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Kayal G, Barbosa N, Marín CC, Ferrer L, Fragoso-Negrín JA, Grosev D, Gupta SK, Hidayati NR, Moalosi TCG, Poli GL, Thakral P, Tsapaki V, Vauclin S, Vergara-Gil A, Knoll P, Hobbs RF, Bardiès M. Quality Assurance Considerations in Radiopharmaceutical Therapy Dosimetry Using PLANETDose: An International Atomic Energy Agency Study. J Nucl Med 2024; 65:125-131. [PMID: 37884334 PMCID: PMC10755524 DOI: 10.2967/jnumed.122.265340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/25/2023] [Indexed: 10/28/2023] Open
Abstract
Implementation of radiopharmaceutical therapy dosimetry varies depending on the clinical application, dosimetry protocol, software, and ultimately the operator. Assessing clinical dosimetry accuracy and precision is therefore a challenging task. This work emphasizes some pitfalls encountered during a structured analysis, performed on a single-patient dataset consisting of SPECT/CT images by various participants using a standard protocol and clinically approved commercial software. Methods: The clinical dataset consisted of the dosimetric study of a patient administered with [177Lu]Lu-DOTATATE at Tygerberg Hospital, South Africa, as a part of International Atomic Energy Agency-coordinated research project E23005. SPECT/CT images were acquired at 5 time points postinjection. Patient and calibration images were reconstructed on a workstation, and a calibration factor of 122.6 Bq/count was derived independently and provided to the participants. A standard dosimetric protocol was defined, and PLANETDose (version 3.1.1) software was installed at 9 centers to perform the dosimetry of 3 treatment cycles. The protocol included rigid image registration, segmentation (semimanual for organs, activity threshold for tumors), and dose voxel kernel convolution of activity followed by absorbed dose (AD) rate integration to obtain the ADs. Iterations of the protocol were performed by participants individually and within collective training, the results of which were analyzed for dosimetric variability, as well as for quality assurance and error analysis. Intermediary checkpoints were developed to understand possible sources of variation and to differentiate user error from legitimate user variability. Results: Initial dosimetric results for organs (liver and kidneys) and lesions showed considerable interoperator variability. Not only was the generation of intermediate checkpoints such as total counts, volumes, and activity required, but also activity-to-count ratio, activity concentration, and AD rate-to-activity concentration ratio to determine the source of variability. Conclusion: When the same patient dataset was analyzed using the same dosimetry procedure and software, significant disparities were observed in the results despite multiple sessions of training and feedback. Variations due to human error could be minimized or avoided by performing intensive training sessions, establishing intermediate checkpoints, conducting sanity checks, and cross-validating results across physicists or with standardized datasets. This finding promotes the development of quality assurance in clinical dosimetry.
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Affiliation(s)
- Gunjan Kayal
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
- SCK CEN, Belgian Nuclear Research Centre, Mol, Belgium
| | | | | | - Ludovic Ferrer
- Medical Physics Department, ICO René Gauducheau, Nantes, France
- CRCINA, UMR 1232, INSERM, France
| | - José-Alejandro Fragoso-Negrín
- DOSIsoft SA, Cachan, France
- IRCM, UMR 1194 INSERM, Universite de Montpellier and Institut Regional du Cancer de Montpellier, Montpellier, France
| | - Darko Grosev
- Department of Nuclear Medicine and Radiation Protection, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Santosh Kumar Gupta
- Department of Nuclear Medicine and PET, Mahamana Pandit Madanmohan Malviya Cancer Centre and Homi Bhabha Cancer Centre, Varanasi, India
| | - Nur Rahmah Hidayati
- Research Center and Technology for Radiation Safety and Metrology-National Research and Innovation Agency, Jakarta, Indonesia
| | - Tumelo C G Moalosi
- Department of Medical Imaging and Clinical Oncology, Medical Physics, Nuclear Medicine Division, Faculty of Medicine and Health Science, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Gian Luca Poli
- Department of Medical Physics, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Parul Thakral
- Department of Nuclear Medicine, Fortis Memorial Research Institute, Gurugram, India
| | - Virginia Tsapaki
- Dosimetry and Medical Radiation Physics, International Atomic Energy Agency, Vienna, Austria
| | | | - Alex Vergara-Gil
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Peter Knoll
- Dosimetry and Medical Radiation Physics, International Atomic Energy Agency, Vienna, Austria
| | - Robert F Hobbs
- Johns Hopkins Medical Institute, Baltimore, Maryland; and
| | - Manuel Bardiès
- IRCM, UMR 1194 INSERM, Universite de Montpellier and Institut Regional du Cancer de Montpellier, Montpellier, France;
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier, Montpellier, France
