Doctoral Degrees (Nuclear Medicine)

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Browsing Doctoral Degrees (Nuclear Medicine) by browse.metadata.advisor "Rubow, Sietske Margarete"

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    Implementation of guidelines on hospital radiopharmacy in low-income settings
    (Stellenbosch : Stellenbosch University, 2020-12) Ekoume, Fany Pricile; Rubow, Sietske Margarete; Boersma, Hendrikus H.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.
    ENGLISH SUMMARY : Although radiopharmacy is more than 50 years old, it is still in a stage of rapid development. This dissertation focuses on quality issues in radiopharmacies in developing countries. Guidelines for radiopharmacy practice in many countries prescribe complex facilities, especially air handling units, and extensive quality assurance and documentation requirements. In developing countries, these guidelines are currently not always met. In numerous countries in Africa, enforcement of the international guidelines would lead to closure of radiopharmacies, and consequently, loss of Nuclear Medicine services. The question arises what the consequences of not meeting the requirements of the guidelines are, and if practice can be improved without major expenditure. This study considered certain aspects of Good Radiopharmacy Practice (GRP) recommendations and collected information from both a relatively well-equipped facility at Tygerberg Hospital (TBH) in South Africa, and a more basic radiopharmacy facility at Yaoundé General Hospital in Cameroon (YGH) to investigate the conditions that will ensure safe and effective products. Factors assessed include efficacy and microbial safety of the radiopharmaceuticals, with some comparison to a state-of-the-art Good Manufacturing Practice (GMP) compliant radiopharmacy at the University Medical Centre Groningen (UMCG) in the Netherlands. An adapted version of the Quality Management Audits in Nuclear Medicine (QUANUM) tool, tailored for the radiopharmacy context, was used to determine the status of practice in the two African radiopharmacies. Once the current situation and product quality in these radiopharmacies was determined, basic, low-cost interventions to minimise deficiencies were implemented at YGH and the effects of the interventions were assessed. Where the necessary level of safety and efficacy could not be met with currently available systems despite interventions, this was reported. The efficacy of radiopharmaceuticals depends on their radiochemical purity. As lack of validation of analytical methods was one of the shortcomings noted in the YGH audit, experimentally validating a cost-effective radiochromatography method to be used at YGH was the first step of corrective actions implemented. As the provision of clean air and maintenance of air handling systems and equipment require a large budget, special emphasis was placed in three further chapters of the dissertation on assessment of microbial contamination of products, and measures to ensure sterility of products. At YGH, we reached better control of microbiological air quality. This was achieved by the implementation of simple microbiological air sampling methods, and subsequent introduction of hygienic and procedural improvements. Sterility testing of SPECT radiopharmaceuticals showed a low contamination rate at both TBH and YGH. Nevertheless, preparing radiopharmaceuticals in a well-maintained laminar air flow cabinet is recommended in order to reduce the risk of contamination of products by airborne microorganisms. The serious consequences that could arise from not meeting GRP requirements, include transmission of microbial infection to patients or administering radiochemically impure products. This dissertation presents the first work evaluating an affordable approach of the implementation of GRP in sub-Saharan Africa. It is highly recommended to all radiopharmacies in the developing world to adapt GRP in their context and to implement an optimised quality assurance programme, striving for continuous improvement.
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    Investigation into various aspects of radiolabelling somatostatin peptide derivatives with 68Ga eluted from a SnO2-based 68Ge/68Ga generator
    (Stellenbosch : Stellenbosch University, 2018-03) Prince, Deidre Mabel; Rubow, Sietske Margarete; Rossouw, Daniel Dutoit; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.
