Adsorption of radiopharmaceuticals to syringes leads to lower administered activity than intended

In this study we examined the delivered activity of radiopharmaceuticals injected into patients and the various factors which lead to incomplete delivery. Four commonly used 99Tcm radiopharmaceuticals were included, namely pertechnetate, methylene diphosphonate (MDP), macro-aggregated albumin (MAA) and tetrofosmin. There was no appreciable residual activity after injection of pertechnetate and MDP other than that due to the dead space in syringes (0.06 ml, 4% of measured activity). However, there was considerable residual activity following an MAA injection. This was particularly dependent on the radiopharmaceutical residence time in the syringe prior to injection. If MAA was pre-dispensed there was up to 80% of activity remaining in the syringe following injection. We have shown that this activity is not bound and can be decreased by agitating the syringe prior to the injection. For tetrofosmin, the activity remaining in the syringe was shown to be mostly due to adsorption of the tetrofosmin onto the plastic syringe (up to 30% of the activity); in particular, onto the rubber plunger. The amount of binding probably depends on the formulation of the rubber plunger and the plastic barrel, which varies between manufacturers. Of the three commonly used syringe brands (Becton-Dickinson, Sherwood, and Braun syringes) the Braun syringes were shown to have the least binding (6%) and would be most suitable for tetrofosmin injection. We recommend the use of Braun syringes for tetrofosmin. We also recommend that pre-dispensed MAA injections should be gently agitated before injection into the patient. No special precautions are necessary for pertechnetate or MDP injections.