curium us llc - Medication Listings

11.1 Chemical Characteristics Detectnet contains copper Cu 64 dotatate, which is a radioactive diagnostic drug for use with PET imaging. Chemically, copper Cu 64 dotatate is described as copper (Cu 64)-N-[(4,7,10-Tricarboxymethyl-1,4,7,10- tetraazacyclododec-1-yl) acetyl]-Dphenylalanyl-L-cysteinyl-L-tyrosyl-D-tryptophanyl-L-lysyl-L- threoninyl-L-cysteinyl-L-threonine-cyclic (2-7) disulfide. The molecular weight is 1497.2 Daltons and the following is the structural formula: Detectnet is a sterile, clear, colorless to yellow solution for intravenous use. Each 10 mL single-dose vial contains 148 MBq (4 mCi) of copper Cu 64 dotatate at calibration date and time in 4 mL solution volume. Additionally, each mL of the solution contains 40 mg ascorbic acid, 0.05 ml of dehydrated alcohol, USP (ethanol) in sterile water for injection, USP. The pH is adjusted with sodium hydroxide, hydrochloric acid and is between 5.5 to 7.5. chemical structure 11.2 Physical Characteristics Table 2 and Table 3 display the principal radiation emission data and physical decay of copper Cu 64. Copper Cu 64 decays with a half-life t 1/2 =12.7 hours: 17.6% by positron emission to Ni 64 followed by emission of two 511 keV annihilation photons, 38.5% by beta decay to Zn 64, 43.8% by electron capture to Ni 64, and 0.475% by gamma radiation/internal conversion. Table 2. Principal radiation emission data (>1%) of copper Cu 64 Radiation/Emission % Disintegration Mean Energy (keV) Positron (β + ) 17.6 278 Beta (β - ) 38.5 190.7 Gamma (γ) 35.7 0.48 511 1346 Table 3. Physical decay chart of copper Cu 64 Hours Fraction Remaining Hours Fraction Remaining 0 1.00 18 0.374 1 0.947 24 (1 day) 0.270 3 0.849 36 (1.5 days) 0.140 6 0.721 48 (2 days) 0.073 9 0.612 72 (3 days) 0.020 12 0.520 96 (4 days) 0.005 11.3 External Radiation Gamma constant: 3.6 X 10 -5 mSv/hr per MBq at 1 meter (0.133 mrem/hr per mCi at 1 meter) Table 4 displays the radiation attenuation by lead shielding of copper Cu 64. Table 4. Radiation attenuation of copper Cu 64 by lead shielding Shield Thickness cm of Lead (Pb) Coefficient of Attenuation 0.51 0.5 1.60 0.1 3.45 0.01 6.83 0.001

Gallium Citrate Ga 67 Injection is supplied in a 10 milliliter vial as an isotonic, sterile, non-pyrogenic solution. Each milliliter of the isotonic solution contains 74 megabecquerels (2 millicuries) of gallium Ga-67 on the calibration date as a complex formed from 8.3 nanograms gallium chloride Ga-67, 1.9 milligrams of sodium citrate dihydrate, 7.8 milligrams of sodium chloride and 0.9 percent benzyl alcohol (v/v) as a preservative. The pH is adjusted to between 5.5 to 8.0 with hydrochloric acid and/or sodium hydroxide solution. Gallium Ga-67, with a half-life of 78.26 hours, is cyclotron produced by the proton irradiation of enriched zinc. At the time of calibration the drug contains no more than 0.02% gallium Ga-66 and no more than 0.2% zinc Zn-65. The concentration of each radionuclidic impurity changes with time. At expiration, the drug contains no more than 0.001% gallium Ga-66 and no more than 1.0% zinc Zn-65. No carrier has been added. Gallium citrate has the following chemical structure: P hysical Characteristics Gallium Ga-67 with a physical half-life of 78.26 hours 1 decays by electron capture to stable zinc Zn-67. Photons that are useful for imaging studies are listed in Table 1. Table 1. Principal Radiation Emission Data Radiation Mean Percent Per Disintegration Energy (keV) Gamma-2 Gamma-3 Gamma-4 Gamma-5 Gamma-6 Gamma-7 2.9 35.7 19.7 2.2 16.0 4.5 91.3 93.3 184.6 209.0 300.2 393.5 1 Kocher, D.C., Radioactive Decay Data Tables, Health and Safety Research Division, National Technical Information Service, DOE/TIC-11026, pg. 80, 1981. E xternal Radiation The specific gamma ray constant for gallium Ga-67 is 1.6 R/mCi-hour at 1 cm. The first half-value thickness of lead (Pb) is 0.066 cm. A range of values for the relative attenuation of the radiation emitted by this radionuclide that results from interposition of various thicknesses of lead is shown in Table 2. For example, the use of 1.2 cm of lead will decrease the radiation exposure by a factor of about 100. Table 2. Radiation Attenuation by Lead Shielding Shield Thickness (Pb), cm Coefficient of Attenuation 0.066 0.41 1.2 2.5 4.8 0.5 10 - 1 10 - 2 10 - 3 10 - 4 To correct for physical decay of this radionuclide, the fractions that remain at selected time intervals after the time of calibration are shown in Table 3. Table 3. Physical Decay Chart; Gallium Ga-67, Half-Life 78.26 Hours Hours Fraction Remaining Hours Fraction Remaining 0* 6 12 18 24 (1d) 30 36 42 48 (2d) 54 60 66 1.000 0.948 0.899 0.853 0.809 0.767 0.727 0.689 0.654 0.620 0.588 0.557 72 (3d) 78 84 90 96 (4d) 108 120 (5d) 132 144 (6d) 156 168 (7d) 0.529 0.501 0.475 0.451 0.427 0.384 0.345 0.311 0.279 0.251 0.226 * Calibration Time Gallium citrate chemical structure

