THE RADIOPHARMACY QUARTERLY
Volume XVI Issue VIIFebruary 2012
In This Issue
2012 Concerns for Nuclear Medicine
FDA Update on Ongoing CardioGen-82 Investigations
Zevalin Scanning Requirement Changed
JNM & JNMT New Mobile Interface
Coding Q & A
Reimbursement Update
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Previous Issues 

 


Free Continuing Education
 
(see article to below)
 

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



 

2012 Concerns for Nuclear Medicine  

Moly Supply Update

The nuclear medicine community learned many lessons from the shortage of molybdenum-99 (Mo-99), the mother radioisotope of technetium-99m (Tc-99m), during the past shutdowns of the Canadian National Research Universal (NRU) reactor in Chalk River, Ontario, and High Flux Reactor (HFR) in Petten, the Netherlands. Both reactors are back online, but are nearing the end of their lifecycles. How is nuclear medicine positioned for the future?

     Each day more than 50,000 patients in the U.S. undergo diagnostic and therapeutic procedures using medical isotopes, and eight out of every 10 of these procedures require Tc-99m, which also is used in 80 percent of imaging scans performed in Europe. The molecular imaging community survived the Mo-99 shortage through various strategies, but it needs to continue to employ these survival strategies and develop new ones as the supply is likely to remain precarious as the Canadian and Dutch reactors are de-commissioned.

     An Ongoing Challenge

   "I think it is clear that NRU will close almost certainly in 2016 and there is a risk of the Petten reactor closing soon after that ... We are not clear where the capacity is ultimately going to come from," says Alexander J. McEwan, MD, professor and division director, division of oncologic imaging, department of oncology at University of Alberta, Edmonton, Canada. The ultimate solution hinges on a combination of initiatives working in tandem.

     On the international front:

  •  The Canadian government has put forward a $35 million grant for alternative non-reactor-based methods of Tc-99m production; proposal results are expected in late fall;
  •  The Nuclear Research and Consultancy Group of the Netherlands is planning to build a replacement reactor, Pallas, to replace the HFR; and
  •  The French Alternative Energies and Atomic Energy Commission, Belgium's Institute for Radioelements, and Ion Beam Applications, three major distributors of radioisotopes in Europe, recently partnered to secure the supply of Tc-99m beyond 2015.

     However, reactors throughout the world cannot guarantee Mo-99 supply in the U.S. When the volcano in Iceland erupted in April, the shipment from Europe was stopped. Even though there are additional capacities in the Polish and Czech reactors as well as the existing capability in Belgium and in France, having that shipping lane shut down because of the volcanic eruption again put the supply in a very precarious position relative to being able to do nuclear medicine in the U.S.

     Within the US there are presently at least three initiatives that are slowly moving forward but would benefit immensely from better funding and particularly from Representative Edward Markey's (D-Mass.) American Isotope production bill. The three possibilities are the University of Missouri reactor, the GE/Hitachi collaboration and the Babcock & Wilcox/Covidien collaboration. The isotope bill would authorize the appropriation of $163 million to support initiatives to produce Mo-99, which could significantly reduce the time to complete the proposed projects. It is currently held up in the Senate by Senator Christopher S. Bond, (R-Mo.).

     Currently the Mo99 supply

The current crisis is mitigated but can certainly flare up at any time. As policymakers around the globe strive to develop proactive plans, imaging facilities also require backup plans should the shortage re-emerge. In the future, lessons learned from the Moly crisis of 2010 could avert a repeat of the crisis. Specifically, the combination of international cooperation and strategic conservation could establish a more secure supply of Tc-99m.

   reimbursement  Reimbursement

SGR Band-Aid clears House, yields a mixed bag for imaging

The U.S. House of Representative passed the Middle Class Tax Relief & Job Creation Act (H.R. 3630) Dec. 13. Among other things, H.R. 3630 prevents an across the board 27 percent cut to Medicare physician reimbursement statutorily required by the Sustainable Growth Rate (SGR) formula. The bill provides physicians with a 1 percent increase in Medicare payments for 2012 and 2013.

     Although more than $1.3 billion in imaging cuts had been considered at various times throughout the process, H.R. 3630 contains no medical imaging cuts.

