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Li S, Schmitz A, Lu YT, Pal R, Sarkar S, Sellmyer MA, Mach RH, Lee H. Automation of simplified two-step radiolabeling via ditosylate synthon for 18F-labeled radiotracers using AllinOne module. Nucl Med Biol 2024; 138-139:108948. [PMID: 39277961 DOI: 10.1016/j.nucmedbio.2024.108948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/03/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024]
Abstract
Direct fluorination of a tosylate or mesylate precursor has been a wide-spread and reliable way for radio-fluorination. This approach can be difficult to achieve when the precursor cannot be easily obtained or is chemically unstable. A possible alternative method is to radiolabel ethylene ditosylate or 1,3-propanediol di-p-tosylate to form a radiofluorinated synthon. Here we present the automation of a simplified and reliable approach for the two-step fluorination using [18F]FP-TMP, an analog of antibacterial agent trimethoprim. We demonstrate the feasibility of purifying the fluorinated synthon via filtration, and one final HPLC purification on a commercially available Trasis AllinOne module. The overall reaction time for the two-step reaction is around 90 min andthe decay-corrected yield for more than fifty preparations of [18F]FP-TMP is 22 ± 5 % with high radiochemical purity (≥ 90 %) and specific activities (147 ± 107 GBq/μmol). All batches passed pre-established quality control specifications, demonstrating the utility of using this method in tracer syntheses that meet good manufacturing practice (GMP) requirement. This method can be adopted to the syntheses of other radiotracers, such as [18F]FE-TMP, (+)-[18F]F-PHNO and [18F]FFMZ.
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Affiliation(s)
- Shihong Li
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA
| | - Alexander Schmitz
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA
| | - Yu-Ting Lu
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA
| | - Rammyani Pal
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA
| | - Swarbhanu Sarkar
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA
| | - Mark A Sellmyer
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA; Department of Biochemistry and Biophysics, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert H Mach
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA
| | - Hsiaoju Lee
- Department of Radiology, University of Pennsylvania; Philadelphia, PA, USA.
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Weitzer F, Stanzel S, Plhak E, Aigner RM. Clinical value of semi-quantitative parameters in 68Ga-DOTANOC PET/CT in treatment and diagnostics of cranial meningioma in a single-center retrospective analysis. EJNMMI REPORTS 2024; 8:13. [PMID: 38744713 PMCID: PMC11093962 DOI: 10.1186/s41824-024-00204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The value of somatostatin-analogon PET tracers in theranostics in cranial meningioma has been demonstrated in several studies however, the value of semi-quantitative parameters for therapy and patient outcome is still unclear. METHODS A retrospective study was performed comparing measured semi-quantitative 68Ga-DOTANOC PET/CT parameters (maximum standardized uptake value = SUVmax, mean standardized uptake value = SUVmean, and metabolic tumor volume = MTV) and calculated ratios (SUVmax tumor/to pituitary gland, SUVmax tumor to superior sinus sagittalis), versus WHO grades and overall outcome. Patients with histological confirmed meningioma or high probability for meningioma in previous cranial MRI were eligible. RESULTS Thirty-two patients from January 2018 to February 2023 were retrospectively included. WHO grade I meningioma was confirmed in 17 patients, WHO grade II in five patients, WHO grade III in two patients, while in eight patients diagnosis was solely based on MRI and 68Ga-DOTANOC PET/CT findings. In 12 cases stable disease was present, in 15 cases radiation therapy was chosen, in three cases neurosurgery was preferred while in two cases palliative care was chosen. Median SUVmax values increased with WHO grade (15.84, 17.22, and 28.4, p = 0.134, Kruskal-Wallis-test) and no statistically significant difference was present for MTV, SUVmax, and calculated ratios, although the ratio for SUVmax tumor to superior sinus sagittalis had the lowest value of p = 0.067. CONCLUSION Increased SUVmax values in the tumor in 68Ga-DOTANOC PET/CT are associated with higher WHO grade, although further studies including larger patient collectives are needed to solidify this hypothesis.
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Affiliation(s)
- Friedrich Weitzer
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria.
| | - Susanne Stanzel
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
| | - Elisabeth Plhak
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
| | - Reingard Maria Aigner
- Department of Radiology, Division of Nuclear Medicine, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
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Weitzer F, Stanzel S, Plhak E, Aigner RM. Clinical value of semi-quantitative parameters in 68Ga-DOTANOC PET/CT in treatment and diagnostics of cranial meningioma in a single-center retrospective analysis. EJNMMI REPORTS 2024; 8:10. [PMID: 38748290 PMCID: PMC11045701 DOI: 10.1186/s41824-024-00193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/21/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The value of somatostatin-analogon PET tracers in theranostics in cranial meningioma has been demonstrated in several studies; however, the value of semi-quantitative parameters for therapy and patient outcome is still unclear. METHODS A retrospective study was performed comparing measured semi-quantitative 68Ga-DOTANOC PET/CT parameters (maximum standardized uptake value = SUVmax, mean standardized uptake value = SUVmean, and metabolic tumor volume = MTV) and calculated ratios (SUVmax tumor to pituitary gland and SUVmax tumor to superior sinus sagittalis), versus the WHO grades and overall outcome. Patients with histological confirmed meningioma or high probability for meningioma in the previous cranial MRI were eligible. RESULTS Thirty-two patients from January 2018 to February 2023 were retrospectively included. The WHO grade I meningioma was confirmed in 17 patients, the WHO grade II in five patients, and the WHO grade III in two patients, while in eight patients, diagnosis was solely based on MRI and 68Ga-DOTANOC PET/CT findings. In 12 cases, stable disease was present, in 15 cases, radiation therapy was chosen, in three cases, neurosurgery was preferred, while in two cases, palliative care was chosen. Median SUVmax values increased with the WHO grade (15.84, 17.22, and 28.4, p = 0.134, Kruskal-Wallis test), and no statistically significant difference was present for MTV, SUVmax, and calculated ratios. CONCLUSION Increased SUVmax values in the tumor in 68Ga-DOTANOC PET/CT are associated with higher WHO grade, although further studies including larger patient collectives are needed to solidify this hypothesis.
