Article Figures & Data
Figures
- FIGURE 1.
Components of 90Y-ibritumomab tiuxetan.
- FIGURE 2.
Radioimmunotherapy uses targeting of monoclonal antibody to produce crossfire effect with radioimmunoconjugate.
- FIGURE 3.
Imaging and therapy protocol is administered over 7–9 d.
- FIGURE 4.
Serial whole-body anterior gamma camera images after injection of 111In-ibritumomab tiuxetan illustrate normal biodistribution, including blood pool (diminishes over time), liver, spleen, and bulky tumor. Abdominal SPECT and CT views correlate uptake with abdominal adenopathy.
Tables
Health-care professional Roles and responsibilities Hematologist/oncologist • Patient identification and assessment (including pregnancy) • Patient education, consent • Prescription of rituximab dose • Patient follow-up and monitoring Oncology nurse • Coordination of patient scheduling with nuclear medicine, infusion clinic, and radiation oncology (as necessary) • Patient education • Patient monitoring before and after infusion Nuclear medicine physician • Review of pertinent patient information • Prescription of 111In- and 90Y-ibritumomab tiuxetan doses • Patient education and consent • Interpretation of whole-body images • Calculation and administration of therapy dose • Final procedure reporting and documentation Nuclear medicine technologist/ nuclear radiopharmacist • Interaction with oncology nurse; coordination of patient scheduling • Procurement and preparation of imaging and therapy doses • Safe and appropriate receipt, handling, administration, and disposal of radiopharmaceuticals • Patient education • Whole-body imaging of patients Commercial radiopharmacist • Receipt of orders; confirmation of patient dose • Order placement with supplier for cold kits and yttrium • Order placement for 111In • Radiolabeling of drugs with ≥95% tagging efficiency • Delivery of unit dose to clinical site Radiation safety officer • Oversight of safe handling, administration, and disposal of radiopharmaceuticals according to state or federal guidelines Utilization review/patient billing staff • Confirmation of appropriate clinical indications • Acquisition of authorization from third-party payers • Follow-up (as necessary) on reimbursement issues Radiation oncologist • Review of pertinent patient information • Prescription of 90Y-ibritumomab tiuxetan dose • Patient education • Calculation and administration of therapy dose • Final procedure reporting and documentation Radiation oncology nurse • Coordination of patient scheduling with nuclear medicine and infusion clinic • Patient education • Patient monitoring before and after infusion Acquisition type Parameter Whole body Dual- or single-head gamma camera Medium-energy collimators 171 and 245 keV (15%–20% window) 256 × 1,024 matrix Camera speed (time dependent) • 10 cm/min (20-min scan) at 2–24 h • 7–10 cm/min (30-min scan) at 48–72 h • 5–7 cm/min (40-min scan) at 90–120 h Planar (spot) 256 × 256 matrix 5 min/500K images Product/procedure Code Description APC Payment* Professional component† 111In-Ibritumomab tiuxetan plus scan G0273 Pre–radiopharmaceutical treatment planning, NHL 0718 $2,750 2003 physician fee schedule, $45.25 90Y-Ibritumomab tiuxetan administration G0274 Radiopharmaceutical treatment, NHL 0725 $20,000 2003 physician fee schedule, $108.88 Product/procedure Code Description Payment 111In A9522 111In-Ibritumomab tiuxetan % of AWP or invoice Imaging 78802 Radiopharmaceutical localization of tumor, whole body Fee schedule, contracted rate, % of charge 90Y-Ibritumomab tiuxetan administration A9523 90Y-Ibritumomab tiuxetan per mCi based on 40 mCi/dose % of AWP or invoice Yttrium administration 79400 Radiopharmaceutical therapy, nonthyroid, nonhematologic Fee schedule, contracted rate, % of charge AWP = average wholesale price.
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- Article
- Abstract
- RATIONALE FOR IBRITUMOMAB TIUXETAN
- USE OF IBRITUMOMAB TIUXETAN
- IMAGING AND THERAPY PROTOCOL
- RADIOPHARMACEUTICAL ACQUISITION, CALIBRATION, AND STORAGE
- DOSE CALCULATION AND ADMINISTRATION
- IBRITUMOMAB TIUXETAN IMAGING AND THERAPY PROTOCOL
- SAFETY OF IBRITUMOMAB TIUXETAN
- PATIENT DISCHARGE INSTRUCTIONS
- CODING AND REIMBURSEMENT
- CONCLUSION
- Acknowledgments
- Footnotes
- REFERENCES
- Figures & Data
- Info & Metrics