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ent of retroperitoneal fibrosis evaluation and follow up of drug induced pulmonary toxicity e g bleomycin amiodarone evaluation of patients who are not candidates for wbc scans wbc count less than 6 000 note that all of these conditions are also seen in pet scans using gallium 68 technique edit the main 67 ga technique uses scintigraphy to produce two dimensional images after the tracer has been injected images are typically taken by a gamma camera at 24 48 and in some cases 72 and 96 hours later 21 22 each set of images takes 30 60 minutes depending on the size of the area being imaged the resulting image will have bright areas that collected large amounts of tracer because inflammation is present or rapid cell division is occurring single photon emission computed tomography spect images may also be acquired in some imaging centers spect images may be combined with computed tomography ct scan using either fusion software or spect ct hybrid cameras to superimpose both physiological image information from the gallium scan and anatomical information from the ct scan a common injection dose is around 150 megabecquerels 23 imaging should not usually be sooner than 24 hours as high background at this time produces false negatives forty eight hour whole body images are appropriate delayed imaging can be obtained even 1 week or longer after injection if bowel is confounding spect can be performed as needed oral laxatives or enemas can be given before imaging to reduce bowel activity and reduce dose to large bowel however the usefulness of bowel preparation is controversial 22 10 to 25 of the dose of gallium 67 is excreted within 24 hours after injection the majority of which is excreted through the kidneys after 24 hours the principal excretory pathway is the colon 22 the target organ organ that receives the largest radiation dose in the average scan is the colon large bowel 21 in a normal scan uptake of gallium is seen in wide range of locations which do not indicate a positive finding these typically include soft tissues liver and bone other sites of localisation can be nasopharyngeal and lacrimal glands breasts particularly in lactation or pregnancy normally healing wounds kidneys bladder and colon 24 gallium psma scan edit see also psma scan ct scan left and gallium psma pet scan right of patient with prostate cancer metastases in the bones the positron emitting isotope 68 ga can be used to target prostate specific membrane antigen psma a protein which is present in prostate cancer cells the technique has been shown to improve detection of metastatic disease compared to mri or ct scans 25 in december 2020 the u s food and drug administration fda approved 68 ga psma 11 for medical use in the united states 26 27 it is indicated for positron emission tomography pet of prostate specific membrane antigen psma positive lesions in men with prostate cancer 28 27 it is manufactured by the ucla biomedical cyclotron facility 27 the fda approved 68 ga psma 11 based on evidence from two clinical trials trial 1 nct0336847 identical to nct02919111 and trial 2 nct02940262 identical to nct02918357 of male participants with prostate cancer 27 some participants were recently diagnosed with the prostate cancer 27 other participants were treated before but there was suspicion that the cancer was spreading because of rising prostate specific antigen or psa 27 the trials were conducted at two sites in the united states 27 the fda considers 68 ga psma 11 to be a first in class medication 29 common indications edit gallium psma scanning is recommended primarily in cases of biochemical recurrence of prostate cancer particularly for patients with low psa values and in patients with high risk disease where metastases are considered likely 30 31 technique edit an intravenous administration of 1 8 2 2 megabecquerels of 68 ga psma 11 per kilogram of bodyweight is recommended imaging should commence approximately 60 minutes after administration with an acquisition from mid thigh to the base of the skull 30 32 gallium dota scans edit 68 ga dota conjugated peptides including 68 ga dota tate dota toc and dota noc are used in positron emission tomography pet imaging of neuroendocrine tumours nets 33 the scan is similar to the spect octreotide scan in that an octreotide based somatostatin analogue such as edotreotide is used as the radioligand and there are similar indications and uses as octreotide scans however image quality is significantly improved 34 somatostatin receptors are overexpressed in many nets so that the 68 ga dota conjugated peptide is preferentially taken up in these locations and visualised on the scan 35 as well as diagnosis and staging of nets 68 ga dota conjugated peptide imaging may be used for planning and dosimetry in preparation for lutetium 177 or yttrium 90 dota therapy 36 37 in june 2016 netspot kit for the preparation of gallium ga 68 dotatate injection was approved for medical use in