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Affiliation(s)
- Friedrich Weitzer
- Department of Radiology, Division of Nuclear Medicine Medical, University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria.
| | - Susanne Stanzel
- Department of Radiology, Division of Nuclear Medicine Medical, University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
| | - Elisabeth Plhak
- Department of Radiology, Division of Nuclear Medicine Medical, University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
| | - Reingard Maria Aigner
- Department of Radiology, Division of Nuclear Medicine Medical, University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
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van Brandwijk EA, Aalbersberg EA, Hosseini AS, Huitema ADR, Hendrikx JJMA. Automated radiolabelling of [ 68Ga]Ga-PSMA-11 (gallium ( 68Ga)-gozetotide) using the Locametz® kit and two generators. EJNMMI Radiopharm Chem 2024; 9:31. [PMID: 38632189 PMCID: PMC11024066 DOI: 10.1186/s41181-024-00260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Steps have been taken by pharmaceutical companies to obtain marketing authorisation of PSMA ligands in the European Union. Since December 2022, Locametz® (PSMA-11, gozetotide) is licensed as kit for manual radiolabelling with gallium-68 and commercially available since mid-2023. The Summary of Product Characteristic (SmPC) describes manual radiolabelling with a maximum activity after radiolabelling of 1369 MBq. We aimed for radiolabelling with a higher activity to increase production efficiency, and thus, automated radiolabelling is strongly preferred over manual radiolabelling to reduce radiation exposure to personnel. The aim of this study was to develop and validate a method for automated radiolabelling of the Locametz® kit using ~ 2000 MBq of gallium-68 eluate for radiolabelling. RESULTS Automated radiolabelling of [68Ga]Ga-PSMA-11 using the Locametz® kit provided a product which complies to the Ph. Eur., had a shelf-life of 6 h at room temperature, and theoretically reduced radiation exposure 5.7 times. Radiolabelling with one and two generator(s) resulted in a radiochemical yield of 91-102% and 96-101% after preparation, respectively. The radiochemical purity ranged from 98.0 to 99.6% for radiolabelling with one generator and ranged from 98.4 to 99.3% for radiolabelling with two generators with similar stability. The activity of the final product was much higher when using two generators, 1961-2035 MBq compared to 740-1260 MBq, which leads to ~ 1.5 times more patient syringes available per preparation. CONCLUSION Automated radiolabelling of [68Ga]Ga-PSMA-11 using the Locametz® kit with higher gallium-68 activity than specified in the SmPC results in a product that is in compliance with the Ph. Eur. monograph and has a shelf-life of 6 h at room temperature. Radiolabelling with two generators proved possible and resulted in a product with similar quality but with much higher efficiency.
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Affiliation(s)
- Elke A van Brandwijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Else A Aalbersberg
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Arman S Hosseini
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Pharmacology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Jeroen J M A Hendrikx
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Cao TT, Aalbersberg EA, Geluk-Jonker MM, Hendrikx JJMA. Validation of an automated dispensing system for subsequent dose dispensing of different radionuclides. EJNMMI Radiopharm Chem 2024; 9:11. [PMID: 38345760 PMCID: PMC10861413 DOI: 10.1186/s41181-023-00228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Automated dispensing systems (ADSs) for radiopharmaceuticals have been developed to reduce the radiation exposure of personnel, to improve the accuracy of the dispensed dose and to limit the microbiological contamination. However, before implementing such systems, validation according to various applicable guidelines is necessary to ensure safety and quality. Here we present the selection, validation and implementation of the PT459R2 from manufacturer Lynax s.r.o. as a guidance protocol for validation according to GMP and GRPP guidelines. Validation included linearity accuracy and precision of the internal scintillation detector for different isotopes and microbiological validation for aseptic procedures. RESULTS The ADS can dispense accurate doses in the following linear range: 1000-10,000 MBq for lutetium-177, 20-74 MBq for zirconium-89, 100-1000 MBq for gallium-68 and 100-2000 MBq for fluorine-18. The maximum bias is 2.35% and the maximum coefficient of variation is 3.03% which meets the acceptance criteria of < 5%. Furthermore, the ADS does not affects the GMP class A environment in a laminar airflow cabinet and can dispense aseptically. In addition, radiation exposure is acceptable and data integrity is preserved. CONCLUSION The PT459R2 ADS met all the requirements from our performance qualification and is therefore suitable for daily routine use in our center. Our approach can be used as a guidance for PQ of an ADS in a Radiopharmacy according to GMP and GRPP guidelines.
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Affiliation(s)
- T T Cao
- Department of Nuclear Medicine, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- GE Healthcare, Leiderdorp, The Netherlands
| | - E A Aalbersberg
- Department of Nuclear Medicine, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M M Geluk-Jonker
- Department of Nuclear Medicine, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Cell Therapy Facility, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J M A Hendrikx
- Department of Nuclear Medicine, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Weitzer F, Pernthaler B, Plhak E, Riedl R, Aigner RM. Diagnostic value of two-time point [ 68Ga]Ga-PSMA-11 PET/CT in the primary staging of untreated prostate cancer. Sci Rep 2023; 13:8297. [PMID: 37217532 DOI: 10.1038/s41598-023-35628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/21/2023] [Indexed: 05/24/2023] Open
Abstract
The emerging PET tracer [68Ga]Ga-PSMA-11 has been established for staging in prostate cancer (PCa). Aim was to determine the value of early static imaging in two-phase PET/CT. 100 men with newly diagnosed histopathologically confirmed untreated PCa who underwent [68Ga]Ga-PSMA-11 PET/CT from January 2017 to October 2019 were included. The two-phase imaging protocol consisted of an early static scan of the pelvis (6 min p.i.) and a late total-body scan (60 min p.i). Associations of semi-quantitative parameters derived via volumes of interest (VOI) with Gleason grade group and PSA were investigated. In 94/100 patients (94%) the primary tumor was detected in both phases. In 29/100 patients (29%) metastases were detected at a median PSA level of 32.2 ng/ml (0.41-503 ng/ml). In 71/100 patients (71%) without metastasis a median PSA level of 10.1 ng/ml (0.57-103 ng/ml) was observed (p = < 0.001). Primary tumors demonstrated a median standard uptake value maximum (SUVmax) of 8.2 (3.1-45.3) in early phase versus 12.2 (3.1-73.4) in late phase and a median standard uptake value mean (SUVmean) of 4.2 (1.6-24.1) in early phase versus 5.8 (1.6-39.9) in late phase, significantly increasing over time (p = < 0.001). Higher SUVmax and SUVmean were associated with higher Gleason grade group (p = 0.004 and p = 0.003, respectively) and higher PSA levels (p = < 0.001). In 13/100 patients the semi-quantitative parameters including SUVmax were declining in the late phase compared to early phase. Two-phase [68Ga]Ga-PSMA-11 PET/CT demonstrates a high detection rate for primary tumor of untreated PCa of 94% and improves diagnostic accuracy. Higher PSA levels and Gleason grade group are associated with higher semi-quantitative parameters in the primary tumor. Early imaging provides additional information in a small sub-group with declining semi-quantitative parameters in the late phase.
