Commonly Utilized Radiopharmaceuticals

Question 1

Diagnosis of pernicious anemia and intestinal absorption deficiencies.

Answer 1

Co-57 Vitamin B12 (DNI)

Question 2

Most commonly used for red cell mass and survival. Also used for splenic sequestration studies. Non-imaging in vitro assay via counting serial blood samples.

Answer 2

Cr-51 Sodium Chromate
RBCS (DNI)

Question 3

Major clinical application in oncology imaging. Used to assess recurrence and to differentiate between recurring tumor and necrotic tissue. Also used for the localization of epileptogenic focus and evaluation of dementias. Cardiac applications in determining metabolic activity and viability of myocardium.

Answer 3

F-18 Fluorodeoxyglúcose
(DI)

Question 4

Bone scan. Uptake of ____ reflects blood flow and bone remodeling. The CT component of PET/CT systems have significantly improved the specificity, allowing for morphologic characterization of the functional lesions and more accurate differentiation between benign lesions and metastases.

Answer 4

F-18 Sodium fluoride (DI)

Question 5

Tumor, abscess imaging;
Hodgkin’s disease; lymphoma, and acute inflammatory lesions.
Interstitial lung diseases and fever of unknown origin.

Answer 5

Ga-67 Citrate (Di)

Question 6

Brain SPECT for dopamine transporter allows visualization of brain striata to evaluate patients with suspected parkinsonian syndromes. Helps differentiate essential tremor from tremor due to Parkinson’s.

Answer 6

I-123 ioflupane also known as DaTscan (DI)

Question 7

Detection of primary or metastatic pheochromocytoma
or neuroblastoma.

Answer 7

1-123 Metaiodobenzylguanidine MIBG (DI)

Question 8

Evaluation of thyroid function and/or morphology. Uptake determined by Nal (TI) thyroid probe

Answer 8

1-123 Sodium lodide (DI
& DNI

Question 9

Blood and plasma volume determinations.

Answer 9

1-125 Albumin (DNI)

Question 10

-370 kBq (-10 uCi) used for uptake studies (DNI).
-74-185 MBq (~2-5 mCi) for diagnostic thyroid carcinoma metastatic survey.
-185-555 MBq (~5-15 mCi) or hyperthyroidism therapy.
-1.1-7.4 GBq (-30-200 mCi) for thyroid carcinoma therapy.

Answer 10

1-131 Sodium lodide. (DI, DNI, T)

Question 11

Radioimmunotherapic monoclonal antibody for the treatment of chemotherapy-refractory low-grade or transformed low-grade
Non-Hodgkin’s Lymphoma

Answer 11

I-131 Tositumomab also known as Bexxar (T)

Question 12

Indicated for patients with biopsy proven prostate cancer that is thought to be clinically localized following standard diagnostic imaging tests. Also indicated in postprostatectomy patients with high clinical suspicion of occult metastatic disease.

Answer 12

In-111 Capromab Pendetide also known as ProstaScint (DI)

Question 13

Localization of primary and metastatic neuroendocrine tumors bearing the somatostatin receptor.

Answer 13

In-111 Pentetreotide also known as as Octreoscan (DI)

Question 14

Detection of occult inflammatory lesions not visualized by other modalities. Confirmation of active infection in a known area. Careful isolation and labeling of WBC’s is essential to maintain cell viability labeling efficiency -80%. Better for deep abscesses or vertebral osteomyelitis than Tc-99m WBC

Answer 14

In-111 White Blood Cells (DI)

Question 15

Lung ventilation studies; however, availability of generator is limitied due to short parent. Used infrequently due to expense for the generator.

Answer 15

Kr-81m Kypton Gas (DI)

Question 16

Instilled directly into the body cavity containing a malignant effusion. Dose range (IP) 370-740 MBq (10-20 mCi) (IPL)
222-444 MBq (6-12 mCi).

Answer 16

P-32 Chromic Phosphate
Colloid (T)

Question 17

Treatment of polycythemia vera (PCV) most common; also myelocytic leukemia, chronic lymphocytic leukemia.

Answer 17

P-32 Sodium Phosphate (T)

Question 18

Myocardial perfusion agent that is useful in distinguishing normal from abnormal myocardium in patients with suspected myocardial infarction.
Short half life allows rest and stress to be performed in less than 1 h.

Answer 18

Rb-82 also known as CardioGen-82 (DI)

Question 19

Therapy only. Indicated for the palliative relief of bone pain in patients with painful skeletal metastases. Beta and gamma. Gamma allows imaging if desired.

Answer 19

Sm-153 EDTMP also known as Quadramet (T)

Question 20

Therapy only. Indicated for the palliative relief of bone pain in patients with painful skeletal metastases. Beta and gamma. Pure beta so radiation safety concerns for caregivers are less than for Sm-153

Answer 20

Sr-89 Chloride also known as Metastron (T)

Question 21

Hepatobiliary imaging agent, hepatic duct and gallbladder visualization occurs -20 min after administration as liver activity decreases.