the united states 38 39 in august 2019 68 ga edotreotide injection 68 ga dotatoc was approved for medical use in the united states for use with pet imaging for the localization of somatostatin receptor positive neuroendocrine tumors nets in adults and children 40 41 42 the u s food and drug administration fda approved 68 ga edotreotide dotatoc based on evidence from three clinical trials trial 1 nct 1619865 trial 2 nct 1869725 trial 3 nct 2441062 of 334 known or suspected neuro endocrine tumors 41 the trials were conducted in the united states 41 gallium 68 ga oxodotreotide was approved for medical use in canada as netspot in july 2019 43 and as netvision in may 2022 44 the combination germanium 68 ge chloride gallium 68 ga chloride was approved for medical use in the european union in august 2024 45 other gallium 68 based pet scanning agents may also be based on the principle of attaching peptides to chelators such as the in development drug ga 68 trivehexin radiochemistry of gallium 67 edit gallium 67 is produced by a cyclotron using charged particle proton bombardment of enriched zn 68 the gallium 67 is then complexed with citric acid to form gallium citrate the half life of gallium 67 is 3 2617 days 46 it decays by electron capture also emitting gamma rays that are detected by a gamma camera the primary emissions are at 93 kev 39 of decays followed by 185 kev 21 and 300 kev 17 47 for imaging multiple gamma camera energy windows are used typically centred around 93 and 184 kev or 93 184 and 296 kev 22 radiochemistry of gallium 68 edit see also gallium 68 generator gallium 68 which has a half life much shorter than gallium 67 at 67 84 minutes is produced in a gallium 68 generator by decay of germanium 68 with a 271 05 day half life or as with gallium 67 by the irradiation of zinc 68 in a cyclotron use of a generator means a supply of 68 ga can be produced easily with minimal infrastructure for example at sites without a cyclotron commonly used to produce other pet isotopes it decays by positron emission and electron capture into zinc 68 46 the maximum energy of the desired positron emission is 1 899 mev 47 references edit treves st 2014 pediatric nuclear medicine and molecular imaging 4th ed springer p 480 isbn 978 1 4614 9551 2 jain sk 2017 imaging infections from bench to bedside springer p 34 isbn 978 3 319 54592 9 archived from the original on 21 february 2022 retrieved 23 june 2017 verberne sj and o p p temmerman 2017 12 imaging of prosthetic joint infections archived 21 february 2022 at the wayback machine arts j j chris management of periprosthetic joint infections pjis j geurts woodhead publishing 259 285 verberne sj raijmakers pg temmerman o 2016 the accuracy of imaging techniques in the assessment of periprosthetic hip infection a systematic review and meta analysis the journal of bone and joint surgery american volume 98 19 1638 1645 doi 10 2106 jbjs 15 00898 pmid 27707850 s2cid 9202184 retrieved 18 december 2016 termaat mf raijmakers pg scholten hj bakker fc patka p haarman hj november 2005 the accuracy of diagnostic imaging for the assessment of chronic osteomyelitis a systematic review and meta analysis the journal of bone and joint surgery american volume 87 11 2464 71 doi 10 2106 jbjs d 02691 inactive 12 july 2025 pmid 16264122 s2cid 26280068 cite journal cs1 maint doi inactive as of july 2025 link becker w october 1995 the contribution of nuclear medicine to the patient with infection european journal of nuclear medicine 22 10 1195 1211 doi 10 1007 bf00800606 pmid 8542906 s2cid 19293222 bryan rn 2010 introduction to the science of medical imaging cambridge cambridge university press p 200 isbn 978 0 521 74762 2 archived from the original on 21 february 2017 retrieved 20 february 2017 bleeker rovers cp vos fj van der graaf wt oyen wj 16 june 2011 nuclear medicine imaging of infection in cancer patients with emphasis on fdg pet the oncologist 16 7 980 991 doi 10 1634 theoncologist 2010 0421 pmc 3228133 pmid 21680576 ziessman ha o malley jp thrall jh 2013 nuclear medicine the requisites e book elsevier health sciences p 281 isbn 978 0 323 11292 5 palestro cj april 1994 the current role of gallium imaging in infection seminars in nuclear medicine 24 2 128 141 doi 10 1016 s0001 2998 05 80227 2 pmid 8023169 shields tw locicero j reed ce feins rh 2009 general thoracic surgery lippincott williams wilkins p 2106 isbn 978 0 7817 7982 1 love c palestro cj june 2004 radionuclide imaging of infection journal of nuclear medicine technology 32 2 47 57 quiz 58 9 pmid 15175400 archived from the original on 7 november 2016 retrieved 20 february 2017 tsan mf january 1985 mechanism of gallium 67 accumulation in inflammatory lesions journal of nuclear medicine 26 1 88 92 pmid 3880816 greenberg am prein j 2007 craniomaxillofacial reconstructive and corrective bone surgery principles of internal fixation using ao asif technique new york springer p 79 isbn 978 0 387 22427 5 weiner r 1996 the mechanism of 67ga localization in malignant