TechneScan DTPA: Uses, Dosage & Side Effects
A diagnostic radiopharmaceutical kit used to prepare technetium-99m pentetate for kidney function imaging, glomerular filtration rate (GFR) measurement, lung ventilation studies and brain perfusion imaging
TechneScan DTPA is a diagnostic radiopharmaceutical kit that, when reconstituted with sodium pertechnetate (99mTc), forms technetium-99m pentetate (Tc-99m DTPA). This radioactive tracer is used in nuclear medicine imaging to assess the blood flow and function of the kidneys, calculate glomerular filtration rate (GFR), visualise lung ventilation, and in some centres to evaluate cerebral blood flow or confirm brain death. TechneScan DTPA itself contains no radioactivity until it is labelled with technetium-99m in the hospital pharmacy. The finished radiopharmaceutical is administered by a specialist team in a licensed nuclear medicine department and emits a short-lived, low-energy gamma signal that is captured by a gamma camera to produce diagnostic images.
Quick Facts: TechneScan DTPA
Key Takeaways
- TechneScan DTPA is a freeze-dried kit of pentetic acid (diethylenetriaminepentaacetic acid) that is radiolabelled with technetium-99m in the hospital pharmacy to produce the diagnostic tracer Tc-99m DTPA.
- It is primarily used for dynamic renal scintigraphy and renography, measurement of glomerular filtration rate (GFR), ventilation lung scans (via aerosol) and, less commonly, cerebral perfusion imaging and brain death assessment.
- The radiation dose from a standard examination is low and the isotope decays rapidly (technetium-99m has a physical half-life of 6.02 hours); the effective half-life in the body is approximately 100 minutes because the tracer is cleared by glomerular filtration.
- TechneScan DTPA is generally very well tolerated; serious adverse reactions are rare, with hypersensitivity or anaphylactoid reactions occurring in far fewer than 1 in 10 000 administered doses in published pharmacovigilance data.
- Good hydration and frequent voiding after the scan are the most important practical steps a patient can take: they improve image quality, shorten renal transit time and reduce the radiation dose to the bladder and gonads.
What Is TechneScan DTPA and What Is It Used For?
TechneScan DTPA is a sterile, pyrogen-free, freeze-dried (lyophilised) kit that contains the chelating agent pentetic acid, also known as diethylenetriaminepentaacetic acid (DTPA), together with stabilising excipients. The kit itself is not radioactive. Radioactivity is introduced only at the point of use, when a radiopharmacist adds sodium pertechnetate (99mTc) injection to the vial. Inside the vial, stannous (tin) ions reduce the pertechnetate and allow it to bind firmly to the DTPA molecule, forming the finished radiopharmaceutical technetium-99m pentetate (Tc-99m DTPA).
Technetium-99m is a metastable isotope widely considered the "workhorse" of diagnostic nuclear medicine. It emits a 140 keV gamma photon that is ideal for detection by a standard gamma camera, and it has a physical half-life of only 6.02 hours, which minimises long-term radiation exposure to the patient. Because Tc-99m DTPA is cleared from the body almost exclusively by glomerular filtration in the kidneys, and is neither secreted nor reabsorbed by the renal tubules, its plasma clearance closely mirrors true glomerular filtration rate (GFR). This makes it uniquely suited to a range of functional imaging studies.
Tc-99m DTPA is used for several well-established indications in nuclear medicine, endorsed by the European Association of Nuclear Medicine (EANM), the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and the International Atomic Energy Agency (IAEA):
- Dynamic renal scintigraphy and renography: After intravenous injection, serial images are acquired over 20–30 minutes to assess renal perfusion, parenchymal function (split function, left vs. right), and drainage of the collecting systems and ureters. Typical indications include investigation of suspected urinary tract obstruction, follow-up of hydronephrosis, evaluation of renal transplants and pre-operative assessment before nephrectomy.
- Glomerular filtration rate (GFR) measurement: Blood samples or imaging-based methods are used to calculate the plasma clearance of Tc-99m DTPA, providing an accurate, reference-standard GFR that is often used before nephrotoxic chemotherapy, in potential living kidney donors and in cases where creatinine-based estimates are unreliable.
