{ "fdg": { "title": "¹⁸F-FDG · Fluorodeoxyglucose", "subtitle": "Glucose analog labeled with fluorine-18, taken up by cells with increased glucose metabolism. Reference PET tracer in oncology, cardiology and infectious diseases.", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved" }, { "cls": "onco", "label": "Oncology" }, { "cls": "cardio", "label": "Cardiology" }, { "cls": "neuro", "label": "Neurology" }, { "cls": "infect", "label": "Infect./Inflam." } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "2.5-3.7 MBq/kg", "statut": "Centralized" }, "formula": "C₆H₁₁18FO₅", "iupac": "2-deoxy-2-(¹⁸F)fluoro-D-glucose", "isotope": "¹⁸F", "indications": [ { "title": "Lung cancer (NSCLC)", "tag": "Onco", "desc": "Initial staging, restaging, post-treatment follow-up. Absolute reference.", "perf": [ "Sn 94%", "Sp 83%", "EANM 2024" ] }, { "title": "Lymphomas", "tag": "Onco", "desc": "Ann Arbor staging, early response (interim PET), Lugano follow-up.", "perf": [ "Deauville 1-5", "Lugano 2014" ] }, { "title": "Melanoma", "tag": "Onco", "desc": "Stage III-IV, metastasis screening, immunotherapy follow-up.", "perf": [ "Sn 89%", "Sp 78%" ] }, { "title": "Infective endocarditis", "tag": "Infect", "desc": "ESC 2023 criteria: prosthetic valves, intracardiac devices.", "perf": [ "Sn 73%", "Sp 90%", "ESC 2023" ] }, { "title": "Sarcoidosis", "tag": "Inflam", "desc": "Activity mapping, cardiac involvement assessment, follow-up.", "perf": [ "Sn 89%", "Sp 78%" ] }, { "title": "Atypical dementias", "tag": "Neuro", "desc": "Differential diagnosis AD / FTD / DLB. Characteristic hypometabolism pattern.", "perf": [ "EANM 2018" ] } ], "protocol": { "uptake": "60 min (acceptable 50-70 min)", "acq": "2-4 min/bed depending on BMI", "total": "≈ 90 min" }, "preparation": [ "Strict 4-6 hour fast (still water allowed and encouraged)", "Capillary blood glucose before injection: ≤ 11 mmol/L (200 mg/dL) — recommended < 8.3 mmol/L (150 mg/dL)", "No intense physical exercise 24h before the exam", "Inflammation/endocarditis: ketogenic diet > 12h + IV unfractionated heparin (myocardial suppression)", "Hydration: 500 mL water during uptake period", "Strict vocal and motor rest in temperate room (24-26°C) to limit BAT and muscle uptake", "Bladder emptying just before acquisition (most exposed organ)" ], "pitfalls": [ "Activated BAT: supraclavicular brown fat (young women, cold)", "Post-surgery inflammation: wait 6 weeks", "Post-chemotherapy: wait 2-3 weeks (flare)", "Post-radiotherapy: wait 3 months (chronic inflammation)", "Hyperglycemia: false negatives on hypermetabolic tumors", "Muscle activity: walking, chewing, talking before injection", "Low-avidity tumors: prostate, well-differentiated HCC, mucinous" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F", "Proton energy: 11-18 MeV", "Target: enriched H₂¹⁸O water", "Automated synthesis (Synthera, FASTlab, TRACERlab)", "Synthesis duration: 35-45 min", "Typical yield: 65-75%" ], "pharm_qc": [ "Appearance: clear, colorless solution", "pH: 4.5 - 8.5", "Radiochemical purity: ≥ 95% (HPLC)", "Chemical purity: Kryptofix < 50 μg/mL", "Bacterial endotoxins: < 175 IU/mL", "Sterility: retrospective testing (release without waiting)" ], "pharm_storage": [ "Multidose lead-shielded vial (10-20 mL)", "Radioactive concentration: ~ 1 GBq/mL at output", "Storage: ambient temperature (15-25°C)", "Stability after calibration: 8 hours", "Beyond 8h: 99% of F-18 has decayed" ], "pharm_distrib": [ "Regional cyclotron production (Curium, AAA, IBA)", "Road delivery in shielded container", "Typical distribution radius: 200 km", "Multiple daily deliveries (8am, 11am, 2pm)", "Average cost: 200-300 € / patient dose" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 1.9 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 7 mSv for 370 MBq injected", "Bladder: 0.13 mGy/MBq (critical organ, frequent voiding recommended)", "Heart: 0.067 mGy/MBq", "Brain: 0.038 mGy/MBq", "Kidneys: 0.021 mGy/MBq", "Source: ICRP Publication 128 (2015) — Radiation Dose to Patients from Radiopharmaceuticals" ], "phys_params": [ "Injected activity (EANM v2.0): 2.5-3.7 MBq/kg in 3D PSF+TOF mode", "For large body mass (BMI>30): possible increase up to 5 MBq/kg", "Bed duration: 90-180 s depending on BMI and scanner sensitivity", "Reconstruction: OSEM-TOF + PSF (3 iterations × 21 subsets)", "Matrix: 256 × 256 (reconstructed voxel ~ 3 mm)", "Post-reconstruction Gaussian filter: 4-5 mm FWHM", "EARL/EARL2 standardization for multicenter studies" ], "phys_radioprot": [ "Dose rate at 1m after injection (370 MBq): ~ 50 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Operator distance: > 2 m during injection", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25% in 2h" ], "mol_svg_2d": "\n \n \n \n \n \n \n \n \n \n O\n \n HO\n \n OH\n \n HO\n \n CH₂OH\n \n \n ¹⁸F\n D-glucose\n" }, "psma-ga68": { "title": "⁶⁸Ga-PSMA-11", "subtitle": "Peptide ligand targeting prostate-specific membrane antigen (PSMA). Reference for prostate cancer assessment (biochemical recurrence, high-risk staging).", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved" }, { "cls": "onco", "label": "Prostate cancer" } ], "stats": { "demi_vie": "67.8 min", "energie": "511 keV", "production": "⁶⁸Ge/⁶⁸Ga generator", "activite": "1.8-2.2 MBq/kg", "statut": "Hospital-only" }, "formula": "C₄₄H₆₃N₉O₁₆", "iupac": "Glu-NH-CO-NH-Lys-(Ahx)-HBED-CC", "isotope": "⁶⁸Ga", "indications": [ { "title": "Prostate biochemical recurrence", "tag": "Onco", "desc": "PSA > 0.2 ng/mL post-prostatectomy or > 2 ng/mL post-RT. Detection > 75% if PSA > 0.5.", "perf": [ "Sn 86%", "Sp 90%", "EAU 2024" ] }, { "title": "Primary high-risk staging", "tag": "Onco", "desc": "ISUP ≥ 4 prostate cancer or PSA > 20 ng/mL. N and M staging.", "perf": [ "proPSMA RCT", "Sn 85%" ] }, { "title": "¹⁷⁷Lu-PSMA therapy selection", "tag": "Onco", "desc": "VISION criteria: ≥1 PSMA+ lesion and no PSMA-/FDG+ lesion. Ideal SUVmax > 10.", "perf": [ "VISION 2021" ] }, { "title": "mCRPC restaging", "tag": "Onco", "desc": "Metastatic castration-resistant prostate cancer. Bone and visceral assessment.", "perf": [ "Superior to bone scan" ] } ], "protocol": { "uptake": "60 min (acceptable 50-100 min)", "acq": "3 min/bed", "total": "≈ 90 min" }, "preparation": [ "No fasting required", "Hydration 500 mL before injection", "Immediate voiding before acquisition", "Optional diuretic (furosemide 20 mg) if urinary retention", "Antiandrogens: no need to stop", "Position arms above head", "Late acquisition 3h if lesion near ureter/bladder" ], "pitfalls": [ "Physiological uptake: salivary glands, liver, spleen, intestine, kidneys, bladder", "False positives: celiac ganglion, sympathetic ganglion, rib fracture, Paget lesion", "Bone hemangiomas may take up (DD with metastases)", "Celiac sympathetic ganglion: classic pitfall in lumbar region", "Non-prostate PSMA-expressing tumors: renal carcinoma, glioblastoma", "Post-ADT: transient PSMA downregulation (false negatives if recent)" ], "pharm_production": [ "⁶⁸Ge/⁶⁸Ga generator: ⁶⁸Ge (T½ 270d) → ⁶⁸Ga by decay", "Elution with 0.1N HCl (3-5 mL)", "Automated synthesis (Modular-Lab, Eluans)", "Synthesis duration: 25-35 min", "Yield: 60-75% after purification", "Activity per elution: 1.5-1.8 GBq (fresh generator)" ], "pharm_qc": [ "pH: 3.5 - 4.5", "Appearance: clear, colorless", "Radiochemical purity: ≥ 95%", "Free Ga-68: < 2%", "Ge-68 breakthrough: < 0.001%", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "Multidose lead-shielded vial (5-10 mL)", "Storage: ambient temperature", "Stability: max 4 hours after synthesis", "Beyond: rapid decay (T½ 68 min)", "Local production mandatory" ], "pharm_distrib": [ "Exclusive hospital production", "No centralized distribution possible (T½ too short)", "1-3 patients per elution depending on protocol", "Generator cost: 50-70 k€ (12-month duration)", "Alternative: ⁶⁸Ga-PSMA-617 or ¹⁸F-PSMA-1007" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (178%)", "Physical half-life T½: 67.71 min (1.128 h)", "Decay mode: β⁺ (89%) + electron capture (11%)", "Maximum β⁺ energy: 1,899 keV", "Average β⁺ energy: 836 keV", "Mean positron range in tissue: 2.9 mm", "Spatial resolution degraded vs ¹⁸F (~ 1 mm more)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 2.1 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 3-4 mSv for 150 MBq injected", "Kidneys: 0.24 mGy/MBq (critical organ)", "Bladder: 0.18 mGy/MBq (frequent voiding)", "Salivary glands: 0.15 mGy/MBq", "Spleen: 0.11 mGy/MBq", "Source: ICRP 128, EANM/SNMMI Guidelines v2.0 (2023)" ], "phys_params": [ "Injected activity (E-PSMA 2021): 1.8-2.2 MBq/kg (max 200 MBq)", "Bed duration: 3 min", "Reconstruction: OSEM-TOF + PSF (3 iter., 21 sub.)", "Matrix: 256 × 256 (voxel ~ 3 mm)", "Gaussian filter: 4-5 mm FWHM", "Acquisition vertex → mid-thighs" ], "phys_radioprot": [ "Dose rate at 1m after injection (150 MBq): ~ 22 μSv/h", "Practical