News from Radiopharmacy, Inc.

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

Current Information on Alpharadin

Alpharadin is a solution of radium-223 chloride (223RaCl2) currently under development for the treatment of cancer patients with bone metastases. It is being produced by Algeta, who has partnered with Bayer Schering Pharma AG.

Radium-223 is a radioisotope that undergoes alpha decay with a half-life of 11.43 days. It emits an α-particle with an energy of 5.8 MeV and weak (<10%) γ emissions of 154 keV. It has a specific activity of 51,216 Ci/g (1,895 TBq/g).

In vivo, radium mimics the behavior of calcium and therefore accumulates in areas of high bone turnover in and around bone metastases. As it deposits in bone, radium emits α-particles that are densely ionizing over a length of two to ten cell diameters. The α-particles cause double-stranded DNA breaks that frequently result in cell death.

Alpharadin recently completed a Phase III trial, designated the ALSYMPCA trial (ALpharadin in SYMptomatic Prostate CAncer patients). It was an international (138 centers in 19 countries), double-blind, randomized (2 Alpharadin:1 placebo), placebo-controlled phase III clinical trial comparing Alpharadin plus best standard of care versus placebo plus best standard of care in patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases. The study contained 922 patients who were docetaxel ineligible or intolerable, or had failed previous docetaxel therapy. Inclusion and exclusion criteria were as follows:

Inclusion Criteria

· Histologically or cytologically confirmed adenocarcinoma of the prostate

· Known hormone refractory disease

· Multiple skeletal metastases (> 2 hot spots) on bone scintigraphy

· No intention to use cytotoxic chemotherapy within the next 6 months

· Either regular (not occasional) analgesic medication use for cancer related bone pain or treatment with external beam radiation therapy (EBRT) for bone pain within the previous 12 weeks

Exclusion Criteria

· Treatment with an investigational drug within the previous 4 weeks, or planned during the treatment period

· Treatment with cytotoxic chemotherapy within the previous 4 weeks, or planned during the treatment period, or failure to recover from adverse events due to cytotoxic chemotherapy administered more than 4 weeks ago

· Systemic radiotherapy with strontium-89, samarium-153, rhenium-186 or rhenium-188 for the treatment of bony metastases within previous 24 weeks

· Other malignancy treated within the last 5 years (except non-melanoma skin cancer or low-grade superficial bladder cancer)

· History of visceral metastasis, or visceral metastases as assessed by abdominal/pelvic CT or chest x-ray within previous 8 weeks

The patients were given either six intravenous administrations of Alpharadin

(1.35 μCi/kg [50 kBq/kg]) or placebo with each administration separated by a period of four weeks. The primary endpoint of the study was overall survival, with secondary endpoints of time to occurrence of skeletal-related events (SREs), changes and time to progression in prostate-specific antigen (PSA) and alkaline phosphatase (ALP), safety, and impact on quality of life measures. The primary endpoint of the study was met, as patients given Alpharadin had an overall survival improvement of 44% (p=0.00185, HR=0.695). The trial data showed the following outcomes:

· A median overall survival of 14 months compared to 11.2 months for the placebo group

· Median time to first SREs of 13.6 vs. 8.4 months (64% improvement, HR=0.610, p=0.00046)

· Total alkaline phosphatase (ALP) normalization in 33% of patients taking Alpharadin vs. 1% of patients on placebo (p<0.001)

· A 49% improvement in time to PSA progression (HR=0.671, p=0.00015)

· Total ALP response (30% reduction from base line) seen in 43% of patients treated with Alpharadin versus 3% in the placebo group p<0.0001).

The most common adverse events were nausea (34% for Alpharadin, 32% for placebo), diarrhea (22% vs. 13%), constipation (18% vs. 18%), and vomiting (17% vs. 13%). Alpharadin had a 2% incidence of grade 3 or 4 neutropenia, compared with 1% for placebo. Bone pain was more frequent with placebo (58%) than with Alpharadin (43%). The trial was halted early following a pre-planned interim analysis to offer patients on the placebo arm treatment with Alpharadin.

