# Radiopharmaceutical

Radiopharmaceuticals, or medicinal radiocompounds, are a group of pharmaceutical drugs containing radioactive isotopes. Radiopharmaceuticals can be used as diagnostic and therapeutic agents. Radiopharmaceuticals emit radiation themselves, which is different from contrast media which absorb or alter external electromagnetism or ultrasound. Radiopharmacology is the branch of pharmacology that specializes in these agents.
The main group of these compounds are the radiotracers used to diagnose dysfunction in body tissues. While not all medical isotopes are radioactive, radiopharmaceuticals are the oldest and remain the most common of such drugs.

## Drug nomenclature

As with other pharmaceutical drugs, there is standardization of the drug nomenclature for radiopharmaceuticals, although various standards coexist. The International Nonproprietary Names (INNs), United States Pharmacopeia (USP) names, and IUPAC names for these agents are usually similar other than trivial style differences. The details are explained at Radiopharmacology § Drug nomenclature for radiopharmaceuticals.

## Specific radiopharmaceuticals

A list of nuclear medicine radiopharmaceuticals follows. Some radioisotopes are used in ionic or inert form without attachment to a pharmaceutical; these are also included. There is a section for each radioisotope with a table of radiopharmaceuticals using that radioisotope. The sections are ordered alphabetically by the English name of the radioisotope. Sections for the same element are then ordered by atomic mass number.

### Calcium-47

$^{47}$Ca is a beta and gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Ca-47-Ca$^{2+}$ | Bone metabolism | IV | In-vitro | Non-imaging |

### Carbon-11

$^{11}$C is a positron emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| C11-L-methyl-methionine | Brain tumour imaging Parathyroid imaging | IV | In-vivo | Imaging |

### Carbon-14

$^{14}$C is a beta emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| C14-Glycocholic acid | Breath test for small intestine bacterial overgrowth | Oral | In-vitro | Non-imaging |
| C14-PABA (para-amino benzoic acid) | Pancreatic studies | Oral | In-vitro | Non-imaging |
| C14-Urea | Breath test to detect Helicobacter pylori | Oral | In-vitro | Non-imaging |
| C14-d-xylose | Breath test for small intestine bacterial overgrowth | Oral | In-vitro | Non-imaging |

### Chromium-51

$^{51}$Cr is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Cr51-[heart scan/blood volume | Red cell volume heart scan; sites of sequestration; gastrointestinal blood loss | IV | In-vitro | Non-imaging |
| Cr51-Cr$^{3+}$ | Gastrointestinal protein loss | IV | In-vitro | Non-imaging |
| Cr51-EDTA (ethylenediaminetetraacetic acid) | Glomerular filtration rate measurement | IV | In-vitro | Non-imaging |

### Cobalt-57

$^{57}$Co is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Co57-Cyanocobalamin (vitamin B$_{12}$) | Gastrointestinal absorption | Oral | In-vitro | Non-imaging |

### Cobalt-58

$^{58}$Co is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Co58-Cyanocobalamin (vitamin B$_{12}$) | Gastrointestinal absorption | Oral | In-vitro | Non-imaging |

### Erbium-169

$^{169}$Er is a beta emitter.
| Name | Treatment of | Route of administration |
| Er169-Colloid | Arthritic conditions | Intra-articular |

### Fluorine-18

$^{18}$F is a positron emitter with a half-life of 109 minutes. It is produced in medical cyclotrons, usually from oxygen-18, and then chemically attached to a pharmaceutical formulation.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| F18-FDG (Fluorodeoxyglucose) | Tumor imaging Myocardial imaging | IV | In-vivo | Imaging |
| F18-Sodium Fluoride | Bone imaging | IV | In-vivo | Imaging |
| F18-Fluorocholine | Prostate tumor imaging | IV | In-vivo | Imaging |
| F18-Desmethoxyfallypride | Dopamine receptor imaging | IV | In-vivo | Imaging |

