ThE

for Thyroid Studies

1 Radioiodineis trapped by the thyroid and organ/fled inthe synthesisof thyroxine.99mTc04is alsotrapped bythe thyroid but is notorganified. Consequently,Tc99mactivity does not always indicate the physiologiccondition of the thyroid.1

2 Radioiodineclearly demonstratesthe “cold,―non-1unctioning nodules that may be associated with malignantthyroid tumors. Such nonfunctioning nodules haveappeared “hot―or “cold―on images obtained withTc99m,necessitatinga confirmatory radioiodinescan.2'3

3 Radioiodinethyroid imaging is preferred toTc99m insuch instancesas investigationof patientswith possibleretrosternalthyroid tissueor with unsatisfactoryTc99mimagesduetopoorradionuclideconcentration.3

Steinbach, HL, Kundy, D, Moss, M, et al: A comparison of three agents in thyroid uptake and scintigraphy. Scientific Exhibit, Society of Nuclear Medicine,Philadelphia, June 16-20,1975.

“Informationfor Physicians—Irradiation-RelatedThyroid Cancer prepared by the Division of Cancer Control and Rehabilitation, National Cancer tnstitute,DHEWPublication No. (NIH) 77-1120,p.13.

3Arnold,JE, Pinsky,5: Comparison of “Tcand123)for Thyroid Imaging.J. NucI. Med., 17:261,1976.

med

NUCLEARMEDICINE:

ATLOWERCOSTYoucan reduce the costs of recordingnuclear images by specifying Kodaktransparency films. And the imagesyou obtain will be clear, informative,and durable.

Typically, the initial cost of Kodak transparency film is lower than paper prints.And in addition, you can record multipleimages on a single sheet or strip of film,and this can make for considerablesavings.

You get excellent display of information, of course, because transparencyfilm provides that “see-through―qualityand versatility that challenges othermethods of imaging.

Kodak transparency films are dimensionally stable andresist curling, so theyenable you to store and retrieve recordsover long periods of time.

For further cost savings, investigateKODAK RP X-OMAT Processors. Theycan provide you with dry ready-to-readtransparencies in a variety of formats in9Oto 150 seconds.

Whatever your needs—single,multiple,or dynamic imaging—Kodak has a filmfor you, including KODAK NuclearMedicine NMB or NMC Film, now available in blue or clear base.

For further details, ask your KodakTechnical Sales Representative or yourx-ray products dealer. Or write:Eastman Kodak Company, Dept. 740-B,Rochester, New York 14650.

TURNINGENERGY@INTOIMAGES

©1979E A Squibb &Sons. Inc 609.505

Minitec®(TechnetiumTc 99m)GeneratorSmall in size and light in weight, butbig in performance. That's Minitec.Designed for minimum amount ofexposure to operator, its uniqueconstruction (no exposed tubing)and thick shielding (1%―lead)provide high shielding-to-activityratio. Small-volume, high-concentration eluates give maximum flexibility for varying applications. Widerange of potencies and calibrationdates fit the 99mTcneeds of every lab.

Minitec(TechnetiumTc99m)Generator—thelargest-sellinggenerator in the U.S.

SquibbTechnicalAssociatesWhen you buy Minitec and Squibbradiopharmaceuticals, you get theback-up service of a Squibb Technica@Associate. He's had extensive training innuclear medicine, radiopharmaceutica@s.RIA and instrumentation. Call him when anew tech needs instruction, a problem develops, you're planning to expand, orthere's need for special information. YouLget the prompt, personal attention of anexperienced specialist.

SQUiBB®

What do you get when youmarry the best Giant-FieldDetector to the most versatileCommandModule imaginable?

Why,you getSTEPONERaytheon'snewestgammacameradevelopment

••.Asuperb

former you'll findto be easyto use

fastsharp

dependablecost effective • . . And it's supported by

a team of knowledgeable,responsive people at...

RAYTHEON MEDICAL ELECTRONICS70 RyanStreetStamford Connecticut06907Tel:800-243-9058

Rapidly preparedinject sodium pertechnetateTc99m into vial,shakefor30 seconds—and it's readyfor administration

Cornpleteno additionalreagentsorequipment

Econornical5 vial package and 30 vialConveniencePak

‘..‘#,.%@@@@@

administration of aggregated albumin to patients with pre-existingsion.Instancesof hemodynamicor idiosyncraticreactionstoaggregatedalbuminhavebeenreported.

Hypersensitivityreactionsarepossiblewheneverprotein-containingmaterialssuchasIc 99m-labeledaggregatedalbuminareusedin man.Epinephrine,antihistaminesandcorticosteroidagentsshouldbeavailablefor use.OssagsaidAdiuistratlsu:Therecommendedintravenousdoserangefortheaveragepatient(70kg) is 1 to 4 millicuries. The volume of the dose may vary from 0.2 to 13m1.Therecommendednumberof aggregatedalbuminparticlesto beadministeredperdoseis

200,000-700,000withthesuggestednumberbeingapproximately350,000.Foreaseandaccuracyindispensingthepreparedagent,it is recommendedthat prior to

reconstitution,concentratedsodiumpertechnetate1199mbefurtherdilutedtoavolumeof8m1with fresh,preservative-freesodiumthlorideinjection(U.5.P.).iIswSupplied:PULMOLITE'TechnetiumL 99mAggregatedAlbuminKit is suppliedin kits of five(5) or thirty (30) vials, sterile and non-pyrogenic, each vial containing in lyophilized form:

Aggregatedalbumin(human)-tomgNormal human serum albumin-lOngSodiumchloride-lOngStannouschloridedihydrate,maximumO.O7mg

Eachvial contains3.6-6.5x lO@aggregatedalbuminparticles.PULMOLITEcontainsnopreservative;after reconstitutionthe shieldedvial shouldbe storedat

2' to 8'C.Included in each five (5) vial kit is one (1) package insert and six (6) radiation

labels. Included in each thirty (30) vial kit is one (1) package insert and thirty-six (36)radiationlabels.

Cat. No. NRP-415

high-quality @P@JLMOLITE ConvenientFor storesat room temperature

lungperfusion T@h@tiu@T@@ Aggi@g@t@dA@huffiuiiKitimaging

.L!

pp I risks.

it y, examinations using radiopharmaceuticais, especially those elective in nature, of awomanofchildbearingcapabilityshouldbeperformedduringthefirst few(approximatelyk@)daysfollowingtheonsetof menses.Pmcaiitioss:Incasesof right-to-leftcardiacshunt,additionalrisk mayexistdueto the rapidentryof aggregatedalbuminintothesystemiccirculation.Thecontentsof thekit arenot radioactive.However,afterthesodiumpertechnetateIc 99niis

added,adequateshieldingof thefinalpreparationmustbemaintained.Thelabelingreactionsinvolvedin preparingtheagentdependonmaintainingtin in thereduced

state.AnyoxidantpresentinthesodiumpertechnetateIc 99msupplymaythusadverselyaffectthequalityof thepreparedagent.Hence,sodiumpertechnetateIc 99mcontainingoxidants,orotheradditives,shouldnotbeemployedwithoutfirst demonstratingthat it is withoutadverseeffectonthepropertiesoftheresultingagent.Thecontentsof thevial aresterileandnon-pyrogenic.It is essentialthat theuserfollowthe

directionscarefullyandadheretostrictasepticproceduresduringpreparationoftheradiodiagnostic.

lbchnetiumTc99maggregatedalbuminis physicallyunstableandassuchtheparticleswillsettlewith time.Failureto mixthevial contentsadequatelybeforeusemayresultin non-uniformdistributionof radioactivity.

It is alsorecommendedthat,becauseof the increasingprobabilityof agglomerationwith aging,a batch of TechnetiumIc 99m aggregated albumin not be used after eight hours from the time ofreconstitution.Refrigerateat 2' to 8'C after reconstitution.If bloodis withdrawnintothesyringe,unnecessarydelaypriorto injectionmayresultinclotformationinsitu.Thecontentsof thevial areundera nitrogenatmosphereandshouldbeprotected

fromair.Donotuseif clumpingor foamingof thecontentsis observed.Adequatereproductionstudieshavenotbeenperformedin animalsto determine

New EnglandNuclearMedical DiagnosticsDivision

601 Treble Cove Rd . North Billerica, MA 01862 Call Toll-Free.800-225-1572 /Telex: 94.09% (In Mass.and International 617-482-9595)

Independent acquisition & displaymemory: Provides 256 x 256 real imageresolution. Acquires and processes a 32interval gated cardiac study with 64 x 64resolution 1,024 counts deep.

Drive train: Rugged.Highlyreliable. Easy maneuverability intight spaces. Number one supplier with mobile van services.

BASIC Interpreter: User programmable. Line oriented. Fast,easy editing and development.Speciallyenhanced by OhioNuclear programmersfor nuclearmedicine.

ohio-nuclear,Inc.A subsidl@y of 1@oIw@@csr. Corpor.tio,@

29100AuroraRoad,Solon.Ohio44139Phone:(216) 248-18001wx No.81O@427-2696

48K program memory: Independentofacquisition and display memory. No processing interruptions.

IOA THE JOURNAL OF NUCLEAR MEDICINE

One OneSc•Ohio-Nucleais Sigma 420/VIP-550.mobile camera and nuclear medicinecomputer. The software isdesigned for nuclear cardiologyas well as general nuclearmedicine. It images, analyzes,displays and moves almost anywhere.Conelation of the VIP-55CYscardiacsoftware with cineangiographyhas been proven in theccu, Icu, ERandin the Sfress Lab.

The TraditionContinues.

AsingleunitintegratingthefinestVideo persistence scope:More reliable. Improved contrast.Less service expense.

Four user interactive controls:(1) Background subtraction. (2) Contrast

enhancement. (3) Movie mode displayrate (4 Region of interest size control.

Standard 5―video monitor Displayscommand sequence or patient images andwall motion studies. Continuous gray scale

for images.

Joystick: Makes setting regions ofinterest easy.

ECG isolator@Eliminatescomplexexternal qate.

Flexible discs: 2.4 megabytesofstoraqe capacity. 30 frames!

second maximum frame rate forfirst transit studies. Practical

archival storage. Rapid randomaccess to patient studies, BASICprogram files and macro protocols. Easy method of upgrading

software.

Clinical protocols: Firsttransitejection fraction. Cerebral blood

flow. Shunt evaluation. Effectiverenal plasma flow.

1/4ff crystal: Improved resolution for low energies.

Square hole collimators:Improved sensitivity. Improvedresolution.

Volume 20, Number 4 hA

..-.@-@----.--..----@

The never ending struggle for productpopularity often leads a manufaoturer toadd gadgets. It's called “one-upmanship.―We sometimes lose sight of what YOU, theuser, wants.

By customer demand, Radx has gone“Backto Basics― and developed the Assayer1, a simple dosecalibrator, a reliable dosecalibrator, an economical dosecalibrator.

The return to basics does not require a

return to the 1960's technology. The Assayer1 is microprocessor controlled, totally solidstate, with a method of isotope selection wayahead of its time (an optical scanner) whichis so precise, reproducible, and reliable thatit will soon be copied.

It is not a gadget, it calibrates doses accurately, with precision and unprecedentedreliability. It's the Assayer 1'—$2495.

Call today for the last dosecalibrator you'llever own.

P.O. Box 19164 Houston, Texas 77024 (713) 468-9628

l2A THE JOURNAL OF NUCLEAR MEDICINE

ft@fl to Basics!The Assayer 1 by Radx

A consistentagentfor skeletalimaging,TechneScanPYP is now available for use as an adjunct in thediagnosisof acute myocardialinfarction,and forgatedcardiacblood-poolimaging.Investigators have found the technetium-99mpyrophosphatescintigraphicstudy to be a highlyuseful diagnostic technique for evaluatingchestpainof uncertainorigin.1“Thegated cardiac blood pool scan permits thecalculationofbothejectionandregionalwallmotionfromasingleexamination.―2Malhinckrodt'sTechneScanPYP...a preferredwaytodetect acute myocardialinfarction...an advancedmethodtodynamicallyassesscardiacfunction.

References:1. Berman, DS, et al: New Approach to Interpretation of Technetium-99mPyrophosphate Scintigraphy in Detection of Acute Myocardial Infarction:Clinical Assessment of Diagnostic Accuracy. Am. J. Cardiol. 39:341-346,(March)1977

2. Strauss, HW, Pitt, B: Cardiovascular Nuclear Medjcine: Its Role in PatientswithCoronaryHeartDisease.CVPJoumaI:(November!December),1974.

•i@iIrnT@1I.i4@@TheIMAGEMAKER

<@s_____N U CLEAR>

Mallinckrodt,Inc.P0. Box5840,St.Louis,Missouri63134Seereversesideforbriefsummaryofcompleteprescribinginformation.

The H@rt@An advance from Mallinckrodt provides an excellent

adjunct in the detection of myocardial infarctionand the dynamic assessmentof cardiacfunction.

TechneScan®PYPTMKit (Stannous Pyrophosphate)for preparation of Technetium Tc-99 m Stannous

Pyrophosphate.

--.-.r@.

BRIEF SUMMARYCLINICAL PHARMACOLOGY

When injected intravenouslyT.chneScan PYPTc99m hasa specificaffinity forareasof altered osteo9enesis. It is also concentrated in the injured myocardium, primarilyin areas of irreversibly damaged myocardial cells.

Oneto two hoursafter intravenousinjectionofT@chneScanPYPTc99m,anestimated40to 50percentof the injecteddosehasbeentakenupby the skeletonandapprox.imately 0.01 to 0.02 percent per gram of acutely infarcted myocardium. Within aperiodof onehour,10to 11percentremainsin thevascularsystem,decliningto ap@proximately 2 to 3 percent twenty-four hours post injection. The average urinary ex@cretion was observed to be about 40 percent of the administered dose after 24 hours.

TechneScan PYP also has an affinity for red blood cells. When administered 30minutes prior to the intravenous administration of sodium pertechnetate Tc•99map•proximately 76 percent of the injected activity remains in the blood pool providing cxcellent images ofthe cardiac chambers.

INDICATIONSAND USAGE

T@chneScanPYPTc99mis a skeletal imagingagentusedto demonstrateareasofaltered osteogenesis, and a cardiac imaging agent used as an adjunct in thediagnosisofacutemyocardialinfarction.

As an adjunct in the diagnosis of confirmed myocardial infarction (ECG and serumenzymespositive),the incidenceof falsenegativeimageshasbeenfoundto be6per.cent. False negative images can also occur if made too early in the evolutionary phaseof the infarct or too late in the resolution phase. In a limited study involving 22 patients in whom the ECG was positive and serum enzymes questionable or negative,but in whom the final diagnosis of acute myocardial infarction was made. the incidence of false negative images was 23 percent. The incidence of false positive images has been found to be 7 to 9 percent. False positive images have also beenreportedfollowing coronaryby-passgraft surgery,in unstableanginapectoris,oldmyocardial infarcts and in cardiac contusions.

TechnoScan PYP is a blood pool imaging agent which may be used for gated cardiacblood pool imaging.Whenadministeredintravenously30 minutesprior to the intravenous administration of sodium pertechnetate Tc-99mapproximately 76 percentotthe injectedactivityremainsinthebloodpool.

CONTRAINDICATIONS

None.

WARNINGS

This radiopharmaceutical should not beadministered to patients who are pregnant orlactating unless the information to be gained outweighs the potential hazards.

Ideally, examinations using radiopharmaceuticals. especially those elective innature, of a woman of childbearing capability should be performed during the firstfew (approximately 10)days following the onset of menses.

Warning: Preliminary reports indicate impairment of brain scans using pertechnetateTc-99mwhichhavebeenprecededbybonescan.Theimpairmentmayresult in falsepositivesor false negatives.It is recommended,wherefeasible,that brain scansprecede bone imaging procedures.

Radiopharmaceuticals should be used only by physicians who are qualified byspecific training in the safe use and handling of radionuclides produced by nuclearreactor or particle accelerator and whose experience and training have been approved by the appropriate government agency authorized to license the use ofradionuclides.

The TechneScan PYPKit must be maintained at refrigerator temperature until use.

The contents of the TechneScan PYPreaction vial are intended for use in the preparation of Technetium Tc 99m Stannous Pyrophosphate. TechneScan PYP may also be

reconstituted with sterile, pyrogen.free normal saline containing no preservativesand injected intravenouslyprior to the administration of sodium pertechnetateTc-99m.

Sodium pertechnetate Tc-99m solutions containing an oxidizing agent are notsuitable for use with the TechneScan PYPKit.

Thecontents ofthe kitare not radioactive. However,afterthe sodium pertechnetateTc•99misadded,adequateshieldingof thefinal preparationmustbemaintained.

T@chneScanPYPTc99mshouldnotbeusedmorethansixhoursafterpreparation.

PRECAUTIONS

As in the use of any other radioactive material, care should be taken to insureminimum radiation exposure to the patient, consistent with proper patient management, and to insure minimum radiation exposureto occupational workers.

BoneImaging

Both prior to and following TechneScan PYPTc99m administration, patients shouldbe encouraged to drink fluids. Patients should void as often as possible after theTechneScan PYP Ic 99m injection to minimize background interference from accumulation in the bladderand unnecessary exposure to radiation.

CardiacImaging

Patients cardiac condition should be stable before beginning the cardiac imagingprocedure.

If not contraindicated by the cardiac status, patients should be encouraged to ingestfluids and to void frequently in orderto reduce unnecessary radiation exposure.

Interferencefromchestwall lesionssuchasbreasttumorsandhealingrib fracturescan be minimized by employing the three recommended projections.

BloodPoolImaging

TchneScan PYP should be injected by direct venipuncture. Heparinized cathetersystemsshouldbeavoided.

ADVERSEREACTIONS

, None.

HOW SUPPLIED

Catalog Number—094 TechneScan PYPKit

KitContains:

5—Stannous Pyrophosphate Reaction Vials (lyophilized) for the preparation ofTechnetiumlc-g9mStannous Pyrophosphate.

ReactionVialContains:

12.0 mg sodium pyrophosphate and 3.4 mg stannous chloride (lyophilized).Hydrochloric acid is added for pH adjustment priorto lyophilization.

5—RadioassayInformation String Tags.

@flhft@T@IIbi.iD@®The IMAGEMAKER

‘cNUCLEAMallinckrodt,Inc.P0. Box 5840, St. Louis, Missouri 63134

An advance from Mallinckrodt provides an excellentadjunct in the detection of myocardial infarctionand the dynamic assessment of cardiac function.

TechneScan®PYP@Kit (Stannous Pyrophosphate) forpreparation of TechnetiumT&99m Stannous Pyrophosphate.

@4@T!

I@ @r

- @: •@. p.....,@@ ‘:@:. .. - @-.

t, . . .@

Results obtained using the DYF@..Camera with its powerful minicompiprocessor, clearly demonstrate the advantages@

of radiocardiology as a diagnostic tec1i@ItqUO.@DYMAXMB Is compact,fully n@Ob4@simple to operate. The camera prodüci@@@@studies with excellent resolution ant . .uniformity at both low and highcountrates, while the self-containedprocessor provides instant clinical@analysisof the data.Amongthe heartfunctions which can be studied “live―@are wall motion, ejection fraction,@cardiac output, interventricular shunts@and other parameters of major .importance.Analytical procedures are speededby automatic repeat of previouslyestablished protocols. On-the-spotanalysis enables the attendingphysician to immediately evaluateresults, eliminating the delays ofbatch processing at a centralinstallation, thus maximising theefficacy of the DYMAX-MB.Check for yourself the significantadvantagesof this highly efficient clinical tool.Youcan:. Spare your patient the trauma o@

catheterization.. Complete the diagnosis at the patient's bed-side, .

sparing him exhaustingmovementto overburdenedlaboratories.. Receive pre-processed data for more rapid and detailed

interpretation than was possible with earlier techniques.

Until you eXamine the performance of this outstanding unit,you haven't heard the last word. Call us or write for moreinformation or demonstration.

!@II

-f@ @y T@'@,@:.@@

@r@ --,.:@,@@ r'@@Th--@@

@@ r@

@ i,,.. ? -@@@@ :.

a@ .@ i,;. :t

,@.@@@ .....@@

@p .at'y.@

@:,@ . ..@ @:.. @.

@ ‘ @..,, . ,@ .@-i... • . ,:s.

,/ \. .@/

, I,‘.

‘ 7.

@/

èL.sc::@ir―i'tcommitmenttoexcellenceU.S.A. ELSCINT INC. 1@.16O Johnson Avenua, Hacknsack, Naw . J@rsy 07609,Telephone: 201-487.5885; Telex : 1353@.Germany: Elscint GmbH, Freudenbergstrasse27, 62 Wiesbaden-Schleretein. Tel.: (06121)2786.U.K. : Elscint (GB) Ltd. 5 Prlestley Way. Crawley. Sussex RHIO 2DW, Tel. : (0293)21285/6/7.Bslgium : Elsclnt N.v./S.A. Rue du Saphlr 31. B.1040 Brussels, Tel.: (02)735.46.06-735.48.13.Holland : Elscint By. Raadhuislaan i2B, Maarn, Tel. : 03432-2987.Brazil : Rua Dos Moras 576 Alto De Pinhelros Q534.@o Paulo, Tel. : 210-8906.Israel : Elscint Ltd. P.O.Box5258Haifa, Tel. : 04-5fl516, 04510692.in other countries : Write to Elsclnt International Sales ServIce Dlv.. EIsCInt - l.8.1.D.Annandale, North End Road, Golders Green . London NW 11 70Y, Tel. : (01)458-7323.

. ..I,,@@.@ -@‘@L@i

I. , .@ A

,- . —-.-.

PYROPH()SPHA FEDl PHOSPH()NATEP0 LYPH( PHATEMoP

PH YTATEDTPAMICRC)SPF IERESHUMAN SFRUM ALBUMIN

(I; LU (@ OH EPT() NATESULFUR C()LLOIDMACR0A(.@GRF GAFFE) ALR@JMIN

@4CI@ERMANNUCLEAR, INC./ .@‘4%@_•@@@ -

7N@@ @.LI ‘@PharmaceuticalsforNuclearMedicine.@.—) 445 West GarfieldAvenue

Glendale, California 91204, U.S A(213) 246-2555

For more detailed intormation, contact:

I ( \ } I@ I(@@ 1.@\.. \ I@@ I @—.@ (@@ \@ \1 I I ) ( I -.1

,@5. .

TechIt!Becausequality is important to your image .. Check your

Produds with a Tech Kit ! It's the only move to make.