Alpharadin was granted Fast Track status by the FDA, with plans to file Alpharadin with the FDA in mid-2012. Algeta is currently in Phase II trials testing Alpharadin for the treatment of skeletal metastases from breast cancer.

Product Pipeline	Indication	Development Phase
		Research	Preclinical	Clinical Development			Registration
				Phase I	Phase II	Phase III
Alpharadin	Skeletal metastases from prostate cancer
Alpharadin	Skeletal metastases from breast cancer
Alpharadin	Skeletal metastases from prostate cancer-Taxotere combo

References

1. Brucer M. Trilinear Chart of the Nuclides. St. Louis, MO: Mallinckrodt; 1979.

2. Radium 223. Wolfram Alpha. 2011. Available at: http://www.wolframalpha.com/entities/isotopes/radium_223/0m/6n/vo/. Accessed October 3, 2011.

3. Hooper S. Radium-223 Calibration. Nation Physical Laboratory. 2007. Available at: http://www.npl.co.uk/upload/pdf/20070131_rcuf_hooper_1.pdf. Accessed October 3, 2011.

Alpharadin Significantly Improves Overall Survival for Patients with Castration-Resistant Prostate Cancer and Symptomatic Bone Metastases. Algeta. 2011. Available at: http://www.algeta.com/xml_press.asp?m=34572&s=34686. Accessed October 3, 2011.

Positive Phase III Data on Bayer's Investigational Drug Alpharadin Show Significant Increase in Overall Survival. Bayer. 2011. Available at: http://www.bayer.com/en/news-detail.aspx?newsid=15028.

FDA and Mobile App Oversight

On July 19 the U.S. Food and Drug Administration (FDA) announced it is seeking input on its proposed oversight approach for certain mobile applications (apps) specific to medicine or health care and designed for use on smartphones and other mobile computing devices. This approach encourages the development of new apps, focuses only on a select group of applications, and will not regulate the sale or general consumer use of smartphones or tablets. "The use of mobile medical apps on smart phones and tablets is revolutionizing health care delivery," said Jeffrey Shuren, MD, JD, director of the FDA Center for Devices and Radiological Health. "Our draft approach calls for oversight of only those mobile medical apps that present the greatest risk to patients when they don't work as intended." The agency's draft guidance defines a small subset of mobile medical apps that affect or may affect the performance or functionality of currently regulated medical devices. This subset includes mobile medical apps that: (1) Are used as an accessory to a medical device or devices already regulated by the FDA (e.g., an application that allows a health care professional to make a specific diagnosis by viewing a medical image from a picture archiving and communication system on a smartphone or a mobile tablet); or (2) Transform a mobile communications device into a regulated medical device by using attachments, sensors, or other devices (e.g., an application that turns a smartphone into an ECG machine to detect abnormal heart rhythms or determine whether a patient is experiencing a myocardial infarction).

--U.S. Food and Drug Administration

Accelarad Releases Imaging iPhone App

Accelarad said this week it released a free iPhone and iPad app for its SeeMyRadiology.com cloud-based medical image-sharing service. The app, now available in the Apple Store, lets physicians signed up with SeeMyRadiology share radiologic images and reports through the service.

SeeMyRadiology.com, run by Atlanta-based Accelarad, stores imaging data on the "cloud," that is, off-site servers, which doctors and patients can access through the company's website. Go to site by clicking on image.

Accreditation Update

24/7 access...FREE of charge...Learn at your leisure from trained accreditation specialists. The ICANL has created a series of webcasts entitled Accreditation On Demand. Now you can learn about accreditation at your leisure, 24 hours a day/7 days a week, for free. Accreditation On Demand is simple and easy to use; just choose the topic you wish to learn more about, sit back and listen.

