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Therapeutic application

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Therapeutic application

  1. 1. RADIOPHARMACY § Radionuclide:131I t1/2: 8.1 days § Energies: 364 keV (g), 606 keV (b−) § Radiopharmaceutical: § 131I as sodium iodide capsule or liquid § Dose of radioiodine therapy: § * 30 – 80mCi 131I as ablative dose for residual thyroid § *120 – 150mCi 131I if cervical lymph nodes positive. § *150 – 200mCi 131I if metastatic lesions Method of Administration: Oral (PO) capsule, through straw from lead container for liquid.
  2. 2. Histopathology: § (1) Differentiated papillary & follicular cancer (90%). § (2) Medullary thyroid cancer (6%). § (3) Anaplastic cancer (4%). § (4) Other tumors (1%). Investigation: * Isotopic thyroid scan--------cold nodule. * Ultrasound solid-----------versus cystic nodule. * Fine needle aspiration cytology.
  3. 3. § * Any patient received a dose > 30mCi should be hospitalized in separate room. § * Patient should be fasting 2 – 4 hours before 131I therapy and 2 hours after therapy. § * Excess intake of fluid and suck of lemon wedges to decrease radiation dose. § * No visitor except for few minutes (no pregnant or children). § * Food & drink in disposable containers. § * Chick room & laundry for contaminations.
  4. 4. • Ablation of residual functioning thyroid carcinoma. • Ablation of residual functioning normal thyroid tissue after total or partial thyroidectomy.
  5. 5. • Pregnancy or nursing. • Allergy to iodine. • Iodinated studies under way or performed recently. • Patient taking thyroid medications or vitamins, or not on low- iodine diet. • Patient extremely likely to regurgitate dose.
  6. 6. RADIOPHARMACY § Radionuclide:131I t1/2: 8.1 days § Energies: 364 keV § Radiopharmaceutical: 131I-mIBG (-meta-iodobenzylguanidine). § Adult Dose Range: 131I: 500 μCi (18.5 MBq) § Method of Administration: Intravenous injected slowly over 5 minutes if possible. § EQUIPMENT § Camera: Large field of view. § Collimator: Medium energy, general purpose § Or medium energy, high resolution.
  7. 7. Laboratory finding: § * High thyroid function . § * Increased 131I uptake. Scan finding: § * Diffuse homogeneous gland. § * Decrease background uptake. § * Prominent pyramidal lobe. § * Increased thyroid uptake.
  8. 8. vRadioactive iodine therapy § Dose calculation: (A) Fixed dose: 10 – 15mCi of 131I. (B) Multi nodular toxic goiter (Fig. 7.6 B): § Scan finding: § * Multiple hot and cold nodules. § * Suppression of the rest of the gland. § * High 131I uptake, high T3,T4. § * Main line of treatment is surgery. § * Radioiodine in larger doses 15 – 20mCi because of greater radio resistance in nodular form with small range for β (1 – 2mm). § * Hypothyroidism in rare following 131I therapy in multi nodular goiter.
  9. 9. (c) autonomous nodule (Fig. 7.6 C) § Scan findings: § * High radioactivity in the nodule suppressing the rest of gland. § * Higher doses of 131I therapy 20 – 30 mCi. § * Recovery of the remaining thyroid is seen following 131I therapy.
  10. 10. § Before Day of Injection § • Physician instructs the patient to take SSKI (saturated solution potassium iodide) or Lugol’s solution to block free iodine uptake in thyroid.This is administered 1 drop, t.i.d., beginning the day before radiotracer administration and continuing for 6 days after injection. If there is an allergy to iodine, perchlorate may be used. § • Physician instructs the patient to take bisacodyl (e.g., Dulcolax®) 10 mg PO, b.i.d. × 3 days before imaging, to reduce bowel activity. Patient may be required to take laxatives and/or enemas on afternoons before imaging days; check with radiologist. § • Physician instructs patients with atopic history (genetic disposition to hypersensitivity or allergy to medications such as iodine or steroids) to be treated with oral antihistamine (e.g., Benadryl® 50 mg)1 hour before injection of radiotracer.
  11. 11. § Days of Injection § • Identify the patient.Verify doctor’s order. Explain the procedure. § • Obtain signed consent from patient and a prescription for the iodine. § • Ensure that the patient is not taking the following drugs: steroids, antihypertensives, reserpine, tricyclic antidepressants, sympathomimetics (adrenergic, stimulates release of epinephrine), diuretics as per physician’s order. Ideally, no medications for 2–3 weeks before the examination (see Drugs to Withhold).
  12. 12. § [standing] hypotension).These occur within the adrenal medulla and are frequently associated § with hereditary multiple endocrine neoplasia (MEN) types 2A and 2B, neurofibromatosis, von § Hippel-Lindau disease, Carney’s triad, and familial pheochromocytoma. § • Localization of site(s) of hormonal overproduction. § • Detection and localization of neuroectodermal (nerve tissue) tumors. § • Paragangliomas (tumors of the adrenal medulla, chromaffin cells, and the paraganglia)
  13. 13. § • Detection and localization of neuroblastomas (malignant hemorrhagic tumors of cells resembling neuroblasts of the sympathetic system, especially the adrenal medulla, and usually occurring in childhood). § • Detection and localization of other neuroendocrine tumors that share the property of amine precursor uptake in decarboxylation (APUD), such as: § • Carcinoid (argentaffin cells of the intestinal tract, bile ducts, pancreas, bronchus, or ovary that secrete serotonin) tumors § Detection and localization of benign and malignant intra-adrenal and extra-adrenal pheochromocytomas (usually benign chromaffin cell tumors of the sympathoadrenal system that produce andsecrete catecholamines, e.g., norepinephrine and epinephrine, producing hypertension and orthostatic
  14. 14. • Allergy to iodine may be a consideration, although doses are small. • Patient taking interfering medications.
  15. 15. Pre- MIBG therapy Post- MIBG therapy Carcinoid tumors :
  16. 16. Paragangliomas Pre- MIBG therapy Post- MIBG therapy
  17. 17. Reference : - https://www.iaea.org/resources/rpop/health-professionals/nuclear- medicine/therapeutic-nuclear-medicine - Therapeutic Nuclear Medicine Editors Richard P. Baum By : Maher alazmi

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