Cyclotron production of (43)Sc for PET imaging

Current Status and Future Perspectives of Nuclear Medicine in Prostate Cancer from Imaging to Therapy: A Comprehensive Review

Nuclear medicine has emerged as a critical modality in the diagnostic and therapeutic management of urological malignancies, particularly prostate cancer. Advances in single-photon emission computed tomography/computed tomography (CT) and positron emission tomography/CT (PET/CT) have enhanced tumor assessment across staging, treatment response, and recurrence settings. Molecular imaging, which offers insights beyond traditional anatomical imaging, is increasingly integral in specific clinical scenarios. Theranostic nuclear medicine, which combines diagnostic imaging with targeted therapy, has become a well-established treatment option, particularly for patients with metastatic castration-resistant prostate cancer (mCRPC). The development of the prostate-specific membrane antigen (PSMA) radioligands has revolutionized clinical management by enabling precise disease staging and delivering effective radioligand therapy (RLT). Ongoing research aims to refine the role of PSMA PET imaging in staging and treatment monitoring, while optimizing PSMA-targeted RLT for broader clinical use. Given that prostate cancer remains highly prevalent, the anticipated increase in the demand for RLT presents both challenges and opportunities for nuclear medicine services globally. Theranostic approaches exemplify personalized medicine by enabling the tailoring of treatments to individual tumor biology, thereby improving survival outcomes and maintaining patients' quality of life with minimal toxicity. Although the current focus is on advanced disease, future research holds promise for expanding these strategies to earlier stages, potentially enhancing curative prospects. This evolving field not only signifies a paradigm shift in the care of prostate cancer patients but also underscores the growing importance of nuclear medicine in delivering precision oncology.

Towards Clinical Development of Scandium Radioisotope Complexes for Use in Nuclear Medicine: Encouraging Prospects with the Chelator 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic Acid (DOTA) and Its Analogues

Scandium (Sc) isotopes have recently attracted significant attention in the search for new radionuclides with potential uses in personalized medicine, especially in the treatment of specific cancer patient categories. In particular, Sc-43 and Sc-44, as positron emitters with a satisfactory half-life (3.9 and 4.0 h, respectively), are ideal for cancer diagnosis via Positron Emission Tomography (PET). On the other hand, Sc-47, as an emitter of beta particles and low gamma radiation, may be used as a therapeutic radionuclide, which also allows Single-Photon Emission Computed Tomography (SPECT) imaging. As these scandium isotopes follow the same biological pathway and chemical reactivity, they appear to fit perfectly into the "theranostic pair" concept. A step-by-step description, initiating from the moment of scandium isotope production and leading up to their preclinical and clinical trial applications, is presented. Recent developments related to the nuclear reactions selected and employed to produce the radionuclides Sc-43, Sc-44, and Sc-47, the chemical processing of these isotopes and the main target recovery methods are also included. Furthermore, the radiolabeling of the leading chelator, 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA), and its structural analogues with scandium is also discussed and the advantages and disadvantages of scandium complexation are evaluated. Finally, a review of the preclinical studies and clinical trials involving scandium, as well as future challenges for its clinical uses and applications, are presented.

Data reconciliation connected to guard bands to set specification limits related to risk assessment for radiopharmaceutical activity

Radiopharmaceuticals have been used to diagnose several diseases, particularly because the procedure is non-invasive. However, it is important that the correct amount of radiopharmaceutical is used to avoid inaccurate diagnostic results and suboptimal therapeutic outcomes. The amount of the radiopharmaceutical is measured when produced (by the supplier) and a second time (by the receiver), before it's use. When measured at the receiver, the result is corrected for its normal radioactivity decay. Even then, it is possible that both measurements should be considered nominal different or even statistically different when compared through various statistical tools. This research combines two innovative techniques in the field of clinical metrology. The first technique is data reconciliation, which not only enhances measurement accuracy but also reduces measurement uncertainty. The second technique involves using uncertainty information to establish specification limits for compliance assessments. In this way, our proposal aimed to minimize the risk of making incorrect decisions regarding the conformity of the concentration of radiopharmaceutical activity, that is, rejecting an item or batch that is within specification or accepting an item or batch that is outside of specification. A spreadsheet, based on these metrology fundamentals, is available to help the user with the calculations, presenting numerical and graphical results for some common radioisotopes. Reliable specification limits can be calculated and used to determine if the radiopharmaceutical is in accordance with its proposed application.

Scandium Radioisotopes-Toward New Targets and Imaging Modalities

The concept of theranostics uses radioisotopes of the same or chemically similar elements to label biological ligands in a way that allows the use of diagnostic and therapeutic radiation for a combined diagnosis and treatment regimen. For scandium, radioisotopes -43 and -44 can be used as diagnostic markers, while radioisotope scandium-47 can be used in the same configuration for targeted therapy. This work presents the latest achievements in the production and processing of radioisotopes and briefly characterizes solutions aimed at increasing the availability of these radioisotopes for research and clinical practice.