Answer 21

Tc-99m Disofenin also known as HIDA (DI)

Question 22

Evaluation of renal parenchymal disorders

Answer 22

Tc-99m DMSA (dimercaptosuccinic acid)
also known as Succimer (DI

Question 23

Ceretec is used to radiolabel leukocytes as an adjunct in the localization of intra-abdominal infection and inflammatory bowel disease. Good for superficial lesions such as diabetic ulcers. Also used in detection of altered regional cerebral perfusion in stroke, Alzheimer’s disease, seizures, etc.

Answer 23

Tc-99m Exametazime also known as Ceretac and HMPAO (DI)

Question 24

Scintigraphic evaluation of pulmonary perfusion. -0.6 million (range 0.2-1.2) particles are injected with an adult dose. Not be used in patients with severe pulmonary hypertension or history of hypersensitivity to human serum albumin. Also used to assess liver perfusion before chemoembolization or sphere therapy.

Answer 24

Tc-99m Macro aggregated
albumin (MAA) (DI)

Question 25

Skeletal imaging agent. Three-phase (flow, blood pool, bone uptake) used to distinguish between cellulitis and osteomyelitis. Theory of bone uptake: (1) hydroxyapatite crystal binding; (2) collagen dependent uptake in organic bone matrix.

Answer 25

Tc-99m phosphonates also known as Tc-99m Methyenediphosphonate (MDP) (DI)

Question 26

Renal imaging agent. Diagnostic aid for assessment of renal function; split function; renal angiograms; renogram curves, whole kidney and renal cortex. Best tubular agent with high extraction faction.

Answer 26

Tc-99m Mertiatide also known as MAG3 (DI)

Question 27

SPECT imaging with Neurolite used as an adjunct to CT and MRI in the localization of stroke in patients in whom stroke has been diagnosed.

Answer 27

Tc-99m Bicisate also known as Neurolite (DI)

Question 28

Kidney imaging; assess renal perfusion; estimate glomerular filtration rate (GFR; -20% filtered per pass). Historically used as a brain imaging agent to identity excessive vascularity or altered blood-brain barrier.

Answer 28

Tc-99m Pentetate also known as Tc-99m DTPA (DI)

Question 29

imaging agent used to demonstrate areas of hyper or hypo osteogenesis and/or osseous blood flow; cardiac agent as an adjunct in diagnosis of acute myocardial infarction.

Answer 29

Tc-99m Pyrophosphate (DI)

Question 30

Blood pool imaging including cardiac first pass and gated equilibrium imaging and detection of sites of G.I. bleeding. Heat damaged RBC are for diagnosis of splenosis and accessory spleen. Also used for diagnosis of hemangiomas.

Answer 30

Tc-99m Red Blood Cells (DI)

Question 31

Diagnosis of myocardial ischemia and infarct. Also used for tumor imaging and parathyroid imaging

Answer 31

Tc-99m Sestamibi also known as Cardiolite (DI)

Question 32

Primary agent for radiopharmaceutical preparations, thyroid imaging, salivary gland imaging, placental localization, detection of vesicourethral reflux, radionuclide angiography/ venography.

Answer 32

Tc-99m Sodium Pertechnetate (DI)

Question 33

Relative functional assessment of liver, spleen, bone marrow RE system; also used for gastroesophageal reflux imaging; esophageal transit time following oral administration. When used as a marrow agent, correlates with WBC imaging. Patency evaluation of peritoneovenous (LeVeen) shunt, administered in shunt.

Answer 33

Tc-99m Sulfur Colloid (DI)

Question 34

Useful in the delineation of regions of reversible myocardial ischemic in the presence or absence of infarcted myocardium.

Answer 34

Tc-99m Tetrofosmin also known as Mlyoview (DI)

Question 35

Identification and semiquantitative assessment of myocardial ischemia and infarction. Delayed imaging used for myocardial viability.

Answer 35

Tl-201 Thallous Chloride (DI)

Question 36

Pulmonary function. Gas is administered by inhalation from a closed respiration system.

Answer 36

Xe-133 Xenon Gas (DI)

Question 37

Treatment of unresectable hepatocellular carcinomas with beads (glass or resin) tagged with Y-90 that are delivered via a catheter to the liver. Bystander and/or radiation crossfire effect on cells of the microvasculature.

Answer 37

Y-90 Microspheres (T)

Question 38

Radioimmunotherapeutic monoclonal antibody for the treatment of relapsed or refractory low-grade, follicular or transformed B cell non-Hodgkin's Lymphoma

Answer 38

Y-90 Zevalin (T)