Radioimmunoassay is an in-vitro assay where an antigen labelled with a radioactive

isotope and a certain amount of antibody which determines the concentration of antigens in a
sample (Alhabbab, 2018). According to Aryal (2017), this test is used to quantify antigens,
antibodies, and hormone concentrations in the body and diagnose cancer and allergies. The
materials needed to perform this test are a pure antigen, radiolabeled antigen, and an antibody or
antiserum (Zaidi & Kamal, 1993). In addition to this, the facility for a radioimmunoassay
procedure must include a gamma counter, table top centrifuge, pH meter, portable contamination
monitor, vortex mixer, Eppendorf-type pipettes, and adjustable repeater pipette (IAEA, n.d.).
Sinha (2019) explained that the 3 principles behind radioimmunoassay are an immune reaction,
competitive binding, and radio emission. The ideal radiopharmaceutical for radioimmunoassay is
Iodine-125 due to its high specificity activity (Sinha, 2019). The procedure starts when an
antigen labeled with I-125 binds to its antibodies causing an immune reaction which is then
followed by the addition of an antiserum that initiates a competitive binding between the
radiolabeled antigen and pure antigen with the specific antibodies (Aryal, 2017). Kramer (2013)
stated that the increase in concentration of the pure antigen will bind tightly to the antibody,
causing an displacement in the radiolabeled antigen. He concluded that “the bound antigens are
then separated from the unbound ones, and the radioactivity of the free antigens remaining in the
supernatant is measured”.

A radioactive iodine uptake test that determines the amount of radioactive iodine in the
thyroid gland within a period of time (UCLA Endocrine Center , n.d.). In this diagnostic
procedure, the patient is given a radiotracer containing the preferred radioactive isotope either 24
hours before scan by capsule or 30 minutes before scan by injection (Iqbal & Rehman, 2020).
Iqbal and Rehman further explained that after the patient has the radiotracer in the body, he or
she will be asked to lie down on examination table where a gamma camera will capture the
thyroid gland from 3 different angles. The preferred radiopharmaceutical for a thyroid uptake
scan is either Iodine-131 or Iodine-123 but I-123 is safer due to the ideal decay energy of 159
keV which causes less harm to the thyroid cells (Mandel, Shankar, Benard, & Yamamoto, 2001).

A urea breath scan is a test to determine the presence of Helicobacter plyori bacteria
(University of Rochester Medical Center, n.d.). Helicobacteria pylori is a spiral-shaped
gram-negative bacteria that causes inflammation or ulcers in the gastrointestinal tract (Diaconu,
Presdescu, Moldoveanu, Pop, & Fierbințeanu-Braticevici, 2017). Basically, a urea breath scan
helps in diagnosing diseases found in the stomach or small intestine. A capsule containing urea
with a radiopharmaceutical and a balloon are essentially what you need to perform this test. The
common radiopharmaceuticals used in this procedure are Carbon-13 and Carbon-14. Both
radiopharmaceuticals are relatively safe but C-13 is more preferred due its lower radioactive
nature, making it safe for children and pregnant women (Wang et al., 2015). According to Balon
et al. (2001), in a non-invasive urea breath scan, the patient will be asked to swallow a capsule
containing a certain amount of urea accompanied by glass of lukewarm water. They further
explained that the patient will be given another glass of water 3 minutes post-dose and
afterwards, he or she will be asked to take a deep breath for 5-10 seconds after 10 minutes
post-dose before blowing into a balloon using a straw. Analysis of the sample from the procedure
involves a scintillation technique where the air from the balloon will be transferred to a
scintillation vial containing trapping solution (Sankararaman & Moosavi, 2019). In addition to
the previous statement, depending on the radiopharmaceutical used, CO2 levels will be
monitored and if there is an increase due to hydrolysis, it could be an indication that H.pylori is
present in the body. With regards to the amount of radiation in the body after the procedures,
Sullivan Nicolaides Pathology (2016) stated that patients should not worry because the exposure
is similar to one-tenth of the dose of a chest x-ray and less than half the standard radiation
exposure rate.

A renal in-vitro glomerular filtration rate (GFR) test takes a look into the condition and
function of the kidneys (National Kidney and Transplant Institute, n.d.). According to an article
that enumerates the guidelines for GFR in children, the ideal radiopharmaceutical is either
Chromium-51 or Technetium-99m (Piepz et al., 2009). Northwestern Memorial Hospital (n.d.)
provided an explanation behind the procedure for renal GFR. The patient will be given the
radiotracer intravenously and a gamma camera will capture images of the kidneys for about 6
minutes which is then followed by a 1 minute picture-taking of the arm injected with the
radiotracer (Northwestern Memorial Hospital, n.d.).