     However, H.R. 3630 does not include language from H.R. 3269, the Diagnostic Imaging Services Access Protection Act. H.R. 3269 would block implementation of a 25 percent multiple procedure payment reduction to the professional component payment for MRI, CT and ultrasound exams.

     H.R. 3269 has 127 co-sponsors in the House. The American College of Radiology has affirmed its commitment to the bill and will continue to press Senators to include language from H.R. 3269 in any SGR legislation considered in the U.S. Senate.

     The bill also seeks to amend provisions of the Patient Protecition and Affordable Care Act that restricts physician-owned hospitals. Included in the bill is a narrow provision that will allow hospitals under construction that missed an arbitrary deadline, and those that need to expand to meet community demand, to serve Medicare and Medicaid patients.

 

Congress Agrees to Short Term SGR Fix  

Congressional leaders have announced that they have accepted a two-month fix to the sustainable growth rate (SGR) formula used to calculate Medicare physician payments.  Without this legislation, physicians would have faced a 27 percent drop in Medicare reimbursement payments.
     Congress passed the two-month Medicare physician payment patch as part of a larger tax bill that also extends other provisions for two months, including a federal payroll tax holiday and unemployment compensation.
     When Congress returns in January, both the House and the Senate will appoint conferees to discuss a longer-term extension of the SGR formula as well as other issues.

 

     Accreditation Deadline

On November 2, Rep. James Renacci (R-OH) introduced HR 3328, which would provide a six-month grace period for Medicare imaging service suppliers to receive accreditation through an approved accrediting organization. The Medicare Improvements for Patients and Providers Act (MIPPA), which goes into effect on January 2, 2012, requires all suppliers billing under the Physician Fee Schedule for advance diagnostic imaging (CT, MR, Nuclear, and PET) to be fully accredited in order to be reimbursed by CMS.

     However, new facilities are unable to apply for accreditation until they have performed studies. The accreditation process then takes a minimum of 90 days. As a result, any new facility would not be reimbursed through Medicare for a minimum of four to six months. In response, Rep. Renacci's bill would establish a six months grace period where new facilities would be paid while undergoing the accreditation process.  

FDA Update on Ongoing CardioGen-82 Investigations

fdaOn January 12, 2012, The U.S. Food and Drug Administration (FDA) updated the public and healthcare professionals about preliminary findings from the ongoing investigations following Bracco Diagnostics, Inc. voluntary recall of CardioGen-82 on July, 25, 2011.

     Multiple investigations from preliminary information, suggests that improper usage of CardioGen-82 at certain clinical sites is responsible for the exposure of patients to more radiation than is normally associated with a CardioGen-82 scan. The increased radiation exposure was due to the administration of CardioGen-82 generator eluates that contained excessive concentrations of strontium-82(SSR-82) and strontium-85(Sr-85), also known as "Strontium breakthrough." The FDA announced that it is very unlikely that this caused major risks to patients.

     Bracco Diagnostics, Inc. are conducting studies at clinical sites to evaluate and assess the amount to which patients have been exposed to excessive radiation. Out of 375 patients surveyed at 43 clinical sites, 54 patients were found to have abnormal screening test results. All 54 patients are from two clinical sites, which appear to have insufficient documentation of compliance with CardioGen-82 labeling recommendations for strontium breakthrough testing.

Zevalin Scanning Requirement Changed

Spectrum Pharmaceuticals Inc. (Irvine, CA) announced on November 21 that U.S. Food and Drug Administration (FDA) regulators had altered the approval of its lymphoma drug, Zevalin, removing a requirement that patients undergo a 111In ibritumomab tiuxetan imaging dose followed by a gamma scan for biodistribution evaluation before the therapeutic dose. Prior to removal of the biodistribution scan, patients typically received an infusion of rituximab on d 1, followed by a diagnostic dose of 111In-ibritumomab tiuxetan and a full-body scan at a nuclear imaging center within 10 min and again on d 3 or 4. Patients would then receive another infusion of rituximab and a 10-min injection of the therapeutic dose of Zevalin on d 7, 8, or 9. With the bioscan requirement removed, patients will receive the 2 infusions of rituximab followed by a 10-min injection of Zevalin. Spectrum will now refer to this simplified regimen as "RRZ"-rituximab, rituximab, Zevalin."