decay: factor 2 every 68 min", "Fast handling: on-site generator, short synthesis", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25-50% in 2h depending on tracer", "Residual activity at patient discharge: ~ 25%" ], "mol_svg_2d": "\n \n \n \n \n \n \n \n \n Glu\n \n Lys\n \n HBED-CC\n \n ⁶⁸Ga\n PSMA-11 peptide\n" }, "dotatate": { "title": "⁶⁸Ga-DOTATATE", "subtitle": "Somatostatin analog binding with high affinity to SSTR2 receptor. Reference for imaging well-differentiated neuroendocrine tumors (NETs).", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved" }, { "cls": "onco", "label": "NETs" } ], "stats": { "demi_vie": "67.8 min", "energie": "511 keV", "production": "⁶⁸Ge/⁶⁸Ga generator", "activite": "1.5-2 MBq/kg", "statut": "Hospital-only" }, "formula": "C₆₅H₈₈N₁₄O₁₈S₂", "iupac": "DOTA-D-Phe¹-Tyr³-octreotate", "isotope": "⁶⁸Ga", "indications": [ { "title": "Well-differentiated NETs G1-G2", "tag": "Onco", "desc": "Digestive, bronchopulmonary, pancreatic tumors. Staging and restaging.", "perf": [ "Sn 88-93%", "Sp 88%", "ENETS 2017" ] }, { "title": "¹⁷⁷Lu-DOTATATE PRRT selection", "tag": "Onco", "desc": "Krenning criteria ≥ 3 on target lesions. NETTER-1 trial.", "perf": [ "NETTER-1" ] }, { "title": "Pheochromocytoma / paraganglioma", "tag": "Onco", "desc": "Superior to ¹²³I-MIBG for SDHB+. Extra-adrenal lesions.", "perf": [ "Sn 93%", "Sp 96%" ] }, { "title": "Meningioma", "tag": "Neuro", "desc": "Helps delineation for stereotactic radiotherapy. Superior to MRI.", "perf": [ "EANO 2021" ] }, { "title": "Medullary thyroid carcinoma", "tag": "Onco", "desc": "Metastasis screening if elevated calcitonin. 2nd-line.", "perf": [ "Sn 70%" ] } ], "protocol": { "uptake": "60 min (acceptable 45-90 min)", "acq": "3-4 min/bed", "total": "≈ 90 min" }, "preparation": [ "No fasting required", "Stop long-acting somatostatin analogs (Sandostatin LAR) 4 weeks before", "Stop short-acting analogs (octreotide) 24h before", "Hydration 500 mL before injection", "Immediate voiding before acquisition", "No concomitant iodinated contrast (renal competition)" ], "pitfalls": [ "Intense physiological uptake: spleen (reference), kidneys, adrenals, uncinate", "False positives: inflammation (SSTR lymphocytes), incidental meningioma, bone hemangioma", "Pancreatic uncinate process: classic pitfall (MRI correlation)", "False negatives: poorly differentiated G3 NETs → prefer FDG", "Under somatostatin analogs: SSTR2 downregulation (competitive blockade)", "Insulinoma: only 50% express SSTR2" ], "pharm_production": [ "⁶⁸Ge/⁶⁸Ga generator", "DOTATATE precursor (lyophilized peptide)", "Labeling by heating 95°C × 7-10 min", "pH adjusted to 4 (sodium acetate)", "Yield: 65-75%", "Activity per preparation: 1.2-1.6 GBq" ], "pharm_qc": [ "pH: 3.5 - 4.5", "Appearance: clear, colorless", "Radiochemical purity: ≥ 91% (HPLC)", "Free Ga-68: < 2%", "Ge-68 breakthrough: < 0.001%", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 4 hours after synthesis", "Local production mandatory" ], "pharm_distrib": [ "Exclusive hospital production", "SomaKit-TOC (AAA, EMA approved)", "1-2 patients per elution", "Generator cost: ~ 50-70 k€/year", "Alternative: ⁶⁴Cu-DOTATATE (T½ 12.7h, centralized)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (178%)", "Physical half-life T½: 67.71 min (1.128 h)", "Decay mode: β⁺ (89%) + electron capture (11%)", "Maximum β⁺ energy: 1,899 keV", "Average β⁺ energy: 836 keV", "Mean positron range in tissue: 2.9 mm", "Spatial resolution degraded vs ¹⁸F (~ 1 mm more)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 2.1 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 3-4 mSv for 150 MBq injected", "Spleen: 0.18 mGy/MBq (critical organ)", "Kidneys: 0.082 mGy/MBq", "Bladder: 0.12 mGy/MBq", "Liver: 0.049 mGy/MBq", "Source: ICRP 128, EANM/SNMMI Guidelines (2017)" ], "phys_params": [ "Injected activity (EANM/SNMMI 2017): 1.5-2 MBq/kg (max 200 MBq)", "Bed duration: 3-4 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Acquisition skull base → mid-thighs" ], "phys_radioprot": [ "Dose rate at 1m after injection (150 MBq): ~ 22 μSv/h", "Practical decay: factor 2 every 68 min", "Fast handling: on-site generator, short synthesis", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25-50% in 2h depending on tracer", "Residual activity at patient discharge: ~ 25%" ], "mol_svg_2d": "\n \n \n \n \n \n \n \n \n D-Phe\n \n Tyr\n \n DOTA\n \n ⁶⁸Ga\n Octreotate\n" }, "fet": { "title": "¹⁸F-FET · Fluoroethyl-tyrosine", "subtitle": "Tyrosine analog labeled with fluorine-18, taken up by the amino acid transport system (LAT). Reference for imaging primary brain tumors and recurrence/radionecrosis differential.", "badges": [ { "cls": "amm-nat", "label": "National appr." }, { "cls": "onco", "label": "Neuro-onco" }, { "cls": "neuro", "label": "Neuro" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "3 MBq/kg", "statut": "Centralized" }, "formula": "C₁₁H₁₄18FNO₃", "iupac": "O-(2-[¹⁸F]fluoroethyl)-L-tyrosine", "isotope": "¹⁸F", "indications": [ { "title": "Gliomas — initial assessment", "tag": "Onco", "desc": "Tumor delineation, identification of high-grade zones in heterogeneous gliomas.", "perf": [ "Sn 89%", "Sp 92%", "RANO-PET 2023" ] }, { "title": "Recurrence vs radionecrosis", "tag": "Onco", "desc": "TBR (tumor-to-brain ratio) > 1.9-2.0 = recurrence. Dynamic acquisition recommended.", "perf": [ "Sn 86%", "Sp 88%" ] }, { "title": "Glioma treatment follow-up", "tag": "Onco", "desc": "Response evaluation to antiangiogenics (bevacizumab), RANO-PET criteria.", "perf": [ "EANO 2021" ] }, { "title": "Brain metastases", "tag": "Onco", "desc": "Viable vs necrosis differential after stereotactic radiosurgery.", "perf": [ "Current practice" ] }, { "title": "Atypical meningiomas", "tag": "Neuro", "desc": "Helps delineation for radiotherapy. Superior to FDG.", "perf": [ "EANO 2021" ] } ], "protocol": { "uptake": "20 min", "acq": "20-40 min dynamic", "total": "≈ 60 min" }, "preparation": [ "No strict fasting (4h fast recommended for standardization)", "No corticosteroid withdrawal (does not affect FET uptake)", "Normal hydration", "Calm before and during injection", "Dynamic acquisition: bolus injection on PET table", "Head fixation system (limit motion)" ], "pitfalls": [ "Low physiological brain uptake: excellent tumor/background contrast (major advantage vs FDG)", "False positives: brain abscess, subacute stroke, active demyelination (MS)", "False negatives: IDH-mutant low-grade non-aggressive glioma (10-15%)", "Physiological uptake: venous sinuses (proximity), parotids, pituitary", "Choroid plexus: modest uptake but possible pitfall", "Static acquisition only: less performant than dynamic" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F → fluoride", "Tyrosine tosylate precursor", "Synthesis by nucleophilic substitution", "Automated module (TRACERlab, FASTlab)", "Synthesis duration: 50-60 min", "Yield: 30-40%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4.5 - 8.5", "Radiochemical purity: ≥ 95%", "Enantiomeric purity: ≥ 99% (L form)", "Residual solvents: compliant", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature (15-25°C)", "Stability: 8 hours", "National approval Germany, Switzerland, France (compassionate)", "Activity per vial: 1-2 GBq" ], "pharm_distrib": [ "Centralized distribution (regional cyclotrons)", "Cost: 400-600 € per dose", "Limited production: few sites in Europe", "Order lead time: D-1 generally", "Alternative: ¹¹C-methionine (T½ 20 min)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 1.6 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 3-4 mSv for 200 MBq injected", "Bladder: 0.12 mGy/MBq", "Pancreas: 0.028 mGy/MBq", "Brain: 0.015 mGy/MBq", "Kidneys: 0.028 mGy/MBq", "Source: ICRP 128, EANM/EANO/RANO Guidelines (2019)" ], "phys_params": [ "Injected activity (EANM/EANO/RANO 2019): 3 MBq/kg (max 200 MBq)", "Dynamic acquisition: 0-40 min in list-mode", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256 (brain: 2 mm voxel ideal)", "Gaussian filter: 3-4 mm FWHM", "Static acquisition 20-40 min post-injection if not dynamic" ], "phys_radioprot": [ "Dose rate at 1m after injection (370 MBq): ~ 50 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Operator distance: > 2 m during injection", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25% in 2h" ], "mol_svg_2d": "\n \n \n \n benzène\n \n HO\n \n CH₂-CH\n NH₂/COOH\n \n O-CH₂CH₂\n \n ¹⁸F\n" }, "choline": { "title": "¹⁸F-Fluorocholine", "subtitle": "Choline analog labeled with fluorine-18, taken up by cells with increased phospholipid metabolism. Main indications: prostate cancer (recurrence) and parathyroid adenomas.", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved" }, { "cls": "onco", "label": "Prostate cancer" }, { "cls": "", "label": "Parathyroid", "style": "background:#0891B2;color:#fff" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "3-4 