Expanding the Nuclear Hot Lab to Accommodate Lutetium-177 - Lyanne Gomez
October 13, 2023
Phillip Koo tours the "hot lab" at an infusion center, guided by Lyanne Gomez, a nuclear medicine technologist. The conversation provides an in-depth look at the equipment used for handling PLUVICTO® (lutetium Lu 177 vipivotide tetraxetan). Lyanne explains the functions of existing equipment, such as the wipe calibrator and dose calibrator. She also introduces new additions required for PLUVICTO, including a larger "dipper" for handling the vial and beta syringe pump shield for radiation safety during injection. Lyanne emphasizes the importance of establishing standard operating procedures for radiation safety.
This video is for demonstration purposes only and no radiative drug was present.
Biographies:
Lyanne Gomez, Lead Nuclear Medicine Technologist, Chesapeake Urology Infusion Therapy Center
Phillip J. Koo, MD, Division Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Arizona.
This video is for demonstration purposes only and no radiative drug was present.
Biographies:
Lyanne Gomez, Lead Nuclear Medicine Technologist, Chesapeake Urology Infusion Therapy Center
Phillip J. Koo, MD, Division Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Arizona.
Read the Full Video Transcript
Phillip Koo: We're here in the hot lab, which occupies a small space in the corner of their infusion center. Thank you, Lyanne. Can you walk us through the various pieces of equipment you have here? And first, let's go over the piece of equipment you had before PLUVICTO, and then we'll go over those that you purchased in order to start your PLUVICTO program.
Lyanne Gomez: Okay. So in any nuclear medicine hot lab, as we like to call it, we will have a wipe calibrator, a wipe tester. This is able to tell us if there's any removable contamination that needs to be wiped up or cleaned up. And with this screen, it measures both of them. So we're able to see both numbers. So this is pretty much what a well counter will look like.
And then, this is our dose calibrator, which every nuclear medicine hot lab should have this too. This is going to be able to tell us what the dose is in a syringe or vial, whatever container we're looking at. It'll tell us how much radiation is in that container. We would have an L-Block, which all of the technologists need to work behind this, and it's to protect us from additional exposure to radiation. And then we manipulate whatever we need to do back here.
Our PLUVICTO comes in a lead-lined container, and it comes in a vial. So once I receive it from our box, and I make sure that there's no leakage in transport, we do a wipe test. We survey with a Geiger counter. Then once I determine that it is okay to open up the box, we have this lead-lined container, and it has our vial in here, which contains our lutetium.
We bring it back here. And then, the first thing I would do, there is no dose in here. But the first thing I would do is, I would measure. I would check labels, and I would measure to make sure we have enough of the product. And we would put it in our dipper, which is something new that we had to purchase for our department. Most of the radiopharmaceuticals are in 10ccs, but because we have now started PLUVICTO, we had to purchase a larger one. So PLUVICTO comes in about 12 to 15 milliliters in the vial, and we have to manipulate it and put it in our 20cc syringe. And then this is how we would measure how much of the radiopharmaceutical we have. The numbers will show up here. It's about 200 millicuries.
And then we would remove that out, put it in our syringe shield, just to protect ourselves. And then we would prep our piece over here, which is... This is another addition we had to have for our facility, syringe pump and syringe pump shields. And it's, again, to keep the technologists as low as reasonably allowable, as far as us getting radiation. So this is the other part of equipment we had to purchase.
Phillip Koo: Great. So the four pieces of equipment that you had to purchase were the syringe pump, the syringe shield, that syringe shield, and the dipper.
Lyanne Gomez: Yes.
Phillip Koo: And the pump, as we discussed, is optional, right?
Lyanne Gomez: Yeah.
Phillip Koo: You could still do a hand injection.
Lyanne Gomez: You can do a hand injection if you do, but here at our practice, we do clinical trials as well, and we just have a little bit of a larger volume. For me to be protected as much as I possibly can, we wanted to go ahead and invest in this. And it was just because we have a lot of injections going on, it was just a better option to minimize additional exposure that did not need to be.