- Diuretic renography (e.g. Lasix/furosemide renogram): An intravenous diuretic is given during the scan to differentiate true mechanical obstruction from a non-obstructive dilated collecting system.
- Captopril renography: An ACE inhibitor (captopril) is administered before or between scans to unmask renovascular hypertension caused by renal artery stenosis.
- Ventilation lung scanning: When Tc-99m DTPA is nebulised and inhaled through a dedicated closed-system aerosol device, it deposits in the alveoli in proportion to regional ventilation. Combined with a separate perfusion study (using Tc-99m macroaggregated albumin), this V/Q scan remains a key tool for diagnosing pulmonary embolism, especially in patients who cannot receive iodinated contrast or in pregnancy.
- Cerebral perfusion imaging and brain death confirmation: In some centres, Tc-99m DTPA (which does not cross an intact blood-brain barrier) is used to demonstrate absence of intracranial blood flow as an ancillary test for the determination of brain death.
- Cystography and other specialised studies: Direct or indirect radionuclide cystography in children with suspected vesicoureteric reflux is sometimes performed using Tc-99m DTPA, depending on local protocols.
Unlike iodinated contrast agents used for CT or conventional radiography, Tc-99m DTPA does not rely on X-ray attenuation; instead, images are generated from the gamma photons emitted as the isotope decays within the body. This functional information — how well each kidney filters blood, how quickly urine drains through the ureters, whether both lungs are ventilating evenly — cannot be obtained from anatomical imaging alone. Consequently, radionuclide studies often provide complementary information to ultrasound, CT or MRI, and in many clinical questions (split renal function, obstruction, GFR) they remain the reference standard.
The letter "m" stands for metastable. It means that the nucleus of technetium-99 is temporarily in a higher-energy state and releases that excess energy as a gamma photon when returning to its ground state. This single, well-defined photon energy is what makes technetium-99m so useful: it produces high-quality images with a comparatively small radiation dose to the patient.
What Should You Know Before Receiving TechneScan DTPA?
Contraindications
There are very few absolute contraindications to a Tc-99m DTPA study. However, the following situations must always be considered before administration:
- Known hypersensitivity: Tc-99m DTPA should not be given to anyone with a confirmed hypersensitivity to pentetic acid, to any excipient in the kit (typically stannous chloride dihydrate, sodium p-aminobenzoate, calcium chloride, and sodium hydroxide or hydrochloric acid for pH adjustment), or to sodium pertechnetate (99mTc).
- Pregnancy (relative contraindication): When pregnancy cannot be excluded, non-radiation imaging (e.g. ultrasound, non-contrast MRI) should be preferred whenever it can answer the clinical question. A radionuclide study should only be performed when the diagnostic benefit clearly outweighs the potential risk to the fetus. Ionising radiation exposure in early pregnancy is best avoided where possible.
Warnings and Precautions
Although extremely rare, severe hypersensitivity reactions (including anaphylaxis) have been reported with almost all radiopharmaceuticals. Every nuclear medicine department must be equipped to recognise and manage such reactions, with immediate access to adrenaline, oxygen, intravenous fluids, corticosteroids and resuscitation equipment. Patients are observed during and after the injection.
Before the scan, the nuclear medicine team will review the following in more detail:
- Adequate hydration: Good hydration is essential before any renal study. Patients are generally asked to drink about 500 mL of water shortly before the scan and to empty the bladder immediately beforehand. Dehydration falsely slows tracer clearance and can mimic obstruction.
- Kidney impairment: In severe renal failure, clearance of Tc-99m DTPA is markedly prolonged, which increases whole-body radiation exposure and can reduce diagnostic image quality. An alternative tracer (e.g. Tc-99m MAG3, which is cleared by tubular secretion) may be preferred when GFR is very low.
- Recent other radiopharmaceuticals or imaging: Residual activity from a recent nuclear medicine scan, or iodinated or gadolinium contrast that could alter renal handling, should be disclosed. Ideally, different scans are scheduled a few days apart so signals do not overlap.
