Wikipedia:WikiProject Chemicals/Chembox validation/VerifiedDataSandbox and Technetium (99mTc) albumin aggregated: Difference between pages

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'''Technetium ^99mTc albumin aggregated''' (^99mTc-MAA) is an injectable [[radiopharmaceutical]] used in [[nuclear medicine]]. It consists of a sterile aqueous suspension of [[Technetium-99m]] (^99mTc) labeled to human [[albumin]] aggregate particles. It is commonly used for [[Ventilation/perfusion scan|lung perfusion scanning]]. It is also less commonly used to visualise a [[peritoneovenous shunt]] and for isotope [[venography]].<ref>{{cite journal | vauthors = MacDonald A, Burrell S | title = Infrequently performed studies in nuclear medicine: Part 1 | journal = Journal of Nuclear Medicine Technology | volume = 36 | issue = 3 | pages = 132–43; quiz 145 | date = September 2008 | pmid = 18703616 | doi = 10.2967/jnmt.108.051383 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gandhi SJ, Babu S, Subramanyam P, Shanmuga Sundaram P | title = Tc-99m macro aggregated albumin scintigraphy - indications other than pulmonary embolism: A pictorial essay | journal = Indian Journal of Nuclear Medicine | volume = 28 | issue = 3 | pages = 152–162 | date = July 2013 | pmid = 24250023 | pmc = 3822414 | doi = 10.4103/0972-3919.119546 | doi-access = free }}</ref>

== Preparation ==

DraxImage MAA kits for preparing ^99mTc-MAA are available in the United States<ref name="DraxImage MAA FDA label">{{cite web | title=DraxImage MAA- kit for the preparation of technetium tc 99m albumin aggregated injection, powder, for solution | work = DailyMed | publisher = U.S. National Library of Medicine | date=31 October 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bbefaa05-1dc0-3ae7-7264-ce1eddf0da2b | access-date=25 March 2020}}</ref> from only a single manufacturer; Jubilant DraxImage Inc. The kits are delivered to nuclear pharmacies as [[Freeze drying|lyophilized]] powders of non-radioactive ingredients sealed under [[nitrogen]]. A nuclear pharmacist adds anywhere from 50 - 100 mCi of Na[[Pertechnetate|[^99mTcO₄]]] to the reaction vial to make the final product, in the pH range of 3.8 to 8.0. After being allowed to react at room temperature for 15 minutes to ensure maximum labeling of the human albumin with ^99mTc, the kit can then be diluted with sterile normal saline as needed.{{medcn|date=March 2020}}

Once prepared the product will have a turbid white appearance.<ref name="Saha92">{{cite book|last1=Saha|first1=Gopal B. |title=Fundamentals of Nuclear Pharmacy |pages=143–167 |date=1992 |publisher=Springer-Verlag |location=New York |isbn=978-1-4757-4027-1 |edition=3rd |chapter=Quality Control of Radiopharmaceuticals |doi=10.1007/978-1-4757-4027-1_8 }}</ref>

===Quality control===

No less than 90% of MAA particles can be between 10 - 90 micrometres in size and no particles may exceed 150 micrometres due to the risk of [[pulmonary artery]] blockade.<ref name="Saha92" /><ref>{{cite journal | vauthors = Fukuoka M, Kobayashi T, Satoh T, Tanaka A, Kubodera A | title = Studies of quality control of 99mTc-labelled macroaggregated albumin--Part 1. Aggregation of non-mercaptalbumin and its conformation | journal = Nuclear Medicine and Biology | volume = 20 | issue = 5 | pages = 643–648 | date = July 1993 | pmid = 8358350 | doi = 10.1016/0969-8051(93)90034-R }}</ref>

No less than 90% of the radioactivity present in the product must be tagged to albumin particles. Thus, no more than 10% soluble impurities may be present.<ref>{{cite book|title=British Pharmacopoeia|isbn=9780113230204|edition=Ph. Eur. 9.0|chapter-url=https://www.pharmacopoeia.com/bp-2017/radiopharmaceutical/technetium--99mtc--albumin-injection.html?date=2017-01-01|chapter=Technetium (99mTc) Albumin Injection|author=British Pharmacopoeia Commission|year=2016|publisher=Stationery Office }}</ref>