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Affiliation(s)
- Friedrich Weitzer
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria.
| | - Birgit Pernthaler
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
| | - Elisabeth Plhak
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Reingard Maria Aigner
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9A, 8036, Graz, Austria
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Kniess T, Zessin J, Mäding P, Kuchar M, Kiss O, Kopka K. Synthesis of [ 18F]FMISO, a hypoxia-specific imaging probe for PET, an overview from a radiochemist's perspective. EJNMMI Radiopharm Chem 2023; 8:5. [PMID: 36897480 PMCID: PMC10006378 DOI: 10.1186/s41181-023-00190-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND [18F]fluoromisonidazole ([18F]FMISO, 1H-1-(3-[18F]fluoro-2-hydroxypropyl)-2-nitroimidazole) is a commonly used radiotracer for imaging hypoxic conditions in cells. Since hypoxia is prevalent in solid tumors, [18F]FMISO is in clinical application for decades to explore oxygen demand in cancer cells and the resulting impact on radiotherapy and chemotherapy. RESULTS Since the introduction of [18F]FMISO as positron emission tomography imaging agent in 1986, a variety of radiosynthesis procedures for the production of this hypoxia tracer has been developed. This paper gives a brief overview on [18F]FMISO radiosyntheses published so far from its introduction until now. From a radiopharmaceutical chemist's perspective, different precursors, radiolabeling approaches and purification methods are discussed as well as used automated radiosynthesizers, including cassette-based and microfluidic systems. CONCLUSION In a GMP compliant radiosynthesis using original cassettes for FASTlab we produced [18F]FMISO in 49% radiochemical yield within 48 min with radiochemical purities > 99% and molar activities > 500 GBq/µmol. In addition, we report an easy and efficient radiosynthesis of [18F]FMISO, based on in-house prepared FASTlab cassettes, providing the radiotracer for research and preclinical purposes in good radiochemical yields (39%), high radiochemical purities (> 99%) and high molar activity (> 500 GBq/µmol) in a well-priced option.
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Affiliation(s)
- Torsten Kniess
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany.
| | - Jörg Zessin
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Peter Mäding
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Manuela Kuchar
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Oliver Kiss
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Klaus Kopka
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany.,Faculty of Chemistry and Food Chemistry, School of Science, Technische Universität Dresden, Mommsenstraße 4, 01069, Dresden, Germany.,National Center for Tumor Diseases (NCT) Dresden, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Atanasova Lazareva M, Kolevska K, Chochevska M, Velickovska M, Jolevski F, Ugrinska A, Janevik-Ivanovska E. Aseptic process validation of [18F]Sodium Fluoride radiopharmaceutical in-house production. MAKEDONSKO FARMACEVTSKI BILTEN 2023. [DOI: 10.33320/maced.pharm.bull.2022.68.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Sodium fluoride ([18F]NaF) is a PET radiopharmaceutical for vizualization of the skeletal system and microcalcification. In the originally designed in-house method, [18F]NaF is recovered in aqueous solution after cyclotron irradiation, sterilized by passage through a 0.22 µm sterile filter and dispensed under aseptic conditions. To ensure the microbiological safety of drugs produced under aseptic conditions, validation of aseptic procedures is always recommended. This is essential for radiopharmaceuticals because most of them are released for administration before any sterility test can be completed due to their radioactive nature.
This study reports the validation of the aseptic process applied to the internal production of [18F]NaF carried out in two phases: testing the number of viable microorganisms in radiopharmaceutical product prior to sterilization and process simulation studies (media fill tests). We found that all samples were sterile and the endotoxin concentration was well below the maximum acceptable level reported in the Ph Eur. monograph on [18F]NaF. The results confirmed that the entire production process of [18F]NaF can be carried out under strictly aseptic conditions following the validated procedures preserving the sterility of the final product.
