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  1. 1. THE OHIO STATE UNIVERSITY COLLEGE OF PHARMACY UNIVERSITY MEDICAL CENTER NUCLEAR PHARMACY CERTIFICATE PROGRAM SUMMARY OF TOPICS AND CLOCK HOURS Lecture Topic Clock Hours History of the Use of Radionuclides in Medicine RP&I 2 Pharmacy Aspects Definitions Chronological Events of Importance Literature/Reference Source Review Nuclear Pharmacy Practice/The Role in Nuclear Medicine RP&I 5 Nuclear Pharmacy as a Practice Specialty M 1 Nuclear Medicine as a Practice Specialty RC 2 Radiation Detection Clinical Nuclear Medicine Radionuclides Radiochemicals Radiopharmaceuticals Gamma Camera/P.E.T. Camera Nuclear Counting Instrumentation Radiolabeled Compounds Preparation of Drugs Radionuclide Generators Quality Assessment Dispensing Procurement Radiation Safety Radiation Physics, Types of Radiation, Radioactive Decay RP&I 5 Sources of Radiation RP 3 Radiation (particulate, wave) M 1 Radioactivity RB 3 N/P Ratio RC 1 Types of Radioactive Decay Alpha Negatron Positron Electron Capture Gamma Photon Basic Atomic Definitions
  2. 2. Nuclide Element Radionuclide Isotopes Isomers Page 2 Lecture Topic Clock Hours Radioactivity Units, Half-Life Concept, Decay Equation RP&I 5 Radiotracer RP 3 Radioactive Pharmaceutical M 2 Radiopharmaceutical RC 1 Units of Radioactivity (Curie, mCi, μCi, nCi, pCi, Bq) Radioactive Decay Parent Daughter Decay Series or Chain Rate of Radioactive Decay Half-Life Concept Decay Equation (post-calibration, pre-calibration) Radioactive Concentration Radioactive Specific Activity Radiation Exposure, Effects of Radiation on Biological Systems RP&I 3 Interaction of Radiation with Matter RP 3 Concept of Threshold Level M 3 LD50/30 concept RB 5 Toxic Effects of Radiation RC 1 History of Radiation Biology Ionizing Radiation Interaction with Matter Ionization Excitation Ionizing Radiation Specific Ionization Linear Energy Transfer (LET) Directly Ionizing Radiation Alpha Particles Beta Particles (negatrons, positrons) Indirectly Ionizing Radiation Gamma Photons and X-rays Photoelectric Effect Compton Effect Pair Production Radiation Chemistry Associated with Biological Effects Free Radical Production Radiolysis of Water Free Radicals Recombination Free Radical Interaction to Form Toxic Substances Direct Theory of Biological Damage Indirect Theory of Biological Damage Effects on Macromolecules, Cells, Tissues and Organs Law of Bergonie and Tribondeau
  3. 3. Radiosensitivity of Cells Radiation Hormesis Risks of Radiation RP&I 5 Comparison with other Risks RP 3 As Low As Reasonably Achievable RB 2 Radiation: Balancing the Record Recent Radiation "Experiments" Page 3 Lecture Topic Clock Hours Radiation Safety, Radiation Protection RP&I 5 ALARA Concept RP 1 Units of Exposure and Radiation Dose M 2 Roentgen (R) and Exposure (X) RB 3 Coulomb per Kilogram Radiation Absorbed Dose (rad) Gray (Gy) Dose Equivalent Relative Biological Effectiveness (RBE factor) Roentgen Equivalent Man (rem) Quality Factor (QF) Seivert (Sv) Annual Limit on Intake (ALI) Dose Equivalent (HT) Committed Dose Equivalent (HT50) Committed Effective Dose Equivalent (HE50) Effective Dose Equivalent (HE) Annual Effective Dose Equivalent (NCRP Report 93, Table 8.2) Dose Limiting Recommendations Occupational Dose Limits (ODL) Dose Limits for the Public or Occasionally Exposed Individuals Radiation Protection Radiation Hazard Internal Contamination External Exposure Time, Distance, Shielding Factors Effecting the Hazards of Radiation Relative Risks of Low Level Radiation Prevention of Internal Radiation Controlling Exposure to External Sources Regulations Controlling the Use of Radioactive Materials RP 4 CFR Part 19, “Notices, Instructions, Reports to Workers” M 2 CFR Part 20,”Standards for Protection Against Radiation” CFR Part 35,”Medical Use of Byproduct Material” Radioactive Material Regulations Review U.S. Department of Transportation RAMREG-001-98 Radioactive Material Shipment Checklist Draft NUREG-1556, Volume 13
