The Kit of Illuccix® for the preparation of 68 Ga-Gozetotide injection, known as PSMA-11

INDICATIONS AND USAGE : After radiolabeling with gallium, 68Ga is indicated for use with positron emission tomography (PET) of prostate specific membrane antigen (PSMA) positive lesions in men with prostate cancer :

with suspected metastasis who are suitable for initial definitive therapy

with suspected recurrence with elevated serum prostate specific antigen (PSA) level

68Ga PSMA is to be administered by slow intravenous bolus injection followed by intravenous flush
of sterile 0.9% sodium chloride injection to ensure full administration of the dose.

Watch here Illuccix® kit preparation video

F-18 FDG (Fluorine-18 FluoroDeoxyGlucose)

INDICATIONS AND USAGE: Lung Cancer: FDG+ is indicated for imaging in patients undergoing oncologic diagnostic procedures for the evaluation of single pulmonary nodules (diagnosis). For lung cancer evaluation, certain thoracic area non-cancerous lesions may show.

FDG+ uptake including acute and chronic infections (such as abscesses, tuberculosis and histoplasmosis), inflammatory/granulomatous conditions (such as sarcoidosis, pleurodesis and bronchiectasis, radiotherapy sites), and atherosclerotic vessels that could mimic tumour accumulation. Absent or less intense relative uptake of FDG+ may be observed in specific lesions including bronchoalveolar, mucinous and lobular carcinoma as well as carcinoid and fibroadenoma sites.

An understanding of lesion size (such as micrometastases) with respect to 18F-FDG relative accumulation and to PET imaging instrumentation system resolution should also be considered as it has been shown that 18F-FDG PET imaging may have a lower sensitivity in evaluating lesion sizes of less than 1 cm

F-18 NaF (Fluorine-18 Sodium Fluoride)

INDICATIONS AND USAGE: Sodium Fluoride [18F] Injection is indicated as an accessory to positron emission tomography (PET) for the detection of areas of altered osteogenesis associated with bone metastases.

I-131 (Iodine-131 Sodium Iodine capsules of solutions)

INDICATIONS AND USAGE:

Ablation – Destroys normal thyroid tissue following surgery; Facilitates long-term monitoring of any progression or spread of cancer; Enhances the effectiveness of future radioiodine treatments, if needed, by allowing delivery of higher doses.

Adjunct therapy – Detects and destroys suspected residual disease and distant metastases; Minimizes risk of DTC relapse or recurrence

Treatment of recurrent thyroid cancer – Diagnostic Formulations used for Thyroid Uptake Studies to evaluate function of the thyroid gland

Tc99m MDP (Technetium-99m Methylene Diphosphonate)

INDICATIONS AND USAGE : Technetium Tc 99m Medronate Injection is a skeletal imaging agent used to demonstrate areas of altered osteogenesis as seen, for example, in metastatic bone disease, Paget’s disease, arthritic disease and osteomyelitis.

F-18 NaF (Fluorine-18 Sodium Fluoride)

INDICATIONS AND USAGE : Sodium Fluoride [18F] Injection is indicated as an accessory to positron emission tomography (PET) for the detection of areas of altered osteogenesis associated with bone metastases.

Tc99m Sestamibi

INDICATIONS AND USAGE: CARDIOLITE® is a myocardial perfusion agent indicated for: • detecting coronary artery disease by localizing myocardial ischemia (reversible defects) and infarction (non-reversible defects) • evaluating myocardial function and developing information for use in patient management decisions.

Tc99m Tetrofosmin

INDICATIONS AND USAGE: Myoview is indicated for scintigraphic imaging of the myocardium following separate administrations under stress (exercise and/or pharmacologic) and resting conditions in patients with known or suspected coronary artery disease. It is useful in the delineation of regions of reversible myocardial ischemia in the presence or absence of infarcted myocardium. Dipyridamole-induced pharmacologic stress may be used as an alternative to exercise in patients who cannot exercise adequately.

Tc99m Gluceptate

INDICATIONS AND USAGE: The multiple equilibrium-gated-radionuclide ventriculogram is a non-invasive, widely available method to examine the function of the pumping chambers of the heart. Ventricular size, configuration, and wall-motion information complement measurements of the ejection fraction.

Tc99 Sulfur colloid

INDICATIONS AND USAGE: Technetium Tc 99m Sulfur Colloid Injection is used in adults and children as an agent for imaging areas of functioning retriculoendothelial cells in the liver, spleen and bone marrow.

Tc99m DMSA (Tc99m Succimer)

Available through the Special Access Program (SPA)

INDICATIONS AND USAGE: DMSA is to be used as an aid in the scintigraphic evaluation of renal parenchymal disorders.

Tc99m MAG3 (Tc99m Mertiatide)

INDICATIONS AND USAGE: Technetium Tc 99m mertiatide is a renal imaging agent for use in the diagnosis of congenital and acquired abnormalities, renal failure, urinary tract obstruction, and calculi in adults and pediatric patients. (See Pediatric Use.) It is a diagnostic aid in providing renal function, split function, renal angiograms, and renogram curves for whole kidney and renal cortex.

Tc99m MAA (Technetium-99m Macro Aggregated Albumin)

INDICATIONS AND USAGE: Technetium Tc 99m Albumin Aggregated Injection is a lung imaging agent which may be used as an adjunct in the evaluation of pulmonary perfusion in adults and paediatric patients. Technetium Tc 99m Albumin Aggregated Injection may be used in adults as an imaging agent to aid in the evaluation of peritoneovenous (LeVeen) shunt patency.