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Affiliation(s)
- Marija Atanasova Lazareva
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Katerina Kolevska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Maja Chochevska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Maja Velickovska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Filip Jolevski
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Ana Ugrinska
- University Institute of Positron Emission Tomography, Skopje, Bledski dogovor 10, 1000 Skopje, North Macedonia
| | - Emilija Janevik-Ivanovska
- Faculty of Medical Sciences, Goce Delcev University, Krste Misirkov 10-A, 2000 Stip, North Macedonia
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Sammartano A, Migliari S, Scarlattei M, Baldari G, Serreli G, Lazzara C, Garau L, Ghetti C, Ruffini L. Performance and long-term consistency of five Galliform 68Ge/68Ga generators used for clinical Ga-68 preparations over a 4 year period. Nucl Med Commun 2022; 43:568-576. [PMID: 35190517 DOI: 10.1097/mnm.0000000000001545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gallium-68 is a positron emitter for PET applications that can be produced without cyclotron by a germanium (Ge-68) chloride/gallium (Ga-68) chloride generator. Short half-life (67.71 min) of Ga-68, matching pharmacokinetic properties of small biomolecules, facilitates isotope utilization in compounding radiopharmaceuticals for PET imaging. The increasing cost of good manufacturing practice-compliant generators has strengthened the need for radionuclide efficient use by planning specific radiopharmaceutical sessions during the week, careful maintenance of the generator and achievement of high labeling yield and radiochemical purity (RCP) of the radiolabeled molecules. METHODS The aim of this study was to evaluate the annual performance of five consecutive 68Ge/68Ga generators used for small-scale preparations of 68Ga-radiopharmaceuticals. To assess the long-term efficiency of isotope production we measured the weekly elution yield. To assess process efficiency we measured elution yield, labeling yield and RCP of four radiopharmaceutical preparations (68Ga-DOTATOC, 68Ga-PSMA-HBED-CC, 68Ga-PENTIXAFOR and 68Ga-DOTATATE). RESULTS The annual mean elution yield of the generators was 74.7%, higher than that indicated by the manufacturer, and it never went below 65%. The Ge-68 level in the final products was under the detection limits in all the produced batches (mean value 0.0000048%). The RCP of radiopharmaceuticals determined by high-performance liquid chromatography was 98 ± 0.22%. The mean yield of radiolabelling was 64.68, 68.71, 57 and 63.68% for 68Ga-DOTATOC, 68Ga-PSMA-HBED-CC, 68GaPENTIXAFOR and 68Ga-DOTATATE. CONCLUSION The ability to prepare in the hospital radiopharmacy high-purity and pharmaceutically acceptable 68Ga-radiolabeled probes on a routine basis facilitates patient access to precision imaging for clinical and research aims.
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Affiliation(s)
| | | | | | | | - Giulio Serreli
- Diagnostic Department, Medical Physics Unit, Azienda Ospedaliero-Universitaria di Parma, Gramsci, Parma, Italy
| | | | | | - Caterina Ghetti
- Diagnostic Department, Medical Physics Unit, Azienda Ospedaliero-Universitaria di Parma, Gramsci, Parma, Italy
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Griffiths GL, Vasquez C, Escorcia F, Clanton J, Lindenberg L, Mena E, Choyke PL. Translating a radiolabeled imaging agent to the clinic. Adv Drug Deliv Rev 2022; 181:114086. [PMID: 34942275 PMCID: PMC8889912 DOI: 10.1016/j.addr.2021.114086] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023]
Abstract
Molecular Imaging is entering the most fruitful, exciting period in its history with many new agents under development, and several reaching the clinic in recent years. While it is unusual for just one laboratory to take an agent from initial discovery through to full clinical approval the steps along the way are important to understand for all interested participants even if one is not involved in the entire process. Here, we provide an overview of these processes beginning at discovery and preclinical validation of a new molecular imaging agent and using as an exemplar a low molecular weight disease-specific targeted positron emission tomography (PET) agent. Compared to standard drug development requirements, molecular imaging agents may benefit from a regulatory standpoint from their low mass administered doses, they nonetheless still need to go through a series of well-defined steps before they can be considered for Phase 1 human testing. After outlining the discovery and preclinical validation approaches, we will also discuss the nuances of Phase 1, Phase 2 and Phase 3 studies that may culminate in an FDA general use approval. Finally, some post-approval aspects of novel molecular imaging agents are considered.
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Affiliation(s)
- Gary L. Griffiths
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Frederick, MD
| | - Crystal Vasquez
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | - Freddy Escorcia
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | | | - Liza Lindenberg
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | - Esther Mena
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
| | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, Bethesda, MD
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Abstract
The EANM herewith clearly expresses its commitment and support to the non-commercial in-house preparation of radiopharmaceuticals for direct use in accordance with European and national regulations.
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Decristoforo C, Lyashchenko SK. Radiopharmaceutical legislation. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Boschi S, Todde S. PET radiopharmacy and automation. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Boersma HH. GMP in radiopharmacy: The current situation in its context. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Asa S, Sonmezoglu K, Uslu-Besli L, Sahin OE, Karayel E, Pehlivanoglu H, Sager S, Kabasakal L, Ocak M, Sayman HB. Evaluation of F-18 DOPA PET/CT in the detection of recurrent or metastatic medullary thyroid carcinoma: comparison with GA-68 DOTA-TATE PET/CT. Ann Nucl Med 2021; 35:900-915. [PMID: 33993425 DOI: 10.1007/s12149-021-01627-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/07/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE PET imaging with F-18 DOPA (FDOPA) and Ga-68 DOTATATE (TATE) shows the most promising results to detect medullary thyroid cancer (MTC) recurrence. We performed this comparative study to detect the site of recurrent or metastatic disease in MTC patients with elevated serum calcitonin (Ctn) and/or carcinoembryonic antigen (CEA) levels. METHODS We studied 46 MTC patients (25 women, 21 men) with elevated Ctn and/or CEA levels during follow-up who had both FDOPA and TATE PET/CT scans for re-staging purposes. RESULTS FDOPA PET imaging yielded an overall sensitivity of 86.8%, specificity of 100%, PPV of 100%, NPV of 61.5%, and accuracy of 89.1%, while TATE PET scan had the same values as 84.2%, 87.5%, 96.9%, 53.8%, and 84.6%, respectively, and there was no statistically significant difference between the two modalities with the exception of the specificity value that was higher for FDOPA imaging. In a subgroup of patients with overt Ctn or CEA elevation, sensitivity of FDOPA increased significantly, whereas TATE sensitivity did not change. FDOPA PET imaging was significantly superior in detecting liver and regional lymph node (LN) metastases, while TATE PET scan was significantly better in the skeletal metastases. Early FDOPA demonstrated 11 invisible lesions on late FDOPA. CONCLUSION Both FDOPA and TATE PET/CT imaging are useful to localize recurrences in MTC patients. While TATE imaging is superior to reveal skeletal disease, FDOPA seems better in liver and regional LN metastases; therefore, the two modalities appear complementary in monitoring MTC patients with elevated serum Ctn and/or CEA levels.