MBq/kg", "statut": "Centralized" }, "formula": "C₅H₁₃18FNO", "iupac": "N,N,N-trimethyl-2-(¹⁸F)ethanolaminium", "isotope": "¹⁸F", "indications": [ { "title": "Prostate biochemical recurrence", "tag": "Onco", "desc": "Detection > 50% if PSA > 2 ng/mL. Largely replaced by PSMA since 2020.", "perf": [ "Sn 73%", "Sp 88%", "2nd-line" ] }, { "title": "Parathyroid adenoma assessment", "tag": "Endo", "desc": "Primary hyperparathyroidism, US/Tc-MIBI failure or discordance.", "perf": [ "Sn 92%", "Sp 95%", "EANM 2022" ] }, { "title": "Hepatocarcinoma (HCC)", "tag": "Onco", "desc": "Well-differentiated HCC not avid for FDG. Superior Sn for well-diff forms.", "perf": [ "Sn 88%", "Sp 96%" ] }, { "title": "High-grade gliomas", "tag": "Neuro-onco", "desc": "Alternative if FET unavailable. Less performant for low-grade.", "perf": [ "Sn ~80%" ] } ], "protocol": { "uptake": "60 min prostate / 5-15 min parathy.", "acq": "3 min/bed", "total": "≈ 90 min" }, "preparation": [ "No fasting required", "Hydration 500 mL before injection", "Voiding before acquisition", "Parathyroid adenoma: early acquisition 5 min AND late 60 min", "Prostate: single acquisition 60 min post-injection", "No antiandrogen discontinuation required" ], "pitfalls": [ "Physiological uptake: liver (intense), kidneys, intestine, pancreas, salivary", "Bladder: significant urinary excretion (systematic voiding)", "Parathyroid false positives: thyroid nodules, inflammatory nodes", "Prostate false positives: inflammation/BPH, inflammatory nodes", "High hepatic uptake: may mask small liver metastases", "Different kinetics by indication: adapted protocol mandatory" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F", "Precursor: dimethylaminoethanol", "Electrophilic substitution with ¹⁸F-CH₂Br", "Automated module", "Synthesis duration: 60-80 min", "Yield: 25-35%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4.5 - 8.5", "Radiochemical purity: ≥ 95%", "Chemical purity: non-radioactive choline < 200 μg/mL", "Endotoxins: < 175 IU/mL", "Residual solvents: Ph. Eur. compliant" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 10 hours after calibration", "EMA approval (IASOcholine - Iason)", "Activity per vial: 1-2 GBq" ], "pharm_distrib": [ "Centralized distribution (regional cyclotrons)", "Cost: 350-500 € per dose", "Production declining (PSMA competition)", "Order lead time: D-1", "Alternative ¹¹C-choline: T½ 20 min, hospital-only" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 2.0 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 5-6 mSv for 250 MBq injected", "Kidneys: 0.073 mGy/MBq", "Bladder: 0.059 mGy/MBq", "Liver: 0.062 mGy/MBq", "Pancreas: 0.058 mGy/MBq", "Source: ICRP 128, EANM Guidelines (2022)" ], "phys_params": [ "Injected activity: 3-4 MBq/kg (max 300 MBq)", "Bed duration: 3 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Parathyroid: biphasic protocol 5 min/60 min" ], "phys_radioprot": [ "Dose rate at 1m after injection (370 MBq): ~ 50 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Operator distance: > 2 m during injection", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25% in 2h" ], "mol_svg_2d": "\n \n \n \n \n \n \n N⁺\n \n \n \n CH₃\n CH₃\n CH₃\n OH\n \n \n ¹⁸F\n Fluorocholine\n" }, "fapi": { "title": "⁶⁸Ga-FAPI-46", "subtitle": "Fibroblast Activation Protein (FAP) inhibitor, expressed on activated fibroblasts of tumor stroma. Emerging pan-oncological tracer in clinical evaluation.", "badges": [ { "cls": "amm-nat", "label": "Research" }, { "cls": "onco", "label": "Pan-oncology" } ], "stats": { "demi_vie": "67.8 min", "energie": "511 keV", "production": "⁶⁸Ge/⁶⁸Ga generator", "activite": "2 MBq/kg", "statut": "Hospital-only (research)" }, "formula": "C₃₂H₃₄F₂N₆O₈", "iupac": "DOTA-FAPI-46 (quinoline-based)", "isotope": "⁶⁸Ga", "indications": [ { "title": "FDG-negative digestive cancers", "tag": "Onco", "desc": "Mucinous, signet-ring carcinoma, some HCC. Superior to FDG in these subtypes.", "perf": [ "Research" ] }, { "title": "Pancreatic cancer", "tag": "Onco", "desc": "Better tumor/healthy pancreas contrast vs FDG.", "perf": [ "Phase II" ] }, { "title": "Cholangiocarcinoma", "tag": "Onco", "desc": "Very avid for FAPI. Superior to FDG for staging.", "perf": [ "Prospective studies" ] }, { "title": "Lobular breast cancer", "tag": "Onco", "desc": "FDG-negative cancer. Excellent tumor/background contrast.", "perf": [ "Phase II" ] }, { "title": "Ovarian cancer", "tag": "Onco", "desc": "Peritoneal carcinomatosis: detection of nodules < 5 mm vs FDG.", "perf": [ "Comparative studies" ] }, { "title": "¹⁷⁷Lu-FAPI theranostics", "tag": "Onco", "desc": "Under development for FAPI+ resistant tumors.", "perf": [ "Phase I-II" ] } ], "protocol": { "uptake": "10-60 min depending on protocol", "acq": "3 min/bed", "total": "≈ 45-90 min" }, "preparation": [ "No fasting required", "No metabolic restriction (advantage vs FDG)", "Hydration 500 mL", "Voiding before acquisition", "Early acquisition possible (10-15 min post-injection)", "Optimized protocol: 60 min post-injection" ], "pitfalls": [ "Low physiological uptake: excellent tumor/background contrast", "False positives: post-surgery fibrosis, post-RT, scarring, inflammation", "Idiopathic pulmonary fibrosis: possible diffuse uptake", "Atherosclerosis: aortic plaques may take up", "Active rheumatoid arthritis: articular uptake", "Regulatory status: research in Europe (check authorizations)" ], "pharm_production": [ "⁶⁸Ge/⁶⁸Ga generator", "FAPI-46 lyophilized precursor (Sofie, ABX)", "Kit labeling (1 step, ~ 20 min)", "Mild conditions (37-95°C depending on precursor)", "Yield: 80-95% (high purity)", "Activity per preparation: 1-1.5 GBq" ], "pharm_qc": [ "pH: 3.5 - 4.5", "Appearance: clear, colorless", "Radiochemical purity: ≥ 95%", "Free Ga-68: < 2%", "Ge-68 breakthrough: < 0.001%", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 4 hours", "No EMA approval in Europe (compassionate/research)", "Off-label status: local authorization required" ], "pharm_distrib": [ "Exclusive hospital production", "Precursor available (Sofie, ABX, iThemba)", "Precursor cost: ~ 150-300 €/preparation", "1-2 patients per preparation", "Theranostics in development (¹⁷⁷Lu-FAPI)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (178%)", "Physical half-life T½: 67.71 min (1.128 h)", "Decay mode: β⁺ (89%) + electron capture (11%)", "Maximum β⁺ energy: 1,899 keV", "Average β⁺ energy: 836 keV", "Mean positron range in tissue: 2.9 mm", "Spatial resolution degraded vs ¹⁸F (~ 1 mm more)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 1.6 × 10⁻² mSv/MBq (estimate)", "Lower than PSMA/DOTATATE (rapid excretion)", "Equivalent to ~ 2-3 mSv for 150 MBq injected", "Bladder: 0.089 mGy/MBq", "Kidneys: 0.034 mGy/MBq", "Liver: 0.019 mGy/MBq", "Source: Published dosimetric studies (Kuyumcu et al., 2021)" ], "phys_params": [ "Injected activity: 2 MBq/kg (max 150-200 MBq)", "Bed duration: 2-3 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Early acquisition possible (10 min post-injection)" ], "phys_radioprot": [ "Dose rate at 1m after injection (150 MBq): ~ 22 μSv/h", "Practical decay: factor 2 every 68 min", "Fast handling: on-site generator, short synthesis", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25-50% in 2h depending on tracer", "Residual activity at patient discharge: ~ 25%" ], "mol_svg_2d": "\n \n \n \n \n quinoline\n DOTA\n \n \n ⁶⁸Ga\n \n F\n F\n FAPI-46\n" }, "psma-1007": { "title": "¹⁸F-PSMA-1007", "subtitle": "PSMA ligand labeled with fluorine-18 with very low urinary excretion (major advantage for pelvis). European reference for prostate cancer assessment.", "badges": [ { "cls": "amm-nat", "label": "National appr." }, { "cls": "onco", "label": "Prostate cancer" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "4 MBq/kg", "statut": "Centralized" }, "formula": "C₄₉H₆₅18FN₈O₁₇", "iupac": "PSMA-1007 (peptide urée-based)", "isotope": "¹⁸F", "indications": [ { "title": "Prostate biochemical recurrence", "tag": "Onco", "desc": "Optimal detection with low urinary excretion. Ideal for local recurrence.", "perf": [ "Sn 86%", "Sp 91%", "EANM 2023" ] }, { "title": "Primary high-risk staging", "tag": "Onco", "desc": "High-risk prostate cancer. Logistic advantage (T½ 110 min vs 68 min Ga).", "perf": [ "Phase III" ] }, { "title": "Post-treatment evaluation", "tag": "Onco", "desc": "Evaluation of residual lesions after prostatectomy or RT.", "perf": [ "Sn 93%", "Sp 89%" ] }, { "title": "Bone lesion assessment", "tag": "Onco", "desc": "Detection of bone metastases. Caution: benign osteoblastic false positives.", "perf": [ "Prospective studies" ] } ], "protocol": { "uptake": "90-120 min (acceptable 60-180)", "acq": "3 min/bed", "total": "≈ 2-3 hours" }, "preparation": [ "No fasting required", "Hydration 500 mL before injection", "Voiding before acquisition (recommended but less critical vs Ga-PSMA)", "Low urinary excretion: major advantage