Automated processing of solid target 86Y using enriched SrO powder.

86Y (t1/2 = 14.74 h, 32% ß+) has significant potential in theranostic applications as a simultaneous PET imaging partner to 90Y-labelled antibody therapy. However, the complex and costly nature of producing 86Y has led to this radiometal being difficult for hospitals and researchers to obtain. The aim of this work was to develop a simple and cost-efficient method for safely producing 86Y. Our approach was twofold: to develop a method of target preparation that would significantly increase the cost efficiency of producing 86Y, and to design and construct an automated purification system that would eliminate manual radiation handling risks and exposure. Multiple automated productions of high radionuclidic purity (99.45%) 86Y were performed resulting in saturation yields of between 518 MBq/µA and 1332 MBq/µA, dependent on target thickness.

Proton Therapy Facility Planning From a Clinical and Operational Model.

This paper provides a model for planning a new proton therapy center based on clinical data, referral pattern, beam utilization and technical considerations. The patient-specific data for the depth of targets from skin in each beam angle were reviewed at our center providing megavoltage photon external beam and proton beam therapy respectively. Further, data on insurance providers, disease sites, treatment depths, snout size and the beam angle utilization from the patients treated at our proton facility were collected and analyzed for their utilization and their impact on the facility cost. The most common disease sites treated at our center are head and neck, brain, sarcoma and pediatric malignancies. From this analysis, it is shown that the tumor depth from skin surface has a bimodal distribution (peak at 12 and 26 cm) that has significant impact on the maximum proton energy, requiring the energy in the range of 130-230 MeV. The choice of beam angles also showed a distinct pattern: mainly at 90° and 270°; this indicates that the number of gantries may be minimized. Snout usage data showed that 70% of the patients are treated with 10 cm snouts. The cost of proton beam therapy depends largely on the type of machine, maximum beam energy and the choice of gantry versus fixed beam line. Our study indicates that for a 4-room center, only two gantry rooms could be needed at the present pattern of the patient cohorts, thus significantly reducing the initial capital cost. In the USA, 95% and 100% of patients can be treated with 200 and 230 MeV proton beam respectively. Use of multi-leaf collimators and pencil beam scanning may further reduce the operational cost of the facility.

The state of positron emitting radionuclide production in 1997.

Thirty years ago Michel M. Ter-Pogossian and Henry N. Wagner, Jr. wrote an article that was published in Nucleonics on the cyclotron production of isotopes for biomedical research. In this report we use the Nucleonics paper as the framework to relate their predictions to the current state of the art, we have broken this into four key areas; commercially available cyclotrons, costs of operating cyclotron facilities, the emergence of compact accelerators, and the cyclotron production of long-lived radionuclides for therapeutic applications. Companies producing cyclotrons commercially are; General Electric Medical Systems, CTI Cyclotron Systems, EBCO, IBA, NNK/Oxford Instruments, and Japan Steel Works. The majority of these machines are now negative ion systems, which allows the option of dual irradiation of two targets. All have a modular design, which allows the system to be customed to a particular facility's need. Cyclotron facility costs have increased dramatically since 1966. We have determined that the bulk of the increase lies in the costs to establish and staff the facility. Increased regulation by Federal and State organizations has severely impacted operational expenses. The growing demand for PET radiopharmaceuticals in the clinical arena has increased the staffing requirements of the facility. Surprisingly, the costs of cyclotrons have not increased (in terms of real dollars) especially when one considers the much greater sophistication in target design, automation, and computer control that has occurred during this time. Innovative approaches are being taken to develop low energy accelerators that are capable of producing PET isotopes. These are easier to operate and less expensive than commercially available cyclotrons. Although many of these systems have been developed, none have as yet gained commercial recognition. A number of groups have begun to address the production of longer lived isotopes on biomedical cyclotrons. Development of this technology may well help to further progress in targeted radiotherapy. We present an overview of potentially useful isotopes.

18FDG synthesis and supply: a journey from existing centralized to future decentralized models.

Positron emission tomography (PET) as the functional component of current hybrid imaging (like PET/ CT or PET/MRI) seems to dominate the horizon of medical imaging in coming decades. 18Flourodeoxyglucose (18FDG) is the most commonly used probe in oncology and also in cardiology and neurology around the globe. However, the major capital cost and exorbitant running expenditure of low to medium energy cyclotrons (about 20 MeV) and radiochemistry units are the seminal reasons of low number of cyclotrons but mushroom growth pattern of PET scanners. This fact and longer half-life of 18F (110 minutes) have paved the path of a centralized model in which 18FDG is produced by commercial PET radiopharmacies and the finished product (multi-dose vial with tungsten shielding) is dispensed to customers having only PET scanners. This indeed reduced the cost but has limitations of dependence upon timely arrival of daily shipments as delay caused by any reason results in cancellation or rescheduling of the PET procedures. In recent years, industry and academia have taken a step forward by producing low energy, table top cyclotrons with compact and automated radiochemistry units (Lab- on-Chip). This decentralized strategy enables the users to produce on-demand doses of PET probe themselves at reasonably low cost using an automated and user-friendly technology. This technological development would indeed provide a real impetus to the availability of complete set up of PET based molecular imaging at an affordable cost to the developing countries.

Positron emission tomography: a financial and operational analysis.

Positron emission tomography (PET) is an emerging clinical imaging technique that is facing the challenges of expansion in a period of imminent health care contraction and reform. Although PET began showing utility in clinical medicine in the mid-1980s [1], its proliferation into mainstream medical practice has not matched that of other new imaging technologies such as MR imaging. Many factors have contributed to this, including the changing health care economy, the high cost of PET, the length of time it takes to develop a PET facility, and its inherent complexity. In part because of the proliferation of the use of other technologies and the general explosion of costs, insurance carriers are now holding diagnostic techniques, including PET, to stricter standards of efficacy. New techniques must show improvement in long-term outcome of patients, a difficult task for diagnostic tools. In addition to these issues, PET is an expensive technology that requires highly trained multidisciplinary personnel. Questions have also been raised about the most appropriate mechanism for regulation of PET isotope preparation, leading to speculation about future regulatory requirements. The current pioneers of PET must meet these challenges in order for it to become a routine imaging technique. Because of its clinical value, PET will probably survive despite the challenges. For many reasons, though, not every hospital should necessarily develop PET services. Conversely, many hospitals without this technology should consider acquiring PET. The purpose of this article is to identify the financial, operational, and clinical challenges facing PET centers today, describe potential organizational configurations that may enable PET to survive in an antitechnology environment, and delineate which institutions should consider this new technology.