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Affiliation(s)
- Sertac Asa
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey.
| | - Lebriz Uslu-Besli
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Onur Erdem Sahin
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Emre Karayel
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Huseyin Pehlivanoglu
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Sait Sager
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Levent Kabasakal
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
| | - Meltem Ocak
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, Beyazit, 34116, Istanbul, Turkey
| | - Haluk B Sayman
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34098, Istanbul, Turkey
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Decristoforo C, Neels O, Patt M. Emerging Radionuclides in a Regulatory Framework for Medicinal Products - How Do They Fit? Front Med (Lausanne) 2021; 8:678452. [PMID: 34124109 PMCID: PMC8192700 DOI: 10.3389/fmed.2021.678452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022] Open
Abstract
Recent years have seen the establishment of several radionuclides as medicinal products in particular in the setting of theranostics and PET. [177Lu]Lutetium Chloride or [64Cu]Copper Chloride have received marketing authorization as radionuclide precursor, [68Ga]Gallium Chloride has received regulatory approval in the form of different 68Ge/68Ga generators. This is a formal requirement by the EU directive 2001/83, even though for some of these radionuclide precursors no licensed kit is available that can be combined to obtain a final radiopharmaceuticals, as it is the case for Technetium-99m. In view of several highly promising, especially metallic radionuclides for theranostic applications in a wider sense, the strict regulatory environment poses the risk of slowing down development, in particular for radionuclide producers that want to provide innovative radionuclides for clinical research purposes, which is the basis for their further establishment. In this paper we address the regulatory framework for novel radionuclides within the EU, the current challenges in particular related to clinical translation and potential options to support translational development within Europe and worldwide.
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Affiliation(s)
- Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Oliver Neels
- Department of Radiopharmaceuticals Production, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Marianne Patt
- Department for Nuclear Medicine, Radiochemistry, University of Leipzig, Leipzig, Germany
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Gillings NM, Elsinga PH. Spotlight on: guideline on current good radiopharmacy practice (cGRPP) for the small-scale preparation of radiopharmaceuticals published in EJNMMI Radiopharmacy and Chemistry (2021)6:8. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00437-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Gillings N, Hjelstuen O, Ballinger J, Behe M, Decristoforo C, Elsinga P, Ferrari V, Peitl PK, Koziorowski J, Laverman P, Mindt TL, Neels O, Ocak M, Patt M, Todde S. Guideline on current good radiopharmacy practice (cGRPP) for the small-scale preparation of radiopharmaceuticals. EJNMMI Radiopharm Chem 2021; 6:8. [PMID: 33580358 PMCID: PMC7881071 DOI: 10.1186/s41181-021-00123-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 11/28/2022] Open
Abstract
This guideline on current good radiopharmacy practice (cGRPP) for small-scale preparation of radiopharmaceuticals represents the view of the Radiopharmacy Committee of the European Association of Nuclear Medicine (EANM). The guideline is laid out in the format of the EU Good Manufacturing Practice (GMP) guidelines as defined in EudraLex volume 4. It is intended for non-commercial sites such as hospital radiopharmacies, nuclear medicine departments, research PET centres and in general any healthcare establishments. In the first section, general aspects which are applicable to all levels of operations are discussed. The second section discusses the preparation of small-scale radiopharmaceuticals (SSRP) using licensed generators and kits. Finally, the third section goes into the more complex preparation of SSRP from non-licensed starting materials, often requiring a purification step and sterile filtration. The intention is that the guideline will assist radiopharmacies in the preparation of diagnostic and therapeutic SSRP’s safe for human administration.
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Affiliation(s)
- Nic Gillings
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | | | - Jim Ballinger
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, UK
| | - Martin Behe
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Philip Elsinga
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Peter Laverman
- Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Thomas L Mindt
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Oliver Neels
- Institute for Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Meltem Ocak
- Department of Pharmaceutical Technology, Istanbul University, Istanbul, Turkey
| | - Marianne Patt
- Department for Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Sergio Todde
- Tecnomed Foundation, University of Milano - Bicocca, Milan, Italy
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Kleynhans J, Rubow S, le Roux J, Marjanovic-Painter B, Zeevaart JR, Ebenhan T. Production of [ 68 Ga]Ga-PSMA: Comparing a manual kit-based method with a module-based automated synthesis approach. J Labelled Comp Radiopharm 2020; 63:553-563. [PMID: 32865290 DOI: 10.1002/jlcr.3879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
The labeling of peptides with gallium-68 is often initially performed by manual labeling, but with high clinical demand, other alternatives are needed. Cold-kits or automated synthesis are viable options for standardized methods and deemed pharmaceutically more acceptable. This study compares these [68 Ga]Ga-PSMA-11 production methods. Data from 40 kit-based and 40 automated syntheses of [68 Ga]Ga-PSMA-11 were analyzed. Pre-set criteria were evaluated including radiochemical purity, radionuclidic purity, chemical purity, physiological acceptability and sterility. The operator time and radiation dose received were measured. The robustness and repeatability of each method were assessed and a comparison of the running costs of each method is also provided. For both the methods all the analyzed products met the release criteria. No differences were found in radiochemical purity, radiochemical identity, radionuclidic purity, and sterility. However, radiochemical yield and apparent molar activity showed significant differences. For both methods, whole body radiation exposure to operators was lower than with manual labeling (25 - 40 μSv). The exposure during kit-based labeling (14.5 ± μSv) was seven times higher than that of automated synthesis (2.05 ± 0.99 μSv). The automated synthesis was the more expensive method. Both methods are sound alternatives to manual synthesis and offer higher quality, better radiation protection and a more reliable manufacturing of radiopharmaceuticals.
