Adverse Events of Diagnostic Radiopharmaceuticals: A Systematic Review

Gastric Accommodation Testing Using Hybrid Nuclear Imaging Volumetry and Combined High-Resolution Manometry-Nutrient Drink Test: A Pilot Study in Healthy Individuals

BACKGROUND

Gastric accommodation (GA) testing is gaining clinical recognition as novel and minimally invasive modalities emerge. We investigated the feasibility of hybrid nuclear imaging volumetry (SPECT/CT) and combined high-resolution manometry-nutrient drink test (HRM-NDT) to assess GA.

METHODS

In this non-randomized pilot study, [99mTc]NaTcO4 gastric SPECT/CT (250 mL protocol) and proximal gastric HRM-NDT (~60 mL/min protocol) were performed separately within 30 days using Ensure Gold test meal (1.05 kcal/mL; Abbott). GA parameters were measured, and their preliminary associations were examined using Spearman's ρ and Hoeffding's D correlation tests. Data were presented as median ± normalized median absolute deviation.

KEY RESULTS

Twenty healthy, asymptomatic individuals (11 females; 23.5 ± 2.2 years, 23.7 ± 2.2 kg/m2) completed both procedures without serious adverse events and interrupted sessions. The accommodation volume and postprandial-to-fasting volume ratio from SPECT/CT were 325.8 ± 28.5 mL and 5.31 ± 1.28, respectively. During HRM-NDT, the nadir-intragastric pressure (IGP) was -6.6 ± 3.6 mmHg at an ingested volume of 360.0 ± 177.9 mL, and the area-under-curve of IGP was -1566.0 ± 1596.8 mmHg·mL. The maximum tolerated volume for reaching satiety/maximum discomfort was 450.0 ± 177.9 mL, and the area-under-curve of satiation score was 900.0 ± 266.9 satiation-unit·mL. The area-under-curve of IGP showed significant associations with maximum tolerated volume (ρ: -0.702; D: 0.234) and the area-under-curve of satiation score (D: 0.119): all p < 0.01. No correlations were found between volumetric with manometric and subjective NDT GA parameters.

CONCLUSIONS & INFERENCES

SPECT/CT and HRM-NDT are feasible and tolerable techniques for measuring GA in healthy individuals. Thus, determining their diagnostic utility among patient populations requires further optimization and standardization.

Adverse events associated with the use of radiopharmaceuticals: A prospective study from a tertiary care institute

Introduction

Radiopharmaceuticals (RPs) are used in the diagnosis and management of various cancer and noncancerous conditions. Like those of conventional drugs, the use of RPs may also be associated with the development of various adverse events (AEs). The information obtained from patients about these AEs may empower medical professionals to identify, evaluate, and manage them more efficiently to ensure the safe use of RPs.

Objective

The objective of our study was to assess the type, timing, and frequency of the reported AEs associated with the use of RPs and to establish their causal association as well as to evaluate the outcome of these AEs from the perspective of patients.

Methods

This study was a prospective cohort study conducted on 315 patients who underwent nuclear medicine examination in a tertiary care center for various indications. Relevant data were collected from the participants regarding suspected AEs associated with the use of various RPs. The collected data were objectively analyzed and assessed.

Results

Of 315 patients, 39 (12.3%) developed 59 AEs. All the reported AEs were mild in nature and neither required hospitalization nor caused death of any participants. 37.2% of the reported AEs occurred within 1 h of administration of the RPs and spontaneously resolved within a few hours. Of these 59 AEs, 10 had causal associations (possible or probable) with RPs and were considered adverse drug reaction (ADR). The incidence of ADR in our study was 2.2%.

Conclusion

RPs can cause ADRs though it is less in comparison to conventional drugs. We expect that our study will increase the awareness of AEs associated with the use of RPs among patients and health-care professionals and encourage its reporting.

Adverse Reactions by Radiopharmaceuticals: Retrospective Analysis of the Portuguese National Pharmacovigilance System

BACKGROUND

Radiopharmaceuticals are essential in the field of nuclear medicine, but like any other medicinal product, radiopharmaceuticals can potentially cause adverse reactions in patients.

OBJECTIVE

To describe the adverse reactions to radiopharmaceuticals reported to the Portuguese National Pharmacovigilance System (SNF).

METHODS

We performed a retrospective, observational study by examining individual case safety reports (ICSRs) provided by the SNF related to all radiopharmaceuticals commercially available in Portugal from 2010 to 2023.