Alpha-induced production and robust radiochemical separation of 43Sc as an emerging radiometal for formulation of PET radiopharmaceuticals

Scandium-43 is an emerging PET radiometal that was produced by α-particle bombardment on natural CaCO₃ target via ^natCa (α,p) ⁴³Sc and ^natCa (α,n) ⁴³Ti→⁴³Sc reactions using K-130 cyclotron at VECC. A robust radiochemical procedure based on selective precipitation of ⁴³Sc as Sc(OH)₃ was developed for separation of the radioisotope from the irradiated target. The overall yield of the separation process was >85% and it was obtained in a form suitable for preparation of target specific radiopharmaceuticals for PET imaging of cancer.

Scandium-44: Diagnostic Feasibility in Tumor-Related Angiogenesis

Angiogenesis-related cell-surface molecules, including integrins, aminopeptidase N, vascular endothelial growth factor, and gastrin-releasing peptide receptor (GRPR), play a crucial role in tumour formation. Radiolabelled imaging probes targeting angiogenic biomarkers serve as valuable vectors in tumour identification. Nowadays, there is a growing interest in novel radionuclides other than gallium-68 (⁶⁸Ga) or copper-64 (⁶⁴Cu) to establish selective radiotracers for the imaging of tumour-associated neo-angiogenesis. Given its ideal decay characteristics (E_β⁺_average: 632 KeV) and a half-life (T_1/2 = 3.97 h) that is well matched to the pharmacokinetic profile of small molecules targeting angiogenesis, scandium-44 (⁴⁴Sc) has gained meaningful attention as a promising radiometal for positron emission tomography (PET) imaging. More recently, intensive research has been centered around the investigation of ⁴⁴Sc-labelled angiogenesis-directed radiopharmaceuticals. Previous studies dealt with the evaluation of ⁴⁴Sc-appended a_vb₃ integrin-affine Arg-Gly-Asp (RGD) tripeptides, GRPR-selective aminobenzoyl-bombesin analogue (AMBA), and hypoxia-associated nitroimidazole derivatives in the identification of various cancers using experimental tumour models. Given the tumour-related hypoxia- and angiogenesis-targeting capability of these PET probes, ⁴⁴Sc seems to be a strong competitor of the currently used positron emitters in radiotracer development. In this review, we summarize the preliminary preclinical achievements with ⁴⁴Sc-labelled angiogenesis-specific molecular probes.

Scandium-44 Radiolabeled Peptide and Peptidomimetic Conjugates Targeting Neuropilin-1 Co-Receptor as Potential Tools for Cancer Diagnosis and Anti-Angiogenic Therapy

Pathological angiogenesis, resulting from an imbalance between anti- and pro-angiogenic factors, plays a pivotal role in tumor growth, development and metastasis. The inhibition of the angiogenesis process by the VEGF/VEGFR-2/NRP-1 pathway raises interest in the search for such interaction inhibitors for the purpose of the early diagnosis and treatment of angiogenesis-dependent diseases. In this work we designed and tested peptide-based radiocompounds that selectively bind to the neuropilin-1 co-receptor and prevent the formation of the pro-angiogenic VEGF-A₁₆₅/NRP-1 complex. Three biomolecules, A7R and retro-inverso ^DR7A peptides, and the branched peptidomimetic Lys(hArg)-Dab-Pro-Arg (K4R), conjugated with macrocyclic chelator through two linkers' types, were labeled with theranostic scandium-44 radionuclide, and studied in vitro as potential targeted radiopharmaceuticals. ELISA (enzyme-linked immunosorbent assay) studies showed no negative effect of the introduced biomolecules' changes and high NRP-1 affinity in the case of A7R- and K4R-radiocompounds and a lack affinity for ^DR7A-radiocompounds. All radiopeptides showed a hydrophilic nature as well as high stability against ligand exchange reactions in cysteine/histidine solutions. Unfortunately, all radiocompounds showed unsatisfactory nano-scale stability in human serum, especially for use as therapeutic radioagents. Further work is ongoing and focused on the search for angiogenesis inhibitors that are more human serum stable.

Cutting edge rare earth radiometals: prospects for cancer theranostics

Background

With recent advances in novel approaches to cancer therapy and imaging, the application of theranostic techniques in personalised medicine has emerged as a very promising avenue of research inquiry in recent years. Interest has been directed towards the theranostic potential of Rare Earth radiometals due to their closely related chemical properties which allow for their facile and interchangeable incorporation into identical bifunctional chelators or targeting biomolecules for use in a diverse range of cancer imaging and therapeutic applications without additional modification, i.e. a “one-size-fits-all” approach. This review will focus on recent progress and innovations in the area of Rare Earth radionuclides for theranostic applications by providing a detailed snapshot of their current state of production by means of nuclear reactions, subsequent promising theranostic capabilities in the clinic, as well as a discussion of factors that have impacted upon their progress through the theranostic drug development pipeline.