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Affiliation(s)
- Janke Kleynhans
- Nuclear Medicine Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- NuMeRI, Nuclear Medicine Research Infrastructure NPC, Pretoria, South Africa
| | - Sietske Rubow
- Nuclear Medicine Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jannie le Roux
- Nuclear Medicine Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- NuMeRI Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jan Rijn Zeevaart
- NuMeRI, Nuclear Medicine Research Infrastructure NPC, Pretoria, South Africa
- The South African Nuclear Energy Corporation (Necsa), Radiochemistry, Pelindaba, Brits, South Africa
| | - Thomas Ebenhan
- NuMeRI, Nuclear Medicine Research Infrastructure NPC, Pretoria, South Africa
- The South African Nuclear Energy Corporation (Necsa), Radiochemistry, Pelindaba, Brits, South Africa
- Nuclear Medicine, University of Pretoria, Pretoria, South Africa
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20
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Sammartano A, Migliari S, Scarlattei M, Baldari G, Ruffini L. Validation of Quality Control Parameters of Cassette-Based Gallium-68-DOTA-Tyr3-Octreotate Synthesis. Indian J Nucl Med 2020; 35:291-298. [PMID: 33642752 PMCID: PMC7905293 DOI: 10.4103/ijnm.ijnm_66_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose of the Study: Gallium (Ga)-68-DOTA peptides targeting somatostatin receptors have been assessed as a valuable tool in neuroendocrine tumor imaging using positron emission tomography. However, at the moment, a specific monograph in the European Pharmacopoeia (Ph. Eur.) does exist only for Ga-68-edotreotide (DOTATOC) injection. Here, we report on the validation process of Ga-68-DOTA-Tyr3-octreotate (DOTATATE) cassette-based production and quality control (QC). Materials and Methods: Preparation of Ga-68-DOTATATE was performed according to the current European Union-good manufacturing practices, the current good radiopharmacy practice, the Ph. Eur., and the guidelines on validation of analytical methods for radiopharmaceuticals. Process was validated via three consecutive production runs to ensure that the methods are reproducible and reliable in routine use. The QC tests for Ga-68-DOTATATE were radiochemical purity (RCP – high-pressure liquid chromatography [HPLC]), radiochemical impurities 68Ga3+ (HPLC and instant thin layer chromatography [ITLC]), chemical purity (HPLC and gas chromatography [GC]), pH (pH-strips), radionuclidic purity (principal γ-photon), germanium-breakthrough (68Ge-content), Ga-68 half-life (γ-ray spectrometry), and sterility/endotoxin assay. Results: Radiolabeling procedure of Ga-68-DOTATATE fits all the applicable Ph. Eur. specifications. RCP measured via ITLC was >99% in the three validation batches. HPLC-measured RCP resulted 99.45%, 99.78%, and 99.75%. Germanium-breakthrough was far below the recommended level established in the Ph. Eur. Ga-68-DOTATOC injection (#2482). Residual ethanol tested with GC was less than 10%. All the batches were tested for endotoxin content, which always resulted lower than 17.5 EU/ml. All preparations passed the sterility tests. pH of the final product was 7 in all samples. Conclusion: Ga-68-DOTATATE fulfilled all the pre-set QCs and release criteria in the batches considered for this validation study. The results demonstrated a batch-to-batch reproducibility, ensuring that synthesis process leads to the expected final product in terms of yield, quality, reliability, safety, and efficacy.
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Affiliation(s)
- Antonino Sammartano
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Silvia Migliari
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Maura Scarlattei
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Giorgio Baldari
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Livia Ruffini
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
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21
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ARRONAX Cyclotron: Setting up of In-House Hospital Radiopharmacy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1572841. [PMID: 32566657 PMCID: PMC7275628 DOI: 10.1155/2020/1572841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/17/2020] [Indexed: 11/17/2022]
Abstract
Whilst radiopharmaceuticals have an important role to play in both imaging and treatment of patients, most notably cancer patients, nuclear medicine and radiopharmacy are currently facing challenges to create innovative new drugs. Traditional radiopharmaceutical manufacture can be considered as either a routine hospital production or a large-scale industrial production. The gap between these two practices has meant that there is an inability to supply innovative radiopharmaceuticals for use at the local level for mono- or multicentric clinical trials with satisfactory quality and safety specifications. This article highlights the regulatory requirements in aseptic pharmaceutical processing and in nuclear medicine to be able to locally produce radiopharmaceuticals. We validate the proof-of-concept for an “in-house” hospital-based radiopharmacy including an on-site cyclotron, that can fulfill the conflicting requirements between radiation safety and aseptic processing. The ARRONAX in-house radiopharmacy is currently able to provide sterile and pyrogenic-free injectable radiopharmaceutical compounds for both industrial and institutional clinical trials.
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22
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Historical and radiopharmaceutical relevance of [18F]FDG. J Radioanal Nucl Chem 2020. [DOI: 10.1007/s10967-020-07013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Goud NS, Joshi RK, Bharath RD, Kumar P. Fluorine-18: A radionuclide with diverse range of radiochemistry and synthesis strategies for target based PET diagnosis. Eur J Med Chem 2020; 187:111979. [DOI: 10.1016/j.ejmech.2019.111979] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022]
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Martin T, Moyon A, Fersing C, Terrier E, Gouillet A, Giraud F, Guillet B, Garrigue P. Have you looked for "stranger things" in your automated PET dose dispensing system? A process and operators qualification scheme. EJNMMI Radiopharm Chem 2019; 4:11. [PMID: 31659501 PMCID: PMC6565780 DOI: 10.1186/s41181-019-0061-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Many nuclear medicine departments have equipped themselves with automated dispensing systems (ADS) for PET radiopharmaceuticals, in both the operators’ and the patients’ interests. Whether partially or fully automated, to date there is no marketed ADS representing a true “closed-system”. Despite the sterile, injectable nature of ready-to-use radiopharmaceutical drug solutions manipulated by these systems, neither manufacturer’s recommendation nor literature report was found about specific qualification of the process’ sterility, or about operators’ qualification on these dispensing systems. We set up a master plan validation in a radiopharmacy equipped with Trasis Unidose®, including: 1) monthly process-simulating media-fill tests and microbiological contamination assessments of the ADS surfaces; 2) initial and periodic qualification of the operators. The microbiological qualification consisted in surface biocontamination assessment on critical zones with Tryptic-Soy agar. The operator qualification consisted in the evaluation of the operators’ knowledge and skills for using the ADS. Results This study highlighted a minor, handborne microbiological contamination on our first assessment, that corrective actions solved. We therefore decided to brief our operators once a month on microbiological control results, hygiene and good practices, with the support of the present case illustrating the biodecontamination efficiency. Conclusions As the automation of PET monodose conditioning process still implies human intervention for material preparation and manual biodecontamination, this study illustrates that initial and periodic qualification of the environment and the conditioning process of ADS, including microbiological qualification and operators’ qualification, are needed to meet specifications.
