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Nuclear Medicine: Instruments
Terms in this set (110)
Sodium Iodide Well Counter
Single Probe Counting Systems
Gamma Scintillation Camera
Single Photon Emission Computed Tomography
Positron Emission Tomography/CT
Geiger-Mueller survey meter
This instrument is used for low levels of radiation or activity. On the instrument, the pancake detector is located at the end of the handle and the face is covered with a red plastic cap. The selector knob has various multipliers to use with the displayed reading. Note the radiation check source affixed to the side, which is used to make sure the instrument is functional. Also there is a calibration sticker.
The dial reads in either counts per minute (CPM) or milliroentgens per hour (mR/hr). There is also a battery test range that is used when the battery check button is pushed or the selector knob is switched to battery check.
This causes one ionization to result in an "avalanche" of other electrons, allowing high efficiency for detection of even a single gamma ray.
The avalanche of electrons takes some time to dissipate; as a result, "dead time" must occur before the next ionization can be detected.
Most GM counters are equipped with a thin window that also allows detection of most beta rays.
Very weak beta rays (such as those from tritium) cannot be detected.
Handheld, very sensitive, inexpensive survey instruments used primarily to detect small amounts of radioactive contamination.
The detector is usually pancake shaped,(could also be cylindrical).
The detector is gas-filled and has a high applied voltage from the anode to the cathode that causes an "avalanche" of electrons.
Usually limited to exposure rates of up to about 100 mR (2.5 x 10⁻⁵ C/kg)/hour.
Detects ionizing radiation such as alpha particles, beta particles and gamma rays using the ionizing effect produced in a geiger-muller tube.
Ionization survey chamber
An ionization chamber must be used if there are high levels of activity or radiation. For this handheld model, the detector is inside the body of the instrument.
The scale reads in units of radiation exposure.
A special form of an ionization chamber.
Handheld survey instruments used to measure low or high exposure rates
They have an air or gas-filled chamber but a low efficiency for detection of gamma rays.
Have a relatively low applied voltage from anode to cathode; there is no avalanche effect and no dead time problem.
Typically are useful at exposure rates ranging from 0.1 mR (2.5 x 10-8 C/kg)/hour to 100 R (2.5 x 10-2 C/kg)/ hour.
An ionization chamber used in nuclear medicine to measure the amount of radioactivity of a radionuclide before injection into a patient.
Sodium iodide well counter
Common in nuclear medicine laboratories for performing in vitro studies as well as quality control and assurance procedures.
Designed for counting radioactive samples in standard test tubes placed in a solid cylindrical sodium iodide crystal with a cylindrical well cut into the crystal.
Well counters can typically count activity only up to about 1 μCi (37 kBq).
Many sodium iodide well counters are designed for counting radioactive samples in standard test tubes.
Generally, there is a solid cylindrical sodium iodide crystal with a cylindrical well cut into the crystal, into which the test tube is placed.
Well counters are heavily shielded scintillation crystals used to measure and identify small amounts of radioactivity contained in small volumes such as a test tube.
Sodium iodide well counter
A photomultiplier tube (PMT) is optically coupled to the crystal base.
Radiation from the sample interacts with the crystal and is detected by the PMT, which feeds into a scalar.
The scalar readout directly reflects the amount of radioactivity in the sample and is usually recorded in counts for the time period during which the sample is measured.
Because the sample is essentially surrounded by the crystal, the geometric efficiency for detection of gamma rays is high.
Geometric efficiency is defined as the fraction of emitted radioactivity that is incident on the detection portion of the counter.
Reflected light and scattering inside the well surface and the thickness of the crystal limit the energy resolution of the standard well counter.
Because the crystal is relatively thick, most low energy photons undergo interaction, and few pass through undetected.
As a result, in the energy ranges below 200 keV, the overall crystal detection efficiency is usually better than 95%.
Because the top of the well in the crystal is open, it is important to keep the sample volume in the test tube small.
If varying sample volumes are placed in the well counter, different amounts of radiation escape near the top of the crystal, resulting in unequal geometric efficiencies.
Absorption of gamma rays within the wall of the test tube is a factor when lower energy sources, such as iodine-125 (125I), are counted; therefore the sample tubes should also be identical.
Single probe counting system
Single probe counting systems using only one crystalline detector are primarily used for measuring thyroid uptake of radioactive iodine.