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Cicone F, Sjögreen Gleisner K, Sarnelli A, Indovina L, Gear J, Gnesin S, Kraeber-Bodéré F, Bischof Delaloye A, Valentini V, Cremonesi M. The contest between internal and external-beam dosimetry: The Zeno's paradox of Achilles and the tortoise. Phys Med 2024; 117:103188. [PMID: 38042710 DOI: 10.1016/j.ejmp.2023.103188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
Radionuclide therapy, also called molecular radiotherapy (MRT), has come of age, with several novel radiopharmaceuticals being approved for clinical use or under development in the last decade. External beam radiotherapy (EBRT) is a well-established treatment modality, with about half of all oncologic patients expected to receive at least one external radiation treatment over their disease course. The efficacy and the toxicity of both types of treatment rely on the interaction of radiation with biological tissues. Dosimetry played a fundamental role in the scientific and technological evolution of EBRT, and absorbed doses to the target and to the organs at risk are calculated on a routine basis. In contrast, in MRT the usefulness of internal dosimetry has long been questioned, and a structured path to include absorbed dose calculation is missing. However, following a similar route of development as EBRT, MRT treatments could probably be optimized in a significant proportion of patients, likely based on dosimetry and radiobiology. In the present paper we describe the differences and the similarities between internal and external-beam dosimetry in the context of radiation treatments, and we retrace the main stages of their development over the last decades.
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Affiliation(s)
- Francesco Cicone
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Nuclear Medicine Unit, "Mater Domini" University Hospital, Catanzaro, Italy.
| | | | - Anna Sarnelli
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Luca Indovina
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland; University of Lausanne, Lausanne, Switzerland
| | - Françoise Kraeber-Bodéré
- Nantes Université, Université Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, F-44000 Nantes, France
| | | | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
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3
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Danieli R, Pistone D, Tranel J, Botta F, Uribe-Munoz C, Raspanti D, Salvat F, Wilderman SJ, Bardiès M, Amato E, Dewaraja YK, Cremonesi M. Technical note: Impact of dose voxel kernel (DVK) values on dosimetry estimates in 177 Lu and 90 Y radiopharmaceutical therapy (RPT) applications. Med Phys 2024; 51:522-532. [PMID: 37712869 PMCID: PMC10843484 DOI: 10.1002/mp.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/23/2023] [Accepted: 08/05/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Radiopharmaceutical therapy (RPT) is an increasingly adopted modality for treating cancer. There is evidence that the optimization of the treatment based on dosimetry can improve outcomes. However, standardization of the clinical dosimetry workflow still represents a major effort. Among the many sources of variability, the impact of using different Dose Voxel Kernels (DVKs) to generate absorbed dose (AD) maps by convolution with the time-integrated activity (TIA) distribution has not been systematically investigated. PURPOSE This study aims to compare DVKs and assess the differences in the ADs when convolving the same TIA map with different DVKs. METHODS DVKs of 3 × 3 × 3 mm3 sampling-nine for 177 Lu, nine for 90 Y-were selected from those most used in commercial/free software or presented in prior publications. For each voxel within a 11 × 11 × 11 matrix, the coefficient of variation (CoV) and the percentage difference between maximum and minimum values (% maximum difference) were calculated. The total absorbed dose per decay (SUM), calculated as the sum of all the voxel values in each kernel, was also compared. Publicly available quantitative SPECT images for two patients treated with 177 Lu-DOTATATE and PET images for two patients treated with 90 Y-microspheres were used, including organs at risk (177 Lu: kidneys; 90 Y: liver and healthy liver) and tumors' segmentations. For each patient, the mean AD to the volumes of interest (VOIs) was calculated using the different DVKs, the same TIA map and the same software tool for dose convolution, thereby focusing on the DVK impact. For each VOI, the % maximum difference of the mean AD between maximum and minimum values was computed. RESULTS The CoV (% maximum difference) in voxels of normalized coordinates [0,0,0], [0,1,0], and [0,1,1] were 5%(21%), 9%(35%), and 10%(46%) for the 177 Lu DVKs. For the case of 90 Y, these values were 2%(9%), 4%(14%), and 4%(16%). The CoV (% maximum difference) for SUM was 9%(33%) for 177 Lu, and 4%(15%) for 90 Y. The variability of the mean tumor and organ AD was up to 19% and 15% in 177 Lu-DOTATATE and 90 Y-microspheres patients, respectively. CONCLUSIONS This study showed a considerable AD variability due exclusively to the use of different DVKs. A concerted effort by the scientific community would contribute to decrease these discrepancies, strengthening the consistency of AD calculation in RPT.