Tc99m DTPA (Technetium-99m Pentetate)

INDICATIONS AND USAGE: Technetium Tc-99m pentetate, administered by inhalation following nebulization to a radio-aerosol, may be used to perform lung ventilation studies as an aid in the assessment of pulmonary embolic or obstructive airway disease.

F-18 FDG (Flourine-18 FluoroDeoxyGlucose)

INDICATIONS AND USAGE: Lung Cancer: FDG+ is indicated for imaging in patients undergoing oncologic diagnostic procedures for the evaluation of single pulmonary nodules (diagnosis). For lung cancer evaluation, certain thoracic area non-cancerous lesions may show .

FDG+ uptake including acute and chronic infections (such as abscesses, tuberculosis and histoplasmosis), inflammatory/granulomatous conditions (such as sarcoidosis, pleurodesis and bronchiectasis, radiotherapy sites), and atherosclerotic vessels that could mimic tumour accumulation. Absent or less intense relative uptake of FDG+ may be observed in specific lesions including bronchoalveolar, mucinous and lobular carcinoma as well as carcinoid and fibroadenoma sites.

An understanding of lesion size (such as micrometastases) with respect to 18F-FDG relative accumulation and to PET imaging instrumentation system resolution should also be considered as it has been shown that 18F-FDG PET imaging may have a lower sensitivity in evaluating lesion sizes of less than 1 cm

Tc99m HMPAO

INDICATIONS AND USAGE: Tc99m exametazime intravenous injection is used for regional cerebral blood flow scintigraphy. In stroke, reduced cerebral blood flow appears as photopenic areas on scintigrams. Tc99m exametazime scintigraphy may also be useful in investigations of transient ischemic attack, migraine and tumors of the brain. In epilepsy, areas of both ictally increased and interictally decreased perfusion have been demonstrated. Characteristic areas of reduced perfusion have been demonstrated in Alzheimer’s disease which may provide the basis for differential diagnosis of dementia.

Tc99m ECD

INDICATIONS AND USAGE: NEUROLITE® single photon emission computerized tomography (SPECT) is indicated as an adjunct to conventional CT or MRI imaging in the localization of stroke in patients in whom stroke has already been diagnosed. NEUROLITE® is not indicated for assessment of functional viability of brain tissue. Also, NEUROLITE® is not indicated for distinguishing between stroke and other brain lesions.

In-111 DTPA (Indium-111 Pentetreotide)

INDICATIONS AND USAGE: Pentetate Indium Disodium In 111 is recommended for use in radionuclide cisternography.

F-18 Florbetaben (Flourine-18 Neuraceq ®)

INDICATIONS AND USAGE: Neuraceq™ is a radioactive diagnostic agent indicated for Positron Emission Tomography (PET) imaging of the brain to estimate β-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer’s Disease (AD) and other causes of cognitive decline. A negative Neuraceq scan indicates sparse to no neuritic plaques and is inconsistent with a neuropathological diagnosis of AD at the time of image acquisition; a negative scan result reduces the likelihood that a patient’s cognitive impairment is due to AD. A positive Neuraceq scan indicates moderate to frequent amyloid neuritic plaques; neuropathological examination has shown this amount of amyloid neuritic plaque is present in patients with AD, but may also be present in patients with other types of neurologic conditions as well as older people with normal cognition. Neuraceq is an adjunct to other diagnostic evaluations.

Tc99m HMPAO Labeled White Blood Cells (Autologous)

INDICATIONS AND USAGE: In Vitro Tc99m Leukocyte Labeling Tc99m Exametazime is an effective agent for in vitro Tc99m leukocyte radiolabeling. Tc99m labeled leukocytes are useful in the detection of sites of focal infection, especially abdominal abscess and as an adjunct in the investigation of pyrexia of unknown origin (PUO), and in the evaluation of inflammatory conditions not associated with infection such as inflammatory bowel disease (IBD).

In-111 Oxine (Indium-111 Oxine) Labeled White Blood Cells (Autologous)

INDICATIONS AND USAGE: Indium In 111 oxyquinoline is indicated for radiolabeling autologous leukocytes. Indium In 111 oxyquinoline labeled leukocytes may be used as an adjunct in the detection of inflammatory processes to which leukocytes migrate, such as those associated with abscesses or other infection, following reinjection and detection by appropriate imaging procedures. The degree of accuracy may vary with labeling techniques and with the size, location and nature of the inflammatory process.

Ga-67 (Gallium-67 Citrate)

INDICATIONS AND USAGE: Gallium Citrate Ga 67 Injection may be useful in demonstrating the presence of the following malignancies: Hodgkins disease, lymphomas and bronchogenic carcinoma. Positive Ga 67 uptake in: the absence of prior symptoms warrants follow-up as an indication of a potential disease state. Gallium Citrate Ga 67 Injection may be useful as an aid in detecting some acute inflammatory lesions.

Tc99m Pertechnetate

INDICATIONS AND USAGE: A generator is a source of sodium pertechnetate Tc 99m for use in the preparation of FDA-approved diagnostic radiopharmaceuticals, as described in the labeling of these diagnostic radiopharmaceutical kits. Sodium Pertechnetate Tc 99m Injection is used IN ADULTS as an agent for: Thyroid Imaging, Salivary Gland Imaging, Urinary Bladder Imaging (direct isotopic cystography) for the detection of vesico-ureteral reflux, and Nasolacrimal Drainage System Imaging. Sodium Pertechnetate Tc 99m Injection is used IN CHILDREN as an agent for: Thyroid Imaging and Urinary Bladder Imaging (direct isotopic cystography) for the detection of vesico-ureteral reflux.

**SNMMI Procedure Guidelines for the safe use of Radiopharmaceuticals**