     Zevalin, a CD20-directed radiotherapeutic antibody, is indicated for the treatment of B-cell non-Hodgkin lymphoma (NHL; relapsed or refractory, low-grade or follicular) and previously untreated follicular NHL in patients who achieve a partial or complete response to first-line chemotherapy. Zevalin was first approved in February 2002 for the treatment of follicular NHL patients in whom disease had recurred or progressed after other systemic therapies. "Despite Zevalin's excellent therapeutic profile, as recognized by inclusion in the NCCN guidelines for appropriate patients with follicular lymphoma, there has been a limited penetration of the potential market. With this approval, we believe that physicians, patients, and payers will find Zevalin to be an exceedingly more attractive treatment option," said Rajesh C. Shrotriya, MD, chair, chief executive officer, and president of Spectrum Pharmaceuticals. "Removal of the bioscan is an important step toward our fulfilling these objectives."

 

----Spectrum Pharmaceuticals

JNM & JNMT New Mobile Interface  

Tsmartphonehe Society of Nuclear Medicine is pleased to announce that its journals, The Journal of Nuclear Medicine (JNM) and the Journal of Nuclear Medicine Technology (JNMT), are now easily accessed via smartphone and other mobile devices.

     "Physicians are increasingly utilizing their smartphones and other mobile devices to access essential medical resources," said SNM President George M. Segall, MD. "Now SNM's high-impact journals can be even better tools, easily accessible no matter where you are."

     The HighWire-designed mobile web interface is device independent, designed to work seamlessly with virtually all mobile phones. When a reader visits SNM's journal sites from a mobile device, they are automatically redirected to the full-featured mobile optimized site, designed for easy use on a small screen.

     The new interface will allow quick access to all journal content and archives, via full text or PDF, with a simplified search page, small-screen-friendly navigation and sharing tools.

 

Coding Q & A

Question: Our nuclear medicine department injected a patient for a bone scan, but the patient never returned for the imaging part. What can we bill?

 

According to the Society of Nuclear Medicine (SNM), when you administer the radiopharmaceutical, you have begun the test. Code the lowest level CPT code in the intended body area. In the case you describe, that would be 78300, and you should assign modifier 52 (reduced services) or 53 (staged or related procedure or service by the same physician during the postoperative period). Also code for the radiopharmaceutical given.

If your payer cannot accept modifier 52, it may instruct you to code for the radiopharmaceutical with an administration code. A report documenting the administration of the radiopharmaceutical would be required.

 

Question: When we perform an OctreoScan (111In) for a carcinoid tumor, we charge, on the first day, code 78802 for a whole body (four-hour scan). For the second day, we charge 78803 with SPECT in two different areas (chest and abdomen). How would you suggest we code this study? Our current coding is being rejected for coding 78803 x 2. Our system is kicking out an MUE (medically unlikely edit).

Your system is correct. While you can bill 78802 and 78803 together, you cannot bill 78803 x 2 for the same date of service.

 

Question: What are the correct code(s) to report for a gastrointestinal bleed study when planar and SPECT/CT images are performed to localize small bleeds?

Answer

If clinically indicated and if separate interpretations are given, it is appropriate to code for the SPECT/CT and anatomic localization studies separately. The CT study is coded separately from the anatomic localization study only when a complete CT study is performed with medical necessity. Since there is no CPT code that accurately describes the anatomic localization of a SPECT/CT study, the unlisted code 78299 (Unlisted gastrointestinal procedure, diagnostic nuclear medicine) should be reported. The GI Bleed planar study is appropriately reported with 78278 (Acute gastrointestinal blood loss imaging).