Topics Include:

ABOUT THE ACCREDITATION PROCESS:

On Demand | ICANL Reaccreditation: It's As Easy As 1-2-3 [NEW!] Related Documents | ICANL Accreditation Checklist | ICANL Review Form - Nuclear Cardiology | Radiopharmaceutical Administration Policy (SAMPLE)

On Demand | Overview of the 2010 ICANL Standards

On Demand | Introduction to ICANL Accreditation

On Demand | Medical and Technical Staff Requirements for Accreditation

On Demand | Clinical Protocols: Do Your Protocols Meet the Minimum Requirements?

On Demand | ICANL Case Studies: Documenting Your Proof of Quality

On Demand | Cardiac Image Interpretation and Reporting

On Demand | Preparing Your Lab for an ICANL Site Visit or Audit

On Demand | Quality Assurance: Documenting Your Lab's Quality

ONLINE APPLICATIONS:

IAC On Demand | Online Accreditation: Taking the First Steps to Create or Access an Account [NEW!]

OTHER RELATED TOPICS:

On Demand | IAC and ASNC Webinar: Facility Accreditation - Learn From The Experts [NEW!]

On Demand | IAC and SNM Accreditation Webinar: What Practices Need to Know to Comply with CMS Rules [NEW!]

Intersocietal Accreditation Commission

Live Webinars

Call Radiopharmacy Inc. for Accreditation Assistance

Newly Approved Guidelines for Radiopharmaceutical Doses for Children

Washington, DC - The Society of Nuclear Medicine (SNM) and the Society for Pediatric Radiology's Board of Directors recently approved new North American Guidelines for Radiopharmaceutical Doses for Children. These societies have expanded their pediatric radiation protection initiative by standardizing doses (based on body weight) for 11 nuclear medicine procedures commonly performed in children. The Alliance for Radiation Safety in Pediatric Imaging has collaborated in this effort, and will support efforts to promote the new, lower radiopharmaceutical doses.

Radiopharmaceutical	Recommended Administered Activiy (based on weight only)	Minimum Activity	Maximum Activity	Comments
¹²³I-MIBG	0.14 mCi/kg	1.0 mCi	10 mCi	The EANM Dosage Card 2007 version¹ administered activity may be used in patients over 10 kg.
^99mTc-MDP	0.25 mCi/kg	1.0 mCi		The EANM Dosage Card 2007 version¹ administered activity may also be used.
¹⁸F-FDG	Body: 0.10-0.14 mCi/kgBrain: 0.10 mCi/kg	1.0 mCi		The low end of the dose range should be considered for smaller patients. Administered activity may take into account patient mass and time available on the PET scanner. The EANM Dosage Card 2007 version¹ administered activity may also be used.
^99mTc-DMSA	0.05 mCi/kg	0.5 mCi
^99mTc-MAG3	Without flow study: 0.10 mCi/kg	1.0 mCi	4 mCi	The administered activities at left assume that image data are reframed at 1min/image. The administered activity may be reduced if image data are reframed at a longer time per image. The EANM Dosage Card 2007 version¹ administered activity may also be used.
	With flow study 0.15 mCi/kg	0.5 mCi
^99mTc-IDA	0.05 mCi/kg			The EANM Dosage Card 2007 version¹ administered activity may also be used.
^99mTc-MAA	If Tc-99m used for ventilation 0.07 mCi/kg			The EANM Dosage Card 2007 version¹ administered activity may also be used.
	No Tc-99m ventilation study: 0.03 mCi/kg	0.4 mCi		The EANM Dosage Card 2007 version¹ administered activity may also be used.
^99mTc-pertechnetate (Meckel's diverticulum imaging)	0.05 mCi/kg	0.25 mCi		The EANM Dosage Card 2007 version¹ administered activity may also be used.
^99mTc (for cystography)	No weight-based dose		No more than 1.0 mCi for each bladder filling cycle	^99mTc-sulfur colloid, 99mTc-pertechnetate, ^99mTc-DTPA or possibly other ^99mTc radiopharmaceuticals may be used. There is a wide variety of acceptable administration techniques
^99mTc-Sulfur colloid (for oral liquid gastric emptying)	No weight-based dose	0.25 mCi	1.0 mCi	The administered activity will depend on the age of the child, the volume to be fed to the child and time per frame used for imaging.
^99mTc-sulfur colloid (for solid is usually used to label egg.)	No weight-based dose	0.25 mCi	0.5 mCi	^99mTc-sulfur colloid is usually used to label egg.