The chemical name for ioflupane I-123 is N-ω-fluoropropyl-2β-carbomethoxy-3β-(4- [123I]iodophenyl)nortropane and it has the following structural formula: 11.1 Chemical Characteristics Ioflupane I 123 Injection is a sterile, pyrogen-free radioactive diagnostic agent for intravenous use. Ioflupane I 123 Injection is a clear and colorless solution is supplied in single-dose vials. Each milliliter contains 0.07 to 0.13 mcg ioflupane, 74 MBq (2 mCi) of iodine-123 (as ioflupane I-123) at calibration time, 5.7 mg acetic acid, 7.8 mg sodium acetate and 0.05 mL (5%) ethanol. The pH of the solution is between 4.2 and 5.2. The chemical name for ioflupane I-123 is N-ω-fluoropropyl-2β-carbomethoxy-3β-(4- [ 123 I]iodophenyl)nortropane and it has the following structural formula: 11. 2 Physical Characteristics Iodine-123 is a cyclotron-produced radionuclide that decays to tellurium-123 by electron capture and has a physical half-life of 13.2 hours. The photon that is useful for detection and imaging studies is listed in Table 2. Table 2 Principal Radiation Emission Data – Iodine-123 Radiation Energy Level (keV) Abundance (%) Gamma 159 83 11. 3 External Radiation The specific gamma-ray constant for iodine-123 is 1.6 R/mCi-hr at 1 cm. The first half-value thickness of lead (Pb) for iodine-123 is 0.04 cm. The relative transmission of radiation emitted by the radionuclide that results from interposition of various thicknesses of Pb is shown in Table 3 (e.g., the use of 2.16 cm Pb will decrease the external radiation exposure by a factor of about 1,000). Table 3 Reduction in In-air Collision Kerma Caused by Lead Shielding a Shield Thickness cm of lead (Pb) Reduction in In-air Collision Kerma 0.04 0.5 0.13 10 -1 0.77 10 -2 2.16 10 -3 3.67 10 -4 a Calculation based on attenuation and energy-transfer coefficients obtained from National Institute of Standards & Technology Internal Report NISTIR 5632.