Nuclear Medicine Records
 

Nuclear Medicine Records




NRC Minimum Retention Periods Required Under 10 CFR Parts 20, 30, and 35




Record

 

Retention

20.2102 Records of Radiation Protection Programs

 

 

Provisions

Indefinitely

 

Audits and other reviews

3 years

20.2103 Records of Surveys (Personnel and Public Radiation Exposure)

 

 

Surveys and Calibrations

3 years

 

Other Records

Indefinitely

20.2104 Determination of Prior Occupational Dose

 

 

NRC Form 4

Indefinitely

 

Exposure Reports

3 years

20.2105 Records of Planned Special Exposures

Indefinitely

20.2106 Records of Individual Monitoring Results

Indefinitely

20.2107 Records of Dose to Individual Members of the Public

Indefinitely

20.2108 Records of Waste Disposal

 

 

Disposal by means other than Decay in Storage or Transfer

Indefinitely

 

 

 

 


 

30.51 Records of Receipt, Transfer, and Disposal

 

 

Receipt (from date of transfer or disposal)

3 years

 

Transfer

3 years

 

Disposal

Indefinitely

 

 

 

 

 

 

35.2024 Records of Authority and Responsibilities for Radiation Protection Programs

 

 

License application, renewals, and amendments

5 years

 

RSO Authority, Duties, and Responsibilities

Indefinitely

35.2026 Records of Radiation Protection Program Changes

5 years

35.2040 Records of Written Directives

3 years

35.2041 Records for Procedures for Administrations Requiring a Written Directive

Indefinitely

35.2060 Records of Calibrations of Instruments Used to Measure the Activity of Unsealed

 

 

Byproduct Material

3 years

35.2061 Records of Radiation Survey Instrument Calibrations

3 years

35.2063 Records of Dosages of Unsealed Byproduct Material for Medical Use

3 years

35.2310 Records of Safety Instruction

3 years

35.2404 Records of Surveys After Source Implant and Removal

3 years

35.2406 Records of Brachytherapy Source Accountability

3 years

35.2432 Records of Calibration Measurements of Brachytherapy Sources                        

3 years

 

(after last use)

 

35.2433 Records of Decay of Strontium-90 Sources for Ophthalmic Treatments

Source Life

35.2605 to 35.2655 Records Required for Remote Afterloader, Teletherapy, and Gamma

Variable

 

Stereotactic Radiosurgery Units

 

 

 

 

These are the NRC required retention periods as of 2/13/2012.   Please be aware that other regulatory


agencies may require longer retention periods (Agreement States).


 

Reimbursement Update

 

                                
Radiopharmacy Inc. recently purchased a copy of the 2012 Nuclear Medicine & PET Coder and would like to make it available to all of our customers for review.

 

     The Nuclear Medicine Coder is designed to help readers understand:

  • Appropriate coding of nuclear medicine procedures for both hospital (technical) and physician (professional) entities;
  • Correct charging or billing for these procedures and associated products;
  • The terms, phrases, and methods related to the procedures.

      Relevant codes are organized by body system (e.g., endocrine system). Each section opens with the code series applicable to the specific body system and pertinent hospital revenue codes. This information is followed by a table that lists drugs and radiopharmaceuticals typically used for nuclear medicine procedures performed on the specific body system (e.g., endocrine system). Each code listed is followed (with few exceptions) by a general definition and tips for billings. A table of information from the 2012 Medicare physician fee schedule (MPFS) and the hospital outpatient prospective payment system (OPPS) concludes the section.

 

An Excerpt    

For 2012, nuclear medicine professionals will see changes to the hepatobiliary and lung imaging CPT families of codes as well as some editorial changes for sentinel node identification.   New, revised and deleted codes are for claims with dates of service on and after January 1, 2012.

     The hepatobiliary and lung family changes are the result of action taken by the AMA Relative Assessment Workgroup (RAW), formerly the Five-Year Review Identification Workgroup of AMA/Specialty Society Relative Value Scale Update Committee (RUC), and Centers for Medicare and Medicaid Services (CMS). This group works to identify potentially mis-valued CPT codes. For 2012, the following were identified as potentially misvalued based on Harvard codes with utilization more than 100,000 in volume.

 

  • 78223   Hepatobiliary ductal system imaging, including gallbladder, with or without pharmacologic intervenetion, with or without quantitative measurement of gallbladder function.
  • 78585    Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and washout, with or without single breath

     In response to the identification of these two individual codes, the Society of Nuclear Medicine (SNM) and the American College of Radiology (ACR) reviewed other procedures that would also be considered part of each procedure code finally. Additionally, the multispecialty society team collaborated by reviewing the coding questions received by their memberships and developed two revised family packages of codes that sometimes simplified and other times divided codes to describe the entirety of the procedures in those families performed clinically today.