disease nuclear medicine and biology 23 6 745 751 doi 10 1016 0969 8051 96 00119 9 pmid 8940716 biersack hj freeman lm 2007 clinical nuclear medicine berlin springer p 324 isbn 978 3 540 28026 2 hoffer p 1980 gallium mechanisms journal of nuclear medicine 21 3 282 5 pmid 6988551 archived from the original on 7 july 2022 retrieved 20 february 2017 gallium scan medlineplus archived from the original on 14 september 2017 retrieved 14 september 2017 acr spr practice parameter for the performance of scintigraphy for inflammation and infection pdf american college of radiology 2014 archived from the original pdf on 16 october 2015 retrieved 14 september 2017 lung gallium scan medlineplus archived from the original on 14 september 2017 retrieved 14 september 2017 a b bombardieri e aktolun c baum rp bishof delaloye a buscombe j chatal jf et al 2 september 2003 67 ga scintigraphy procedure guidelines for tumour imaging pdf eanm archived pdf from the original on 26 october 2020 retrieved 14 september 2017 a b c d society of nuclear medicine procedure guideline for gallium scintigraphy in inflammation pdf snmmi 2 june 2004 archived pdf from the original on 21 october 2016 retrieved 7 september 2016 notes for guidance on the clinical administration of radiopharmaceuticals and use of sealed radioactive sources pdf administration of radioactive substances advisory committee january 2016 archived pdf from the original on 24 september 2016 retrieved 7 september 2016 palestro cj 2012 spect and pet in the assessment of bone infections in fogelman i gnanasegaran g van der wall h eds radionuclide and hybrid bone imaging berlin springer pp 523 559 doi 10 1007 978 3 642 02400 9_20 isbn 978 3 642 02399 6 maurer t eiber m schwaiger m gschwend je 23 february 2016 current use of psma pet in prostate cancer management nature reviews urology 13 4 226 235 doi 10 1038 nrurol 2016 26 pmid 26902337 s2cid 2448922 drug approval package gallium ga 68 psma 11 u s food and drug administration fda 16 december 2020 archived from the original on 26 january 2021 retrieved 25 december 2020 a b c d e f g drug trials snapshot ga 68 psma 11 u s food and drug administration fda 1 december 2020 archived from the original on 10 december 2020 retrieved 11 december 2020 this article incorporates text from this source which is in the public domain gallium ga 68 psma 11 labeling package insert pdf drugs fda university of california los angeles 17 november 2021 archived from the original pdf on 13 may 2022 retrieved 18 march 2022 new drug therapy approvals 2020 u s food and drug administration fda 31 december 2020 archived from the original on 18 january 2021 retrieved 17 january 2021 a b fendler wp eiber m beheshti m bomanji j ceci f cho s et al 10 march 2017 68ga psma pet ct joint eanm and snmmi procedure guideline for prostate cancer imaging version 1 0 european journal of nuclear medicine and molecular imaging 44 6 1014 1024 doi 10 1007 s00259 017 3670 z pmid 28283702 s2cid 5882407 rai bp baum rp patel a hughes r alonzi r lane t et al september 2016 the role of positron emission tomography with 68gallium ga labeled prostate specific membrane antigen psma in the management of patients with organ confined and locally advanced prostate cancer prior to radical treatment and after radical prostatectomy urology 95 11 15 doi 10 1016 j urology 2015 12 048 pmid 26790588 afaq a batura d bomanji j 14 february 2017 new frontiers in prostate cancer imaging clinical utility of prostate specific membrane antigen positron emission tomography international urology and nephrology 49 5 803 810 doi 10 1007 s11255 017 1541 y pmid 28197764 s2cid 3902900 harbi e aschner m 2025 nuclear medicine and perspective thoughts in the diagnosis and treatment of pheochromocytoma and paraganglioma journal of neuroendocrinology 37 8 e70017 doi 10 1111 jne 70017 issn 1365 2826 mojtahedi a thamake s tworowska i ranganathan d delpassand es 15 august 2014 the value of 68ga dotatate pet ct in diagnosis and management of neuroendocrine tumors compared to current fda approved imaging modalities a review of literature american journal of nuclear medicine and molecular imaging 4 5 426 434 issn 2160 8407 pmc 4138137 pmid 25143861 virgolini i ambrosini v bomanji jb baum rp fanti s gabriel m et al 2 july 2010 procedure guidelines for pet ct tumour imaging with 68ga dota conjugated peptides 68ga dota toc 68ga dota noc 68ga dota tate pdf european journal of nuclear medicine and molecular imaging 37 10 2004 2010 doi 10 1007 s00259 010 1512 3 pmid 20596866 s2cid 11469889 archived pdf from the original on 17 may 2017 retrieved 6 october 2017 kam bl teunissen jj krenning ep de herder ww khan s van vliet ei et al 3 march 2012 lutetium labelled peptides for therapy of neuroendocrine tumours european journal of nuclear medicine and molecular imaging 39 s1 103 112 doi 10 1007 s00259 011 2039 y pmc 3304065 pmid 22388631 taïeb d garrigue p bardiès m abdullah ae pacak k october 2015 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