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Sporadic supply interruptions of select radiopharmaceuticals on the global market require consideration of alternative agents to support continuity of essential nuclear medicine examinations. During an acute shortage of Xenon-133 and technetium-99 metastable (Tc-99m) diethylene-triamine-pentaacetate (DTPA), our institution used aerosolized Tc-99m hydroxymethylene diphosphonate (HDP), a radiopharmaceutical traditionally used in bone scintigraphy, in lieu of traditional ventilation agents, for two cases of suspected pulmonary embolism. Similar to Tc-99m-DTPA, Tc-99m-HDP was readily available and easily compounded in our pharmacy, and tolerated well by patients. Identical delivery equipment was used for administration of Tc-99m-HDP as that used in Tc-99m-DTPA, and thus, there was no requirement for a negative pressure room. Similar to Tc-99m-DTPA and unlike Xenon-133, Tc-99m-HDP allowed direct comparison of all 8 ventilation-perfusion images. In addition, the cost per dose of Tc-99m-HDP proved to be less than Tc-99m-DTPA. Despite these favorable characteristics of Tc-99m-HDP, our experience identified an important challenge in obtaining an optimal flux override ratio of &gt; 3 in a reasonable time frame while obtaining ventilation and perfusion images sequentially despite reversing the imaging order in an attempt to overcome this limitation. Although our experience with Tc-99m-HDP in these two cases was favorable, more clinical experience and investigation are warranted before Tc-99m-HDP can be incorporated as a standard alternative ventilation agent.

world journal of nuclear medicine

Initial experience in the use of technetium-99 metastable hydroxymethylene diphosphonate as an alternative ventilation agent during periods of interim shortage