Tech is a quality control testing system which provides a quick, convenient and inexpensivemeans for determining unbound and free Technetium 99m in the following products:

THE OBVIOUSSOLUTIONLow*Dissolved OxygenNon-preservative normal saline USP

DesignedwithNuclearMedicineinmind,LowDissolvedOxygen,non-preservative,normalsalinefor routineuseis nowavailablefromAckermanNuclear,Inc.

@ ELUTION:Usefor elutingTechnetium-99mgenerators.

. DILUTION:Usefor dilutinghighspecificconcentrationsof Technetium-99m.

SODIUMCHLORIDEINJECTIONU.S.P.with LOWDISSOLVEDOXYGEN

pH 4.5 to 7.0DESCRIPTION:SODIUM CHLORIDE INJECTION U.S.P. with LOW DISSOLVED OXYGEN is a sterileisotonic solution of sodium chloride in water for injection. It contains no antimicrobialagent. It contains 0.9% sodium chloride and is packaged in single dose vials. Theosmolarity is 300 m0sm/1 , the dissolved oxygen @ntentis less than 5 ppm.INDICATIONS:SODIUM CHLORIDE INJECTION U.S.P.with LOW DISSOLVED OXYGEN is indicatedfor eluting, preparing and/or diluting pharmaceuticals that specify oxidants may causeadverse effects on the final product. SODIUM CHLORIDE INJECTION U.S.P with LOWDISSOLVED OXYGEN is also used as a fluid and electrolyte replenisher or as an irrigatingsolution.WARNING:Excessive amounts of sodium chloride by any route may cause hypopotassemia andacidosis. Excessive amounts by the parental route may precipitate congestive heartfailure and acute pulmonaryedema, especially in patients withcardiovasulardisease, andin patients receivin9 corticosteroids or corticotropin drugs that may give rise to sodiumretention. No antimicrobial agent has been added.PRECAUTIONS:Unused amounts should be discarded immediately following withdrawal of any portion ofthe contents.HOWSUPPLIED:Cataloo No. Product Packaging

@-25 SODIUM CHLORIDE INJECTION U.S.P. 25/10 ml vialswith LOW DISSOLVEDOXYGEN

Each 10 ml single dose vial contains approximately 6 ml. Each ml contains 9 mg sodiumchloride providing 0.154 mEq each of sodium and chloride ions. Total osmolarity 300m0sm/1 ;pH between4.5 and 7.0. Dissolvedoxygen contentlessthan 5ppm.Contains nopreservatives.

ACKERMANNUCLEAR,INC.445 W. Garfield AvenueGlendale, Calif. 91204

1/78

Decreasethe amountofoxygenyouadddailyandreducetheeffectof onemorevariablefromyourradiopharmacy.UseLowDissolvedOxygensalinewhenpreparingkitscontaininganystannoustin products.

*less than 5 ppm

c@J@C@ERMANNUCLEARINC

N I PharmaceuticalsforNuclearMedicine445 W.GarfieldAve.Glendale,CA91204,USA(213) 240-8555

For additional information call or write to:

**

1*'

TheLIIJfl[i]F@ . ., THand-heldConsole...TheOnlyKeyboardYouNeed.. The UNION CARBIDE Large Field Gamma

Camerahand-held console eliminatestheneed for a separate operator console.. The hand-held console looks and works like a

pocket calculator,with all controls for presettingstudy parametersand detector positioning.. 1 5' flexible cable provides complete freedom of

movementfor the operator.. Built-in digital display indicates time, count, or

countrateatthetouchofa button.. Eliminates need for a second technologist.

. The hand control isn't the only thing we've

done just right: even the feet of the camera arespecially designed to accommodate wheelchairs,hospitalbedsandstretchers.

AskUNIONCARBIDEforthefacts.UnionCarbide MedicalProducts are designedto enhance diagnosisandresearch,producea returnon investment,andcreatebetterhealthcareatlowerpatient costs. Sendtodayfordescriptiveliterature.Orcallforfastaction.

S.

Above—Diffusemetastaticdiseasethroughouttorsoand limbs.

Top—Hepatomain31-year-oldfemalewith 3.5 mCi Tc99mSulfurColloid.Bottom —Subduralhematomaonleft,seenin 76-year-oldmalewith20mCiD.TP.A.

LookIntoLife...

lma;r;g Systems,Inc.MedicalProducts DMsion333 Providence HighwayNorwood,Massachusetts02062Withinarea617, call 769-5400.Outside,call1-800-225-9887.TELEX924-494

9

-—.5

—.5 —.5

4—

. Capable of performing more than 1 8 whole

body scans per 8 hour day; maximumscanspeed is 20cm/minute.. Dual detector heads provide simultaneous

anterior/posterior focal tomographic views withno patient repositioning.. Parabolic focus collimators allow superior

resolutionat depth without sacrificing sensitivity.. Thick Nal crystals (.86―) and dual pulse

height analyzers make the system ideal forGallium imaging.. Built-in floppy diskette stores raw data.

. Image enhancement controls and 2xmagnification are standard.. Organ mode allows high-resolution static

organ studies, two views at a time.. Priced below comparable gamma camera

systems.

AskUNIONCARBIDEforthefacts.UnionCarbide Medical Products are designedtoenhancediagnosisandresearch,produce a returnon investment,and createbetter healthcare atlowerpatientcosts.Sendtodayfordescriptive literature.Or call for fastaction.

•1@

. -

E@

J@I.

@@ r1P@

I

t, 4

)&Above —Actual 13.5 to 1minification ofposterior and anteriorwhole body bone scan of a 45 year old m@letwo hourspost-injection with20 mCi TechnetiumTC.@@9mMDP.Diagnosis:normal.

Below —Organmode Galliumscans ofa3Oyearoldmale 72hourspost-injection (posterior andanterior views) and 96 hourspost-injection with 5 mCi of Ga-67.Abnormalactivity in the lowerabdomen is seen clearly with twophotope:s.

LookIntoLife...

Ima;r;g Systems,Inc.MedicalProducts Division333 Providence HighwayNorwood,Massachusetts02062Withinarea617, call 769-5400.Outside,call 1-800-225-9887.TELEX 924-494

TheUNION @@I.TIDEWholeBodyImager...FasterPatientThroughput.

For further information, call Edward R. Bamhart,Business Manager, at 201-262-3030.

The

first

placeto look.

for professional products and suppliesPDR®is the acknowledged ethical reference source for professional product information . . . it organizes package insert information on radiopharmaceuticals and commonly used general pharmaceuticals. It alsoincludes manufacturers' information on test kits, radiographic film anddosimetry devices.

for sophisticated Instruments and equipmentLook into PDR for advanced diagnostic aids—ultrasound equipment,linear accelerators, computerized tomographic scanners—selections areorganized by manufacturer to suit your needs and budget. A reply cardinformation service is included for your convenience.

and moreBooks, monographs, reference volumes, audiovisual programs . . . PDRholds a library full of professional growth opportunity . . . and an easyorder card, to bring it to you.

Nuclear Medicine M.D.s, Radiologists, and Pathologists refer to PDRactively . . . consulting it more than 500,000 times a year for productinformation.

PDR For Radiology and Nuclear Medicineyour source for professional product selection.

OSTEOLITEboneimaginginmetabolicdisease

Th@the bone scanisa moresensitiveindicatorof

@ ImetabolicactivitythantheX-ray!@11. SemNuclMed6:1, 1976

OSTEOLI TMTechnetiumTc99mMedronateSodiumKit(MDP)

t@1NewEnglandNuclear®

@@./1.@..:_____

@iii-pp.@@.@-

L.@@,‘.;â€-̃.

RL LL

The superioragent:

Inmetabolicbonedisease...forevaluatinc@extent

andactivityolskeletalinvolvement

Most rapid blood clearance 2. At 90 minutes postinjection, blood clearance of MDP phar

macologically identical to OSTEOLITEwas approximatelyequal to that of tested pyrophosphate agents at 6 hourspostinjection.U At 3 hours, MDP blood levels were considerably less than

those of tested EHDPand pyrophosphate.Resultlow-backgroundstudies,whetheryoumustscanearlytomeetpatient-flowdemands,orat3 hoursformoreoptimalimagedetail.

Lowestsofttissueactivity2,3The “differencein soft tissue activity (highest with polyphosphate and lowest with MDP) is discernible in clinical images.―2A University of Minnesota study found that only 4% of 175MDP imagesshowed moderate to marked soft tissue activity,compared to 17%of EHDPimages.3Result:highestassuranceofvisualizingallskeletalstructures.

Highesttarget-to-backgrounddifferentiaI@OSTEOLITE's rapid blood clearance and lower soft tissueuptake usually enable current gamma cameras to resolveperipheral skeletalstructures and phalanges.Result:confidenceofdetectingresolution-challengingalterations in osteogenesis...even roentgenographically

“invisible―fractures and small metastases.

Convenientstorage and preparationAvailablein 5-vial or 30-vial “ConveniencePacks' OSTEOLITEcan be stored and used at room temperature (15—30C).

REFERENCES

1 Freeman LM, Blaufox MD: Letter from the editors. Sem Nuci Med 6:1, 1976

2. Subramanian G el al: Technetium-99m-methylenediphosphonate —a superior agent forskeletal imaging:Comparisonwithothertechnetium complexes. J Nuci Med 16:744, 1975

3. ForstromLet al: Data on fileat NewEngland Nuclear.MedicalDiagnostics Division,NorthBillerica,MA4. Davis MA. Jones AG: Comparison of 99mTc -labeled phosphate and phosphonate agents for skeletal imaging. Sem Nucl Med 6:19, 1976

5. Sy WM, Mittal AK: Bone scan in chronic dialysis patients with evidence of secondary hyperparathyroidism and renal osteodystrophy. Br J.Radio! 48:878, 1975

Casereport:68-year-old female, hypercalcemic onroutineexamination,referredto @ruleoutmetastaticdisease.“No knownprimary.OSTEOLITEimages show increasedcalvarialuptake,poorly visualizedkidneys,generallydiffuseskeletaluptake.Findingsinterpretedas more consistentwith hyperparathyroidismthan metastaticdisease.Nuclearmedicine interpretationwas confirmed by further laboratorystudy.

Discussion:Thedifferentialdiagnosisof hyper

calcemia is often difficultand onlyoccasionallyresolvedby a clearhistoryofvitaminD intoxication,sarcoidosis,ormultiplemyeloma.The incidentaldiscoveryof elevatedserumcalciumrequiresdifferentiation:is it malignantdiseasewith osseousmetastases;ectopic pseudohyperparathyroidism;benign, true hyperparathyroidism?

Osseousmetastasescan usuallybedetectedor ruledout by routineskeletalimaging.Primarysitesof osteitisassociatedwith increased parathyroidhormoneproduction include the skull,

.@i: endsoftheclavicles,andhands.Syand@ Mittalhave reported that bone scans @in

renalpatientswith secondary hyperparathyroidismtypically show increasedactivity in the calvaria, mandible,acromioclaviculararea, sternum,vertebrae,distalthirds of long bones,andthe phalanagesand metacarpals.5

RL

: E

4@

Ant

..@i.

Post

Images produced with 15mCi technetium-99m-labeled OSTEOLITE;recorded at 500 K counts,Searle LFOV1Mcamera with Micro Dot's Imager.

,.LL

Pleaseseefollowingpageforfullprescribinginformation.

TM

TechnetiumTc99mMedronateSodiumKit(MOP)

I@J NewEnglandNuclear®

October1977

sodiumshouldbeusedinpregnantwomenonlywhenclearlyneeded.It isnotknownwhetherthisdrugisexcretedinhumanmilk.Asageneralrulenursingshoukinotbeundertakenwhenapatientisadministeredradioactivematerial.Safetyandeffectivenessinchildrenhavenotbeenestablished.ADVERSEREACTiONS:Nonereported.DOSAGEN@ADMINISTRATION:Therecommendeddosefortheaverage70kgadultpatientisl5mCiwitharangeof10-2OmCi.Thepatientdoseshouldbemeasuredbyasuitableradioactivitycalibrationsystemimmediatelypriortoadministration.Optimalimagingresultsareobtainedwithinonetofourhoursafteradministration.OSTEOUTEshouldbeusedwithinsixhoursafterasepticreconstitutionwithsodiumpertechnetateTc99m.Foroptimumresultsthistimeshouldbeminimized.Thevialcontainsnobacteriostat.Radiopharmaceuticalsshouldbeusedbypersonswhoarequalifiedbyspecifictraininginthesafeuseandhandlingofradionuclidesproducedby nuclearreactoror particleacceleratorandwhoseexperienceandtraininghavebeenapprovedbytheappropriategovernmentalagenciesauthorizedtolicensetheuseof radionuclides.

RADIATIONDOSIMETRYTheestimatedabsorbedradiationdosetoanaveragepatient(70kg)fromanintravenousinjectionofamaximumdoseof20millicuriesofTechnetiumTc99mOSTEOLITEis showninTable4.

Tatile4.AbsorbeulRadiationDoseTechnetiumTc9@iMedronateSodium

c@gan (rads/2OmCi)TotalBody 0.13BoneTotal 0.70RedMarrow 0.56Kidneys 0.62Liver 0.16BladderWall 2hrvoid 2.60

4.8hr void 6.20Ovaries 2hrvoid 0.24

4.8hrvoid 0.34Testes 2hrvoid 0.16

4.8hr void 0.22Methodofcalculation:ASchemaforAbsorbed-DoseCalculationsForBiologK@allyL@stributedRadionuclkies,supplementNo.1,MIRDPamphletNo.1,p.7,1968.

HOWSUPPLIED:NEN'sOSTEOUTE'@TechnetiumTc99mMedronateSodiumKitissuppliedasasetoffiveorthirtyvials,sterileandnon-pyrogenic.Eachnitrogen-flushedvialcontainsin lyophilizedform:

MedronateD@odium-1OmgStannousQilorideDihydrate—O.85mg

ThepHisadjustedtobetween7.0—7.5withhydrochloricacidand/orsodiumhydroxidesolution.Thecontentsofthevialwerelyophilizedundernitrogen.Storeatroomtemperature(15°-30°C).Includedineachfive(5)vial kit is one(1)packageinsertandsix(6)radiationlabels.Includedineachthirty(30)vialkit isone(1)packageinsertandthirty-six(36)radiationlabels.INSTRUCTiONSFOIlPREPABATJONOFTEI@HNE1IUMIc 99mOSTEDUTE:Asepticallyinject2to8m1ofsodiumpertechnetateTc9@n(pertechnetatein isotonicsalinewithouta bacteriostat)intothesuppliedvialof OSTEOLITEenclosedbya radiationshield.Swirlforatleasttensecondstodissolvecompletely.Labelappropriately.SuitablelabelshavebeensuppliedwitheachOSTEOLITEKit.Usewithinsixhoursafterreconstitution.Foroptimumresults,thistimeshouldbeminimized.Usingpropershielding,thevialcontainingthereconstitutedsolutionshouldbevisuallyinspectedto insurethat it is clearandfreeofparticulatematter.Thecontentsofthekitvialsarenotradioactive;however,afturreconstltutiouwithaudiopev1ec@metateIc 9@theosn@tentsareradioactiveandadequateSIIIekIEIgandhandlrng@.cautionsmustbemaintaln@l.Donotuseif thereisavacuumintheimmediatedrugcontamerorifairisinjectedintothecontainerwhenthedoseiswithdrawn.

CatalogNumberNRP-420(5 vIal kit)CatalogNumberNRP-420C(30 vIal kit)

lwscRlPTmN:NewEnglandNuclea@sOSTEOUTE'TechnetiumTc9@nMedronateSodiumKit (formerlyknownasMOP),issup_ stecileandnon-pyrogenicinlyophilizedkitformsuitableforreconstitutionwithsodiumpertechnetateTc99mtoformadiagnosticskeletalimagingagentforintravenousath*sistration.Eachvialcontains10mgmedronatedisodiumand0.85mgstannouschloridedihydrate;pHisadjustedtobetween7.0—7.5withhydrochloricacidand/orsodiumhydroxidesolution.Thecontentsofthevialarelyophilizedandstoredundernitrogen.

PHYSICALCHARACTERISTICSTechnetiumTc99mdecaysbyisomerictransitionwithaphysicalhalf-Ideof6.02hours.(SOURCE:Martin,M.J.NuclearDataProject,OakRidgeNationalLaboratory,Marct@1976.)Photonsthatareusefulfor imagingStudiesarelistedinT@Ie1.

Table1.PrIncipalRadIati@M1EmissionDataTechnetiumTc @i

Mean%/ MeanRadiation Disintegration Energy(key)Gaiima-2 88.96 140.5

TofacilitatecorrectionforphysicaldecayofTechnetiumTc9@T1,thefractionsofinitialactivitythatremainatselectedintervalsafterthetimeofcalibrationareshowninTable2.

Tile2@PhysicalOscay1@sartTechnetiumIc 99mHalt-life6.02Hours

UptakeoftheTechnetiumTc99minboneappearstoberelatedtoosteogenicactivityandtoskeletalbloodperfusion.Thedepositionintheskeletonisbilaterallysymmetrical,withincreasedaccumulationintheaxialstructureascomparedtotheappendimlarskeleton.Thereisincreasedactivityinthedistalaspectoflongbonesascomparedtothediaphyses.Inpediatricpatients,inwhomtheepiphysealcentersarestillopen,thereismoremarkedaccumulationoftheradiopharmaceuticalinthedistalaspectsoflongbonesthanisseeninadultsinwhomtheepiphysealcentersareclosed.Localizedareasofabnormalaccumulationoftheradiopharmaceuticalmaybeseeninprimaryskeletalmalignancies,metastaticmalignanciestobone,acuteorchronicosteomyelitis,arthritides,recentfractures,areasofectopiccalcification,Paget'sdisease,regionalmigratoryosteoporosis.areasofasepticnecrosisand,ingeneral,anypathologicalsituationinvolvingboneinwhichthereisincreasedosteogenicactivityorlocalizedincreasedosseousbloodperfusion.Sinceincreasedosteogenicactivityandlocalizedincreasedosseousbloodperfusionarenotusuallypresentinchronicbonediseases,boneimagingagents,ingeneral,arenoteffectiveindetectingsuchdiseases.Localizedareasofdecreasedaccumulationoftheradiopharmaceuticalmaybenotedinareasofbonewhichhavereceivedlocalizedfieldsof externairadiationor to whichbloodflowhasbeeninterrupted.OSTEOLITEhasalsobeennotedto accumulatein areasof acutemyocardialinfarctionfromonetofourteendaysafterthepathologicevent.INDICAI1ONSAimus@c@TechnetiumTc99mOSTEOUTEmaybeusedasaboneimagingagenttodelineateareasofalteredosteogenesis.IONTBAINDICAI1ONS:Noneknown.WARNPIGS:Thecontents of the OSTEOUTEvial are intendedonlyforuseinthepreparationofTechnetiumTc9@nmedronatesodiumandareNOTtobedirectlyadministeredtothepatient.Ideally.examinationsusingradiopharmaceuticals—especiallythoseelectiveinnature—ofwomenofchildbearingcapabilityshouldbeperformedduringthefirsttendaysfollowingtheonsetofmenses.PRECMJTIONS:AthoroughknowledgeofthenormaldistributionofintravenouslyadministeredTechnetiumTc99mmedronatesodiumis essentialin orderto accuratelyinterpretpathologicstudies.TechnetiumTc99mmedronatesodium,aswellasanyradioactiveagent,mustbehandledwithcare.OncesodiumpertechnetateTc99misaddedtothekit,appropriatesafetymeasuresshouldbeusedtominimizeexternalradiationexposuretoclinicalpersonnel.Careshouldalsobetakentommimizeradiationexposureto patientsin a mannerconsistentwithproperpatientmanagement.TheTechnetiumTc99mlabelingreactioninvolvedinpreparingTechnetiumTc99mmedronatesodiumdependsonthemaintenanceoftininthedivalentstate.AnyoxidantpresentinthesodiumpertechnetateTc 99m employedmay adverselyaffectthequalityofthepreparedagentThus,sodiumperfectnetateTc99mcontainingoxidantsshouldnotbeusedwithoutfirstdemonstratingthatit iswithoutadvemeeffectonthepropertiesoftheresultingagent.TheuseofbacteriostaticsodiumchlorideasadiluentforsodiumpertechnetateTc99n1mayadverselyaffectthebiologicdistributionofthepreparedagent,anditsuseisnotrecommended.Mequatereproductionstudieshavenotbeenperformedinanimalstodeterminewhetherthisdrugaffectsfertilityinmalesorfemales,hasteratogenicpotential,orhasotheradverseeffectsonthefetus.TechnetiumTc99mmedronate

HoursFractionRemainingHours8Fraction

Remaining.3980*1.0001.8919.3552.79410.3163.708112824.631122515.56218.1266.50124.0637.447

*CaIit@ationTime

BOB@NALRA@Afl0NThespedficgaTilnarayconstantforTechnetiumTc9@nis0.8R/mCi-tv.atlan.Thehalfvaluelayeris02mmofPb.Tofacilitatecontrolofradiat@nexposurefrommillkaineamountsofTechnetiumTc99m,theuseofa6.35mmthickstandardradiationeIut@nleadsh@Idwillattenuatetheradiationemittedbyafactor@eaturthan10-'.

Table3.RaiMatimiAttenuatiouByLealShiekiingSlieldTh@kness(Pb)mm CoefficientofAttenuatkn

0.2 0.50.95 1011.8 10@2.7 10@3.6 10@4.5 10@5.4 10'6.3 10@

QJNICALPHARMA1@OLO6Y:uponintravenousinjection,TechnetiumTc99mOSTEOUTEexhibitsaspeolicaffinityforareasofalteredosteogenesis.Inhumans,bloodlevelsfallto4-10%oftheinjecteddosebytwohourspost-injectionandto3-5%bythreehours.Duringthefirst 24hoursfollowingitsadn@nistrationinpat@ntswithnormalrenalfunction,50-75%c@theradioactivityisexcretedintotheurineandlessthan2%oftheinjecteddoseremainsinthevascularsystem.

OSTEOLITE'TechnetiumTc99mMedronateSodiumKit(FormerlyKnownasMOP)

I@J NewEnglandNucleara Medical Diagnostics Division

aol Treble Cove Rd., North Billerica, MA 01862Call toil-free:800-225-1572 Telex:94-0996(InMassachusettsandInternational:617-482-9595)Canada:NENCanada.245346thAvenue,Lachine,Que.H8T3C9Tel:514-636-4971Europ.: NEN ChemicalsGmbH, D-6072 Dreieich,W.Germany,Postfach 401240 Tel: (06103)85034 Order Entry: (06103)81013

ImprovedPicker Resolution

2 75%2C 50%

3C,4-12 40%1/8― 20%

—-ii@@@@@@@@

AFTER

NEN Thallium 201 phantom at 2―distancefrom collimator.