### Gallium-67

$^{67}$Ga is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Ga67-Ga$^{3+}$ | Tumor imaging | IV | In-vivo | Imaging |
| Ga67-Ga$^{3+}$ | Infection/inflammation imaging | IV | In-vivo | Imaging |

### Gallium-68

$^{68}$Ga is a positron emitter, with a 68-minute half-life, produced by elution from germanium-68 in a gallium-68 generator or by proton irradiation of zinc-68.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Ga68-Dotatoc or Dotatate | Neuroendocrine tumor imaging | IV | In-vivo | Imaging |
| Ga68-PSMA | Prostate cancer imaging | IV | In-vivo | Imaging |

### Hydrogen-3

$^3$H or tritium is a beta emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| H3-water | Total body water | Oral or IV | In-vitro | Non-imaging |

### Indium-111

$^{111}$In is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| In111-DTPA (diethylenetriaminepenta-acetic acid) | Ventriculo-peritoneal shunt (LaVeen Shunt) | intraperitoneal injection | In-vivo | Imaging the radioactive substance |
| In111-DTPA (diethylenetriaminepenta-acetic acid) | Cisternography | Intra-cisternal | In-vivo | Imaging |
| In111-Leukocytes | Infection/inflammation imaging | IV | In-vivo | Imaging |
| In111-Platelets | Thrombus imaging | IV | In-vivo | Imaging |
| In111-Pentetreotide | Somatostatin receptor imaging | IV | In-vivo | Imaging |
| In111-Octreotide | Somatostatin receptor imaging (Octreoscan) | IV | In-vivo | Imaging |

### Iodine-123

Iodine-123 (I-123) is a gamma emitter. It is used only diagnostically, as its radiation is penetrating and short-lived.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| I123-Iodide | Thyroid uptake | Oral or IV | In-vivo | Non-imaging |
| I123-Iodide | Thyroid imaging Thyroid metastases imaging | Oral or IV | In-vivo | Imaging |
| I123-o-Iodohippurate | Renal imaging | IV | In-vivo | Imaging |
| I123-MIBG (m-iodobenzylguanidine) | Neuroectodermal tumour imaging | IV | In-vivo | Imaging |
| I123-FP-CIT | SPECT imaging of Parkinson's Disease | IV | In-vivo | Imaging |

### Iodine-125

$^{125}$I is a gamma emitter with a long half-life of 59.4 days (the longest of all radioiodines used in medicine). Iodine-123 is preferred for imaging, so I-125 is used diagnostically only when the test requires a longer period to prepare the radiopharmaceutical and trace it, such as a fibrinogen scan to diagnose clotting. I-125's gamma radiation is of medium penetration, making it more useful as a therapeutic isotope for brachytherapy implant of radioisotope capsules for local treatment of cancers.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| I125-fibrinogen | Clot imaging | IV | In-vivo | Imaging |

### Iodine-131

$^{131}$I is a beta and gamma emitter. It is used both to destroy thyroid and thyroid cancer tissues (via beta radiation, which is short-range), and also other neuroendocrine tissues when used in MIBG. It can also be seen by a gamma camera, and can serve as a diagnostic imaging tracer, when treatment is also being attempted at the same time. However iodine-123 is usually preferred when only imaging is desired.

#### Diagnostic

| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| I131-Iodide | Thyroid uptake | Oral | In-vivo | Non-imaging |
| I131-Iodide | Thyroid metastases imaging | Oral or IV | In-vivo | Imaging |
| I131-MIBG (m-iodobenzylguanidine) | Neuroectodermal tumor imaging | IV | In-vivo | Imaging |

#### Therapeutic

| Name | Treatment of | Route of administration |
| I131-Iodide | Thyrotoxicosis | IV or Oral |
| I131-Iodide | Non-toxic goiter | IV or Oral |
| I131-Iodide | Thyroid carcinoma | IV or Oral |
| I131-MIBG (m-iodobenzylguanidine) | Malignant disease | IV |

