Featured Article
Chocolate Interaction with RBC's
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Case Study of the Month
Meckel's Diverticulum
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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
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TC99M UPDATE
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Dear Radiopharmacy Customer, 
As you know, the High-Flux Reactor in Petten, Netherlands
that currently supplies the bulk of molybdenum 99 (Mo-99) for the U.S., will
shut down for a planned six-month repair beginning on February 19.
Additionally, the NRU reactor in Canada will probably not resume
Mo-99 production until sometime in April of this year. Although Mo-99
supply from the remaining three on-line reactors (the smaller ones) is still
being finalized, we currently have a clearer picture for the month of March to
share with you.
· From March
1 through March 20, we expect to receive the same decreased generator standing
orders that we have been receiving for the past several months.
Radiopharmacy will likely be able to meet your patients' requirements for
all non-cardiac technetium-99m (Tc-99m) doses. However, rationing of
cardiac doses for Thursdays and Fridays may become necessary. We request
that you schedule Tc-99m cardiac studies as early in the week as possible.
As usual, we will have thallium-201 (Tl-201) available for cardiac studies
during times of Tc-99m shortages.
· There will be NO generator production for the week
beginning March 21. We have been told that this lack of Mo-99
will be market wide globally. All five major medical isotope reactors in
Europe, Canada and South Africa
will be off-line during this period. Unless something changes, we will
have only a very limited amount or Tc-99m from the previous week's
generators. Thallium-201 will be available as usual for any cardiac
studies. Other radioisotopes (Indium-111, Iodine-123, Gallium-67, and
probably Iodine-131) will be available as usual. We will be forced to
ration the very limited amount of Tc-99m that we will have. We ask that
you not schedule any Tc-99m studies to be performed during the week of March 21,
and make your staff aware that Tc-99m may not be available at all.
·
There will be only limited generator
production for the week beginning March 27. Generator
production for the Americas
should resume on Friday, March 26. However, no more than 20% of needed Mo 99
supply is expected. We have been told that available generators will be
distributed as fairly as possible to maximize patient access globally. If
we in fact receive 20% of our standing order, we should be able to supply
Tc-99m for non-cardiac studies throughout the week. However, we will have
to severely ration Tc-99m for cardiac studies. Thallium-201 and other
radioisotopes will be available as usual. We again ask that you use
Tl-201 for cardiac studies, schedule as lightly as possible any Tc-99m studies,
and schedule any essential Tc-99m studies as early in the week as possible.
On a positive note, the outlook for April is
moderately improved over March. We expect to have an April update and a daily
view of March by the end of this month to share with you. As the situation evolves, we will
continue to keep you informed.
Please don't hesitate to call if you have any
questions.
Tim Quinton
812.421.1002 |
Chocolate Interaction with Red Blood Cell Labeling
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The following is an abstract reprinted from the most recent JNMT issue.
Red blood cells (RBC) labeled in vivo with 99mTc-pertechnetate are used  worldwide in nuclear medicine departments. Methods: Here, we present a case of 99mTc-RBC labeling failure associated with chocolate intake in a 25-y-old woman, resulting in uninterpretable images. Because of this clinical observation, we performed in vitro RBC labeling on blood samples from volunteers after they consumed chocolate. Results: Chocolate intake inhibited the labeling rate, compared with the control condition, and significantly increased the 99mTc free fraction (34.1% ± 11.3% vs. 14.0% ± 1.2%). Conclusion: We cannot explain how this interaction could occur, but cacao components are known to modulate red cell and plasma oxidoreductive status and to modify red cell membrane permeability and plasticity. Therefore, for patients who can be considered likely to consume chocolate, such as young patients, we recommend that they limit their consumption of chocolate for 12 h before RBC labeling.
Labeling of red blood cells (RBCs) with 99mTc is a simple andsensitive  method for evaluating total RBC mass, performing radionuclide ventriculography, and localizing gastrointestinal bleeding sites.Irreversible tracer trapping is achieved through 2 steps. Thefirst is the accumulation of stannous pyrophosphate inside RBCs;during the second step, technetium pertechnetate anion reachesthe internal compartment of the RBCs, is reduced by stannousion, and subsequently binds to hemoglobin (1,2). 99mTc labelingof RBCs is known to be influenced by some medicines such asdigoxin (3), by medicinal plants (4), and by the use of Teflon(DuPont) canulas (5,6). We report here the case of a 25-y-oldwoman referred for planar equilibrium radionuclide ventriculographybecause of suspected arrhythmogenic right ventricular dysplasiaand for whom images were not interpretable. Known potentialsources of image quality degradation were checked, and no explanationother than a strong chocolate intake was obvious. That observationled us to repeat the radionuclide ventriculography after thepatient had discontinued chocolate consumption and to studythe interference of chocolate intake on RBC labeling in vitro.
--SNM Abstract
(J Nucl Med Technol. 2009 Jun;37(2):107-10. Epub 2009 May 15.)
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ALPHARADIN PHASE III BEGINS
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Algeta ASA, the cancer therapeutics company, announces that the first clinical center in the US, the Tulane Cancer Center, New Orleans, has started randomizing patients in the phase III clinical study of Alpharadin® (Radium-223 for palliation of bone metastases) in men with castration-resistant (also known as hormone-refractory) prostate cancer (CRPC) that has metastasized to the skeleton.
Please see a video for further information on Alpharadin® and the ALSYMPCA study. Click to view video.