  4. 4. Consolidated Guidance About Materials Licenses Program-Specific Guidance About Commercial Radiopharmacy Licenses Suggested Commercial Radiopharmacy Audit Checklist USNRC Regulatory Guide 8.39 Release of Patients Administered Radioactive Materials USNRC Regulatory Guide 8.13 Instruction Concerning Prenatal Radiation Exposure Regulations for Procedures Federal Agencies (USNRC,USFDA,USDOT,USEPA) State Agencies (Agreement States, State Radiation Control Boards) Institutional Control (Office of Radiation Safety) International Agencies (IAEA,ICRU) Page 4 Lecture Topic Clock Hours Radiation Safety Short Course-Office of Radiation Safety RP&I 5 Administration of Radiation Safety Program RP 3 Authorization for the Use of Radioactive Materials M 3 Procurement of Radioactive Materials RB 3 Facilities for the Use and Storage of Radioactive Materials Training and Instructions Required for Approved Supervisors, Investigators and Users Personnel Monitoring Programs Personal Dosimeters Pregnant Workers Radiation Safety Inspections and Enforcement of Federal, State and Local Regulations Procedures and Precautions for the Use of Radioactive Materials Major and Minor Spills Required Laboratory Posting Radioactive Materials: Transportation, Packaging and Disposal RP&I 5 Definitions RP 3 Radioactive Material M 1 Special Form Radioactive Material Normal Form Radioactive Material Fissile Material Specific Activity A-1 Value, A-2 Value Limited Quantity Type A Quantity and Package Type B Quantity and Package Label Marking Placarding Transport Index
  5. 5. Consignor Conveyance Common Carrier Contract Carrier Private Carrier Exclusive Carrier Non-Exclusive Carrier LSA-I, II and III Surface Contaminated Object Industrial Packaging Source Material Special Source Material Byproduct Material Licensed Material Regulatory History 49 CFR Marking Labeling Placarding 10CFR, Part 20 Packaging Overview Page 5 Lecture Topic Clock Hours Production of Radionuclides in Nuclear Reactors RP&I 5 Sources of Radionuclides RP 3 Nuclear Reactor Production Versus Particle Accelerator M 1 Byproduct Material Production in Nuclear Reactors RC 2 Neutron Activation and Fission Nuclear Reactions Using Neutrons Nuclear Reactions Using Fission History of Nuclear Reactor Fission Components of a Nuclear Reactor Parameters Controlling Quantity of Radioactivity Produced Typical Reactions Seen in a Nuclear Reactor Purification of Products Fission Moly Neutron Irradiated Moly Carrier Material Production of Radionuclides in Accelerators RP&I 4 Artificial Radioactivity M 1 Concept of Acceleration of Charged Particles RC 2 Particle Accelerators (Linear Accelerator, Cyclotron) Cyclotron Design History of the Cyclotron Magnetic Resonance Acceleration
