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Nuclear Pharmacy

Expectations

Agenda

Ahmed Atwan

MSc Radiopharmaceutics & PET Radiochemistry,

MBA International Business, BPharm

Webinar Objectives

  • 1. To introduce the field of Nuclear Pharmacy to students and recent graduates and show its impact in the medical field.
  • 2. To give pharmacy students and graduates the prospectus to specialize in this field.

Webinar Objectives

Agenda

  • What is nuclear pharmacy?
  • Clarifying terms
  • Radiation Physics
  • Medical applications
  • Nuclear Pharmacy story at CCHE-57357
  • How to Become a Nuclear Pharmacist?

Case

AA (MRN: 20172976) is an LCH patient scheduled for W6 evaluation. His last chemotherapy was on 28/2/2018, and his primary investigator (PI) scheduled him for PET/CT scan on 4/3/2018.

CASE

What would you do?

About

Introduction

What is Nuclear Pharmacy?

Importance

Nuclear Pharmacy

Nuclear pharmacy is a specialty area of pharmacy practice dedicated to the compounding and dispensing of radioactive materials for use in medical procedures.

(Purdue University, 2019)

Nuclear Pharmacy

Importance of Nuclear Pharmacist

Improve and promote public health through the safe and effective use of radiopharmaceuticals for diagnosis and therapy.

(BPS, 2019).

Importance

The

Science

Terminology

Clarifying Terms

What is a Radiopharmaceutical?

Radiopharmaceutical

A radiopharmaceutical is a radioactive drug used for diagnosis or therapy in a tracer quantity with no pharmacological effect. It is composed of two parts; a radionuclide and a pharmaceutical.

Example

FDG: Fluorodeoxyglucose

  • Metabolic marker
  • Positron emitter
  • Used for cancer imaging
  • Half-life (109.8 min)

Nuclear Medicine

Nuclear medicine is a medical specialty that uses small amounts of radioactive drugs to diagnose and treat a variety of diseases, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body.

Nuclear Medicine

Cyclotron

A cyclotron is a type of particle accelerator that uses a constant magnetic field to hold charged particles in a circular spiral pattern.

Cyclotron

Radiology

Radiologists are medical doctors who specialize in diagnosing and treating diseases and injuries using medical imaging techniques, such as x-rays, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET) and ultrasound.

Radiology

Radiotherapy

Radiotherapy means the use of radiation, usually X-rays, to treat illness.

Radiotherapy

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is a scan that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. It may involve the use of contrast agents.

Alpha

Why do you need to know about radiation physics ?

Radiation Physics

  • Properties and selection of radionuclides
  • Diagnostics / imaging
  • Therapy
  • Radiation dosimetry
  • Radiobiology
  • Quality control + analysis
  • Imaging systems
  • Radiation protection

Types of Radiation

Radiation Types

Alpha

Gamma

Beta

Positron

Alpha Particles

  • Helium nucleus
  • Highly energetic
  • Low penetration (Stopped by paper)

Alpha

Beta Particles

  • Electrons (negatively charged)
  • Also highly energetic (but lower than alpha partials)
  • Stopped by Aluminum plate

Beta

Gamma Rays

  • High energy electromagnetic radiation
  • Exponentially attenuated by dense material
  • (Lower energy EM than x-rays)

Gamma

Positron Particles

  • Positively charged electrons
  • Annihilation phenomena
  • Produces 2 anti-parallel gamma rays

Positron

Medical Applications

What are the possible applications?

Diagnosis

PET-CT Scan

SPECT Scan

SPECT Scan

SPECT Whole Process

Example:

  • Tc-99m (used with various kits)
  • MDP for scan
  • DTPA for renal scan
  • In-111

PET Scan process

PET Whole Process

eg. F-18-FDG

Radionuclide Therapy

Examples

  • I-131 Therapy

  • Y-90

  • Ga-68/Lu-177 Theranostics

Therapy

Targeted Alpha Therapy (TAT)

Bi-213/Ac-255

Radium-223

treatment of bone metastasis

Radiopharmaceutical Research

Research Applications

  • Localisation mechanisms
  • Oncology treatment and imaging
  • Neuroimaging
  • Proteins labelling
  • Targeted Alpha Therapy
  • Cell tracking
  • Imaging gene therapy

Nuclear Pharmcy at CCHE

Birth of the Future

Nuclear Pharmacy beginnings at 57357

Our Journey

Mission Statement

Mission Statement

1. Ensure safe and effective use of radiopharmaceuticals for patients and provide best quality service that outstands as model of practice for organisations around the world.