500K

BEFORE

NEN Thallium 201 phantom at 2―distancefrom collimator.

500K

Picker 2C with ultrafine collimatorand SX-1 1 detector head.

Picker 2C with ultrafine collimator.

Enjoy new camera performance without a majorinvestment. NuclearService Inc. can upgradeyour existing gammacamera system to provideyou with 1/10―or betterintrinsic resolution.

With NSI upgrade younot only receive Stateof-the-Art resolution,but in most cases your

converted system willprovide you withIMPROVED FIELDUNIFORMITY.

Learn more about thisefficient and economicalmethod available fromone of the country's

largest independent nuclear medicine service organizations. Call or writeNSI for complete infor

mation on gamma cameraupgrade.

Up to 75% Better Resolution.

::Leasing plans and reconditioned upgraded systems also available.

(516) 752-9270(203) 281-3957

Volume 20, Number 4 27A

1110Inch or Better Resolution at afraction of new system cost.

The picture on your left'. @1oes not provide@

.@@solution for cardiac wo:@-@hepicture on the right I.•@:more than adequate!@

1?::@r@@@ -- NuclearServicesInc.. ,..@ P.O.Box5492

Nuclear Services Inc.@ ..@......---...@ Hamden,CT06518

ADAC.- I.@, 1t@),.J1J: @;@1.(1A.1 liLse it :1

With an ADAC Nuclear Medicine Computer, you are only one shortstep from a full capability in Emission Tomography.

All youneedistheeconomicalnewADACTomographyOption.

It makes this valuable new diagnostic tool immediatelyavailable for myocardial perfusion tomography.

The Option includes a multiple-pinhole coffimator, cart,pointsource,andfloodphantomforthecamera—plussophisticated,clinically-proven software developed on the ADAC computer itself.

The software enables your ADAC Nuclear MedicineComputer to display multiple images that have been obtainedsimultaneously by the gamma camera.

The quality is everything you'dexpect from the developer of the

@-@----@

L

.@@ -@@ . @. ..@@@ ,,-@ . .

ADACNuclear Medicine Computer. For more than three years,doctors have called it the finest system of its kind.

Why? Among other things, a 512X 512 display format and 64shades of gray that deliver an image nearly identical to originalanalog scintiphotos. And an easy-to-usecomputer language in plainEnglish.

What's more, the cost is surprisingly low.I_fyour plans for the present or future include emission

tomography, ADAC is the system of choice. Foradditional informationplease write or call collect.

ADAC Laboratories, Inc. 255 San Geronimo Way, Sunnyvale,@ California 94086. Telephone: @4O8)736-1101.

“., f@@DAC

Nuclear Medicine Computer

@oits@ls .1

. , -..@:•@

.... :‘h.

@— — t .@ S@ .@ . . . . . . . .1:' .?‘@‘@

@ ., .,;.@.. . ..@ .@

—--—--\ I

.@ .‘

I. —@

@VARNlNG:@ @uid@ nudsirrwtor or:@ $@I$S1I@Ot.@ bS@ 0@Ybypi@@@O

.-@ ,,,@ b@ OPI@ t@S'@'@@@@ avid oils

‘.rc‘I0 °@°@•@w@@OSSsiporwl@$ill-3 , ‘lbioS biSfliPP@'@ @1$‘Irdoiduil ii@Y or.,, M@' *@ @c.@ssd M@tt@i U$ O@fidlO@$0@0P@

@ .-“I@ O@$tSt*5.P1@°S'@'@$odo@nPOf.@--,.,$t, Ic 99oi.

:@-@,-,@ 0$@@@@ Wi5'Od0!.@# @,MO@O @ltt@S ‘@°@@@ pst.nis: 3,3@2.i5@.

,ai@.9@S@353S.°55@‘:@ ADDItIONAL@@ PACK.&@ INStRT

M&llflGk@°@Inc.ST LOUtS. uiSSOU@' 53147

Rw7e

i

Tud@ow'FM(TIcHN!I1UM Tc99m

GENERATOR)

•@llflT@@L@<r@J@uCL@

RADIOPHARMACEUTICALSMallinckrodt,Inc.P.O. Box 5840St.Louis,MO63134

,1T/

.@.@cuATI::;IING !@

@ @to@t@@ I -@@@

As nuclear medicine has matured and progressedso has the development of the UItra@TechneKowRFMTc99m Generator. In keeping pace with the changing needs of the nuclear medicine community, wehave redesigned the Ultra-Technekow system andfurther refined those features that have, through theyears, made the Ultra-TechneKowGenerators amongthe safest, easiest-to-operate,and most rel able performing technetium delivery systems in the world.

An important part of the total system is ourcommitment to provide the best overall, on-timedelivery record in the industry. The CustomerService people have established a reputation forsolving some of the most difficult routing problemsimaginable.

We inviteyou to evaluate our evolutionary systemand challenge the people in Customer Service todemonstrate why they're the best, at what they do,in the industry. Contact your local Mallinckrodt representative or call Don Burkhead at 314-895-0247.

Here are a few of the changesthat make the latest

Ultra-Technekow easier to useand more reliable than ever:

. Redesigned canister:

Foreasierlifting and maneuverability, thecanister has a large firm top handle.Change in design simplifies engaging andremoving the Luer-lock needle on a dailybasis;an important feature in maintainingsterile elution technique.

. New valve system:

Provides positive protection againstaccidental elution or leakage.

. Boiler shielding:

To reduce radiation levels during elution, an additional lead plate has beeninserted inside between the tubing andthe canister.A redesigned auxiliary shield is availablethat provides added reduction in surfaceradiation levels on all sides and the top.

. Reduced weight (smaller units):

Achange in the configuration of the internal column shield allows weight reductionof our smaller generators.

See following page for b,lef summary.

Volume 20, Number 4 31A

Ma11Inckrodt@Ultra-TechneKowFM

(TECHNETIUM Tc99m)Generato,@

Ultra-TechneKow®FM None.(TechnetiumTc-99mGenerator)

Forthe Productionof SodiumPertechnetateTc99m

DESCRIPTION

The Ultra-TechnoKow FM Generator is prepared with fission-producedmolybdenum-99. This generator provides a closed system for the production of sterile metastable technetium-99m, which is produced by thedecay of molybdenum-99.Sterile, pyrogen-free isotonic solutions ofSodium Pertechnetate Tc 99m can be obtained conveniently by periodicaseptic elution of the generators. These solutions should be crystal clear.

The generator consistsof a sealed glasschamber containing speciallyprocessed alumina. This treated alumina has a high absorption capacityfor molybdenum-99 and a low affinity for technetium-99m. As a result,elution of the generator yields a solution of technetium-99m containingne9ligible amounts of molybdenum-99.

DOSAGE AND ADMINISTRATION

Sodium pertechnetate Tc-99m is usually administered by intravascularinjection but can be given orally. The dosage employed varies with eachdiagnostic procedure.

The suggested dose range employed for various diagnostic indicationsin the average patient (70 kg) is:

NOTE: Up to 1 gram of reagent grade potassium perchiorate in a suitablebase or capsule may be given orally prior to administration of sodiumpertechnetate Tc-99m injection for brain imaging, placenta localizationand blood pool imaging.

The patient dose should be measured by a suitable radioactivity calibra-'tion system immediately prior to administration.

brain imaging:thyroid gland imaging:salivary gland imaging:placenta localization:blood pool imaging:

10 to 20 mCi1 tol0mCi1 to 5 mCi1 to 3 mCi10 to 20 mCi

ACTIONS

The pertechnetate ion distributes in the bodysimilarly to the iodide ion but is not organifiedwhen trapped in the thyroid gland. Pertechnetatetends to accumulate in intracranial lesions withexcessive neovascularityor an altered blood-brainbarrier. It also concentrates in thyroid gland.salivary glands, stomach and choroid plexus. Afterintravascular administration it remains in the circulatory system for sufficient time to permit bloodpool, organ perfusions,and majorvesselstudies.It gradually equilibrates with the extracellularspace. A fraction is promptly excreted via thekidneys.

INDICATIONS

Sodium pertechnetate Tc-99m is used for brainimaging, thyroid imaging, salivary gland imaging,placenta localization and blood pool imaging.

CONTRAINDICATIONS

None.

WARNINGS

This radiopharmaceutical should not be administered topatients who arepregnantorduring lactation unlessthe information to be gained outweighsthe potential hazards.

Ideally, examinations using radiopharmaceuticals, especially thoseelective in nature, of a woman of childbearing capability should beperformed during the first few (approximately 10) days following theonset of menses.

Radiopharmaceuticals should be used only by physicians who are qualifiedbyspecifictraining in the safe use and handling of radionuclides producedby nuclear reactor or particle accelerator and whose experience andtraining have been approved by the appropriate government agencyauthorized to license the use of radionuclides.

PRECAUTIONS

As in the use of any other radioactive material, care should be taken toinsure minimum radiation exposure to the patient, consistent with properpatient management, and to insure minimum radiation exposure tooccupational workers.

At the time of administration the solution should be crystal clear.

HOW SUPPLIED

The Ultra-TochnoKow FM (Technetium Tc 99m)Generators contain the following amount ofmolybdenum-99 at the time of calibration statedon the label.

Each generator is supplied with the following components for the elutionof the generator.

6—Sterile, graduated, evacuated collecting vials6—Sterile Luer-Lock needles with plastic covers6—Pressure-sensitive “Caution—RadioactiveMaterial―collecting

vial labels6—Pressure-sensitive radioassay data labels for lead dispensing

shield

EVACUATED COLLECTING VIALS. Collecting vials are available onrequest in 5, 10 and 30 milliliter sizes.

Mallinckrodt, Inc.P.O.Box5840St. Louis, MO 63134

CatalogNumber100101106102103104105107

0.25 curies0.50curies0.75 curies1.0 curies1.5 curies2.0 curies2.5 curies3.0 curies

p.@@AR

RADIOPHARMACEUTICALS

32A THE JOURNAL OF NUCLEAR MEDICINE

INTRODUCINGOurlatestEvolutionaryTechnetium

delivery system.ADVERSE REACTIONS

Q. Dr. Johnston, what observationshave come fromN.I.H. work with multiplegated blood pool studies?

A. The equilibriummethodisa muchmorereliabletestthan the traditional ECO method. Patients withforms of aortic stenosis, whose resting ejectionfractions are higher than normal, experience a drop inejection fraction during exercise.Following correctionofthe stenoticlesion,the ejectionfractionrises.Withexercise there is an improvement in the ejectionfraction of patients who have had coronary bypasssurgery, indicating that patients can benefit from thisoperation. Studying patients with aortic insufficiencyhas provided some hope that the nuclear method maybe helpful in selecting the optimal time for valvularreplacement.

Q. Comparingmultiplegatedstudieswith thalliumstudies, which in your opinion are easiest to interpret?

A. They are both relativelyeasyto interpretoncetheobserver has had some experience with them. Becausethe thallium studies are stationary studies, thesubtleties of a very minor lesion might escape you.Because the wall is moving in an equilibrium study,you should be able to pick up very subtle lesions.Therefore, either would be relatively easy to interpret,but probably the equilibrium study would be theeasiest.

Q. Whichof thetwostudiesyieldsthemostdiagnosticinformation?

A. The equilibriumstudygivesyoumoreinformation.The thalliumstudy willshowa walldefectif there isan infarct or marked ischemia. However, deficienciesin coronary flow are a bit harder to pick up wheremyocardial function is still intact. When comparing arest and exercise equilibrium study, slightabnormalities can be readily observed.

Q. Whatparticularadvantagesdo nuclearcardiologystudies have over other methods in the evaluation ofheart disease?

A. Theseproceduresarelessinvasiveandprovideglobaland regional functional information. Contrast studiesare more invasive. In addition, a significant amountof radiation is required for contrast studies so thatrepeating them is not taken lightly. Once the initial

baseline nuclear cardiology information is obtainedfrom a patient, one would then be in a position tofollow the patient's status and see if he was improvingas a result of treatment. This is one of the bigadvantages of these methods, particularly theequilibrium approach.

Q. In your research, how do these tests correlate withcineangiography?

A. We fmd that the nuclear cardiology data correlatesvery well with coronary catheterization and contrastangiography data. The three dimensional nuclear datagives us an edge over contrast angiography's twodimensional view. In all probability, nuclearcardiology studies will become the standard withwhich to judge contrast angiography.

Q. Asyoulookto the future, is nuclearcardiologygoingto become the primary diagnostic method in cardiacdisorders?

A. When you are involved with nuclear cardiology, itseems like that may well be the case. A considerableamount of effort is going into simplifying thecomputerized aspects of nuclear cardiology as well asimproving the detector devices. However, consideringthe largeamount of informationgainedin exchangefor the smalldoseof radiationthat is involvedin thismethod, I think that nuclear cardiology has thepotential of being one of the primary methods used incardiology.

For the complete transcript of this interview withDr. Johnston, write Inner-View, General ElectricCompany, Medical Systems Division, P.O. Box 414(Mail Code W-504), Milwaukee, WI 53201.

General Electric Medical Systems, Milwaukee,Toronto, Madrid.

GENERAL•ELECTRIC

33AVolume 20, Number 4

Inner-View No. 3A continuing educational series in Nuclear Cardiology

The interview excerpted here was;;i 4@—conductedwithGeraldS. Johnston,

M.D., Chief of Nudear Medicine,Clinical Center of the NationalInstitutes ofHealth, Washington,D. C.

@-.

WalterReedArmyMedicalCenterWashington,D.C.University of MarylandBaltimore,MarylandUniversity of UtahSaltLakeCity,UtahVeteran's Administration HospitalNorthChicago,IllinoisJohnsHopkinsHospitalBaltimore,MarylandUniversity of ConnecticutHealth CenterFarmington,ConnecticutDurham County General HospitalDurham,NorthCarolinaResearch Medical CenterKansasCity,MissouriBon Secours HospitalMethuen,MassachusettsBrookhaven National LaboratoryUpton,NewYorkSt.JosephHospitalAlbuquerque,NewMexicoSt. Joseph's HospitalBangor,MaineSt.JosephMercyHospitalAnnArbor,MichiganSt.BarnabasHospitalBronx,NewYorkRadiology Service of El PasoElPaso,TexasPolyclinic HospitalHarrisburg, PennsylvaniaPrince George's HospitalCheverly,MarylandMt.SinaiMedicalCenterMiamiBeach,FloridaNYU Medical CenterNew York,New YorkJewish HospitalSt.Louis,Missouri

‘RegisteredtrademarkSearleRadiographics.

Themajormedicalcentersareseeingthe differencea MedxX-37Upgradecan make.Betterpicturesat lowcost.Medx can convert your existing19 tube gamma camera to amodern37tubehighresolutionsystemforonly$22,900.

Medx UpdateX-37 isa simple,practicalwaytomodernizeyourexistingPho/GammallI'@or

. Pho/Gamma HPsystem. It pro

videsyouwitha fullyupgraded. 37 tube system that guarantees

you1/8inchintrinsicbarpatternresolutionfor99mTC.Formoreinformationcall(312)991-0660.

Yourpresent19-phototubegammacamera hasonly3/16―tO¼“resolution.

We can convertitto 37 phototubeswithahigh1/8“resolution.

AddressCityStateZipPhone

Journal of Nuclear MedicIne

Save thousands.

MedxUpdateX-37includes: a2yearservicewarrantyonanewdetectorassemblyand yournewcrystal.an upgraded“A―scopeand a 1 yearwarrantyonthepowersupply. gammacamera.workdoneonanexchange TOthiprice:$22,900basisinyourownlaboratory.(Theentireinstallationtakesonly four hours and can bedoneduringtheeveningorslacktime.)r@ -

0 Sure,I'dliketofindoutmoreabout your techniques for upgradingourpresentgamma

AnaffiliateofTransUnionLeasingCorporationcamera.

Name

Title

ComDanv

First ClassPermit No. 9782Chicago, Illinois

Business Reply MailNopostagestampnecessaryif mailedinUnitedStates

Postagewillbe paidby

MEDX CO.501 South Vermont StreetPalatine, Illinois 60067

Ifyou orderedonly aperfu.sionlung scanon thispatient...

washout—3 mm

..youcouldhavemissedthediagnosis.

“

The new definition of ‘lungscan―

Xenon-133 ventilation lung imagingreliably increases the specificity ofthe perfusion study by demonstratingregions of abnormal perfusion—normalventilation (strongly suggesting PE) orof abnormal perfusion—abnormalventilation (COPD, effusion or infiltrate).

Perfusion lung imaging is recognized as the mostsensitive noninvasive means of detecting pulmonaryembolism (PE). Almost every patient with PE will have anabnormal study—while a normal study virtually rulesout PE. But perfusion defects are nonspecific, since bothvascular disorders, such as PE, and parenchymal diseaseor effusion alter pulmonary perfusion.

.-..‘.-.

.... @..,# ..

@..@ ..:.)

initial breath I posterior

Pleasesee followingpagefor full prescribinginformation.

(SPECIFICITY) (SENSITIVITY)

36-year-old female, 7 years oral contraceptive use. presented with 10-dayhistory of increasingshortness of breath, dyspnea and nonproductive cough. No history of hemoptysis. fever orthrombcphlebitis. Bilateral wheezes and rhonchi. Chest X-ray normal. Sent to nuclear medicinewith suspected pulmonary embolism. Perfusion lung images showed multiple peripheral defects.many concave and wedge-shaped. The ventilation study showed severe bilateral air trapping,particularly lower lobes, corresponding in distribution to perfusion defects. Studies compatiblewith alpha-1-antitrypsin deficiency. confirmed by laboratory tests.

For convenient, safe ventilation imaging

XenonXe133Ga s (CALIDOSE)

Dispensing System

I@J New England Nuclear®

. —‘-‘I.—

For high-qualityperfusion lung imaging

PULMOLITETechnetium Tc 99mAggregated Albumin Kit

TherecommendednumberofaggregatedibenvnpennIestofiradministeredshoeis200.000-100.000neththesuiggestilnumberbeinguppruuenatoly350. -

Foruseandaccuracyatdispenomgthepreparedapnt@itisrecommiedodthatmuirtoreconstitution.concentratedsodiumantechnetateIc99mhehitherddutaiftoavokinviof8odwithfresh.preservative-freesoduimchltndeqectixet(U.S.P.).

TauIs4.Parlklss/Desex10'(T=5x 1PpaflldssuvIuI@Recttistnunne DoteActivity(nC@ lmCt 2m0 3nCi 4vd@i

20 0.25 0.50 0.75 1.030 0.17 0.33 0.50 0.6140 0.13 0.25 0.38 0.5050 0.10 0.20 0.30 0.40

@ThepertidespermilEurmdose*8 mcseuseinrelationtothephysucidecayofTc99wtedsthatatsuntestis(onehif-N@afterpreparation.thevubsesmthetoble.01mcreaeebyafactoroftwo.

Incuteofnght-to-leftcaidicshuntthenumberofaggregatedulsumatpartadesucbtvnoteredperdoseshouldbereducedtotheminunumfeuds.

Thepatentdoneshoedbemeasuredbyasuitablerauboacouwutycifsnaeioesystemonnteibatelypairtopatitttaibnmistratioe.Rweupuedparticlesbyrepeateduweesaseofthesyringeonateduatinypeattosegacteet.(Ifbleedisthemeewepinege.anyueeecessanydulsymontoirgactitemayleadtodotformationinsitu).Donotbuckfleitthespringy.stoweyection0 recommended.endforopsunemresults.ena@egshouldbeji onwonuspessubleshotogecotoe.

RADIATIONDUSIMETRYTheestimatedabsorbedradiatoutdoses(1)toananenappataino)lObglfromatnitranetistissyecnmtof4 nilhcaeesofTc99waggregateddbemmareshowainTide5.

@ 5.laleNs OasisTisas RechaflanWoxochedDotehyds/4mC4Longs 1.04WtIcIeBOdy 0.06Liner 0.12Spleen 0.11BIadder@2hourvoxd 0.08

4.8hootnoel 0.11Onaies 0.08Testes 0.07(1)MethOdofCalculation:ASchemaforAdiSotbetl-DOseCalculationsforBEOIOgicaIyastnbutedRadiotvscbdes.SupplementNo.1.MOOPattpNnoNo.1.p. 1.(1968).1mw$OPPUE@PUU40LffE@TechneeusnTc99wAggmgatalAlieneekita sgsq*edat hits of 9w @)In dirty (30) mali. steeN iii nonpyregen. each ii coetieleg in— kie@

A@egatedaliurnm(human).1.OmgNotmihumanserumibumuni0mgSodesmchlonide-lOmgStuenouscfdoedeibeydrute.masmum-0.Olmg

Eachvolcontains3.6-6.5t 10'aggregatedulbuminparticles.PULMOtJTEcontainsxepreservatM@afterreconstitutiontheidveldadvii shouldbe

stinalat2@to8C.Itmiadedineachfee(5)vii kitisone(1)packageinsertandso(6)radiationlibeli.

Includedineachthirty(30)nil kitisone(1)packageinsertandthntpse(36)radiation

DIRECTI06SMepnculyqua pisproatiatoly9wofsodesmpenachnetateIc 99m.cuastumungabout20to50 mlcunus@re-dAatedsib steole.preservatioe4teesold.onnecaunery@intoaoltuoldadvii ofPULMILITE.NOTE:Entertheviolseptumnechtheneedleatatoblepseangleii aidthepertectme.totesokitoteinsuchamaythatit Instnotesthevii matShakevigorouslyfinatleast30sacondsbeforeuse.CompletetheRadiationLabiprovidedandapplytoshaM.Peontovetfsh@ at Iqant.rwsuspendtheparticleshyrepeateelyineertmgtheultuehalvielfor15seconds.Abetmcoestuttgimt.storeat2' to8@CaolusesheprepanjoewithmwglnNun

ThisreagentbeinapprovedforusebypersonskennedkgtheU.S.NuclearRegudetoryCommissionpursuanttoSection35.14and35.100GripesIllof1OCFR35orunderhonsesofAgreementStates.

511188 CaIile@He@sr @P4I5 PrmtadatUSA

bulqoooftommdlassofradioactivityintothe @oraOwyiowansnotspecthcalyprotectedbyethaustsysOents.ADv@sEIEACTIOIIS:Todate.noinverseinactionsbasedooHatuseofsaoooXe133gashaveheenreportati.DO9W*110AONllSTl@IOIlXenonXe133gaso admexstexedfr@athahoonfromdosedrespiatorsystemsorspirometers.