Here is our radioactive emergency spill kit, that. It's nice to have. Obviously, it's just if you were to have a spill, you want to contain it in a very small area, and you want to start cleaning from outside inwards. You don't want it to spill, continuing on. So this is a nice box that the company makes for us, and it just has everything that you would possibly need in order to contain that spill.
This is where we hold our waste after an injection. So we have lead-lined bins. We have four of them. So we scoop it out. Our current waste is in here, and then we have our waste that is decaying back here. We have to wait about 10 half-lives, two and a half months. Once this completely decays, we would dispose of it as normal biohazard waste.
Phillip Koo: We're here in the hot lab, which occupies a small space in the corner of their infusion center. Thank you, Lyanne. Can you walk us through the various pieces of equipment you have here? And first, let's go over the piece of equipment you had before PLUVICTO, and then we'll go over those that you purchased in order to start your PLUVICTO program.
Lyanne Gomez: Okay. So in any nuclear medicine hot lab, as we like to call it, we will have a wipe calibrator, a wipe tester. This is able to tell us if there's any removable contamination that needs to be wiped up or cleaned up. And with this screen, it measures both of them. So we're able to see both numbers. So this is pretty much what a well counter will look like.
And then, this is our dose calibrator, which every nuclear medicine hot lab should have this too. This is going to be able to tell us what the dose is in a syringe or vial, whatever container we're looking at. It'll tell us how much radiation is in that container. We would have an L-Block, which all of the technologists need to work behind this, and it's to protect us from additional exposure to radiation. And then we manipulate whatever we need to do back here.
Our PLUVICTO comes in a lead-lined container, and it comes in a vial. So once I receive it from our box, and I make sure that there's no leakage in transport, we do a wipe test. We survey with a Geiger counter. Then once I determine that it is okay to open up the box, we have this lead-lined container, and it has our vial in here, which contains our lutetium.
We bring it back here. And then, the first thing I would do, there is no dose in here. But the first thing I would do is, I would measure. I would check labels, and I would measure to make sure we have enough of the product. And we would put it in our dipper, which is something new that we had to purchase for our department. Most of the radiopharmaceuticals are in 10ccs, but because we have now started PLUVICTO, we had to purchase a larger one. So PLUVICTO comes in about 12 to 15 milliliters in the vial, and we have to manipulate it and put it in our 20cc syringe. And then this is how we would measure how much of the radiopharmaceutical we have. The numbers will show up here. It's about 200 millicuries.
And then we would remove that out, put it in our syringe shield, just to protect ourselves. And then we would prep our piece over here, which is... This is another addition we had to have for our facility, syringe pump and syringe pump shields. And it's, again, to keep the technologists as low as reasonably allowable, as far as us getting radiation. So this is the other part of equipment we had to purchase.
Phillip Koo: Great. So the four pieces of equipment that you had to purchase were the syringe pump, the syringe shield, that syringe shield, and the dipper.
Lyanne Gomez: Yes.
Phillip Koo: And the pump, as we discussed, is optional, right?
Lyanne Gomez: Yeah.
Phillip Koo: You could still do a hand injection.
Lyanne Gomez: You can do a hand injection if you do, but here at our practice, we do clinical trials as well, and we just have a little bit of a larger volume. For me to be protected as much as I possibly can, we wanted to go ahead and invest in this. And it was just because we have a lot of injections going on, it was just a better option to minimize additional exposure that did not need to be.
Here is our radioactive emergency spill kit, that. It's nice to have. Obviously, it's just if you were to have a spill, you want to contain it in a very small area, and you want to start cleaning from outside inwards. You don't want it to spill, continuing on. So this is a nice box that the company makes for us, and it just has everything that you would possibly need in order to contain that spill.
This is where we hold our waste after an injection. So we have lead-lined bins. We have four of them. So we scoop it out. Our current waste is in here, and then we have our waste that is decaying back here. We have to wait about 10 half-lives, two and a half months. Once this completely decays, we would dispose of it as normal biohazard waste.