2. Revolutionise the radiopharmaceutical industry and achieve excellence in radiopharmaceutical service and practice.

ROLE

Perform all duties required of a Nuclear Pharmacist at CCHE-57357 nuclear medicine department. Be responsible for operational support in compliance with cGMP, radiation safety program, license commitments and corporate policies in the preparation and distribution of quality radiopharmaceuticals. Provides support in all aspects of the local business including financial, human resource management, regulatory compliance and customer support.

Questions

As a pharmacist verifying any order to be administered to a pt., we had to answer…

  • Why this radiopharmaceutical?
  • Why this timing?
  • The first question was well understood in our preparatory training.
  • THE SCAN TIMING…?!
  • Time of evaluation (in protocol )
  • Is it the suitable way of evaluation? ( some are not clear in the protocol roadmap )

Impact

Impact

Automation of Workflow

Automation

Verification step added extra quality to the service

Many patients were about to make a PET/CT scan in wrong timings, that would result in …

  • False evaluation results!!!, and so
  • Wrong case judgment, and may be
  • Wrong clinical decision…

So we saved patients from…

  • False results
  • Unnecessary radiation dose
  • Wasting time and money of traveling to the hospital then be postponed

Clinical Interventions

Total Clinical Interventions in 2018 is 1025 intervention.

Clinical Interventions

Financial Impact

Total No. Canceled or Postponed in the Last 6 Month of 2018 : 24 patients

Financial Savings

Case

AA (MRN: 20172976) is an LCH patient scheduled for W6 evaluation. His last chemotherapy was on 28/2/2018, and his primary investigator (PI) scheduled him for PET/CT scan on 4/3/2018.

CASE

It’s not the future anymore

It’s the PRESENT

Patient PET/CT scan was postponed to 11/3/2018 (10 days after last chemotherapy)

How to Become a Nuclear Pharmacist?

Nuclear Pharmacist

Nuclear Pharmacy Education Programs

Education

  • Radiopharmaceutics & PET Radiochemistry MSc, King's College London
  • The BPS Board Certified Nuclear Pharmacist (BCNP) program
  • Nuclear Education Online, University of Arkansas for Medical Sciences & University of New Mexico
  • Nuclear Pharmacy CE Program, Purdue University
  • Radiopharmacy Courses, EANM

Call of Duty

  • Legalisation of nuclear pharmacist role in MENA region
  • Apply the nuclear pharmacist role in every nuclear medicine unit, hospital or production facilities.
  • Radiopharmaceutical research
  • Network for nuclear pharmacists in Africa MENA region
  • Nuclear pharmacy society
  • Social responsibility of nuclear pharmacist

References

  • Sampson’s Textbook of Radio-pharmacy, Tony Theobald (ed.), 4th ed., 2010, Pharmaceutical Press
  • Fundamentals of Nuclear Pharmacy, G B Saha, 6th ed., 2010, AD
  • Handbook of Radiopharmaceuticals: Radiochemistry and Applications, M J Welch & C S Redvanly (eds.) 2004, Wiley
  • British Pharmacopoeia 2004, Volume II, HMSO, 2004 (available on line in the Library & IT Services)
  • Current Directions in Radiopharmaceutical Research and Development, S J Mather (ed.), 1996, Kluwer Academic

Activity

  • F-18
  • Tc-99m
  • I-131
  • FDG targeting mechanism

Must Know

Future Presentations

  • Nuclear chemistry and cyclotron engineering
  • Positron emitting isotopes
  • FDG production and medical importance
  • Tc-99m based radiopharmaceuticals
  • Biological effects of radiation
  • Radiation dosimetry
  • Instrumentation & types of detector
  • Radiation protection and personnel safety
  • GMP and quality control
  • Role of nuclear pharmacist and interdisciplinary collaboration

Questions?

Contact

Info

ahmed.atwan@57357.org

nph.ahmedatwan@gmail.com

https://www.linkedin.com/in/ahmed-atwan-8080a13b/

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