- Recent thyroid or hormonal therapy: If thyroid protection with potassium iodide is indicated locally for other isotopes, it should be reviewed, although Tc-99m DTPA itself does not target the thyroid.
- Bladder disease or urinary catheterisation: In patients with bladder outflow problems, neurogenic bladder or urinary retention, catheterisation may be considered before the study so that the bladder can be emptied regularly. This reduces the radiation dose to the pelvic organs.
- Young children: Paediatric doses are carefully calculated according to body weight using the EANM Dosage Card, and children are helped to drink fluids and void after the scan to minimise exposure.
- Infection control during aerosol ventilation studies: When Tc-99m DTPA is used for lung ventilation, the aerosol is delivered through a closed-system nebuliser to contain exhaled activity and protect staff.
- Claustrophobia and mobility: Although the gamma camera is more open than an MRI scanner, some patients find it uncomfortable to remain still for 20–30 minutes. Tell the team beforehand if you may need support or anxiolysis.
Radiation Safety and the ALARA Principle
All diagnostic radiopharmaceutical administrations follow the ALARA principle — As Low As Reasonably Achievable. The administered activity is individualised by patient weight, clinical indication and camera sensitivity, and is kept to the minimum required to obtain a diagnostic-quality image. Patients are encouraged to drink extra fluids and void frequently for 24 hours after the scan to accelerate excretion of the tracer.
Typical effective doses from Tc-99m DTPA studies in adults are on the order of 2–3 mSv for a standard renal scan — less than a contrast-enhanced CT of the abdomen and close to the average annual natural background radiation exposure in many countries (approximately 2.4 mSv worldwide, according to UNSCEAR).
Pregnancy and Breastfeeding
Before administration, any possibility of pregnancy must be excluded in women of childbearing potential. When a radiopharmaceutical is essential in pregnancy (for example, a ventilation/perfusion scan in a woman with suspected pulmonary embolism where CT pulmonary angiography is relatively contraindicated), the lowest diagnostic activity is used, the pelvis is shielded where possible, the bladder is emptied frequently, and the procedure is discussed with the woman and her obstetric team.
Although technetium-99m does not readily cross the placenta in significant amounts, the bladder concentrates the tracer and sits close to the uterus; the fetal dose from a standard renal scan is generally estimated to be well under 1 mSv, but this should always be weighed against the diagnostic benefit.
For breastfeeding women, the Summary of Product Characteristics and the ICRP recommend interrupting breastfeeding for at least 12 hours after administration of Tc-99m DTPA. Breast milk expressed during that period should be discarded. Milk that was expressed and stored before the scan can be used in the interim. In practice, many nuclear medicine departments recommend a longer interruption period for very young infants or when higher activities have been used; follow local guidance.
Driving and Daily Activities
Tc-99m DTPA does not cause sedation, drowsiness or visual disturbance, and has no known effect on the ability to drive or operate machinery. Most patients return to work or normal activities immediately after the scan. For 24 hours afterwards, it is sensible to avoid prolonged close contact with infants or pregnant women where possible, to drink extra fluids and to flush the toilet twice after voiding; your department will give specific local advice.
Important Information About Ingredients
The finished injection contains small amounts of sodium (generally less than 1 mmol per dose), which is clinically insignificant and does not need to be taken into account even in patients on a low-sodium diet. The kit also contains small amounts of stannous chloride (tin) used to reduce pertechnetate; the quantity is well below any toxicologically relevant threshold.
How Does TechneScan DTPA Interact with Other Drugs?
Because only microgram (tracer) quantities of DTPA are administered, conventional pharmacokinetic drug-drug interactions do not occur. However, several classes of medication can modify the appearance of the renogram curve by altering renal haemodynamics, tubular function or urinary drainage. Inform your nuclear medicine team of every medication you are taking, including over-the-counter products and herbal supplements.