for pelvic evaluation", "Antiandrogens: no withdrawal needed", "Acquisition possible up to 3h post-injection" ], "pitfalls": [ "Physiological uptake: salivary glands, liver, intestine, kidneys (moderate)", "Frequent bone false positives: osteoblastoma, hemangioma, fracture (vs Ga-PSMA)", "High hepatic uptake: may mask small liver lesions", "Celiac sympathetic ganglion: classic pitfall", "Local inflammation: prostatitis can confound primary staging", "Biliary excretion: 3-5% (difference with PSMA-11)" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F → fluoride", "PSMA-1007 precursor (Cardinale et al.)", "Nucleophilic synthesis (95°C, 10 min)", "Automated module (Synthera, AllinOne)", "Synthesis duration: 80-90 min", "Yield: 25-35%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4.5 - 7.5", "Radiochemical purity: ≥ 95% (HPLC)", "Chemical purity: residual precursor < limits", "Endotoxins: < 175 IU/mL", "Residual solvents (acetonitrile): compliant" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 10 hours after calibration", "National approval (Germany, Austria)", "ATU/compassionate use in France" ], "pharm_distrib": [ "Centralized distribution (regional cyclotrons)", "Cost: 400-600 € per dose", "Production: ABX, Curium, AAA", "Order lead time: D-1", "Alternative: ¹⁸F-DCFPyL (Pylarify)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 2.2 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 6.6 mSv for 300 MBq injected", "Liver: 0.12 mGy/MBq (critical organ)", "Kidneys: 0.11 mGy/MBq", "Bladder: 0.036 mGy/MBq (low)", "Salivary glands: 0.17 mGy/MBq", "Source: ICRP 128, EANM/SNMMI Guidelines v2.0 (2023)" ], "phys_params": [ "Injected activity (E-PSMA 2021): 4 MBq/kg (max 300 MBq)", "Bed duration: 3 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Acquisition vertex → mid-thighs" ], "phys_radioprot": [ "Dose rate at 1m after injection (300 MBq): ~ 40 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Patient contact time: limit to 5 min in force position per operator", "Moderate urinary elimination (~ 30-40% in 2h depending on tracer)", "Residual activity at patient discharge: ~ 60-70%" ], "mol_svg_2d": "\n \n \n \n \n \n \n \n \n \n \n \n ¹⁸F\n PSMA-1007\n" }, "dcfpyl": { "title": "¹⁸F-DCFPyL · Piflufolastat (Pylarify®)", "subtitle": "PSMA ligand labeled with fluorine-18, first PSMA radiotracer approved by FDA. Assessment of metastatic or recurrent prostate cancer.", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved 2023" }, { "cls": "onco", "label": "Prostate cancer" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "333 MBq (fixed)", "statut": "Centralized" }, "formula": "C₁₉H₂₃18FN₄O₉", "iupac": "2-(3-{1-carboxy-5-[(6-[¹⁸F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}ureido)-pentanedioic acid", "isotope": "¹⁸F", "indications": [ { "title": "Prostate biochemical recurrence", "tag": "Onco", "desc": "PSA > 0.2 ng/mL post-prostatectomy. CONDOR trial: detection rate > 60%.", "perf": [ "Sn 85%", "Sp 96%", "CONDOR" ] }, { "title": "Primary high-risk staging", "tag": "Onco", "desc": "OSPREY trial: performance similar to Ga-PSMA-11. Superior to CT/MRI.", "perf": [ "OSPREY", "Sn 80%" ] }, { "title": "Prostate metastasis assessment", "tag": "Onco", "desc": "Identification of bone, nodal and visceral lesions.", "perf": [ "EAU 2024" ] }, { "title": "Treatment follow-up", "tag": "Onco", "desc": "Response evaluation to ADT, chemotherapy, radioligands.", "perf": [ "EANM/SNMMI 2023" ] } ], "protocol": { "uptake": "60 min", "acq": "3 min/bed", "total": "≈ 90 min" }, "preparation": [ "No fasting required", "Hydration 500 mL before injection", "Voiding before acquisition (important: significant urinary excretion)", "Fixed dose: 333 MBq (9 mCi) as single IV injection", "No need to stop antiandrogens", "Position arms above head" ], "pitfalls": [ "Strong urinary excretion: very active bladder, mandatory voiding", "Physiological uptake: kidneys, salivary glands, liver, spleen, intestine", "False positives: inflammatory nodes, osteoblastoma", "Non-prostate PSMA+ tumors: renal carcinoma, glioblastoma", "Post-ADT: possible PSMA downregulation", "Different kinetics from Ga-PSMA-11 (slower excretion)" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F", "Protected precursor (Lantheus, Curium)", "Nucleophilic synthesis + deprotection", "Automated module", "Synthesis duration: 60-80 min", "Yield: 30-40%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4.5 - 7.5", "Radiochemical purity: ≥ 95%", "Specific activity: ≥ 1,000 mCi/μmol at TOA", "Endotoxins: < 175 IU/mL", "Sterility: retrospective testing" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 10 hours after EOS (End of Synthesis)", "EMA approval 2023 (Pylclari)", "FDA approval 2021 (Pylarify)" ], "pharm_distrib": [ "Centralized distribution (Curium, Lantheus)", "Cost: 1,500-2,500 € per patient dose (commercial)", "Production: Curium / Lantheus networks", "Order lead time: D-1", "Wide availability (vs Ga-PSMA)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 1.4 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 4.7 mSv for 333 MBq injected", "Kidneys: 0.089 mGy/MBq (critical organ)", "Bladder: 0.082 mGy/MBq", "Liver: 0.022 mGy/MBq", "Salivary glands: 0.03 mGy/MBq", "Source: ICRP 128, EANM/SNMMI Guidelines v2.0 (2023)" ], "phys_params": [ "Injected activity (E-PSMA 2021): 333 MBq fixed (9 mCi)", "Bed duration: 3 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Acquisition vertex → mid-thighs" ], "phys_radioprot": [ "Dose rate at 1m after injection (300 MBq): ~ 40 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Patient contact time: limit to 5 min in force position per operator", "Moderate urinary elimination (~ 30-40% in 2h depending on tracer)", "Residual activity at patient discharge: ~ 60-70%" ], "mol_svg_2d": "\n \n \n \n \n \n \n \n \n \n \n \n ¹⁸F\n DCFPyL\n" }, "fdopa": { "title": "¹⁸F-FDOPA · Fluoro-DOPA", "subtitle": "Dopamine precursor labeled with fluorine-18. Imaging of dopaminergic system (Parkinson), neuroendocrine tumors and gliomas.", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved" }, { "cls": "neuro", "label": "Parkinson" }, { "cls": "onco", "label": "NETs / Gliomas" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "4 MBq/kg", "statut": "Centralized" }, "formula": "C₉H₁₀18FNO₄", "iupac": "6-[¹⁸F]fluoro-L-DOPA", "isotope": "¹⁸F", "indications": [ { "title": "Atypical parkinsonian syndrome", "tag": "Neuro", "desc": "Differential diagnosis idiopathic PD vs other syndromes (PSP, MSA, CBD).", "perf": [ "Sn 90%", "Sp 100%", "EANM 2020" ] }, { "title": "Neonatal hyperinsulinism", "tag": "Endo", "desc": "Focal vs diffuse lesion localization (pancreas) — major pediatric indication.", "perf": [ "Sn 96%", "EANM 2019" ] }, { "title": "Well-differentiated NETs", "tag": "Onco", "desc": "Alternative to Ga-DOTATATE. Particularly performant for insulinomas.", "perf": [ "Sn 75-90%" ] }, { "title": "Gliomas (recurrence vs necrosis)", "tag": "Onco", "desc": "Alternative to FET. Comparable performance for recurrence/necrosis differentiation.", "perf": [ "EANO 2021" ] }, { "title": "Pheochromocytoma / paraganglioma", "tag": "Onco", "desc": "2nd-line after ¹²³I-MIBG or Ga-DOTATATE.", "perf": [ "Sn 80%" ] } ], "protocol": { "uptake": "60 min (brain) / 60-90 min (NETs)", "acq": "15-25 min", "total": "≈ 90 min" }, "preparation": [ "4-6 hour fast before injection (competing amino acids)", "No levodopa 12h before (competition)", "Carbidopa premedication 100-200 mg PO 1h before (recommended for NETs)", "No protein-rich foods 4h before", "Normal hydration", "Comfortable position for acquisition (45-60 min)" ], "pitfalls": [ "Physiological uptake: striatum (reference), pancreas, gallbladder, kidneys", "Gallbladder: intense excretion, may mask liver lesions", "NET false positives: benign neuroendocrine tumors, inflammation", "Physiological pancreas: high uptake (pancreatic pitfall)", "Without carbidopa: reduced sensitivity for NETs (~50% vs 90%)", "Concomitant levodopa: false negatives" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F or ²⁰Ne(d,α)¹⁸F", "Protected precursor", "Electrophilic or nucleophilic synthesis", "Complex automated module", "Synthesis duration: 60-90 min", "Yield: 20-30%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4 - 5.5", "Radiochemical purity: ≥ 95%", "Enantiomeric purity: ≥ 99% (L form)", "Chemical purity: < precursor limits", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 8 hours", "EMA approval (Iasodopa)", "Activity per vial: 1-2 GBq" ], "pharm_distrib": [ "Centralized distribution (regional cyclotrons)", "Cost: 600-900 € per dose", "Production: Curium (IASODOPA), AAA", "Order lead time: D-1", "Variable availability by region" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 2.5 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 5 mSv for 200 MBq injected", "Gallbladder: 0.30 mGy/MBq (critical