The present invention relates to the field of radiopharmaceuticals. More specifically the present invention is directed to a method of preparing a radiopharmaceutical kit from which doses of radiopharmaceutical are drawn.
Pharmacies prepare thousands of Technetium (99mTc) kits daily and dispense millions of prescriptions annually. As a result of preparing these prescriptions the compounding pharmacists each receive between 10,000 mrem (100 mSv) and 30,000 mrem (300 mSv) annually in extremity dose based on ring dosimeter measurements. Pharmacy Operations and Pharmacy Regulatory Assurance have concluded that the majority of extremity exposure is associated with kit preparation. Pharmacy Operations anticipates that in order to be in keeping with ALARA (As Low As Reasonably Achievable) levels, it should continue to lower radiation dose limits (current company and regulatory limits are listed in Table 1). In addition, recent Nuclear Regulatory Commission (NRC) inspections throughout the industry have concentrated on the licensee's ability to demonstrate that the ring dosimeter accurately represents the dose to the maximally exposed area of the extremity (e.g., fingertips). As a result of these issues, it will be critical that Pharmacy Operations successfully implement a hands free kit preparation method and device, thereby allowing US pharmacies to continue to maintain employee doses ALARA and demonstrate that the use of the ring badge accurately reflects the dose to the maximally exposed area of the extremity.
Currently preparation of Technetium based kits is done by manually drawing the radioactive solution out of an eluate vial, and depositing the solution into multiple kits. It is the combination of the 99mTc, saline and the chemicals in the kit that form the active pharmaceutical that will be ultimately administered to the patient.
The current preparation process may result in excessive exposure and possible handling of unshielded radioactive material.
The manual process of
There are many instances during this process when the pharmacist may be exposed to radiation. It is also possible that the pharmacist may over fill the cold kit with eluate causing radioactive product to flow out the vent needle or even unseat the septum. When the pharmacist or technician must prepare many kits from one or more eluate vials, the cumulative risk and effect of even low level exposures are multiplied. There is therefore a need to reduce the potential for pharmacist and technician exposure by providing an automated system for preparing radioactive pharmaceutical kits.
Previous attempts to provide remotely operated drawing of radioactive compounds result in undesirable levels of wasted compound, which requires additional safe handling and disposal procedures as well as loss of valuable product. U.S. Pat. No. 5,039,863 describes an automated radioisotope filling apparatus in which a vial containing a radioisotope, a vial containing a saline solution, a drain vial, and a number of vials containing a label/drug are each connected via a network of valves and tubes so that the proper amounts of saline and radioisotope will be serially drawn through separate portions of the tube network into a single dispense syringe. From the dispense syringe the saline and radioisotope will each flow through a portion of the tube network so as to be dispensed into the label vials. The label vials are mounted to rotate about a transverse axis so as to stir and mix the contents of the label vial. Each of the vials are manually connected to the system by manually inserting the drain and vent needles into the vials. The radioisotope vial is taught to be mounted upside-down and the withdrawal needle is inserted well through, and perpendicularly to, the septum. The normal orientation of the needle and the septum (whereby the needle flow port extends some distance above the low septum floor) will result in some radioisotope not being drawn through the needle and dispensed to a label vial. The unused radioisotope is thus wasted and requires careful handling and disposal. Additionally, the disclosed network of tubing will retain some undispensed radioisotope which will also require careful handling, cleaning, and disposal of the tubing. Therefore, while providing a hands-free system for filling the radioisotope kits, the filling apparatus described still requires much operator interaction with radioactively dose intensive or radioactively contaminated components.
There is therefore a need for an improved hands-free device which will minimize operator exposure to radiation during both dispensing and cleaning/maintenance operations.
In view of the needs of the prior art, the present invention provides a kit preparation system having a housing defining a preparation cavity. The housing is formed from a radiation-shielding material. The system also includes a syringe having an elongate hollow needle connected to a hollow syringe barrel supporting a syringe piston therein. The system further includes a syringe actuator for extending and retracting the syringe piston. The system also includes a vial holder for holding the pierceable septum for a vial in registry with the needle tip of the syringe and a translational mechanism for extending the needle tip through the septum of the vial.