11.1 Chemical Characteristics Kit for the Preparation of Technetium Tc 99m pentetate injection, a radioactive diagnostic agent, for intravenous or inhalation use. Each multiple-dose 10 mL glass vial contains a sterile, non-pyrogenic, non-radioactive lyophilized powder of 20 mg of pentetic acid, 5 mg of p-aminobenzoic acid, 3.73 mg of calcium chloride dihydrate, and not less than 0.25 mg stannous chloride dihydrate and not more than 0.385 mg maximum tin expressed as stannous chloride dihydrate. The lyophilized product is sealed under an atmosphere of nitrogen. No bacteriostatic preservative is present. Its chemical name is: Technetate (1-)99mTc,[N,N-bis[2-[bis(carboxymethyl)amino]ethyl]-glycinato(5-)]-, sodium. The structure of the technetium labeled form is: The pH is adjusted with HCl and/or NaOH prior to lyophilization so that the pH range of the reconstituted radiopharmaceutical is 6.5 to 7.5. image description 11.2 Physical Characteristics Technetium Tc 99m decays by isomeric transition with a physical half-life of 6 hours. The principal photon that is useful for detection and imaging studies is listed in Table 7 . Table 7 Principal Radiation Emission Data Radiation Mean % per Disintegration Mean Energy (keV) Gamma-2 88.5 140.5 The air-kerma-rate (exposure-rate) constant for Technetium Tc 99m is 5.23m 2 ·pGy·(MBq) -1 ·s -1 [0.795cm 2 ·R·(mCi) -1 ·h -1 ]. A range of values for the relative radiation attenuation by the various thicknesses of lead is shown in Table 8 . For example, the use of a 3 mm thickness of lead will attenuate the radiation emitted by a factor of about 1,000. Table 8 Radiation Attenuation by Lead Shielding Shield Thickness (Pb) mm Coefficient of Attenuation 0.25 0.5 1 10 -1 2 10 -2 3 10 -3 4 10 -4 To correct for physical decay of this radionuclide, the fractions that remain at selected intervals after the time of calibration are shown in Table 9 . Table 9 Physical Decay Chart of Technetium 99m Tc, Half Life: 6 Hours Hours Fraction Remaining Hours Fraction Remaining 0* 1.000 5 0.562 1 0.891 6 0.501 2 0.794 8 0.398 3 0.708 10 0.316 4 0.631 12 0.251 *Calibration Time

Octreoscan ™ is a kit for the preparation of Indium In 111 Pentetreotide Injection, a radioactive diagnostic agent. It is a kit consisting of two components: 1) A 10-mL Octreoscan Reaction Vial which contains a lyophilized mixture of: (i) 10 mcg pentetreotide [N-(diethylenetriamine-N,N,N′,N″-tetraacetic acid-N″-acetyl)-D-phenylalanyl-L-hemicystyl-L-phenylalanyl-D-tryptophyl-L-lysyl-L-threonyl-L-hemicystyl-L-threoninol cyclic (2→7) disulfide], (also known as octreotide DTPA), (ii) 2 mg gentisic acid [2, 5-dihydroxybenzoic acid], (iii) 4.9 mg trisodium citrate, anhydrous, (iv) 0.37 mg citric acid, anhydrous, and (v) 10 mg inositol. Pentetreotide has the following structural formula: Prior to lyophilization, sodium hydroxide or hydrochloric acid may have been added for pH adjustment. The vial contents are sterile and nonpyrogenic. No bacteriostatic preservative is present. 2) A 10-mL vial of Indium In 111 Chloride Solution, which contains: 1.1 mL or 111 MBq/mL (3 mCi/mL) indium In 111 chloride in 0.02N HCl at time of calibration. The vial also contains ferric chloride at a concentration of 3.5 mcg/mL (ferric ion, 1.2 mcg/mL). The vial contents are sterile and nonpyrogenic. No bacteriostatic preservative is present. Indium In 111 Pentetreotide Injection is prepared by combining the two kit components ( see INSTRUCTIONS FOR THE PREPARATION OF INDIUM In 111 PENTETREOTIDE INJECTION ). Indium In-111 reacts with the diethylenetriaminetetraacetic acid portion of the pentetreotide molecule to form indium In 111 pentetreotide. The pH of the resultant Indium In 111 Pentetreotide Injection is between 3.8 and 4.3. No bacteriostatic preservative is present. The Indium In 111 Pentetreotide Injection is suitable for intravenous administration as is, or it may be diluted to a maximum volume of 3 mL with 0.9% Sodium Chloride Injection, USP, immediately before intravenous administration. In either case, the radiolabeling yield of Indium In 111 Pentetreotide Injection should be determined before administration to the patient. A method recommended for determining the radiolabeling yield is presented at the end of this package insert (see RECOMMENDED METHOD FOR DETERMINATION OF RADIOLABELING YIELD OF INDIUM In 111 PENTETREOTIDE INJECTION ). Structural Formula Physical Characteristics Indium In-111 decays by electron capture to cadmium-111 (stable) and has a physical half-life of 2.805 days (67.32 hours) ( see Table 2 ). From Radiopharmaceutical Internal Dosimetry Information Center, Oak Ridge Associated Universities, Oak Ridge, TN 37831-0117, February 1985. The principal photons that are useful for detection and imaging are listed in Table 1. Table 1. Principal Radiation Emission Data Kocher, David C., "Radioactive Decay Data Tables,” DOE/TIC-11026, 115 (1981). Radiation Mean Percent Per Disintegration Energy (keV) Gamma-2 90.2 171.3 Gamma-3 94.0 245.4 The specific gamma ray constant for In-111 is 3.21 R/hr-mCi at 1 cm . The first half-value thickness of lead (Pb) for In-111 is 0.023 cm. Selected coefficients of attenuation are listed in Table 2 as a function of lead shield thickness. For example, the use of 0.834 cm of lead will attenuate the external radiation by a factor of about 1000. Table 2. Radiation Attenuation by Lead Shielding Shield Thickness (Pb) cm Coefficient of Attenuation 0.023 0.5 0.203 0.1 0.513 0.01 0.834 0.001 1.12 0.0001 Table 3 lists fractions remaining at selected time intervals before and after calibration. This information may be used to correct for physical decay of the radionuclide. Table 3. Physical Decay Chart: Indium In-111, Half-life 2.805 Days (67.32 hours) Hours Fraction Remaining Hours Fraction Remaining -72 2.100 0 Calibration time 1.000 -60 1.854 3 0.970 -48 1.639 6 0.940 -36 1.448 12 0.885 -24 1.280 24 0.781 -12 1.131 36 0.690 -6 1.064 48 0.610