Main body

In light of this interest, a great deal of research has also been focussed towards certain under-utilised Rare Earth radionuclides with diverse and favourable decay characteristics which span the broad spectrum of most cancer imaging and therapeutic applications, with potential nuclides suitable for α-therapy (¹⁴⁹Tb), β⁻-therapy (⁴⁷Sc, ¹⁶¹Tb, ¹⁶⁶Ho, ¹⁵³Sm, ¹⁶⁹Er, ¹⁴⁹Pm, ¹⁴³Pr, ¹⁷⁰Tm), Auger electron (AE) therapy (¹⁶¹Tb, ¹³⁵La, ¹⁶⁵Er), positron emission tomography (⁴³Sc, ⁴⁴Sc, ¹⁴⁹Tb, ¹⁵²Tb, ¹³²La, ¹³³La), and single photon emission computed tomography (⁴⁷Sc, ¹⁵⁵Tb, ¹⁵²Tb, ¹⁶¹Tb, ¹⁶⁶Ho, ¹⁵³Sm, ¹⁴⁹Pm, ¹⁷⁰Tm). For a number of the aforementioned radionuclides, their progression from ‘bench to bedside’ has been hamstrung by lack of availability due to production and purification methods requiring further optimisation.

Conclusions

In order to exploit the potential of these radionuclides, reliable and economical production and purification methods that provide the desired radionuclides in high yield and purity are required. With more reactors around the world being decommissioned in future, solutions to radionuclide production issues will likely be found in a greater focus on linear accelerator and cyclotron infrastructure and production methods, as well as mass separation methods. Recent progress towards the optimisation of these and other radionuclide production and purification methods has increased the feasibility of utilising Rare Earth radiometals in both preclinical and clinical settings, thereby placing them at the forefront of radiometals research for cancer theranostics.

Advances in PSMA theranostics

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PSMA is an appealing target for theranostic because it is a transmembrane protein with a known substrate that is overexpessed on prostate cancer cells and internalizes upon ligand binding.

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There are a number of PSMA theranostic ligands in clinical evaluation, clinical trial, or clinically approved.

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PSMA theranostic ligands increase progression-free survival, overall survival, and pain in patients with metastatic castration resistant prostate cancer.

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A major obstacle to PSMA-targeted radioligand therapy is off-target toxicity in salivary glands.

The validation of prostate specific membrane antigen (PSMA) as a molecular target in metastatic castration-resistant prostate cancer has stimulated the development of multiple classes of theranostic ligands that specifically target PSMA. Theranostic ligands are used to image disease or selectively deliver cytotoxic radioactivity to cells expressing PSMA according to the radioisotope conjugated to the ligand. PSMA theranostics is a rapidly advancing field that is now integrating into clinical management of prostate cancer patients. In this review we summarize published research describing the biological role(s) and activity of PSMA, highlight the most clinically advanced PSMA targeting molecules and biomacromolecules, and identify next generation PSMA ligands that aim to further improve treatment efficacy. The goal of this review is to provide a comprehensive assessment of the current state-of-play and a roadmap to achieving further advances in PSMA theranostics.

Prospects for the production of radioisotopes and radiobioconjugates for theranostics

The development of diagnostic methods in medicine as well as the progress in the synthesis of biologically active compounds allows the use of selected radioisotopes for the simultaneous diagnosis and treatment of diseases, especially cancerous ones, in patients. This approach is called theranostic. This review article includes chemical and physical characterization of chosen theranostic radioisotopes and their compounds that are or could be useful in nuclear medicine.

Separation of 44Sc from 44Ti in the Context of A Generator System for Radiopharmaceutical Purposes with the Example of [44Sc]Sc-PSMA-617 and [44Sc]Sc-PSMA-I&T Synthesis

Today, ⁴⁴Sc is an attractive radionuclide for molecular imaging with PET. In this work, we evaluated a ⁴⁴Ti/⁴⁴Sc radionuclide generator based on TEVA resin as a source of ⁴⁴Sc. The generator prototype (5 MBq) exhibits high ⁴⁴Ti retention and stable yield of ⁴⁴Sc (91 ± 6 %) in 1 mL of eluate (20 bed volumes, eluent—0.1 M oxalic acid/0.2 M HCl) during one year of monitoring (more than 120 elutions). The breakthrough of ⁴⁴Ti did not exceed 1.5 × 10⁻⁵% (average value was 6.5 × 10⁻⁶%). Post-processing of the eluate for further use in radiopharmaceutical synthesis was proposed. The post-processing procedure using a combination of Presep^® PolyChelate and TK221 resins made it possible to obtain ⁴⁴Sc-radioconjugates with high labeling yield (≥95%) while using small precursor amounts (5 nmol). The proposed method takes no more than 15 min and provides ≥90% yield relative to the ⁴⁴Sc activity eluted from the generator. The labeling efficiency was demonstrated on the example of [⁴⁴Sc]Sc-PSMA-617 and [⁴⁴Sc]Sc-PSMA-I&T synthesis. Some superiority of PSMA-I&T over PSMA-617 in terms of ⁴⁴Sc labeling efficiency was demonstrated (likely due to presence of DOTAGA chelator in the precursor structure). It was also shown that microwave heating of the reaction mixture considerably shortened the reaction time and improved radiolabeling yield and reproducibility of [⁴⁴Sc]Sc-PSMA-617 and [⁴⁴Sc]Sc-PSMA-I&T synthesis.