The present invention also provides a cradle for holding a vial for holding radioactive contents. The cradle includes a cradle base, at least one upstanding wall supported on the cradle base, and a vial retention mechanism defining a vial cavity for accepting a vial. The retention mechanism releasably engages a vial in the vial cavity. The cradle also includes a crownpiece supported by the at least one upstanding wall to extend over the vial cavity. The crownpiece defines a first aperture therethrough in overlying registry with the vial cavity. In alternative embodiment of the present invention, the cradle includes a second aperture through the crownpiece so as to accommodate a vent or overflow needle which can extend through the septum without interfering with a needle inserted through the first aperture. In yet another embodiment of the present invention, the cradle includes a slanted geometry so as to hold an vial at an angle so as to present the lowest portion of the tilted-vial interior in registry with the first aperture so as to maximize the amount of fluid in the vial that may be withdrawn by a needle inserted through the first aperture.
The present invention yet further provides a method of withdrawing the contents from a vial with an automated fluid transfer device, wherein the vial defines an interior chamber and includes a planar base, an upstanding cylindrical wall and a pierceable septum about said interior chamber, and wherein the transfer device includes an elongate syringe supporting an elongate needle wherein said syringe and vial are linearly moveable with respect to each other so as to allow the needle to pierce a septum of the vial. The method includes the step of placing the vial into a vial holder which holds the vial in a slanted geometry with respect to the needle so that the needle may reach the lowest portion of the vial chamber as defined between the planar base and cylindrical wall.
The present invention even further provides a method of dispensing the contents of a syringe in an automated dispense system into a kit vial, wherein the kit vial defines an interior chamber and includes a planar base, an upstanding cylindrical wall and a pierceable septum about the interior chamber, wherein the transfer device includes an elongate syringe supporting an elongate needle wherein the syringe and vial are linearly moveable with respect to each other so as to allow the needle to pierce a septum of the vial. The method includes the steps of placing the vial, within its shield, into a vial holder; and inserting the tip of an elongate overflow needle through the vial holder into the vial chamber.
Thus, the present invention provides several benefits over the prior art. The present invention removes the need for manual manipulation of the vials, shields, or syringes during radioactive material fluid transfer. The present invention further reduces operator risk by reducing the internal the number and amount of fluid-handling components which require specialized handling, cleaning, and disposal when through with use. The present invention also provides the ability to precisely volumetrically dispense the required 99mTc into kits. Additionally, the present invention provides the ability to detect the type of vials, ie, eluate or kit (dispense) vials, are in place before initiating fluid transfer. Furthermore, the present invention provides shielding about an entire remotely-performed eluate transfer process. Also, the present invention provides overflow protection in case vial capacity is exceeded or other leakage occurs.
The development of a hand free kit preparation method and device will reduce extremity exposure. The method and device of the present invention will enable the pharmacists to perform their functions without having to manually extract a volume of Technetium from an eluate vial, and then manually dispense that volume into a pharmaceutical kit vial.
Referring now to
With additional reference to
Eluate cradle assembly 22 accommodates a vent needle to pierce the septum 4 of the kit vial 1 in a manner that will not interfere with the insertion and withdrawal of needle 32 through septum 4 of vial 1. The vent needle may include a filter which allows air to pass through but not liquid, or alternatively may include be connected to a flexible conduit for transporting away any liquid flowing out from vial 1 through the vent needle. Once eluate cradle assembly 22 is properly positioned such that a container 70 housing a vial 1 of eluate is in underlying registry with needle 32, syringe 18 is moved linearly downward to pierce septum 4. Cradle 22 holds the radioisotope vial at an angle so that needle 32 may be advanced to the lowest portion of the vial interior so as to maximize the amount of radioisotope withdrawn from the vial. The lowest portion is contemplated to mean about where planar surface 2 of vial 1 meets cylindrical wall 3 as the vial is held in the tilted position. The lowest portion of slanted vial chamber 5 is thus reachable by needle 32 as it is inserted through septum 4. By allowing needle 32 to reach this lowest portion of the tilted vial 1, the present invention increases the amount of eluate within vial chamber 5 which will be available for withdrawal and thereby minimizing waste of the eluate.
The barrel 24 of syringe 18 defines a container reservoir 36 for, desirably, holding sufficient volume of the radioisotope to fill multiple fill vials containing a drug to be labeled with the radioisotope. Once the radioisotope has been withdrawn from vial 1 into reservoir 36 of syringe 18, needle 32 and vial 1 will be linearly separated so that needle 32 is withdrawn clear of cradle 22. An operator may now replace eluate cradle 22 with a dispense cradle assembly 40 having a shielded vial which will be injected with eluate from syringe 18.
The present invention therefore removes the need for manual manipulation of the vials, shields, or syringes during radioactive material fluid transfer. The present invention further reduces operator risk by reducing the internal the number and amount of fluid-handling components which require specialized handling, cleaning, and disposal when through with use, as only syringe 18 (and needle 32) receive the radioactive eluate. The control system provides the ability to precisely meter the required amounts of 99mTc into the kits. Additionally, the system 10 provides the ability to detect the type of vials, ie, eluate or kit (dispense) vials, are in place before initiating fluid transfer. Significantly, system 10 provides shielding about an entire remotely-performed eluate transfer process. Also, system 10 provides overflow protection in case vial capacity is exceeded or other leakage occurs.