### Iron-59

$^{59}$Fe is a beta and gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Fe59-Fe$^{2+}$ or Fe$^{3+}$ | Iron metabolism | IV | In-vitro | Non-imaging |

### Krypton-81m

$^{81}$Kr$^m$ is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging the radioactive substance |
| Kr81m-Gas | Lung ventilation imaging | Inhalation | In-vivo | Imaging |
| Kr-81m-Aqueous solution | Lung perfusion imaging | IV | In-vivo | Imaging |

### Lutetium-177

$^{177}$Lu is a beta emitter.
| Name | Treatment of | Route of administration | In-vitro / in-vivo |
| $^{177}$Lu-DOTA-TATE | gastroenteropancreatic neuroendocrine tumors (GEP-NETs) | IV | In-vivo |

### Nitrogen-13

$^{13}$N is a positron emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| N13-Ammonia | Myocardial blood flow imaging | IV | In-vivo | Imaging |

### Oxygen-15

$^{15}$O is a positron emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| O15-Water | Cerebral blood flow imaging Myocardial blood flow imaging | IV bolus | In-vivo | Imaging |

### Phosphorus-32

$^{32}$P is a beta emitter.
| Name | Treatment of | Route of administration |
| P32-Phosphate | Polycythemia and related disorders | IV or Oral |

### Radium-223

$^{223}$Ra is an alpha emitter.
| Name | Treatment of | Route of administration |
| Ra223 cation ($^{223}$RaCl$_2$) | metastatic cancer in bone | IV |

### Rubidium-82

$^{82}$Rb is a positron and gamma emitter.
| Name | Investigation of | Route of administration |
| Rb-82 chloride | Myocardial Imaging | IV |

### Samarium-153

$^{153}$Sm is a beta and gamma emitter.
| Name | Treatment of | Route of administration |
| Sm153-EDTMP (Ethylenediaminotetramethylenephosphoric acid) | Bone metastases | IV |

### Selenium-75

$^{75}$Se is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Se75-Selenorcholesterol | Adrenal gland imaging | IV | In-vivo | Imaging |
| Se75-SeHCAT (23-Seleno-25-homo-tauro-cholate) | Bile salt absorption | Oral | In-vivo | Imaging |

### Sodium-22

$^{22}$Na is a positron and gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Na22-Na$^+$ | Electrolyte studies | Oral or IV | In-vitro | Non-imaging |

### Sodium-24

$^{24}$Na is a beta and gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Na24-Na$^+$ | Electrolyte studies | Oral or IV | In-vitro | Non-imaging |

### Strontium-89

$^{89}$Sr is a beta emitter.
| Name | Treatment of | Route of administration |
| Sr89-Chloride | Bone metastases | IV |

