We used a combination of radioiodine scanning and quantitative radiation dosimetry to evaluate responses to therapeutic irradiation with 131I in 76 patients with thyroid adenocarcinoma. Fifty patients received 131I treatment for ablation of residual thyroid tissue after surgical thyroidectomy, and 26 had 131I treatment for metastatic thyroid cancer. Successful ablation was observed in patients receiving higher radiation doses to the thyroid--about 4.4 times those in patients whose lesions were not ablated--largely because of a longer effective half-life of 131I in residual thyroid tissue in the patients with ablated lesions. Patients with metastases that persisted after 131I therapy tended to have more advanced disease and received significantly lower radiation doses per millicurie of administered 131I than did persons whose lesions responded to treatment. Initial 131I treatment resulting in radiation doses of at least 30,000 rad to thyroid remnants and 8000 rad to metastases was associated with a significant increase in the rate of response to therapy.

Quantitative external counting methods for the in vivo determination of the activity uniformly distributed in an area of interest (lesion) have been developed. The theoretical work has been extended to include the effects of regions of differing attenuation coefficient and of non-target organ activity in the tissue surrounding the lesion. A clinical quantitative procedure utilizing a "calibrated" gamma camera and associated computer system is described. Studies including a bone substitute material in a water phantom confirmed the basic theoretical work.

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Knowledge of the normal liver size is essential for making the scintigraphic estimate of hepatomegaly. A nomogram for sonographic liver size versus height of the patient was developed for the normal pediatric patient. Liver size was measured as the longitudinal liver length in the plane midway between the xiphoid and the right lateral liver margin. Scintigraphic and sonographic measurements showed a good correlation. The scintigraphic nomogram was developed using the experimentally determined relationship between the two modalities.

A quantitative technique is described which allows the physician to predict more accurately whether a recurrent or metastatic well-differentiated thyroid carcinoma is amenable to radioiodine-131 therapy or is better treated by other means. A calibrated uptake probe and scaler system is used to obtain conjugate view (i.e., diametrically opposed) counting rates for both the whole body and for any areas of abnormal uptake (lesion) at 24,48 annd 72 hours following the administration of 2 mCi 131l. Quantitative calculations accounting for patient attenuation, lesion size and geometrical factors then provide a determination of the lesion uptake as well as the effective half-life of 131l in the lesion. The radiation dose which would be delivered to the lesion by a given therapeutic amount of 131l may then be calculated to help determine the desirability of 131l treatment. The results of patient studies indicate the potential benefit of such quantitative evaluation.