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SAMARIUM-153 THERAPY and Scan
10.6
Clearwater Imaging Associates Protocol
INDICATIONS:
Palliative treatment of painful bone metastasis.
SCHEDULING:
1. Instructions to Patients:
a. Obtain insurance authorization, if necessary.
b. No special preparation is required.
c. Schedule all patients to be treated on day scheduled. Consultation is not
required, as long as:
(1) Consent form is signed and witnessed.
(2) Check-list is completed and signed by referring physician, and
reviewed by nuclear medicine nurse.
** A consult may be requested by the referring physician**
d. Dose is available only on Wednesday, Thursday, and expires at noon on
Friday.
Patient must be scheduled for Wednesday or Thursday at 1:00 pm.
2.
3.
When patient arrives, an IV line will be started, nuclear medicine
physician may wish to speak with patient. Patient is to have whole body
scan with Sm-153 dose 1-2 hours after injection or next day if OK with
physician, if no bone scan within 60 days or if requested by referring
physician. Total exam time is approximately 3 hours.
Image Correlation:
Films and reports of recent bone scans and bone x-rays from Morton
Plant Hospital, or elsewhere.
4.
Other Information:
a. Morton Plant Hospital chart to be available on day of appointment.
b. Prepare a red therapy file, containing the Sr-89/Sm-153 Therapy Data
Sheet, Patient Pain Record, and Sm-153 Therapy Consent Form.
Fill in patient name, medical record number, date of appointment,
and laboratory values.
c. After completion of treatment, the red therapy file should contain the
following information, in order, stapled together as a packet:
(1) Prescription.
(2) Nuclear medicine physician letter to referring physician.
(3) Copy of treatment report.
(4) Data sheet.
(5) Patient pain record.
(6) Any additional notes from the nuclear medicine physician.
(7) Any additional reports enclosed by the nuclear medicine physician.
(8) Signed consent form.
(9) Requisition.
(10) Therapy QM sheet must be filled out with appropriate information
attached.
RADIOPHARMACEUTICAL:
Samarium-153 (Quadramet), I.V., 1.0 mCi/kg, 46.3 HR T½ (1.93 days). The
nuclear medicine physician will determine the dose on a case-to-case basis.
(Supplied by Berlex, order from Syncor 1-800-934-2434. Manufactured on
Tuesday – supplied to pharmacy Wednesday 12:00 noon, and expires Friday
12:00 noon.)
PREPARATION:
1.
2.
Shielding: Sm-153 is a beta and gamma emitter with a maximum range of
0.5 to 3.0 mm. HVL 0.1 mm Pb (lead). The most important shielding
consideration is bremsstrahlung radiation. Sm-153 should be kept in a
plastic or glass syringe. The unshielded vial should be handled with
tongs, due to the high surface activity levels.
Calibration:
a. Available in two sizes, shipped in lead, expiration 48 hrs after
calibration:
·
·
2 mL, 100 mCi (3,700 MBq)
3 mL, 150 mCi (5,550 MBq)
b. Follow the manufacturer's instructions for confirming dose activity in
the dose calibrator, using an appropriate manual dial setting and
conversion factor.
c. Review a) and b) with the nuclear medicine physician. The technologist
must initial the dose labels and the data sheet.
d. The Quality Management form must be filled in and signed by the
technologist.
3.
Do not proceed until patient has met with the nuclear medicine physician,
and the consent form has been signed.
4.
RN will place a reseal intravenous line in the largest arm vein available.
PROCEDURE:
1.
Confirm proper placement of the IV line by gently obtaining blood return.
Don gloves and start IV fluid hydration. Hydrate 500 cc over one hour.
Inject Sm-153 at 30 min. after hydration begins. Patient can be scanned
at 1.5 hours later on Helix or Varicam, using Sm-153 isotope settings.
2.
When an implanted port (e.g., Infusaport, A-port, etc.) or tunneled
catheter (Broviac, Hickman, Groshong, etc.) is used for IV access, care
must be taken to assure patency. If no blood return is obtained upon
accessing port, notify attending physician, with request for contrast study
in x-ray to determine the exact location of catheter tip. If placement is
correct, as determined by radiologist or attending physician, therapy may
begin, following same procedure as for peripheral site. Port or catheter
MUST be flushed with additional fluid to prevent retention of Sm-153 in
reservoir or catheter, followed by appropriate amount of heparin.
3.
Remove the entire IV apparatus with syringes (no need to store IV fluid,
just tubing and down), wrap in absorbable paper, label with date. Store
wrapped Chux in waste storage area in Hot Lab. DUE TO THE 46.3 HR
HALF LIFE OF SM-153, THIS MUST BE STORED FOR 20 DAYS FOR
DECAY, PRIOR TO DISPOSAL (approximately 10T½). This is not
considered an extra long-lived isotope, and does not need to be sent back
to pharmacy.
3.
Survey the room for contamination after injection, using the GeigerMueller count rate meter with shield open.
4.
Patients are instructed to call the referring oncologist or nuclear medicine
physician after treatment with any questions or concerns, but all
management decisions will be made only by the referring physician.
Patients are instructed that any new symptoms should be reported
promptly to the referring physician. These symptoms include (but are not
limited to) nausea, vomiting, fever, bruising, easy bleeding, trouble with
bowel or bladder control, weakness in the legs, or sudden increase in
pain. Patients are instructed to take pain medications regularly, according
to the directions of their referring physician, and to reduce pain medication
only in accord with the instructions of the referring physician.
5.
Individuals with incontinence should wear disposable diapers for three days
after therapy. Send disposable gloves home to be worn by care givers.
IMAGING PROCEDURE:
1.
Imaging WB scan to be done at 1-2 hours after injection of Sm-153.
2.
Perform whole body images using a dual head camera.
3.
Change isotope to Sm-153. The peaks should be at 70 KeV and
103 KeV with 20% windows.
4.
Imaging time changed from 240 sec. to 180 sec.
5.
Film off Xeleris system 1:1 and label Quadramet or Samarium-153
WB scan.
NOTES:
1.
Spills: Inform, contain, and decontaminate per standard departmental
protocol. Cleaning materials must be held for 20 days before disposal.
2.
If emergency surgery is required after administration of Sm-153, the
Radiation Safety Officer must contact the surgeon to advise appropriate
precautions, including double gloving and use of safety glasses.
3.
In the event of death after administration of Sm-153, instruct the Medical
Director or Funeral Director to wait for the Radiation Safety Officer to
measure distribution before proceeding with autopsy, embalming, or
cremation.
REFERENCES:
1.
Resche I, Chatal J-F, Pecking I, et al. A dose-controlled study of 153Smethylenediaminetetramethylenephosphonate (EDTMP) in the treatment of
patients with painful bone metastases. Eur J Cancer 33(10):1583-1591,
1997.
JSM
PROTOCOL\10.6
Rev. 7/25/08
Note:
This procedure has not yet been reviewed by the Society of nuclear
medicine procedure guideline development process.