  6. 6. Neutron Deficient Radionuclides Nuclear Reactions Seen in Accelerators Radionuclides Produced in Accelerators Positron Emittors Gamma-Emitting, Cyclotron-Produced Radionuclides An Overview of Positron Emission Tomography (PET) Positron + Electron Transmutation Radionuclide Generators RP&I 5 Radionuclide Generator Concept RP 3 Parent-Daughter Decay M 1 Biomedically Useful Parent-Daughter Decay Combinations RC 2 Properties of Ideal Radionuclide Generator Systems Basis of Radionuclide Generator Operation Secular Equilibrium and Transient Equilibrium Radionuclide Generator Design/Construction Gas Generator Chromatograph-column Generator Radionuclide Generators of Medical Interest Molybdenum-99/Technetium-99m Radionuclide Generator Separation of Technetium-99m or Elution of the Mo-99/Tc-99m Generator Eluant and Eluate Wet Column and Dry Column Mo-99/Tc-99m Generators Shelf Life of a Mo-99/Tc-99m Generator Choosing a Generator Size Quality Assessment of Mo-99/Tc-99m Generator Eluate Moly Breakthrough Regulatory Requirements for Mo-99/Tc-99m Generator Eluates Performance of Tc-99m Generating Systems Mo-99/Tc-99m Radionuclide Generator Kinetics Page 6 Lecture Topic Clock Hours Properties of Radiopharmaceuticals RP&I 5 Radiopharmaceuticals as Signal Generators RP 3 Radiopharmaceutical Definition M 1 Essential Properties of Diagnostic Radiopharmaceuticals RB 2 Physical Properties RC 2 Radioactive Decay Characteristics Physical Half-Life Radiation Dosimetry Biological Properties Biological Half-Life Effective Half-Life Saturability of Receptor Sites Biodistribution/Pharmacokinetics Chemical/Pharmaceutical Properties Chemical Form and Synthesis Stability
  7. 7. Toxicity Sterility Apyrogenicity Radionuclide Purity Radiochemical Purity Presence of Particulate Matter pH, Ionic Characteristics Properties of Ideal Diagnostic Radiopharmaceuticals USP Listing of Radioactive Pharmaceuticals Applying Radiopharmaceuticals in Nuclear Medicine Quality Control Procedures Moly Breakthrough ITLC Chromatography HPLC Chromatography Sep-Pak Chromatography TLC Chromatography Column Chromatography Particle Sizing Particle Number Mechanisms of Localization of Radiopharmaceuticals RP&I 3 Pharmacology Versus Mechanisms of Localization RP 2 Biological Basis of Distribution of Radiopharmaceuticals M 1 Substrate Nonspecific Localization RC 2 Active Transport Phagocytosis Cell Sequestration Capillary Blockade Simple Diffusion Compartmental Localization Substrate Specific Localization Metabolically Useful Compounds Substituted Biochemical Compounds Receptor Binding Compounds Drug-Radiopharmaceutical Interactions Pharmacologic Pharmaceutical Toxicologic Page 7 Lecture Topic Clock Hours Pharmacokinetic Physical Occupational Dietary Recreational Personal Habits Interventional Nuclear Medicine Technetium Chemistry RP&I 4
  8. 8. Desirable Radionuclide Characteristics RP 2 An "Ideal" Radionuclide for Diagnostic Imaging M 1 Reduction Methods RC 2 Labeling with Technetium-99m Hydrolysis of Reduced Technetium and Tin Technetium-99m Radiopharmaceutical Kits Additives Technetium-99m Complexes Formation Structure Stability Radionuclide Chemistry RP&I 2 Gallium Chemistry RP 1 Radionuclides of Gallium RC 2 Indium Chemistry Radionuclides of Indium Thallium Chemistry Radionuclides of Thallium Gallium and Indium Radiopharmaceuticals Thallium Radiopharmaceuticals Iodine Chemistry Radionuclides of Iodine Radioiodination Procedures Radiopharmaceuticals Containing Iodine Radionuclides Urinary System Radiopharmaceuticals RP&I 2 Overview of Renal Imaging RP 1 Perfusion Agents RC 2 Static Imaging Agents Glomerular Filtration Agents Renal Tubular Function Agents Radionuclide Renography Radiopharmaceuticals for Renograms Iodohippurate Sodium I-131 Technetium Tc99m Mertiatide Radiopharmaceuticals for Renal Imaging Technetium Tc99m Pentetate Technetium Tc99m Gluceptate Technetium Tc99m Succimer Technetium Tc99m Mertiatide Glomerular Filtration Rate Determination Iodine I125 Iothalamate Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Renal Nuclear Medicine Page 8 Lecture Topic Clock Hours Central Nervous System Radiopharmaceuticals RP&I 2 Overview of CNS Imaging RP 1 Blood-Brain-Barrier Concept RC 2 CNS Radiopharmaceuticals Conventional Agents