Major Interactions (Scan Interpretation)
| Interacting Drug | Effect on the Scan | Clinical Significance |
|---|---|---|
| ACE inhibitors (e.g. enalapril, ramipril, lisinopril) | Reduce glomerular filtration in a kidney with renal artery stenosis; used intentionally in captopril renography | Usually held for 3–7 days before a routine baseline study; deliberately given for captopril renography |
| Angiotensin II receptor blockers (ARBs) | Same as ACE inhibitors; can unmask or obscure renal artery stenosis | Treat as ACE inhibitors; check with the ordering clinician whether to withhold |
| Diuretics (furosemide) | Accelerates drainage of tracer from a dilated collecting system; used diagnostically in diuretic renography | Given intravenously during the scan to differentiate true obstruction from dilatation |
| NSAIDs (ibuprofen, naproxen, diclofenac) | Reduce prostaglandin-mediated renal vasodilation; can lower apparent GFR | Ideally withheld for 24–48 hours before quantitative GFR measurement |
| Iodinated contrast media (recent CT) | May transiently reduce renal function (contrast-associated AKI) and alter clearance | Allow at least 24 hours (preferably 48 hours) between CT with contrast and a quantitative renal study |
Other Interactions (Scan Quality and Radiation Dose)
| Interacting Drug / Situation | Effect | Clinical Significance |
|---|---|---|
| Nephrotoxic drugs (aminoglycosides, cisplatin, tacrolimus, ciclosporin) | Reduce baseline GFR, can prolong retention of the tracer | Interpret results in the context of current kidney function; adjust timing if clinically possible |
| Recent other radiopharmaceuticals | Residual activity in the body may be detected by the gamma camera and interfere with image interpretation | Schedule examinations to avoid overlap, particularly after Tc-99m MAG3, bone scans or iodine-123/131 studies |
| Bladder outlet obstruction (e.g. untreated BPH) | Retained tracer in the bladder increases radiation dose and may obscure ureteric drainage | Consider catheterisation or ensure complete voiding during and after the scan |
| Bronchodilators (for ventilation scans) | May improve aerosol distribution in obstructive lung disease | Can be administered before aerosol inhalation if the patient is wheezing |
Importantly, most routine medications — including statins, metformin, thyroid replacement, oral contraceptives, asthma inhalers and antidepressants — do not need to be stopped before a Tc-99m DTPA scan. Decisions to hold a drug should be made by the referring physician in consultation with the nuclear medicine team.
What Is the Correct Dosage of TechneScan DTPA?
Tc-99m DTPA is administered only by authorised nuclear medicine personnel, in a facility licensed to handle unsealed radioactive materials. The activity (measured in megabecquerels, MBq, or millicuries, mCi) is selected according to the clinical question, patient weight, gamma camera sensitivity and local diagnostic reference levels (DRLs).
Adults
Dynamic Renal Scintigraphy and Renography
Typical activity: 100–200 MBq (approximately 2.7–5.4 mCi) administered as a rapid intravenous bolus
Mass of DTPA: Approximately 1–5 mg, far below any pharmacologically active concentration
Imaging: Dynamic imaging begins immediately after injection, typically for 20–30 minutes, in posterior projection (or anterior for transplanted kidneys)
Quantitative GFR Measurement (Plasma Clearance)
Typical activity: 40–100 MBq (approximately 1–2.7 mCi) intravenously
Sampling: Two or more venous blood samples (e.g. at 2 and 4 hours, or 3 and 4 hours) are taken to calculate plasma clearance using single- or multi-sample methods
Precision: Typical inter-session variability of ~5–10%, comparable to iohexol or chromium-51 EDTA clearance
Diuretic or Captopril Renography
Typical activity: 100–200 MBq intravenously
Pharmacological intervention: Furosemide 0.5 mg/kg IV (up to 40 mg) typically given at 20 minutes after the start, or captopril 25–50 mg orally 60 minutes before injection
Monitoring: Blood pressure is monitored during captopril renography because of the risk of symptomatic hypotension
Lung Ventilation Scanning (Aerosol)
Typical activity: 25–35 MBq deposited in the lungs, requiring 600–1000 MBq placed in the nebuliser (most activity is retained in the nebuliser and tubing)
Delivery: Closed-system aerosol generator, inhaled via a mouthpiece with noseclip for 3–5 minutes while seated
Imaging: Multiple static or SPECT projections of the thorax, often immediately followed by a Tc-99m MAA perfusion study for V/Q comparison
Brain Perfusion / Brain Death Study
Typical activity: 370–740 MBq (10–20 mCi) intravenously as a rapid bolus
Imaging: First-pass dynamic angiographic imaging followed by static images of the head
Interpretation: Absence of intracranial blood flow on first-pass and static images supports brain death when combined with clinical criteria
Children
In paediatrics, activities are individualised by body weight using the EANM Paediatric Dosage Card. For dynamic renal imaging, the base activity is approximately 34 MBq multiplied by a weight-dependent factor, with a minimum administered activity around 15 MBq. Children are supported with careful hydration, warm blankets, distraction or play therapy, and occasional sedation for infants who cannot lie still. Paediatric nuclear medicine should, whenever possible, be performed in specialised centres.