Thesuggestedactiatyrangeempksyedforinhalationbytheaverageaibsitpatient(10kg)IS:

Puimooatyfunctionetcbithngenagmg:230 050in3horSofan.CIrSbrulbkSOdflOW:1030n@m3htnttofai.

ThepatentdoseshouldI. measuredbyatunableratboaconetyc@bnnoesystemonmeibutelyprostoatlmñstratson.PWY$IC*LtHARACTERISTIC$:XenonXe133decaysbybetaaidgananaemuoxansnetha thysa&hidfbfeof5.27days(1).Photonsthatareusefulforuna@egstudatsarehstodnTulde1.

@h1.PrIuc@ @dIa@emE@lasisuD@aXiusuXe133Meae%per Meaninergy

Raibasoin Doattegyatton (heX)Bota2 99.30 100.6Gamma2 34.99 81.0Knt.con.

ahctrons2 41.24 45.0I pot.coo.

dscuoos.2 7.81 15.7Mott.cot@

dnctrons.2 9.84 80.0ko-roys 34.10 30.8Ko.ruys 1.61 35.2(1)Odlman.LT..RaIbOmJCbdeDecaySchemesandNaclearParametersIreUseinRabatowOose(stanatoxtiPart2.SppçdementNo.4.MfROpansphhtNo.6.J.Ned.Med..p.28.1910.

ThespecdicgammarayconstantforxenonXe133o 0.44R/eCi4v.at1an.Thehuffvakatfoyero I mmofPb.

Tocorrectfor @uldecayoftfasrathonudide.thefractionsthatremanatsahcoadboretntervulabeforearidafterthedateofcaNtratiooareshaminTable2.

T@e2.IsuenXe133P@yaIoalDousycNalplduls 527ia@s@Fraction Frecean

Day Remaitung Day Remaining-5 1.930 8 .349-4 1.693 9 .302-3 1.483 10 .2682 1.300 11 .2351 1.140 12 .2060@ 1.000 13 .1811 .811 14 .1592 .169 15 .1393 .614 16 .1224 .591 11 .1015 .518 18 .0946 .454 19 .0821 .398 20 .072CMthranooDay

NAI@ DO$1IETNY:Theestimatedidiseibidraiflanondoom12)toanmangyparnor(70kg)forpulmonarypenfusemvealcemlsnrdMoodIke,ooathesfromamanunumdoseof30inicoresofxenonXe133it 3bntnsofanarethem,atTuNe3.

@ 3.ladI@IsuEffective WholeHulf.tmsoluttgs Bran Body

tath/3OeCiPolmonenyPeefuoxon 2mm. 0.25 0.0814 0.0827Cune&@Bleednan 5 ten. 0.63 0.0035 . 0.0068•99%ofactivityoinkings(2)MethodofC*tdstion:ASCheinaforAbSOrbe@0OseCalculationtinBrdlo@cuIy@sOnLOJtedRadinmicides,SupplementNo.1.M$1DpansphletNo.1.J.Ned.Med..p.

1.1968.NOWSUPPlIED:ThexenonXe133gaso supØedaspantoftheC@douesystem.consistingof2 ndunitdosenodsandtheCIdoue@ fo@sledded@penulng.

N@ malecontaingeither10or20mCi/viap.th.dppto5odleperoldeNtistir.aresuppled.Violsetscontainingopto100nC&Ivi&areaniliNe.‘PotentPending‘JO121hay1915.Rev1

Lungtohourratiosofabout19:1areottanedwxthmthebitt fewminutes.EhnsoanonoftheTc99maggregatedabiminfromthekingsoccursnethahit-lifeofabout5.6hours.CumulativeurinaryescmationsotabesshIneanaveragyxl 20%ilmuwtot'oftheeyectedIc 99mdose24hourspostadministration.MIIICATIOIIS*im usA@@btheeeeimIc994aggregatedibummisetibcatedanakingmtagmgagenttobeusednoanadpinctintheevoluatmeofpulmonaryperkasoe.tOIITMINDICAT1ONS:TacfmenumTc99inaggregateddbianmitoesldnorbeaihanttrtunedtopataintsveilsseverepulmonaryhypenensune.

TheuseofTc99rnaggregatedabummocontruetducotedinpistonsoathatestoryofttypetsunsittetyreactionstoproductscontaininghumansunsetibemin.WANIUIB$:Thepossibityofilergrcreactoxnsshouldbeconsideredinpatientswhorecuwamids@demo

Ttteorettiy.themtruveeoustefmmistrationofpartealateovitenisuchasaggregatedibeminonposesatemporarytotalmechamcalenpedimenttobloodflowWhilerhoeffectisprobablyoft@@y essyptificantin ,@ parserstheadministrationofaggregatediburranispossibdyhazardousinacutecorpeimoerdeandotherstatesofseverulyenpanedpulmonaryhoodflow

Thisrudmyharmacaisticiptnparatuueshoukinotbewinunoteredtochddrenortopregnantorlactatingwomenunlesstheexpectedbunefitstobegamedoutweighthepotennitots.

fdeoty.etainmonons10@9ratbophamtuceuncal@especiilythoseulecaveinnotate.ofawomanofchddbeatmgcapabdeyshould1wpetformedduringthehatfew(approi@mutoly10)daysftAtwngtheonsetofmenses.PRECAUTIONS:It casesofnght.to.leftcaribacshunt.addatoniriotmayassetduetositer@ entryofaggregatedibuminintothesystwnrcctrculauoe.

Thecontentsofthekitarenotradioactive.Hnuever.afterthesothampertechnerateTc99misadded,adequateshieldingofthekninpreparationmust1wmaintained.

ThehoeIngreactionsinvolvedto wepanngsheagaindependonmantaimngtmintheredecedstate.AnyosadentpresentinthesodiumpertacheetaueIc 99msupplymaythusadverselyifect theqoabtyofthepreparedagate.Hence.sodusinperrachtwoateTc99mcontainingtinduots,orotheradiboives.shouldnotbeemØoyedwttfunuttestdemonstrat09thatoiswithoutadverseeffectonthepropertaisoftheresultingagynt.

Thecontentsofthevolaresteeleandtion-pyrogerac.It stessentiolthattheuserfolnotheibtectuotsciefultyandwihecetostemasepticproceduresduengpreparationoftheraduotbagnostic.

TechivititonIc99maggregatedibenaninpltysucalyonstisleandatsuchtheparticlesviAlsettlevethtine.Faihimtomisthevolcontentsadequatelybeforeusemayresubsooon-undonnsbsrnbunonofrachoactivity.

fiISiso recommendedthat.becauseoftheincreasungprobabItyofagglomerainonnethugat@abatchofTecfmetusmTc99maggregatedibeminnotbeusedafteraighthourshintthetorteofreconstttutme.Refrigerateat2' to8@Cafterreconstitution.Hbloodisvethdrannintothesynlep.unnecessarydelaypriortoqectesemayresultit chitformationinsutu.

Thecontentsoftheviolareunderamtrogeoatmosphereandshouldheprotectedfroman.Donotusesidumpingorfoamingofthecontentsisobserved.

Adequatereprsducvoottudwthavenotbeenpuefonaudataeumaltitochseenunewhetherfinsdrugaffectslenloyinmalesorfemales.hasteratogenucpotwtndorhasotheradverseeffectsonthefetus.TecisteteamIc99maggregatedilaaunmshouNbeusedinpregnantwomentardywhendearlyneeded.

Itisnotknownwhetherthusdragisuncretedinfeamasnob.Asageeeninde.reirsungshotchinotbeundertakenadrdeapatentistiea hugneonmnydrugsareexcretedmfrontonsib.

Safetyendnffectrvvnessindtddmnhonenotbeenestafthshed.A,intheuseofanyrodiouctivemetertal.careshouldbetakentominimiseradiation

elgtosuretothepatios.consistentwithpropermanagementandtoentirenimmumraibatonesposoreintheoccupationalmachat.

Rach@ainnuceigeisshindebeusedoedykgphysucianswhoareipsihedkgnamingandespenetrctmthesafeuseandhuedhtgofreiboeecbdesandwhoa.paseeenceandtru000ghavebeenapprovedbytheappropnategoveenmeneolagyncyaethouinedtohoesetheuseofrudionucbdes.ADWIISEIEACTIOItThehteratwecontainsreportsofdeathsoccumngaltertheodeunistratmnofaggregated®ummtopatientswithpie-existingsenempehitonaryhypertension.Instancesofhemodynanacix obooyncratcreactionstopneparatmesofTcWm4iieledaggregatedibeuninhavebeenreported.

lffpetsensuteetymactextsarepossibleodvinemaprotem-cmnaumngmateealsstackonIt O9m4abeledaggregatedaflutninateusedinmowEpinuphene.anoxhuotainmesandcorncostaroxdagyotsshouldbeavadableforuse.DOSAGE*110A0NISTR@I0N:TherecommendedeteruvenousdoserangeItotheavers,patent(10kg)is1to4 milicunes.Thevokimeofthedosemaynaryfrom0.2to1.3ot

Xenon Xe 133 Gastk@UlPTION:XenonXe133b thagnost@usea avs@abIsa 5% @smcabon

@ @@jsnI95%.ICTIOII$:XenonXe133@ amat9lyddtus@gaswIth o neohautizednorpraJi@edLPId@lady.UpisonthroughceImembraneandfreelyexchangesbetonen@odandassue.It tendstoconcentratemenmbodyta thana tdood.Øasmawaone protanwhtioia.Inalacoi@ontm@tinusedkotkagnontopurposeao physioIo@calymactine.WndilneamiXs133gas.@In, thealneobrwalnedemitdinpidmonaryvenousamsiationviathecap@anes.MostofthexenonXe133thatentersthecirculationfromaw@ebreatha vitarondto thehingsandothaladafterasin@epassthroughthep.t_ arcidanorLNIIIICATION$:lnhdanoeofaeonXe133pushasprovedvalaoft@hetheevalaunonof_onary fractionaidfinonagmgthekings.It mayafrobeapp@ndtoassessmentofcarid%idflowcOIITRAIII0ICAT1OIIs:Todate.noknmancoetrvindicanonstotheateofxenonXe133gashavebeen.pwtml.WAIIIIIGS:TtnomdiopharmacoutUidtoukfoatbeadmm.sterviftopregtamviInctatVIPwomen utsiessthe benefits to be gained outweigh the poteonid hazards.

tiMidI@.esanmanonsstompradiophannacauoids.espea@ythoseelecteninnature.ofamamanofcltldbeanngca@y shoukitatpertonnedthsnngthefirstfew(approwmainly10)daysfobningtheonsetofthemenses.

Raibophannnceete:alsshiandbeusafonlybyphysiciansvihoamtpiáfmd@ specthchalingatthesafeuseendhandbagofrarbonechdesproducedbynuclearreactaror—acceheatin.and*hoseeapenencaandCraninghavebeenapprovedtrqtheappropnategonernmentidagencyauthmtzsdto @onsetheuseofrndmnuchdes.PUECAImONs:Asintheuseofanyotherratboacttvematertidcornshoulabetakentoinsuremmimumraibatoreexposuretothepatiant.consistentv@ohproperpatientman@apement.andtoesitemnmumraduxeeseesposinetoaccupatmardworkers.(speedventstte133gasshouMhecontreledmameenerthatomcom@atcswiththeappropriategovsrnmietofapencyregulations.

XermoXe133adherestosomeplasticsandrobberandshookinotbealowedtostandintubingorrespeatsecontainers.Suchonrecogmzedlossofrathoactxvityfromthedoseforathninintranoomayrenderthestudynonihagnostic.XenonX. 133gasdövery

@stIn5.e. repieratotsorspeenvixersendassociatedtubingassemblesmostfat

PULM0LrFETMTechne@umIc99mAggregatedi@JbuminK@August1976

DIAGNOSTIC—FORINTRAVENOUSUSEDEStHIPTIlNeEadtvii ofPULM0UTE@TechnetiumIc99mAg@egatedAlbumin(0containsasteele.pyrogewfree.@ophdtzedmatureof1.0mgofaggregatedibumin)Ha@. 10mgofnormolmaimalbumin.10mgofanthemdtktnde.arid0.01mg

@enun4ofstaeeouschlostile@ty&asu.PULMOLITEoxpreparedbornilsummthatwastoxeneictireiltantestedforhupatitoBantigen(H8,kg)kgmdioiminonoassay.Eachviicoroaos3.6.6.5@ 10'aggregatedalseminpartides.Thepainesiredisinbutionoftheaggysgatodibuirun0 suchthatnotlessthan85%urnwithintivirangeof15.90moronsinsue.Thereurnnoaggregatedibummpanniesgreaterthen150micronsatwe.ReconstnutmnofPULM)3J1Ew@hsoibumperoecheefateTc99mprovidesonaipleoussuspenneonoftechnetiumTc09maggregatedibumin.oddsalabebngefhaencyof>90%.

PHYSICALCHARACTEIUSTICSbdvretiumTc99mtlecaysbyatomenrcvumanonwokaphpacihalfWeof6.03hours(1).Photonsthatareusehilfordetactionandena@ngarekitedinTide1.

bNls 1.Prludpls @MIenEailsslssDoleMean%/ Mean

Rathaixen Domtegration Energyhot)Gamow2 87.9 140.5(1)Ddhnae.IT.andVanderLags.F.C.RaibonacbdeDecaySchemesaidNuclearParametersforUseatRadiatsonDoseEstimation.MIRDPampldstNo.10,p.62.(1975).

EXTERNALRAIXAT1ONThespecthcgammarayconstantforIc99me 0.8R/mO.hrat 1cm.Thelasthalfnolandscthenotdleil(Pb@orTc99mo02mm.AnaegyofnuksesfortIwmhnnuattenuationoftheradiationennttadbydesradsoeirchdethatresultsfrominterpositionofveeouuttadtnessesofPboshownmTablu2.Fonoxample.theuseof2.lmmofPbwdtilecreasetheesternirathationexposurebyafactorofabout1.000.

@e2.killsu Alt@aIwabyLied$NellIqShodTfuckoessf'b)mm CoethciereofAovemsatan

0.2 0.50.95 101.8 10@2.1 10-'3.6 10-'4.5 10@

Tocorrectfarplt@ decayof thatrathonudele.thefractionsthatremanat siectedtimeiniutoabalterthetimeofcidsrononemthereinmTitle3.

bI@ 3.PNyiicaIDecay@Nart% 9@ lIolI.Ule6.03HeirsFraction Fraction

Hines Remaimng Hours Remanmg0@ 1.000 8 .3991 .891 9 .3552 .795 10 .3173 208 11 .2824 .631 12 .2525 .5636 .5027 .441

CaNeasonTune

@lJllC@PIIA$MA08LOGY:Wnfnn5-10namstesofintravenousmpictmn.aner90%ofTc99maggregatedihummo trappedintheortenolusandcapdhnesoftheking.

Organselectivityatadirectresultofparticlewe.Below1.10micronstheaggyegatesaresianupbythevinculoendothehosystem.Above10.15micronstheaggregatesbecomeedgedmthekingcapilaeeskga @ajmlymecharacimacmrs.Oitrtuteieofpiticlisintti hogse afunctoeofne@onipuknonarybloodflan.

Eupt@@ New England NucleaNENCtun.ca@GmbH, F NENCanada,0.6072Ddaeich.W.Gennan@

245346thk@enue,Postlach401240 Medical Diagnostics Division i@. o@.imT3c9T@@J6103)85034thier Entry:(06103)81011 601 Tteb@C@eRd..Nwth B@eeica,MA 01862. Ci WAmo: 8O0-225-1572/@lis94-0996 (InMass.w@1lntemation@611.482-9595) T@514-636-4911

Stableformulationpreparedwithstannoustartrate, which is more resistant to oxidationthanstannouschloride.2Lowestdoseratetothelungsofanycommerciallyavailablekit.3

NOWAVAILABLEFORUSEW1TH UPTO

90 mCi PER VIAL.\ Easytoprepare.1

Adequatereproductionstudieshavenotbeenperformedinanimalstodeterminewhether this drug affects fertility in males or females, has teratogenic potential, orhasotheradverseeffectsonthefetus.TechnetiumTc9gmAggregatedAlbuminshould be used in pregnant women only when clearfy needed.It isnotknownwhetherthisdrugisexcretedinhumanmilk.Asa generalrule,nursingshouldnotbeundertakenwhileapatientisonadrugsincemanydrugsareexcretedinhumanmilk.Safetyand effectivenessin children have not been established.Asintheuseofanyradioactivematerial,careshouldbetakentominimizeradiation exposure to the patient, consistent with proper patient management. and toinsureminimumradiationexposuretotheoccupationalworker.Radiopharmaceuticals should be used only by physicians who are qualified bytraining and experience in the safe use and handling of radionuclides and whoseexperienceand traininghavebeenapprovedby the appropriategovernmentalagencyauthorizedtolicensetheuseof radionucfides.

adverse reactionsThe literaturecontainsreportsof deaths occurringafter the administrationofaggregated albumin to patients with pre-existing severe pulmonary hypertension.Instancesof hemodynamic or idiosyncratic reactions to preparations of Technetium Tc 99m labeled aggregated albumin have been reported.Hypersensitivityreactionsare possiblewheneverprotein-containingmaterialssuch as TechnetiumTc 99m labeled aggregated albuminare used in man.Epinephnne, antihistamines and corticosteroid agents should be available for use.

how suppliedkit contents

5 STERILE MULTIDOSE REACTION VIALS (10 cc, silver aluminum overseal),eachcontaining0.34mgMM AggregatedNormalSerumAlbumin(Human)2.0x1O@±25%particles,0.27mgstannoustartrate,0.6mlof isotonicsaline.Hydrochloric acid and/or sodium hydroxide may have been added for pHadjustment.

10 PRESSURE-SENSITIVE LABELSfor final TechnetiumTc 99m AggregatedAlbuminpreparation.

1 PACKAGE INSERT.

FOR FULL PREPARATION AND PRESCRIBING INFORMATION,SEE PACKAGE INSERT.Notes: 1. See package unsertfor full preparation instructions. 2. Reg. U. S. Pat.Off.#3987157,UnionCarbideCorporation,Oct.19,1976.3.RefertoUnionCarbide and competitive package inserts for full lung dosimetry information.

E ___.!@ c_)@ I ;=:.::—@

@ c2@-@-@ cJ .-@;-;:@@T@; -@

BRIEFSUMMARYOFPRESCRIBINGINFORMATIONIndicationsandusageTechnetium Tc 99m Aggregated Albumin is indicated as a lungimaging agentto beusedasan adjunctintheevaluationof pulmonaryperfusion.

contraindicatlonsTechnetiumTc 99m AggregatedAlbuminshouldnotbe administeredto patientswith severe pulmonary hypertension.

The use of Technetium Tc 99m Aggregated Albumin is contraindicated in personswith a history of hypersensitivity reactions to products containing human serumalbumin.

warningsThe possibilityof allergicreactionsshouldbe consideredinpatientswhoreceivemultiple doses.Theoreticallythe intravenousadministrationof any particulatemateñalsuchasaggregated albumin imposes atemporary small mechanical impediment to bloodflow. Whilethis effect is probably physiologically insignificant in most patients, theadministrationof aggregatedalbuminis possiblyhazardousin acutecotpulmonale and other states of severely impaired pulmonary blood flow.This radiopharmaceutical preparation should not be administered to children, topregnantwomenor lactatingwomenunlesstheexpectedbenefitsto begainedoutweighthepotentialrisks.Ideally,examinationsusingradiopharmaceuticals,especiallythoseelectiveinnature,of a womanofchildbearingcapabilityshouldbeperformedduringthefirstfew (approximately 10) days following the onset of menses.

precautionsIn cases of right-to-leftcardiacshunt,additionalriskmay existdue to the rapidentryofaggregatedalbuminintothesystemiccirculation.Thecontentsof the kitare notradioactive.However,aftertheSodiumPertechnetateTc 99m is added,adequateshieldingof the finalpreparationmustbe maintamed.The labelingreactionsinvolvedinpreparingthe agentdependonmaintainingthetin in the reduced state. Any oxidant present in the Sodium Pertechnetate Tc 99msupplymaythusadverselyaffectthequalityofthepreparedagent.Hence,SodiumPertechnetateTc 99m containingoxidants,or other additives,shouldnot beemployedwithout first demonstratingthat it is without adverseeffecton the propertiesofthe resultingagent.The contentsof the vialare sterileand pyrogen-free.It isessentialthat the userfollowsthe directionscarefullyandadheresto strictasepticproceduresduringpreparationofthe radiodiagnostic.Technetium Tc 99m Aggregated Albumin is physically unstable and as such theparticleswill settle withtime. Failureto agitatethe vial adequatelybefore use mayresultinnon-uniformdistributionof radioactivity.It isalsorecommendedthat,becauseof the increasingprobabilityof agglomeration with aging, a batch of Technetium Tc 99m Aggregated Albumin not be usedaftereighthou@sfromthetimeofpreparation.Refrigerateat2°to8°Cafterpreparation. It blood is withdrawn intothe syringe, unnecessary delay pnorto injectionmayresultinclotformationinsitu.Thecontentsofthevialareunderanitrogenatmosphereandshouldbeprotectedfrom air. On preparation with Sodium Pertechnetate Tc 99m, the contents of thevial should be mixed by gentle swirling to avoid changes in particle size. Do not useifclumping or foaming ofthe contents is observed.

Forordering,customerserviceandtechnicalinformationcall toll-free:(800)431-1146.In NewYorkState,call (914)351-2131,ext.227.

@ r i@@@ •,—@@@ I e@@@ @-I

@.@L_L_@@@ J

TECHNETIUMi@:ii

lëchnetiumTc99m Aggreqated AlbuminKitDL61@@14OS-nC-FORINTRAVENOUSUSE

@i@I@1@IFROMATOMTOIMI@GEUnionCarbide corporation . Medical Products Division.Nuclear Products •P.O. Box 324 •Tuxedo, New York 10987

CintiChemisaregisteredtrademarkof UnionCarbideCorporation.

Sometimesthedetectionandevaluationof heartdiseasecan indeedbe a puzzle.. you haveto put all of thepieces of information together in orderto make an accurate diagnosis.

And that information is often elusive...sometimes impossible to obtainwithout resorting to expensive andtime-consuming invasiveprocedures.

But, now with the advent ofradionuclide scanning techniques,many invasiveprocedures have beeneliminated.. or at least the absoluteneed for the procedure can now bedeterred.

