Personalized 18FDG Dose Synthesis Using BG-75 Generator: 1st Year Experience at JCI Accredited Tertiary Care Hospital in Pakistan

Background: Compact cyclotrons are getting popular to fulfill enormous current demands of PET tracers. Aga Khan University Hospital, Karachi, Pakistan has acquired the first smallest footprint of BG-75 Generator for 18FDG-based PET/CT clinical imaging. We are sharing our experience of BG-75 in the first year (December 2015-November 2016) after commissioning. Material and Methods: BG-75 Generator (ABT, USA) was installed in available space without major design modification. It has a self-shielded mini-cyclotron (7.5 MeV proton beam, positive ion with current < 5µA) to produce [18F]F-, an automated card-based radiochemistry module to produce 18FDG and automated QC module to perform tests upon each batch of 18FDG. Data were collected for yields of [18F]F-, 18FDG, QC and radiation safety parameters. Results: Total 545 runs in 167 days (3±01 runs/day) were made. Average yield with 60 minute bombardment using 4.5 µA current was 37 mCi and 21 mCi for [18F]F- and 18FDG, respectively. Total 29 runs had chemistry or QC failures and were discarded. Remaining 516 batches were used to perform imaging upon 1370 patients (8±03 patients/day). Radiation dose in BG-75 suite and effective doses to 02 operators were within statutory limits. Conclusion: BG-75 Generator provides safe, dependable and sustainable supply of 18F-Fluoride for 18FDG and other low-volume clinical PET imaging. Its compactness and automation need minimal space and manpower. Radiation dose rate in cyclotron suite and personal dosimetry were also found within safe limits. Its Dose-on-Demand workflow offers a new concept of Personalized Dose Preparation which is currently not possible with a conventional cyclotron.