Production of a broad palette of positron emitting radioisotopes using a low-energy cyclotron: Towards a new success story in cancer imaging?

Over the last several years, positron emission tomography (PET) has matured as an indispensable component of cancer diagnostics. Owing to the large variability observed among the cancer patients and the need to personalize individual patient's diagnosis and treatment, the need for new positron emitting radioisotopes has continued to grow. This mini review opens with a brief introduction to the criteria for radioisotope selection for PET imaging. Subsequently, positron emitting radioisotopes are categorized as: established, emerging and futuristic, based on the stages of their advancement. The production methodologies and the radiochemical separation procedures for obtaining the important radioisotopes in a form suitable for preparation of radiopharmaceuticals for PET imaging are briefly discussed.

Production of scandium radionuclides for theranostic applications: towards standardization of quality requirements

In the frame of "precision medicine", the scandium radionuclides have recently received considerable interest, providing personalised adjustment of radiation characteristics to optimize the efficiency of medical care or therapeutic benefit for particular groups of patients. Radionuclides of scandium, namely scandium-43 and scandium-44 (43/44Sc) as positron emitters and scandium-47 (47Sc), beta-radiation emitter, seem to fit ideally into the concept of theranostic pair. This paper aims to review the work on scandium isotopes production, coordination chemistry, radiolabeling, preclinical studies and the very first clinical studies. Finally, standardized procedures for scandium-based radiopharmaceuticals have been proposed as a basis to pave the way for elaboration of the Ph.Eur. monographs for perspective scandium radionuclides.

Impact of prompt gamma emission of 44Sc on quantification in preclinical and clinical PET systems

⁴⁴Sc is an increasingly investigated positron emitter for use in positron emission tomography (PET) imaging. However, ⁴⁴Sc is a non-pure positron emitter, since prompt photons are co-emitted during the decay process. This study investigates coincidence energy spectra of ⁴⁴Sc and its impact on PET quantification on a preclinical and clinical PET system in comparison with ¹⁸F. The raw data of the coincidence events revealed characteristic differences comparing the photon energy distribution of ⁴⁴Sc and ¹⁸F. Due to prompt gamma emission of ⁴⁴Sc, activity recovery is underestimated on PET systems. However, clinical PET imaging of ⁴⁴Sc with acceptable quantitative accuracy appears feasible by using a single, constant correction factor.

Radiometals for imaging and theranostics, current production, and future perspectives

The aim of this review is to make the reader familiar with currently available radiometals, their production modes, capacities, and quality concerns related to their medical use, as well as new emerging radiometals and irradiation technologies from the perspective of their diagnostic and theranostic applications. Production methods of ¹⁷⁷ Lu serve as an example of various issues related to the production yield, specific activity, radionuclidic and chemical purity, and production economy. Other radiometals that are currently used or explored for potential medical applications, with particular focus on their theranostic value, are discussed. Using radiometals for diagnostic imaging and therapy is on the rise. The high demand for radiometals for medical use prompts investigations towards using alternative irradiation reactions, while using existing nuclear reactors and accelerator facilities. This review discusses these production capacities and what is necessary to cover the growing demand for theranostic nuclides.

Photonuclear production, chemistry, and in vitro evaluation of the theranostic radionuclide 47Sc

Background

In molecular imaging and nuclear medicine, theranostic agents that integrate radionuclide pairs are successfully being used for individualized care, which has led to rapidly growing interest in their continued development. These compounds, which are radiolabeled with one radionuclide for imaging and a chemically identical or similar radionuclide for therapy, may improve patient-specific treatment and outcomes by matching the properties of different radionuclides with a targeting vector for a particular tumor type. One proposed theranostic radionuclide is scandium-47 (⁴⁷Sc, T_1/2 = 3.35 days), which can be used for targeted radiotherapy and may be paired with the positron emitting radionuclides, ⁴³Sc (T_1/2 = 3.89 h) and ⁴⁴Sc (T_1/2 = 3.97 h) for imaging. The aim of this study was to investigate the photonuclear production of ⁴⁷Sc via the ⁴⁸Ti(γ,p)⁴⁷Sc reaction using an electron linear accelerator (eLINAC), separation and purification of ⁴⁷Sc, the radiolabeling of somatostatin receptor-targeting peptide DOTATOC with ⁴⁷Sc, and in vitro receptor-mediated binding of [⁴⁷Sc]Sc-DOTATOC in AR42J somatostatin receptor subtype two (SSTR2) expressing rat pancreatic tumor cells.

Results

The rate of ⁴⁷Sc production in a stack of natural titanium foils (n = 39) was 8 × 10⁷ Bq/mA·h (n = 3). Irradiated target foils were dissolved in 2.0 M H₂SO₄ under reflux. After dissolution, trivalent ⁴⁷Sc ions were separated from natural Ti using AG MP-50 cation exchange resin. The recovered ⁴⁷Sc was then purified using CHELEX 100 ion exchange resin. The average decay-corrected two-step ⁴⁷Sc recovery (n = 9) was (77 ± 7)%. A radiolabeling yield of > 99.9% of [⁴⁷Sc]Sc-DOTATOC (0.384 mg in 0.3 mL) was achieved using 1.7 MBq of ⁴⁷Sc. Blocking studies using Octreotide illustrated receptor-mediated uptake of [⁴⁷Sc]Sc-DOTATOC in AR42J cells.