References:
Aryal, S. (2017). Radioimmunoassay – Principle, Uses, and Limitations. Retrieved September
18, 2020 from ​https://microbenotes.com/radioimmunoassay-principle-uses-and-limitations/

Alhabbab R.Y. (2018) Radioimmunoassay (RIA). (2018). Basic Serological Testing. Techniques
in Life Science and Biomedicine for the Non-Expert. Springer, Cham.
https://doi.org/10.1007/978-3-319-77694-1_11

Zaidi, P. & Kamal, S. (1993) Radioimmunoassay: principle and technique. Retrieved September
18, 2020 from ​https://jpma.org.pk/PdfDownload/5022

International Atomic Energy Agency. (n.d.). Setting up a Laboratory for Radioimmunoassay

(RIA). Retrieved September 18, 2020 from
http://www-naweb.iaea.org/nafa/aph/resources/ria-lab-list.pdf

Sinha, A. (2019). Radioimmunoassay: Principle and Protocol Simplified. Retrieved September

18, 2020 from
https://labs.biotecnika.org/blogs/research-tips/radioimmunoassay-principle-and-protocol-simplifi
ed

Kramer, D. (2013, June 12). Radioimmunoassay (RIA). Retrieved on September 17, 2020 from
https://www.antibodies-online.com/resources/17/1215/radioimmunoassay-ria/

UCLA Endocrine Center. (n.d.). Radioactive Iodine Uptake Test. Retrieved September 18, 2020
from ​https://www.uclahealth.org/endocrine-center/radioactive-iodine-uptake-test

Iqbal, A. & Rehman, A. (2020). Thyroid Uptake and Scan. Retrieved September 18, 2020 from:
https://www.ncbi.nlm.nih.gov/books/NBK555978/
Mandel, S.J., Shankar, L., Benard, F., & Yamamoto, A. (2001). Superiority of iodine-123
compared with iodine-131 scanning for thyroid remnants in patients with differentiated thyroid
cancer. ​Clinical Nuclear Medicine,​ ​26(​ 1), 6-9. DOI: 10.1097/00003072-200101000-00002

University of Rochester Medical Center. (n.d.). Helicobacter Pylori Urea Breath. Retrieved
September 18, 2020 from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=helic
obacter_pylori_urea_breath

Diaconu, S., Predescu, A., Moldoveanu, A., Pop, C. S., & Fierbințeanu-Braticevici, C. (2017).
Helicobacter pylori infection: old and new. ​Journal of medicine and life,​ ​10(​ 2), 112–117.

Wang, Y. K., Kuo, F. C., Liu, C. J., Wu, M. C., Shih, H. Y., Wang, S. S., Wu, J. Y., Kuo, C. H.,
Huang, Y. K., & Wu, D. C. (2015). Diagnosis of Helicobacter pylori infection: Current options
and developments. World journal of gastroenterology, 21(40), 11221–11235.
https://doi.org/10.3748/wjg.v21.i40.11221

Balon, H., Gold, C. A., Dworkin, H. J., McCormick, V. A., & Freitas, J. E. (1998). Procedure
guideline for carbon-14-urea breath test. Society of Nuclear Medicine. ​Journal of nuclear
medicine : official publication, Society of Nuclear Medicine​, ​39​(11), 2012–2014. Retrieved from
​http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.172.174&rep=rep1&type=pdf

Sankararaman, S., & Moosavi, L. (2019). Urea Breath Test. Retrieved September 18, 2020 from
https://www.ncbi.nlm.nih.gov/books/NBK542286/

Sullivan Nicolaides Pathology. (2016). Urea breath test (UBT). Retrieved September 18, 2020
from
https://www.snp.com.au/patients/collection-information/collection-notes/urea-breath-test-ubt/

National Kidney and Transplant Institute. (n.d.). IN-VITRO GLOMERULAR FILTRATION

RATE (GFR). Retrieved September 18, 2020 from
https://www.nkti.gov.ph/index.php/news/11-services/597-in-vitro-glomerular-filtration-rate-gfr

Piepz, A., Colarinha, P., Gordon, I., Hahn, K., Olivier, P., Sixt, R., & van Velzen, J. (2009)
GUIDELINES FOR GLOMERULAR FILTRATION RATE DETERMINATION IN
CHILDREN. Retrieved September 18, 2020 from
https://eanm.org/publications/guidelines/gl_paed_gfrd.pdf

Northwestern Memorial Hospital. (n.d.). Renal Glomerular Filtration Rate (GFR) Scan.
Retrieved September 18, 2020 from
file:///Users/acgabay/Desktop/3rd%20Term%20(SY%202019-2020)/NUCLMED/northwestern-
medicine-renal-glomerular-filtration-rate-gfr-scan.pdf