This information is intended as a guideline only. Local practice may vary depending on patient population, choice of collimater, and the specific requirements of clinical protocols. Administered activity may be adjusted when appropriate by order of the nuclear medicine practitioner.

For patients who weigh more than 70 kg, it is recommended that the maximum administered activity not exceed the product of the patient's weight (dg) and the recommended weight-based administered activity. Some practitioners may choose to set a fixed maximum administered activity equal to 70 times the recommended weight-based administered activity, for example, approximately 370 MBq (10 mCi) for 18F body imaging. The administered activities assume use of a low energy high resolution collimater for 99mTc radiopharmaceuticals and a medium energy collimater for I123-MIBG.

Individual practitioners may use lower administered activities if their equipment or software permit them to do so. High administered activities may be required in selected patients.

No recommended dose is given for 67Ga-citrate should be used very infrequently and only in low doses.

1Lassman M. Chiesa C, Flux G, Bardies M. The new EANM pediatric dosage card. Eur J Nucl Med Mol Imaging. 2007; 34:796-8. Additional notes and erratum found in Eur J Nucl Med Mol Imaging. 2008; 35:1666-8 and Eur J Nucl Med Mol Imaging 2008; 35:2141.
Image Gently 2

Radiopharmaceutical Adverse Reactions

Radiopharmaceutical	Side Effects, Comments & Other Reactions
⁵¹Cr-sodium chromate	erythema, flushing, hypertension, tachycardia and diaphoresis.
¹⁸F-fludeoxyglucose, FDG	None.
⁶⁷Ga-gallium citrate	nausea, vomiting, erythema, flushing, diffuse rash, pruritus, hives/urticaria, respiratory reaction, tachycardia, syncope or faintness, dizziness, vertigo, facial swelling, metallic taste, dyspnea, salty taste.
¹¹¹In-capromab pendetide	increase in bilirubin, hypotension, hypertension, injection site reactions, elevated liver enzymes (could be due to tumor), pruritus, fever, rash, headache, myalgia, asthenia, burning sensation in thigh, shortness of breath, alterations of taste, production of HAMA by the recipient.
¹¹¹In-indium Oxine	fever, diffuse rash, pruritus and hives/urticaria.
¹¹¹In-pentetate DTPA	fever, nausea, vomiting, erythema, flushing, pruritus, hives/urticaria, cardiac arrest, hypertension, headache, aseptic meningitis; one death 20 min postinjection.
¹¹¹In-pentetreotide	fever, nausea, erythema, flushing, hypotension, bradycardia, dizziness, vertigo, headache, diaphoresis, arthralgia and asthenia, one case of anemia.
¹²³I-sodium iodide	nausea, vomiting, diffuse rash, pruritus, hives/urticaria, chest pain, tightness or heaviness, respiratory reaction, tachycardia, syncope or faintness and headache, tachypnea; parosmia.
¹³¹I-sodium iodide	chills, nausea, vomiting, pruritus, hives/urticaria, chest pain, tightness or heaviness, tachycardia, headache, dizziness.
¹⁵³Sm-lexidronam	myelosuppression, bone pain from the flare phenomenon.
⁸⁹Sr-strontium chloride	chills, fever, myelosuppression, bone pain from the flare phenomenon.