Elderly
No specific dose reduction is required purely on the basis of age, but renal function is often reduced in older patients, which prolongs tracer retention and may increase whole-body dose. The ordering clinician and nuclear medicine physician jointly weigh the benefit of the scan against this modest additional exposure. Extra fluids and frequent voiding are particularly helpful in this age group.
Missed Appointment
Because Tc-99m DTPA is only used for a single scheduled examination and is not a maintenance medication, there is no "missed dose" in the conventional sense. If you miss your scan, contact the nuclear medicine department to reschedule. The prepared tracer has a limited shelf life (governed by the 6-hour half-life of technetium-99m) and cannot usually be saved for another day.
Overdose and Accidental Over-Administration
In the unlikely event that a higher-than-prescribed activity is administered, the principal concern is an increased radiation dose to the patient. Because Tc-99m DTPA is cleared rapidly and exclusively by glomerular filtration, the most effective corrective measure is forced diuresis: administering oral or intravenous fluids together with an intravenous diuretic, and instructing the patient to void frequently. This shortens the effective half-life in the body and substantially reduces the absorbed dose. Pharmacological "antidotes" to DTPA are not required; the chemical quantity of DTPA involved is too small to produce any toxic effect. The incident should be reported to the local radiation safety officer and to the national regulatory authority where required.
How TechneScan DTPA Is Given
In practice, the workflow in a typical nuclear medicine department proceeds as follows:
- Kit preparation: A radiopharmacist aseptically adds sodium pertechnetate (99mTc) injection to the TechneScan DTPA vial. The reconstituted vial is mixed and allowed to stand for approximately 15 minutes at room temperature to complete the labelling reaction.
- Quality control: Radiochemical purity is verified (usually by instant thin-layer chromatography) — regulatory guidelines require a radiochemical purity of at least 95%. Only a compliant batch is released.
- Patient identification and consent: The patient's identity is confirmed, pregnancy excluded where applicable, and the procedure is explained. Informed consent (local requirements vary) is obtained.
- Hydration and voiding: The patient is asked to drink water and to empty the bladder immediately before the scan.
- Injection: A peripheral intravenous cannula is placed. The tracer is administered as a rapid bolus, usually with the patient already under the gamma camera so that dynamic acquisition starts simultaneously with injection.
- Image acquisition: Dynamic, static or SPECT images are acquired according to the protocol. The total scanning time is typically 20–40 minutes.
- Post-scan instructions: The patient is advised to drink extra fluids and void frequently for at least 24 hours, and to flush the toilet twice after voiding.
TechneScan DTPA is a radioactive medicinal product and must never be handled or administered outside a licensed nuclear medicine facility. Preparation, administration, patient dosimetry, quality control and waste disposal are tightly regulated and governed by international (IAEA, ICRP), regional (EANM, EMA) and national legislation.
What Are the Side Effects of TechneScan DTPA?
Because only trace (microgram) quantities of DTPA are administered, classical dose-related pharmacological side effects do not occur. Adverse events observed in published pharmacovigilance data are dominated by uncommon idiosyncratic reactions and by local reactions at the injection site. The frequencies below are derived from published EANM pharmacovigilance reviews, SNMMI guideline reports and manufacturer Summaries of Product Characteristics (SmPC).