RESULTS

The SNF received a total of 84 ICSRs. These reports resulted in a total of 224 adverse drug reactions (ADR), which involved a total of 15 different radiopharmaceuticals. The mean age of patients was 61.9 years old. Twenty-one different system organ classes (SOCs) were identified, with the most prevalent situations being "Gastrointestinal Disorders" (18.3%; n = 41) followed by "General disorders and administration site conditions" (16.5%; n = 37), "Skin and subcutaneous tissue disorders" (11.2%; n = 25) and "Blood and lymphatic system disorders" (10.3%; n = 23). Fifty-seven reports (67.85%) showed at least 1 serious ADR. Most notified radiopharmaceuticals were, respectively, radium-223 (n = 36, 41.4%), lutetium-177 oxotreotide (n = 12, 13.8%) and iodide-131 (n = 9, 10.3%).

CONCLUSION AND RELEVANCE

Although the number of notifications is limited, these findings provide valuable insights into the types and frequencies of adverse reactions associated with radiopharmaceuticals used in Portugal between 2010 and 2023. The data highlight the importance of continued pharmacovigilance efforts to monitor the safety of these specialized medical products and inform clinical decision-making.

Transcutaneous sentinel lymph node detection in skin melanoma with near-infrared fluorescence imaging using indocyanine green

The aim of the study is to assess whether indocyanine green (ICG) fluorescence can replace technetium in the preoperative detection of sentinel lymph nodes (SLN) from cutaneous melanoma. The current golden standard for SLN detection is the radioisotope technetium. A promising alternative is fluorescence imaging (FLI) using ICG. In this study, we enrolled patients undergoing sentinel lymph node biopsy (SLNB) for skin melanoma at the Erasmus Medical Center between November 2022 and July 2023. The SLNB procedure was performed as a standard of care. After general anesthesia, ICG was injected intradermally around the primary tumor site. Both the patient and the surgeon were not blinded for the location of the SLN. FLI was performed before incision, in vivo after incision, and ex vivo. Fluorescent SLNs were confirmed using the gamma probe in all cases. Thirty-two patients were included in this study, and a total of 39 SLNs were harvested. The transcutaneous detection rate of ICG was 21.9%. The combined ex vivo ICG fluorescence and technetium uptake was 94.9%. One SLN contained only ICG (2.6%) and one SLN contained only technetium-uptake (2.6%). FLI using ICG resulted in a relatively low transcutaneous detection, which means that exclusive use of this technique in its present form is not feasible. However, we did find a high accumulation of ICG in the SLN, indicating the potential of ICG in combination with other imaging techniques.

Metallosurfactant aggregates: Structures, properties, and potentials for multifarious applications

Metallosurfactants offer important scientific and technological advances due to their novel interfacial properties. As a special class of structures formed by the integration of metal ions into amphiphilic surfactant molecules, these metal-based amphiphilic molecules possess both organometallic and surface chemistries. This review critically examines the structural transitions of metallosurfactants from micelle to vesicle upon metal coordination. The properties of a metallosurfactant can be changed by tuning the coordination between the metal ions and surfactants. The self-assembled behavior of surfactants can be controlled by selecting transition-metal ions that enhance their catalytic efficiency in environmental applications by applying a hydrogen evolution reaction or oxygen evolution reaction. We present the different scattering techniques available to examine the properties of metallosurfactants (e.g., size, shape, structure, and aggregation behavior). The utility of metallosurfactants in catalysis, the synthesis of nanoparticles, and biomedical applications (involving diagnostics and therapeutics) is also explored.

EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine

PURPOSE

The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children.

METHODS

We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies.

RESULTS

The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field.

CONCLUSION

Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.

Proceedings: PET Drugs-A Workshop on Inspections Management and Regulatory Considerations

Recent advances in the development of new molecular imaging agents for PET have led to the approval of several new molecular entities for PET imaging by the U.S. Food and Drug Administration (FDA) within the last 10 y. However, the continued use of PET drugs for diagnostic imaging procedures is reliant on a sustainable network of PET manufacturing facilities operating in accordance with the regulations for current good manufacturing practices for PET drugs (title 21, Code of Federal Regulations, part 212). With this goal in mind, a public workshop entitled "PET Drugs: A Workshop on Inspections Management and Regulatory Considerations" was held on the FDA campus in Silver Spring, MD, on February 21, 2020. The workshop was cosponsored by the FDA's Center for Drug Evaluation and Research, the Society of Nuclear Medicine and Molecular Imaging, the Medical Imaging Technology Alliance, and the World Molecular Imaging Society, in collaboration with the Coalition of PET Drug Manufacturers. The organizing committee for the workshop consisted of representatives from academic and commercial PET manufacturers as well as FDA staff members. The coauthors on this paper are all members of the workshop-organizing committee.