organ)", "Bladder: 0.19 mGy/MBq", "Kidneys: 0.13 mGy/MBq", "Pancreas: 0.16 mGy/MBq", "Source: ICRP 128, EANM Guidelines (2020)" ], "phys_params": [ "Injected activity (EANM 2020): 4 MBq/kg (max 250 MBq)", "Bed duration: 3-4 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256 (brain: 2 mm voxel ideal)", "Gaussian filter: 4-5 mm FWHM", "Brain: static 60-90 min or dynamic for Parkinson" ], "phys_radioprot": [ "Dose rate at 1m after injection (370 MBq): ~ 50 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Operator distance: > 2 m during injection", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25% in 2h" ], "mol_svg_2d": "\n \n aromatic\n \n R\n \n \n ¹⁸F\n Fluoro-L-DOPA\n" }, "naf": { "title": "¹⁸F-Fluoride (NaF) · Sodium fluoride", "subtitle": "Bone tracer by incorporation in hydroxyapatite. Detection of bone metastases and skeletal pathologies. Pre-FDG reference in osteology.", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved" }, { "cls": "onco", "label": "Bone metastases" }, { "cls": "", "label": "Skeleton", "style": "background:#0891B2;color:#fff" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "2-4 MBq/kg", "statut": "Centralized" }, "formula": "Na18F", "iupac": "Sodium [¹⁸F]fluoride", "isotope": "¹⁸F", "indications": [ { "title": "Bone metastases", "tag": "Onco", "desc": "Prostate, breast, lung cancer. Superior to ⁹⁹ᵐTc-bisphosphonate bone scan.", "perf": [ "Sn 96%", "Sp 94%", "SNMMI 2020" ] }, { "title": "Unexplained bone pain", "tag": "Onco", "desc": "Hyperactive focus localization (tumor, occult fracture, inflammation).", "perf": [ "Current practice" ] }, { "title": "Paget's disease", "tag": "Bone", "desc": "Extension mapping, follow-up under IV bisphosphonates.", "perf": [ "EANM 2019" ] }, { "title": "Osteonecrosis / algodystrophy", "tag": "Bone", "desc": "Early diagnosis of femoral head osteonecrosis, CRPS syndrome.", "perf": [ "Sn 87%" ] }, { "title": "Painful prosthesis", "tag": "Bone", "desc": "Differential aseptic loosening vs prosthetic infection.", "perf": [ "EANM 2018" ] } ], "protocol": { "uptake": "60 min (acceptable 30-90)", "acq": "2-3 min/bed", "total": "≈ 90 min" }, "preparation": [ "No fasting required", "Hydration +++: 500 mL before + 500 mL during uptake", "Frequent voiding (renew bladder urine)", "Voiding just before acquisition", "No treatment withdrawal (bisphosphonates, denosumab)", "Generally whole-body acquisition (vertex → feet)" ], "pitfalls": [ "Physiological uptake: intense throughout skeleton (cortex + growth)", "False positives: osteoarthritis, recent fracture, osteomyelitis, trauma", "Growth plates: very avid in children/adolescents", "Bladder: intense urinary excretion (up to 60% at 2h)", "Long bone uptake: depends on age and metabolic status", "Difficult differentiation osteoblastic metastasis vs benign lesion without CT" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F", "Precursor: enriched H₂¹⁸O water", "No complex synthesis (direct fluoride ion)", "Purification on anion column", "Production duration: 20-30 min", "Yield: 90-95% (very simple)" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4.5 - 8.5", "Radiochemical purity: ≥ 98.5% (very high)", "Specific activity: variable (no carrier added)", "Endotoxins: < 175 IU/mL", "Solvents: Ph. Eur. compliant" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 10 hours after calibration", "EMA approval (multiple manufacturers)", "Activity per vial: 2-5 GBq" ], "pharm_distrib": [ "Centralized distribution", "Cost: 200-350 € per dose (low)", "Production: all medical cyclotrons", "Order lead time: D-1", "Wide availability (simple production)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 1.7 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 6.3 mSv for 370 MBq injected", "Bladder: 0.22 mGy/MBq (critical organ)", "Bone surface: 0.061 mGy/MBq", "Kidneys: 0.008 mGy/MBq", "Heart: 0.003 mGy/MBq (very low)", "Source: ICRP 128, SNMMI Guidelines (2020)" ], "phys_params": [ "Injected activity (SNMMI 2020): 2-4 MBq/kg (typically 185-370 MBq)", "Bed duration: 2-3 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Acquisition vertex → feet (whole-body)" ], "phys_radioprot": [ "Dose rate at 1m after injection (370 MBq): ~ 50 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Operator distance: > 2 m during injection", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25% in 2h" ], "mol_svg_2d": "\n \n Na⁺\n \n ¹⁸F⁻\n ·\n Na¹⁸F — fluorure de sodium\n" }, "flortaucipir": { "title": "¹⁸F-Flortaucipir (Tauvid®)", "subtitle": "Tau protein (PHF) deposit tracer labeled with fluorine-18. Imaging of Alzheimer's disease and tauopathies. EMA approval 2024.", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved 2024" }, { "cls": "neuro", "label": "Alzheimer / Tau" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "370 MBq (fixed)", "statut": "Centralized" }, "formula": "C₁₈H₁₂18FN₃", "iupac": "7-(6-[¹⁸F]fluoro-pyridin-3-yl)-5H-pyrido[4,3-b]indole", "isotope": "¹⁸F", "indications": [ { "title": "Probable Alzheimer's disease", "tag": "Neuro", "desc": "PHF-tau cortical density estimation. Braak criteria with brain mapping.", "perf": [ "Sn 92%", "Sp 80%", "FDA 2020" ] }, { "title": "Unexplained dementia", "tag": "Neuro", "desc": "Differential diagnosis AD vs FTD, DLB, other tauopathies.", "perf": [ "EANM/EAN 2023" ] }, { "title": "Clinical research", "tag": "Neuro", "desc": "Inclusion in anti-tau / anti-amyloid therapeutic trials.", "perf": [ "DIAN, A4" ] } ], "protocol": { "uptake": "80 min", "acq": "20 min", "total": "≈ 100 min" }, "preparation": [ "No fasting required", "No specific medication restriction", "Normal hydration", "Comfortable position (20 min motionless acquisition)", "Head fixation system (limit motion)", "Static brain exam window 80-100 min" ], "pitfalls": [ "Physiological uptake: choroid plexus, meninges, venous sinuses, benign brain plaques", "Choroid plexus: high non-specific uptake (classic pitfall)", "Off-target binding: monoamine oxidase (MAO), neurometabolism", "Incidental meningiomas: may take up", "Normal aging brain: light physiological tau deposit uptake", "Non-AD tauopathy false positives: PSP, CBD (different pattern)" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F", "Protected precursor (Avid/Lilly)", "Nucleophilic synthesis + deprotection", "Complex automated module", "Synthesis duration: 90-120 min", "Yield: 15-25%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4 - 8", "Radiochemical purity: ≥ 95%", "Specific molar activity: > 30 GBq/μmol", "Endotoxins: < 175 IU/mL", "Residual solvents: compliant" ], "pharm_storage": [ "Lead-shielded vial", "Storage: ambient temperature", "Stability: 10 hours after calibration", "EMA approval 2024 (Tauvid)", "FDA approval 2020 (Tauvid)" ], "pharm_distrib": [ "Centralized distribution (Eli Lilly / Curium)", "Cost: 2,000-3,000 € per patient dose", "Production: Lilly/partner sites", "Order lead time: D-1", "Limited availability (complex production)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 1.9 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 7 mSv for 370 MBq injected", "Bladder: 0.14 mGy/MBq (critical organ)", "Gallbladder: 0.21 mGy/MBq", "Brain: 0.022 mGy/MBq", "Kidneys: 0.058 mGy/MBq", "Source: ICRP 128, Tauvid SmPC (EMA 2024)" ], "phys_params": [ "Injected activity (Tauvid SmPC): 370 MBq fixed (10 mCi)", "Acquisition: 80-100 min post-injection", "Acquisition duration: 20 min static", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256 (2 mm brain voxel)", "Gaussian filter: 3-4 mm FWHM" ], "phys_radioprot": [ "Dose rate at 1m after injection (370 MBq): ~ 50 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Operator distance: > 2 m during injection", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25% in 2h" ], "mol_svg_2d": "\n \n N-cycle\n \n R\n \n \n ¹⁸F\n Flortaucipir\n" }, "amyloid-f18": { "title": "¹⁸F-Amyloid (Florbetaben/Flutemetamol/Florbetapir)", "card_title": "¹⁸F-Amyloid", "subtitle": "Family of 3 β-amyloid plaque tracers with fluorine-18 (Neuraceq, Vizamyl, Amyvid). Diagnostic imaging of Alzheimer's disease.", "badges": [ { "cls": "amm-ema", "label": "✓ EMA approved" }, { "cls": "neuro", "label": "Alzheimer / Amyloid" } ], "stats": { "demi_vie": "109.8 min", "energie": "511 keV", "production": "Cyclotron", "activite": "300-370 MBq", "statut": "Centralized" }, "formula": "Varies by tracer", "iupac": "¹⁸F-florbetaben / florbetapir / flutemetamol", "isotope": "¹⁸F", "indications": [ { "title": "Probable Alzheimer's diagnosis", "tag": "Neuro", "desc": "Detection of cortical β-amyloid plaques. Braak criteria with visual + quantitative analysis (Centiloid).", "perf": [ "Sn 92%", "Sp 90%", "EANM/EAN 2023" ] }, { "title": "MCI vs unexplained dementia", "tag": "Neuro", "desc": "Mild Cognitive Impairment: positive → AD conversion in 80% at 3 years.", "perf": [ "AMA Pet 2018" ] }, { "title": "Anti-amyloid