Technetium 99m Radiopharmaceuticals

Radioactive drug development is a multi-disciplinary task. Therefore, dedicated scientists and experts from different fields of specialisation have contributed to this book. The text reviews forty years of advances in radiopharmaceutical development based on Technetium. The first section reviews basic principles and analytic methods, and information on chemical makeup of radiopharmaceuticals. Part 2 reviews 99mTc-radiopharmaceuticals used in nuclear medicine, thoroughly outlining their chemistry, formulation, pharmacokinetics and clinical applications.

The decay product of the medical isotope molybdenum-99 (Mo-99), technetium-99m (Tc-99m), and associated medical isotopes iodine-131 (I-131) and xenon-133 (Xe-133) are used worldwide for medical diagnostic imaging or therapy. The United States consumes about half of the world's supply of Mo-99, but there has been no domestic (i.e., U.S.-based) production of this isotope since the late 1980s. The United States imports Mo-99 for domestic use from Australia, Canada, Europe, and South Africa. Mo-99 and Tc-99m cannot be stockpiled for use because of their short half-lives. Consequently, they must be routinely produced and delivered to medical imaging centers. Almost all Mo-99 for medical use is produced by irradiating highly enriched uranium (HEU) targets in research reactors, several of which are over 50 years old and are approaching the end of their operating lives. Unanticipated and extended shutdowns of some of these old reactors have resulted in severe Mo-99 supply shortages in the United States and other countries. Some of these shortages have disrupted the delivery of medical care. Molybdenum-99 for Medical Imaging examines the production and utilization of Mo-99 and associated medical isotopes, and provides recommendations for medical use.

Technetium-99m radiopharmaceuticals will continue to have a significant impact in several areas of nuclear medicine. This publication is intended to provide a broad overview of the current status of technetium-99m radiopharmaceuticals. It includes chapters on the most advanced chemical techniques for labelling biomolecules and synthesizing suitable multifunctional ligands that will help in the development of specific radiotracers. Of special interest for the reader are details of recent research to develop technetium-99m tracers for monitoring different biological processes enabling the development of new radiopharmaceuticals with greatly improved clinical potential.

This book is the product of a congressionally mandated study to examine the feasibility of eliminating the use of highly enriched uranium (HEU2) in reactor fuel, reactor targets, and medical isotope production facilities. The book focuses primarily on the use of HEU for the production of the medical isotope molybdenum-99 (Mo-99), whose decay product, technetium-99m3 (Tc-99m), is used in the majority of medical diagnostic imaging procedures in the United States, and secondarily on the use of HEU for research and test reactor fuel. The supply of Mo-99 in the U.S. is likely to be unreliable until newer production sources come online. The reliability of the current supply system is an important medical isotope concern; this book concludes that achieving a cost difference of less than 10 percent in facilities that will need to convert from HEU- to LEU-based Mo-99 production is much less important than is reliability of supply.

Participants of the July 17-18, 2017, symposium titled Opportunities and Approaches for Supplying Molybdenum-99 and Associated Medical Isotopes to Global Markets examined current trends in molybdenum-99 production, prospects for new global supplies, and technical, economic, regulatory, and other considerations for supplying molybdenum-99 to global markets. This publication summarizes the presentations and discussions from the symposium.

This report describes the procedures for preparing 23 selected Tc-99m radiopharmaceutical kits. Details of the preparation of ten of the active ingredients are also included. The procedures described here can be used to develop manuals, monographs and standard operating procedures. This report is expected to serve as a guide to radiopharmaceutical manufacturing centers and centralized pharmacies involved in the production of kits, and to be a useful resource for the many hospital radiopharmacies that routinely use the kits to compound Tc-99m radiopharmaceuticals, and a source of information for regulators of radiopharmaceuticals.--Publisher's description.