Radiopharmaceutical Diagnostics

"Radiopharmaceuticals are used as a contrast compound that is injected into the patient. It makes it possible to observe the inside of the body in a non-invasive way".

DR. IVÁN PEÑUELAS SÁNCHEZ
DIRECTOR. RADIOPHARMACY UNIT

The radiopharmaceutical results from the union of a normal biological molecule (protein, amino acid...) with an isotope, a radioactive substance that originates in an apparatus called a cyclotron.

Radiopharmaceuticals are used to perform diagnostic tests using PET technology (positron emission tomography). 

This substance allows the tomographer to detect the radiation emitted by radioactive atoms and to locate the tumor. PET is based on marking the molecules or metabolic substrates that are to be used in diagnostic studies.

Radiopharmaceuticals in Nuclear Medicine are used as contrast compounds that are injected into the patient, intravenously, allowing the interior of the body to be observed in a non-invasive way and thus obtaining the molecular image of that organism or of the specific pathology that is to be studied.

Its main use is in diagnosis and research. Among the most commonly used radiopharmaceuticals are FDG (glucose), methionine, choline or FDOPA.

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When are radiopharmaceuticals used?

The Clinic's PET-GMP laboratory allows access to new compounds that enable the study of more complex diseases, within fields such as oncology, neurology or inflammatory diseases.

The benefit that supposes the synthesis of a wide variety of radiopharmaceuticals (like methionine, choline, thymidine, acetate, dopa, etc.) is translated in the possibility of determining the most precise treatment or the most suitable therapeutic handling in complex pathologies like prostate tumors, cerebral, liver, degenerative diseases like Parkinson or Alzheimer or dementias in general.

The facilities thus comply with GMP (good manufacturing practices) conditions or internationally established standards of correct processing, with which, in addition to producing a greater number of radiopharmaceuticals, the conditions for producing the medicines are improved, both in terms of radiological protection and in the personalized dosage for each patient.

Most frequent indications of this test:

  • Alzheimer's disease
  • Parkinson's disease
  • Hepatocarcinoma
  • Brain tumors

Do you suspect you have this disease?

You may need to be diagnosed with radiopharmaceuticals

PIONEERS IN SPAIN

PET-GMP Laboratory

The Clínica Universidad de Navarra is the first Spanish hospital capable of synthesizing and applying up to 18 different radiopharmaceuticals to accurately diagnose some oncological diseases, Alzheimer's and Parkinson's, etc.

Learn more about radiopharmaceuticals

A radiopharmaceutical is any medicinal product for clinical purposes which, when ready for use, contains one or more radionuclides (radioactive isotopes). In Nuclear Medicine, approximately 95% of radiopharmaceuticals are used for diagnostic purposes.

Radiopharmaceuticals are administered to the patient only once in his or her life or a couple of times at most. These products contain minute amounts of active ingredients, so they do not show pharmacodynamic activities since they are used in trace amounts. Therefore, there is no dose-response relationship, so they differ significantly from the rest of the conventional drugs.

The radioactive activity of the dose administered to the patient must be sufficient to carry out the study or the intended treatment, but no more. Each radiopharmaceutical has a recommended dose range for each of the authorized clinical indications.

Sterility is also an indispensable requirement in preparations for parenteral administration, so it must be controlled. In the preparation and marking of radiopharmaceuticals, previously sterilized products are used and work is done under aseptic conditions.

The radiopharmaceutical is produced in the production room in a sterile environment

Once the materials have been received at the PET-GMP Laboratory of the Clínica Universidad de Navarra, the elaboration of the radiopharmaceutical begins. This phase of the process is carried out in the production room. This is an area of the laboratory where the purity of the air is superior to that of the reception exit. In order to achieve the highest possible degree of asepsis, the personnel must be dressed in special clothing, in a totally sterile environment.

The radiopharmaceutical is prepared from two components: a radioactive fraction and another compound that acts as a reagent to which the radioactive part is attached to constitute the final radiopharmaceutical.

The production of the radioactive isotope is carried out by a team outside the laboratory facilities called a cyclotron.

Once elaborated, it is transferred from the cyclotron to the laboratory, through some subway tubes. The tubes end up in the synthesis cells which are shielded, ensuring that there is no risk of irradiation. In this area the chemical reactions between the radioactive material and the reagent, necessary to obtain the radiopharmaceutical, begin to take place.

Once the process is finished, the product is purified and extracted from the synthesis module in a single-dose vial, calculated for individual use in a specific patient.