Conclusions

⁴⁷Sc can be produced via the ⁴⁸Ti(γ,p)⁴⁷Sc reaction and separated from natural Ti targets with a yield and radiochemical purity suitable for radiolabeling of peptides for in vitro studies. The data in this work supports the potential use of eLINACs for studies of photonuclear production of medical radionuclides and the future development of high-intensity eLINAC facilities capable of producing relevant quantities of carrier-free radionuclides currently inaccessible via routine production pathways or limited due to costly enriched targets.

Electronic supplementary material

The online version of this article (10.1186/s13550-019-0515-8) contains supplementary material, which is available to authorized users.

Feasibility study of the positronium imaging with the J-PET tomograph

A detection system of the conventional PET tomograph is set-up to record data from [Formula: see text] annihilation into two photons with energy of 511 keV, and it gives information on the density distribution of a radiopharmaceutical in the body of the object. In this paper we explore the possibility of performing the three gamma photons imaging based on ortho-positronium annihilation, as well as the possibility of positronium mean lifetime imaging with the J-PET tomograph constructed from plastic scintillators. For this purposes simulations of the ortho-positronium formation and its annihilation into three photons were performed taking into account distributions of photons' momenta as predicted by the theory of quantum electrodynamics and the response of the J-PET tomograph. In order to test the proposed ortho-positronium lifetime image reconstruction method, we concentrate on the decay of the ortho-positronium into three photons and applications of radiopharmaceuticals labeled with isotopes emitting a prompt gamma. The proposed method of imaging is based on the determination of hit-times and hit-positions of registered photons which enables the reconstruction of the time and position of the annihilation point as well as the lifetime of the ortho-positronium on an event-by-event basis. We have simulated the production of the positronium in point-like sources and in a cylindrical phantom composed of a set of different materials in which the ortho-positronium lifetime varied from 2.0 ns to 3.0 ns, as expected for ortho-positronium created in the human body. The presented reconstruction method for total-body J-PET like detector allows to achieve a mean lifetime resolution of  ∼40 ps. Recent positron annihilation lifetime spectroscopy measurements of cancerous and healthy uterine tissues show that this sensitivity may allow to study the morphological changes in cell structures.

Radioactive Main Group and Rare Earth Metals for Imaging and Therapy

Radiometals possess an exceptional breadth of decay properties and have been applied to medicine with great success for several decades. The majority of current clinical use involves diagnostic procedures, which use either positron-emission tomography (PET) or single-photon imaging to detect anatomic abnormalities that are difficult to visualize using conventional imaging techniques (e.g., MRI and X-ray). The potential of therapeutic radiometals has more recently been realized and relies on ionizing radiation to induce irreversible DNA damage, resulting in cell death. In both cases, radiopharmaceutical development has been largely geared toward the field of oncology; thus, selective tumor targeting is often essential for efficacious drug use. To this end, the rational design of four-component radiopharmaceuticals has become popularized. This Review introduces fundamental concepts of drug design and applications, with particular emphasis on bifunctional chelators (BFCs), which ensure secure consolidation of the radiometal and targeting vector and are integral for optimal drug performance. Also presented are detailed accounts of production, chelation chemistry, and biological use of selected main group and rare earth radiometals.

Promising Scandium Radionuclides for Nuclear Medicine: A Review on the Production and Chemistry up to In Vivo Proofs of Concept

Scandium radionuclides have been identified in the late 1990s as promising for nuclear medicine applications, but have been set aside for about 20 years. Among the different isotopes of scandium, ⁴³Sc and ⁴⁴Sc are interesting for positron emission tomography imaging, whereas ⁴⁷Sc is interesting for therapy. The ⁴⁴Sc/⁴⁷Sc or ⁴³Sc/⁴⁷Sc pairs could be thus envisaged as true theranostic pairs. Another interesting aspect of scandium is that its chemistry is governed by the trivalent ion, Sc³⁺. When combined with its hardness and its size, it gives this element a lanthanide-like behavior. It is then also possible to use it in a theranostic approach in combination with ¹⁷⁷Lu or other lanthanides. This article aims to review the progresses that have been made over the last decade on scandium isotope production and coordination chemistry. It also reviews the radiolabeling aspects and the first (pre) clinical studies performed.