### Technetium-99m

Technetium-99m is a gamma emitter. It is obtained on-site at the imaging center as the soluble pertechnetate which is eluted from a technetium-99m generator, and then either used directly as this soluble salt, or else used to synthesize a number of technetium-99m-based radiopharmaceuticals.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Tc99m-pertechnetate | Thyroid uptake and thyroid imaging Stomach and salivary gland imaging Meckel's diverticulum imaging Brain imaging Micturating cystogram First pass blood flow imaging First pass peripheral vascular imaging | IV | In-vivo | Imaging |
| Tc99m-pertechnetate | Lacrimal imaging | Eye drops | In-vivo | Imaging |
| Tc99m-Human albumin | Cardiac blood pool imaging | IV | In-vivo | Imaging |
| Tc99m-Human albumin | Peripheral vascular imaging | IV | In-vivo | Imaging |
| Tc99m-Human albumin macroaggregates or microspheres | Lung perfusion imaging | IV | In-vivo | Imaging |
| Tc99m-Human albumin macroaggregates or microspheres | Lung perfusion imaging with venography | IV | In-vivo | Imaging |
| Tc99m-Phosphonates and phosphates (MDP/HDP) | Bone imaging | IV | In-vivo | Imaging |
| Tc99m-Phosphonates and phosphates | Myocardial imaging | IV | In-vivo | Imaging |
| Tc99m-DTPA (diethylenetriaminepenta-acetic acid) | Renal imaging First pass blood flow studies Brain imaging | IV | In-vivo | Imaging |
| Tc99m-DTPA (diethylenetriaminepenta-acetic acid) | Lung ventilation imaging | Aerosol inhalation | In-vivo | Imaging |
| Tc99m-DMSA(V) (dimercaptosuccinic acid) | Tumor imaging | IV | In-vivo | Imaging |
| Tc99m-DMSA(III) (dimercaptosuccinic acid) | Renal imaging | IV | In-vivo | Imaging |
| Tc99m-Colloid | Bone marrow imaging GI Bleeding | IV | In-vivo | Imaging |
| Tc99m-Colloid | Lymph node imaging | Interstitial | In-vivo | Imaging |
| Tc99m-Colloid | Esophageal transit and reflux imaging Gastric emptying imaging | Oral | In-vivo | Imaging |
| Tc99m-Colloid | Lacrimal imaging | Eye drops | In-vivo | Imaging |
| Tc99m-HIDA (Hepatic iminodiacetic acid) | Functional biliary system imaging | IV | In-vivo | Imaging |
| Tc99m-Denatured (heat damaged) red blood cells | Red cell volume Spleen imaging | IV | In-vitro | Non-imaging |
| Tc99m-Whole red blood cells | GI bleeding Cardiac blood pool imaging Peripheral vascular imaging | IV | In-vivo | Imaging |
| Tc99m-MAG3 (mercaptoacetyltriglycine) | Renal imaging First pass blood flow imaging | IV | In-vivo | Imaging |
| Tc99m-Exametazime (HMPAO) | Cerebral blood flow imaging | IV | In-vivo | Imaging |
| Tc99m-Exametazime labelled leucocytes | Infection/inflammation imaging | IV | In-vivo | Imaging |
| Tc99m-Sestamibi (MIBI - methoxy isobutyl isonitrile) | Parathyroid imaging Non-specific tumor imaging Thyroid tumor imaging Breast imaging Myocardial imaging | IV | In-vivo | Imaging |
| Tc99m-Sulesomab (IMMU-MN3 murine Fab'-SH antigranulocyte monoclonal antibody fragments) | Infection/inflammation imaging | IV | In-vivo | Imaging |
| Tc99m-Technegas | Lung ventilation imaging | Inhalation | In-vivo | Imaging |
| Tc99m-Human immunoglobulin | Infection/inflammation imaging | IV | In-vivo | Imaging |
| Tc99m-Tetrofosmin | Parathyroid imaging Myocardial imaging | IV | In-vivo | Imaging |
| Tc99m-ECD (ethyl cysteinate dimer) | Brain imaging----- | IV | In-vivo | Imaging |

### Thallium-201

$^{201}$Tl is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Tl201-Tl$^+$ | Non-specific tumor imaging Thyroid tumor imaging Myocardial imaging Parathyroid imaging | IV | In-vivo | Imaging |

### Xenon-133

$^{133}$Xe is a gamma emitter.
| Name | Investigation | Route of administration | In-vitro / in-vivo | Imaging / non-imaging |
| Xe133-gas | Lung ventilation studies | Inhalation | In-vivo | Imaging |
| Xe133 in isotonic sodium chloride solution | Cerebral blood flow | IV | In-vivo | Imaging |

### Yttrium-90

$^{90}$Y is a beta emitter.
| Name | Treatment of | Route of administration |
| Y90-Silicate | Arthritic conditions | Intra-articular |
| Y90-Silicate | Malignant disease | Intracavitary |