The typical crystal is 5 cm in diameter and 5 cm in thickness, with a cone shaped (flat field) collimator.
A PMT is situated at the crystal base.
Single probe counting system
Single crystal thyroid probe used for measuring radioiodine uptake. The end of the barrel is placed a fixed distance from the sitting patient's neck.
In addition to the larger type probes there are also handheld intraoperative probes most commonly used to identify and localize sentinel lymph nodes and parathyroid adenomas
These need to have excellent spatial resolution and are highly collimated counting devices with solid state scintillation or semiconductor detectors.
Scintillation based detectors have an NaI(Tl), CsI(Tl), or bismuth germanate crystal connected to a photomultiplier tube and are best for medium to high energy photons.
A well-type ionization chamber capable of measuring quantities in the millicurie (37 MBq) range.
It does not contain a sodium iodide crystal.
The chamber is cylindrical and holds a defined volume of pressurized inert gas (usually argon).
Within the chamber is a collecting electrode
Limits for maximum activity to be measured by dose calibrators are usually specified for 99mTc.
Gamma Scintillation Camera
A gamma camera converts photons emitted by the radionuclide in the patient into a light A gamma camera converts photons emitted by the radionuclide in the patient into a light pulse and subsequently into a voltage signal which is used to form an image.
The most widely used imaging devices in nuclear medicine are the simple gamma scintillation (Anger) camera and the single-photon emission computed tomography (SPECT) capable gamma camera.
The scintillation crystal
An array of photomultiplier tubes (PMTs)
A pulse height analyzer (PHA)
Digital correction circuitry
A cathode ray tube (CRT)
The control console
Basic Components of Gamma Camera
A computer and picture archiving systems (PACs) are also integral parts of the system.
Also called as scintillation camera or Anger camera.
Made of perforated or folded lead and is interposed between the patient and the scintillation crystal.
A device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy.
Allows the gamma camera to localize accurately the radionuclide in the patient's body.
Parallel Hole Collimator
Converging and Diverging Collimators
Five Basic Collimators:
There are 5 basic collimator designs to channel photons of different energies, to magnify or minify images, and to select between imaging quality and imaging speed.
Parallel Hole Collimator
All holes are parallel to each other.
Low Energy All-Purpose (LEAP)
Low Energy High-Resolution (LEHR)
Medium- and High Energy Collimators
Most common designs:
Have holes with large diameter (larger holes allow more scattered photons).
Have higher resolution, more holes that are smaller and deeper.
Medium energy collimators
Used for medium energy photons such as krypton81, gallium67, indium111.
Have thicker septa than LEAP and LEHR mainly used in Technicium99m.
A variation of the Parallel hole , which has all tunnels slanted at a specific angle.
It generates an oblique view for better visualization of an organ, which view is (partly) blocked by other parts of the body.
As an advantage, this collimator can be positioned close to the body for the maximum gain in resolution.
Converging and diverging collimators
In a Converging collimator the holes are not parallel but focused toward the organ.
The focal point is normally located in the center of the field of view (FOV).
The organ appears larger at the face of the crystal with a Converging collimator
When the Converging collimator is flipped over you get a Diverging collimator, generally used to enlarge the FOV.
Fan Beam Collimators
Designed for a rectangular camera head to image smaller organs like the brain and heart.
When viewed from one direction, the holes are parallel.
When viewed from the other direction, the holes converge. This arrangement allows the data from the patient to use the maximum surface of the crystal.
When the Fanbeam is flipped over it is called a Single Pass Diverging Collimator used for whole body sweeps.
Cone-shaped collimators have a single hole with interchangeable inserts that come with a 3, 4 or 6 mm aperture.
A pinhole generates magnified images of a small organ like the thyroid or a joint.
Most Pinhole collimators are designed for low energy isotopes.
Radiation emerging from the patient and passing through the collimator typically interacts with a thallium activated sodium iodide crystal
Crystals also can be made with thallium or sodium activated cesium iodide or even lanthanum bromide, but these are uncommon.
Interaction of the gamma ray with the crystal may result in ejection of an orbital electron (photoelectric absorption), producing a pulse of fluorescent light (scintillation event) proportional in intensity to the energy of the gamma ray.
A photomultiplier tube (PMT) converts a light pulse into an electrical signal of measurable magnitude.