treatment selection", "tag": "Neuro", "desc": "Trial inclusion (lecanemab, donanemab). Amyloid presence validation required.", "perf": [ "CLARITY-AD", "TRAILBLAZER" ] }, { "title": "Clinical research", "tag": "Neuro", "desc": "Prospective cohort follow-up (DIAN, A4, DIAGNAUTO).", "perf": [ "Prospective studies" ] } ], "protocol": { "uptake": "60-90 min (depending on tracer)", "acq": "15-20 min", "total": "≈ 90 min" }, "preparation": [ "No fasting required", "No medication restriction", "Normal hydration", "Florbetaben (Neuraceq): 90 min uptake", "Florbetapir (Amyvid): 30-50 min uptake", "Flutemetamol (Vizamyl): 60-120 min uptake", "Static brain acquisition 15-20 min" ], "pitfalls": [ "Physiological white matter uptake: intense non-specific (internal reference)", "Healthy elderly >65 years: 20-30% positive without dementia", "Quantification: essential (Centiloid scale) as visual analysis is subjective", "Brain atrophy: modifies cortex/white matter ratios", "Cerebellar uptake: variable, may affect normalization", "No discrimination diffuse vs neuritic" ], "pharm_production": [ "Medical cyclotron: ¹⁸O(p,n)¹⁸F", "Protected precursors (different by manufacturer)", "Nucleophilic synthesis + HPLC purification", "Automated modules", "Synthesis duration: 60-90 min", "Yield: 15-30%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4 - 9 (depending on tracer)", "Radiochemical purity: ≥ 95%", "Specific molar activity: variable", "Endotoxins: < 175 IU/mL", "Residual solvents: compliant" ], "pharm_storage": [ "Lead-shielded vial", "Storage: ambient temperature", "Stability: 8-10 hours", "EMA approval: Neuraceq 2014, Vizamyl 2014, Amyvid 2013", "Activity per vial: 1-2 GBq" ], "pharm_distrib": [ "Centralized distribution (Curium, Life Molecular Imaging)", "Cost: 1,500-2,500 € per patient dose", "Production: multiple manufacturers", "Order lead time: D-1", "Wide availability in Europe" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 109.77 min (1.829 h)", "Decay mode: β⁺ (96.73%) + electron capture (3.27%)", "Maximum β⁺ energy: 633.5 keV", "Average β⁺ energy: 249.8 keV", "Mean positron range in tissue: 0.6 mm", "γ constant: 0.143 μSv·m²·MBq⁻¹·h⁻¹", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 1.9-3.4 × 10⁻² mSv/MBq depending on tracer (ICRP 128)", "Equivalent to ~ 5.7-10 mSv for 300-370 MBq injected", "Bladder: 0.12-0.15 mGy/MBq (critical organ)", "Gallbladder: 0.14-0.20 mGy/MBq", "Brain: 0.028 mGy/MBq", "Source: ICRP 128, amyloid tracer SmPCs" ], "phys_params": [ "Injected activity: 300 MBq (Neuraceq) / 370 MBq (Vizamyl, Amyvid)", "Static acquisition 15-20 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256 (2 mm voxel)", "Gaussian filter: 3-4 mm FWHM", "Quantification: Centiloid scale (cerebellar reference)" ], "phys_radioprot": [ "Dose rate at 1m after injection (370 MBq): ~ 50 μSv/h", "Practical decay: factor 2 every 110 min", "Lead-lined uptake room (5 mm Pb minimum)", "Operator distance: > 2 m during injection", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25% in 2h" ], "mol_svg_2d": "\n \n aromatic\n \n R\n \n \n ¹⁸F\n Amyloid-PET\n" }, "dotatoc": { "title": "⁶⁸Ga-DOTATOC", "subtitle": "Somatostatin analog (DOTA-D-Phe¹-Tyr³-octreotide) with high affinity for SSTR2. Alternative to DOTATATE for NET imaging.", "badges": [ { "cls": "amm-nat", "label": "National appr." }, { "cls": "onco", "label": "NETs" } ], "stats": { "demi_vie": "67.8 min", "energie": "511 keV", "production": "⁶⁸Ge/⁶⁸Ga generator", "activite": "1.5-2 MBq/kg", "statut": "Hospital-only" }, "formula": "C₆₅H₈₉N₁₄O₁₈S₂", "iupac": "DOTA-D-Phe¹-Tyr³-octreotide", "isotope": "⁶⁸Ga", "indications": [ { "title": "Well-differentiated NETs G1-G2", "tag": "Onco", "desc": "Same indications as DOTATATE. Slightly lower SSTR2 affinity.", "perf": [ "Sn 88%", "Sp 88%", "ENETS" ] }, { "title": "¹⁷⁷Lu-DOTATOC PRRT selection", "tag": "Onco", "desc": "Krenning criteria ≥ 3. Alternative to ¹⁷⁷Lu-DOTATATE.", "perf": [ "German practice" ] }, { "title": "Pheochromocytoma / paraganglioma", "tag": "Onco", "desc": "Comparable to DOTATATE for SDHB+.", "perf": [ "Sn 90%" ] }, { "title": "Meningioma", "tag": "Neuro", "desc": "Stereotactic radiotherapy delineation. German approval for this indication.", "perf": [ "EANO 2021" ] } ], "protocol": { "uptake": "60 min (acceptable 45-90 min)", "acq": "3-4 min/bed", "total": "≈ 90 min" }, "preparation": [ "No fasting required", "Stop long-acting somatostatin analogs (Sandostatin LAR) 4 weeks before", "Stop short-acting analogs (octreotide) 24h before", "Hydration 500 mL before injection", "Immediate voiding before acquisition", "No concomitant iodinated contrast (renal competition)" ], "pitfalls": [ "Physiological uptake: spleen (reference), kidneys, adrenals, uncinate, pituitary", "False positives: inflammation, incidental meningioma, bone hemangioma", "Pancreatic uncinate process: classic pitfall", "Pituitary: high uptake, may mask lesion (adenoma differential)", "False negatives: poorly differentiated G3 NETs (prefer FDG)", "Under somatostatin analogs: SSTR downregulation" ], "pharm_production": [ "⁶⁸Ge/⁶⁸Ga generator", "DOTATOC precursor (lyophilized)", "Labeling by heating 95°C × 7-10 min", "pH adjusted to 4", "Yield: 65-75%", "Activity per preparation: 1.2-1.6 GBq" ], "pharm_qc": [ "pH: 3.5 - 4.5", "Appearance: clear, colorless", "Radiochemical purity: ≥ 91% (HPLC)", "Free Ga-68: < 2%", "Ge-68 breakthrough: < 0.001%", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "Multidose lead-shielded vial", "Storage: ambient temperature", "Stability: 4 hours after synthesis", "National approval (Germany, Austria)" ], "pharm_distrib": [ "Exclusive hospital production", "Lyophilized precursor available (ABX)", "1-2 patients per preparation", "Generator cost: ~ 50-70 k€/year", "Alternative: ⁶⁸Ga-DOTATATE or ⁶⁸Ga-DOTANOC" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (178%)", "Physical half-life T½: 67.71 min (1.128 h)", "Decay mode: β⁺ (89%) + electron capture (11%)", "Maximum β⁺ energy: 1,899 keV", "Average β⁺ energy: 836 keV", "Mean positron range in tissue: 2.9 mm", "Spatial resolution degraded vs ¹⁸F (~ 1 mm more)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 2.1 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 3-4 mSv for 150 MBq injected", "Spleen: 0.17 mGy/MBq (critical organ)", "Kidneys: 0.082 mGy/MBq", "Bladder: 0.11 mGy/MBq", "Pituitary: 0.11 mGy/MBq", "Source: ICRP 128, EANM Guidelines" ], "phys_params": [ "Injected activity (EANM/SNMMI 2017): 1.5-2 MBq/kg (max 200 MBq)", "Bed duration: 3-4 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Acquisition skull base → mid-thighs" ], "phys_radioprot": [ "Dose rate at 1m after injection (150 MBq): ~ 22 μSv/h", "Practical decay: factor 2 every 68 min", "Fast handling: on-site generator, short synthesis", "Patient contact time: limit to 5 min in force position per operator", "Urinary elimination ~ 25-50% in 2h depending on tracer", "Residual activity at patient discharge: ~ 25%" ], "mol_svg_2d": "\n \n \n \n \n \n \n \n \n D-Phe\n \n Tyr\n \n DOTA\n \n ⁶⁸Ga\n Octreotide\n" }, "methionine-c11": { "title": "¹¹C-Methionine", "subtitle": "Essential amino acid labeled with carbon-11. Imaging of primary brain tumors and gliomas. Historical reference for amino acids in PET.", "badges": [ { "cls": "amm-nat", "label": "Hospital-only" }, { "cls": "onco", "label": "Neuro-onco" }, { "cls": "neuro", "label": "Gliomas" } ], "stats": { "demi_vie": "20.4 min", "energie": "511 keV", "production": "On-site cyclotron", "activite": "3-7 MBq/kg", "statut": "Hospital-only" }, "formula": "11CH₃-S-CH₂CH₂CH(NH₂)COOH", "iupac": "L-[methyl-¹¹C]methionine", "isotope": "¹¹C", "indications": [ { "title": "Gliomas — initial assessment", "tag": "Onco", "desc": "Tumor delineation, identification of high-grade zones. Alternative to FET.", "perf": [ "Sn 88%", "Sp 90%", "EANO-RANO 2019" ] }, { "title": "Recurrence vs radionecrosis", "tag": "Onco", "desc": "TBR > 1.5-2.0 depending on protocol. Comparable performance to FET.", "perf": [ "Sn 85%" ] }, { "title": "Pituitary adenoma", "tag": "Endo", "desc": "Microadenoma detection (Cushing, prolactinoma). Superior to MRI in 30% of cases.", "perf": [ "Sn 86%" ] }, { "title": "Brain metastases", "tag": "Onco", "desc": "Viable vs necrosis differential after radiosurgery.", "perf": [ "German practice" ] } ], "protocol": { "uptake": "10-20 min", "acq": "15-30 min", "total": "≈ 45 min" }, "preparation": [ "4 hour fast", "Normal hydration", "Calm before and during injection", "Head fixation system (limited motion)", "On-site production mandatory (T½ 20 min)", "Injection immediately after synthesis" ], "pitfalls": [ "Very short T½ (20 min): very constraining logistics", "Physiological uptake: salivary glands, pancreas, liver, bone marrow", "False positives: abscess, active inflammation, demyelination", "No premedication required (vs ¹⁸F-DOPA)", "Unavailable outside