EANM Dosimetry Committee series on standard operational procedures for internal dosimetry for 131I mIBG treatment of neuroendocrine tumours

Gear, Jonathan; Chiesa, Carlo; Laßmann, Michael; Gabiña, Pablo Mínguez; Tran-Gia, Johannes; Stokke, Caroline; Flux, Glenn

doi:10.1186/s40658-020-0282-7

Cited by 48 publications

(33 citation statements)

References 48 publications

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“…Basic standards and nomenclature within dosimetry can be found in the MIRD pamphlets 16, 20, 21 and 22 [11][12][13][14], and guidelines for quantitative SPECT are provided in MIRD pamphlets 23, 24 and 26 [15][16][17]. The EANM dosimetry committee has published standard operating procedures for several radionuclide therapies [18][19][20][21], and recommendations for dosimetry of 90 Y liver embolization are currently under evaluation. Additionally, recommendations have been written on reporting clinical dosimetry data and a practical guidance on the quantification of the uncertainties associated with dosimetry [10,22].…”

Section: Guidance Materials For Treatment and Dosimetry Protocolsmentioning

confidence: 99%

EANM position paper on article 56 of the Council Directive 2013/59/Euratom (basic safety standards) for nuclear medicine therapy

Konijnenberg

Herrmann

Kobe

et al. 2020

Eur J Nucl Med Mol Imaging

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Executive Summary The EC Directive 2013/59/Euratom states in article 56 that exposures of target volumes in nuclear medicine treatments shall be individually planned and their delivery appropriately verified. The Directive also mentions that medical physics experts should always be appropriately involved in those treatments. Although it is obvious that, in nuclear medicine practice, every nuclear medicine physician and physicist should follow national rules and legislation, the EANM considered it necessary to provide guidance on how to interpret the Directive statements for nuclear medicine treatments. For this purpose, the EANM proposes to distinguish three levels in compliance to the optimization principle in the directive, inspired by the indication of levels in prescribing, recording and reporting of absorbed doses after radiotherapy defined by the International Commission on Radiation Units and Measurements (ICRU): Most nuclear medicine treatments currently applied in Europe are standardized. The minimum requirement for those treatments is ICRU level 1 (“activity-based prescription and patient-averaged dosimetry”), which is defined by administering the activity within 10% of the intended activity, typically according to the package insert or to the respective EANM guidelines, followed by verification of the therapy delivery, if applicable. Non-standardized treatments are essentially those in developmental phase or approved radiopharmaceuticals being used off-label with significantly (> 25% more than in the label) higher activities. These treatments should comply with ICRU level 2 (“activity-based prescription and patient-specific dosimetry”), which implies recording and reporting of the absorbed dose to organs at risk and optionally the absorbed dose to treatment regions. The EANM strongly encourages to foster research that eventually leads to treatment planning according to ICRU level 3 (“dosimetry-guided patient-specific prescription and verification”), whenever possible and relevant. Evidence for superiority of therapy prescription on basis of patient-specific dosimetry has not been obtained. However, the authors believe that a better understanding of therapy dosimetry, i.e. how much and where the energy is delivered, and radiobiology, i.e. radiation-related processes in tissues, are keys to the long-term improvement of our treatments.

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Section: Guidance Materials For Treatment and Dosimetry Protocolsmentioning

confidence: 99%

EANM position paper on article 56 of the Council Directive 2013/59/Euratom (basic safety standards) for nuclear medicine therapy

Konijnenberg

Herrmann

Kobe

et al. 2020

Eur J Nucl Med Mol Imaging

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“…In the previous study, a Philips FORTE gamma camera was used. This camera operates a “high-count rate mode,” which is automatically activated at count rates above 20 kcps [ 13 ]. Moreover, to determine the A linmax, an indirect approach was taken [ 4 ], which included the measurement of an intrinsic count rate curve (i.e., acquired without collimators) of an activity-filled vial in the full energy window, combined with separate measurements of the system sensitivity using a Petri dish with a thin layer of activity, hence without scatter material producing scattered photons and bremsstrahlung, in both the full-energy window and the photopeak window, underestimating the intrinsic count rate.…”

Section: Discussionmentioning

confidence: 99%

Gamma camera characterization at high holmium-166 activity in liver radioembolization

