SRMC RADIOPHARMACEUTICALS AND PHARMACEUTICALS—REVISED 7/2014 Note: All therapies (I-131, Sr-89, etc) and all administrations of I-131 > 30 Ci require a written directive signed by an Authorized User Note: Pediatric Patients are <18 years old; for pediatric patients > 100kg, consult with the radiologist about the dose Procedure Adult Dose Bone Marrow Radiopharmaceutical/ Pharmaceutical Tc-99m Sulfur Colloid Bone Scan (MDP) Tc-99m MDP 25 mCi Bone Scan (High resolution bone PET) Brain SPECT F-18 NaF 10 mCi *Tc-99m ECD (Neurolite) or HMPAO (Ceretec) 30 mCi Tl-201 Chloride 6 mCi Acetazolimide (Diamox)* 1000 mg Cardiac Perfusion Tl-201 Chloride (stress/redistribution) UNMH Protocol Cardiac Perfusion Tc-99m Sestamibi (rest/stress 1-day protocol) UNMH Protocol 10 mCi Stress: 3.5 mCi Reinjection (if needed): 1 mCi Rest: 8 mCi (<100 kg) 10 mCi (100-150 kg) Peds Dose 0.14 mCi/kg 0.25 mCi/kg 0.06 mCi/kg 0.35 mCi/kg Peds Min 1 mCi Peds Max Ref 10 mCi 1,4 1.0 mCi 17.5 mCi 2,3 0.5 mCi 4.2 mCi 2,4 3 mCi 25 mCi 1,3 0.07 mCi/kg 14 mg/kg 0.75 mCi 5 mCi 1 Adult dose 4 0.035 mCi/kg 2.5 mCi 1,3 Rest: 0.07 mCi/kg Rest: 6 mCi 1,3 Comments *Tc-99m HMPAO (Ceretec) must be injected through a filter (provided by the radiopharmacy) Slow intravenous push (over 2-5 min) 15-20 min prior to radiopharmaceutical administration; contraindicated with known sulfa allergy If doing a gated resting study only (e.g., as part of a PETsestamibi viability Procedure Radiopharmaceutical/ Pharmaceutical Adult Dose 12 mCi (>150 kg) Stress: 30 mCi (<100 kg) 35 mCi (100-150 kg) 40 mCi (>150 kg) Rest: 12 mCi Stress: 33 mCi Peds Dose Stress: 0.28 mCi/kg Cardiac Perfusion (rest/stress 1-day protocol) SRMC Protocol Cerebral Blood Flow (Brain Death study) Cisternogram/Cisternogram for CSF Leak CSF Shunt Study Tc-99m Tetrofosmin Gallium Scan Ga-67 Citrate 10 mCi 0.14 mCi/kg Gastric Emptying (standardized meal) Tc-99m Sulfur Colloid in solid 1 mCi - Tc-99m Pertechnetate 30 mCi In-111 DTPA Pyrogen 1.0 mCi Free Tc-99m DTPA 1 mCi (preservative free, calcium-sodium salt), less than 8% of a prepared vial of Tc-99m DTPA Peds Min Peds Max Ref Stress: 24 mCi Comments study), use the stress dose To be read by Cardiologist 0.28 mCi/kg 0.007 mCi/kg Adult dose 4 mCi 20 mCi 1,4 0.1 mCi .5 mCi 1 1 10 mCi 0.25 mCi 0.5 mCi Confirm with supplier *Draximage* brand DTPA meeting listed requirements. If not, consult with attending radiologist. Small volume (<0.5 mL) 1,3,5 Consult with nuclear medicine attending physician prior to ordering 2,4 Consult with nuclear medicine attending physician for pediatric dose; standard meal is SC in 120 g Egg Beaters, 2 slices of bread, 30 g Procedure Radiopharmaceutical/ Pharmaceutical Adult Dose Peds Dose Peds Min Peds Max Ref Gastric Emptying (liquid) / Reflux / Aspiration Tc-99m Sulfur Colloid in liquid 1 mCi - 0.25 mCi 1.0 mCi 2 Gastrointestinal Bleed Tc-99m pertechnetate, UltraTag Kit (in vitro) Tc-99m DTPA 30 mCi 2.5 mCi 17.5 mCi 1,5 0.5 mCi 3 mCi Tc-99m IDA (mebrofenin, Choletec) 5 mCi 2 mCi for reinjection 0.25 mCi/kg 0.043 mCi/kg 0.05 mCi/kg 0.5 mCi* 3.5 mCi Sincalide (CCK) 0.02 g/kg if via pump infusion. 