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Affiliation(s)
| | - Anaïs Moyon
- Radiopharmacie Hôpital Timone AP-HM, Marseille, France.,CERIMED, CNRS 2012, Aix-Marseille Université, Marseille, France.,C2VN, INRA 1260, INSERM 1263, Aix-Marseille Université, Marseille, France
| | - Cyril Fersing
- Radiopharmacie Hôpital Nord AP-HM, Marseille, France
| | - Evan Terrier
- Radiopharmacie Hôpital Nord AP-HM, Marseille, France
| | - Aude Gouillet
- Radiopharmacie Hôpital Nord AP-HM, Marseille, France
| | | | - Benjamin Guillet
- Radiopharmacie Hôpital Nord AP-HM, Marseille, France.,CERIMED, CNRS 2012, Aix-Marseille Université, Marseille, France.,C2VN, INRA 1260, INSERM 1263, Aix-Marseille Université, Marseille, France
| | - Philippe Garrigue
- Radiopharmacie Hôpital Nord AP-HM, Marseille, France. .,CERIMED, CNRS 2012, Aix-Marseille Université, Marseille, France. .,C2VN, INRA 1260, INSERM 1263, Aix-Marseille Université, Marseille, France.
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Boschi A, Martini P, Costa V, Pagnoni A, Uccelli L. Interdisciplinary Tasks in the Cyclotron Production of Radiometals for Medical Applications. The Case of 47Sc as Example. Molecules 2019; 24:molecules24030444. [PMID: 30691170 PMCID: PMC6385051 DOI: 10.3390/molecules24030444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/17/2022] Open
Abstract
The growing number of cyclotrons of different sizes installed in the territory has given a strong impulse to the production of conventional and emerging radionuclides for medical applications. In particular, the great advantage of using medical cyclotrons is the possibility to produce on-site, when needed (on-demand), with medical radionuclides of interest encouraging the personalized medicine approach. Radiometals satisfy the ideal characteristics that radionuclides should have for routine employment in nuclear medicine, especially since they have a robust chemistry suitable to synthetize stable in vivo radiopharmaceuticals with high radiochemical yields. In this letter several interdisciplinary aspects involved in the radiometals cyclotron production cycle are summarized focusing the attention on cyclotron production facilities, target material, and chemical processing available for medical applications. As an example, the current status and recent development in the production of the theranostic radionuclide scandium-47 have been reported.
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Affiliation(s)
- Alessandra Boschi
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Luigi Borsari, 46-44121 Ferrara, Italy.
| | - Petra Martini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Luigi Borsari, 46-44121 Ferrara, Italy.
- Legnaro National Laboratories, Italian National Institute for Nuclear Physics (LNL-INFN), Viale dell' Università, 2, 35020 Legnaro (PD), Italy.
| | - Valentina Costa
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Via Luigi Borsari, 46-44121 Ferrara, Italy.
| | - Antonella Pagnoni
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Via Luigi Borsari, 46-44121 Ferrara, Italy.
| | - Licia Uccelli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Luigi Borsari, 46-44121 Ferrara, Italy.
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An Unexpected and Less Recognized Altered Distribution on Bone Scintigraphy; Possibility of 99mTc-Dextrose Complex as a Cause. Clin Nucl Med 2017; 42:952-957. [PMID: 29076896 DOI: 10.1097/rlu.0000000000001857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optimal performance of diagnostic tests and correct interpretation depend on multiple factors, one of which is proper radiopharmaceutical preparation. Unwanted impurities result in altered distribution of radiopharmaceuticals and then poor-quality or uninterpretable studies. Therefore, following the reconstitution steps according to standard and validated protocols by the technologist is mandatory. Here, we present 2 cases with unexpected and less recognized distribution of Tc-methylene diphosphonate on bone scintigraphy.
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Todde S, Peitl PK, Elsinga P, Koziorowski J, Ferrari V, Ocak EM, Hjelstuen O, Patt M, Mindt TL, Behe M. Guidance on validation and qualification of processes and operations involving radiopharmaceuticals. EJNMMI Radiopharm Chem 2017; 2:8. [PMID: 29503849 PMCID: PMC5824699 DOI: 10.1186/s41181-017-0025-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/23/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Validation and qualification activities are nowadays an integral part of the day by day routine work in a radiopharmacy. This document is meant as an Appendix of Part B of the EANM "Guidelines on Good Radiopharmacy Practice (GRPP)" issued by the Radiopharmacy Committee of the EANM, covering the qualification and validation aspects related to the small-scale "in house" preparation of radiopharmaceuticals. The aim is to provide more detailed and practice-oriented guidance to those who are involved in the small-scale preparation of radiopharmaceuticals which are not intended for commercial purposes or distribution. RESULTS The present guideline covers the validation and qualification activities following the well-known "validation chain", that begins with editing the general Validation Master Plan document, includes all the required documentation (e.g. User Requirement Specification, Qualification protocols, etc.), and leads to the qualification of the equipment used in the preparation and quality control of radiopharmaceuticals, until the final step of Process Validation. CONCLUSIONS A specific guidance to the qualification and validation activities specifically addressed to small-scale hospital/academia radiopharmacies is here provided. Additional information, including practical examples, are also available.