Referring again to
Frame 62 supports radiation shield 90 mounted thereabout. Shield 90 includes a first access door 92 which is openable to allow operator access to syringe assembly 12 in the retracted, or raised, position. Shield 90 includes an access drawer 94 mounted below door 92 which is slideably openable along tracks 97 to allow operator access to the loading area for either eluate cradle 22 or fill cradle 40. Shield 90 is thereby designed to minimize operator exposure to radiation during use of the present invention.
As shown in
Crownpiece 108 defines a first and second through-hole 132 and 134, respectively, positioned to be in overlying registry with the septum of a vial held by cradle 22. Through-hole 132 extends normally through the opposing faces of crownpiece 108 so as to accommodate needle 18 being longitudinally extended therethrough so as to pierce through the septum of the vial and extend down to the lowest portion of the tilted vial and thereby be best positioned to withdraw all, or substantially all, of the contents of the vial. Through-hole 134 extends through the opposing faces of crownpiece 108 so as to accommodate an optional air-vent spike therethrough, not shown, which will allow airflow into the vial as the contents are withdrawn from the vial. Through holes 132 and 134 are formed to extend through crownpiece 108 in a manner which insures that needle 32 of syringe 18 inserted through through-hole 132 and a vent needle inserted through through-hole 134 will properly extend through the septum of the underlying vial without interfering with each other. Desirably, through-holes 132 and 134 extend along axes which are non-coplanar or non-parallel. As shown in
Crownpiece 108 further supports detection prong 140 which engages sensor 64 of syringe assembly 12 so as to notify the dispense system that the cradle has been inserted. Crownpiece 108 further supports an identification prong 142 which engages sensor 65 of syringe assembly 12 so as to indicate that the cradle supports a vial of radioisotope eluate. When cradle 22 is detected by the system, the system will know that needle 18 should be lowered to its fully-extended position to allow maximum withdrawal of the contents of the vial.
Crownpiece 208 defines a first and second through-hole 232 and 234, respectively, positioned to be in overlying registry with the septum of a vial held by cradle 40. Through-hole 232 extends normally through the opposing faces of crownpiece 208 so as to accommodate needle 18 being longitudinally extended therethrough so as to pierce through the septum of the vial and extend into the container cavity of the vial. Through-hole 234 extends through the opposing faces of crownpiece 208 so as to accommodate a vent needle therethrough which will allow airflow from the vial as the eluate is added to the contents of the vial. The vent needle may also contain any fluid which might overflow from the vial due to the filling operation. Through holes 332 and 234 are formed to extend through crownpiece 208 in a manner which insures that needle 32 of syringe 18 inserted through through-hole 232 and a vent needle inserted through through-hole 234 will properly extend through the septum of the underlying vial without interfering with each other. Desirably, through-holes 232 and 234 extend along axes which are non-coplanar or non-parallel.
Crownpiece 208 further supports detection prong 240 which engages a sensor of syringe assembly 12 so as to notify the dispense system that the cradle has been inserted. Crownpiece 208 further supports an identification prong 242 which engages a sensor of syringe assembly 12 so as to indicate that the cradle supports a vial of radioisotope. When cradle 40 is detected by the system, the system will know that needle 18 should be lowered to an extended position which allows dispensement of the radioisotope into the vial.
Holder assembly 300 also provides a place to store a venting needle when not in use. Holder assembly 300 includes a mounting bracket 302 and a holder block 304. Holder block 304 defines an elongate storage receptacle 306 which is sized and shaped to receive a vent needle 310 while the vent needle is not in use.
It is further contemplated by the present invention that an automated feed system may be provided to automatically position a series of fill cradles 40 under syringe 18 for filling.
One method of preparing a radiopharmaceutical kit of the present invention is depicted in
The method E10 of transferring eluate of the present invention is provided in
In step E20 the system desirably checks to ensure that the eluate vial is in position by detecting a device or signal unique to the vial holder for an eluate vial. If the system fails to detect that an eluate vial or vial holder is in the proper position, the operator will be notified. The operator may then access the drawer holding the eluate vial and ensure the vial holder is properly placed therein and repeat from step E16 to ensure the drawer is properly closed so that the vial is properly positioned within the system. In step E22 the system will also ensure that the door to the system is properly closed and signal the operator if is not so.