An array of these tubes is situated behind the sodium iodide crystal and may be placed directly on the crystal, connected to the crystal by light pipes, or optically coupled to the crystal with a silicone-like material.
Pulse Height Analyzer
The basic principle of the PHA is to discard signals from background and scattered radiation and/or radiation from interfering isotopes, so that only primary photons known to come from the photopeak of the isotope being imaged are recorded.
The photopeak is the result of total absorption of the major gamma ray from the radionuclide.
Controls the selection of image exposure time and is usually a preset count, a preset time, or preset information density for the image accumulation.
Information density refers to the number of counts per square centimeter of the gamma camera crystal face.
One of the common performance parameters for gamma cameras.
•refers to either spatial or energy resolution.
Energy resolution is the ability to discriminate between light pulses caused by gamma rays of differing energies.
Spatial resolution refers to the ability to display discrete but contiguous sources of radioactivity.(either inherent or overall).
Inherent spatial resolution
This is the ability of the crystal PMT detector and accompanying electronics to record the exact location of the light pulse on the sodium iodide crystal. Gamma cameras have an inherent resolution of about 3 mm.
Overall spatial resolution
This is the resolution capacity of the entire camera system, including such factors as the collimator resolution, septal penetration, and scattered radiation.
A radioactive compound used for diagnostic or therapeutic purposes.
Drugs that have been synthesized with radioactive components, which allow the drugs to be followed within the human body
Radiopharmaceuticals portray physiology, biochemistry, or pathology in the body without causing any physiological effect.
They are referred to as radiotracers because they are given in subpharmacological doses that "trace" a particular physiological or pathological process in the body.
Most radiopharmaceuticals are a combination of a radioactive molecule, a radionuclide, that permits external detection and a biologically active molecule or drug that acts as a carrier and determines localization and biodistribution.
The uptake and retention of radiopharmaceuticals by different tissues and organs involve many different mechanisms such as:
Since the physiological approach defines a disease in terms of the failure of a normal physiological or biochemical process.
Blood pool imaging, direct cystography
Passive diffusion (concentration dependent)
Blood-brain barrier breakdown, glomerular filtration, cisternography
Capillary blockade (physical entrapment)
Perfusion imaging of lungs
Physical leakage from a luminal compartment
Gastrointestinal bleeding, detection of urinary tract or biliary system leakage
Glucose, fatty acids
Active transport (active cellular uptake)
Hepatobiliary imaging, renal tubular function, thyroid and adrenal imaging
Chemical bonding and adsorption
Splenic imaging (heat-damaged red blood cells), white blood cells
Receptor binding and storage
Adrenal medullary imaging, somastostain receptor imaging
Reticuloendothelial system imaging
Perfusion and active transport
Active transport and metabolism
Thyroid uptake and imaging
Active transport and secretion
Hepatobiliary imaging, salivary gland imaging
Trapping (Tc99m pertechnetate)
Thyroid gland imaging
Adsorption by hydroxyapatite crystals (Tc99m methylene diphosphonate [Tc99m MDP])
Active uptake by hepatocytes and excretion with bile
(Tc99m iminodiacetic acid [IDA] derivatives)
Blockage of capillaries and precapillary arterioles (Tc99m macroaggregated albumin particles [Tc99m MAA])
Lung perfusion imaging
Tubular excretion (Tc99m MAG-3)
Renal dynamic imaging
Iron containing globulins binding (Gallium-67 citrate)
Tumor and infection imaging
Cell migration (Labeled white blood cells)
Active transport to cells (glucose analogue) (Flourine-18 florodeoxyglucose [F-18 FDG])
General Production of Radionuclide
(e.g. uranium,actinium,thorium, radium, and radon)
(nuclear fission or bombardment of stable materials by neutrons or charged particles)
Molybdenum-99/Technetium-99m Generator Systems
Mo99 is produced by the fission of U-235.
("fission" is the action of dividing or splitting something into two or more parts.)
Mo99 has a half life of 2.8 days and is produced in a reactor by beta minus decay.
Tc 99m is produced by Isometric transition of Mo-99.
Tc 99m has a half life of 6 hr. and is produced in a generator.
This is the process of extracting one material from another by washing with a solvent; as in washing of loaded ion-exchange resins to remove captured ions.