     As a result, two family-code proposals were submitted jointly by the SNM and ACR. Regarding the hepatobiliary family, the joint societies believed that current practice with available radiopharmaceuticals (RPs) would be better defined by two codes that describe the current procedures for heapatobiliary imaging, without separating hepatic form hepatic duct/gallbladder studies. Hepatobiliary imaging is now done with a single type of RP from a variety of compounds that share the common imminodiacetate moity.

     CPT 78220, which was formerly performed with 131I rose Bengal (an RP no longer available), is now done with the same RP used for gallbladder imaging and all other hepatobiliary imaging. Hepatobiliary imaging is occasionally requested to assess a bile leak in a post-operative patient who has had surgery involving the gallbladder and/or biliary tract. Therefore, adding the language "gallbladder when present" to both new codes will help to clarify the appropriate code to report. The 2011 codes also did not reflect the major difference in physician and technical work required to perform a study that includes a pharmacological intervention during the procedure, whether or not there is quantification of gallbladder or hepatic function.

     The second new procedure, identified with CPT code 78227, includes administration of a drug during procedure that stimulates gallbladder contraction. When used during assessment for acute cholecystitis, it can cause spasm at the Sphincter of Oddi, and can help differentiate between acute and chronic cholecystitis.

     The 2011 pulmonary (lung) code family has several ventilation codes that are based on a gas-versus-aerosol method, and include single-view and multiple-view ventilation studies, which can make choosing the appropriate code difficult.   The joint societies believe that there is little physician work or cost difference between a gas and aerosol technique and consistent with other procedures, recommended consolidation of the codes describing the ventilation part of the study. There was also some ambiguity about the appropriate code for pulmonary function quantification, since in 2011 there was only one pulmonary quantification code, which is used for measurement of both ventilation and perfusion. The current practice usually involves measurement of just perfusion, either regional or global, and not both ventilation and perfusion. The new 2012 structure of the pulmonary section simplifies the coding of these studies and will address all of the possible nuclear medicine lung studies and combinations currently performed.

     The final 2012 change is a editorial change to CPT 38792. The AMA added the words "radioactive tracer" to the CPT description to make clear that this code is now only used for radiopharmaceutical injections (i.e., the procedure).

     As you may recall, prior to 2011 providers used CPT 38792 for the blue dye injection. Then, the AMA created the following code for the blue-dye injection: 3890-intraoperative identification (e.g., mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (list separately in addition to code for primary procedure).

     As with any new codes, it is critically important for facilities to carefully review their procedure costs prior to setting the 2012 charges for these new codes. Charges should account for the varying work performed for each new 2012 code. Hospitals should NOT simply crosswalk the previous codes noted earlier; crosswalk are for assistance, and if the AMA created a new number and code, their difference must be considered.

     The table to the right includes the new, revised and deleted CPT category I CPT codes in the Nuclear Medicine section that are effective on January 1, 2012.

 

2012 CPT NUCLEAR MEDICINE CODE CHANGES

 

The following symbols are used in the table to the right.

  •  This indicates a new code and description created by the AMA (effective January 1, 2012)

This indicates a revised description (effective January 1, 2012).

 

A strike-through indicates that codes deleted by the AMA effective January 1, 2012.

  

 

2012 CPT NUCLEAR MEDICINE CODE CHANGES

Gastrointestinal System

2012 CPT Code

Description

Comments

78220

Liver function study with hepatobiliary agents, with serial images

Deleted obsolete procedure

78223

Hepatobiliary ductal system imaging, including gallbladders, with or without pharmacologic intervention, with or without quantitative measurement of gallbladder function

Crosswalk 78226 or 78227 based on procedure performed

  •  78226

Hepatobiliary system imaging, including gallbladder when present;

Crosswalk 78220 or 78223.   Includes pre-treatment with morphine when provided.

  •  78227

Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed

Crosswalk 78223 includes pre-treatment with morphine, when provided. Intervention refers to a "drug" administered DURING the procedure. Fatty meals and water are not pharmacologic.

