Estimation of patient dose in <sup>18</sup> F-FDG and <sup>18</sup> F-FDOPA PET/CT examinations

Kaushik, Aruna; Jaimini, Abhinav; Tripathi, Madhavi; D’Souza, Maria; Sharma, Rajnish; Mishra, Anil K.; Mondal, Anupam; Dwarakanath, Bilikere S.

doi:10.4103/0973-1482.119354

Cited by 22 publications

(8 citation statements)

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“…CT is also important in neurooncological studies using 11 C-MET PET/CT studies, where the CT can help by adding structural information. CT doses reported in this study are similar to those in the study by Kaushik et al [20], where brain CT parameters were adapted for obese patients and contrast-enhanced studies.…”

Section: Discussionsupporting

confidence: 83%

“…Kaushik et al evaluated a PET effective dose of 3.5 and 5.8 mSv for 18 FDOPA and 18 FDG brain PET/CT studies [20], respectively, similar to that found in this study. The PET dose for 18 F-florbetapir corresponds to the dose reported for 370 MBq activity administration to a 70-kg patient [19].…”

Section: Discussionsupporting

confidence: 71%

“…However, as different protocols covered different patient lengths, a variety of conditions have been evaluated. Previously published studies have analyzed differences between adapted CT protocols for normal and obese patients or between contrast-enhanced CT [20] and CT adapted for high-quality or interspaced high-speed CT [21]. Others demonstrated an increase in CT dose when moving from a standard protocol to a diagnostic protocol [22] or from low-dose protocols to contrast-enhanced protocols [23].…”

Section: Discussionmentioning

confidence: 99%

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Effective dose estimation for oncological and neurological PET/CT procedures

et al. 2017

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BackgroundThe aim of this study was to retrospectively evaluate the patient effective dose (ED) for different PET/CT procedures performed with a variety of PET radiopharmaceutical compounds.PET/CT studies of 210 patients were reviewed including Torso (n = 123), Whole body (WB) (n = 36), Head and Neck Tumor (HNT) (n = 10), and Brain (n = 41) protocols with 18FDG (n = 170), 11C-CHOL (n = 10), 18FDOPA (n = 10), 11C-MET (n = 10), and 18F-florbetapir (n = 10). ED was calculated using conversion factors applied to the radiotracer activity and to the CT dose-length product.ResultsTotal ED (mean ± SD) for Torso-11C-CHOL, Torso-18FDG, WB-18FDG, and HNT-18FDG protocols were 13.5 ± 2.2, 16.5 ± 4.5, 20.0 ± 5.6, and 15.4 ± 2.8 mSv, respectively, where CT represented 77, 62, 69, and 63% of the protocol ED, respectively. For 18FDG, 18FDOPA, 11C-MET, and 18F-florbetapir brain PET/CT studies, ED values (mean ± SD) were 6.4 ± 0.6, 4.6 ± 0.4, 5.2 ± 0.5, and 9.1 ± 0.4 mSv, respectively, and the corresponding CT contributions were 11, 14, 23, and 26%, respectively. In 18FDG PET/CT, variations in scan length and arm position produced significant differences in CT ED (p < 0.01). For dual-time-point imaging, the CT ED (mean ± SD) for the delayed scan was 3.8 ± 1.5 mSv.ConclusionsThe mean ED for body and brain PET/CT protocols with different radiopharmaceuticals ranged between 4.6 and 20.0 mSv. The major contributor to total ED for body protocols is CT, whereas for brain studies, it is the PET radiopharmaceutical.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Effective dose estimation for oncological and neurological PET/CT procedures

et al. 2017

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“…The best imaging technique available is 18 fluorodeoxyglucose positron emission tomography with co-localized computerized tomography (FDG PET CT) to identify areas of abnormal glucose uptake. However, this involves exposure to an average of 14.4 mSv for females and 11.8 mSv for male patients ( 34 ) per scan. Nevertheless, it is important to quantify the presence of sub-clinical disease to find ways of preventing end stage ischemic complications or other vascular events such as thrombosis, dissection, and aneurysm.…”

Section: Can We Induce Remission?mentioning

confidence: 99%

State of the Art in the Treatment of Systemic Vasculitides

Luqmani

2014

Front. Immunol.

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Anti-neutrophil cytoplasm antibodies (ANCA) are associated with small vessel vasculitides (AASV) affecting the lungs and kidneys. Structured clinical assessment using the Birmingham Vasculitis Activity Score and Vasculitis Damage Index should form the basis of a treatment plan and be used to document progress, including relapse. Severe disease with organ or life threatening manifestations needs cyclophosphamide or rituximab, plus high dose glucocorticoids, followed by lower dose steroid plus azathioprine, or methotrexate. Additional plasmapheresis is effective for very severe disease, reducing dialysis dependence from 60 to 40% in the first year, but with no effect on mortality or long-term renal function, probably due to established renal damage. In milder forms of ANCA-associated vasculitis, methotrexate, leflunomide, or mycophenolate mofetil are effective. Mortality depends on initial severity: 25% in patients with renal failure or severe lung hemorrhage; 6% for generalized non-life threatening AASV but rising to 30-40% at 5 years. Mortality from GPA is four times higher than the background population. Early deaths are due to active vasculitis and infection. Subsequent deaths are more often due to cardiovascular events, infection, and cancer. We need to improve the long-term outcome, by controlling disease activity but also preventing damage and drug toxicity. By contrast, in large vessel vasculitis where mortality is much less but morbidity potentially greater, such as giant cell arteritis (GCA) and Takayasu arteritis, therapeutic options are limited. High dose glucocorticoid results in significant toxicity in over 80%. Advances in understanding the biology of the vasculitides are improving therapies. Novel, mechanism based therapies such as rituximab in AASV, mepolizumab in eosinophilic granulomatosis with polyangiitis, and tocilizumab in GCA, but the lack of reliable biomarkers remains a challenge to progress in these chronic relapsing diseases.