0.01 g/kg if via 2-3 minute infusion. Max dose 2.4 g. Adult dose 4 Ensure Plus 1 can (8 oz), any flavor Adult dose (less if unable) ** GFR (Glomerular Filtration Rate) Hepatobiliary 3 mCi 2,3 Comments strawberry jam, 120 cc water; may use 1 can (8 oz) Ensure Plus (any flavor) if patient cannot eat the solid meal Use lowest dose if <1 year old; consult with nuclear medicine attending physician for other peds patients *use 1 mCi for neonatal jaundice *reinjection dose is half initial dose for pediatric patients For prolonged fast (>24 hrs), give 1 can orally. Wait 4 hrs prior to starting study. For GBEF, give 1 can, Procedure Radiopharmaceutical/ Pharmaceutical Adult Dose Peds Dose Peds Min Peds Max Ref Comments image for 60 minutes. Hemangioma 25 mCi Liver-Spleen Tc-99m pertechnetate, UltraTag Kit (in vitro) Tc-99m Sulfur Colloid Liver MAA Tc-99m MAA 2-6 mCi per injection* Lung Perfusion Tc-99m MAA Lung Ventilation (gas) Xe-133 gas 5 mCi 2.5 mCi if pregnant or breast-feeding 5-25 mCi Lung Ventilation (aerosol) Tc-99m DTPA Lymphoscintigraphy for Breast or Melanoma SRMC Protocol Tc-99m Sulfur Colloid Lymphoscintigraphy for Breast or Melanoma UNMH Protocol Tc-99m Sulfur Colloid 5 mCi 30 mCi to aerosolizer Same-day surgery: 4 syringes, each 0.25mCi, (Total of 1mCi) Millipore filtered Next-day surgery: 4 syringes, 0.5mCi each, NOT Millipore filtered Same-day surgery: 3 syringes, each 0.5 mCi, Millipore filtered 0.28 mCi/kg 0.05 mCi/kg ** 2.5 mCi 20 mCi 1,4 0.2 mCi 3.5 mCi 1,4 ** **Adult dose 0.03 mCi/kg 0.4 mCi 2.1 *May be changed at the discretion of the administering physician **Consult with nuclear medicine attending physician 2,3 Adult dose Adult dose Adult dose 1,3 Adult dose 1,4 1,3 1,4 Provide 2 syringes and keep the 3rd in reserve if additional injections are required; injected Procedure Radiopharmaceutical/ Pharmaceutical Adult Dose Tc-99m Sulfur Colloid Meckels Scan Tc-99m pertechnetate 10 mCi MIBG I-123 MIBG 10 mCi SSKI Tc-99m pertechnetate (with Ultratag kit if in vitro labeling) Stannous Pyrophosphate (for in vivo labeling only) OctreoScan In-111 OctreoScan Parathyroid Scan Tc-99m Sestamibi PET (FDG) F-18 FDG Peds Min Peds Max 1,4 0.25 mCi 1 mCi 1 drop (300 mg of potassium iodide) 0.05 mCi/kg 0.14 mCi/kg Adult dose 30 mCi (for in vitro or in vivo labelling) 0.36 mCi/kg 2 mCi Reconstitute vial with 3 mL normal saline; administer 1 mL of solution 6 mCi 30 mCI (with SPECT) 3 mCi for injection only (presurgery) 15 mCi Ref 3.5 mCi 2,5 10 mCi 2,5 25 mCi 2,3 1 mL 0.08 mCi/kg 0.28 