Immediate and Delayed Reactions
Most reactions, if any, occur within minutes to a few hours after injection. Delayed reactions (flushing, mild rash) have been reported up to 24 hours later. As with any radiopharmaceutical, the department is equipped and trained to manage acute reactions.
Common
May affect up to 1 in 10 people (usually mild and transient)
- Mild discomfort, bruising or stinging at the injection site
- A transient warm or flushed sensation on injection
- Mild nausea
- Throat or mouth irritation and cough during aerosol inhalation for ventilation scans
- Anxiety or claustrophobic feeling under the gamma camera
Uncommon
May affect up to 1 in 100 people
- Headache
- Dizziness or light-headedness
- Transient taste disturbance (metallic taste)
- Mild skin rash or itching (pruritus)
- Hypotension, particularly after captopril administration in captopril renography
- Transient urinary urgency following diuretic administration in diuretic renography
Rare
May affect up to 1 in 1 000 people
- Vomiting
- Generalised urticaria (hives)
- Facial flushing with tachycardia
- Vasovagal syncope (fainting), often related to injection rather than to the tracer itself
- Bronchospasm, particularly in patients with severe asthma undergoing ventilation imaging
Very Rare / Not Known
Frequency cannot be reliably estimated from available data
- Anaphylactoid or anaphylactic reaction, including angioedema, bronchospasm and circulatory collapse
- Extravasation at the injection site, with local inflammation, pain and swelling
- Long-term theoretical stochastic risk (carcinogenesis, heritable effects) from exposure to ionising radiation, considered extremely low for a single diagnostic procedure
Radiation Risk in Perspective
All exposure to ionising radiation carries a theoretical, stochastic long-term risk of cancer induction. The effective dose of a standard adult Tc-99m DTPA renal study (typically 2–3 mSv) is equivalent to roughly one year of natural background radiation and considerably lower than a typical contrast-enhanced CT of the abdomen (5–10 mSv). For an individual patient referred for a clinically justified scan, the expected benefit in terms of diagnosis and improved management substantially outweighs this small theoretical risk.
Patients with severe asthma or poorly controlled COPD may develop bronchospasm during aerosolised ventilation scans. The department may give a bronchodilator before the study and will keep the patient under close observation during and after aerosol delivery.
If you experience any side effects during or after a Tc-99m DTPA scan, including those not listed here, report them to the nuclear medicine team or your referring doctor. You can also report suspected side effects to your national pharmacovigilance authority (e.g. the EudraVigilance system in the EU, the FDA MedWatch program in the United States, or the MHRA Yellow Card Scheme in the United Kingdom) to support the ongoing monitoring of the benefit-risk profile.
How Should TechneScan DTPA Be Stored?
TechneScan DTPA is delivered directly to hospital radiopharmacies under controlled conditions, and storage is managed entirely by trained staff in compliance with national and international regulations for radioactive materials. Patients never receive the kit in the community. The most important storage principles are:
- Unopened kits: Stored in a refrigerator at 2°C to 8°C (36°F to 46°F), protected from light, in compliance with the manufacturer's SmPC. Do not freeze.
- Expiry: The kit has a shelf life specified on the packaging; expired kits must not be used.
- Reconstituted radiopharmaceutical: Once labelled with sodium pertechnetate, the final solution is kept at room temperature (below 25°C), protected from light, and used within the period stated in the SmPC (typically up to 6–8 hours). Storage times are dictated by both chemical stability and radioactive decay.
- Radiation protection during storage: All radioactive materials are kept in lead-shielded containers in designated, controlled areas with restricted access, monitored dosimetry and documented inventory control.
- Visual inspection: The reconstituted solution should be clear and colourless, free of visible particles. It must not be administered if any discolouration or particulate matter is observed.
- Waste handling: Unused radiopharmaceutical and contaminated materials (syringes, tubing, dressings) are disposed of as radioactive waste according to local, national and international regulations, typically by decay-in-storage.