The only Spanish hospital that can synthesize 18 different radiopharmaceuticals

  • 18FDG
    It has indications in Neurology, Cardiology and, mainly, in Oncology (it is the main radiopharmaceutical in the study of tumoral pathology). FDG is not a specific tumor marker, so it is necessary to develop other radiopharmaceuticals for the diagnosis of specific pathologies, such as prostate cancer, in which the exploration with 11C-choline complements the study with FDG.
  • 11C-Methionine
    Its main clinical application is to study brain tumors, their recurrence and the assessment of the response to radiotherapy.
  • 11C-Choline
    Specific marker for the early diagnosis of prostate cancer and the study of its extension.
  • 18F-FDOPA
  • It is mainly used as a marker for parkinsonism and to locate neuroendocrine tumors that are difficult to detect.
  • 11C-Flumazenil
    It is used to locate epileptogenic foci in the pre-surgical evaluation of epilepsy.
  • 11C-Dihydrotrabenazine
    It allows the study of neuronal losses in neurodegenerative diseases, such as Parkinson's, multi-system atrophy, sleep disorders (REM phase) and the determination of neuronal density by PET.
  • [18F]FDDNP
    It binds to the beta-amyloid and tau proteins, allowing to distinguish between people with mild cognitive impairment from those with Alzheimer's disease, and those without any cognitive impairment.
  • [18F]MPPF
    It allows the study of abnormalities in the serotonergic system by binding to 5-HT1A serotonin receptors.
  • [18F]FHBG
    Tracer used for gene therapy monitoring studies.
  • [11C]FLB457
    It is a tracer of high affinity for the striatal dopamine D2 receptors
  • [15O]H2O
    It allows to determine and quantify the blood flow for the analysis of the perfusion of a tumoral lesion or for studies of brain activation in response to a stimulus.
  • [13N]NH3
    Used mainly for myocardial viability studies.
  • 18F-Misonidazole
    It is a marker of tumor hypoxia. Very useful for the selection of the therapeutic treatment and for the monitoring of the effects after the treatment.
  • 18F-FLT
    It is a marker of cell proliferation. Its main application is the study of gliomas and the early assessment of response to treatment in other tumors earlier than FDG.
  • 68Ga-DOTATOC
    It is the only PET radiopharmaceutical obtained in our center without using the cyclotron. Its main application is the diagnosis and management of gastro-entero-pancreatic carcinoid and neuroendocrine tumors, helping to locate them.
  • 11C-Acetate
    Radiopharmaceutical used in cardiological (visualization of myocardial oxidative metabolism) and oncological (mainly hepatocarcinomas) indications.
  • 11C-Hydroxyephedrine
    Visualization of the myocardial innervation
  • 11-C-GDP
    Central marker in Alzheimer's disease that identifies amyloid plaques in the brain.

The foundation of PET technology is based on marking, with positron-emitting isotopes, the molecules or metabolic substrates that are to be used in diagnostic studies.

For this purpose, radiopharmaceuticals in Nuclear Medicine are used as a contrast compound that is injected into the patient and makes it possible to observe the inside of the body, in vivo, in a non-invasive way and thus obtain the molecular image of the organism or of the specific disease that is to be studied. This process takes place before the patient is tested on the tomograph.

By using PET technology, the molecules or metabolic substrates used in the diagnostic studies are marked with positron-emitting isotopes.

PET technology makes it possible to use various radiopharmaceuticals to obtain the diagnosis of certain pathologies in a very specific way. Thus, for example, a patient who suspects having a brain tumor, instead of applying the radiopharmaceutical FDG -one of the most used in the study of the tumor pathology-, in the Clinic another one called methionine is used, specific for brain tumors.

However, if it is suspected that the patient to be studied has a hepatocarcinoma, then a different radiopharmaceutical is used, and a different one if a diagnosis of Parkinson's has to be determined.

Where do we do it?

IN NAVARRE AND MADRID

The Nuclear Medicine Service
of the Clínica Universidad de Navarra

The Nuclear Medicine Service-PET is accredited by the European Association of Nuclear Medicine, an association that guarantees the excellence and quality control of the procedures performed in this service. This accreditation also facilitates access to phase I and II clinical trials.

We have the most advanced diagnostic technology, such as PET-CT, which allows us to detect small tumor lesions that were previously practically impossible to identify.

The Clinic is the only Spanish center with the capacity to synthesize and apply up to 18 types of radiopharmaceuticals.

Diagnostic tests we perform

  • Bone densitometry.
  • Gammagraphy.
  • SPECT-CT.
  • Cellular markings.
  • Perfusion monitoring with TNF.
  • PET and PET-CT.
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Why at the Clinica?

  • We have the most advanced technology nationwide.
  • Radiopharmacy Unit with experts and capacity to synthesize the largest number of radiopharmaceuticals in Spain.
  • Radiophysics and Radiological Protection Unit to guarantee the safety of our patients and professionals.

Safer than ever to continue taking care of you

We update safety protocols weekly with the latest scientific evidence and the knowledge of the best international centers with which we collaborate.