  9. 9. Technetium Tc99m Sodium Pertechnetate Technetium Tc99m Pentetate Technetium Tc99m Gluceptate PET Agents Fluorine F18 Fluorodeoxyglucose Carbon C11 Deoxyglucose Lipophilic Agents Technetium Tc99m bicisate Technetium Tc99m exametazime Cisternography Indium In111 Pentetate Adjunctive Medications and Drug Intervention Studies Procedures of Choice in CNS Nuclear Medicine Liver and Spleen Radiopharmaceuticals RP&I 2 Overview of Liver/Spleen Imaging RP 1 Reticuloendothelial System (Kuppfer Cells) RC 2 Technetium Tc99m Sulfur Colloid Technetium Tc99m Albumin Colloid Spleen Imaging Technetium Tc99m Sulfur Colloid Technetium Tc99m Albumin Colloid Technetium Tc99m red blood cells (heat damaged) Hepatobiliary System Imaging (Parenchymal Cells) Metabolic Functions of the Liver Clinical Goals Chemistry of IDA compounds Technetium Tc99m Disofenin Technetium Tc99m Mebrofenin Technetium Tc99m Lidofenin Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Liver and Spleen Nuclear Medicine Gastrointestinal System Radiopharmaceuticals RP&I 2 Overview of Nuclear Medicine Imaging of the GI Tract RP 1 Salivary Gland Imaging RC 2 Esophageal Transit Study Gastroesophageal Reflux Study Gastric Emptying Study Small Bowel Transit Study Gastrointestinal Absorption Study Meckel's Diverticulum Imaging Enterogastric Reflux Study Gastrointestinal Bleed Detection Colon Transit Study Gastrointestinal Absorption Study Radiopharmaceuticals Technetium Tc99m Sodium Pertechnetate Page 9 Lecture Topic Clock Hours
  10. 10. Technetium Tc99m Sulfur Colloid Technetium Tc99m Albumin Colloid Technetium Tc99m Labeled Chelex Resin Liquid Meals Solid Meals Technetium Tc99m Labeled Autologous Red Blood Cells Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Gastrointestinal Nuclear Medicine Pulmonary System Radiopharmaceuticals RP&I 2 Overview of the Lungs RP 1 Regional Pulmonary Function Studies (Ventilation Imaging) RC 2 Radiopharmaceuticals Xenon Xe133 Gas Krypton Kr81m Gas Technetium Tc99m Pentetate Radioaerosol Pulmonary Perfusion Studies (Perfusion Imaging) Radiopharmaceuticals Technetium Tc99m Albumin Aggregated MAA Particles Calculations Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Pulmonary Nuclear Medicine Cardiovascular System Radiopharmaceuticals RP&I 2 Overview of the Cardiovascular System RP 1 Evaluation of Ventricular Function (Blood Pool Imaging) RC 2 Ejection Fraction Determination, MUGA Studies Radiopharmaceuticals Technetium Tc99m Albumin Technetium Tc99m Labeled Autologous Red Blood Cells In Vitro Labeling In Vivo Labeling Semi In Vitro Labeling Red Blood Cell Labeling Kit (UltraTAG®-RBC) C-11 or O-15 Labeled Red Blood Cells (PET Imaging) Evaluation of Myocardial Perfusion, Rest/Stress Studies Radiopharmaceuticals Thallium Tl201 Thallous Chloride Technetium Tc99m Sestamibi Technetium Tc99m Tetrofosmin Rubidium-82 Chloride (PET imaging) Evaluation of Myocardial Necrosis (Myocardial Infarction) Radiopharmaceuticals Technetium Tc99m Pyrophosphate Fluorine F18 Fluorodeoxyglucose (PET imaging) Evaluation of Myocardial Metabolism Radiopharmaceuticals Iodine I123 Iodophenylpentadecanoic Acid Fluorine F18 Fluorodeoxyglucose (PET imaging) Carbon C11 Deoxyglucose (PET imaging) Evaluation of Acute Venous Thrombosis