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“…Although several dose estimates in humans have been reported from internal administration of 18 FDG, most of these are based on the bio-distribution studies in animals 6 7 8 9 or by combining data from animals and measurements in humans 10 11 12 13 14 15 16 . Kinetics of 18 FDG distribution has also been reported using segmented dynamic PET scan protocols, whole body PET scans at different time intervals or using thermoluminescent dosimeters (TLD) 17 18 19 20 21 22 23 . However, Niven et al 18 have provided comprehensive data/information on 18 FDG kinetics and radiation dosimetry using dynamic PET scan protocol for both the genders involving many patients.…”

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confidence: 99%

Estimation of radiation dose to patients from^[18]FDG whole body PET/CT investigations using dynamic PET scan protocol

Kaushik¹,

Jaimini²,

Tripathi³

et al. 2015

Indian J Med Res

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Background & objectives:There is a growing concern over the radiation exposure of patients from undergoing 18FDG PET/CT (18F-fluorodeoxyglucose positron emission tomography/computed tomography) whole body investigations. The aim of the present study was to study the kinetics of 18FDG distributions and estimate the radiation dose received by patients undergoing 18FDG whole body PET/CT investigations.Methods:Dynamic PET scans in different regions of the body were performed in 49 patients so as to measure percentage uptake of 18FDG in brain, liver, spleen, adrenals, kidneys and stomach. The residence time in these organs was calculated and radiation dose was estimated using OLINDA software. The radiation dose from the CT component was computed using the software CT-Expo and measured using computed tomography dose index (CTDI) phantom and ionization chamber. As per the clinical protocol, the patients were refrained from eating and drinking for a minimum period of 4 h prior to the study.Results:The estimated residence time in males was 0.196 h (brain), 0.09 h (liver), 0.007 h (spleen), 0.0006 h (adrenals), 0.013 h (kidneys) and 0.005 h (stomach) whereas it was 0.189 h (brain), 0.11 h (liver), 0.01 h (spleen), 0.0007 h (adrenals), 0.02 h (kidneys) and 0.004 h (stomach) in females. The effective dose was found to be 0.020 mSv/MBq in males and 0.025 mSv/MBq in females from internally administered 18FDG and 6.8 mSv in males and 7.9 mSv in females from the CT component. For an administered activity of 370 MBq of 18FDG, the effective dose from PET/CT investigations was estimated to be 14.2 mSv in males and 17.2 mSv in females.Interpretation & conclusions:The present results did not demonstrate significant difference in the kinetics of 18FDG distribution in male and female patients. The estimated PET/CT doses were found to be higher than many other conventional diagnostic radiology examinations suggesting that all efforts should be made to clinically justify and carefully weigh the risk-benefit ratios prior to every 18FDG whole body PET/CT scan.

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Estimation of patient dose in ¹⁸ F-FDG and ¹⁸ F-FDOPA PET/CT examinations

Abstract: The effective radiation doses from whole body PET/CT examination was approximately 4-8 times higher than the background radiation dose from both (18)F-FDG and (18)F-FDOPA scans, while it was 1-3 times the background radiation dose from PET/CT scans of brain.

Cited by 22 publications

References 11 publications

Effective dose estimation for oncological and neurological PET/CT procedures

Effective dose estimation for oncological and neurological PET/CT procedures

State of the Art in the Treatment of Systemic Vasculitides

Estimation of radiation dose to patients from^[18]FDG whole body PET/CT investigations using dynamic PET scan protocol

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Estimation of patient dose in 18 F-FDG and 18 F-FDOPA PET/CT examinations

Abstract: The effective radiation doses from whole body PET/CT examination was approximately 4-8 times higher than the background radiation dose from both (18)F-FDG and (18)F-FDOPA scans, while it was 1-3 times the background radiation dose from PET/CT scans of brain.

Cited by 22 publications

References 11 publications

Effective dose estimation for oncological and neurological PET/CT procedures

Effective dose estimation for oncological and neurological PET/CT procedures

State of the Art in the Treatment of Systemic Vasculitides

Estimation of radiation dose to patients from[18]FDG whole body PET/CT investigations using dynamic PET scan protocol

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Estimation of patient dose in ¹⁸ F-FDG and ¹⁸ F-FDOPA PET/CT examinations

Estimation of radiation dose to patients from^[18]FDG whole body PET/CT investigations using dynamic PET scan protocol