11.1 Product Characteristics PULMOTECH MAA contains albumin aggregated obtained by fractionating material (source blood, plasma, serum, or placentas) from healthy human donors. The macroaggregated albumin (MAA) particles are formed by heat denaturation of stannous chloride treated albumin human under controlled conditions. Each vial contains 2,000,000 to 4,000,000 particles. The particle size distribution of the aggregated albumin is such that not less than 90% are 10 to 90 micrometers in size. There are no aggregated albumin particles greater than 150 micrometers in size as determined by circular equivalents. PULMOTECH MAA (kit for the preparation of technetium Tc 99m albumin aggregated) injection provides a sterile, non-pyrogenic, non-radioactive, white lyophilized powder in a multiple-dose reaction vial, sealed under an atmosphere of nitrogen, for radiolabeling with Sodium Pertechnetate Tc 99m Injection to prepare Technetium Tc 99m Albumin Aggregated Injection, a radioactive diagnostic agent, for intravenous or intraperitoneal use. Each reaction vial contains 2 mg of albumin aggregated, albumin human (7.1 mg), stannous chloride (0.1 mg minimum; 0.22 mg maximum stannous and stannic), sodium chloride (9 mg). Hydrochloric acid may have been added for pH adjustment. The pH is between 5 and 7. It contains no preservatives. 11.2 Physical Characteristics Technetium-99m decays by isomeric transition with a physical half-life of 6.02 hours. The principal photon that is useful for detection and imaging is listed in Table 4. Table 4 – Principal Radiation Emission Data for Technetium-99m Radiation Mean % per Disintegration Energy (keV) Gamma-2 89.07 140.5 11.3 External Radiation The specific gamma ray constant for technetium-99m is 0.78 R/mCi-hr at 1 cm. The first half-value thickness of lead (Pb) for technetium-99m is 0.017 cm. A range of values for the relative attenuation of the radiation emitted by this radionuclide that results from interposition of various thicknesses of Pb is shown in Table 5. For example, the use of 0.25 cm of Pb will decrease the external radiation exposure by a factor of about 1,000. Table 5 – Radiation Attenuation by Lead Shielding Shield Thickness(Pb) cm Coefficient of Attenuation 0.017 0.5 0.08 10 -1 0.16 10 -2 0.25 10 -3 0.33 10 -4 To correct for physical decay of this radionuclide, the fractions that remain at selected time intervals after the time of calibration are shown in Table 6. Table 6– Physical Decay Chart for Technetium-99m, Half-Life 6.02 Hours Hours Fraction Remaining Hours Fraction Remaining 0* 1.000 7 0.447 1 0.891 8 0.398 2 0.794 9 0.355 3 0.708 10 0.316 4 0.631 11 0.282 5 0.562 12 0.251 6 0.501 *Calibration Time