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Affiliation(s)
- Rachele Danieli
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium
- Université Libre De Bruxelles (ULB), Radiophysics and MRI Physics Laboratory, Brussels, Belgium
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Department of Nuclear Medicine, Brussels, Belgium
| | - Daniele Pistone
- Department of Biomedical and Dental Sciences and of Morphologic and Functional Imaging (BIOMORF), University of Messina, Messina, Italy
- National Institute for Nuclear Physics (INFN), section of Catania, Catania, Italy
- Università degli Studi della Campania “Luigi Vanvitelli”, Dipartimento di Matematica e Fisica, Caserta, Italy
| | - Jonathan Tranel
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Francesca Botta
- Medical Physics Unit, Instituto Europeo di Oncologia IRCCS, via Ripamonti 435, 20141 Milan, Italy
| | - Carlos Uribe-Munoz
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada
| | - Davide Raspanti
- Temasinergie S.p.A., Via Marcello Malpighi 120, 48018 Faenza, Italy
| | - Francesc Salvat
- Facultat de Física (FQA and ICC), Universitat de Barcelona, Diagonal 645, 08028 Barcelona, Catalonia, Spain
| | - Scott J Wilderman
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, Michigan
| | - Manuel Bardiès
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier (ICM), Montpellier F-34298, France
- IRCM, UMR 1194 INSERM, Université de Montpellier and Institut Régional du Cancer de Montpellier (ICM), Montpellier F-34298, France
| | - Ernesto Amato
- Department of Biomedical and Dental Sciences and of Morphologic and Functional Imaging (BIOMORF), University of Messina, Messina, Italy
- National Institute for Nuclear Physics (INFN), section of Catania, Catania, Italy
- Health Physics Unit, University Hospital “Gaetano Martino”, Messina, Italy
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Marta Cremonesi
- Radiation Research Unit, Instituto Europeo di Oncologia IRCCS, Via Giuseppe Ripamonti 435, 20141 Milano, Italy
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Ivashchenko OV, O'Doherty J, Hardiansyah D, Cremonesi M, Tran-Gia J, Hippeläinen E, Stokke C, Grassi E, Sandström M, Glatting G. Time-Activity data fitting in molecular Radiotherapy: Methodology and pitfalls. Phys Med 2024; 117:103192. [PMID: 38052710 DOI: 10.1016/j.ejmp.2023.103192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/18/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
Absorbed radiation doses are essential in assessing the effects, e.g. safety and efficacy, of radiopharmaceutical therapy (RPT). Patient-specific absorbed dose calculations in the target or the organ at risk require multiple inputs. These include the number of disintegrations in the organ, i.e. the time-integrated activities (TIAs) of the organs, as well as other parameters describing the process of radiation energy deposition in the target tissue (i.e. mean energy per disintegration, radiation dose constants, etc). TIAs are then estimated by incorporating the area under the radiopharmaceutical's time-activity curve (TAC), which can be obtained by quantitative measurements of the biokinetics in the patient (typically based on imaging data such as planar scintigraphy, SPECT/CT, PET/CT, or blood and urine samples). The process of TAC determination/calculation for RPT generally depends on the user, e.g., the chosen number and schedule of measured time points, the selection of the fit function, the error model for the data and the fit algorithm. These decisions can strongly affect the final TIA values and thus the accuracy of calculated absorbed doses. Despite the high clinical importance of the TIA values, there is currently no consensus on processing time-activity data or even a clear understanding of the influence of uncertainties and variations in personalised RPT dosimetry related to user-dependent TAC calculation. As a first step towards minimising site-dependent variability in RPT dosimetry, this work provides an overview of quality assurance and uncertainty management considerations of the TIA estimation.