  11. 11. Radiopharmaceuticals Technetium Tc99m Apcitide Page 10 Lecture Topic Clock Hours Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Cardiovascular Nuclear Medicine Skeletal System Radiopharmaceuticals RP&I 2 Overview of Skeletal System RP 1 Organic Matrix RC 2 Inorganic Matrix Hydroxyapatite Crystals Reactive Bone Radiopharmaceuticals Historical Perspective Strontium Sr-85 Chloride Strontium Sr-87m Chloride Fluorine F18 Sodium Fluoride Polyphosphate Compounds Technetium Tc99m Pyrophosphate Technetium Tc99m Pyro- and Trimeta- Phosphates Technetium Tc99m Oxidronate Technetium Tc99m Medronate Clinical Comparison of Bone Imaging Agents Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Skeletal System Nuclear Medicine Endocrine System Radiopharmaceuticals RP&I 2 Overview of Endocrine System RP 1 Thyroid Hormone Chemistry RC 2 Thyroid Function Studies Radiopharmaceuticals Iodine I131 Sodium Iodide Iodine I123 Sodium Iodide Thyroid Imaging Studies Radiopharmaceuticals Iodine I131 Sodium Iodide Iodine I123 Sodium Iodide Technetium Tc99m Sodium Pertechnetate Thyroid Therapy Radiopharmaceuticals Iodine I131 Sodium Iodide Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Thyroid Nuclear Medicine Adrenal Gland Hormone Chemistry Radiopharmaceuticals I-131-6-beta-iodomethylnorcholesterol (NP-59) Iobenguane Sulfate I-131 (MIBG) Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Adrenal Nuclear Medicine Cancer Imaging RP&I 2
  12. 12. Overview of Nuclear Medicine Oncology RP 1 Characterstics of Tumor Cells RB 2 Increased Metabolic Activity RC 2 Tumor-Specific Receptor Compounds Increased Tumor Blood Flow Altered Microvasculature Page 11 Lecture Topic Clock Hours Radiopharmaceuticals Metabolite Related Agents I-131-6-beta-iodomethylnorcholesterol (NP-59) Iobenguane Sulfate I-131 (MIBG) Positron Emitting Amino Acids (PET imaging) Cationic Agents Gallium Ga67 Citrate Technetium Tc99m sestamibi Indium In111 Chloride Receptor Compounds Indium In111 Satumomab Pendetide Indium In111 Capromab Pendetide Indium In111 Pentetreotide Technetium Tc99m Arcitumomab Technetium Tc99m Nofetumomab Technetium Tc99m Depreotide Sentinel Lymph Node Mapping (Intraoperative Lymphatic Mapping) Filtered Technetium Tc99m Sulfur Colloid Technetium Tc99m Albumin Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Nuclear Oncology Therapeutic Nuclear Medicine RP&I 2 Therapeutic Intervention in Nuclear Medicine RP 1 Characteristics of Therapeutic Radiopharmaceuticals RB 2 Clinical Indications for Therapeutic Radiopharmaceuticals RC 2 Hyperthyroidism and Thyroid Cancer Radiopharmaceuticals Iodine I131 Sodium Iodide Safe Handling of Radioiodine Preparations Malignant and Hematologic Diseases Radiopharmaceuticals Sodium Phosphate P-32 Chromic Phosphate P-32 Painful Osseous Metastases Radiopharmaceuticals Strontium Sr-89 Chloride Samarium Sm-153 EDTMP Rhenium Re-186 HEDP Tin-117m DTPA Therapeutic Applications of Radionuclides Adjunctive Medications and Drug Intervention Studies Procedures of Choice in Therapeutic Nuclear Medicine
  13. 13. Clock hours code: RP&I Radiation Physics and Instrumentation RP Radiation Protection M Mathematics Pertaining to the Use and Measurement of Radioactivity RB Radiation Biology RC Radiation Chemistry