Thedifference is decisive.

em

Manyclaims are being made for newradionuclide techniques. ..patientcomfort.. lowmedicalcosts...convenience. ..speed. ..noninvasive.

And they all operate on the sameprinciple.

All except one.

SystemSeventy-Sevenhas all of theadvantages mentioned...the bigdifference is in data accumulationpotential. The type of data that helpsyou makeyour diagnosis complete.

Writetodayforinformationandcompare the data accumulationpotentialwith all ofthe other systems.

Youwon't haveto be puzzled anymore.

@. s'...@

@ @/

Vr

@—..,..

Puzzled....

The Cordis-Baird SystemSeventy-Seven.andFirst-PassTechnology.@

co@dlls®CordisCorporationNuclearMedicalSystemsDivisionTelephone:toll-free1-800-327-7820,Ext.2711P0.Box370428,Miami,Florida33137

•1\

I

New Gai@mniaTh@®

I I

\ I\ I

/

, I

I

The fastest way to assaytotal estriol in urine or serum.. 1/2-hour incubation

•Foursimple steps, single incubation

•No separate hydrolysisS Routinely provides STAT performance

•Urine and serum controls of conjugatedestriol supplied at two levels

•Minimal reagent preparation, minimalpipetting

Send for data sheet today.

Complcocdirectionsforuseareprovidcdwitheachproduct.Thesedirectionsshouldbereadandunderstoodbeforeuse.Particularattentionshouldbepaidtoallwarningsandprecautions.Additionalperformancedataareavailable.Shouldyouhaveanyquestions,contact your Clinical Assays/liavenol representative.

Volume 20, Number 4 43A

:010.9

Helps detectfetal distress

laster

,

[1251] ESTRIOLRadioimniunoassay Kit

CLINICP@LP@ssP@YsDIVISIONOF TRAVENOLLABORATORIES,INC.

620 Memorial Drive •Cambridge, Mass. 02139(617)492-2526•TWX: (710)320-6460Tollfree:(800)225-1241In Mass:(617)492-2526

For other worldwide locations please contactyourlocal Clinical Assays/Travenolrepresentative or the International SalesDepartment, Clinical Assays, Cambridge,Mass. 02139, U.S.A.

@i___

, A

360degreevisibilitybecauseit'smadeofNuclearPacific's optically clear lead glassySafe. Reduces exposure of 99nffc by a factorof 70.Ughtweight Easy to handle@Quick, smooth insertion and removal with an“0―ring seal.Anti-roll desig@Professional appearance reduces patient anxiety.No shielding leakage@Available for immediate shipment.Developed by a company with 30 years experiencein radiation shielding.Currently in use in hospitals worldwide.

Price schedule@Mth@&I@k

Model 110 (icc Tuberculin)Model 310(3cc)Model 510 (5cc and 6cc)

Wffi@xd @erI@k1Model 120 (icc Tuberculin)Model 220(2cc)Model 320(3cc)Model 520 (5cc and 6cc)Model 1012 (10 and 12cc)

1. All models without [tier Lock will acceptLi.ierLock and non-Luer Lock syringes.

Prices effective in U.S.A. and Canada@

NuclearPacilic,Inc.

$125.00 ea.94.00 ea.97.00 ea.

$125.00 en.125.00 ea.125.00 ea.125.00 en.125.00 ea.

Hi-D lead gIass(6.2gn@cm@. Registered U.S. Patent Office. Platinum melted ultra high density optical glass.

For ithwmalion contact Nuclear Pacific, Inc@,6701 Sixth Avenue So., Seattle@WA. 98108 (206) 763-2170.

44A THE JOURNAL OF NUCLEAR MEDICINE

3c@sy@ngeand @eWth@tianactuad@

A syringe shieldwith all the visibility of glassall the protection of solid lead.

I1IIIIII

@@@ I

,@@ @\,@ \\@C,@S@ <@I@ — — — — @.

,@

,_‘@—

\@ .@

q)

@,

I

Medi-Ray, Inc.

@T\@T@±T@―—j

CCC-4TP

1

I

•1 1AF@%@@

cI,,,,,*I c.,@,,@

on leg

i@c7f@C7

S

1W).')'

0-Li

i.@—cs0 ‘-‘r.@.- :Oo.LJ

@ 1@tiI$__.. :@

@II.,n

,..@_, .@:@

., Sn, : @‘@

c:@@@::S .@

•Directdigital percentreadout

•Printoutsavestime

•Bedsideoperation

•Rightangle probeminimizespatient disturbance

•Controlsare on probe

•Operator error protection

•Versatile settable for otherisotopes

Print Out1% inchwide

7051 ETONAVE. •CANOGA PARK,CA. 91 303 (21 3) 883-7043

46A THE JOURNAL OF NUCLEAR MEDICINE

thrombosisdetection of DVT using I-i 25 fibrinogen

NICAL. ASSOCIATES

-@

:::E'@:@HSA@@@;@@ :‘:;,:z:@

yourkitcompany

—@ 99m MAA Aggregated Albumin Kit

Consistent withour commitmentto the needs of the nuclearmedicineprofession,we are proud to announcethe expansionofourlineof diagnostickitsto includeIc 99m MAAAggregatedAlbumin Kit and Ic 99m HSA HumanSerumAlbumin Kit.

Eachkit contains10multi-dosevials.All kitsareavailablefromstock and competitively priced. And since Diagnostic Isotopes offers substantial discounts for quantity orders,you now haveagreateropportunitythanevertosave.Forinstance,toearna10-kit quantity discount, you do not have to order 10 identicalkits. Any combination of kits in a single order may earna quantity discount. Progressivediscounts are also availablein orders of25, 50 and 100 kits.

Onetoll-freecallto(800)631-1260willgiveyoucompleteinformationonallourkits.Diagnostic Kits Available: MAA HSA DTPA,Polyphosphate;Dlphosphonate.

Diagnostic Isotopes, Incorporat•d225 Belleville Avenue, Bloomfield, N.J. 07003in N.J.(201)429-7590Telex:133393CallToll Free(800)631-1260OurQualityHelpsYourImage.

I making

4@., ‘

--U

I Address

0 Please send literature.

D Please have representative call.

Name ___________________ Title _____________

Organization

City State Zip

II

202 EASTW@SHlNGTONSLATE401 ANN ARBOR,MCHIGAN 48104 (313)973-2335

@is

for Nuclear Medicine Departments.Leadshieldingwithinthe systemprovidesfor personnelsafetyfromradiation.Maximumefficiencyis obtainedthroughthe “Work-Flow―patternconcept.

kewauneeKEWAUNEESCIENTIFICEQUIPMENTCORP.SPECIALPRODUCTSDIVISIONAdrian,Michigan49221Phone:517/263-5731

48A THE JOURNAL OF NUCLEAR MEDICINE

DON'TWYASTFESS V'BLE...

.:.

WY A STRESSSySTEM! @SJEILL

\(1(IC.ir@1eIu@ %@t

Picture the 600 Beta SerIes user and you will see multi-image photography so automated its effortless.Freedom from worry about operator or camera error. And cootconfidence that images of the highest

quality will be recordedon film.Consistently.After all, Inthe practiceof ultrasound,CT or anyvideo readout imagingtechnique,your mindshouldbefree to

focuson tOeessentials:the patient,the gereration of the imagesand the interpretationof same.TheDunncamera will work quietly in the background. to preserve those images for analysis, display and the medical record.

This requires the versatility of programmable electronics, well-engineeredfeatureslikefilmcassetteanddarkslideinterlocks,andthevideostability

andaccuracyofmonitorslikethesuperbnewflat-facedTektronix634.Letusfillinthepictureforyou.

CallorwriteDunnInstruments,lnc.,544SecondStreet.P0. Box77172,San Francisco. California 94107. (415) 957-1600.

The600 BetaSeriesCamerabyDunnInstruments

4..—-—

!@‘,@I . n@ a

I

Ta,a@

Aldosterone

And rostened lone

Circulating T3

Corticoids

DHEA(Dehydroepiandrosterone)

17-Hydroxyprogesterone

Digitoxin

Digoxin

DPH (Dilantin)

Estradiol

Estriol

Estrone

Progesterone

Testosterone

EPI-Testosterone

Total T4

50A THE JOURNAL OF NUCLEAR MEDICINE

INNOVATORS IN R.LA.

NEWESTRIOL1251

50 UL SAMPLESIMPLE EXTRACTION

2ND ANTIBODY SEPARATION30 MINUTE INCUBATION

2NG/ML SENSITIVITY

DIGOXIN12513 PIPETTING STEPS50 UL SAMPLE2ND ANTIBODY SEPARATION

30 MINUTE INCUBATION

.2 NG/ML SENSITIVITY

WienLaboratoriez,htc.P0. Box227.Succasunna.NewJerseyO7B76Telephonet201)584-7019

Outside N.J. Call (800) 631-9384

VICTOREEN

ef fi'cient,a. çorlimator,@.1.an arrayofholes withleadsepta

that pass gamma radiation to agamma camera's crystal

in parallel rays.

ef'fi‘cieiitcot'ii mãtör

1. a new. multi-purpose. parallel-holecollimatorcombining high resolution with high sensitivity—ideal for imaging with low-energy gamma ray

emitters such as Tc-99m. Xe-133 and 11-201.

2. a collimator ideally suited for stress cardiacstudies and others requiring high resolution with“general-purpose collimators' sensitivity.

3. a collimator that reduces imaging timeand patient motion effects (because of

its high sensitivity) while providingexceptional high resolution.

You no longer have to trade sensitivity forresolution (a typical high-resolution collimator)or resolution for sensitivity (a genera1@purposecollimator).The“EfficientCollimator―providesbothhighresolutionandhighsensitivityin one unit,which means:

For more information, including samples of clinical results with thissignificant advance in collimator technology, write or call for Bulletin 272-B.

NUCLEAR ASSOCIATES_______________ Division of VICTOREEN,INC.

________________ 100VoiceRoad •CarlePlace,N.Y.11514 •(516)741-6360

1. producing the desired effect orresult with a minimum of effort,expense or waste.

. Shorter imaging time

. No collimator changes. Improved statistical accuracy. Reducedpatient motion effects

Volume 20, Number 4 51A

Useof @@@!JL@>Afor@@ @.@,;@T@.@ .

The following abstract is taken from apaper written by James Thrall, M.D., ThomasJ. Brady, M.D., and Bertram Pitt, M.D., with thetechnical assistance of Jean M. Clare, ARRT,ofthe Divisions of Nuclear MedicineCardiology, Departmentoflnternal Medicine,University of Michigan Medical Center, AnnArbor, Michigan.

The complete paperwas published inthe February, 1979 issue ofRadiology/Nuclear Medicine Magazine.Copies ofthe protocol are available uponrequest from Medical Data Systems as acontinuing service to the medical communityto provide current information on newtechnologies and practices in NuclearMedicine.

Also ask usto send you information aboutour new A2Image Processing Systemintroduced in March atthe American Collegeof Cardiology Meeting. Demonstrations willalsobegivenduringtheSocietyof NuclearMedicine Meeting in Atlanta in June.

IntroductionOVERthe pastdecaderadionuclide

ventriculography has been shown to be anaccurate technique for evaluating leftventricular function, and its clinical utility iswell established for diagnosing, managingand assessing therapeutic responses inmanytypesof heartdisease.Withinthe pasttwo years, the value of radionuclideventriculography for detection ofhemodynamicallysignificantcoronaryarterydiseasehasbeenenhancedbythedevelopmentoftechniques for performing thestudies during exercise. The rationaleunderlying this application is that theimbalance between myocardial oxygensupplyanddemandwith resultingventriculardysfunction becomes manifest in manypatients with stable coronary artery diseaseonlyafterthehearthasbeensubjectedtostress.

Thepurposeofthis paperisto illustratean approach to graded exercise gated bloodpoolradionuclideventriculographybasedonexperienceatthe Universityof MichiganMedicalCenter.

MUGX@―GradedExercise(1)

Coronary Artery Disease

Left 1..VentricleEjection .80Fraction

.60

.40

00

Watt load

RequiredInstrumentationandSupplies

1. Medical Data Systems Computer withMUGX@Mprogram.2. Gamma scintillation camera with low

energycollimator.3. A-wavegate with ECGstrip chart

recorderandaccessories.4. Non-fadeoscilloscopeforECG.5. Modifiedimagingtableandstabilizing

harness(supineexercise).6. (Bicycle)ergometer.7. Blood Pressure cuff and stethoscope.8. Hardwarezoomdevice(optional).9. Cardiacshield(optional).

10. Defibrillator, emergency kit.

The MUGXprogram is a special programcomponentofthe MUGA@―cardiac programpackage.MUGXwasdevelopedspecificallyforexercisetesting.Dataiscollected inframemode(histogrammode)format,therebyessentiallyeliminatingcountratelimitationsthrough the computer interface which in turnfacilitatesrapidcollectionofstatisticallyadequatestudiesduringexercise.

ExercIseResponsePatternsFunctional response ofthe left ventricle toexerciseis extremelycomplexandthecompletesignificanceofobservedpatternsduring graded radionuclide exerciseventriculographyis by nomeanscompletelyestablished.Innormalsubjectstheejectionfractionincreasesprogressivelywithdistinctplateauingoftherateofincreaseduringthehigherexerciselevels(1).Patientsdevelopingsignificantmyocardialischemiaoftendemonstratea monotonically

MDS products,hardwareand software,are toolsfordiagnosisandresearchwhichdonotcomeincontactwith,andcannotcausedirectInjurytothepatient.Refertotheoperationmanualandinstructionsaccompanyingthe gamma cameraandinjectableimagingagentforfurtherinformationon their use.To ensureproperclinicalresults,anMDSproductmustbeusedunder the direction of, and using proceduresverifiedbyaqualifiedphysician.

decreasing ejection fraction pattern duringgraded exercise with a diminished ejectionfraction compared to the baseline valueobserved at even the lowest exerciselevel(2). In such cases the diagnosis is quiteclearcut and infactvirtually any two points onthe curve could be used to establish thepresence of a hemodynamically significantcoronary artery lesion. However in somepatients with coronary artery disease, theejection fraction actually rises at the lowerexerciselevelswithanabnormaldownturninthe ejection fraction response curve onlynoted at higher levels. If a single exerciselevelwereobtainedin suchcases,thefunctional response ofthe ventricle mightappear equivocal, or perhaps even normal ifmaximalexercisehadnotbeenachieved(3).

ConclusionGradedexerciseradionuclide

ventriculography is a valuable newdiagnostic procedure for detectinghemodynamicallysignificantcoronaryarterydisease. Although further refinements willundoubtedly be forthcoming, the reporteddiagnostic accuracy ofexercise radionuclideventriculography is impressively high. Theprocedure is technically demanding andrequires a melding of knowledge and skillsfrom two disciplines: nuclear medicine andcardiology.

For a copy of the complete paper, write to:

medical Data sustems

division of Medtronic, Inc.2311 Green RoadAnnArbor,Michigan48105313 769 9353Telex235794

MedicalDataSystemsInternationalAbbeyRoad,BlackrockCounty Dublin, Ireland

Coronary Artery Disease

Left 1.@VentricleEjection .80Fraction

0

Watt load

Ventriculography

MD

Ourautomatedsamplechangerhasbecome the “workhorse―of the RIAsector, and is respected worldwidefor reliabilityandendurance.

THE NEWACTUS If-scan..Usedin conjunction with intravenousinjection of 1125labeled humanfibrinogen, r-scan,, presentsthe mostaccurate, reliablesystemever developedfor the detection and monitoring of deepvein thrombosis of the legs.Lightweightand portable, r-scan,,provides a fast,safe,and simple monitoringprocedure.

For a full-color brochuredetailingthenewIf-scan@and itsexclusivefeatures,calltoll free:800-354-9875

I@\ -

L: @.

,@-

TMTrademark

DoDoMD

...is our wellknown reputationIf you've never heard of ACTUS,Inc., it's certainly

not becausewe'renewto nuclearmedicine.In fact,we'vecontributedto the field of Radioimmunoassayfor yearswith someof the most respected,advancedanddurableinstrumentationon the market.

But until now, we've pioneered, developed andproduced our instruments under some

one else'slabel —our automatedsamplechanger, for example, is

@*@144@44 marketed WOddWid@ by Abboft

@ .\ •Laboratories under the AutoLogic tradename.Now we're taking our reputa

tionforquality,dependabilityand performancedirectly to you, with

our innovative diagnostic fibrinogenmonitor, the @f-scan,@

A moredirectroleforus,thesame,high-quality product for you.

Inthecomingmonthsyou'llbehearinga lotmoreaboutus.And

ournameshouldbecomealittle morefamiliar.

ACTUS,Inc. Youknow usbyourreputation.

ACTUS7964 Kentucky DriveFlorence,KY41042

State-of-the-arttechnologyindiagnostic nuclear medicine.

El

BehindOurUnfamiliarName...

TO MONITORThe Chemotherapy Of

The Cancer PatientDiagnosticBiochemistryInc.

PresentsMethotrexate[12511RadloimmunoassayKit

High dose Methotrexate therapy incombination with Ieucxvorin “rescue―traatment creates a vital need for closemonitoring of circulating Methotrexateplasma levels. Methotrexate overdosehas beenshownto be associatedwithseveremyelosuppresslon,renaldamage12 and hepatotoxicity.3

Our 1251MethotrexateRadioimmunoassayKit providesa rapidsimple method,withsensitivityof 10plcogramsin serum,plasma, cerebrospinal fluid or urine.Results can be reported In less than 11/2hours. Precalibrated human serumstandardsand controlserumare providedas well as a stable 1251tracer and antiserum.1. S.W. Pitman et al: clinical Trial of High.Dose

Methotrexete(NSC-740).With CitrovorumFactor(NSC-35@0)-Toxicologkcand Therapeutic Observations. Cancer Chemotherapy Reports Part 3Vol.6,No.1, July1975.

2. Stoller, Ronald G. et al: Use of Plasma Phar@macokinetics to Predict and PreventMethotrexate Toxicity. N.E Jr. of Med. Vol. 297No. 12:630-634,Sept. 22, 1977.

3. Jaffe N. and Traggls D. Toxicity of high-dosernethotrexate(NSC- 740) and citrovorum factor(NSC.3590) rescue in osteogenic sarcoma.Cancer Chemother. Rep. Part 3, Vol.6(1):31-36,1975.

Ekixorubicin[129]

Rsdioimmunoa@sayKft Forlnvestigat1on@UseOnly.

HighcIrculatingleveleof Adriarnycin*may result in irreversIble myocardialdamage, bone marrow depression, andgastrointestinaltrauma.1@@ Knowledgeofcirculating Adriamycln*concentrationstherefore,is important.

Our ‘@9Doxorubicin (Adriamyciri)RadioimmunoassayKit featuresa rapid,simple procedure with 100 picogramsensitivityin serum,plasmaor urine.Stxprecalibratedstandardsas well as a controt serumare supplied.The stable 1251tracer and one hour incubation timemakesthis kit a uniquetool in cancermanagement.1. Bonadonna, G. et al: Phase I and preliminary

Phase IIevaluationof adrlamycin(NSC 123127),CancerRes.30,2512,1970

2. Middleman, E. et at: CtI@ic& @1d$1swithadriamycin.Cancer,28,844,1971.@

3. Wang, J. et at:Therapeuticeffect an@'t@ld@@*.;.@adriamycinin patientswithneoplasticdiSe@@L@•Cancer,28, 837, 1971

Tradename Adria Labs.

Forfurther informationcallor writrn

gnostic@ I@ @hemist@ ‘@

@. @:Tnc@ t7_@iT

:@ •‘@.@.

I =:@::=:::::.@.@@ ,@--‘.—-,

. RAPID EASY PREPARATION1I EXCELLENT BINDING EFFICIENCY2

C STABLE FORMULATION2

. CONVENIENT USAGE METHODOLOGY'

. CONSISTENT RESULTS2I UNIT DOSE ECONOMY

OR MULTIDOSE UTILITY

For ordering, customer service and technical information call toll-free: (800)431-1146,until 7:00 p.m. Eastern Standard Time. InNew York State, call (914) 351-2131 , ext.227.

IndIcationsandusageTechnetium Tc 99m Human Serum Albumin is used as an agent forimaging the heart blood pool and to assist In the detection of pericardialeffusion and ventricular aneurysm.

contralndlcatlonsTheuseofTechnetiumTc99mHumanSerumAlbuminiscontraindicatedin personswith a historyof hypersensitivityreactionsto productscontaining human serum albumin.

warningsThe contentsof the kit are not radioactive.However,aftertheSodiumPertechnetateTc99misadded,adequateshieldingof thefinalpreparationmustbemaintained.This radiopharmaceuticalpreparationshouldnot be administeredtochildrenortopatientswhoarepregnantortonursingmothersunlesstheexpectedbenefitsto be gainedoutweighthe potentialhazards.Ideally, examinationsusing radiopharmaceuticals,especiallythoseelectivein nature,of womenof childbeanngcapabilityshouldbeperformedduringthefirstfew (approximately10)daysfollowingtheonsetofmenses.

precautionsThecomponentsofthekitaresterileandpyrogen-free.It isessentialthatthe userfollowsthe directionscarefullyand adheresto strictasepticproceduresduring preparationof the radiodiagnostic.TechnetiumTc 9GmHumanSerumAlbuminmustnot be usedafter threehoursfromthetimeof formulation.Adequatereproductionstudieshavenotbeenperformedin animalstodeterminewhether this drug affects fertility in malesor females,hasteratogenicpotential,orhasotheradverseeffectsonthefetus.TechnetiumTc 9GmHumanSerumAlbuminshouldbeusedInpregnantwomenonlywhenclearlyneeded.It isnotknownwhetherthisdrugisexcretedinhumanmilk.Asa generalrule,nursingshouldnotbeundertakenwhilea patientisona drugsincemanydrugsareexcretedin humanmilk.Safetyandeffectivenessin children havenot beenestablished.TechnetiumTc 99mHumanSerumAlbumin.aswellasother radioactivedrugs,mustbehandledwithcareandappropriatesafetymeasuresshouldbe usedto minimizeexternal radiationexposureto clinicalpersonnel.Also,careshouldbetakentominimizeradiationexposuretopatients,consistentwith proper patient management.