mCi/kg 0.14 Comments amount is at the discretion of the injecting physician Next-day surgery: 3 syringes, 1.0 mCi each, NOT Millipore filtered 3 syringes, each 0.5 Adult mCi dose Lymphoscintigraphy for Lower Extremity Edema MUGA Peds Dose 6 mCi 1,5 2 mCi 20 mCi 1,3 1 mCi 10 mCi 2,3 Provide 2 syringes and keep the 3rd in reserve if additional injections are required; injected amount is at the discretion of the injecting physician Administer minimum 1 hr prior to I-123 MIBG Use in vitro labeling (Ultratag) for all patients unless otherwise instructed by the radiologist Procedure Radiopharmaceutical/ Pharmaceutical Adult Dose Renal Cortical Scan Tc-99m DMSA 5 mCi Renogram Tc-99m MAG-3 6 mCi Tc-99m DTPA 10 mCi Furosemide (Lasix) 40 mg Captopril 50 mg Tc-99m in vitro labeled heat damaged red cells I-123 sodium iodide 5 mCi I-131 sodium iodide 5 mCi I-123 sodium iodide 0.15-0.45 mCi (150450 Ci) Splenic Imaging (heatdamaged red blood cells) Thyroid Cancer Diagnostic Imaging Thyroid Uptake/Scan 4 mCi Peds Dose mCi/kg (body); 0.10 mCi/kg (brain) 0.05 mCi/kg 0.15 mCi/kg 0.2 mCi/kg 1 mg/kg Peds Min Peds Max Ref Comments (body); 7 mCi (brain) 0.5 mCi 3.5 2,5 1.0 mCi 6 mCi 2,5 2.0 mCi 10 mCi 1,5 1 mg Adult dose 1 1 0.03 mCi/kg 0.07 mCi/kg 0.07 mCi/kg .5 mci 0.003 mCi/kg 0.1 mCi (100 Ci) 5 mCi 1,4 4 mCi 1,3 5 mCi 1,3 0.15-0.45 mCi (150450 Ci) 1,3 *May substitute bumetanide at 1/40 of furosemide dose if furosemide is unavailable Consult with attending physician for pediatric dose Only if I-123 not available; consult with attending radiologist; written directive required Preferred when thyroid imaging is to be performed; may substitute I-131/TcO4- Procedure Radiopharmaceutical/ Pharmaceutical Adult Dose Peds Dose Peds Min Peds Max Ref Comments with radiologist approval Thyroid Uptake I-131 sodium iodide 0.004-0.015 mCi (415 Ci) 10 mCi Thyroid Scan Tc-99m pertechnetate WBC Imaging In-111 Oxine 0.2-0.6 mCi (200600 Ci) Tc-99m HMPAO (Ceretec) 10-20 mCi Adult dose 0.14 mCi/kg 0.0040.007 mCi/kg 0.140.28 mCi/kg 1,3 1 mCi 10 mCi 1,3 Adult dose 1,3 Range due to variable labeling efficiency Adult dose 1,3 Range due to variable labeling efficiency References for Administered Activities: 1) Nuclear Medicine Procedure Manual, Division of Nuclear Medicine, Mallinckrodt Institute of Radiology; gamma.wustl.edu/index2.html 2) North American Consensus Guidelines for Administered Radiopharmaceutical Activities in Children and Adolescents; http://interactive.snm.org/docs/Pediatric_dose_consensus_guidelines_Final_2010.pdf 3) Image Wisely, http://www.imagewisely.org/Imaging-Professionals/Nuclear-Medicine#Topic0 4) Society of Nuclear Medicine and Molecular Imaging Practice Guidelines, www.snmmi.org 5) ACR Practice Guidelines – Nuclear Medicine Guidelines, www.acr.org
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