Separation of 44Sc from Natural Calcium Carbonate Targets for Synthesis of 44Sc-DOTATATE

The rapid increase in applications of scandium isotopes in nuclear medicine requires new efficient production routes for these radioisotopes. Recently, irradiations of calcium in cyclotrons by α, deuteron, and proton beams have been used. Therefore, effective post-irradiation separation and preconcentration of the radioactive scandium from the calcium matrix are important to obtain the pure final product in a relatively small volume. Nobias resin was used as a sorbent for effective separation of ⁴⁴Sc from calcium targets. Separation was performed at pH 3 using a column containing 10 mg of resin. Scandium was eluted with 100 μL of 2 mol L⁻¹ HCl. Particular attention was paid to the reduction of calcium concentration, presence of metallic impurities, robustness and simple automation. ⁴⁴Sc was separated with 94.9 ± 2.8% yield, with results in the range of 91.7–99.0%. Purity of the eluate was confirmed with ICP-OES determination of metallic impurities and >99% chelation efficiency with DOTATATE, followed by >36 h radiochemical stability of the complex. A wide range of optimal conditions and robustness to target variability and suspended matter facilitates the proposed method in automatic systems for scandium isotope separation and synthesis of scandium-labeled radiopharmaceuticals.

Scandium and terbium radionuclides for radiotheranostics: current state of development towards clinical application

Currently, different radiometals are in use for imaging and therapy in nuclear medicine: ⁶⁸Ga and ¹¹¹In are examples of nuclides for positron emission tomography (PET) and single photon emission computed tomography (SPECT), respectively, while ¹⁷⁷Lu and ²²⁵Ac are used for β⁻- and α-radionuclide therapy. The application of diagnostic and therapeutic radionuclides of the same element (radioisotopes) would utilize chemically-identical radiopharmaceuticals for imaging and subsequent treatment, thereby enabling the radiotheranostic concept. There are two elements which are of particular interest in this regard: Scandium and Terbium. Scandium presents three radioisotopes for theranostic application. ⁴³Sc (T_1/2 = 3.9 h) and ⁴⁴Sc (T_1/2 = 4.0 h) can both be used for PET, while ⁴⁷Sc (T_1/2 = 3.35 d) is the therapeutic match—also suitable for SPECT. Currently, ⁴⁴Sc is most advanced in terms of production, as well as with pre-clinical investigations, and has already been employed in proof-of-concept studies in patients. Even though the production of ⁴³Sc may be more challenging, it would be advantageous due to the absence of high-energetic γ-ray emission. The development of ⁴⁷Sc is still in its infancy, however, its therapeutic potential has been demonstrated preclinically. Terbium is unique in that it represents four medically-interesting radioisotopes. ¹⁵⁵Tb (T_1/2 = 5.32 d) and ¹⁵²Tb (T_1/2 = 17.5 h) can be used for SPECT and PET, respectively. Both radioisotopes were produced and tested preclinically. ¹⁵²Tb has been the first Tb isotope that was tested (as ¹⁵²Tb-DOTATOC) in a patient. Both radionuclides may be of interest for dosimetry purposes prior to the application of radiolanthanide therapy. The decay properties of ¹⁶¹Tb (T_1/2 = 6.89 d) are similar to ¹⁷⁷Lu, but the coemission of Auger electrons make it attractive for a combined β⁻/Auger electron therapy, which was shown to be effective in preclinical experiments. ¹⁴⁹Tb (T_1/2 = 4.1 h) has been proposed for targeted α-therapy with the possibility of PET imaging. In terms of production, ¹⁶¹Tb and ¹⁵⁵Tb are most promising to be made available at the large quantities suitable for future clinical translation. This review article is dedicated to the production routes, the methods of separating the radioisotopes from the target material, preclinical investigations and clinical proof-of-concept studies of Sc and Tb radionuclides. The availability, challenges of production and first (pre)clinical application, as well as the potential of these novel radionuclides for future application in nuclear medicine, are discussed.

Re-thinking the role of radiometal isotopes: Towards a future concept for theranostic radiopharmaceuticals

The potential and future role of certain metal radionuclides, for example, ⁴⁴ Sc, ⁸⁹ Zr, ⁸⁶ Y, ⁶⁴ Cu, ⁶⁸ Ga, ¹⁷⁷ Lu, ²²⁵ Ac, and ²¹³ Bi, and several terbium isotopes has been controversially discussed in the past decades. Furthermore, the possible benefits of "matched pairs" of isotopes for tandem applications of diagnostics and therapeutics (theranostics) have been emphasized, while such approaches still have not made their way into routine clinical practice. Analysis of bibliographical data illustrates how popularity of certain nuclides has been promoted by cycles of availability and applications. We furthermore discuss the different practical requirements for diagnostic and therapeutic radiopharmaceuticals and the resulting consequences for efficient development of clinically useful pairs of radionuclide theranostics, with particular emphasis on the underlying economical factors. Based on an exemplary assessment of overall production costs for ⁶⁸ Ga and ¹⁸ F radiopharmaceuticals, we venture a look into the future of theranostics and predict that high-throughput PET applications, that is, diagnosis of frequent conditions, will ultimately rely on ¹⁸ F tracers. PET radiometals will occupy a niche in the clinical low-throughput sector (diagnosis of rare diseases), but above all, dominate preclinical research and clinical translation. Matched isotope pairs will be of lesser relevance for theranostics but may become important for future PET-based therapeutic dosimetry.