et al. 2021

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Background High activities of holmium-166 (166Ho)–labeled microspheres are used for therapeutic radioembolization, ideally directly followed by SPECT imaging for dosimetry purposes. The resulting high-count rate potentially impacts dead time, affecting the image quality and dosimetric accuracy. This study assesses gamma camera performance and SPECT image quality at high 166Ho activities of several GBq. To this purpose, the liver compartment, including two tumors, of an anthropomorphic phantom was filled with 166Ho-chloride, with a tumor to non-tumorous liver activity concentration ratio of 10:1. Multiple SPECT/CT scans were acquired over a range of activities up to 2.7 GBq. Images were reconstructed using a commercially available protocol incorporating attenuation and scatter correction. Dead time effects were assessed from the observed count rate in the photopeak (81 keV, 15% width) and upper scatter (118 keV, 12% width) window. Post reconstruction, each image was scaled with an individual conversion factor to match the known total activity in the phantom at scanning time. The resulting activity concentration was measured in the tumors and non-tumorous liver. The image quality as a function of activity was assessed by a visual check of the absence of artifacts by a nuclear medicine physician. The apparent lung shunt fraction (nonzero due to scatter) was estimated on planar and SPECT images. Results A 20% count loss due to dead time was observed around 0.7 GBq in the photopeak window. Independent of the count losses, the measured activity concentration was up to 100% of the real value for non-tumorous liver, when reconstructions were normalized to the known activity at scanning time. However, for tumor spheres, activity concentration recovery was ~80% at the lowest activity, decreasing with increasing activity in the phantom. Measured lung shunt fractions were relatively constant over the considered activity range. Conclusions At high 166Ho count rate, all images, visually assessed, presented no artifacts, even at considerable dead time losses. A quantitative evaluation revealed the possibility of reliable dosimetry within the healthy liver, as long as a post-reconstruction scaling to scanning activity is applied. Reliable tumor dosimetry, instead, remained hampered by the dead time.

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“…Gear and et al [17] The curve depends on the mean count within projection. Based on it, we made a decision that sensitivity decreases with increasing activity.…”

Section: Discussionmentioning

confidence: 99%

Predictive Model For Preliminary Assessment of Repeated Radioiodine Therapy Course Based On 131-I Suv

Bubnov¹,

Трухин

Rumyantsev³

et al. 2021

Preprint

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Purposes: Current research design is dedicated to 131-I SUV evaluation on post therapeutic scintigrams and setting up predictive model for radioiodine therapy repeated course prescription in differentiated thyroid cancer (DTC). Methods: Study includes 148 patients (f-105, m-43) with DTC treated with 131-iodine. Administered treatment activities of 131I calculated according to clinical features and tumor recurrence risk group. Patients were divided into three groups using ATA 2018 recommendations. Absolute risk groups: low risk (L), medium risk (M), high risk (H). Administered 131-I activity [MBq]: <AL> = 3223±729, <AM> = 3696±456, <AH> = 4589±1078; Tg [ng/ml]: <TgL> = 7,4±1.7 ng/ml, <TgM>= 14,8 ±5,9, <TgH> = 68,3 ±18,5; TgAb [IU/ml]: <TgAbL> = 124,3 ± 81.7, <TgAbM> = 29,2 ±15,9, <TgAbH> = 85,7 ±28,9. All null hypothesis were checked using paired Mann-Whitney U-test. Calibration of system SPECT/CT and evaluation SUVs completed according to protocols designed using Jaszczak phantom Deluxe. Model development based on logistic regression with ROC-analysis, regularization and cross-validation. Results: Reference intervals of SUVpeak and SUVmax calculated for all groups of risk. SUVpeak: low risk >155, medium risk 105-155, high risk 0-105 pL-M=0.069 pL-H=0.0037 pM-H=0.7514; SUVmax: low risk >38, medium risk 29-38, high risk 0-29 pL-M=0.052 pL-H=0.0033 pM-H=0.949. Logit model based on SUVpeak without regularization has: AUC = 0.67 (95%CI 0.33-1.00); Accuracy = 0.82; SE = 0.89; SP = 0.4; PPV = 0.41; NPV = 0.89, cross-validated AUC =0.67 (0.4-0.88), regression coefficients: B0=0.037, B1=0.001. Regularization (SUVpeak<100) lead to AUC = 0.75, (95%CI 0.44-1.00); accuracy = 0.89; SE =0.98; SP = 0.4; PPV = 0.76; NPV = 0.87, cross-validated AUC = 0.513 (0.36-0.71) regression coefficients: B0=0.473, B1=0.003.Conclusion: Study shows that SUV has wide range of values and can be matched with existed model of risk assessment of DTC. Algorithm of image segmentation and evaluation of SUVpeak and SUVmax for SPECT/CT systems was developed. According to the ROC analysis, developed predictive model shows an acceptable performance for further clinical investigation and advancement focused on refining model parameters and introducing additional predictors

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EANM Dosimetry Committee series on standard operational procedures for internal dosimetry for 131I mIBG treatment of neuroendocrine tumours

Cited by 48 publications

References 48 publications

EANM position paper on article 56 of the Council Directive 2013/59/Euratom (basic safety standards) for nuclear medicine therapy

EANM position paper on article 56 of the Council Directive 2013/59/Euratom (basic safety standards) for nuclear medicine therapy

Gamma camera characterization at high holmium-166 activity in liver radioembolization

Predictive Model For Preliminary Assessment of Repeated Radioiodine Therapy Course Based On 131-I Suv

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