Respiratory System

  •  78579

Pulmonary ventilation imaging (e.g., aerosol or gas)

Crosswalk(s) 78586, 78587, 78591, 78593 or 78594 (Collapsed into one simplified code for all ventilation-only studies.)

� 78580

Pulmonary perfusion imaging particulate (e.g., particulate)

Crosswalk 78580

  •  78582

Pulmonary ventilation (e.g., aerosol or gas) and perfusion imaging

Crosswalk(s) 78584, 78585 or 78588 (Collapsed into one simplified code to report a bundled ventilation and perfusion lung study.)

78584

Pulmonary perfusion imaging, particulate, with ventilation; single breath

Deleted

78585

Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and washout, with or without single breath

Deleted

78586

Pulmonary Ventilation imaging, aerosol; single projection

Deleted

78587

Pulmonary Ventilation imaging, aerosole; multiple projections (e.g., anterior, posterior, lateral views)

Deleted

78588

Pulmonary perfusion imaging, particulate, with ventilation imaging, aerosol, 1 or multiple projections

Deleted

78591

Pulmonary ventilation imaging, gaseous, single breath, single breath

Deleted

78593

Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath; single projection

Deleted

78594

Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or without single breath;   multiple projections (e.g., anterior, posterior, lateral views)

Deleted

78596

Pulmonary quantitative differential function (ventilation/perfusion) study

Deleted

  •  78597

Quantitative differential pulmonary perfusion, including imaging when performed

There is no crosswalk.   Use new code to report differential perfusion only.

  •  78598

Quantitative differential pulmonary perfusion and ventilation (e.g., aerosol or gas), including imaging when performed

Crosswalk 78596

 

(Report 78579, 78580, 78582-78598 only once per imaging session)

Choose the single best code. DO NOT UNBUNDLE.

Lymph Nodes and Lymphatic Channels Introduction

� 38792

Injection procedure radioactive tracer; for identification or sentinel node

Makes clear this code is no longer used to report blue dye.


 

Medications That May Interfere With Radioiodine Uptake

thyroid

 
Exposure to iodinated contrast media (ICM) during imaging procedures is associated with changes in thyroid function and an increased risk of hyperthyroidism, according to a report in the Jan. 23 issue of Archives of Internal Medicine. An accompanying commentary argued that the study is a good example of why patients who may be particularly vulnerable to thyroid dysfunction should be monitored after iodine exposure.
     Connie M. Rhee, MD, and colleagues from Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School in Boston, examined data from patients treated between January 1990 and June 2010 who did not have pre-existing hyperthyroidism or hypothyroidism. Patients were matched with euthyroid (normal thyroid function) controls, and exposure to iodinated contrast media was assessed using claims data. A total of 178 patients with incident hyperthyroidism and 213 patients with incident hypothyroidism were matched to 655 and 779 euthyroid persons, respectively.
     The authors found that iodinated contrast media exposure was associated with incident hyperthyroidism, but no statistically significant association was found with incident hypothyroidism. Secondary analysis indicated an association between iodinated contrast media exposure and incident overt hypothyrodism and incident overt hyperthyroidism.
     "The observed association between ICM exposure and incident hyperthyroidism is likely explained by the iodine or iodide load conveyed by ICM," wrote the authors. "Under physiological conditions, the capture and organification of iodide and the subsequent synthesis and release of triiodothyronine and thyroxine are tightly regulated. However, exposure to supraphysiological levels of iodide may overwhelm regulatory capacity and precipitate hyperthyroidism via Jod-Basedow [a thyrotoxic condition caused by exposure to excessive amounts of iodine]." 
     Results were not affected by sex, race/ethnicity or renal function, according to Rhee et al. 
     While further studies are needed to confirm the generalizability of these findings and establish causality, the authors wrote that physicians and patients should be aware of the potential thyroidal complications associated with ICM and take the necessary precautions. 
     An accompanying commentary, written by Elizabeth N. Pearce, MD, MSc, of the Boston University School of Medicine, agreed and expanded on the authors' point about caution. 
     "These data represent an important contribution to our knowledge about a clinically relevant and understudied area," wrote Pearce. "Rhee et al have demonstrated that a relatively large proportion of individuals who developed iodine-induced thyroid dysfunction were not known to have underlying risk factors. Therefore, patients who may be particularly unable to tolerate thyroid dysfunction, such as those with underlying unstable cardiovascular disease, are also good candidates for monitoring of thyroid function after iodine exposure."