    ENGLISH SUMMARY : 68Ge/68Ga generators ensure the supply of 68Ga for positron emission tomography (PET), for instance for somatostatin receptor imaging with 68Ga-DOTA-labelled somatostatin analogues. There are various generators available and their eluates are processed differently for radiolabelling of peptides. The objectives of this study were to investigate various aspects of the elution characteristics of the generator, to optimize labelling conditions using different eluate processing techniques such as fractionation and cation exchange chromatography and to develop user-friendly kit formulations. This study was approved by the Stellenbosch University Health Research Ethics Committee and permission was granted for the experimental work to be conducted at iThemba LABS. Elution efficiencies were determined using different HCl concentrations (0.2 M – 1.0 M). Metal analysis and 68Ge breakthrough determination were performed on eluates. Radiolabelling parameters were optimized, using fractionated eluates and different DOTA-peptide masses (15 to 50 μg) at pH 3.5 – 4.0 in sodium acetate buffer. Different heating times and heating methods and the influence of various periods of non-elution of the generator on radiolabelling results were investigated. Cationic resins were investigated for eluate processing. Radiolabelling parameters, using cationic resin-processed eluates, were optimized. Labelling was conducted at various pH values, using different quantities of buffer. DOTA-peptide kits for both fractionated and resin-processed eluates were developed and tested for sterility, endotoxin content and stability. Radiochemical yields, radiolabelling efficiency and radiochemical purity of 68Ga-DOTA-peptides were determined. The elution efficiency of the generator increased with an increase in the concentration of HCl eluent. The 68Ge breakthrough increased dramatically at 0.8 M HCl. Most metal contaminants were lowest when eluting with 0.2 M HCl and the Zn content increased with the increase in HCl concentration. The eluent of choice for the SnO2-based generator was confirmed to be 0.6 M HCl. For radiolabelling, 35 μg DOTA-peptide (9.2 – 9.4 μM) was the most favourable. Extended heating times and heating method did not significantly impact on the radiolabelling. The radiolabelling efficiencies were consistently above 90 % even after 3 weeks of non-elution of the generator, but radiochemical yields dropped after 7 days. DOTA-peptide kits for fractionated eluates were successfully developed and the radiolabelling quality was found to be superior over peptide stock solutions. A radiolabelling method using a cationic exchange resin was successfully adapted for the SnO2 generator. 68Ga was efficiently adsorbed on a Bond Elut SCX (100 mg) cartridge and desorbed by acidified solutions of NaCl. The SCX resin effectively removed about 98 % of deliberately “spiked” metals from the 68Ga eluate. An optimized labelling method based on the use of SCX-purified eluates was developed, producing radiochemical yields of almost 85 % and lead to the successful formulation of DOTATATE kits. The quality was found to be suitable over a 3-month period. In conclusion, a kit type labelling procedure, using cationic resin purified 68Ga eluates, provides the most practical method to produce 68Ga-labelled DOTA-peptides.
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    Optimization of production methods for gallium-68 PET radiopharmaceuticals in a hospital radiopharmacy
    (Stellenbosch : Stellenbosch University, 2020-12) Le Roux, Johannes Stephanus; Rubow, Sietske Margarete
    ENGLISH SUMMARY : Production of radiopharmaceuticals intended for human use and research purposes is generally performed in well-equipped commercial or research facilities that usually have access to advanced equipment for the synthesis and quality control of radiopharmaceuticals. Nuclear Medicine departments are in most cases situated in hospitals. Radiopharmacies in these departments usually have limited space and equipment which necessitates careful consideration of suitable production methods. Optimization may include methods to simplify quality control procedures through the use of less sophisticated equipment and procedures. The purpose of this study was to demonstrate how to optimize production methods in an environment with limited resources using ubiquicidin labelled with gallium-68 as an example. The peptide ubiquicidin is currently investigated for localization of infections in patients using positron emission tomography (PET). Until recently, labelling ubiquicidin with gallium-68 was limited to a manual labelling method. Manual labelling methods are not recommended for the routine production of radiopharmaceuticals because of difficulty to comply with Good Manufacturing Practice (GMP). Manual labelling methods can also result in high radiation exposure to personnel. These disadvantages can be addressed by automation of production methods. The research conducted in this study shortly entails the following aspects: •Automation of a manual labelling method of ubiquicidin with gallium-68 •Optimization of the synthesis methods using radical scavengers •In-depth comparison of the labelling characteristics of the manual method to that of theautomated methods •Conducting a literature search into the toxicity of HEPES in humans and animals in order toclarify its use as a buffering agent in the labelling of radiopharmaceuticals • Investigating thin-layer chromatography as method to determine the radiochemical purity of gallium-68 ubiquicidin Two different automated synthesis methods were developed in this study. Optimization of the labelling methods was achieved by adding free-radical scavengers to reduce the formation of impurities. A comparison of the labelling characteristics of the manual labelling method with the automated methods showed that the results obtained with automated methods were more robust and repeatable. The literature search into the toxicity of HEPES showed that its toxicity in humans and animals may be overestimated by pharmacopoeias. The current limits applied by pharmacopoeias may be too strict. An evaluation of several thin-layer chromatography methods indicated that the method currently described in the literature may underestimate the presence of colloidal impurities in the final product. None of the other methods investigated in this study could distinguish the colloidal impurity from the labelled product. This aspect highlights the need for a final purification step to reduce the presence of colloidal impurities in the final product. The work presented in this study creates an important basis for optimization of production methods in a clinical environment. The study can further serve as a guideline to other nuclear medicine departments for optimization of radiopharmaceutical production methods.