2 Types of Generator System for Elution:
Most commonly used in regional radiopharmacies,comes with a reservoir of saline (0.9%).
Elution happens by placing a special sterile vacuum vial on the exit or collection port.
Common in imaging clinics, a volume calibrated saline charge is placed on the entry port and a vacuum vial is placed on the collection port.
Tc-99m sodium pertechnetate
Meckel's diverticulum detection, salivary and thyroid gland scintigraphy
Tc-99m sulfur colloid
Liver/spleen scintigraphy, bone marrow scintigraphy
Tc-99m macroaggregated albumin (MAA)
Pulmonary perfusion scintigraphy, liver intraarterial perfusion scintigraphy
Tc-99m red blood cells
Radionuclide ventriculography, gastrointestinal bleeding, hepatic hemangioma
Tc-99m diethylenetriamine-pentaacetic acid (DTPA)
Renal dynamic scintigraphy, lung ventilation (acrosol), glomerular filtration rate
Tc-99m mercaptoacetyltriglycine (MAG3)
Renal dynamic scintigraphy
Tc-99m dimercaptosuccinic acid (DMSA)
Renal cortical scintigraphy
Tc-99m iminodiacetic acid (HIDA)
Tc-99m sestamibi (Cardiolite)
Myocardial perfusion scintigraphy, breast imaging
Tc-99m tetrofosmin (Myoview)
Myocardial perfusion scintigraphy
Tc-99m Exametazime (HMPAO)
Cerebral perfusion scintigraphy, white blood cell labeling
Tc-99m bicisate (ECD)
Cerebral perfusion scintigraphy
The specific activity of the radioisotope corresponds to the ratio between the activity of this radionuclide and the total mass of the element or molecule present.
A radioisotope solution is called carrier free when only radioactive atoms are present, even in an extremely dilute solution.
Specific activity is expressed in becquerels per mass unit.
Radioactive concentration (or volumetric concentration) determines the degree of radioactive substance per volume unit.
Due to radioisotope decay, the composition of a radiopharmaceutical product changes over time.
It is therefore necessary to define several measurable parameters, and in particular those informing physicians on the precise quantities of radioactive substances actually injected into patients.
A radiopharmaceutical must be produced in a precise time frame.
Calibration Date is the basis of physicians to precisely calculate the volume fraction to be taken when patient is being injected or the radio-labeling staging.
It is the certificate indicating the radioactive concentration at a precisely defined time.
Using a generator
Using a reactor
Extracting products after having obtained them in a thermal reactor, or separating them from fission products
Radionuclides can be produced in several ways:
Handling radioactive substances requires a suitably safe environment that is therefore very costly.
Nuclear medicine can only use radionuclides of very high purity, requiring optimized methods of separation and purification
Two major difficulties that limit the methods of production:
A radioactive substance can be formed by bombarding a stable substance with charged particles in a linear or circular type accelerator.
The tools most frequently used are circular accelerators, also called cyclotrons.
In a cyclotron, charged particles of low mass, such as protons, are accelerated in a circular trajectory until they reach high energy.
These particles are used to bombard a specific target which may be solid, liquid or gaseous, transforming it into radioactive material.
A generator is a small device containing a radioisotope of medium half-life which transforms slowly over time into an isotope displaying ideal characteristics for a nuclear medicine application.
The "parent" isotope is fixed to a medium which acts as a filter and retains it.
When washed with a saline solution, this medium releases the formed "daughter" radionuclide while the nondecayed parent still remains trapped.
Technetium 99m, the most frequently used diagnosis isotope, is produced using a generator.
Involved in more than two thirds of nuclear imaging techniques.
Has a half life of 6 hours.
Formed by the breakdown of Molybdenum 99 with a half-life of 66 hours.
In the alumina generator system, the molybdenum activity is absorbed on an alumina column.
By passing physiologic saline over the column, 99mTc is eluted or washed off as sodium pertechnetate (Na 99mTcO4-).
Most radionuclides used in nuclear medicine are artificial isotopes.
The most usual method of production consists of bombarding a stable isotope (the target) with a flow of neutrons in a nuclear reactor.
This neutron condenses with the existing atomic nucleus, thus creating an unstable isotope of the metal used as the target.
Molybdenum 99, used in the generator described above, may be formed by neutron bombardment of stable Molybdenum 98.