The ALSYMPCA (ALpharadin® in SYMptomatic Prostate CAncer) study is a double-blind, randomized, controlled trial that enrolls patients with CRPC and symptomatic bone metastases who will be randomized to receive Alpharadin® plus best standard of care or placebo plus best standard of care. Approximately 750 patients are expected to be enrolled at more than 125 medical centers worldwide. Algeta expects to enroll patients across up to 15 sites in the US. Global recruitment remains on schedule and is expected to be complete by the second half of 2010.
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ACC Sues Government
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Heart specialists recently filed suit against Secretary of Health and Human Services Kathleen Sebelius in an effort to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.
The lawsuit, filed in U.S. District Court for the Southern District of Florida, charges that the government's planned cutbacks will deal a major blow to medical care in the USA, forcing thousands of cardiologists to close their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.
"What they've done is basically killed the private practice of cardiology," says Jack Lewin, CEO of the American College of Cardiology (ACC), which represents 90% of the roughly 40,000 heart specialists in the USA.
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14C-Urea Breath Test
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 Radiopharmacy has been dispensing test kits for Helicobacter Pylori (H. Pylori) bacteria for several years. This is a simple test in which the patient takes a capsule containing 14C-urea and then blows up a series of two balloons ten and twenty minutes post capsule consumption. These balloons are then analyzed to see if they contain 14C. If the patient has H. Pylori present in their stomach, the urease enzyme, produced by the bacteria will break the 14C-urea bond and produce 14CO2 that is exhaled into the balloon.
Figure 1: Helicobacter pylori invading epithelial cells.
This simple test allows easy determination of the presence of H. Pylori in the patient's stomach. The test kit can be delivered with any Radiopharmacy delivery and retrieved with your normal pick up. Once we receive the breath samples they are analyzed within 24 hours. This allows you return of results within one business day of analysis. There are several confounding factors associated with this test. Below is the list of the current confounding factors associated with the 14C-urea breath test.
Antibiotics: The patient should be off of all antibiotics for one month prior to the breath test. The only exception to this is the Sulfa drugs.
Bismuth: The patient should be off all bismuth drugs for one month prior to the breath test.
Carafate® (Sucralfate) : The patient should be of Carafate® for one week before the breath test.
Proton Pump Inhibitors:
PrilosecTM (omeprazole
NexiumTM (esomeprazole magnesium)
PrevacidTM (lansoprazole)
AciphexTM (rabeprazole sodium)
ProtonixTM (pantoprazole sodium)
The patient should be off of these proton pump inhibitors for two weeks before the breath test.
Fasting: The patient should be fasting for 6 hours prior to the breath test
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Parathyroid Imaging
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Standard
nuclear scintigraphy of parathyroid cancer produces enough false
positives for patients with multigland disease to lead researchers to
recommend rapid intraoperative parathyroid hormone assay along with
preoperative technetium-99m sestamibi imaging to assure that all
lesions have been removed.
Tc-99m sestamibi planar and SPECT
are the imaging modalities of choice for surgery planning for primary
hyperparathyroidism. About 15% of cases involve multigland disease,
with the rest involving single-gland disease.
Figure 1: Parathyroid scintigraphy using 99m Tc-sestamibi (2 nd
hour after injection of radiotracer) showing 3 hearths of high uptake
in the level of the right superior and inferior lobe and the left upper
lobe.
While imaging
is not required before traditional open surgery to remove parathyroid
tumors, surgeons have come to rely on nuclear scintigraphy to identify
the location of parathyroid adenomas as they have adopted minimally
invasive excision, according to Dr. William G. Spies, a professor of
radiology at Northwestern University.
----Diagnostic.com
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Breast Specific Gamma Imaging
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In an issue of the American Journal of Surgery (2009;198:470-474),  Killelea et al. from the Beth Israel Medical Center (New York, NY) reported on a study using breast-specific gamma imaging to determine the incidence of additional, mammographically occult lesions in patients with newly diagnosed breast cancer. The results were recognized earlier this year with the George Peters Award at the annual meeting of the American Society of Breast Surgeons. The study included 82 patients who underwent breast-specific gamma imaging for newly diagnosed breast cancer. Of these, 18 patients were found to have additional abnormalities. Seventeen biopsies were performed with results indicating 4 invasive ductal carcinomas, 1 invasive lobular carcinoma, 1 ductal carcinoma in situ, 1 lobular carcinoma in situ, and 2 papillomas; 8 biopsy results were benign. Over all, breast-specific γ imaging findings resulted in a change in surgical management for 22% of patients in the study. The imaging technique detected additional cancer in 9% of patients. The authors concluded that ''breast-specific gamma imaging plays an important role in the clinical management of patients with known breast cancer.''
--American Journal of Surgery
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Free Continuing Education
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 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
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Reimbursement Update
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Effective January 1st there were revisions in the HCPCS code descriptors for several products. Here are the revised codes:
The code for Lexiscan (J2785) changed from .4 mg to read .1 mg of product. The descriptors for both Cardiolite (A9500) and Myoview (A9502) changed to simply read "per study dose" rather than "up to 40 mCi".
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For Sale....Slightly used, heavily discounted
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 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.
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Technologist Job Line
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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: Karen.foncannon@hotmail.com
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Radiopharmacy Services
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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.
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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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effort to keep the Monthly Scan relevant, useful and informative,
feedback on the contents of the newsletter is welcome. Readers desiring
to contribute articles, suggestions for future articles, bulletins,
website postings, and other items of interest to the Monthly Scan
readership, should contact a pharmacist at Radiopharmacy, Inc. Sincerely,
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