^99mTc-exametazime (Ceretec)	fever, erythema, flushing, diffuse rash, hypertension, hypotension, respiratory reaction, seizures, diaphoresis, cyanosis, anaphylaxis, facial swelling, abdominal pain, dyspnea with myoclonus (labeled WBC).
^99mTc-macroaggregated albumin (MAA)	chills, nausea, erythema, flushing, diffuse rash, pruritus, hives/urticaria, cardiac arrest, chest pain, tightness or heaviness, hypertension, hypotension, respiratory reaction, tachycardia, syncope or faintness, diaphoresis, cyanosis, anaphylaxis, metallic taste, dyspnea; throat tightness; arm numbness; parosmia.
^99mTc-mebrofenin	hives/urticaria.
^99mTc-medronate (MDP)	chills, fever, nausea, vomiting, erythema, flushing, diffuse rash, pruritus, hives/urticaria, cardiac arrest, chest pain, tightness or heaviness, hypertension, hypotension, respiratory reaction, tachycardia, seizures, syncope or faintness, dizziness, vertigo, headache, diaphoresis, anaphylaxis, abdominal pain, metallic taste, asthenia, pain/burning at inj. site, photophobia, one death secondary to cardiac arrhythmia.
^99mTc-mertiatide (MAG3)	nausea, vomiting, erythema, flushing, syncope or faintness, sore, thick throat.
^99mTc-oxidronate (HDP)	nausea, vomiting, erythema, flushing, diffuse rash, pruritus, chest pain, tightness or heaviness, heartburn, seizures, diaphoresis, facial swelling.
^99mTc-pentetate (DTPA)	chills, nausea, erythema, flushing, diffuse rash, pruritus, hives/urticaria, hypertension, hypotension, respiratory reaction, tachycardia, syncope or faintness, headache, cyanosis, anaphylaxis, arthralgia, pain, burning at inj. site, cough; wheezing; trisodium salt can cause neurologic signs if given inthrathecally.
^99mTc-sestamibi	nausea, erythema, flushing, diffuse rash, pruritus, seizures, headache, metallic taste, tingling.
^99mTc-sodium pertechnetate	chills, nausea, vomiting, diffuse rash, pruritus, hives/urticaria, chest pain, tightness or heaviness, hypertension, dizziness, vertigo, headache, diaphoresis, anaphylaxis.
^99mTc-sulfur colloid	chills, fever, nausea, vomiting, erythema, flushing, diffuse rash, pruritus, hives/urticaria, cardiac arrest, chest pain, tightness or heaviness, hypertension, hypotension, respiratory reaction, tachycardia, bradycardia, seizures, syncope or faintness, dizziness, vertigo, headache, diaphoresis, cyanosis, anaphylaxis, arthralgia, pain/burning at inj. site, wheezing, dyspnea, choking; sneezing, itchy throat, parasthesia, weakness.
^99mTc-tetrofosmin	angina, hypertension, Torsades de Pointes (these three probably occurred because of underlying heart disease); vomiting, abdominal discomfort, cutaneous allergy, hypotension, dyspnea,metallic taste, burning of mouth, unusual odor, mild leukocytosis.
²⁰¹Tl-thallous chloride	fever, erythema, flushing, diffuse rash, pruritus, hypotension.

Methylxanthines and Pharmacologic Stress Testing

WHAT ARE METHYLXANTHINES?

Xanthine-based compounds have known stimulant and bronchodilator effects, and have been used as treatment for respiratory diseases such as asthma. Methylated derivatives of xanthine, or methylxanthines, include caffeine, theophylline, and theobromine, and they are present in various foods, drinks, and medications (Table 1).1
Common Sources of Methylxanthines