cyclotron-equipped centers", "Lower hepatic uptake (unlike FET)" ], "pharm_production": [ "On-site cyclotron mandatory: ¹⁴N(p,α)¹¹C", "Methyl-¹¹C-iodide precursor", "Fast synthesis (5-10 min)", "Compact automated module", "Total synthesis duration: 15-25 min", "Yield: 70-85%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 5 - 8", "Radiochemical purity: ≥ 95%", "Enantiomeric purity: ≥ 99% (L form)", "Specific activity: > 50 GBq/μmol", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "No storage possible (T½ 20 min)", "Immediate use", "Just-in-time production before injection", "No preservation" ], "pharm_distrib": [ "Exclusive hospital production", "Distribution impossible (T½)", "1 patient per synthesis", "Cyclotron cost: ~ 2-3 M€ (installation)", "Operating cost: ~ 200-300 € per dose" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 20.38 min", "Decay mode: β⁺ (99.76%)", "Maximum β⁺ energy: 960 keV", "Average β⁺ energy: 386 keV", "Mean positron range in tissue: 1.1 mm", "Advantage: can be incorporated without modifying structure (native molecule)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 0.52 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 3-4 mSv for 740 MBq injected", "Pancreas: 0.038 mGy/MBq (critical organ)", "Kidneys: 0.027 mGy/MBq", "Liver: 0.025 mGy/MBq", "Brain: 0.008 mGy/MBq", "Source: ICRP Publication 128" ], "phys_params": [ "Injected activity: 3-7 MBq/kg (max 740 MBq)", "Acquisition duration: 15-30 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256 (2 mm brain voxel)", "Gaussian filter: 3-4 mm FWHM", "Brain only: static protocol 10-30 min" ], "phys_radioprot": [ "Dose rate at 1m after injection (740 MBq): ~ 100 μSv/h", "Practical decay: factor 2 every 20 min (very fast)", "On-site production mandatory (local cyclotron)", "Patient contact time: limit to 5 min in force position per operator", "Residual activity at patient discharge: very low (~ 5%)", "Advantage: low cumulative staff exposure" ], "mol_svg_2d": "\n \n aromatic\n \n R\n \n \n ¹¹C\n Méthionine\n" }, "choline-c11": { "title": "¹¹C-Choline", "subtitle": "Choline labeled with carbon-11. Imaging of cells with high membrane metabolism. Hospital alternative to ¹⁸F-choline.", "badges": [ { "cls": "amm-nat", "label": "Hospital-only" }, { "cls": "onco", "label": "Prostate cancer" } ], "stats": { "demi_vie": "20.4 min", "energie": "511 keV", "production": "On-site cyclotron", "activite": "4-7 MBq/kg", "statut": "Hospital-only" }, "formula": "(CH₃)₂N⁺(11CH₃)CH₂CH₂OH", "iupac": "[methyl-¹¹C]choline", "isotope": "¹¹C", "indications": [ { "title": "Prostate biochemical recurrence", "tag": "Onco", "desc": "Largely replaced by PSMA since 2020. Still used in centers without PSMA access.", "perf": [ "Sn 75%", "Sp 88%", "2nd-line" ] }, { "title": "Hepatocarcinoma (HCC)", "tag": "Onco", "desc": "Well-differentiated HCC not avid for FDG. Superior Sn for well-diff forms.", "perf": [ "Sn 90%" ] }, { "title": "Parathyroid adenoma assessment", "tag": "Endo", "desc": "Alternative ¹⁸F-choline if cyclotron-equipped site.", "perf": [ "Sn 90%" ] }, { "title": "Gliomas", "tag": "Neuro-onco", "desc": "Alternative to amino acids if site is limited.", "perf": [ "Sn 75%" ] } ], "protocol": { "uptake": "5-10 min", "acq": "15-25 min", "total": "≈ 45 min" }, "preparation": [ "No fasting required", "Hydration 500 mL before injection", "Voiding before acquisition", "On-site production (T½ 20 min)", "Immediate injection", "Early acquisition recommended (5-10 min)" ], "pitfalls": [ "Very short T½ (20 min): on-site production mandatory", "Physiological uptake: liver, kidneys, pancreas, salivary, intestine", "Moderate biliary excretion (vs ¹⁸F-choline)", "False positives: inflammation, lymph nodes", "Unavailable outside cyclotron-equipped centers", "Prefer ¹⁸F-choline if no cyclotron" ], "pharm_production": [ "On-site cyclotron mandatory: ¹⁴N(p,α)¹¹C", "Dimethylaminoethanol precursor", "Methylation with ¹¹CH₃-OTf or ¹¹CH₃I", "Fast synthesis (5-10 min)", "Automated module", "Yield: 50-70%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 4 - 7", "Radiochemical purity: ≥ 95%", "Endotoxins: < 175 IU/mL", "Specific activity: > 100 GBq/μmol", "Residual solvents: compliant" ], "pharm_storage": [ "No storage (T½ 20 min)", "Immediate use", "Just-in-time production", "No preservation" ], "pharm_distrib": [ "Exclusive hospital production", "1-2 patients per synthesis", "No external distribution", "Operating cost: ~ 250 €/dose", "Alternative: ¹⁸F-choline (centralized)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.5%)", "Physical half-life T½: 20.38 min", "Decay mode: β⁺ (99.76%)", "Maximum β⁺ energy: 960 keV", "Average β⁺ energy: 386 keV", "Mean positron range in tissue: 1.1 mm", "Advantage: can be incorporated without modifying structure (native molecule)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 0.42 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 2-3 mSv for 700 MBq injected", "Pancreas: 0.027 mGy/MBq (critical organ)", "Liver: 0.025 mGy/MBq", "Kidneys: 0.021 mGy/MBq", "Source: ICRP Publication 128" ], "phys_params": [ "Injected activity: 4-7 MBq/kg (max 700 MBq)", "Bed duration: 2-3 min", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "Gaussian filter: 4-5 mm FWHM", "Acquisition vertex → mid-thighs (prostate)" ], "phys_radioprot": [ "Dose rate at 1m after injection (740 MBq): ~ 100 μSv/h", "Practical decay: factor 2 every 20 min (very fast)", "On-site production mandatory (local cyclotron)", "Patient contact time: limit to 5 min in force position per operator", "Residual activity at patient discharge: very low (~ 5%)", "Advantage: low cumulative staff exposure" ], "mol_svg_2d": "\n \n aromatic\n \n R\n \n \n ¹¹C\n ¹¹C-Choline\n" }, "ammonia-n13": { "title": "¹³N-Ammonia", "subtitle": "Ammonia labeled with nitrogen-13. PET myocardial perfusion imaging. Reference for absolute coronary blood flow quantification.", "badges": [ { "cls": "amm-nat", "label": "Hospital-only" }, { "cls": "cardio", "label": "Myocardial perfusion" } ], "stats": { "demi_vie": "9.97 min", "energie": "511 keV", "production": "On-site cyclotron", "activite": "7-10 MBq/kg", "statut": "Hospital-only" }, "formula": "13NH₃", "iupac": "[¹³N]-ammonia", "isotope": "¹³N", "indications": [ { "title": "Stable coronary disease", "tag": "Cardio", "desc": "Myocardial ischemia evaluation. Absolute coronary flow quantification (MBF).", "perf": [ "Sn 90%", "Sp 91%", "EANM/ESC 2023" ] }, { "title": "Myocardial viability assessment", "tag": "Cardio", "desc": "Combined with FDG: dual-tracer protocol for viability.", "perf": [ "EANM 2018" ] }, { "title": "Microangiopathy", "tag": "Cardio", "desc": "Microvascular coronary flow assessment (CFR / MFR).", "perf": [ "Coronary reserve" ] }, { "title": "Post-revascularization", "tag": "Cardio", "desc": "Regional perfusion evaluation after stenting / bypass.", "perf": [ "Clinical practice" ] } ], "protocol": { "uptake": "3-5 min (very fast)", "acq": "5-15 min", "total": "≈ 30 min (rest+stress)" }, "preparation": [ "6h fast before exam", "No caffeine 24h before (regadenoson) / 48h (dipyridamole)", "No tobacco 24h before", "No beta-blockers 24h before (unless medical decision)", "Set up 2 IV lines (injection + stress)", "Separate rest + stress acquisitions (50 min between the 2)" ], "pitfalls": [ "Ultra-short T½ (10 min): requires mandatory on-site cyclotron", "Physiological uptake: liver, kidneys, bladder, salivary, muscle", "Respiratory motion: artifacts on inferior wall", "False positives: attenuation artifact, LBBB (left bundle branch block)", "Hepatic uptake: interferes with inferior wall", "Absolute quantification: requires dedicated software (HeartSee, MunichHeart)" ], "pharm_production": [ "On-site cyclotron mandatory: ¹⁶O(p,α)¹³N (water target)", "Direct ¹³N ammonia production", "No complex synthesis", "Compact automated module", "Production duration: 10-15 min", "Yield: 30-50%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 5 - 7", "Radiochemical purity: ≥ 95%", "Specific activity: variable", "Endotoxins: < 175 IU/mL", "Sterility: retrospective testing" ], "pharm_storage": [ "No storage (T½ 10 min)", "Immediate use", "Just-in-time production", "Multiple preparations per exam session" ], "pharm_distrib": [ "Exclusive hospital production", "Distribution impossible", "1-2 preparations per patient (rest+stress)", "Cyclotron + operation cost: ~ 400-600 €/session", "Alternative: ⁸²Rb (generator)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.6%)", "Physical half-life T½: 9.97 min", "Decay mode: β⁺ (99.8%)", "Maximum β⁺ energy: 1,199 keV", "Average β⁺ energy: 492 keV", "Mean positron range in tissue: 1.5 mm", "Production: on-site cyclotron (¹⁶O(p,α)¹³N on water)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 0.2 × 10⁻² mSv/MBq (ICRP 128)", "Equivalent to ~ 1.5-2 mSv for 750 MBq (rest+stress)", "Bladder: 0.008 mGy/MBq", "Kidneys: 