Radiopharmacy, Inc.
MONTHLY SCAN 
Volume XIV Issue XII
December 2009
In This Issue
Pulmonary Embolism
PET on Cocaine
Cardiac Imaging and Proton Pump Inhibitors
Projected Reactor Restart
CMS Issues Memo
Florbetaben Phase III begins
Featured Article

Pulmonary Embolism
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Previous Issues 

Free Continuing Education
(see article to right)

Anatomy and Physiology Review for Nuclear Medicine Technology - 2009 Update

Cardiac Electrophysiology for Nuclear Medicine Technology - 2007 Update

Correct Coding for Diagnostic Nuclear Medicine Procedures, Part 1
 
Myocardial Perfusion Imaging - 2009 Update

 Stress Testing in Cardiac Nuclear Medicine Technology - 2009 Update




Pulmonary Embolism
   Which technique is the most effective for diagnosing pulmonary embolism? Research published in the December issue of The Journal of Nuclear Medicine (JNM) suggests single photon emission computed tomography (SPECT), when combined with low-dose CT, may provide an accurate diagnosis-allowing physicians to improve care for patients suffering from this often critical condition by using a diagnostic test that does not expose the patient to a great deal of radiation. 

PET on Cocaine
When asked to inhibit their response to a "cocaine-cues" video, active cocaine abusers were, on average, able to suppress activity in brain regions linked to drug craving, according to a new study at the U.S. Department of Energy's Brookhaven National Laboratory. The results, to be published in an upcoming issue of NeuroImage, suggest that clinical interventions designed to strengthen these inhibitory responses could help cocaine abusers stop using drugs and avoid relapse.

Above: When active cocaine users watched a video showing people taking cocaine and other cocaine-associated cues, the areas of the brain shown in orange "lit" up, or became more activated an indication that they were craving the drug.


Effect of Proton Pump Inhibitors and H2 Antagonists on the Stomach Wall in 99mTc-Sestamibi Cardiac Imaging
The December 2009 issue of the Journal of Nuclear Medicine Technology includes an interesting report of the effect that long-term proton pump inhibitor (ex. Prilosec, Prevacid, etc.) use may have on Tc99m sestamibi biodistribution.  Specifically, uptake of radioactivity in the stomach wall that may interfere with myocardial perfusion imaging.  The following is the conclusion of the article.
     Stomach wall activity is completely different from the well-known stomach cavity activity frequently observed secondary to enterogastricreflux of sestamibi. The patients in our study who showed significant stomach wall activity had acid reflux disease of a chronic nature and were taking PPIs. Prolonged PPI therapy, but not H2 antagonist therapy, contributes to a significant increase in stomach wall activity, potentially resulting in Compton scatter or ramp filter artifacts affecting the inferior wall of the left ventricle.Stomach wall activity, unlike the stomach cavity activity, can not be prevented by the ingestion of water before imaging. Other investigators have reported a possible role of a full stomach in diminishing this activity. Therefore, it is important to elicit a history of prolonged PPI use to better anticipate the possibility of increased stomach wall activity, which can confound the image quality and interpretation. The mechanisms explaining this stomach wall activity remain speculative.



FIGURE 1.  99mTc stress images showing curvilinear activity in stomach wall interfering with inferior wall of left ventricle (dashed circle). Reconstruction using different filters can induce artifacts.

Proton Pump Inhibitors
  • Omeprazole (Losec, Prilosec, Zegerid, Ocid, Lomac, Omepral, Omez)
  • Lansoprazole (Prevacid, Zoton, Inhibitol, Levant)
  • Dexiansoprazole (Kapidex)
  • Esomeprazole (Nexium, Esotrex)
  • Pantoprazole (Protonix, Somac, Pantoloc, Pantozol, Zurcal, Pan)
  • Rabeprazole (Rabecid, Aciphex, Pariet, Rabeloc, Dorafem)

----------------------------------Journal of Nuclear Medicine Technology, December 2009
Projected Reactor Restart
The dormant NRU reactor at Atomic Energy of Canada Limited's Chalk River Laboratories is scheduled for restart and the resumption of medical isotope production by March 2010.
     The National Research University reactor has been out of service since a small leak of heavy water was detected during routine maintenance last fall.

Go to SNM's Domestic Isotope Availability page

Peregrine Completes Patient Enrollment in Cotara(R) Dose Confirmation and Dosimetry Brain Cancer Trial

Peregrine Pharmaceuticals, Inc. (Nasdaq: PPHM) recently reported completion of patient enrollment in a dose confirmation and dosimetry trial of Cotara(R) in patients with relapsed glioblastoma multiforme (GBM), the deadliest form of brain cancer. Cotara is a targeted monoclonal antibody linked to a radioisotope being developed as a potential new treatment for GBM. Cotara specifically targets cells at the center of brain tumors, so its radioactive payload is able to kill cancer cells while leaving healthy tissue largely unaffected. Cotara is also being tested in a Phase II clinical trial in patients with recurrent GBM.