Once the door is properly closed, in step E24 the control system will indicate to the operator that the eluate vial is ready to raise. In step E26 the operator pushes the appropriate button (desirably through a graphic user interface display of the control system) to cause the system to cause the syringe needle of the system to pierce through the septum of the eluate vial. Desirably, as the eluate vial holder holds the eluate vial in a slanted geometry, the syringe needle may extend to the lowest portion of the vial chamber, e.g., where the planar base wall meets the upstanding cylindrical wall, so as to maximize the amount of eluate available for withdrawal and thereby minimize the amount of unused eluate remaining in the eluate vial. Desirably, the method of the present invention causes the piercing of the vial septum by raising the eluate vial holder towards the syringe needle, although the present invention contemplates that the syringe of the system is itself movably mounted to linearly extend through the vial septum in a similar manner as described for kit preparation system 10.
When the system detects that the syringe needle is properly positioned with respect to the eluate vial from step E26, the system in step E28 will enable the syringe pump and in step E30 indicate to the operator that the eluate vial is ready for transfer. In step E32 the operator will push the appropriate control system button, either hardwired or a soft switch provided by a graphical user interface, to commence fluid transfer of an operator-inputted volume of eluate from the eluate vial to the syringe. The system will, in step E34, indicate to the operator that eluate transfer is taking place. As identified in step E36, this operator action will cause the syringe piston to be drawn away from the syringe needle, thereby drawing the eluate from eluate vial into the syringe barrel. The control system will then signal to the operator, in step E38, when the eluate transfer is complete.
In step E40 the operator will then push the appropriate button to cause the separation of the syringe needle from the vial, again by lowering the vial holder, raising the needle, or some combination thereof. In step E42, the control system will display that the pump is not ready, indicating that separation from the needle and vial is attained. Desirably, an appropriate signal is sent to the syringe pump in step E44 to prevent additional withdrawal or dispensement by the syringe. In step E46 the operator would open the system door, pull out the drawer, remove the vent needle from the vial holder and insert it into its needle holster mounted inside the sliding drawer and remove the eluate vial holder. In step E48 the system would ask the operator whether additional eluate will be transferred from additional eluate vials. If so, the operator would then repeat this process from step E12 until sufficient eluate has been loaded into the syringe barrel for dispensement into the cold kits, when the method proceeds to step E50, or otherwise allows the operator to then go to the kit filling process.
While certain steps of the present invention have been discussed as being automated, the present invention also contemplates that certain steps of the present invention may be completed manually. For example, steps E28, E36, and E44 are indicated as being desirably performed automatically through operation of the control system, its software, and the automated components of the system. The present invention contemplates that steps E28, E36, and B44 may alternatively be performed by the operator by actuating components located outside of the shielded container of the system. For example, steps E28 and E36 may be performed by an operator manually pulling or raising an elongate piston rod which engages the syringe piston and extends through the top of the shielded system container. This piston rod is desirably formed from a radiation shielding material such as lead. Similarly, step E44 may be performed by the operator manually locking out or preventing movement of the syringe piston by locking the above-identified piston rod in place. The present invention further contemplates that step E26 may be performed manually by the operator via use of a manually engageable linkage which can cause the lifting of the vial holder or the lowering of the syringe so that the syringe needle extends through the vial septum in accordance with the present invention.
Moreover, the present invention contemplates that the withdrawal and dispense system of the present invention may include sensors which detect whether the system drawer and door are in an open or closed position. The system also includes a sensor which cooperates with the vial or the vial holder to both determine the type of vial, ie, an eluate vial or a cold kit vial, have been placed in the system and whether the vial holder has been properly positioned within the system to allow eluate transfer to proceed. While the present invention has disclosed a detection system employing a projecting lug on the vial holder which is detectable by a sensor within the system, other types of identification methods, such as bar codes, radio-frequency identification are also contemplated by the present invention. Additionally, a sensor is desirably employed to ensure that the eluate vial holder has been properly raised so that the syringe needle tip is placed therein so as to extend to its lowest portion.
The method K10 of preparing a radioactive kit of the present invention is provided in
In step K16 the operator manually slides the drawer into a closed position, thereby placing the kit vial under the syringe needle. In step K18 the operator closes the door to the filling and dispense system. In step K20 the system desirably checks to ensure that the kit vial is in position by detecting a device or signal unique to the vial holder for a kit vial. If the system fails to detect that a kit vial or vial holder is in the proper position, the operator will be notified. The operator may then access the drawer holding the kit vial and ensure the vial holder is properly placed therein and repeat from step K16 to ensure the drawer is properly closed so that the vial is properly positioned within the system. In step K22 the system will also ensure that the door to the system is properly closed and signal the operator if is not so.
