90Y PET-based dosimetry after selective internal radiotherapy treatments

D’Arienzo, Marco; Chiaramida, Paola; Chiacchiararelli, Laura; Coniglio, A.; Cianni, Roberto; Salvatori, Rita; Ruzza, Alberto; Scopinaro, Francesco; Bagni, Oreste

doi:10.1097/mnm.0b013e3283524220

Cited by 81 publications

(80 citation statements)

References 23 publications

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“…HCC lesion dosimetry using rescaled VSVs (using MCNP) showed a mean D T of 139.3 Gy and D NL of 33.8 Gy [120] and this work noted a dose of 287 Gy to the tumour periphery, and 70…”

Section: Y Pet Imagingmentioning

confidence: 99%

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A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Doherty¹

2015

J Diagn Imaging Ther

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Yttrium-90 radioembolization ( 90 Y-RE) is a well-established therapy for the treatment of hepatocellular carcinoma (HCC) and also of metastatic liver deposits from other malignancies. Nuclear Medicine and Cath Lab diagnostic imaging takes a pivotal role in the success of the treatment, and in order to fully exploit the efficacy of the technique and provide reliable quantitative dosimetry that are related to clinical endpoints in the era of personalized medicine, technical challenges in imaging need to be overcome. In this paper, the extensive literature of current 90 Y-RE techniques and challenges facing it in terms of quantification and dosimetry are reviewed, with a focus on the current generation of 3D dosimetry techniques. Finally, new emerging techniques are reviewed which seek to overcome these challenges, such as highresolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.

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“…HCC lesion dosimetry using rescaled VSVs (using MCNP) showed a mean D T of 139.3 Gy and D NL of 33.8 Gy [120] and this work noted a dose of 287 Gy to the tumour periphery, and 70…”

Section: Y Pet Imagingmentioning

confidence: 99%

“…Adequate visualisation can be achieved with a 20 minute per bed scan [117,118] and sensitivities of 0.11 cps/MBq in patients [119], 0.577 and 1 cps/MBq in phantom [117,120] have been reported. In a recent study, the optimal contrast for hot and cold spheres in a phantom was obtained with LYSO crystals and TOF technology [121].…”

Section: Y Pet Imagingmentioning

confidence: 99%

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Doherty¹

2015

J Diagn Imaging Ther

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Section: Sequence Of Activity Measurements Within a Defined Tissue Vomentioning

confidence: 99%

“…Currently, SPECT-based quantitative imaging is more widely used than PET, as most therapeutic radionuclides emit photons suitable only for SPECT (Table 1). Recently, the possibility of performing PET quantitative imaging with 90 Y exploiting the extremely small β + branch ratio of this radionuclide has been proposed by several authors and applied both to SIRT treatments [9][10][11][12][13][14] and locoregional therapies that use 90 Y as therapeutic agent [15].To give absolute activity, the system must be calibrated and each image must be corrected for scatter, attenuation, partial volume effect, and dead time. While considerable work has been done in the application of correction techniques to both the filtered back-projection and iterative image reconstruction methodologies [16], there is no validated standard protocol, or any established methods for calibration or verification of system performance.…”

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confidence: 99%

Metrological Issues in Molecular Radiotherapy

D’Arienzo

Capogni

Smyth

et al. 2014

EPJ Web of Conferences

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Abstract. The therapeutic effect from molecular radiation therapy (MRT), on both tumour and normal tissue, is determined by the radiation absorbed dose. Recent research indicates that as a consequence of biological variation across patients the absorbed dose can vary, for the same administered activity, by as much as two orders of magnitude. The international collaborative EURAMET-EMRP project ಯMetrology for molecular radiotherapy (MetroMRT)ರ is addressing this problem. The overall aim of the project is to develop methods of calibrating and verifying clinical dosimetry in MRT. In the present paper an overview of the metrological issues in molecular radiotherapy is provided. Introducing the problem of molecular radiation therapyMolecular radiation therapy (MRT), also known as targeted radionuclide therapy, is a unique form of radiotherapy where a high radiation dose is delivered internally, ideally to a specific target. The therapeutic agent may be administrated in several ways: ingestion, intravenous infusion, injection to a body cavity or pathological space (locoregional therapy) or direct injection into a solid tumour.Molecular radiotherapy is routinely prescribed on the basis of administered activity of the therapeutic agent. However, uptake and retention differ from patient to patient and therefore the individual dose to the target can vary between patients given the same administered activity. Recent research indicates the range of variation can be up to two orders of magnitude, which is particularly alarming from the point of view of radiation protection [1,2]. At the low extreme, the patient might gain negligible therapeutic benefit. At the high extreme, the patient might receive more radiation than is needed to treat the tumour. Both cases technically constitute maladministrations.Recent research and new technology developments have permitted estimates of radiation dose in individual patients to target tissues and critical normal tissues at risk to be obtained. However, there has been almost no adoption of these methodologies in routine clinical MRT practice. The reasons are many, but, mainly because the methodology is difficult, there is no standardization of procedures, and there is no objective means of predicting the effect of individual patient dosimetry on treatment outcomes.In fact, when compared with conventional external beam radiotherapy, in which individual patient dosimetry is mandatory and strictly controlled according to agreed protocols, there is full traceability to primary standards, and there are even legal requirements for accuracy (within 5 % of a reference value), it is clear that MRT is urgently in need of metrological support in order to bring dosimetry practice to an acceptable and comparable standard.The new international collaborative EURAMET-EMRP project ಯMetrology for molecular radiotherapyರ (MetroMRT) is addressing this problem. The project is developing the background metrology to support routine individual MRT patient dosimetry, and together with a programme of disseminatio...

