Purpose: Yttrium‐90 (90Y) is one of the most commonly used radionuclides in targeted radionuclide therapy (TRT). Since it decays with essentially no gamma photon emissions, surrogate radionuclides (e.g., 111In) or imaging agents (e.g., 99mTc MAA) are typically used for treatment planning. It would, however, be useful to image 90Y directly in order to confirm that the distributions measured with these other radionuclides or agents are the same as for the 90Y labeled agents. As a result, there has been a great deal of interest in quantitative imaging of 90Y bremsstrahlung photons using single photon emission computed tomography (SPECT) imaging. The continuous and broad energy distribution of bremsstrahlung photons, however, imposes substantial challenges on accurate quantification of the activity distribution. The aim of this work was to develop and evaluate an improved quantitative 90Y bremsstrahlung SPECT reconstruction method appropriate for these imaging applications. Methods: Accurate modeling of image degrading factors such as object attenuation and scatter and the collimator‐detector response is essential to obtain quantitatively accurate images. All of the image degrading factors are energy dependent. Thus, the authors separated the modeling of the bremsstrahlung photons into multiple categories and energy ranges. To improve the accuracy, the authors used a bremsstrahlung energy spectrum previously estimated from experimental measurements and incorporated a model of the distance between90Y decay location and bremsstrahlung emission location into the SIMIND code used to generate the response functions and kernels used in the model. This improved Monte Carlo bremsstrahlung simulation was validated by comparison to experimentally measured projection data of a 90Y line source. The authors validated the accuracy of the forward projection model for photons in the various categories and energy ranges using the validated Monte Carlo (MC) simulation method. The forward projection model was incorporated into an iterative ordered subsets‐expectation maximization (OS‐EM) reconstruction code to allow for quantitative SPECT reconstruction. The resulting code was validated using both a physical phantom experiment with spherical objects in a warm background and a realistic anatomical phantom simulation. In the physical phantom study, the authors evaluated the method in terms of quantitative accuracy of activity estimates in the spheres; in the simulation study, the authors evaluated the accuracy and precision of activity estimates from various organs and compared them to results from a previously proposed method. Results: The authors demonstrated excellent agreement between the experimental measurement and Monte Carlo simulation. In the XCAT phantom simulation, the proposed method achieved much better accuracy in the modeling (error in photon counts was −1.1 %) compared to a previously proposed method (errors were more than 20  %); the quantitative accuracy of activity estimates was excellent for all organs (errors were fr...

I-131 is a frequently used isotope for radionuclide therapy. This technique for cancer treatment requires a pre-therapeutic dosimetric study. The latter is usually performed (for this radionuclide) by directly imaging the uptake of the therapeutic radionuclide in the body or by replacing it by one of its isotopes, which are more suitable for imaging. This study aimed to compare the image quality that can be achieved by three iodine isotopes: I-131 and I-123 for single-photon emission computed tomography imaging, and I-124 for positron emission tomography imaging. The imaging characteristics of each isotope were investigated by simulated data. Their spectrums, point-spread functions, and contrast-recovery curves were drawn and compared. I-131 was imaged with a high-energy all-purpose (HEAP) collimator, whereas two collimators were compared for I-123: low-energy high-resolution (LEHR) and medium energy (ME). No mechanical collimation was used for I-124. The influence of small high-energy peaks (>0.1%) on the main energy window contamination were evaluated. Furthermore, the effect of a scattering medium was investigated and the triple energy window (TEW) correction was used for spectral-based scatter correction. Results showed that I-123 gave the best results with a LEHR collimator when the scatter correction was applied. Without correction, the ME collimator reduced the effects of high-energy contamination. I-131 offered the worst results. This can be explained by the large amount of septal penetration from the photopeak and by the collimator, which gave a low spatial resolution. I-124 gave the best imaging properties owing to its electronic collimation (high sensitivity) and a short coincidence time window.

Today, new single photon emission computed tomography (SPECT) reconstruction techniques rely on accurate Monte Carlo (MC) simulations to optimize reconstructed images. However, existing MC scintillation camera models which usually include an accurate description of the collimator and crystal, lack correct implementation of the gamma camera's back compartments. In the case of dual isotope simultaneous acquisition (DISA), where backscattered photons from the highest energy isotope are detected in the imaging energy window of the second isotope, this approximation may induce simulation errors. Here, we investigate the influence of backscatter compartment modelling on the simulation accuracy of high-energy isotopes. Three models of a scintillation camera were simulated: a simple model (SM), composed only of a collimator and a NaI(Tl) crystal; an intermediate model (IM), adding a simplified description of the backscatter compartments to the previous model and a complete model (CM), accurately simulating the materials and geometries of the camera. The camera models were evaluated with point sources ((67)Ga, (99m)Tc, (111)In, (123)I, (131)I and (18)F) in air without a collimator, in air with a collimator and in water with a collimator. In the latter case, sensitivities and point-spread functions (PSFs) simulated in the photopeak window with the IM and CM are close to the measured values (error below 10.5%). In the backscatter energy window, however, the IM and CM overestimate the FWHM of the detected PSF by 52% and 23%, respectively, while the SM underestimates it by 34%. The backscatter peak fluence is also overestimated by 20% and 10% with the IM and CM, respectively, whereas it is underestimated by 60% with the SM. The results show that an accurate description of the backscatter compartments is required for SPECT simulations of high-energy isotopes (above 300 keV) when the backscatter energy window is of interest.