Once the door is properly closed, in step K24 the control system will indicate to the operator that the kit vial is ready to raise. In step K26 the operator pushes the appropriate button (desirably through a graphic user interface display of the control system) to cause the system to cause the syringe needle of the system to pierce through the septum of the kit vial. Desirably, the syringe needle for this operation only pierces the septum a sufficient distance so that the needle tip is just inside the kit vial chamber, typically no more than about 0.25 inches past the septum. Desirably, the method of the present invention causes the piercing of the vial septum by raising the kit vial holder towards the syringe needle, although the present invention contemplates that the syringe of the system is itself movably mounted to linearly extend through the vial septum in a similar manner as previously described for kit preparation system 10.
When the system detects that the syringe needle is properly positioned with respect to the kit vial from step K26, the system in step K28 will enable the syringe pump and in step K30 indicate to the operator that the kit vial is ready to receive the fluid transfer. In step K32 the operator will push the appropriate control system button, either hardwired or a soft switch provided by a graphical user interface, to commence fluid transfer from the syringe barrel to the kit vial. The system will, in step K34, indicate to the operator that kit fill transfer is taking place. As identified in step K36, this operator action will cause the syringe piston to be extended towards the syringe needle, thereby dispensing the eluate from syringe barrel into the kit vial. The requested volume of fluid will be transferred into the kit. Although the fluid is volumetrically dispensed, the completed kit consists of saline and 99mTc added to a kit to produce a finished volume at a reference, i.e. 50 mCi/mL for a total kit volume of 10 mL (with a total activity of 500 mCi). The control system will then signal to the operator, in step K38, when the fill transfer is complete. In step K40 the operator will then push the appropriate button to cause the separation of the syringe needle from the vial, again by lowering the vial holder, raising the needle, or some combination thereof. In step K42, the control system will display that the pump is not ready, indicating that separation from the needle and vial was attained. Desirably, an appropriate signal is sent to the syringe pump in step K44 to prevent additional withdrawal or dispensement by the syringe. In step K46 the operator would open the system door, pull out the drawer, and remove the eluate vial holder. In step K48 the system would ask the operator whether additional eluate will be transferred into additional kit vials. If so, the operator would then repeat this process from step K12 until the radioactive eluate has been loaded into the desired number of kit vials or the eluate supply in the syringe barrel has been depleted.
While certain steps of the present invention have been discussed as being automated, the present invention also contemplates that certain steps of the present invention may be completed manually. For example, steps K28, K36, and K44 are indicated as being desirably performed automatically through operation of the control system, its software, and the automated components of the system. The present invention contemplates that steps K28, K36, and K44 may alternatively be performed by the operator by actuating components located outside of the shielded container of the system. For example, steps K28 and K36 may be performed by an operator manually pulling or raising an elongate piston rod which engages the syringe piston and extends through the top of the shielded system container. This piston rod is desirably formed from a radiation shielding material such as lead. Similarly, step K44 may be performed by the operator manually locking out or preventing movement of the syringe piston by locking the above-identified piston rod in place. The present invention further contemplates that step K26 may be performed manually by the operator via use of a manually engageable linkage which can cause the lifting of the vial holder or the lowering of the syringe so that the syringe needle extends through the vial septum in accordance with the present invention.
Moreover, the present invention contemplates that the withdrawal and dispense system of the present invention may include sensors which detect whether the system drawer and door are in an open or closed position. As discussed hereinabove, the system also includes a sensor which cooperates with the vial or the vial holder to both determine the type of vial, ie, an eluate vial or a cold kit vial, have been placed in the system and whether the vial holder has been properly positioned within the system to allow kit fill transfer to proceed. While the present invention has disclosed a detection system employing a projecting lug on the vial holder which is detectable by a sensor within the system, other types of identification methods, such as bar codes, radio-frequency identification are also contemplated by the present invention. Additionally, a sensor is desirably employed to ensure that the kit vial holder has been properly raised so that the syringe needle tip is placed therein so as to extend just past the vial septum.
While the particular embodiment of the present invention has been shown and described, it will be obvious to those skilled in the art that changes and modifications may be made without departing from the teachings of the invention. The matter set forth in the foregoing description and accompanying drawings is offered by way of illustration only and not as a limitation. The actual scope of the invention is intended to be defined in the following claims when viewed in their proper perspective based on the prior art.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US06/42714 | 10/31/2006 | WO | 00 | 4/30/2008 |
Number | Date | Country | |
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60731732 | Oct 2005 | US |