 

 

---Molecular Imaging

 

 

Radiographic Contrast Agents


 

 

 

 

Drug

Generic Name (Ingredient)

Recommended Time of Withdrawal


 

Amipaque

Metrizamide

3-4 weeks


 

Angiografin

Diatrizoate

3-4 weeks


 

Biligrafin

Iodipamide

3-4 weeks


 

Biliscopin

Iotroxate

3-4 weeks


 

Cholografin

Iodipamide

3-4 weeks


 

Conray

Iothalamate

3-4 weeks


 

Cysto-Conray

Iothalamate

3-4 weeks


 

Cystografin

Diatrizoate

3-4 weeks


 

Diaginol

Acetrizoate

3-4 weeks


 

Endobil

Iodoxamate

3-4 weeks


 

Ethiodol

Ethiodized Oil

>1 month


 

Hexabrix

Ioxaglate

3-4 weeks


 

Hypaque

Diatrizoate

3-4 weeks


 

Imagopaque

Iopentol

3-4 weeks


 

Ioglicate

Rayvist

3-4 weeks


 

Ioglycamate

Biligram

3-4 weeks


 

Iopamiro

Iopamidol

3-4 weeks


 

Isopaque

Metrizoate

3-4 weeks


 

Isovist

Iotrolan

3-4 weeks


 

Isovue

Iopamidol

3-4 weeks


 

Lipiodol

Lipiodol

>1 month


 

MD-76

Diatrizoate

3-4 weeks


 

MD-Gastroview

Diatrizoate

3-4 weeks


 

Niopam

Iopamidol

3-4 weeks


 

Omnipaque

Iohexol

3-4 weeks


 

Optiray

Ioversol

3-4 weeks


 

Oxilan

Ioxilan

3-4 weeks


 

Reno-30

Diatrizoate

3-4 weeks


 

Reno-60

Diatrizoate

3-4 weeks


 

RenoCal-76

Diatrizoate

3-4 weeks


 

Reno-Dip

Diatrizoate

3-4 weeks


 

Renografin

Diatrizoate

3-4 weeks


 

Sinografin

Diatrizoate/Iodipamide

3-4 weeks


 

Solutrast

Iopamidol

3-4 weeks


 

Telebrix

Ioxithalamate

3-4 weeks


 

Triosil

Metrizoate

3-4 weeks


 

Ultravist

Iopromide

3-4 weeks


 

Urografin

Diatrizoate

3-4 weeks


 

Urokon

Acetrizoate

3-4 weeks


 

Uromiro

Iodamide

3-4 weeks


 

Urovision

Diatrizoate

3-4 weeks


 

Vascoray

Iothalamate

3-4 weeks


 

Visipaque

Iodixanol

3-4 weeks


 

 

Oral Radiographic Contrast Agents





Drug

Generic Name (Ingredient)

Recommended Time of Withdrawal


Bilibyk

Iobenzamic Acid

6-9 months


Bilimiro

Iopronic Acid

6-9 months


Bilopaque

Tyropanoate Sodium

6-9 months


Biloptin

Iopadate

6-9 months


Cholebrin

Iocetamic Acid

6-9 months


Cistobil

Iopanoic Acid

6-9 months


Gastrografin

Diatrizoate

6-9 months


Gastromiro

Iopamidol

6-9 months


Gastrovision

Diatrizoate

6-9 months


Gastrovist

Diatrizoate

6-9 months


Oragrafin

Ipodate

6-9 months


Solu-Biloptin

Iopadate

6-9 months


Telepaque

Iopanoic Acid

6-9 months



NRC Reporting Requirements

NRC Reporting Requirements Required Under 10 CFR Part 20













Incident










Timeframe to Report

20.2201 Reports of Theft or Loss of Licensed Material

 

 

 

 

 

 

 

 

Report lost, stolen, or missing licensed material in an aggregate quantity equal to or



Immediately

 

greater than 1000 times the quantity specified in Appendix C to part 20.





