Nuclear Cardiology: Nuclear Cardiology:

12 Nuclear Cardiology, The BasicsAn Important Choice: Making YourOwn Kits or Purchasing Unit DosesFor free-standing imaging facilities a practical arrangement to ensurea regular supply of radiopharmaceuticals may be through a contract witha regional commercial radiopharmacy. Radiopharmacies deliverprecalibrated vials of quality-controlled radiopharmaceuticals, alsoknown as “unit doses.” The unit-dose approach is generally more expensivethan the use of an on site generator.It may be useful to compare the pros and cons of receiving unit dosesversus preparing radiopharmaceuticals on site in an imaging facility.Cost and staffing are probably the two most important issues to consider.The price of molybdenum (Mo)-99 generators and of radiopharmaceuticalkits depend on whether or not the imaging facility has a contractwith a radiopharmaceutical vendor and also on the volume of patientstudies. If the imaging facility has a contract with a radiopharmaceuticalvendor, one may be entitled to discount pricing. In addition, the largerthe patient volume, the better the price that can be negotiated. This is alsotrue for unit dosing: the more doses one orders, the cheaper each dosewill be. If price is a major factor, one should meet with local salesrepresentatives and obtain quotes for the products.Staff availability is also an important consideration. To elute thegenerator, to perform the QC, and to prepare the kits, a technologist hasto come to the laboratory earlier in the morning than the rest of thetechnical staff. Depending on the number of kits to be made, this can takefrom 30 min to over 1 h. This technologist will be entitled to leave earlierat the end of the day than the rest of the staff . Therefore, one needs tohave sufficient staff to be able to stagger shifts and to accommodate thesehot lab duties.Table 1-1 lists some other issues to be considered when deciding toorder unit doses or to prepare radiopharmaceuticals on the premises.Preparing Radiopharmaceutical Kits on SiteIf the decision is made to prepare radiopharmaceuticals on site in theimaging facility, written protocols must be in place that describe detailsof the procedures. For each specific brand of radiopharmaceutical separateprotocols should exist. Kits from different vendors have differentprocedural steps and criteria. The protocol should meet the manufacturers’recommendations found in the package insert. The protocol shouldalso detail radiation safety equipment and techniques to be used for thepreparation of kits.