Many centres processing nuclear waste from fission reactions have access to large quantities of materials that are considered as being useless. Most of these are by-products of Uranium 235 fission used in nuclear power plants.
Iodine 131 used in therapy is produced from this waste.
Molybdenum 99 is also available. It is a compound identical to that described in the neutron bombardment method, but much easier to separate from the other radionuclides.
Minimum of particulate emission
Primary photon energy between 50 and 500 keV
Physical half-life greater than the time required to prepare material for injection
Effective half-life longer than the examination
Suitable chemical form and reactivity
Stability or near-stability of the product
Choosing a radionuclide considerations in NucMed:
Iodine 123 and 131
Two isotopes of iodine (123I and 131I) are clinically useful for imaging and may be administered as iodide
Iodine-123 has a 13.2-hour half-life and decays by electron capture to tellurium-123 (123Te).
The photons emitted are 28-keV (92%) and 159-keV (84%) gamma rays
Iodine-123 is usually produced in a cyclotron by bombardment of antimony-121 (121Sb) or tellurium-122 or -124 (122Te or 124Te).
Another method is to bombard iodine-127 (127I) to produce 123Xe and let this decay to 123I.
Iodine-131 is a much less satisfactory isotope from an imaging viewpoint because of the high radiation dose to the thyroid and its relatively high photon energy.
It is widely available, is relatively inexpensive, and has a relatively long shelf life
Has a half-life of 8.06 days and decays by beta-particle emission to a stable 131Xe.
The principal mean beta energy (90%) is 192 keV.
When iodine is orally administered as the iodide ion, it is readily absorbed from the gastrointestinal tract and distributed in the extracellular fluid.
Iodine is a useful radionuclide because it is chemically reactive and is used to produce a variety of radiopharmaceuticals.
Xenon is a relatively insoluble inert gas and is most commonly used for pulmonary ventilation studies.
Xenon is commercially available in unit dose vials or in 1 Ci (37 GBq) glass ampules.
Xenon is highly soluble in oil and fat, and there is some adsorption of xenon onto plastic syringes.
Xenon-133 has a physical half-life of 5.3 days.
The principal gamma photon has an energy of 81 keV and emits a 374-keV beta particle.
With normal pulmonary function, its biologic halflife is about 30 seconds.
133Xe include its relatively low photon energy, beta-particle emission, and some solubility in both blood and fat.
Gallium-67 has a physical half-life of 78.3 hours and decays by electron capture, emitting gamma radiation.
It can be produced by a variety of reactions in a cyclotron.
The principal gamma photons from 67Ga are 93 keV (40%), 184 keV (24%), 296 keV (22%), and 388 keV (7%).
When injected intravenously, most 67Ga is immediately bound to plasma proteins, primarily transferrin.
During the first 12 to 24 hours, excretion from the body is primarily through the kidneys, with 20% to 25% of the administered dose being excreted by 24 hours.
Indium 111 and Indium 113m
Indium is a metal that can be used as an iron analog; it is similar to gallium.
Isotopes of interest are 111In and 113mIn.
Indium-111 has a physical half-life of 67 hours and is produced by a cyclotron.
The principal photons are 173 keV (89%) and 247 keV (94%).
Indium-113m can be conveniently produced by using a 113Sn generator system.
It has a physical half-life of 1.7 hours and a photon of about 392 keV.
Indium-111 can be prepared as a chelate with diethylenetriaminepentaacetic acid (DTPA).
Because of its long half-life, the 111In chelate can be used for intracranial cisternography.
Indium-111 is also used to label platelets, white cells, monoclonal antibodies, and peptides.
Indium-111 oxine labeled white cells are commonly used to scan for infections.
When a thallium metal target is bombarded with protons in a cyclotron, lead 201 (201Pb) is produced, which can be separated from the thallium target and allowed to decay to 201Tl.
Thallium- 201 has a physical half-life of 73.1 hours and decays by electron capture to mercury-201 (201Hg).
Mercury-201 emits characteristic x-rays with energies from 68 to 80 keV (94.5%) and much smaller amounts of gamma rays with higher energies.
Because 201Tl is produced by a cyclotron, it is expensive
Thallium-201 is normally administered as a chloride and rapidly clears from the blood with a half-life between 30 seconds and 3 minutes.