As a patient, you do not need to worry about storage. The nuclear medicine team will prepare and administer the correct activity on the day of your scan. Excreted tracer in urine is not considered a significant environmental hazard given the short half-life and low activities involved, but you will receive simple instructions (e.g. flushing the toilet twice, washing hands thoroughly) for the first 24 hours after the examination.
What Does TechneScan DTPA Contain?
Active Substance (Before Radiolabelling)
The active pharmaceutical substance in the kit is pentetic acid (diethylenetriaminepentaacetic acid, DTPA). Each single-use vial typically contains approximately 5 mg of pentetic acid (the exact amount varies by manufacturer and presentation). DTPA is a powerful multidentate chelating agent that forms a very stable complex with reduced technetium-99m.
Radiolabelling Partner
The kit must be combined with a separately supplied sodium pertechnetate (99mTc) injection, freshly eluted from a 99Mo/99mTc generator. The generator itself is produced by manufacturers of radiopharmaceuticals (historically Mallinckrodt, now part of Curium, as well as others) and delivered weekly to hospital radiopharmacies.
Inactive Ingredients (Excipients)
Typical excipients in a TechneScan DTPA kit include:
- Stannous chloride dihydrate (SnCl₂·2H₂O): Reducing agent that converts Tc(VII) pertechnetate to Tc(IV), allowing formation of the Tc-DTPA complex.
- Sodium p-aminobenzoate (PABA): Antioxidant / stabiliser that protects stannous ions from premature oxidation.
- Calcium chloride (or disodium edetate): Calcium-containing agents used to optimise complex stability.
- Hydrochloric acid and/or sodium hydroxide: For pH adjustment.
- Nitrogen: Used to flush the headspace of the vial and exclude oxygen during manufacture.
The exact composition of each presentation is described in the product's Summary of Product Characteristics (SmPC). Always refer to the current SmPC or package insert for the specific product in use at your institution.
Appearance
Before radiolabelling, TechneScan DTPA is a sterile, pyrogen-free, freeze-dried (lyophilised) white to off-white cake or powder, supplied in a multidose glass vial sealed with a rubber stopper and aluminium cap. After reconstitution with sodium pertechnetate (99mTc) injection, the solution is clear and colourless. It must be visually inspected before use, and any discolouration or particulate matter is a reason to reject the preparation.
Manufacturer and Marketing Authorisation
TechneScan DTPA is manufactured and marketed internationally by Curium Pharma (formerly Mallinckrodt Nuclear Medicine). Curium is a leading supplier of nuclear medicine products in Europe, the United States and numerous other countries. Marketing authorisation, labelling and availability vary by jurisdiction; equivalent DTPA kits are also supplied by other manufacturers under different brand names.
Frequently Asked Questions About TechneScan DTPA
TechneScan DTPA is a diagnostic radiopharmaceutical kit used to prepare technetium-99m pentetate (Tc-99m DTPA). Once labelled with technetium-99m in the hospital pharmacy, it is used for dynamic renal scintigraphy and renography, measurement of glomerular filtration rate (GFR), diuretic and captopril renography, ventilation lung scans (via aerosol), cerebral blood flow imaging and confirmation of brain death. It is a diagnostic tool and is not used to treat disease.
The scan itself is painless. You will feel a brief pinprick when a small intravenous cannula is placed for the injection. You then lie under the gamma camera for roughly 20–30 minutes. The radiation dose from a standard adult study is typically 2–3 mSv, similar to one year of natural background radiation and considerably less than a contrast-enhanced abdominal CT. Serious adverse reactions are extremely rare.
Technetium-99m has a physical half-life of 6.02 hours, which means the radioactivity in your body halves every six hours simply by decay. Tc-99m DTPA is also rapidly cleared by the kidneys: the effective biological half-life in the body is approximately 100 minutes. By 24 hours after the scan, more than 95% of the activity has decayed or been excreted in urine. Drinking extra water and voiding frequently accelerates elimination.
Most routine medications do not need to be stopped. However, if you are scheduled for a renal study, your doctor may ask you to withhold ACE inhibitors or angiotensin receptor blockers for several days before a baseline scan (unless a captopril renogram is being performed intentionally), and to avoid non-steroidal anti-inflammatory drugs (NSAIDs) for 24–48 hours before quantitative GFR measurement. Always follow the specific instructions given by your nuclear medicine department.
