1. Department of Nuclear Medicine Asan Medical Center, Seoul, Korea Eun Mi Chung

2.  The use of 99m Tc-RBC –Gastrointestinal Bleeding Scan –Hemangioma Scan –Multi-Gated Blood Pool Scan (MUGA)

3. 1. The labeling method of 99m Tc-RBC –In vivo Method –In vitro Method –Modified-In vitro (In vivo) Method –AMC RBC labeling method Method

4.  Modified-In vitro (In vivo) Method –The most complicated method –Combined In vivo with In vitro : for the convenience and safe : for the convenience and safe & for the increased labeling efficiency & for the increased labeling efficiency –Obtain over 90 % labeling efficiency

5.  AMC RBC labeling Method –Re-modified conventional modified-In vitro method –Centrifugal separation process again offers more favorable condition to combine RBC with 99m Tc0 4 - by eliminating an plasma ingredient. –Only 5~6mins more required –Avg. labeling efficiency ≥ 95 %, about 5 % increased

6. Stable labeling efficiency Supplement a problem about additional time More needs the additional centrifugal separation process for 3~5minutes Compared conventional In-vitro labeling method (AMC RBC labeling method) More needs the additional centrifugal separation process for 3~5minutes Compared conventional In-vitro labeling method (AMC RBC labeling method) Require to be additional time, efforts and process

7.  Term –May. 2009 ~ Sept. 2009 (Department of Nuclear Medicine Asan Medical Center) (Department of Nuclear Medicine Asan Medical Center)  Population of study  Statistical analysis by SPSS 12.0 –One-way ANOVA & Duncan’s test –Independent Samples t-test Hemangima G-I bleeding totalMale81321 Female729 total151530

8.  Modified-In vitro labeling method ➀ Stannous ion IV (Sncl 2 10ug/kg) 20min ACD 99m TcO 4 ➁ Withdrawing 5cc of blood with 1cc of ACD is contained syringe ➂ Adding 30mCi of 99m Tc0 4 - ➃ Incubating on the agitator for 20 mins ➄ Centrifugal separating for 5 mins ➅ Withdrawing 99m Tc-RBC only

9.  AMC labeling Method -1 ➀ Stannous ion IV (Sncl 2 10ug/kg) 20min ACD 99m TcO 4 ➁ Withdrawing 5cc of blood with 1cc of ACD is contained syringe ➂ Centrifugal separating for 5 mins ➄ Adding 30mCi of 99m Tc0 4 - ➃ Remove plasma (check its’ volume)

10.  AMC labeling Method -2 ➅ Incubating on the agitator for ➈ Withdrawing 99m Tc-RBC only ➆ Adding saline as much as removed plasma volume ➇ Centrifugal separating for 5 mins 20 mins

11.  Differences of the labeling efficiency from change of incubating time ** p < 0.05

12.  Boxplots of AMC labeling Method in different incubating time

13. StudynMean(%)SD(%)tp GI bleeding1590.25.6 2.540.017 Hemangioma1594.43.2  Incubating time in Study (5 min)  Incubating time in Study (10 min) StudynMean(%)SD(%)tp GI bleeding1594.46.6 1.970.066 Hemangioma1597.71.8

14.  Incubating time in Study (15 min)  Incubating time in Study (20 min) StudynMean(%)SD(%)tp GI bleeding1596.06.7 1.550.141 Hemangioma1598.71.1 StudynMean(%)SD(%)tp GI bleeding1596.36.8 1.660.118 Hemangioma1599.20.8

15.  We couldn’t consider a variety of factors due to lack of specimens which affect RBC labelling efficiency  We performed exam using PYP instead of RBC. That’s because RBC agent is not produced any more.

16. AMC RBC labeling Method We acquire labeling efficiency well what we want within 10min to rotate only. We have almost 20min to rotate to acquire stable labeling efficiency Modified in-vitro Method We have almost 20min to rotate to acquire stable labeling efficiency

17.  Decrease of rotating time can complement the AMC RBC labeling method which goes through the centrifugal separation process again  Provide more rapid study such as GI bleeding study due to fast labeling.