Purpose: This study aimed to describe our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the management of adrenal gland metastases from multiple primary cancers. Materials and Methods: We retrospectively reviewed 31 patients who underwent SBRT as treatment for 33 adrenal gland lesions in the academic radiotherapy department of Oscar Lambret cancer center between May 2011 and September 2018. The primary study endpoints were 1- and 2-year local control rates, defined as the absence of progression at the treatment site based on the response evaluation criteria in solid tumors (RECIST). Toxicities were graded in accordance with the Common Terminology Criteria for Adverse Events version 4.03. Results: The average tumor volume was 33.5 cm 3 (standard deviation: 51.7 cm 3 ), and the prescribed dose ranged from 30 to 55 Gy given in 3–9 fractions. The median biological effective dose was 112.5 Gy (range: 45–115.5 Gy), assuming α/β = 10. Considering progression at distant sites or death as competing events, the 1- and 2-year actuarial local control rates were 96.5% (95% confidence interval: 84.9–99.7) and 92.6% (95% confidence interval: 79.2–98.7), respectively. According to RECIST, a complete response was achieved in 10 (32.3%) lesions, a partial response in 10 (32.3%) lesions, and stability in 8 (25.8%) lesions. Three patients presented with local relapse at 8.8, 14, and 49.4 months. After a median follow-up of 18 months (range: 4.4–66.4), the median overall survival was 33.5 months (95% confidence interval: 17–not reached), while the median progression-free survival was 7.4 months (95% confidence interval: 3.8–14.1). Treatment-related toxicity was grade 1 or 2 in 42.4% of patients, including nausea (27.3%), abdominal pain (18.2%), vomiting (15.2%), and asthenia (9.1%). None of the patients developed acute grade ≥3 or late toxicity. Conclusion: SBRT seems to be a safe and effective treatment for adrenal gland metastases in patients whose primary tumor and metastatic spread are controlled by systemic treatment. With a 2-year local control rate of 92.6%, SBRT may be considered as one of the first-line treatments in oligometastatic patients with adrenal metastases.

BackgroundAccelerated partial breast irradiation (APBI) is a new breast treatment modality aiming to reduce treatment time using hypo fractionation. Compared to conventional whole breast irradiation that takes 5 to 6 weeks, APBI is reported to induce worse cosmetic outcomes both when using three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). These late normal tissue effects may be attributed to the dose volume effect because a large portion of the non-target breast tissue volume (NTBTV) receives a high dose. In the context of APBI, non-coplanar beams could spare the NTBTV more efficiently. This study evaluates the dosimetric benefit of using the Cyberknife (CK) for APBI in comparison to IMRT (Tomotherapy) and three dimensional conformal radiotherapy (3D-CRT).MethodsThe possibility of using surgical clips, implanted during surgery, to track target movements is investigated first. A phantom of a female thorax was designed in-house using the measurements of 20 patients. Surgical clips of different sizes were inserted inside the breast. A treatment plan was delivered to the mobile and immobile phantom. The motion compensation accuracy was evaluated using three radiochromic films inserted inside the breast. Three dimensional conformal radiotherapy (3D-CRT), Tomotherapy (TOMO) and CK treatment plans were calculated for 10 consecutive patients who received APBI in Lille. To ensure a fair comparison of the three techniques, margins applied to the CTV were set to 10 mm. However, a second CK plan was prepared using 3 mm margins to evaluate the benefits of motion compensation.ResultsOnly the larger clips (VITALITEC Medium-Large) could be tracked inside the larger breast (all gamma indices below 1 for 1 % of the maximum dose and 1 mm). All techniques meet the guidelines defined in the NSABP/RTOG and SHARE protocols. As the applied dose volume constraints are very strong, insignificant dosimetric differences exist between techniques regarding the PTV coverage and the sparing of the lung and heart. However, the CK may be used to reduce high doses received by the NTBTV more efficiently.ConclusionsRobotic stereotactic radiotherapy may be used for APBI to more efficiently spare the NTBTV and improve cosmetic results of APBI.