The Summary of Product Characteristics and ICRP guidance recommend interrupting breastfeeding for at least 12 hours after Tc-99m DTPA administration. Milk expressed during this window should be discarded. Milk expressed and stored before the scan can be used in the meantime. In most cases, normal breastfeeding can resume the next morning. Your department will give specific local advice based on the activity used and your infant's age.
Both are technetium-99m-based tracers used for renal imaging, but they differ in how the kidneys handle them. Tc-99m DTPA is cleared by glomerular filtration only and provides an accurate measurement of GFR. Tc-99m MAG3 is cleared mainly by tubular secretion, so it extracts very efficiently even in kidneys with reduced function. MAG3 therefore often produces better image quality in patients with poor renal function, while DTPA remains the preferred tracer when the clinical question is quantitative GFR measurement.
Highly sensitive radiation portal monitors at airports, seaports and border crossings can occasionally detect the minimal residual activity for 24–48 hours after a nuclear medicine scan. If you are travelling within this window, ask your nuclear medicine department for a signed letter confirming the date of the scan, the isotope used and the activity administered. Carry the letter with your travel documents in case of questioning by security personnel.
References
- Curium Pharma. TechneScan DTPA — Summary of Product Characteristics. Current version. Available from national medicines agencies and manufacturer documentation.
- European Medicines Agency (EMA). Guideline on core SmPC for technetium (99mTc) pentetate kits. EMA Committee for Medicinal Products for Human Use (CHMP), current revision.
- U.S. Food and Drug Administration (FDA). Technetium Tc 99m Pentetate Injection — Prescribing Information. Available from: FDA Drugs@FDA.
- Taylor AT, Brandon DC, de Palma D, et al. SNMMI Procedure Standard/EANM Practice Guideline for Diuretic Renal Scintigraphy in Adults With Suspected Upper Urinary Tract Obstruction 1.0. Semin Nucl Med. 2018;48(4):377–390. doi:10.1053/j.semnuclmed.2018.02.010.
- Bubeck B. Renal Clearance Determination with One Blood Sample: Improved Accuracy and Universal Applicability by a New Calculation Principle. Semin Nucl Med. 1993;23(1):73–86.
- International Commission on Radiological Protection (ICRP). Publication 128: Radiation Dose to Patients from Radiopharmaceuticals: A Compendium of Current Information Related to Frequently Used Substances. Ann ICRP. 2015;44(2 Suppl):7–321.
- Gordon I, Piepsz A, Sixt R; Auspices of Paediatric Committee of European Association of Nuclear Medicine. Guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging. 2011;38(6):1175–1188.
- Lassmann M, Treves ST; EANM/SNMMI Paediatric Dosage Harmonization Working Group. Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5.2008) and the 2010 North American consensus guidelines. Eur J Nucl Med Mol Imaging. 2014;41(5):1036–1041.
- Bajc M, Neilly JB, Miniati M, et al. EANM guidelines for ventilation/perfusion scintigraphy. Part 1 & 2. Eur J Nucl Med Mol Imaging. 2009;36(8):1356–1370.
- Taylor A Jr, Nally JV. Clinical applications of renal scintigraphy. AJR Am J Roentgenol. 1995;164(1):31–41 (classical reference; principles still relevant).
- International Atomic Energy Agency (IAEA). Nuclear Medicine Resources Manual. 2nd Edition. IAEA, Vienna, 2023.
- Blaufox MD, De Palma D, Taylor A, et al. The SNMMI and EANM practice guideline for renal scintigraphy in adults. Eur J Nucl Med Mol Imaging. 2018;45(12):2218–2228.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians with expertise in nuclear medicine, diagnostic radiology and clinical pharmacology.
Medical Content
iMedic Nuclear Medicine Editorial Team — specialist physicians in nuclear medicine and diagnostic imaging, with direct clinical experience in renal, ventilation and cerebral scintigraphy
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