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Affiliation(s)
- S. Todde
- University of Milano-Bicocca, Tecnomed Foundation, 20900 Monza, Italy
| | - P. Kolenc Peitl
- Department of Nuclear Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - P. Elsinga
- University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - J. Koziorowski
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - E. M. Ocak
- Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul University, 34116 Beyazit, Istanbul Turkey
| | - O. Hjelstuen
- Institute for Energy Technology, Instituttveien 18, PO Box 40, 2027 Kjeller, Norway
| | - M. Patt
- Department for Nuclear Medicine, Radiochemistry, Liebigstrasse 18, 04103 Leipzig, Germany
| | - T. L. Mindt
- Ludwig Boltzmann Institute Applied Diagnostics, General Hospital Vienna, Nuklearmedizin, Vienna, Austria
- Department of Biomedical Imaging and Image Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - M. Behe
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ Paul-Scherrer-Institute, 5232 Villigen-PSI, Switzerland
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Li S, Schmitz A, Lee H, Mach RH. Automation of the Radiosynthesis of Six Different 18F-labeled radiotracers on the AllinOne. EJNMMI Radiopharm Chem 2016; 1:15. [PMID: 29564391 PMCID: PMC5843816 DOI: 10.1186/s41181-016-0018-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/22/2016] [Indexed: 11/21/2022] Open
Abstract
Background Fast implementation of positron emission tomography (PET) into clinical and preclinical studies highly demands automated synthesis for the preparation of PET radiopharmaceuticals in a safe and reproducible manner. The aim of this study was to develop automated synthesis methods for these six 18F-labeled radiopharmaceuticals produced on a routine basis at the University of Pennsylvania using the AllinOne synthesis module. Results The development of automated syntheses with varying complexity was accomplished including HPLC purification, SPE procedures and final formulation with sterile filtration. The six radiopharmaceuticals were obtained in high yield and high specific activity with full automation on the AllinOne synthesis module under current good manufacturing practice (cGMP) guidelines. Conclusion The study demonstrates the versatility of this synthesis module for the preparation of a wide variety of 18F-labeled radiopharmaceuticals for PET imaging studies.
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Affiliation(s)
- Shihong Li
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Alexander Schmitz
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Hsiaoju Lee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Robert H Mach
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
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Decristoforo C, Patt M. Are we "preparing" radiopharmaceuticals? EJNMMI Radiopharm Chem 2016; 1:12. [PMID: 29564388 PMCID: PMC5843809 DOI: 10.1186/s41181-016-0011-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria.,Universitätsklinik für Nuklearmedizin, Medizinische Universität Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Marianne Patt
- Klinik und Poliklinik für Nuklearmedizin, University of Leipzig, Leipzig, Germany
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30
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Abstract
Radiopharmaceuticals are widely accepted to be a very safe class of drugs, with very few adverse reactions and unexpected biodistributions. However, problems can arise because of technical issues in manufacture or reconstitution, patient preparation, or drug administration. This review presents highlights of issues that have arisen in the newer classes of radiopharmaceuticals in the last 20 years and expands the scope of the previous report to include PET and therapeutic radiopharmaceuticals. Variations in the "quality" of the eluate of a (99)Mo/(99m)Tc generator remain a major issue. Several of the newer (99m)Tc tracers require a heating step in preparation that can also lead to unacceptably low radiochemical purity. Radiolytic breakdown can be a problem with all classes of radiopharmaceuticals. Many of the newer radiopharmaceuticals localize by receptor- or transporter-mediated processes and thus can be affected by other drugs, making patient preparation more important than ever. Therapeutic radiopharmaceuticals may require coadministration of radioprotectant regimens, such as the use of lysine-arginine infusions with radiopeptide therapy. Extravasation can have serious consequences with therapeutic radiopharmaceuticals. Adverse reactions to newer radiopharmaceuticals remain rare, though may increase because of coadministration of agents such as contrast media. However, there is known to be underreporting of minor adverse reactions. Knowledge of the pitfalls that can occur with radiopharmaceuticals is important in the interpretation of nuclear medicine images and optimal patient care.
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Affiliation(s)
- James R Ballinger
- Department of Nuclear Medicine, Guy's and St Thomas' Hospital, London, UK; Division of Imaging Sciences, King's College London School of Medicine, London, UK.
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31
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Gijs M, Aerts A, Impens N, Baatout S, Luxen A. Aptamers as radiopharmaceuticals for nuclear imaging and therapy. Nucl Med Biol 2015; 43:253-71. [PMID: 26746572 DOI: 10.1016/j.nucmedbio.2015.09.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/24/2015] [Accepted: 09/10/2015] [Indexed: 12/27/2022]
Abstract
Today, radiopharmaceuticals belong to the standard instrumentation of nuclear medicine, both in the context of diagnosis and therapy. The majority of radiopharmaceuticals consist of targeting biomolecules which are designed to interact with a disease-related molecular target. A plethora of targeting biomolecules of radiopharmaceuticals exists, including antibodies, antibody fragments, proteins, peptides and nucleic acids. Nucleic acids have some significant advantages relative to proteinaceous biomolecules in terms of size, production, modifications, possible targets and immunogenicity. In particular, aptamers (non-coding, synthetic, single-stranded DNA or RNA oligonucleotides) are of interest because they can bind a molecular target with high affinity and specificity. At present, few aptamers have been investigated preclinically for imaging and therapeutic applications. In this review, we describe the use of aptamers as targeting biomolecules of radiopharmaceuticals. We also discuss the chemical modifications which are needed to turn aptamers into valuable (radio-)pharmaceuticals, as well as the different radiolabeling strategies that can be used to radiolabel oligonucleotides and, in particular, aptamers.
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Affiliation(s)
- Marlies Gijs
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK·CEN), Mol, Belgium; Cyclotron Research Centre, University of Liège, Liège, Belgium
| | - An Aerts
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK·CEN), Mol, Belgium
| | - Nathalie Impens
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK·CEN), Mol, Belgium
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK·CEN), Mol, Belgium
| | - André Luxen
- Cyclotron Research Centre, University of Liège, Liège, Belgium.
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32
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Velikyan I. 68Ga-Based radiopharmaceuticals: production and application relationship. Molecules 2015; 20:12913-43. [PMID: 26193247 PMCID: PMC6332429 DOI: 10.3390/molecules200712913] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/25/2015] [Accepted: 07/06/2015] [Indexed: 12/26/2022] Open
Abstract
The contribution of 68Ga to the promotion and expansion of clinical research and routine positron emission tomography (PET) for earlier better diagnostics and individualized medicine is considerable. The potential applications of 68Ga-comprising imaging agents include targeted, pre-targeted and non-targeted imaging. This review discusses the key aspects of the production of 68Ga and 68Ga-based radiopharmaceuticals in the light of the impact of regulatory requirements and endpoint pre-clinical and clinical applications.
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Affiliation(s)
- Irina Velikyan
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala SE-751 85, Sweden.
- PET Center, Center for Medical Imaging, Uppsala University Hospital, Uppsala SE-751 85, Sweden .
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