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“…Many studies have demonstrated the feasibility of using these PET images for patient-specific dosimetry (12,13). 90 Y is not an ideal radionuclide for PET imaging because of the low pair-production branching ratio.…”

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The Impact of Image Reconstruction Bias on PET/CT ⁹⁰Y Dosimetry After Radioembolization

et al. 2014

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PET/CT imaging after radioembolization is a viable method for determining the posttreatment 90 Y distribution in the liver. Low true-torandom coincidence ratios in 90 Y PET studies limit the quantitative accuracy of these studies when reconstruction algorithms optimized for traditional PET imaging are used. This study examined these quantitative limitations and assessed the feasibility of generating radiation dosimetry maps in liver regions with high and low 90 Y concentrations. Methods: 90 Y PET images were collected on a PET/CT scanner and iteratively reconstructed with the vendor-supplied reconstruction algorithm. PET studies on a Jaszczak cylindric phantom were performed to determine quantitative accuracy and minimum detectable concentration (MDC). 90 Y and 18 F point-source studies were used to investigate the possible increase in detected random coincidence events due to bremsstrahlung photons. Retrospective quantitative analyses were performed on 90 Y PET/CT images obtained after 65 right or left hepatic artery radioembolizations in 59 patients. Quantitative image errors were determined by comparing the measured image activity with the assayed 90 Y activity. PET images were converted to dose maps through convolution with voxel S values generated using MCNPX, a Monte Carlo N-particle transport code system for multiparticle and high-energy applications. Tumor and parenchyma doses and potential bias based on measurements found below the MDC were recorded. Results: Random coincidences were found to increase in 90 Y acquisitions, compared with 18 F acquisitions, at similar positron emission rates because of bremsstrahlung photons. Positive bias was observed in all images. Quantitative accuracy was achieved for phantom inserts above the MDC of 1 MBq/mL. The mean dose to viable tumors was 183.6 ± 156.5 Gy, with an average potential bias of 3.3 ± 6.4 Gy. The mean dose to the parenchyma was 97.1 ± 22.1 Gy, with an average potential bias of 8.9 ± 4.9 Gy. Conclusion: The low signal-to-noise ratio caused by low positron emission rates and high bremsstrahlung photon production resulted in a positive bias on 90 Y PET images reconstructed with conventional iterative algorithms. However, quantitative accuracy was good at high activity concentrations, such as those found in tumor volumes, allowing for adequate tumor 90 Y PET/CT dosimetry after radioembolization.

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90Y PET-based dosimetry after selective internal radiotherapy treatments

Abstract: According to our experience, 90Y PET is a promising and reliable technique for microsphere dose assessment and might pave the way for a patient-specific PET-based dosimetry after liver SIRT treatments.

Cited by 81 publications

References 23 publications

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Metrological Issues in Molecular Radiotherapy

The Impact of Image Reconstruction Bias on PET/CT ⁹⁰Y Dosimetry After Radioembolization

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90Y PET-based dosimetry after selective internal radiotherapy treatments

Abstract: According to our experience, 90Y PET is a promising and reliable technique for microsphere dose assessment and might pave the way for a patient-specific PET-based dosimetry after liver SIRT treatments.

Cited by 81 publications

References 23 publications

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Metrological Issues in Molecular Radiotherapy

The Impact of Image Reconstruction Bias on PET/CT 90Y Dosimetry After Radioembolization

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The Impact of Image Reconstruction Bias on PET/CT ⁹⁰Y Dosimetry After Radioembolization