==Dosage and imaging ==

The typical adult dose for a lung imaging study is 40-150 [[Megabecquerel]]s (1-4 mCi) (containing between 100,000 - 200,000 albumin particles).<ref>{{cite journal | vauthors = Bajc M, Neilly JB, Miniati M, Schuemichen C, Meignan M, Jonson B | title = EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography | journal = European Journal of Nuclear Medicine and Molecular Imaging | volume = 36 | issue = 8 | pages = 1356–1370 | date = August 2009 | pmid = 19562336 | doi = 10.1007/s00259-009-1170-5 | hdl-access = free | s2cid = 1469776 | hdl = 2158/774307 }}</ref><ref>{{cite journal | vauthors = Parker JA, Coleman RE, Grady E, Royal HD, Siegel BA, Stabin MG, Sostman HD, Hilson AJ | title = SNM practice guideline for lung scintigraphy 4.0 | journal = Journal of Nuclear Medicine Technology | volume = 40 | issue = 1 | pages = 57–65 | date = March 2012 | pmid = 22282651 | doi = 10.2967/jnmt.111.101386 | doi-access = free }}</ref> The particle burden should be lowered for most [[pediatric]] patients and lowered to 50,000 for infants.<ref>{{cite book|last1=Zolle|first1=Ilse |title=Technetium-99m pharmaceuticals |url=https://archive.org/details/technetiummpharm00zoll|url-access=limited|date=2007 |publisher=Springer |location=Berlin |isbn=978-3-540-33989-2 |page=[https://archive.org/details/technetiummpharm00zoll/page/n196 187] |edition=1st |chapter=Monographs of 99mTc Pharmaceuticals }}</ref> The use of more than 250,000 particles in a dose is controversial as little extra data is acquired from such scans while there is an increased risk of toxicity.<ref>{{cite journal | vauthors = Dworkin HJ, Gutkowski RF, Porter W, Potter M | title = Effect of particle number on lung perfusion images: concise communication | journal = Journal of Nuclear Medicine | volume = 18 | issue = 3 | pages = 260–262 | date = March 1977 | pmid = 839273 | url = http://jnm.snmjournals.org/content/18/3/260.long }}</ref><ref>{{cite journal | vauthors = Kaplan WD, Come SE, Takvorian RW, Laffin SM, Gelman RS, Weiss GR, Garnick MB | title = Pulmonary uptake of technetium 99m macroaggregated albumin: a predictor of gastrointestinal toxicity during hepatic artery perfusion | journal = Journal of Clinical Oncology | volume = 2 | issue = 11 | pages = 1266–1269 | date = November 1984 | pmid = 6491704 | doi = 10.1200/JCO.1984.2.11.1266 }}</ref> Patients with pulmonary hypertension should be administered a minimum number of particles to achieve a lung scan (i.e. 60,000). In any patient by administering a greater quantity of particles than necessary for the diagnostic procedure increases the risks of toxicity.{{medcn|date=March 2020}}

Because of gravity effects, people administered ^99mTc MAA should be in the supine position to ensure as even a distribution of particles throughout the lungs as possible.{{medcn|date=March 2020}}

The total percentage of particles trapped in the lungs can be determined through a whole body scan after the administration of ^99mTc MAA through the equation:{{medcn|date=March 2020}}

:<math>\%\ \text{Right-to-left shunt} = \left(\frac{(\text{Total body counts}) - (\text{Total lung counts})}{(\text{Total body counts})}\right)\times 100\%</math>.

==History==

The technetium tc 99m aggregated albumin kit was approved for use in the United States in December 1987.<ref>{{cite web | title=Technetium tc 99m aggregated albumin kit: FDA-Approved Drugs | website=U.S. [[Food and Drug Administration]] (FDA) | date=23 March 2020 | url=https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=017881 | access-date=25 March 2020}}</ref>

== References ==

{{reflist}}

== Further reading ==

{{refbegin}}

* {{cite book | vauthors = Kowalsky RJ, Falen SW | title = Radiopharmaceuticals in Nuclear Pharmacy and Nuclear Medicine | edition = 2nd | publisher = American Pharmacist Association | date = 2004 }}

{{refend}}

{{Radiopharmaceuticals}}

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[[Category:Radiopharmaceuticals]]

[[Category:Technetium-99m]]