Technetium TC 99m sodium pertechnetate is a radiopharmaceutical imaging agent that is used in the thyroid, salivary gland, urinary bladder, and nasolacrimal gland imaging.

Technetium TC 99m sodium pertechnetate Uses:

• Imaging agent:

  • It is used as a radiopharmaceutical imaging agent for nasolacrimal drainage system imaging which is known as dacryoscintigraphy.
  • It can also be used in salivary gland imaging.
  • Thyroid imaging.
  • Urinary bladder imaging (direct isotopic cystography) for the detection of vesicoureteral reflux.

Technetium 99m sodium pertechnetate Dose in Adults

It is important to measure the dose with an appropriate radioactivity calibration system immediately prior to administration. The dose is based on an approximation of the weight of 70 kg.

Technetium 99m sodium pertechnetate Dose in Nasolacrimal drainage system imaging:

• Dacryoscintigraphy (ophthalmic instillation with a micropipette or similar method): Maximum: 0.1 mCi (3.7 MBq)

Technetium TC 99m sodium pertechnetate Dose in Salivary gland imaging:

• IV: 1 to 5 mCi (37 to 185 MBq)

Technetium TC 99m sodium pertechnetate Dose in Thyroid gland imaging:

• IV: 1 to 10 mCi (37 to 370 MBq)

Technetium TC 99m sodium pertechnetate Dose in Urinary bladder vesicoureteral imaging:

• Intravesicular (via urethral catheter): 0.5 to 1 mCi (18.5 to 37 MBq)

Technetium 99m sodium pertechnetate Dose in Childrens

It is important to measure the dose with an appropriate radioactivity calibration system immediately before administration.

Technetium TC 99m sodium pertechnetate Dose in Thyroid gland imaging:

• Children and Adolescents:

  • IV: 60 to 80 µCi/kg (2.2 to 2.96 MBq/kg)

Technetium TC 99m sodium pertechnetate Dose in Urinary bladder imaging (direct isotopic cystography):

• Children and Adolescents:

  • Intracatheter (urethral): 0.5 to 1 mCi (18.5 to 37 MBq

Pregnancy Risk Factor C

• Studies on animal reproduction have not been completed.
• Technetium Tc99m can be detected within a fetus. The exact formulation, the route of administration and the trimester of pregnancy will determine how much you get (Adelstein 1999).
• The likelihood of a radiopharmaceutical causing harm to the fetus is dependent on how much the baby ingests and what stage the pregnancy is at.
• Radiopharmaceuticals that are used in therapeutic procedures at high doses are more likely than to cause fetal harm.
• To reduce fetal risk, a medically approved diagnostic procedure can be modified.
• You should not perform elective diagnostic procedures until after the delivery.
• Women with childbearing potential should avoid pregnancy.
• According to the manufacturer, elective procedures should be performed in women with reproductive potential within the first 10 day after menstruation.

Technetium Tc-99m sodium pertechnetate use during breastfeeding:

• Breast milk contains Technetium Tc99m.
• Literature suggests that you switch to formula milk over breastfeeding.
• Many studies recommend that breastfeeding should be stopped for no more than four hours.
• However, as technetium 99 DTPA excretion into breast milk can vary, some sources suggest breastfeeding for no less than 12 hours.
• In general, following the administration of radiopharmaceuticals, a woman with a good milk supply should pump at normal feeding times and discard the milk until breastfeeding can be resumed.
• Technetium Tc99m excretion into colostrum can vary widely and data are limited. It is therefore not possible to make recommendations regarding early breastfeeding.
• It is important to delay elective diagnostic procedures until after breastfeeding has stopped.
• It may be necessary to comply with all regulatory requirements regarding recordkeeping and instructions to patients, depending on the dose.

Dose in Kidney Disease:

No dose adjustments are required in renal disease.

Dose in Liver disease:

According to the literature there are no required dose adjustments in liver impairment.

Technetium tc 99m sodium pertechnetate Side effects:

• Hypersensitivity:

  • Anaphylaxis (infrequent)

Contraindications to Technetium tc 99m sodium pertechnetate:

The literature does not contain any specific contraindications.

Warnings and precautions

• Hypersensitivity

  • It has been reported that hypersensitivity reactions can lead to severe allergic reactions and even anaphylaxis.
  • It is important to have the appropriate equipment and personnel available for emergency treatment.

• Radiation accumulation:

  • The cumulative radiation exposure of a patient to Tc 99m is influenced by the dose.
  • Exposure to cumulative radiation for long periods of time is linked with an increased risk of developing cancer. For imaging, use the lowest dose possible.
  • Pediatric patients are at greater risk due to their higher radiosensitivity and longer lives expectancy.
  • To minimize radiation exposure for the patient and their health care providers, ensure safe handling

Monitoring parameters:

• Observe for signs & symptoms of hypersensitivity.

How to administer Technetium tc 99m sodium pertechnetate?

Salivary gland and thyroid imaging: Administer IV.

Nasolacrimal drainage system imaging:

• Ophthalmic instillation via a micropipette or similar method to ensure dosage accuracy.
• Instruct patient to blow nose and wash eyes with sterile distilled water or isotonic sodium chloride to minimize radiation dose absorbed following procedure.

Urinary bladder and ureters imaging (direct isotopic cystography):

• Instill via urethral catheter directly into the bladder.
• After instillation, flush the catheter with ~200 mL of sterile saline directly into the bladder.
• Patients should void immediately after the imaging study is complete and then frequently over the next 12 hours to decrease radiation exposure to the bladder.
• Patients should be adequately hydrated before and after intravenous or intravesicular administration.

Radiopharmaceutical:

• Use of appropriate precautions for handling and disposal is recommended. Use waterproof gloves and effective radiation shielding when handling the product.

Mechanism of action of Technetium tc 99m sodium pertechnetate:

• It is a radioactive diagnostic drug that is distributed in the body in a similar way to the iodide.
• However, pertechnetate is not organized in thyroid. Pertechnetate is unaltered from the thyroid.

Distribution:

• Pertechnetate concentrates in the gastric mucosa, thyroid gland, salivary glands, and urinary bladder

Half-life elimination:

• Physical half-life: 6.01 hours

Time to peak:

• IV: 3.5 hours (cerebral spinal fluid); 0.25 to 2 hours (thyroid [euthyroid patients])

Excretion:

• Urine (27% in 1 day; 31% in 4 days and 34% in 8 days)

International Brand Names of Technetium Tc-99m sodium pertechnetate:

• LEU TechneLite
• TechneLite
• Ultra TechneKow FM
• Ultra Technekow FM
• Ultra-TechhneKow FM
• UltratechneKow FM

Technetium Tc-99m sodium pertechnetate Brands Names in Pakistan:

It may be available in certain specialized centers.