Review of Adverse Reactions Associated with the Use of Common Diagnostic Radiopharmaceuticals

Radiopharmaceuticals are used in the diagnosis and management of various diseases. There are several reports of adverse reactions related to the use of radiopharmaceuticals, though it is not as common as conventional drugs. Adverse reactions related to radiopharmaceuticals have been not widely reported and documented. In this review, we have tried to summarize the adverse reactions associated with some of the commonly used radiopharmaceuticals.

Patient-Reported Adverse Events of Radiopharmaceuticals: A Prospective Study of 1002 Patients

INTRODUCTION

Adverse events of radiopharmaceuticals may be underreported or remain undetected. Patients can provide information about these adverse events to enable healthcare professionals to detect, understand, and manage them more efficiently.

OBJECTIVE

In this study, we aimed to (a) determine the type, causality, and frequency of patient-reported adverse events of radiopharmaceuticals and to (b) assess the onset, outcome, and follow-up of these adverse events from the patient's perspective.

METHODS

We performed a prospective cohort study of 1002 patients who underwent a nuclear medicine examination. Using a validated questionnaire, we collected patient-reported information on adverse events that occurred immediately after administration of the radiopharmaceutical as well as those that occurred later. Adverse events were analysed, coded and assessed for causality by two independent researchers.

RESULTS

A total of 187 (18.7%) patients reported 379 adverse events. Most patient-reported adverse events of radiopharmaceuticals belonged to the 'general disorder and administration site conditions' (42.0%) and 'nervous system disorders' (16.9%) system organ classes. Of the patient-reported adverse events, 43.0% were possibly or probably causally related to radiopharmaceuticals. We found the frequency of patient-reported adverse drug reactions to diagnostic radiopharmaceuticals to be 2.8%. No important medical events were related to the administrations of diagnostic radiopharmaceuticals. Most adverse events (80.0%) occurred shortly after administration of the radiopharmaceutical and were resolved within a few hours. Some events (20.0%) emerged after patients had left the nuclear medicine department, took longer to resolve, and sometimes prompted the patient to consult a healthcare professional.

CONCLUSION

Adverse reactions to diagnostic radiopharmaceuticals can occur, and the frequency reported by patients was found to be 2.8%, which is higher than reported in the existing literature. We hope that the results of this study increase awareness of these adverse reactions among patients and healthcare professionals.

Patient-Reported Adverse Events of Radiopharmaceuticals: Development and Validation of a Questionnaire

Introduction

Radiopharmaceuticals may cause adverse events. Knowledge about adverse events from a patient’s perspective could help healthcare professionals to detect, understand, and manage adverse events more efficiently when using radiopharmaceuticals. Researchers need a validated questionnaire that can be used in patients to assess adverse events with radiopharmaceuticals.

Objective

The aim of this study was to develop, validate the content of, and perform initial testing of a questionnaire assessing patient-reported adverse events of radiopharmaceuticals.

Methods

Based on existing literature, six professionals drafted and evaluated a first version of the questionnaire. Further content validation was performed using cognitive interviews with six patients undergoing a nuclear medicine examination. After adaptations, the questionnaire was developed into a web-based questionnaire. One hundred patients undergoing nuclear examination tested this version, and the results were used to assess its acceptability and evaluate reported adverse events.

Results

Questions and answer options were revised in the initial questionnaire to improve clarity. In addition, some questions were removed. The final version consisted of 18 questions. In the test phase, the acceptability of the questionnaire was demonstrated (e.g. 79% of the patients who received the questionnaire completed it, and the median time to complete the questionnaire was 12 min for patients who reported an adverse event). Of the 100 patients (53% men, median age 64 years), 12 reported a total of 22 adverse events. One of these adverse events had a high causal association.

Conclusion

After validation and testing, the developed questionnaire to study patient-reported adverse events of radiopharmaceuticals is a suitable and valid instrument which can be used in future research.

Electronic supplementary material

The online version of this article (10.1007/s40264-019-00895-2) contains supplementary material, which is available to authorized users.