Chocolate and cocoa products Coffee and tea Sodas, including those labeled "caffeine free" Diet supplements, including bards, energy drinks, and products containing guarana Over-the-counter medications (Anacin®, Excedrin®, Vivarin®), prescription medications
Caffeine	Theophylline
Cafergot®	Aerolate®	Theo-24®
Esgic®	Constant-T®	Theoclear®
Fioricet®	Elixophylline®	Theo-Dur®
Fiorinal®	Quibron®	Theolair®
Norgesic®	Resbid®	Theo-Qrganidine®
Norgesic®-Forte	Slo-bid®	Theo-Sav®
Synalgos®-DC	Slo-Phyllin®	Theostat®
Wigraine®	T-Phyl®	Theo-X™
	Tedral® SA

COMPETITIVE ANTAGONISM OF ADENOSINE RECEPTORS

Methlyxanthines are structurally similar to adenosine and are able to bind adenosine receptors, but not activate them (Figure 1).1,2 Thus, methlyxanthines act as competitive antagonists of the adenosine receptors: they physically bind to the adenosine receptors and either block or displace endogenous adenosine.2

The physiological effects of adenosine are mediated by 4 types of receptors located in various tissues throughout the body.3 The A1 and A2 adenosine receptors mediate the known cardiovascular effects of adenosine, and activation of the A2A receptor stimulates coronary vasodilation.3,4 The vasodilatory pharmacologic stress agents, dipyridamole, adenosine, and regadenoson, either directly or indirectly activate the A2A receptors in the coronary arteries to induce hyperemia.5-7 By binding to and interfering with the activation of A2A adenosine receptors in the coronary arteries, methlyxanthines attenuate the effect of vasodilatory stress agents on coronary blood flow.

Several studies have demonstrated the blunting effect of caffeine and theophylline on dipyridamole- and adenosine-induced blood flow.8-10 Aminophylline is a mixture of the methylxanthine theophylline and the compound ethylenediamine, and is used clinically to reverse the effects of vasodilatory stress agents.5-7

CLINICAL IMPLICATIONS

Exercise and pharmacologic stress agents produce heterogeneous blood flow in the coronary arteries necessary for identifying areas of reduced perfusion due to flow-limiting stenoses.2 Blockade of the A2A adenosine receptors and reduction of the hyperemic response to vasodilatory pharmacologic stress by methylxanthines can impact the accuracy of stress testing.2,12 Several studies have demonstrated masking of reversible perfusion defects in patients exposed to either caffeine or theophylline prior to dipyridamole stress imaging.13-15

A recent study by Zoghbi et al reported that a single cup of coffee given 1 hour prior to adenosine single-emission photon computed tomography (SPECT) myocardial perfusion imaging (MPI) had no effect on the presence or severity of perfusion defects.16 Similarly, Gaemperli et al recently described a minimal effect of caffeine (220 mg) given 2 hours prior to regadenoson dosing on myocardial blood flow.17

PRACTICAL ISSUES

Because caffeine and other methylxanthines attenuate the effects of vasodilator stress agents on heart rate,18,19 the lack of an increase in heart rate after stress administration is an indicator of pretest exposure to methylxanthines and may prompt test termination and rescheduling.8,20

Prior to vasodilator stress administration, it can be difficult to determine whether suspected methylxanthine exposure warrants rescheduling. Pretest screening relies on accurate reporting by the patient, and the methylxanthine content in food, drink, and medications vary widely.2,12 For example, a single cup of coffee may contain between 20 mg and 175 mg of caffeine.12 Furthermore, interindividual variability in methylxanthine metabolism and clearance can mean that 2 patients who ingested the same amount of caffeine may have different blood levels of caffeine at the time of the test. Patients with liver disease21 or those taking certain medications, such as oral contraceptives,22,23 may have slower clearance of caffeine, and thus may have higher blood levels of caffeine. These variables have also made it difficult to define the smallest level of methylxanthine exposure that leads to false negative stress test results. Recommendations for withholding caffeine and other methylxanthines prior to a vasodilator stress test are estimates based on clinical experience and a few studies correlating methylxanthine blood levels and changes in blood flow, heart rate, and perfusion defects.8,10,20, 24,25

PRETEST PATIENT PREPARATION

Thorough patient preparation on the possible sources of methylxanthines and the importance of abstaining from these compounds prior to a scheduled stress test can help avoid terminated or rescheduled tests. It may be worthwhile to counsel patients who are scheduled for an exercise stress test to abstain from caffeine and other methylxanthine-containing products, in the event that they are unable to complete the exercise test and need to undergo pharmacologic stress testing.

