After intravenous injection, particles larger than red blood cells will be trapped in the first capillary bed that they encounter. This is the principle of lung perfusion imaging in nuclear medicine, where macroaggregated albumin (MAA) is radiolabeled with (99m)Tc, infused into a patient's arm vein, and then imaged with gamma scintigraphy. Our aim was to evaluate if monosized microspheres could replace (99m)Tc-MAA. Biodegradable poly(L-lactide) microspheres containing chelating bis(picolylamine) end groups were prepared by a flow focusing method on a microfluidic glass chip and were of highly homogeneous size (9.0 +/- 0.4 microm). The microspheres were radiolabeled with [(99m)Tc(H(2)O)(3)(CO)(3)](+) and then evaluated in mice for lung perfusion imaging. Fifteen minutes after injection, 79.6 +/- 3.8% of the injected activity was trapped in the lungs of mice. Monosized biodegradable radioactive microspheres are, thus, appropriate lung perfusion imaging agents. Other sizes of these highly uniform microspheres have the potential to improve diagnostic and therapeutic approaches in diverse areas of medicine.