0.011 mGy/MBq", "Liver: 0.013 mGy/MBq", "Heart: 0.022 mGy/MBq", "Source: ICRP 128, EANM/ESC Guidelines" ], "phys_params": [ "Injected activity: 7-10 MBq/kg (max 740 MBq/dose × 2)", "Immediate list-mode acquisition post-injection", "Acquisition duration: 5-15 min (dynamic)", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256 (2 mm voxel)", "Gaussian filter: 3-4 mm FWHM" ], "phys_radioprot": [ "Dose rate at 1m after injection: ~ 80 μSv/h", "Practical decay: factor 2 every 10 min (very fast)", "On-site production mandatory", "Patient contact time: limit to 5 min in force position per operator", "Residual activity at patient discharge: very low", "Advantage: minimal cumulative staff exposure" ], "mol_svg_2d": "\n \n ¹³N\n H₃\n \n ¹³NH₃ — ammoniaque\n" }, "water-o15": { "title": "¹⁵O-H₂O · Labeled water", "subtitle": "Water labeled with oxygen-15. Gold standard reference for absolute cerebral and myocardial blood flow quantification. Free diffusion.", "badges": [ { "cls": "amm-nat", "label": "Research" }, { "cls": "cardio", "label": "Perfusion" }, { "cls": "neuro", "label": "Quantitative CBF" } ], "stats": { "demi_vie": "2.04 min", "energie": "511 keV", "production": "On-site cyclotron", "activite": "500-1500 MBq", "statut": "Research" }, "formula": "H₂15O", "iupac": "[¹⁵O]-water", "isotope": "¹⁵O", "indications": [ { "title": "Absolute myocardial perfusion quantification", "tag": "Cardio", "desc": "Gold standard for MBF (mL/min/g). Superior to ammonia for quantification.", "perf": [ "Absolute reference" ] }, { "title": "Coronary reserve (CFR)", "tag": "Cardio", "desc": "Microcirculation assessment. Very used in research.", "perf": [ "EANM" ] }, { "title": "Cerebral blood flow (CBF)", "tag": "Neuro", "desc": "Absolute regional quantification. Evaluation of stroke, dementia.", "perf": [ "Research" ] }, { "title": "Cerebral metabolism (with ¹⁵O₂)", "tag": "Neuro", "desc": "Combined with ¹⁵O-O₂ for OEF, CMRO₂.", "perf": [ "Stroke research" ] } ], "protocol": { "uptake": "Immediate (dynamic acquisition)", "acq": "3-5 min", "total": "≈ 20 min" }, "preparation": [ "4h fast", "Normal hydration", "No caffeine 24h before if stress (regadenoson)", "IV line setup for fast bolus", "On-site production mandatory (immediate cyclotron)", "Dynamic acquisition in list-mode (0-3 min)" ], "pitfalls": [ "Ultra-short T½ (2 min): on-site production, extreme logistics", "Free tissue diffusion: no organ-specific uptake", "Absolute quantification requires: arterial input function, pharmacokinetic model", "Dedicated software: Carimas, PMOD needed", "No qualitative imaging: quantitative interest only", "Limited availability: very few equipped centers in Europe" ], "pharm_production": [ "On-site cyclotron mandatory: ¹⁴N(d,n)¹⁵O or ¹⁵N(p,n)¹⁵O", "¹⁵O O₂ production then hydrogenation → H₂¹⁵O", "Dedicated module integrated into cyclotron", "Continuous flow production possible", "Total duration: 5-10 min", "Yield: 60-80%" ], "pharm_qc": [ "Appearance: clear, colorless", "pH: 5.5 - 7.5", "Radiochemical purity: ≥ 99%", "Sterility: retrospective testing", "Endotoxins: < 175 IU/mL", "Specific activity: very high" ], "pharm_storage": [ "No storage possible (T½ 2 min)", "Continuous production during exam", "Multiple preparations per session (3-6 doses)", "No preservation" ], "pharm_distrib": [ "Exclusive hospital production", "Absolute impossibility of distribution", "Multiple doses per patient (rest+stress)", "Operating cost: variable", "Very few equipped sites" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV (199.8%)", "Physical half-life T½: 2.04 min (very short)", "Decay mode: β⁺ (99.9%)", "Maximum β⁺ energy: 1,732 keV", "Average β⁺ energy: 735 keV", "Mean positron range in tissue: 2.5 mm", "On-site production mandatory (cyclotron in immediate proximity)", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 0.1 × 10⁻² mSv/MBq (ICRP 128) — very low", "Equivalent to ~ 1-2 mSv for 1,000 MBq cumulative (rest+stress)", "Lungs: 0.004 mGy/MBq", "Heart: 0.003 mGy/MBq", "Kidneys: 0.003 mGy/MBq", "Source: ICRP Publication 128" ], "phys_params": [ "Injected activity: 500-1500 MBq (fast bolus)", "Dynamic acquisition 0-3 min in list-mode", "Reconstruction: OSEM-TOF + PSF", "Matrix: 128 × 128 or 256 × 256", "Gaussian filter: 5-7 mm FWHM", "Quantification: Renkin-Crone model, Carimas/PMOD software" ], "phys_radioprot": [ "Dose rate at 1m after injection: ~ 200 μSv/h (instant)", "Ultra-fast decay: factor 2 every 2 min", "On-site production mandatory", "Patient contact time: very brief (immediate administration)", "Residual activity at patient discharge: negligible", "Advantage: very low cumulative staff exposure" ], "mol_svg_2d": "\n \n ¹⁵O\n H\n H\n \n \n H₂¹⁵O — eau marquée\n" }, "zr89-trastuzumab": { "title": "⁸⁹Zr-Trastuzumab", "subtitle": "Trastuzumab antibody (anti-HER2) labeled with zirconium-89. ImmunoPET for HER2+ breast cancer assessment. Long T½ (78h) adapted to antibody pharmacokinetics.", "badges": [ { "cls": "amm-nat", "label": "Research" }, { "cls": "onco", "label": "HER2+ breast cancer" } ], "stats": { "demi_vie": "78.4 h (3.3 d)", "energie": "511 keV", "production": "Cyclotron", "activite": "37-74 MBq", "statut": "Research" }, "formula": "⁸⁹Zr-DFO-trastuzumab", "iupac": "Zirconium-89 desferrioxamine-trastuzumab", "isotope": "⁸⁹Zr", "indications": [ { "title": "HER2+ breast cancer", "tag": "Onco", "desc": "In vivo HER2 mapping. Intra and inter-lesional heterogeneity.", "perf": [ "Phase II" ] }, { "title": "HER2 treatment selection", "tag": "Onco", "desc": "Identification of HER2-discordant patients (IHC- but HER2+ lesion).", "perf": [ "ZEPHIR trial" ] }, { "title": "HER2+ gastric cancer", "tag": "Onco", "desc": "Extension assessment of HER2+ lesions in advanced gastric cancer.", "perf": [ "Prospective studies" ] }, { "title": "Research / theranostics", "tag": "Onco", "desc": "Antibody pharmacokinetic evaluation. Theranostics with ¹⁷⁷Lu-trastuzumab.", "perf": [ "Phase I-II" ] } ], "protocol": { "uptake": "4-7 days post-injection", "acq": "20-40 min", "total": "4-7 days (logistics)" }, "preparation": [ "No fasting required", "Acquisition at 4-7 days post-injection (biodistribution equilibrium)", "No specific premedication (antibodies already used therapeutically)", "Prior hepatic function evaluation", "Inform patient about delayed return for acquisition", "Normal hydration" ], "pitfalls": [ "Long T½ (3 d): non-negligible dosimetric dose", "Physiological uptake: liver (elimination), spleen, bone marrow, intestine", "HAMA effect possible (human anti-mouse antibodies)", "Tumor heterogeneity: may underestimate extension", "Bone uptake: free ⁸⁹Zr from DFO deposits in bone", "909 keV contaminating photon: degrades spatial resolution" ], "pharm_production": [ "Medical cyclotron: ⁸⁹Y(p,n)⁸⁹Zr", "Proton energy: 14-17 MeV", "Target: yttrium-89 (100% natural)", "Hydroxamate chromatography purification", "Trastuzumab labeling via DFO: 60 min, pH 7", "Labeling yield: 70-85%" ], "pharm_qc": [ "Appearance: clear", "pH: 7.0 - 7.5", "Radiochemical purity: ≥ 95% (HPLC)", "Immunoreactive purity: ≥ 80% (ECL test)", "Free ⁸⁹Zr: < 5%", "Endotoxins: < 175 IU/mL" ], "pharm_storage": [ "Lead-shielded vial", "Storage: 4°C (antibody)", "Stability: 48-72 hours", "Centralized production possible (long T½)", "Activity per vial: 100-200 MBq" ], "pharm_distrib": [ "Centralized distribution possible (T½ 3 d)", "Production: Curium, BV Cyclotron Amsterdam", "Cost: 3,000-5,000 € per patient dose", "Essentially research use", "No approval (compassionate/research)" ], "phys_isotope": [ "Annihilation photons detected in PET: 511 keV", "Physical half-life T½: 78.4 h (3.27 days)", "Decay mode: β⁺ (22.74%) + electron capture (77.26%)", "Maximum β⁺ energy: 902 keV", "Average β⁺ energy: 396 keV", "Mean positron range in tissue: 1.3 mm", "Contaminating γ photon: 909 keV (99%) — impact on image resolution", "Sources: ICRP 107, IAEA Nuclear Data" ], "phys_dosi": [ "Adult effective dose: 5.4 × 10⁻¹ mSv/MBq (ICRP 128) — high", "Equivalent to ~ 20-30 mSv for 37-74 MBq injected", "Liver: 1.5 mGy/MBq (critical organ)", "Spleen: 0.7 mGy/MBq", "Bone surface: 0.8 mGy/MBq", "Kidneys: 0.5 mGy/MBq", "Source: ICRP 128, ImmunoPET studies" ], "phys_params": [ "Injected activity (research): 37-74 MBq (1-2 mCi)", "Acquisition at D+4 to D+7", "Acquisition duration: 20-40 min (scanner sensitivity)", "Reconstruction: OSEM-TOF + PSF", "Matrix: 256 × 256", "909 keV photon correction (specific filters)" ], "phys_radioprot": [ "Dose rate at 1m after injection (74 MBq): ~ 10 μSv/h", "Slow decay: factor 2 every 78 h", "Centralized production possible (long T½)", "Patient contact time: limit to 5 min in force position per operator", "Prolonged post-injection precautions (5-7 days)", "Residual activity at patient discharge: very high" ], "mol_svg_2d": "\n \n \n \n trastuzumab\n (anti-HER2)\n \n DFO\n \n ⁸⁹Zr\n ImmunoTEP HER2\n" } }