The American Society of Nuclear Cardiology (ASNC), the American College of Cardiology (ACC), and the American Heart Association (AHA) provide general recommendations regarding withholding caffeine and other methylxanthines prior to undergoing a vasodilator stress test (Table 2).5-7,11,26

	Package Insert	ASNC¹¹	ACC/AHA/ASNC²⁶
Dipyridamole	None⁵	Aminophylline, caffeine, theobromine: 12 hours	Caffeine and other methylxanthines: 24 hours
Adenosine	None⁶	Aminophylline, caffeine, theobromine: 12 hours	Caffeine and other methylxanthines: 24 hours
Regadenoson	Methylxanthines, theophylline: 12 hours⁷	Aminophylline: 24 hours Caffeine and theophylline 12 hours

Table 2. Recommended Withholding of Methylxanthines Prior to Vasodilator Pharmacologic Stress Testing

CONCLUSIONS

Methlyxanthines such as caffeine and theophylline are competitive antagonists of the adenosine receptors, and interfere with vasodilatory stress agents that act through these receptors. Pretest exposure to caffeine and theophylline can attenuate the effect of vasodilatory pharmacologic stress on coronary blood flow and heart rate, and can lead to false negative stress tests. Helping patients recognize and avoid foods and medications that contain methylxanthines prior to undergoing stress testing can reduce the number of terminated and rescheduled tests.

References 1. Boushey, HA. In: Katzung BG, ed. Basic and Clinical Pharmacology. 10th Ed. Columbus, OH: McGraw-Hill Companies, Inc; 2007. 2. Kovacs D, Pivonka R, Khosla PG, Khosla S. Am J Ther. 2008;15:431-434. 3. Jacobson MA. In: Belardinelli L, Pelleg A, eds. Adenosine and Adenine Nucleotides: From Molecular Biology to Integrative Physiology. Norwell, MA: Kluwer Academic Publishers; 1995:5-13. 4. Belardinelli L, Shryock JC, Snowdy S, et al. J Pharmacol Exp Ther. 1998;284:1066-1073. 5. Dipyridamole injection USP [package insert]. Bedford, OH: Bedford Laboratories. 6. Adenoscan (adenosine injection) [package insert]. Deerfield, IL: Astellas Pharma US, Inc. 7. Lexiscan (regadenoson) injection [package insert]. Deerfield, IL: Astellas Pharma US, Inc. 8. Böttcher M, Czernin J, Sun KT, Phelps ME, Schelbert HR. J Nucl Med. 1995;36:2016-2021. 9. Kubo S, Tadamura E, Toyoda H, et al. J Nucl Med. 2004;45:730-738. 10. Smits P, Lenders JW, Thien T. Clin Pharmacol Ther. 1990;48:410-418. 11. Henzlova MJ, Cerqueira MD, Hansen CL, Taillefer R, Yao S-S. In: DePuey EG, ed. American Society of Nuclear Cardiology imaging guidelines for nuclear cardiology procedures. http://www.asnc.org/imageuploads/Imaging GuidelinesStressProtocols021109.pdf. Accessed April 9, 2009. 12. Lapeyre AC 3rd, Goraya TY, Johnston DL, Gibbons RJ. J Nucl Cardiol. 2004;11:506-511. 13. Daley PJ, Mahn TH, Zielonka JS, Krubsack AJ, Akhtar R, Bamrah VS. Am Heart J. 1988;115:1185-1192. 14. Smits P, Corstens FH, Aengevaeren WR, Wackers FJ, Thien T. J Nucl Med. 1991;32:1538-1541. 15. Smits P, Aengevaeren WR, Corstens FH, Thien T. J Nucl Med. 1989;30:1723-1726. 16. Zoghbi GJ, Htay T, Aqel R, Blackmon L, Heo J, Iskandrian AE. J Am Coll Cardiol. 2006;47:2296-2302. 17. Gaemperli O, Schepis T, Koepfli P, et al. J Am Coll Cardiol. 2008;51:328-329. 18. Smits P, Straatman C, Pijpers E, Thien T. Clin Pharmacol Ther. 1991;50:529-537. 19. Smits P, Schouten J, Thien T. Clin Pharmacol Ther. 1989;45:593-599. 20. Zheng XM, Williams RC. J Nucl Med Technol. 2002;30:123-127. 21. Scott NR, Stambuk D, Chakraborty J, Marks V, Morgan MY. Br J Clin Pharmacol. 1989;27:205-213. 22. Patwardhan RV, Desmond PV, Johnson RF, Schenker S. J Lab Clin Med. 1980;95:603-608. 23. Roberts RK, Grice J, McGuffie C, Heilbronn L. J Lab Clin Med. 1983;101:821-825. 24. Majd-Ardekani J, Clowes P, Menash-Bonsu V, Nunan TO. Nucl Med Commun. 2000;21:361-364. 25. Jacobson AF, Cerqueira MD, Raisys V, Shattuc S. Eur J Nucl Med. 1994;21:23-26. 26. Klocke FJ, Baird MG, Lorell BH, et al. Circulation. 2003;108:1404-1418.