The labelingreactionsinvolvedin preparingthe agent dependonmaintainingthetininthereducedstate.AnyoxidantpresentintheSodiumPertechnetate Tc 99m supply may thus adversely aftect the quality of theprepared agent. Hence, Sodium PertechnetateTc 99m containingoxidants,or other additives,shouldnot be employedwithoutfirstdemonstrating that it is without adverse effect on the properties of theresulting agent.

adverse reactionsHypersensitivity reactions are possible whenever protein-containingmaterialssuchasTechnetiumTc99mlabeledhumanserumalbuminareused in man. Epinephrine,antihistaminesand corticosteroid agentsshouldbeavailableforuse.

how suppliedunIt dose kitThekitconsistsof10unitdosereactionvialseachcontainingalyophilizedmixture of 7 mg humanserumalbuminand 0.08mg stannoustartrate.Hydrochloric acid was added prior to lyophilization for pH adjustment.

multidose kitThekitconsistsof5multidosereactionvialseachcontainingalyophilizedmixtureof 21 mghumanserumalbuminand0.23mgstannoustartrate.Hydrochloric acid was added prior to lyophilization for pH adjustment.

FOR FULL PREPARATION AND PRESCRIBING INFORMATION,SEE PACKAGE INSERTS.

Notes: ‘Referto package insert for full preparation and prescribinginformation.‘Dataon file at UnioncarbideCorporation.Tuxedo,NewYork

@ FROM ATOM TO IMAGE

UnionCarbideCorporation•MedicalProductsDivision.NuclearProducts•P.O.Box324•Tuxedo,NewYork10987CintiChem is a registered trademark of Union Carbide Corporation.

56A THE JOURNAL OF NUCLEAR MEDICINE

THE EASY WAYTO YOURPATIENT'SHEART

r HSA,@,— ., @:..@@ Dos•@ UMIc9@uHUMANSERUMAt.BUMINUNITDOSEREAGENTKIT

CintiChem®TECHNETIUM99m

Technetium Tc 99m Normal Serum Albumin (Human) Reagent Kft HSADIAGNOSTiC-FOR INTRAVENOUS USE

BRIEFSUMMARYOF PRESCRIBINGINFORMATION

r,.@ @!

r@

r :‘@V@:

A good reputation is built overa long period oftime. ..and It stands the test of time. Since ourinception, our foremost goals have been toprovide innovative products and to establish astatureof stability and dependability.KITSThat'sonereasonwerecentlydecidedto focusall@urexpertiseandresourceson producingkits.

We'll settle for no less than excellence. And that@oesfar beyond product integrity. It also means

streamlined order processing, and dedicatedresponsivenessto customers and requirements in@hemarket place.

LAA, DTPA, Sulfur Collold ...Three of our many@@citsthat stand readyto illustrate our claims.lace an order by phone (will ship within 24 hours

f required), or send for our technical data. You@ancount on a prompt response.@@Omp@PQf@enslveRIA Kits for reproduction andregnancy,hypertension, cardlovascular,thyrold,

@idrenalfunction and metabolism testing.

1@pi..@.sendmorsIntormMionon II@ ViseDiagnosticKits: II 0 MM 0 DTPA D TechnetiumSulfurColloidI InvitroDiagnosticKits: Rpmductlon &PrsgnsncyI@ FSH 0TestosteroneDEstriolI@ LH D Progesterone U EstradlolI 0 HPL(HCS) 0 Prolactin3 Hypertension f@ardlovascular

LI Anglotensin 1 (Renln) 0 Digoxlnn Aldosterone E Myoglobin I

Adrenal Thyroid MetabolIsm IFunctIon fl TSH@ InsulinEACTH DTBG DHGH ILI Cortisol DAntrrhyroglobulin D Gastrin

LI l7OHProgesterone I

f@_w@ CIS Radiopharmaceuticals, Inc.@ IS DeAngelo Drive I Bedford, MA 01730 I Tel:(617) 275-7120 Organization IOutside Massachusetts (800) 225-1145 I Telex 94-9465 Address I

L@@ @__ ——————@@

RADIOCHEMICALPURITYAKALYSISAND QC CHROMATOGRAPHIC RECORD

RADIOPHARMACEUTICAL@4@@k@

NUCLIDE: TECHNETILRI99M

LOT NO.@LS@3fO IcIT NO.JILkK ici

ABSORBENT:2@@2@aa2}@‘

SOLVENT: @@‘ma@(@

DATE: 30 JAIl78

SAMPLE RATIO'NUMBER

19 0.900

18 0.014

17 0.018

16 0.019

15 0.049

MULTIPLY RATIO BY 100TO GET PERCENTAGE

I

136 SUMMITAVENUEâ€M̃ONTVALE,NJ 07645U.S.A. ‘(201)391-3930TELEX 138630(CAPINTECMTLE)4151MIDDLEFIELDROADâ€P̃ALOALTO,CALIFORNIA94306. (415)493-5011

NOW PROGRAMMED@ RADIOCHEMICAL

PURITYANALYSIS.

Q.C.DATA

YOUMAYALREADYHAVE1/2 OF THE MOST ADVANCED

CALIBRATOR/COMPUTER,'PRINTERINNUCLEARMEDICINE.

HISTOGRAMOF ACTIVITY

DISTRIBUTION

The new Capintec CRC4J®computer/printerprovides a quick and easy method of computing and recording the target to non-target ratioof imaging compounds as demonstrated byradiochromotographic separation of the imaging compound.

The CRC-U®works with your present CapinteCcalibrator to provide the most advanced callbrator/computer/printer system in nuclearmedicine.Write or call for prices and orderinginformation.

Anticipating the purchase of a new calibrator?The Capintec Model 30 incorporates all of thefeatures available with the CRC-U®.

CAHNlEGINC

—@————--————@ tiest:@“@‘‘@ @.Ioite'itboqt'ns

11cc/tie r@@i,'ktiiiinze'i'

zI/b4V'R'@ZZ4Ot€ZStf/eI@EWZ5e1UZPte7'I@

ffèJ'Z51t/âJ@t'

N

Reeltie lieIzkzJ7zJneI

M@obki'@I IUA kkbyNMS

. Simple 15 minute RIA STAT lest

. M@gkbth peaks earlier than CPK fdBo@Mngacute M.I.

. H@h c1h@ cct@e@on @thM.I.

. 0.1% aoss re@fivity with other potentiallyh@terfth-lgprote@is

57AVolume 20, Number 4

For Sensitive & Specific DetectionofMyoglobinemiaAn Early & Quantitative Index of Acute M .1.

Xethfr.s' IJe'i'zo/ir

For technical help or forsupportive literature, call toll free

800-854.3002

[01iIIIiIi@@@NUCLEAR MEDICAL SYS1@S, INC.

1533MonrovIaAvenueNewport Beach, CA 92663

(714)645-2111

Complete,Self-Contained

QualityControlSystem

Tc-99m Labelling Efticiencyfor only...

$135000AUTOMATICRADIOCHROMATOGRAMSCANNER (Cat. No. 149-100)

Quickly and accurately analyzesradiochromatography strips.

TECTROLTMQuality Control Test Kitdetermines Tc-99m labelling efficiencyin 30 SECONDS.

. Rapid, Reproducible, Precise.

. Economical . . . individual tests at

half the price of other kits.

. Simple to use. . .color-coded.

. Precision-engineered instrumen

tation for easily discernable anddependable results.

FOR COMPLETE INFORMATIONWRITE ORCALL

AtomicProductsCorporationP.O. BOX 657 CENTER MORICHES, NEW YORK 11934 USA

Tel. (516) 878-1074

CONTENTSOFTHE“TECTROL―TESTKITOnly $3750complete (Cat. No. 151-110)

58A THE JOURNAL OF NUCLEAR MEDICINE

Health Physics Associates, Ltd.,also offers these services:. Leak/wipe tests (mail or personal)

. NRC and State License preparation

. Radiation safety services to meet NRCand State regulations (e.g. Surveys,calibrations, standards)

. Quality Assurance Programs for Nu

clear Medicine Departments. Continuing education programs for

staff and laboratory personnel. Decontamination services

. Emergency room radioactivity services

Formore information,write or callus.HEALThPHYSICSASSOCIATES,LTD.

&e 3304 dommercial Avenue@ Northbrook,IL60062

312/564-3330

@@ S@yS@esSk,c1961Please send more Information on:

TITLE

DEPARTMENT

.-@ - .@@

Heafth PhysIcs Associates, Ltd., servicing the radiation safety field since1961, specializes in survey meter repairand calibration . . .with guaranteed resuIts. All work is performed Accurately,Promptly and Thoroughly by electronicspecialists and supervised by qualifiedphysicists certified by the AmericanBoard of Health Physics. Instrumentcalibration is normally completed In24-48 hours. Health PhysicsAssociates,Ltd., services most radiation safety instruments including Geiger Counters,Ionization Chambers, Portable Scintillation Counters, and Direct and IndirectReading Dosimeters. These services indude:

. full preventive maintenance check

. repair and replace all defective components

. all services fully insured

. zero drift and radiationfield drift checks

. calibration accuracy of ±10%

. meets or exceeds all Federal, State,

Local and JCAH requirements. shipping cases and loaner instruments

available

NAME

I HOSPITAL

I ADDRESS

STATE ZIP CODECr1-v

ORSEND YOUR SURVEY METERS

TO THE EXPERIENCED

@I II$TRUMBfl SER@EfREEOROModet# 5en.@l#____________

Cakbta@on0s@e___________________Caib,attan Sowce____________________

a.@ M@n@@ce0*o Du.@.,Recahbtabon______________________________

Th*;@@ NRC10CFR3424 Wv@iwd.@ .ItO* b,..*.d@ eca*W* .. d@. @h*@k@t*pI@'c, @h

@ ‘-@

HEALTHPHYSICSASSOCIATES,LTD.

, n k@@@ J Li@ !

asitssourceOursourceshaveanexcellentreputationfor safetyand

convenience; they offer you references you can trust.

I@Te!@

SealedfloodsourcesSu@@pliedas57Co(2and3mCi)and

133@ (0.5 and 1.OmCi) in two sizes, to checkthe uniformity and resolution of conventionaland widefield-of-view gammacameras,and for

‘transmissionimaging.The maximum acceptablevariation in activity over the entire active area,

is ±1% of the mean value. Each uniformly activeplas@iccomponentissurroundedbyinactiveplastic

and enclosed in an anodized aluminium casing. A shieldedstorage case is supplied with each source.

ç;@@c@@

Spotsourcesareavailableasa 1mmbeadof57Coor133@ (10 and lOOjiCi). Features include a welded plastic capsule,point source geometry with a visible active bead, and colour codingfor quick ident@ficatianof nuclide and activity.They are packed insets of three in shielded boxes; replacements are available separately.

Pen point tracers have a 1mm diameter bead of57Co(100@Ci)sealedin the ______________tipofaball-pointpenshaped@holderwith a brassshiekifor@ @‘@‘@“the active end.

Flexible sourcesare 50cmx 4mmdiameter;57Co(100i.@Ci)isdispersedinan innercoreofactive plastic, sealed in an inactive PVC tube,and closed by aluminium caps.

The Radiochemical CentreAmersham

1291@(0. 1pCi) gamma/X-ray spectrum is virtually identical@ 251,and hasa hoff-lifeof 1.57x i07 years.Calibrationin terms of1251isavailable.Thelength is @00mm,maximumdiameter 15mmsu@tableformostmanualand automaticcounters.Activematerial

issealedina plasticcapsuleattachedto a handlingrod.Other nuclides Am1 33Ba,57Co,60Co137Cs,@ 22@Ir@,755@,123mTe,88Yand rroc1 311.

For further @mformatK@nplease write or phoneTheRodkchemcalCentreLimited,Arnershom, Englond.Telephone:024-04-4444

Inthe Americos:Amershom Corporation, Illinois60005.Telephone: 312-593-6300InWGermonyAmershom BuchierGmbH &Co KG,Braunschweig.Telephone:05307-4693.97@

1@I@@ is

as

Anatomicalmarkersources

1291rod sources fory counters

LOEWY & PUISEUX: THE MOON, 1894Courtesy of Simone Gossner.

In many instances, our demand to seethings more clearly could only be satis

fied with technology that finally@A@'hena camera can be enabledcamerastogowheretot@enwhereoneonehasneverbeenbefore.Indiagnosticimaging, Searle Radiographics'has never been belore. Pho/GammaL.E.M.(lowenergy

mobile) Scintillationmari@sperceptionol realltqCamerasatisfiesaISexpanded.similardemandinthatitcanbetakenwherever the patient's environment maybe, and incorporates state-of-the-art electronics that result in excellent inherentresolution and uniformity, as well as overall system reliability, accuracy, and imagestability.

The Scintistore@ Time-compressionStorage/Retrieval System docks compactly with the L.E.M. camera for transport and makes ventricular wall motionstudies possible, as well as allowing playback of all studies in a fraction of realrecording time.

For detailed information on Searle'sPho/Gamma L.E.M./Scintistore combination, contact Searle Radiographics.

=Searle RadlographicsDivision of Searle Diagnostics Inc.2000 Nuclear DriveDes Plaines, Illinois 60018

51-8-8442 1007CM01988

Se@Fho/@3@ommO@L(fst/

nudeormedidneto the potleits

envfrbnment to mol@eGREATIMAG(&

!@@

, ;@

@ :@

@I_.@i @-

..A‘-

@ @,

,.4 Y@―:@

With the introduction of lighter photographiccameras that enabled man to seek new perspectives from which to take pictures, new horizons

. ‘ in realism were made possible. Searle Radio

@A,hen the subject graphicssimilarlyinfluences

technology in thecantbemoved.fieldofnuclearmedicinewithits extensive line ofIt helps to have systemsthatextend

the clinical utility ofacamerathatcan nuclearcardiology. throughout the hospital.

The Pho/Gamma®L.E.M. Low-energy Mo bileScintillation Camera. With the ability to be easilymaneuvered anywhere in the hospital for a widerange of cardiac studies without compromisingpatient comfort and safety.

The Scintistore@ Time-compression DataStorage/Retrieval Systems. A portable, cornputer-compatible disc-based system thatenhances the capabilities of the Pho/GammaL.E.M. with time-compressed replay and cardiacgating functions.

The Gamma/Cor@ RCG Cardiac Probe. ASearlenuclearuniquedirectmethodfor rapid,cardloloc;isqstemsmoverepeatable

assessment of leftwheretheqreventricularperformanceneeded inanoninvasive,safet0 maI@emannerrightatthepatient'sbedside.The Scintiview@GR(ATIMAG(S. ImageControl

Station. An easily operated and economicalsystem, complementing the L.E.M., other SearlePho/Gamma cameras, and Scintistore by recording, storing, and manipulating nuclear imageswithout additional computers, codes, and programming.

Versatility and great images. They're thereasons why this is the most efficient nuclearcardiology line available. Find out how our product technology can serve your needs in nuclearcardiology by contacting Searle Radiographics.

ISearle R&ographlcsDivisionof SearleDiagnosticsInc.2000 Nuclear DriveDesPlaines,Illinois60018

-J

NUCLEAR MEDICINE TECHNOLOGIST.StaffTechnologist for a 363 bed hospital locatedin a community of 35,000, unlimited recreation,educational and cultural opportunities, inSoutheastern Ohio. Excellent fringe benefits.Salary open, call collect William B. Montgomcry, Vice President for Personnel (614) 454-4601,Bethesda Hospital, 2951 N. Maple Ave., Zanesville, Ohio 43701.

NUCLEAR PHYSICIAN. THE UNIVERsity of Missouri-Columbia is seeking a boardcertified or board eligible nuclear physician forJuly 1, 1979.The successfulcandidatewill fillstaff position with imaging and in vitro responsibilities. Background in internal medicine, radiology or pathology is acceptable. Candidatesmust be prepared to accept full clinical dutiesand teaching responsibilities.There is ampleopportunity for research. Contact H. Haibach,M.D., Chief of Nuclear Medicine, Departmentof Radiology, University Medical Center, 807Stadium Road, Columbia, Mo. 65212, Tel(314) 882-2541. An Equal Opportunity Employer.

CERTIFIED NUCLEAR MEDICINETechnician needed for busy Cardiology Department to work with Multi-Crystal Gamma Camera, to help in the development and organizationof a Department ofNuclear Cardiology. Possibleopportunities in ClinicalResearchand Teaching.Addressall inquiriesto E. EnriqueLeguizamon,M.D., 1717ShafferStreet,Suite 106,Kalamazoo, Michigan, 49001.

NUCLEAR MEDICINE TECHNICIAN,Registeredor RegistryEligible.Progressive401-bed teaching hospital is seeking qualified applicants for immediate openings in its NuclearMedicine Laboratory. Imaging and radioimmunoassay. Competitive salary and excellentfringe benefits. Please direct reply to: PersonnelDepartment, Flint Osteopathic Hospital, 3921BeecherRoad, Flint, Mich. 48502.Telephone(313) 762-4740.

NUCLEAR MEDICINE PHYSICIAN:Board eligible/certified, with cardiovascularnuclear medicine experience preferred; to jointwo full-time nuclear medicine staff physiciansat 650 bed teaching hospital in Pittsburgh, Pennsylvania. Reply: Box 400, Society of NuclearMedicine,475 Park AvenueSouth, NewYork,N.Y. 10016,

FACTORY REPRESENTATIVES ANDdealers wanted manufacturer of large line ofnuclear, ultrasound and X-ray equipment. CallBill Cashman at 800-645-91 10 for details.

HADASSAH MEDICAL ORGANIZAtion, Department of Medical BiophysicsandNuclear Medicine. There are vacancies for physiclans in Nuclear Medicine in senior (Board certifled or Board eligible)and junior (residency)positions. The department has the latest equipment for all in vivo procedures including advanced computerized cardiac studies. Inquiriesand applications accompanied by curriculumvitae and list of publications may be addressedto Prof. H. Atlan, M.D., Ph.D., Director, Dcpartment of Medical Biophysics and NuclearMedicine, Hadassah University Hospital, KiryatHadassah, Jerusalem, IsraeL

NUCLEARMEDICINETECHNOLOGIST.Full timepositionat progressive200bedfriezendesign hospital in western New ‘YorkState suburb. Must be Registered or Registry eligible withBS and experience. Competitive salary andexcellent benefits. Send resume to: PersonnelDepartment, Park Ridge Hospital, 1555 LongPond Road, Rochester,NewYork 14626.AreaCode716-225-1949.

POSITION AVAILABLEFOR INDIVIDual with background in physics and nuclearmedicine.Preferencegivento thosewithMastersDegreeor moreandtwoyearsexperience.Dutiesinclude laboratory administration, coordinationof technological staff, computer operations, andinstrument quality controL Contact: Stanley M.Levenson, M.D., Assistant Director, Divisionof Nuclear Medicine, Georgetown UniversityHospital, 3800 Reservoir Rd. NW, Washington,D.C.20007.Phone:(201)625-2056.

NUCLEARMEDICINETECHNOLOGIST:Immediate opening for two staff technologistsin the Nuclear Medicine Department of a 650bed teachin@ hospital in Pittsburgh, Pennsylvania. Only imaging I I computer. Cardiovascular Nuclear Medicine experience is preferred.Reply: Box 401, Society of Nuclear Medicine,475 Park Avenue South, New York, N.Y. 10016.

A TWO YEARTRAININGPROGRAMINnuclear medicine leading to certification by theAmerican Board of Nuclear Medicine or oneyear training program leading to certificationin nuclear radiologyby the AmericanBoardofRadiology is offered in an AMA approved integrated program offered by Vanderbilt University Hospital and the Veterans' AdministrationHospital in Nashville, Tennessee. Five full-timeboard certified nuclear medicine physicians andeight full-time nuclear medicine Ph.D's participate in the didactic as well as clinical experience in the program. Equipment includes threelarge field scintillation cameras, three smallfield scintillation cameras, the PhoCon tomographic scanner, a solid state scanning tomographic camera, a proportional wire chamber, afluorescent scanner, a portable camera and fivecomputer systems. The clinical experience ineludes a complete spectrum of all imaging procedures for adults as well as the pediatric population. Particular emphasis is placed on nuclearcardiology, renal evaluation,pulmonary function studies and tumor evaluation. The programincludes rotations through CT and ultrasoundand has heavy emphasis on correlation betweenthese two modalities and nuclear medicine procedures. A complete experience in a large radioimmunoassay laboratory and radiopharmacyis included. Requests for further informationshould be directed to F. David Rollo, M.D.,Ph.D., Director,Divisionof NuclearMedicine,Department of Radiology and RadiologicalSciences, Vanderbilt University Hospital,Nashville, Tennessee 37232.

NUCLEAR PHARMACIST: APPLIcants should have some radiopharmaceuticaleducation and pharmacy degree. We will provideclinical training if necessary. Salary commensurate with experience. Submit resume to:Pharmatopes, Inc., 25721 Coolidge Hwy., OakPark, Mich. 48237, Attention: Personnel.

REGISTERED NUCLEAR MEDICINETechnologist/Registered X-Ray Technician.Private Office in NW WashI D.C. BeginningJuly 1, 1979. Salary Negotiable. Send resumeto: Dr. V. Mascatello, Georgetown UniversityHospital, Dept. of Radiology, 3800 ReservoirRd. NW, Washington, D.C. 20007Ph: (202)625-2141.

CONFIDENTIAL SERVICE NATIONwide.Wearea searchfirmdealingnationwideinthe Health Care Industry. All fees paid by employer. Forward resume with salary requirements and location preferences to BMI, HealthCare Division, P.O. Box 6457, Columbia, S.C.29260, (803) 787-8710.

NUCLEAR MEDICINE PHYSICIAN. Anuclear medicine physician is being sought tojoin two full time physicians in this active department in a 540bed communityhospitaLExperience in nuclear cardiology is desired. Inquiriesand curriculum vitaes should be addressed to:John B.Richards,M.D.,DepartmentofNuclearMedicine,Saint John's Hospital and HealthCenter, 132822nd 5treet, Santa Monica,CA90404.

ASSISTANTCHIEF,NUCLEARMEDICINEService. ABNM certified or eligible physicianJuly 1, 1979or sooner.Expertisein radioassayand all ima@ingprocedures,especiallycardiacnuclearmedicinedesirable.Earlyadvancementto Chief of Serciceis a definitepossibilityforBoard certified candidate. Affiliation withWrightState UniversitySchoolofMedicinewillafford teaching responsibilityand academicappointment.Excellentsalary and fringebanefits. Equal Opportunity Employer. Send. inquiries includingCurriculumVitaeto: Jane B.Schieve, M.D., Chief, Nuclear Medicine Service(115),VeteransAdministrationMedicalCenter,4100 West Third Street, Dayton Ohio 45428.