Sodium Iodide I 123 (Na 123 I) for diagnostic use is supplied in capsules for oral administration. The capsules are available in strengths of 3.7 and 7.4 megabecquerels (MBq) (100 and 200 μCi) I-123 at time of calibration. The radionuclidic composition at calibration is not less than 97.0 percent I-123, not more than 2.9 percent I-125 and not more than 0.1 percent Te-121. The radionuclidic composition at expiration time is not less than 87.2 percent I-123, not more than 12.4 percent I-125 and not more than 0.4 percent Te-121. The ratio of the concentration of I-123 and I-125 changes with time. Graph 1 shows the minimum concentration of I-123 as a function of time and Graph 2 shows the maximum concentration of I-125 as a function of time. Graph 1. Radionuclidic Concentration of I-123 PERCENT OF TOTAL RADIOACTIVITY: IODINE-123 Graph 2. Radionuclidic Concentration of I-125 PERCENT OF TOTAL RADIOACTIVITY: IODINE-125 Graph 1 Graph 2 Physical Characteristics Iodine-123 decays by electron capture with a physical half-life of 13.2 hours Kocher, David C., Radioactive Decay Data Tables. DOE/TIC-11026, 122 (1981). . The photon that is useful for detection and imaging studies is listed in Table 1. Table 1. Principal Radiation Emission Data Radiation Mean % Disintegration Energy (keV) Gamma-2 83.4 159 External Radiation The specific gamma ray constant for I-123 is 1.6 R/hr-mCi at 1 cm. The first half-value thickness of lead (Pb) for I-123 is 0.005 cm. A range of values for the relative attenuation of the radiation emitted by this radionuclide that results from the interposition of various thicknesses of Pb is shown in Table 2. For example, the use of 1.63 cm of lead will decrease the external radiation exposure by a factor of about 1,000. Table 2. Radiation Attenuation by Lead Shielding Shield Thickness (Pb), cm Coefficient of Attenuation 0.005 0.10 0.88 1.63 2.48 0.5 10 -1 10 -2 10 -3 10 -4 Note that these estimates of attenuation do not take into consideration the presence of radionuclidic contaminants. To correct for physical decay of I-123, the fractions that remain at selected intervals after the time of calibration are shown in Table 3. Table 3. Iodine I-123 Decay Chart: Half-Life 13.2 Hours Hours Fraction Remaining Hours Fraction Remaining *Time of Calibration 0* 3 6 9 12 15 1.000 0.854 0.730 0.623 0.533 0.455 18 21 24 27 30 0.389 0.332 0.284 0.242 0.207

Drug Characteristics Technescan™ HDP (kit for the preparation of technetium Tc 99m oxidronate injection) is a radioactive diagnostic drug for intravenous use after radiolabeling with sodium pertechnetate Tc 99m injection. Each vial contains 3.15 mg oxidronate sodium and 0.258 mg, minimum, stannous chloride (SnCl 2 •2H 2 O), 0.297 mg, theoretical, stannous chloride (SnCl 2 •2H 2 O) with 0.343 mg, maximum, tin chloride [stannous and stannic] dihydrate as SnCl 2 •2H 2 O, and the following inactive ingredients: 0.84 mg gentisic acid as a stabilizer and 30 mg sodium chloride. The pH is adjusted with hydrochloric acid and/or sodium hydroxide. The pH of the radiolabeled drug is between 4.0 and 5.5. The vial contains a sterile, non-pyrogenic, lyophilized powder packaged under nitrogen. The chemical structure of oxidronate sodium is: The structure of the technetium Tc 99m oxidronate complex is unknown. The chemical structure of oxidronate sodium is:

Technescan MAG3™ is a kit for the preparation of technetium Tc 99m mertiatide, a diagnostic radiopharmaceutical. It is supplied as a sterile, nonpyrogenic, lyophilized powder. Each vial contains betiatide (N-[N-[N-[(benzoylthio) acetyl]glycyl]glycyl]-glycine). After reconstitution with sterile sodium pertechnetate Tc 99m injection, the technetium Tc 99m mertiatide (disodium[N-[N-[N-(mercaptoacetyl) glycyl]glycyl] glycinato (2-) - N,N′,N″,S′]oxotechnetate (2-)) which is formed is suitable for intravenous administration. Each 10 milliliter vial contains 1 milligram betiatide, 0.05 milligram (minimum) stannous chloride dihydrate (SnCl 2 •2H 2 O) and 0.2 milligram (maximum) total tin expressed as stannous chloride dihydrate (SnCl 2 •2H 2 O), 40 milligrams sodium tartrate dihydrate (Na 2 C 4 H 2 O 6 •2H 2 O), and 20 milligrams lactose monohydrate. Prior to lyophilization, sodium hydroxide or hydrochloric acid may be added for pH adjustment. The pH of the reconstituted drug is between 5.0 and 6.0. No bacteriostatic preservative is present. The contents are sealed under argon. Betiatide is light sensitive and must be protected from light. Betiatide and technetium Tc 99m mertiatide have the following structural formulas: image description image description