 


F-18

1000

mCi

Mo-99

100

mCi

Xe-133

1000

mCi

Reporting Method

 


P-32

10

mCi

Tc-99m

1000

mCi

Cs-137

10

mCi

Telephone Report*

 

Common

Cr-51

1000

mCi

Pd-103

100

mCi

Ba-133

100

mCi


 

Isotopes

Co-57

100

mCi

In-111

100

mCi

Sm-153

100

mCi


 


Ga-67

1000

mCi

I-123

100

mCi

Tl-201

1000

mCi


 


Sr-89

10

mCi

I-125

1

mCi





 


Y-90

10

mCi

I-131

1

mCi





 












 

Report lost, stolen, or missing licensed material in an aggregate quantity equal to or



Within 30 days

 

greater than 10 times the quantity specified in Appendix C to part 20.






 


F-18

10

mCi

Mo-99

1

mCi

Xe-133

10

mCi


 


P-32

0.1

mCi

Tc-99m

10

mCi

Cs-137

0.1

mCi

Reporting Method

 

Common

Cr-51

10

mCi

Pd-103

1

mCi

Ba-133

1

mCi

Telephone Report*

 

Isotopes

Co-57

1

mCi

In-111

1

mCi

Sm-153

1

mCi


 


Ga-67

10

mCi

I-123

1

mCi

Tl-201

10

mCi


 


Sr-89

0.1

mCi

I-125

0.01

mCi





 


Y-90

0.1

mCi

I-131

0.01

mCi





 

 

 

 

 

 

 

 

 

 

 

 

 












20.2202 Notification of Incidents










 

Report any event involving byproduct, source, or special nuclear material possessed



Immediately

 

by the licensee that may have caused or threatens to cause any of the following conditions




 

--

An individual to receive TEDE of 25 rems or more, LDE of 75 rems or more,


Reporting Method

 


or SDE of 250 rads or more; or







Telephone Report*

 

--

The release of radioactive material, so that, had an individual been present




 


for 24 hours, the individual could have received an intake 5 times the annual




 


limit on intake









 












 

Report any event involving loss of control of licensed material possessed by the




Within 24 hours

 

or threatens to cause any of the following conditions licensee that may have caused




 

--

An individual to receive, in a period of 24 hours TEDE exceeding 5 rems,




 


LDE exceeding 15 rems, or SDE exceeding 50 rems; or





Reporting Method

 

--

The release of radioactive material, so that, had an individual been present



Telephone Report*

 


for 24 hours, the individual could have received an intake in excess of one




 


occupational annual limit on intake







 

 

 

 

 

 

 

 

 

 

 

 

 












20.2203 Reports of exposures, radiation levels, and concentrations of radioactive material



Within 30 days

 

exceeding the constraints or limits









 

         Doses in excess of any of the following:








 

--

The occupational dose limits for adults (20.1201)





Reporting Method

 

--

The occupational dose limits for a minor (20.1207)





Written Report

 

--

The limits for an embryo/fetus of a declared pregnant woman (21.1208)




 

--

The limits for an individual member of the public (20.1301)





 

--

Any applicable limit of the license







 

--

The ALARA constraints for air emissions (20.1101(d))





 


or










 

         Levels of radiation of concentrations of radioactive material in






 

--

A restricted area in excess of any applicable limit in the license





 

--

An unrestricted area in excess of 10 times any applicable limit set forth in




 


this part or in the license








 


or










 

        For licenses subject to the provisions of EPA's generally applicable





 

         environmental radiation standards in 40 CFR Part 190, levels of






 

         radiation or releases of radioactive material in excess of those standards, or





 

         of license conditions related to those standards.







 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20.2204 Reports of Planned Special Exposures








Within 30 days

 

 

 

 

 

 

 

 

 

 

 

Written Report

 












20.2205 Reports to Individuals of Exceeding Dose Limits






At the time of NRC

 











Report

 

 

 

 

 

 

 

 

 

 

 

Written Report

*Written report required within 30 days of initial report.










 

New Education Online Resources

The American Society of Nuclear Cardiology is pleased to announce a

new online education resource,
, 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

 

For Sale....Slightly used, heavily discounted
 
Lead Lined Waste Container.....$200
 
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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