CMS Issues Proposed Decision Memo for PET (NaF-18) to Identify Bone Metastasis of Cancer

On November 30, 2009, the Centers for Medicare and Medicaid Services (CMS) issued a proposed decision memo for PET (NaF-18) to identify bone metastasis of cancer. In June, CMS opened a reconsideration of Section 220.6 of the National Coverage Determinations Manual to review evidence on the use of NaF-18 (sodium fluoride-18) imaging (NaF-18 PET) to identify bone metastasis of cancer. CMS proposes that the evidence is not sufficient to determine that the results of NaF-18 PET imaging to identify bone metastases improve health outcomes of beneficiaries with cancer.  Therefore CMS proposes that this use is not reasonable and necessary under �1862(a)(1)(A) of the Social Security Act (the Act).
Florbetaben Phase III Begins
Bayer initiated enrollment for a Phase III trial of PET imaging agent florbetaben, which zeroes in on beta-amyloid plaques associated with Alzheimer's disease. The study will have about 400 participants. A Phase II study showed that the agent can help diagnose the disease in eight of 10 cases.

Free Continuing Education
There are currently 26 NucMed credits available on the Covidien www.nucmeded.org web site.  All classses are free of charge.  See below some of the offerings.
 
Anatomy and Physiology Review for Nuclear Medicine  Technology - 2009 Update

Cardiac Electrophysiology for Nuclear Medicine Technology - 2007 Update

Correct Coding for Diagnostic Nuclear Medicine Procedures, Part 1

Myocardial Perfusion Imaging - 2009 Update

Stress Testing in Cardiac Nuclear Medicine Technology - 2009 Update

Enrollment Instructions:
Go to www.nucmeded.org
Click on the self-enroll button
Fill out the information and click on submit
A link will pop up taking you back to main page
Login into site.  Go to the site now
For Sale....Slightly used, heavily discounted
Lead Bricks..........$60.00 each

Rectangular Lead Brick; 8" l x 4" w x 2" h (20 x 10 x 5 cm), 27 lb (12.5 kg)/each



Thyroid Uptake Neck Phantom....$295.00

(Complete with Bottle Carrier, Capsule Holder and  12 Polyethylene bottles)    


Lead Apron...................$100.00

......a protective shield of lead and rubber that may be worn by a patient, radiologic technologist or radiologist.
Technologist Job Line
If you are interested in the following position please feel free to contact the department directly, or give us a call at the pharmacy.  Technologists looking for full-time or part-time position.  

Karen Foncannon: 731-661-9287 Wk: 731-541-7866
Contact info: [email protected]
Radiopharmacy Services
Survey Meter Calibration:  
Radiopharmacy's price for survey meter calibration is $50.00/meter.  Shipping and handling from and back to your location is $20.00.  Shipping will be by FedEx ground unless otherwise specified.  We will pick up the instrument, send it to Mid-America Calibrations, and after calibration return it directly to you.  If required, Radiopharmacy has rental survey meters while your unit is being calibrated.

Co-57 Flood Sources and Dose Calibrator Reference Sources
Don't forget; Radiopharmacy, Inc. sells all types of radioactive sources for all types of cameras and equipment. We supply sources from a variety of major vendors in our efforts to pass along the best products at the lowest cost.  Just give us a call for a price quote or for information about anything your department may need.



Linearity Check
Radiopharmacy, Inc. has a Lineator for performing dose calibrator linearity.  The Lineator allows linearity to be performed in minutes rather than days.  Call Radiopharmacy for more information.
      Radiopharmacy, Inc. is staffed by Board Certified Nuclear Pharmacists (BCNP's) with advanced education, training and experience in the preparation, distribution, and pharmacology of radiopharmaceuticals. Our staff is always available to answer questions or research information regarding radiopharmaceuticals and nuclear medicine studies, unexpected biodistributions, adverse reactions, drug interactions, radiation safety, regulatory requirements, and reimbursement strategies.   We also offer assistance with literature searches, research design preparation, investigational drug procurement, specialized labeling procedures, pharmacokinetic analyses, and dosimetry estimations. 
      Radiopharmacy's services are designed to assist your department in offering the newest, most progressive therapies and diagnostic tests available, and to help you maximize your overall efficiency in order to improve patient satisfaction and your profitability.  To go to our website click on the image above.
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