MA THE JOURNAL OF NUCLEAR MEDICINE

PLACEMENT

POSITIONS OPENCHIEF NUCLEAR MEDICINE TECH

nologist:Divisionof NuclearMedicine,Georgetown Univ.Hospital.Washington,D.C. 20007.Contact: John C. Harbert, M.D. (202) 625-7492.Positionopen immediately.

NUCLEAR MEDICINE RESIDENCY:Two yearprogramin NuclearMedicinewith twopositionsavailable.Requirementfor admissionIs completion of prep post-doctoral training asoutlined by the American Board of NuclearMedicine.Positions offered are in a 600 bedgeneral hospital, with over 7,000 scans andI1,000in-vitrostudies yearly.This program isdedicated to the clinical aspect of Nuclear Medicine, with research projects of a clinical nature.Two full-time Nuclear Medicine physiciansdirect the training, with the assistance of associated physicians, a radiation physicist and aradiopharmacist. Equipment includes six modem gamma cameras and large modern computing facility. Contact: D. R. Spiegeihoff.M.D., Director of Nuclear Medicine, St. Luke'sHospital, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215.

ASSISTANTCHIEF, NUCLEAR MEDIcine Service. The Minneapolis Veterans Administration Medical Center seeks candidate forthe position of AssistantChief, NuclearMcdicine Service effective July 1. 1979. Requirementsinclude certification by the ABNM, a strongpatient orientation and expertise in all phases ofclinical medicine, including imaging, radioassayand internal radionuclide therapy. In addition,the Assistant Chief, Nuclear Medicine Servicewill have specific responsibilities in research andeducation. Applications from all qualified candidates are welcome. Inquiries, including a curriculum vitae and an autobiographical letter,should be sent to: Rex B. Shafer, M.D., Chief,Nuclear Medicine Service (1 15), Veterans Administraion Medical Center, 54th Street and48th AvenueSouth, Minneapolis,MN 55417.An Equal Opportunity Employer.

NUCLEAR MEDICINE RESIDENCYExtensive clinical base of imaging, in-vitro testing, in-vivo testing, and therapy in combinedUniversity Hospital! VA Hospital program.Opportunities for clinical and laboratory research. Write: W. N. Tauxe, M.D., Professor ofRadiology and Pathology (Nuclear Medicine),University of Alabama Hospitals, Birmingham,AL 35233.An Equal Opportunity/AffirmativeAction Employer.

CHIEF, NUCLEAR MEDICINE SERVICE.Modern 550 bed Veterans Administration teaching hospital closely affiliated with Emory University School of Medicine. Academic interestimportant with appropriate faculty appointmentto be made. Well-equipped and staffed department, excellent suburban location. Opportunityto expand and develop new programs. Positionavailable immediately; Reply with CV. andthree references to: Chairman, Search Committee do Radiology Service, V.A. Medical Center(Atlanta), 1670 Clairmont Road, Decatur,Georgia 30033.

POSTDOCTORAL FELLOW TO WORKin area of 3-dimensionalnuclearmedicineimaging and instrumentation with special emphasison cardiac applications. Must be citizen, noncitizen national, or admitted for permanent U.S.residency. Position open immediately. Sendresume and phone numbers of 3 referencestoDr. W. L. Rogers, Division ofNuclear Medicine,University of Michigan Medical Center, AnnArbor, Michigan 48109. A nondiscriminatory!Affirmative action employer.

RADIOLOGISTS — 400 BED MAJORmedical center in South Florida seeking Boardcertified Diagnostic Radiologist with a subspecialty. Also, seeking a second Radiologistwith specialization in ultrasound. Must haveflorida license. Position opening September,1979. Send CV., photograph, current salaryand minimum starting salary desired. WriteChairman,Boardof Directors,FloridaMedicalCenter, 5000 West Oakland Park Boulevard,Ft. Lauderdale,Florida 33313.

NUCLEAR PHARMACIST—DYNAMICyoung corporation has immediate positionavailable for qualified registered pharmacistwith training in nuclear pharmacy. Excellentlocation in San Diego, California offers roomfor personal and professional growth. The individual must be licensed in California or mustbe able to take next available board examination. Salary commensurate with experience.Submit resume to: Nuclear Pharmacy of California, Inc., P.O. Box 25141, Albuquerque, NewMexico, 87125.

NUCLEAR MEDICINE PHYSICIANNorth Shore University Hospital, a teachinghospital of Cornell University Medical College,is looking for a nuclearmedicine physician,whois board-certified or eligible, and has severalyears ofexperience. The individual willfilla staffposition in the Nuclear Medicine Division of thehospital,and receivean academicappointmentat Cornell University Medical College. Priortraining in Radiology or Internal Medicine isacceptable. Appointees are required to assumeclinical teaching and research responsibilities.Position is available July.l, 1979 or sooner. Address inquiries to Donald Margouleff, M.D.,Chief, Nuclear Medicine Division, Departmentof Medicine, North Shore University Hospital,300 Community Drive, Manhasset, N.Y. 11030.(516)562-4400.Anequalopportunityemployer.

NUCLEAR MEDICINE TECHNOLOGIST.Position open in progressive 350 bed MedicalCenter. Must be registered or certified withtraining in all phases of imaging. This is a fullyequipped department including five cameras anda DEC Gamma Eleven Computer. Excellentfringe benefits. Contact: Mr. Charles E. Duxbury, Upstate MedicalCenter,Divisionof Nuclear Medicine, 750 East Adams Street, Syracuse, New York 13210. An Equal Opportunity/Affirmative Action Employer.

POSITIONS WANTED

NUCLEAR MEDICINE TECHNOLOGIST.CNMT, RT(ARRT),5 years experiencein allphases seeking position in southeastern states.Reply Box 407. Society of Nuclear Medicine.475 Park Avenue South. New York. N.Y. 10016.

PATHOLOGIST - AP/CP - NUCLEARMedicine. California. Details with first reply:Box 406, Society of Nuclear Medicine, 475 ParkAvenue South, New York, N.Y. 10016.

ABNM, ABR CERTIFIED. COMPLETEDtwo year nuclear medicine fellowship. Presentlystaff, university hospital for three years. Hasexpertise in all aspects of nuclear cardiology,computers, and also abdominal ultrasound.Wishes to relocate. Date available - negotiable.keply to: Box404,SocietyofNuclearMedicine,475 Park Ave. S., New York, New York, 10016.

NUCLEAR MEDICINE PHYSICIAN,ABNM certified,Ph.D., M.D., internalmedicinebackground.Adacemic,clinicalandadministrative experience. Will consider university orcommunity hospitaL Reply Box 405, Society ofNuclear Medicine,475 Park Ave. So., NewYork,N.Y. 10016.

TECHNOLOGISTS AVAILABLE. GRADuatesofthe SUNY/BuffaloB.S.inN.M.T.Program will be available for placement in June1979. The program prepares generalists throughcomprehensive basic science and clinical trainingin both imagingand RIA. ContactAnn Steves,N.M.T. ProgramCoordinator, 3495 BaileyAve.,Buffalo, NY 14215(716-838-5889)or JehudaSteinbach, M.D., Chief, Nuclear MedicineService, Veterans Administration Medical Center, 3495 Bailey Ave., Buffalo, NY 14215 (716-834-9200 EXT. 380).

ABNMCERTIFIEDSEEKSPARTTIMEor full time position in New York City or surrounding areas. Reply: Box 402, Society of Nuclear Medicine, 475 Park Avenue South, NewYork,N.Y. 10016.

CERTIFIED ABNM WISHES TO JOIN ORbuy private practice any location. Reply: Box403, Society of Nuclear Medicine, 475 ParkAvenue South, New York, N.Y. 10016.

Volume 20, Number 4 65A

CHIEF TECHNOLOGISTC.S.R.T. (N.M.) required for a modern newly expandedNuclear Medicine Department. Full time Director anda staffofnine.

Engaged in both in-vitro and in-vivo procedures.Latest imaging equipment and computer facilities.

Please apply in writing, stating past experience andsalary expected to:

DIrector of PersonnelBellevllle General HospItalP.O. Box 428,Bellevllle, Ontario K8N 5A9

RESIDENCY

Two-yearapprovedprogram offering broad clinicalexperience including tertiary care and communityhospitals, oncology and pediatrics. Ultrasound andCT. Strong basic science teaching, radiation safety,central radiopharmacyand AlA. Opportunity for research.

An intergrated program at State University of NewYork at Buffalo School of Medicine. Available July 1,1979. Contact: MA. Bender, M.D., Program Director,Dept.of NuclearMedicine,666ElmStreet,Buffalo,NY14263 or M. BIau, Ph.D., Chairman, Dept. of Nuclear,3495 Bailey Avenue, Buffalo, NY 14215.

JNM CLASSIFIED PLACEMENTSERVICE SECTION

This section in the Journal of Nuclear Medicinecontains “PositionsOpen―,“PositionsWanted―,and“ForSale―listings. Nondisplay“PositionsWanted―adsby members of the Society are billed at 50@perword foreach insertion with no minimum rate. Nondisplay “Positions Wanted―ads by nonmembers and all nondisplay “PositionsOpen―and “ForSale―ads by members and nonmembersare charged at 75@per word.Display advertisements are accepted at $110 for@page,$155for‘/@page,$260for½page,and $450fora full page. Closing date for each issue is the 1st of themonth preceding publication. Agency commissionsand cash discounts are allowed on display ads only.Box numbers are available for those who wish them.

All classified ads must be prepaid or accompaniedby a purchase order. Send orders to:

Journal of Nuclear Medicine475 Park Ave. SouthNew York, NY 10016

r New, from Nuclear Instrument Service

& Engineering,comes...

NISE,NISER,NISEST

@3NISEWAYSTOGO!

The mostpractical,economicalandreliableway tomake consistent high quality hard copies on X-Ray film.

< StandardDeLuxe >

DeluxeAutomatic

NISE,Inc. ‘.NUCLEAR INSTRUMENT SERVICt 6 INGINEERING

@ Swsdsn.@ F.,I...d KYORITSU MEDICAL ELECTRIC CO. LTD.SCANFLEX 31-ISMOTOYOYOGIMACHIBOX 262. 183 23 TABY SHIBUVA-KU. TOKYO 151SWEDEN (TEL. @/758-@@@) JAPAN (TEL. 1031 4S@2251)

B__I., @.d@ G.mi..,yVEENSTRA NETS. E.V.SCHAAPSSTREEK 5 EEXT. DR.)@P4@THERLANDE(TEL. €@@-12O3)

U.S.A.. @Iod'.' c.....kis...d O.EM.RISE. INC.200IESTATE ROADCERRITOS. CALIFORNIA E0701U.S.A. (TEL. 1213i 8SO47@)

66A THE JOURNAL OF NUCLEAR MEDICINE

cARDLi@cs@iiELD$95SMALL,$125LARGE7-dayFREEtrial!Phone or write on yourprofessional letterhead:O'NEILLINC. SUITE400202 EASTWASHINGTONANNARBOR,Ml, 48104AREA313/973-2335

ONEILLSPEOLAIJSTSIN

NUOLEARMED@NE

LOYOLAUNIVERSITYMEDICALCENTERMAYWOOD,ILLINOIS

POSITION AVAILABLE IMMEDIATELY

- RegIstered Nuclear Medical TechnicIan

- Preferably with computer experlencf

- Interested In research

- To operate new clinical laboratory for measur

Ing regional cerebral blood flow, using the iasXenon methodWest Suburban Chicago locationPleasant working conditions, newly equippedfacilities

- Most current data processing system available,

including: Meditronic inhalation Cerebrograph,and Hewlett Packard 9845 Data Processing Sys.

- Competitive salary and benefits

- Rapidly growing University Medical Center

Pleasecontact Dr. 0. Howard Reichman,Professorand Chief, Division of Neurological Surgery, Loyola University MedIcal Center, 2160 S. First Avenue, Maywood, Illinois 60153.Tointerview, please phone: (312) 531-3207.

ATLAS OF CARDIOVASCULARNUCLEAR MEDICINE: Selected CaseStudfes.EditedbyH. William Strauss, M.D.,et al. Using selected case studies, thissuperbly illustrated atlas describes —anddepicts — normal and abnormal images

commonly seen in caithovascular diseases.The authors suggest “checklists―to assurecorrect interpretations of gated blood poolscans, and myocardial perfusion images —and include follow-up studies. 1977. 208pp., 665 illus. Price, $44.50.

COMPUTER METHODS: The FundamentalsofDigltalNuclearMedlcine.ByDavid E. Liebermann, B.S.E.E., M.S.E.E.;with 19 contributors. Rely on thisauthoritative book foracomprehensive lookat the principles of computerized analysis.You'llparticularlyappreciate an interestingchapter discussing the operation of colorvideo display systems to represent nuclearmedicine images. 1977. 244 pp., 215 illus.Price, $16.50.

RADIOIMMUNOASSAY AND RELATEDTECHNIQUES:MethodologyandCliniCal ApplicatIons. By Jan I. Thorell,M.D. and Steven M. Larson, M.D. Review theessential principles and methods ofradioassay techniques with this practicalguide. It provides definitive information onreceptors, assay performance, pharmacology, quality control and other majortopics. A helpful appendix details fortyspecific procedures. 1978.3O8pp., 132 illus.Price, $23.50.

A New Book. ATLAS OF PEDIATRIC NUCLEAR MEDICINE By Philip 0.Alderson, M.D.; David L. Gilday, M.D.,B.Eng., F.R.C.P.;and Henry N. Wagner, M.D.;with 2 assistants. This graphic atlasprovides a broad overview of tracer

procedures you can use to evaluate yourpediatric clients. Organized according tosystems, It uses case studies to examinecongenital diseases, oncologic diagnosis,trauma, metabolic disorders and otheracquired conditions. December, 1978. 310pp., 788 illus. Price, $4430.

New 3rd Edition. TEXTBOOK OFNUCLEAR MEDICINE TECHNOLOGY.By Paul J. Early, B.S.; Muhammad AbdelRazzak, M.B.B.C1L, D.M.M.D. (Cairo),FAC.P. (U.S.A.); and D. Bruce Sodee, M.D.,F.A.C.P. Keep pace with exciting newadvances in nuclear medicine with thisoutstandlngbook!Thisedition incorporatestimelynewchaptersonradiopharmaceuticaltumor location, computed tomography andultrasound imaging. A new appendix detailsconversion factors for units ofactivity (A)and absotbed dose (D). May, 1979. Approx.640 pp., 590 illus. About $21.95.

A New Book. RADIOGRAPHICFUNDAMENTALS AND TECHNIQUEGUIDE. By Terry R. Eastman, R.T.Questions on x-ray production? Thisconcise guide offers definitive informationon minimal exposure techniques, radiographic quality, grids, intensifying screens,calibration and other pertinent topics. Stepby-step explanations aid in developingrequired technique charts. May, 1979.Approx. 208 pp., 185 Illus. About $12.00.

67AVolume 20, Number 4

The latest advancesIn nuclear niediciiietechnology are asclose as your phone.Here's proof ...A New Book

@OLORAUAS OF SEC ONAL ANAU)MY:Chest, Abdonien aiid Pelvis

This impressive atlas promises to become one ofthe most valuable clinical tools in yourfield. Designed as a reference for normals, it features a complete set of sections (sagittal,tzansverse, and coronal) 1 cm. thick —all in full colorplates —ofthe neck, chest, abdomen andpelvis. It also offers oblique views of the heart. To aid you In interpretation, each plate isaccompanied by a labelled line diagram. Throughout, thephotogzaphyisfärsuperiorto that inany other atlas currently available on this subject . . . and further, everyorgan is shown in itsnatural color since the body was fmzen withoutembalming! In addition, 60 unmounted slides(ten 35 mm strips, each with six plates) are included at the back ofthe book Orderyourcopytodayt

By E. A. Lyons, M.D., F.RC.P. (C). November, 1978. 328 pages, 283 illustrations,including 138 in full color, plus 60 unmounted 35 mm transparencies. Price, $13750.

Also ofinterest ...

To order, Cliii US tOll free: @oo@325-4177 ext 10;In Missouri, call collect (314) 872-8370 ext. 10 durIng regularbusiness hours.

A90360 MOSBYTIMES MIRRORTHE C. V. MOSSY COMPANY

11830 WESTLINE INDUSTRIAL DRIVEST. LOUIS.MISSOURI63141

@.

ChiefNuclearMedicalTechnologistLarge teaching medical facility needs experienced person to assume leadershiprole in active nuclear medicine laboratory.Clinical expertise in all aspects of nuclearmedicine required.Abilityto effectivelyinteract with other departments. REQUIREMENTS: B.S. plus ASCP or eligibleand special training in radioisotopes. Weoffer attractive salary and comprehensivebenefits and a convenient Central NewJersey location.

For more info, call Personnel(201) 668-3040

MUHLENBERGHOSPITAL

Plainfield, N.J. 07061

An equal opportunity employer

r

r

@@@@An,qualOpportunity Employer

68A THE JOURNAL OF NUCLEAR MEDICINE

NUCLEARMED. TECH.

You're compassionate and understanding. Youenjoy direct patient contact and the special rewardthat a one-to-one relationship can offer. You'realso well trained and knowledgeable, a graduateof an approved NM (ASCP) or (ARRT) programwith nuclear medicine experience, and able towork independently. St. Joseph, the progressive,modern, on-the-lake hospital, has a full-timeposition that will utilize all your talents. We offera highly competitive salary and liberal fringebenefits. To arrange a confidential interview, call:

975-3010

JANET BURDULIS

SAINT JOSEPHHOSPITAL2900 N. Lake Shore Dr.

Chicago, III. 60657

An Equal Opportunity Employer

NUCLEARMEDICINE MANAGER

Challenging opportunity available for an experienced Nuclear Medicine Technologist toassume management duties in the areas ofnuclear medicine, radioassay and echo cardiography. Individual will be responsible for technical and administrative functions includingdeveloping and monitoring budgets, overallperformance of nuclear medicine and ultrasoundtraining programs,qualityassurance,andsupervision of personnel. Applicant should haveproven technical expertise with at least 2 yearsexperience at a chief technologist level. Mustbe ARRT registered. Salary commensurate withexperience. Please send complete resume inconfidence to Vivian Lopez.

JACKSON MEMORIALHOSPITAL

1611 NW. 12th AvenueMiami, Florida 33136

WE ARE SOUTHEAST FLORIDA'SLARGEST TEACHING MEDICAL CE$

DEPARTMENTOF

NUCLEARMEDICINE

The Universityof MassachusettsMedical Schoolis seeking a faculty membertojoin the Departmentof Nuclear Medicineto begin on July 1, 1979,orsoon thereafter.

It is essential that the candidate have provenexcellence and achievement in research andteaching. Clinical expertise in all aspects ofNuclear Medicine is also required. Rank andsalary depend on experienceand qualifications.

Send curriculum vitae and three letters of reference to: Dr. L.E. Braverman, Department ofNuclear Medicine. 55 Lake Avenue North,Worcester,MA 01605,(617)856-3176.

An Equal OpportunityAffirmative

ActionEmployer

..,

@@ .

@ t.$k@

,-.#@@

r;@

Ifyou'vewaitéduntilnow.@togetstarted

incardiovascularnuclearmedicine@...

A

11201.1@I NewEnglandNuclear

Exercise

Delayedanterior view

Tohelpruleout,confirmorevaluate

Coronaryçtery

diseasePositivestress E@GwithoutanginaHisto,yA.C., 50-year-oldaCcountant, asymptomatic, required toundergo exerciseECG as part of“executivephysical'EGG findingsNormal at rest,2.5-3 mm ST

segment depressionon exercise; deniedaccompanyingangina.Thallium -201imagingLarge apical defecton immediate postexercise anteriorview; defect filledin on delayedimages.Working diagnosisCoronary arterydisease, confirmedon preoperativeangiography.

Acutemyocardialinfarction

EarlydiagnosIsHistoryJ.B.,54-year-oldconstruction worker,admitted to CCUfollowing episode ofsevere chest pain,diaphoresis, dizziness. Patient fell toground upon onsetof symptoms, severely bruising leftthigh, chest wall.No history of anginapectoris or prior MI;ECG documentedleft bundle branchblock.Senm enzymes, EGGElevated shortlyfollowing admission;isoenzyme analysisunavailable to differentiate elevationsecondary to traumafrom possible elevation secondary toacute MI; ECGnondiagnosticbecause of LBBB.Thallium-201imagingImages made uponadmission displayedanterior wall defect(@nteriorview),large septal defect(LAOview).Working diagnosisExtensive anteroseptal MI.

Arecentmodel37photomultipliertubecamerawith all-purpose collimator,capable of resolving 1 cmline separations on an Au 195line phantom

TreadmillorbicydeergometerandECGF—to perform maximal stresstesting in accordance withgood clinical practice

Abilitytobeginimagingpmmptly(within 3—5minutes) following thallous chloride Tl 201injection and terminationof stress

1@;

Tostartusing

thajlium-201inyour

departmentyouIIneed

TogetthemostoutofthaiIium-20fl

totaldiagnosticcapability,youIIwant

‘@ ‘@4 ainicaIfr@ining

dwI.

inscanUIILVIp1via uuuuat an institution experiencedin thallium-201 imaging*

Electronic imageacqUI5ItIOflandpmcessing,to help resolve ambiguousstudies

Mobileimaging/acquisitioninstrumentation,to facilitate acute MI thallium201 studies when patientscannot be transported to thenuclear medicine department

Continuingmedicaleducation

s@On thallium-201,-@; f( )@ your staff and for your

@— 1•tf@riii ig physicians*

*YourNEN representative may help recommend an institution in yourarea. For c()ntinurngmedical education programming, ask your NENrepresentative @rwrite: Teaching Program Administrator, New EnglandNudear, 549 Albany Street, 1@ston,Mass. 02118.

See followingpage forfull prescribinginf )rnlati()n.

120 mm

ThallousChkWIdell201@ NewEnglandNuclear

shown that the myocardial distribution ofThailous Chloride TI @O1correlates well withregional perfusion.In clinical studies, thallium images have beenfound to visualize areas of infarction confirmed by electrocardiographic and enzymechanges. Regions of transient myocardialischemia corresponding to areas perfused bycoronary arteries with partial stenoses havebeen visualized when thallium was administered in conjunction with an exercise stresstest. It is usually not possible to differentiaterecent from old myocardial infarction, and noexact differentiation can be made betweenrecent myocardial infarction and ischemia.After intravenous administration, ThallousChloride TI 201 clears rapidly from the bloodwith maximal concentration by normal myocardium occurring at about ten minutes.