New Education Online Resources

The American Society of Nuclear Cardiology is pleased to announce a

new online education resource,

Conference Highlights Meetings on Demand

, a digital library of audio and slide presentations captured during ASNC2010, September 23 - 26, 2010 in Philadelphia.

Chaired by Brian G. Abbott, MD, FASNC, this online product features 10 sessions, 23 lectures, and more than 10 hours of audio recordings. Nuclear cardiology and cardiac imaging professionals will obtain the latest information in clinical practice as well as review cutting-edge scientific advances in the field. Sessions include Nuclear Cardiology in an Emerging CT World - Have the Clinical Paradigms Changed?, Basics of Interpretation and Reporting - A Case-Based Presentation, and Radiation Risk from Cardiac CT and Nuclear Cardiology - Addressing Concerns with Innovative Solutions. To view the complete program content, please click here.

Both CME and ACE credits are available for Conference Highlights Meetings on Demand - order your online copy today!

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

CE Opportunity

Radiation Safety and Health Effects

Tuesday, November 29th

Presentation at 6:00 p.m.

Location: Maloney's Roca Bar
                          3030 Highland Pointe Drive
           Owensboro, KY
            (270) 684-8080

Please RSVP by Monday, November 28th by calling Radiopharmacy, Inc. at (812) 421-1002. You may also fax your reservation at (812) 421 -1004.

Approved for 1 hour technologist CE credit.

Sponsored By:

Covidien &

Upcoming Webinars

December 8, 2011: FDG PET - Standardized Protocol/IND Status Speaker: Jeffrey Yap, PhD (to be confirmed)

Go to SNM Webinar page

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

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.

Full time postion:

DHS: Nuclear Medicine Technologist
Part-time prn for Southern Illinois
Contact: Bill Gooch @ 800 322-6341

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.

Products and Services

Radiopharmaceuticals - Diagnostic and therapeutic
Radioactive Sealed Sources
Brachytherapy Sources (I-125 and Pd-103)
Lab Testing
Nuclear Medicine Department Computer Software,
Reimbursement Assistance
Continuing Education
Health Physics Consulting
ICANL and ACR Accreditation Assistance
Professional Consultation regarding radiopharmaceuticals and their clinical use.

NOTE TO READERS: In an 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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