Drug Characteristics Technescan™ PYP™ (kit for the preparation of technetium Tc 99m pyrophosphate injection) is a radioactive diagnostic drug for intravenous use after radiolabeling with sodium pertechnetate Tc 99m injection or after reconstitution with 0.9% sodium chloride injection in conjunction with sodium pertechnetate Tc 99m injection. Each vial contains 11.9 mg sodium pyrophosphate, 3.2 mg (minimum) stannous chloride (SnCl 2 •2H 2 O), and 4.4 mg (maximum) total tin expressed as stannous chloride (SnCl 2 •2H 2 O). Prior to lyophilization, the pH is adjusted with hydrochloric acid. The pH of the reconstituted drug is between 4.5 and 7.5. No bacteriostatic preservative is present. The vial contains a sterile, non-pyrogenic, lyophilized powder packaged under nitrogen. The precise structures of the stannous-pyrophosphate and technetium Tc 99m pyrophosphate complexes are not known.

Each 10 mL vial contains a sterile, non-pyrogenic, lyophilized mixture of: Tetrakis (2-methoxy isobutyl isonitrile) Copper (I) tetrafluoroborate – 1 mg Sodium Citrate Dihydrate - 2.6 mg L-Cysteine Hydrochloride Monohydrate – 1 mg Mannitol - 20 mg Stannous Chloride, Dihydrate, minimum (SnCl 2 •2H 2 O) - 0.025 mg Stannous Chloride, Dihydrate (SnCl 2 •2H 2 O) - 0.075 mg Tin Chloride (stannous and stannic) Dihydrate, maximum (as SnCl 2 •2H 2 O) - 0.086 mg Prior to lyophilization the pH is 5.6 to 5.7, and sodium hydroxide and/or hydrochloric acid may have been added for pH adjustment. The contents of the vial are lyophilized and stored under nitrogen. This drug is administered by intravenous injection for diagnostic use after reconstitution with sterile, non-pyrogenic, oxidant-free Sodium Pertechnetate Tc99m Injection. The pH of the reconstituted product is 5.5 (5.0-6.0). No bacteriostatic preservative is present. The precise structure of the technetium complex is Tc99m[MIBI] 6 + where MIBI is 2-methoxy isobutyl isonitrile. Tetrakis (2-methoxy isobutyl isonitrile) Copper (I) tetrafluoroborate has the following structural formula: Structural formula The molecular formula is C 24 H 44 N 4 O 4 BF 4 Cu, and the molecular weight is 602.98. Tetrakis (2-methoxy isobutyl isonitrile) Copper (I) tetrafluoroborate structural formula 11.1 Physical Characteristics Technetium Tc99m decays by isomeric transition with a physical half-life of 6.02 hours. 1 Photons that are useful for detection and imaging studies are listed below in Table 3.0. 1 Kocher, David, C., Radioactive Decay Data Tables, DOE/TIC-11026, 108(1981). Table 3.0 Principal Radiation Emission Data 11.2 External Radiation The specific gamma ray constant for Tc99m is 5.4 microcoulombs/Kg-MBq-hr (0.78 R/mCi-hr) at 1 cm. The first half value layer is 0.017 cm of Pb. A range of values for the relative attenuation of the radiation emitted by this radionuclide that results from interposition of various thicknesses of Pb is shown in Table 4.0. To facilitate control of the radiation exposure from Megabequerel (millicurie) amounts of this radionuclide, the use of a 0.25 cm thickness of Pb will attenuate the radiation emitted by a factor of 1,000. To correct for physical decay of this radionuclide, the fractions that remain at selected intervals after the time of calibration are shown in Table 5.0. Table 4.0 Radiation Attenuation by Lead Shielding Table 5.0 Physical Decay Chart; Tc99m Half-Life 6.02 Hours