Production and separation of 43Sc for radiopharmaceutical purposes

Background

The favorable decay properties of ⁴³Sc and ⁴⁴Sc for PET make them promising candidates for future applications in nuclear medicine. An advantage ⁴³Sc (T_1/2 = 3.89 h, Eβ⁺_av = 476 keV [88%]) exhibits over ⁴⁴Sc, however, is the absence of co-emitted high energy γ-rays. While the production and application of ⁴⁴Sc has been comprehensively discussed, research concerning ⁴³Sc is still in its infancy. This study aimed at developing two different production routes for ⁴³Sc, based on proton irradiation of enriched ⁴⁶Ti and ⁴³Ca target material.

Results

⁴³Sc was produced via the ⁴⁶Ti(p,α)⁴³Sc and ⁴³Ca(p,n)⁴³Sc nuclear reactions, yielding activities of up to 225 MBq and 480 MBq, respectively. ⁴³Sc was chemically separated from enriched metallic ⁴⁶Ti (97.0%) and ⁴³CaCO₃ (57.9%) targets, using extraction chromatography. In both cases, ~90% of the final activity was eluted in a small volume of 700 μL, thereby, making it suitable for direct radiolabeling. The prepared products were of high radionuclidic purity, i.e. 98.2% ⁴³Sc were achieved from the irradiation of ⁴⁶Ti, whereas the product isolated from irradiated ⁴³Ca consisted of 66.2% ⁴³Sc and 33.3% ⁴⁴Sc. A PET phantom study performed with ⁴³Sc, via both nuclear reactions, revealed slightly improved resolution over ⁴⁴Sc. In order to assess the chemical purity of the separated ⁴³Sc, radiolabeling experiments were performed with DOTANOC, attaining specific activities of 5–8 MBq/nmol, respectively, with a radiochemical yield of >96%.

Conclusions

It was determined that higher ⁴³Sc activities were accessible via the ⁴³Ca production route, with a comparatively less complex target preparation and separation procedure. The product isolated from irradiated ⁴⁶Ti, however, revealed purer ⁴³Sc with minor radionuclidic impurities. Based on the results obtained herein, the ⁴³Ca route features some advantages (such as higher yields and direct usage of the purchased target material) over the ⁴⁶Ti path when aiming at ⁴³Sc production on a routine basis.

Electronic supplementary material

The online version of this article (10.1186/s41181-017-0033-9) contains supplementary material, which is available to authorized users.

Electron linear accelerator production and purification of scandium-47 from titanium dioxide targets

The photonuclear production of no-carrier-added (NCA) ⁴⁷Sc from solid ^NatTiO₂ and the subsequent chemical processing and purification have been developed. Scandium-47 was produced by the ⁴⁸Ti(γ,p)⁴⁷Sc reaction with Bremsstrahlung photons produced from the braking of electrons in a high-Z (W or Ta) convertor. Production yields were simulated with the PHITS code (Particle and Heavy Ion Transport-code System) and compared to experimental results. Irradiated TiO₂ targets were dissolved in fuming H₂SO₄ in the presence of Na₂SO₄ and ⁴⁷Sc was purified using the commercially available Eichrom DGA resin. Typical ⁴⁷Sc recovery yields were >90% with excellent specific activity for small batches (<185 MBq batches).

Highlights lecture EANM 2016: "Embracing molecular imaging and multi-modal imaging: a smart move for nuclear medicine towards personalized medicine"

The 2016 EANM Congress took place in Barcelona, Spain, from 15 to 19 October under the leadership of Prof. Wim Oyen, chair of the EANM Scientific Committee. With more than 6,000 participants, this congress was the most important European event in nuclear medicine, bringing together a multidisciplinary community involved in the different fields of nuclear medicine. There were over 600 oral and 1,200 poster or e-Poster presentations with an overwhelming focus on development and application of imaging for personalized care, which is timely for the community. Beyond FDG PET, major highlights included progress in the use of PSMA and SSTR receptor-targeted radiopharmaceuticals and associated theranostics in oncology. Innovations in radiopharmaceuticals for imaging pathologies of the brain and cardiovascular system, as well as infection and inflammation, were also highlighted. In the areas of physics and instrumentation, multimodality imaging and radiomics were highlighted as promising areas of research.

47Sc production development by cyclotron irradiation of 48Ca

The therapeutic radionuclide ⁴⁷Sc was produced through the ⁴⁸Ca(p,2n) channel on a proton beam accelerator. The obtained results show that the optimum proton energies are in the range of 24-17 MeV, giving the possibility to produce ⁴⁷Sc radionuclide containing 7.4% of ⁴⁸Sc. After activation, the powdery CaCO₃ target material was dissolved in HCl and scandium isotopes were isolated from the targets. The performed separation experiments indicate that, due to the simplicity of the operations and the chemical purity of the obtained ⁴⁷Sc the best separation process is when scandium radioisotopes are separated on the 0.2 µm filter.