INDICATIONSANDUSAGE:Thallous Chloride Ti 201may be useful in myocardial perfusion imagingfor the diagnosis and localization of myocardial infarction.It may also be useful in conjunction withexercise stress testing as an adjunct in thediagnosis of ischemic heart disease (atherosclerotic coronary artery disease).

CONTRAINDIIATIONS:None known.

WARNINGS:In studying patients in whom myocardial infarction or ischemia is known orsuspected, care should be taken to assure continuous clinical monitoring and treatment inaccordance with safe, accepted procedure.Exercise stress testing should be performedonly under the supervision of a qualified physician and in a laboratory equipped withappropriate resuscitation and supportapparatus.Ideally, examinations using radiopharmaceutical drug products—especially those electivein nature—of women of childbearing capability should be performed during the first tendays following the onset of menses.

PRECAUTiONS:Data are not available concerningthe effect of marked alterations in blood glucose, insulin, or pH (such as is found in diabetes mellitus) on the quality of thallium TI201 scans. Attention is directed to the factthat thallium is a potassium analog, and sincethe transport of potassium is affected by thesefactors, the possibility exists that the thalliummay likewise be affected.Thallous Chloride TI 201, as all radioactivematerials, must be handled with care andused with appropriate safety measures tominimize external radiation exposure to clinical personnel. Care should also be taken tominimize radiation exposure to patients in amanner consistent with proper patientmanagement.

No long-term animal studies have been performed to evaluate carcinogenic potential.Adequate reproduction studies have not beenperformed in animals to determine whetherthis drug affects fertility in males or females,

@asteratogenic potential, or has otheradverse effects on the fetus. Thallous Chloride Ti 201 should be used in pregnantwomen only when clearly needed.It is not known whether this drug is excretedin human milk. As a general rule nursingshould not be undertaken when a patient isadministered radioactive material.Safety and effectiveness in children have notbeen established.

ADVERSEREACTIONS:Adverse reactions related touse of this agent have not been reported todate.

DOSAGEANDADMINISTRATION:The recommendedadult (70kg) dose of Thallous Chloride TI 201

is 1-1.5mCi.Thallous Chloride Ti 201 isintended for intravenous administration only.For patients undergoing resting thalliumstudies, imaging is optimally begun within10-20minutes after injection. Several investigators have reported improved myocardial.to-background ratios when patients areinjected in the fasting state, in an uprightposture, or after briefly ambulating.Best results with thallium imaging performedin conjunction with exercise stress testingappear to be obtained if the thallium isadministered when the patient reaches maximum stress and when the stress is continuedfor 30 seconds to one minute after injection.Imaging should begin within ten minutespost-injection since target-to-backgroundratio is optimum by that time. Several investigators have reported significant decreasesin the target-to-background ratios of lesionsattributable to transient ischemia by twohours after the completion of stress testing.The patient dose should be measured by asuitable radioactivity calibration systemimmediately prior to administration.Radiopharmaceuticals should be usedby persons with specific training in the safe use andhandling of radionuclides produced bynuclear reactor or particle accelerator andwhose experience and training have beenapproved by the appropriate governmentagencies authorized to license the use ofradionuclides.

RADIATION DOSIMETRYThe estimated absorbed radiation dose2 to anaverage patient (70kg) from an intravenousinjection of a maximum dose of 1.5 millicuries of TI 201 is shown in Table 4.

Table4. RadiatienDoseEsthutes ofThallousChlsrldsTIall:AbsorbedDose/1$@m1@iTIIaIIIUIIITI201MaMI$terSd

Rads/1.5mCiHeart 0.51SmallIntestines 0.97Kidneys 22Over 093RedMarrow 0.51Ovaries 0.85Testes 0.81Thyroid 1.12TotalBody 0.36

?Vaiueslisted includea maximumcorrection of 13%to the radiationdosesfromTI201dueto theradiocontaminantsPb203andTI202.

HOWSUPPUED:ThaliousChlorideTi 201forintravenous administration is supplied as asterile, non-pyrogenic solution containing atcalibration time, lmCi/ml of Thailous TI 201,9mg/mi sodium chloride, and 9mg/ml ofbenzyl alcohol. The pH is adjusted to between4.5-6.5 with hydrochloric acid and/or sodiumhydroxide solution. Vials are available in thefollowing quantities of radioactivity: 1.5, 3.0,4.5, 6.0, and 9.0 millicuries of Thallous Ti 201.ThecedentsofthevialareradioactiveAdequateshieIdIiandhamftingjrecauflonsmustbemaintaleed.

Radiation

Gaiima-4Gamma-6MercuryX-rays

0.23 0.50.83 10-j1.93.1 10.@4.4 10.@5.7 10-s

To correct for physical decay of this radionuclide, the fractions that remain at selectedintervals before and after calibration areshown in Table 3.

Table3. ThalliumTI201DecayChart Half-Life73.1 l@urs

HoursFractionRemainingHoursFractionRemainingHoursFractionRemaining-721.98180.84720.51-601.77240.80780.48-481.58300.75840.45-361.41360.71900.43-121.12420.67960.40-61.06480.631080.360@1.00540.601200.3260.95600.571320.29120.89660.541440.26

.::CallbratmonTime

CUNICAI.PHARMACOLOGY:Carrier-free ThallousChloride TI 201 has been found to accumulatein viable my()cardium in a manner analogousto potassium. Experiments employing labeledmicrospheres in human volunteers have

ThallousChlorideTI 201 Novemi@er 1977

. . FORDIAGNOSTICUSEDESCRIPflOP@Thallous Chloride Ti 201 is sup.plied in isotonic solution as a sterile, non@pyrogenic diagnostic radiopharmaceutical forintravenous administration . The aqueoussolution at calibration time contains lmCi/miThallous Chloride Ti 201, adjusted to pH 4.5.6.5 by the addition of hydrochloric acid and!Of@sodium hydroxide solution. it is made

isotonic with 0.9% sodium chloride and is pre.served with 0.9@ benzyl alcohol. Thallium Ti201 has a half.life of 73. 1 hours and is cyciotron-produced. It is essentially carrier@free,and contains less than 0.25% lead Pb 203 andless than 1.9@Thallium TI 202.

PHYSICAL CHARACTERISTICSThallium TI 201 decays by electron captureto Mercury Hg 201 with a physical half.life of73.1 hours.' Photons that are useful for detec@tion and imaging are listed in Table 1.Thelower energy X-rays obtained from the Mercury Hg 201 daughter of Ti 201 are recommended for myocardial imaging, because themeari@ /disintegration at 68.80.3 keV ismuch greater than the combination ofgamma-4 and gamma-6 meanc@/disintegration.

Table1.PrincipalRadiationEmissionData

Mean Mean%/Disintegration Energy(keV)

2.65 135.310.0 167.494.5 68-80.3

Martin.MJ . NuclearDataProject.ORNLJanuary1977

EXTERNAL RADIATIONThe specific gamma ray constant for Thaihum Ti 201 is 0.47R/mCi-hr. at 1 cm. The firsthalf-value layer is 0.23mm of lead. A range ofvalues for the relative attenuation of the radiation emitted by this radionuclide that resultsfrom the interposition of various thicknessesof lead (Pb) is shown in Table 2. For example,the use of 4.4mm of lead will decrease theexternal radiation exposure by a factor ofabout 10,000.

Table2. RadiationAttenuationByLeadShieldingmmof Lead(Pb) CoeftictentofAttenuation

cataloilNumberNRP-427

E@JNewEnglandNuclearMedical Diagnostics DIVISIOn.

601 Treble Cove Rd., North Billerica, MA 01862

CallToll-Free:800-225-1572/Telex:94-0996(In Mass. and International: 617-482-9595)

LosAngeles:NENWest,17210SouthGramercyPlace,Gardena,California 90247 Tel:213-321-3311Canada: NEN Canada, 2453 46th Avenue, Lachine, Oue.H8T3C9 Tel:514-636-4971Europe: NENChemicalsGmbH,D-6072Dreieich.WGermany,Postlach401240TeI:(06103)85034OrderEntry:(06163) 81011

-@.- -‘@\

A spirometer xenonrebreathing device for less than

$2500!!! Impossible? Almost,but we did it! We used the

technology and know-howgained from 5 years of

experience with the Ventil-Conand created the first low-cost

spirometer xenon unit.

XenaCon I basic spirometerunit

XenaCon II spirometer unitwith built-in Xenon Trap

XenaCon III spirometer unitwith Xenon Trap and Xenon

Trap Exhaust Port Monitordetector/alarm system

PERTINENT SPECIFICATIONS

Mobility: all units are highly mobile,making bedside studiespractical

Unit dead space: less than 25 ml in bothwashout and rebreathing

Spirometer volume: 0-10litersBreathing resistance: less than 0.1Inch of

water to normalbreathing

Shielding: spirometer area —@ inch leadtrap area —¼inch lead

Oxygen replenishment: manualpushbutton valve

Xenon izijection port: located In headvalve for either direct bolus orhomogeneous mixture patientadministration

Bacteriological ifiter: inline autoclavablebacteriological filterC02 trap: high capacity, easy access CO@atrap

Xenon trap cartridge pack: New vertical activatedCharcoal cartridge pack eliminates channeling

For more Information, call or write Radx today.

@ :@cP.O. Box 19164 Houston@Texas 77024713-468-9628

Volume 20, Number 4 73A

FROMRADX

RADIOLOGYPROGRAMSJANFEBMAltAPRMAYJUNJULAUGSEPOCTNOVDECUnderstandingX-ray GenerationI••Standardizationof RadiologicTechniquesII•SQuality

Assurance in RadiologyIII••IntroductiontoRadiologicTechniquesSSRadiology

Registration &CertificationSSAdvancedConcepts in Diagnosticlmaging*SCOMPUTED

TOMOGRAPHYPROGRAMSPrinciplesof Computerized TomographyISSQuality

Control in Computerized TomographyIISSQualityAssurance in Computerized TomographyIllSSAdvanced

Concepts in DiagnosticImaging*SNUCLEARMEDICINEPROGRAMSBasics

of NuclearMedicineSSSSQualityControl & Compliance in NuclearMedicineSSAdvanced

Conceptsof NuclearMedicineSSDynamicsin NuclearMedicineSSNuclearCardiologySSSComprehensive

NuclearMedicineS•SNuclearMedicine Registration &Certification•SRadiopharmaceutical

TechniquesS•AdvancedConcepts in Diagnosticlmaging*SRadioisotope

HandlersSSS5MONITORINGPROGRAMPrinciples

of CardiovascularMonitoringSSULTRASOUNDPROGRAMSBasics

of Ultrasound I•SS

SSS45555lanagement

for Diagnostic- - it__________________________S

rT-@

-@@@ -@..

applications are processed ona first come, first served basis.

For complete details, dates,accommodations, etc., write to:

Charles Rose, Director MedicalEducation Programs,General

Electric Medical Systems,Dept. NMT, P.O.Box 414TI 40,

Milwaukee, Wisconsin53201. Or call:

414-383-3211,ext.2286, Dept. NM.

GEMedicalEducationProgramsare comprehensive, yet concisecourses for physicians andtechnologists. These concentrated programs are offered allyear around to accommodatebusy schedules, and are taughtby a skilled, experiencedfaculty, using the latesteducational techniques.Completed courses can@be applied to meetaccreditation andcontinuing education .requirements. But (@sizes are limited, soenroll today. All

MedicalEducationPrograms

1979 GE MEDICAL EDUCATION PROGRAMS

Quality Control & Compliance in II

S S

74A THE JOURNAL OF NUCLEAR MEDICINE

Announcing a 24 course, low-fat curriculumfor healthcare professionals.

I

. I@‘o@

@ -,.@..——-@ I

r@@@ ,@

@-._-._@s.@_.@ _@.... ..@@ - —.@-@ .@

Radio-Labware CleanerThe most effective solution anywhere offered for cleansing hotlab apparatus of adherent radioactivity. Safe and easy-to-use.Proves itself thousands of times daily in research and clinicallaboratories throughout the world.

Now available at reasonable cost, internationally, through Iicensed manufacture to Isolab's exacting specifications, plusnational distribution from local stocks.

Contact your nearest Isoclean licensee or distributor for cornplete information.

WESTERN EUROPEBIOLABS. A.Ave. Michel-Ange81040 Brussels, Belgium

IBERIAN PENINSULAATOMPaseodel Monte,34Barcelona-12, Spain

SOUTH AFRICACHEMLAB Pty.Ltd.

P.O. Box 56218Pinegowrie, Transvaal, RSA

AUSTRALASIAS.R.E.Pty.Ltd.P.O. Box 69PennantHills,N.S.W.2120

In the U.S. and Canada: Order from any office of Amersham-Searle, Nuclear Associates, Picker and other distributors—orcall Isolab collect.

Volume 20, Number 4 75A

0

World-Wide AcceptanceU U S Global Availability

ISOCLEAN

INNOVATIVEPRODUCTSFOR RESEARCH

Drawer 4350 Akron Ohio USA 44321

Phone: 216/82.5-4528 collect Or800/321-9632toll-free

Cables: ISOLAB AKRONTelex:98-6475

1251RIAKits

@ Co$r& olsrESTRIOL@

ESTRADIOLPROGESTERONE

DIreCtTest

sj@s]@1l:Iu1@:fr,,--

NMS—IUpto@ i@owvaiues1N

MS—liUpto45 High Values

@:jiiij:@@IIIIY4

Availablein Reprint fromJohnson Reprint Corporation

Journal ofNuclear

MedicineVolumes1-8

The Journal of Nuclear Medicine, official publication of the Society of Nuclear Medicine, features original articles in clinical medicine,basic and clinical medicine research, physicsand chemistry dealing with the use ofisotopes in humans and articles on relatedsubjects. This includes dosimetry, instrumentation, protection, techniques, biologic effectscontributing to the use or effects of isotopes

in clinical medicine and the clinical effects ofionizing radiation.

Journal of Nuclear Medicine(Society of Nuclear Medicine)

Vols. 1-8. St. Louis; Chicago 1960-1967

Quantitative&Qualitative

. HighestsensitMty (1 mlu/ml)

HPL StatTestforPlaentalDysfunction

@Ô@LÔBINDireCtTest

TOBRAMYCINSolidphase,Direct,NoDilutions

r Manual&AutomatedNeo.T/Neo..TSH

(Automated on CentriaDirectonBloodSpot

Confirmatory,DoubleAb

i:i'd;i'iiui1iRI'Ui'1@—

T3 T4 TSHT BO with Free T4 Assessment

3 Uptake—LowCost

Clothbound set

Paperbound set

Vols. 1-4, 1960-1963Per volume, paperbound

Vols. 5, 6, 1964-1965Per volume, paperbound

Vols. 7, 8, 1966-1967Per volume, paperbound

$435.00

385.00r I27.00

60.00

81.00Many single issues available in the originaledition.Please inquire

NuclearMsdiculSystsas,Inc.1533MonroviaAve.

NewportBeach,CA92663(714) 645-2111

Johnson Reprint Corporation111 Fifth Avenue

New York, New York 10003A Subsidiary of Harcourt Brace Jovanovich, Publishers

76A THE JOURNAL OF NUCLEAR MEDICINE

- : •@ . -@ @..@ .@. ,.-.

. Connector provided to interface

thecalibratortoCRC-UComputer/Printer system

. Push-button operation . . . instant

digitalreadoutoftotalactivityofeight most frequently usedradionuclides

. Manual radioisotope selection for over

200 radionuclides. Deep ionization chamber well allows

convenient measurements of virtuallyany radioisotope in clinical use andaccommodates sample sizes up to200 mlvial

. Ion collection potential supply

easily displayed by pushing TESTbutton

. High sensitivity (0.1 pCi resolution)

. Moly-assay capability

. Pressurized argon detector

:@csTh

SQUIBB CRC' -17 Radioisotope Dose CalibratorMedotopes

SQUiBB

Medotopes' Product ManagerE. R. Squibb & Sons, Inc.Box 4000Princeton, N.J. 08540

E Send CRC-17 information.

E Haverepresentativecall.

NAME

ADDRESS

CITY STATE ZIP

CRCisa registeredtrademarkotcap@ntec,Inc.©1978E.A.Squibb&Sons,inc.609-507

memo

commitment to excellence in service,innovative design,and materialsresearchismore importanttodaythanever before.

Experienced physicists,engineersanddesign teamsare constantlypreparedto serve you.Wecan help youtranslate today'sideas into provendetectors for tomorrow'ssystems.Call us!The HarshawChemicalCompany,Crystal& ElectronicProducts,6801Cochran Road, Solon,Ohio44139,(216)248-7400.

II!a1;I.@jIEurope: Harshaw Chemie B.V./Postbus 19DeMeern, Netherlands/Telex: 84447017

A@ INDUSTRY

79AVolume 20, Number 4

Whenyourplanscallfora newscintillationdetectordesign—call Harshaw.

EveryHarshawscintillationdetectorrepresentsthesolutiontoaspecific application problem.Ourinnovativedesignshavehelpedtoadvancenuclear medical technologyin manyareas,including gammacameras,computerized axial tomographic scanners,and positronemission tomography systems.

Harshaw@partnershipwith nuclearmedicine spans25 years.Our

-w@

I DETECTOR I.. ELECTRONICS

IDISPLAY f

Ifyou're now using aPickerDyna®Camerasystem you're alreadyaccustomed toworking with imageswell within established clinicalconfidence levels.With many othersystems it takesuniformitycorrectionto approach Picker'sintrinsic system image quality. When youstart with a Picker system and add our newMicro Z@Processor, you now get unequaledresolution and uniformity through ourunique and exclusive energy correctiontechnique. And, unlike other correctiondevices, Picker's Micro Z shows you moreof what you're looking for —withouteliminating events you might need to seeand in less time.

Beware the cover.up. Systems that

reject counts at the scope end tend toproduce cosmetically acceptable pictures.You can see definite improvement.Unfortunately, in correcting these non

uniformities, directcount-skipping orcount-adding

methods can coverupthe very lesions youseek to find. ThePicker system worksdifferently.Micro Z isinterfaced with theDynaCamera system

at the front end between the detectorand the electronics. It functions not bycoveringup information,but by acceptingmore good counts before electronicprocessing.Cosmeticallyyou get the Clinicalimage you expected. Diagnostically, youget a great deal more information.

Don't trade numbers for clarit@Theaccompanying defect of cosmetics is a lossof numeric accuracy. The Picker system givesyou both— and a choice ofeither. A simpleswitchlets you optimizeenergyresolutionand/or cosmetic uniformity.The secretof our Micro Z Processor is a digitallycontrolled energy window that is automaticallyset for optimum scatterrejection

pulse by pulse and improved photopeakefficiency.

The Picker investment in betterresolution. Our new Micro Z Processorwill keep your DynaCamera system performing well ahead ofits competitors. Atthe same time, it will bring you morerelevant information better clinicalcontrast, and an increase in your diagnosticcertitude. It'sanother example of Picker'scontinuingplan to let you do more with thediagnostic equipment you already own.For more information and a reprint of apaper delivered at SNM in Anaheim,entitled “UniformityCorrection with theMicro Z Processor:' please write: PickerCorporation, 12 Clintonville Road,Northford, CT 06472 (203-484-2711);orPicker International, 595 Miner Road,Cleveland, OH 44143.

80A THE JOURNAL OF NUCLEAR MEDICINE

C R;lfl up

clin!rdUri

IL

PUCKER®ONE OF THE C IT COMPANIES

-@ .@

L'.

£@.

RAO. SYSTOLE LAO. DIASTOLE

The RAOview shows akinesis of thelower antero-lateralwall and apex;and contraction of the inferior walland high up the antero-lateral wall.The LAOview showsgood contrac

tion po@teriorIyand akinesisof theseptal aspect of the cham ber. Patientwas injected IVwith 2OmCiof 99mTclabelled HumanSerumAlbumin. Theagentwaspreparedusing the New

England Nuclear Electrolysis Kit forlabellingHSA.Writeorcallforaportfolio of Brattle-gated lung, liver andheart studies.

No knobs, no meters, no errorsThe spartan panel above tells thesecond-best part of our story. If youwant to photograph peak systole,pressthe SYSTOLEbutton. If, say,you want systoleonly at full expiration, press the EXPIRATIONbuttonaswell. If only breathing is relevant,don't pressthe heart button.

The Brattle is connected to thepatient and to your gamma (or x-rayor ultrasonic)camera.Wheneverthepatient is in the selected phase,boththescopeandthescaleronyourgamma camera are gated ON, andfilm is exposed. Otherwise, theyare OFF.

Brattles lock onto patientsand stay locked onIt doesn't matter if the patients heartrate and breathing depth changewhile he's under the collimator be

causewe stay right with him. BrattIes contain an ECG to track heart, aplethysmograph to track respiration,and a tiny computer to deducesystoleanddiastoletimesfromtheheartsignal. And becauseit's all built in,your operator need not be aphysiologist.

Wedon'tcoverourtrackswe printthemThepanellightsflashwheneverthepatient reaches the selected phases;and pushing the RECORDER-ONbuttongetsyouanECGtracingmarked with breathing and cameraon times.Youcanverifyfunctionbefore,duringandafterexposure.

A singlepairof axillaryelectrodescaptures both heart and breathIt's easy. And we supply disposable,pre-filled electrodes.

Some Brattles have been In clinicaluse for over three yearsin community and major hospitalsMore than half of our instrumentsareincommunityhospitalsandthelistisgrowingrapidly.Upon request,we'll supply namesof happy users inyourarea.

What's the next step?Get intouchAsk your NEN man about Brattles andHSA Kits. He can show you a portfolio of clinical pictures and arrangeto haveoneof ourpeoplegiveyouademo. Or write or call us direct. We'llsend you brochures on this and othermodels,andwill giveyouyourownset of clinical pictures and a bibliography on gated scintigraphy. If youwish, we'll evenmakeyou a Brattleowner. (This is the bestpart ofour story.)

Help your cardiologiststudy heart kineticsnon-invasivelywith Brattle-gatedscintiphotos.

LAO.SYSTOLERAO. DIASTOLE

Brattle Instrument corporation243VassarStreet •Cambridge,Massachusetts02139•617-661-0300

NUCLEARMEDICINE.

Since 1962,UNIONCARBIDEhas played a vital role innuclear medicine that has led to a broadly integratedproduct line of diagnostic chemicals and instrumentation. . . unit dose radiopharmaceuticals . . . reagent kits for a

wide range of organs and functions . . .whole bodyimagers . . . gamma cameras . . . image processors ...and emission systemsfor brain and body tomography.

LookIntoLife...@Ni1

M@ Produce DM@on270 ParkAvenueNewYork, NewYork 10017

I0CARBIDE