusion solution tc99m blood flow agent obtain sequential images 2 sec for 30 60 sec first part of renogram dynamic flow for renal perfusion then images for about a half hour then furosemide lasix given to rule out uretheral obstruction Renal Morphology solution tc99m DMSA cortical imaging discontinue daily use 3 7 days prior well hydrated and void before procedure 1 hour before RP administration Renal Imaging with ACE Inhibitors solution most common Capoten captopril and Vasotec enalaprit Tc99m Pentetate solution cleared by glomerular filtration binds to renal parenchyma renal uptake is proportional to GFR rapid clearance rate useful in demonstrating glomerular filtration rate as well as relative blood flow to each kidney Tc99m MAG3 solution excreted from kidneys via tubular secretion used to measure renal tubular flow high first pass extraction fraction and rapid plasma clearance used to assess effective renal plasma flow ERPF Tc99m DMSA solution succimer binds to the tubules in the renal cortex cortical imaging 50 of RP bound within 2 hours of administration tracer remains fixed in renal parenchyma for a relatively long period of time therefore most useful for imaging space occupying lesions cysts tumors or gross renal anatomy Radionuclide cystography solution evaluation of vesicoureteral reflux most common in children indirect IV administration of renal agent after it is administered patient is asked to void while being imaged direct cath patient connect to 1mci iv saline tc99m pertechnetate image while filling bladder discontinue administration when bladder capacity is reached Adrenal Imaging solution I 131 123 MIBG methyliodbenzyl guanidine prep Luglos given to block thyroid 123 10 mCi 131 5mCi goes to liver spleen heart free iodine may be in urine Liver spleen solution tc99m sulfur collod average 1um in size liver 85 spleen 10 BM 5 5 t010 mci image 10 15 minutes post injection Detection of Liver Hemangioma solution cavernous hemangioma tc99m labeled RBC s 20 25 mCi abnormal decreased or normal perfusion on flow but increased on delays Lung quantitation solution access patients before lung resection monitor result ion of PE s 55 to right 45 to left quantitation of blood flow drawn with regions 1 to 4 mCi TC99m MAA IV Mo 99 solution 67 hour half life 740 KeV positron emission solution when a proton is converted to a neutron a position a neutrino and energy calibration of survey meters solution daily reference checks using long lived sourced within 20 NRC calibration records annually kept for 3 years battery reference check before each use F 18 solution 110 min half life 511 KeV Th 201 solution t 1 2 73 hours 69 81 KeV accelerator produced 1 Gy solution 100 rad 1 000 mrad 1 rad solution 01 Gy 0001 mGy 1 Sv 01 Sv 1 rem solution 100 rem 1 te solution 1 tp 1 tb dpm solution gross cpm bkg cpm efficiency expressed as a decimal At solution Ao