47Sc as useful β--emitter for the radiotheragnostic paradigm: a comparative study of feasible production routes

Background

Radiotheragnostics makes use of the same molecular targeting vectors, labeled either with a diagnostic or therapeutic radionuclide, ideally of the same chemical element. The matched pair of scandium radionuclides, ⁴⁴Sc and ⁴⁷Sc, satisfies the desired physical aspects for PET imaging and radionuclide therapy, respectively. While the production and application of ⁴⁴Sc was extensively studied, ⁴⁷Sc is still in its infancy. The aim of the present study was, therefore, to investigate and compare two different methods of ⁴⁷Sc production, based on the neutron irradiation of enriched ⁴⁶Ca and ⁴⁷Ti targets, respectively.

Methods

⁴⁷Sc was produced by thermal neutron irradiation of enriched ⁴⁶Ca targets via the ⁴⁶Ca(n,γ)⁴⁷Ca → ⁴⁷Sc nuclear reaction and by fast neutron irradiation of ⁴⁷Ti targets via the ⁴⁷Ti(n,p)⁴⁷Sc nuclear reaction, respectively. The product was compared with regard to yield and radionuclidic purity. The chemical separation of ⁴⁷Sc was optimized in order to obtain a product of sufficient quality determined by labeling experiments using DOTANOC. Finally, preclinical SPECT/CT experiments were performed in tumor-bearing mice and compared with the PET image of the ⁴⁴Sc labeled counterpart.

Results

Up to 2 GBq ⁴⁷Sc was produced by thermal neutron irradiation of enriched ⁴⁶Ca targets. The optimized chemical isolation of ⁴⁷Sc from the target material allowed formulation of up to 1.5 GBq ⁴⁷Sc with high radionuclidic purity (>99.99%) in a small volume (~700 μL) useful for labeling purposes. Three consecutive separations were possible by isolating the in-grown ⁴⁷Sc from the ^46/47Ca-containing fraction. ⁴⁷Sc produced by fast neutron irradiated ⁴⁷Ti targets resulted in a reduced radionuclidic purity (99.95–88.5%). The chemical purity of the separated ⁴⁷Sc was determined by radiolabeling experiments using DOTANOC achievable at specific activities of 10 MBq/nmol. In vivo the ⁴⁷Sc-DOTANOC performed equal to ⁴⁴Sc-DOTANOC as determined by nuclear imaging.

Conclusion

The production of ⁴⁷Sc via the ⁴⁶Ca(n,γ)⁴⁷Ca nuclear reaction demonstrated significant advantages over the ⁴⁷Ti production route, as it provided higher quantities of a radionuclidically pure product. The subsequent decay of ⁴⁷Ca enabled the repeated separation of the ⁴⁷Sc daughter nuclide from the ⁴⁷Ca parent nuclide. Based on the results obtained from this work, ⁴⁷Sc shows potential to be produced in suitable quality for clinical application.

Electronic supplementary material

The online version of this article (doi:10.1186/s41181-017-0024-x) contains supplementary material, which is available to authorized users.

Comparison between Three Promising ß-emitting Radionuclides, (67)Cu, (47)Sc and (161)Tb, with Emphasis on Doses Delivered to Minimal Residual Disease

PURPOSE: Radionuclide therapy is increasingly seen as a promising option to target minimal residual disease. Copper-67, scandium-47 and terbium-161 have a medium-energy β^- emission which is similar to that of lutetium-177, but offer the advantage of having diagnostic partner isotopes suitable for pretreatment imaging. The aim of this study was to compare the efficacy of ⁶⁷Cu, ⁴⁷Sc and ¹⁶¹Tb to irradiate small tumors.

METHODS: The absorbed dose deriving from a homogeneous distribution of ⁶⁷Cu, ⁴⁷Sc or ¹⁶¹Tb in water-density spheres was calculated with the Monte Carlo code CELLDOSE. The diameters of the spheres ranged from 5 mm to 10 µm, thus simulating micrometastases or single tumor cells. All electron emissions, including β^- spectra, Auger and conversion electrons were taken into account. Because these radionuclides differ in electron energy per decay, the simulations were run assuming that 1 MeV was released per µm³, which would result in a dose of 160 Gy if totally absorbed.

RESULTS: The absorbed dose was similar for the three radionuclides in the 5-mm sphere (146-149 Gy), but decreased differently in smaller spheres. In particular, ¹⁶¹Tb delivered higher doses compared to the other radionuclides. For instance, in the 100-µm sphere, the absorbed dose was 24.1 Gy with ⁶⁷Cu, 14.8 Gy with ⁴⁷Sc and 44.5 Gy with ¹⁶¹Tb. Auger and conversion electrons accounted for 71% of ¹⁶¹Tb dose. The largest dose differences were found in cell-sized spheres. In the 10-µm sphere, the dose delivered by ¹⁶¹Tb was 4.1 times higher than that from ⁶⁷Cu and 8.1 times that from ⁴⁷Sc.

CONCLUSION: ¹⁶¹Tb can effectively irradiate small tumors thanks to its decay spectrum that combines medium-energy β^- emission and low-energy conversion and Auger electrons. Therefore ¹⁶¹Tb might be a better candidate than ⁶⁷Cu and ⁴⁷Sc for treating minimal residual disease in a clinical setting.