11.1 Drug Characteristics Thallous Chloride Tl 201 Injection is a sterile, radioactive diagnostic drug for intravenous use. Each mL contains 37 MBq (1 mCi) thallous chloride Tl 201 at calibration time and the following inactive ingredients: 9 mg sodium chloride and 0.9% (v/v) benzyl alcohol. The pH is adjusted to between 4.5 to 7.0 with hydrochloric acid and/or sodium hydroxide. Thallium-201 is cyclotron produced. At the time of calibration it contains no more than 1% thallium-200, no more than 1% thallium-202, no more than 0.25% lead-203, and no less than 98% thallium-201 as a percentage of total activity. No carrier has been added. The concentration of each radionuclidic contaminant changes with time. Figure 1 shows maximum concentration of thallium-200 (Tl 200) and thallium-202 (Tl 202) radionuclidic contaminants as a function of time. Figure 1. Radionuclidic Contaminants figure 1 11.2 Nuclear Physical Characteristics Thallium-201, with a physical half-life of 72.9 hours, decays by electron capture to mercury-201. Photons that are useful for detection and imaging are listed in Table 2. The lower energy x-rays obtained from the mercury-201 daughter of thallium-201 are recommended for myocardial imaging, because the mean percent disintegration at 68.9 to 80.3 keV is much greater than the combination of gamma-4 and gamma-6 mean percent disintegration. Table 2. Principal Radiation Emission Data Radiation Mean Percent/ Disintegration Energy (keV) Gamma-4 2.7 135.3 Gamma-6 10.0 167.4 Mercury x-rays 94.4 68.9-80.3 The specific gamma ray constant for thallium-201 is 0.45 R/mCi-hr at 1 cm. The first half-value thickness of lead (Pb) is 0.026 cm. A range of values for the relative attenuation of the radiation emitted by this radionuclide that results from interposition of various thicknesses of Pb is shown in Table 3. For example, the use of 0.194 cm of lead will decrease the external radiation exposure by a factor of about 1,000. Table 3. Radiation Attenuation by Lead Shielding cm of Lead (Pb) Coefficient of Attenuation 0.026 0.5 0.052 10 -1 0.089 10 -2 0.194 10 -3 0.310 10 -4 To correct for physical decay of the radionuclide, the fractions that remain at selected intervals after calibration time are shown in Table 4. Table 4. Physical Decay Chart for Thallium-201; Half-Life 72.9 Hours Hours Fraction Remaining Hours Fraction Remaining 0* 1 66 0.53 6 0.95 72 0.50 12 0.89 78 0.48 18 0.84 84 0.45 24 0.80 90 0.43 30 0.75 96 0.40 36 0.74 108 0.36 42 0.67 120 0.32 48 0.63 132 0.29 54 0.60 144 0.25 60 0.57 * Calibration Time

Ultratag ™ RBC (Kit for the Preparation of Technetium Tc 99m Red Blood Cells Injection) is a sterile, nonpyrogenic, diagnostic kit for the in vitro preparation of Technetium Tc 99m Red Blood Cells Injection. Each kit consists of three separate nonradioactive components: 1. A 10 milliliter reaction vial containing: Stannous Chloride, Dihydrate (SnCl 2 •2H 2 O) – 50 mcg minimum Stannous Chloride, Dihydrate (SnCl 2 •2H 2 O) – 96 mcg theoretical Tin Chloride (Stannous and Stannic), Dihydrate (as SnCl 2 •2H 2 O) – 105 mcg maximum Sodium Citrate, Dihydrate – 3.67 mg Dextrose, Anhydrous – 5.5 mg Hydrochloric Acid – 0.47 mg Prior to lyophilization, the pH is adjusted to 7.1 to 7.2 with sodium hydroxide. The contents of the vial are lyophilized and stored under argon. 2. Syringe I contains: Sodium Hypochlorite – 0.6 mg in Sterile Water for Injection The total volume of this syringe is 0.6 mL. Sodium hydroxide may have been added for pH adjustment. The pH of this solution is 11 to 13. The syringe must be protected from light to prevent degradation of the light-sensitive sodium hypochlorite. 3. Syringe II contains: Citric Acid, Monohydrate – 8.7 mg Sodium Citrate, Dihydrate – 32.5 mg Dextrose, Anhydrous – 12 mg in Sterile Water for Injection The total volume of this syringe is 1 mL. The pH range of this solution is adjusted to 4.5 to 5.5 with sodium citrate or citric acid as needed.