Fluorine-18 and other Positron Emitters
The most commonly used positron-emitting radiopharmaceutical in clinical imaging is the glucose analog fluorine-18 fluorodeoxyglucose (18F-FDG)
Fluorine-18 is also used in a sodium form as skeletal imaging agent.
The positron emitters carbon-11, nitrogen-13, and oxygen-15 are not used commonly in clinical practice primarily because of the need for an on-site cyclotron.
Carbon-11 acetate and palmitate are metabolic agents, carbon monoxide can be used for blood volume determinations, and there are a few carbon-11 labeled receptor binding agents.
Nitrogen-13 ammonia is a perfusion agent and nitrogen glutamate is a metabolic agent.
Oxygen-15 carbon dioxide and water are perfusion agents and oxygen as a gas is a metabolic agent.
Rubidium-82 chloride is obtained from a generator and used for myocardial perfusion studies; (expensive).
Radioactive Iodine 123
Technetium-99m hydroxymethylene diphosphate (Tc-99m HMDP)
Technetium-99m methylene diphosphate (Tc-99m MDP) - more commonly used
1980s Iodine 123 Rose bengal
Tc-99m dimethyl iminodiacetic acid (IDA)
(referred to as hepatic IDA 'HIDA')
Tc-99m Mercaptoacetyltriglycerine (MAG3)
- Most common renal radiopharma
Tc-99m Diethylenetriaminepentaacetic Acid (DTPA)
- GFR imaging
Tc-99m Dimercaptosuccinic Acid (DMSA
- (renal cortex) renal scarring or acute pyelonephritis
Iodine-131 macroaggregated albumin
Tc-99m human albumin microspheres
Tc-99m macroaggregated albumin (MAA)
ceuticals:Technetium-99m sulfur colloid
Tc-99m diethylenetriaminepentaacetic acid (DTPA)
Infection and Inflammation
In-111 oxine-labeled leukocytes
Tc-99m HMPAO-labeled leukocytes
Central Nervous System
F-18 FDG - glucos metabolism
Tc-99m hexamethylpropyleneamine oxime (HMPAO)
Tc-99m ethyl cysteinate dimer (ECD)
- Perfusion cerebral blood flow
Tc-99m sestamibi firstly approved by FDA
- For myocardial perfusion
Rubidium-82 for dual photon imaging
Thallium 201 (old one used)
- Behaves similarly to radioactive potassium
Potassium is used because it is the major intracellular cation.
Oncology: Positron Emmision Tomography
Oxygen-15, Nitrogen-13, Carbon-11, and hydroxyl analog, F-18
F-18 FDG is the only PET radiopharmaceutical widely used in oncology.
The various positron emitters can be attached to biological carrier molecules. Carrier molecules such as nucleosides, amino acids, fatty acid components, and glucose analogs are chosen to form radiopharmaceuticals that target components of cellular metabolism and division.
Oncology: Non-Positron Emmision Tomography
Cold Spot Imaging
Thyroid: I-123, Tc-99m pertechnetate
Liver: Tc-99m sulfur colloid
Hot Spot Imaging
Bone: Tc-99m MDP, Tc-99m HDP
Ga-67: Lymphoma, others
Tl-201 chloride: Bone sarcomas, brain tumors
Tc-99m sestamibi: Breast cancer, parathyroid adenomas, and Tl-201 applications
Tc-99m tetrofosmin: Similar to sestamibi
F-18 fluorodeoxyglucose: Multiple tumors, especially aggressive disease
I-131: Papillary and follicular thyroid cancer
I-131 MIBG: Neural crest tumors (adrenal medulla imaging)
I-131 iodomethylnorcholesterol (NP-59)*: Adrenal cortical tumor imaging
Tc-99m HIGA: tumors of hepatocyte origin
Radiolabeled monoclonal antibodies:
In-111 satumomab*: Ovarian and colorectal cancer
Tc-99m arcitumomab (CEA-Scan)*: Colorectal cancer
In-111 capromab pendetide (ProsaScint): Prostate cancer
Tc-99m Veraluma*: Small cell lung cancer
In-111 ibritumomab tiuxetan (Zevalin): Lumphoma
I-131 tositumomab (Bexxar): Lymphoma
Radiolabeled peptides: Somatostatin receptors
In-111 pentreotide (OctreoScan): Neuroendocrine tumors
Tc-99m depreotide*: Lung cancer
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