The Ultra-Technekow ™ V4 Generator is prepared with fission-produced molybdenum Mo-99 adsorbed onto alumina in a column shielded by lead, tungsten, or depleted uranium. The column assembly and shielding are encased in a plastic container that is covered with a plastic elution hood. The elution hood has an opening for the column assembly double inlet needles and an opening for the single outlet needle. The needles accommodate the sterile eluant vials that contain 0.9% Sodium Chloride Injection and sterile evacuated collection vials. A sterile vial containing a bacteriostat is supplied with the generator for the customer to aseptically seal the outlet needle after each elution. This terminally sterilized generator provides a closed system for the production of sterile metastable technetium Tc-99m, which is produced by the decay of molybdenum Mo-99. Incorporated between the column outlet and the collection vial is a sterile 0.22 micrometer filter. Sterile, non-pyrogenic isotonic solutions of Sodium Pertechnetate Tc 99m Injection in 0.9% Sodium Chloride Injection can be obtained conveniently by periodic aseptic elution of the generator. These solutions should be clear, colorless, and free from any particulate matter. The Sodium Pertechnetate Tc 99m Injection is suitable for intravenous injection and direct instillation. The carrier-free solution may be used as is, or diluted to the proper concentration. Over the life of the generator, an elution will contain an amount of technetium Tc-99m in direct proportion to the quantity of Mo-99 decay since the previous elution of the generator. The quantity of Tc-99m in the eluate is determined by quantity of Mo-99 on the column, and the elapsed time between elutions. Each eluate of the generator should not contain more than the USP limit of 0.15 kilobecquerel molybdenum Mo-99 per megabecquerel technetium Tc-99m (0.15 microcurie Mo-99 per millicurie Tc-99m) per administered dose at the time of administration and an aluminum ion concentration of not more than 10 micrograms per milliliter of the generator eluate, both of which must be determined by the user before administration. Since the eluate does not contain an antimicrobial agent, it should not be used after 12 hours from the time of generator elution. Physical Characteristics Technetium Tc-99m decays by isomeric transition with a physical half-life of 6 hours. The principal photon that is useful for detection and imaging studies is listed in Table 1. Table 1. Principal Radiation Emission Data Radiation Mean Percent Per Disintegration Energy (keV) Gamma-2 89.07 140.5 External Radiation The specific gamma ray constant for technetium Tc-99m is 0.795 R/hr-mCi at 1 cm. The first half-value layer is 0.023 cm of lead (Pb). A range of values for the relative attenuation of the radiation emitted by this radionuclide that results from interposition of various thicknesses of Pb is shown in Table 2. For example, the use of 0.27 cm thickness of Pb will attenuate the radiation emitted by a factor of about 1000. Table 2. Radiation Attenuation by Lead Shielding Shield Thickness (Pb) cm Coefficient of Attenuation 0.023 0.5 0.09 10 -1 0.18 10 -2 0.27 10 -3 Molybdenum Mo-99 decays to technetium Tc-99m with a molybdenum Mo-99 half-life of 2.75 days, or 66 hours (see Table 3). The physical decay characteristics of molybdenum Mo-99 are such that only 88.6% of the decaying molybdenum Mo-99 atoms form technetium Tc-99m. Generator elutions may be made at any time, but the amount of technetium Tc-99m available will depend on the interval measured from the last elution. Approximately 47% of the maximum available technetium Tc-99m is reached after 6 hours and 95% after 23 hours. To correct for physical decay of molybdenum Mo-99 and technetium Tc-99m, the fractions that remain at selected intervals of time are shown in Tables 3 and 4. Table 3. Physical Decay Chart; Molybdenum Mo-99, Half-Life 66 Hours Days Percent Remaining Days Percent Remaining 0 100 10 8 1 78 11 6 2 60 12 5 3 47 13 4 4 37 14 3 5 28 15 2 6 22 20 0.6 7 17 25 0.2 8 13 30 0.05 9 10 Table 4. Physical Decay Chart; Technetium Tc-99m, Half-Life 6 Hours Hours Percent Remaining Hours Percent Remaining 0* 100 9 35 1 89 10 32 2 79 11 28 3 71 12 25 4 63 14 20 5 56 16 16 6 50 18 13 7 45 24 6 8 40 *Calibration Time

Xenon Xe 133 Gas is for diagnostic inhalation use only. It is supplied in vials containing either 370 or 740 megabecquerels (10 or 20 millicuries) of Xenon Xe 133 Gas in 2 milliliters of carrier xenon and atmospheric air. Xenon Xe 133 Gas is chemically and physiologically similar to elemental xenon, a non-radioactive gas which is physiologically inert except for anesthetic properties at high doses. Xenon Xe 133 is produced by fission of Uranium U 235. At the time of calibration, it contains no more than 0.3% Xenon Xe 133m, no more than 1.5% Xenon Xe 131m, no more than 0.06% Krypton Kr 85 and no more than 0.01% Iodine I 131, with no less than 99.9% total radioactivity as radioxenon. Table 1 shows the effect of time on radionuclidic composition. Table 1. Radionuclidic Composition Percent of Total Radioactivity Days % Xe-133 % Xe-133m % Xe-131m % Kr-85 % I-131 -5 >98.3 <0.6 <1.0 <0.03 <0.01 0 Calibration Date >98.1 <0.3 <1.5 <0.06 <0.01 7 >97.2 <0.08 <2.5 <0.15 <0.02 14 Expiration Date >95.7 <0.02 <4.1 <0.37 <0.02