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Affiliation(s)
- Oleksandra V Ivashchenko
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, the Netherlands.
| | - Jim O'Doherty
- Siemens Medical Solutions, Malvern, PA, United States of America; Department of Radiology & Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America; Radiography & Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Deni Hardiansyah
- Medical Physics and Biophysics Division, Physics Department, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok, Indonesia; Research Collaboration Centre for Theranostic Radiopharmaceuticals, BRIN, Bandung, Indonesia
| | - Marta Cremonesi
- Unit of Radiation Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Eero Hippeläinen
- Department of Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caroline Stokke
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
| | - Elisa Grassi
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Gerhard Glatting
- Medical Radiation Physics, Department of Nuclear Medicine, Ulm University, Ulm, Germany
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Della Gala G, Santoro M, Rasoatsaratanany GA, Paolani G, Strolin S, Strigari L. A single centre intercomparison between commercial treatment planning systems for 90Y radioembolization using virtual and experimental phantoms. Phys Med 2023; 116:103172. [PMID: 38001000 DOI: 10.1016/j.ejmp.2023.103172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Dedicated Treatment Planning Systems (TPSs) were developed to personalize 90Y-transarterial radioembolization. This study evaluated the agreement among four commercial TPSs assessing volumes of interest (VOIs) volumes and dose metrics. METHODS A homogeneous (EH) and an anthropomorphic phantom with hot and cold inserts (EA) filled with 99mTc-pertechnetate were acquired with a SPECT/CT scanner. Their virtual versions (VH and VA, respectively) and a phantom with activity inside a single voxel (VK) were generated by an in-house MATLAB script. Images and delineated VOIs were imported into the TPSs to compute voxel-based absorbed dose distributions with various dose deposition approaches: local deposition method (LDM) and dose kernel convolution (DKC) with/without local density correction (LDC). VOI volumes and mean absorbed doses were assessed against their median value across TPSs. Dose-volume histograms (DVHs) and VK-derived dose profiles were evaluated. RESULTS Small (<2.1 %) and large (up to 42.4 %) relative volume differences were observed on large (>500 ml) and small VOIs, respectively. Mean absorbed doses relative differences were < 3 % except for small VOIs with steep dose gradients (up to 89.1 % in the VA Cold Sphere VOI). Within the same TPS, LDC negligibly affected the mean absorbed dose, while DKC and LDM showed differences up to 63 %. DHVs were mostly overlapped in experimental phantoms, with some differences in the virtual versions. Dose profiles agreed within 1 %. CONCLUSION TPSs showed an overall good agreement except for small VOI volumes and mean absorbed doses of VOIs with steep dose gradients. These discrepancies should be considered in the dosimetry uncertainty assessment, thus requiring an appropriate harmonization.
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Affiliation(s)
- Giuseppe Della Gala
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Miriam Santoro
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Garoson Albertine Rasoatsaratanany
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy; International Center for Theoretical Physics (ICTP), Strada Costiera, 11, 34151, Trieste, Italy
| | - Giulia Paolani
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy.
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Sjögreen-Gleisner K, Flux G, Bacher K, Chiesa C, de Nijs R, Kagadis GC, Lima T, Georgosopoulou ML, Gabiña PM, Nekolla S, Peters S, Santos J, Sattler B, Stokke C, Tran-Gia J, Gilligan P, Bardiès M. EFOMP policy statement NO. 19: Dosimetry in nuclear medicine therapy - Molecular radiotherapy. Phys Med 2023; 116:103166. [PMID: 37926641 DOI: 10.1016/j.ejmp.2023.103166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023] Open
Abstract
The European Council Directive 2013/59/Euratom (BSS Directive) includes optimisation of treatment with radiotherapeutic procedures based on patient dosimetry and verification of the absorbed doses delivered. The present policy statement summarises aspects of three directives relating to the therapeutic use of radiopharmaceuticals and medical devices, and outlines the steps needed for implementation of patient dosimetry for radioactive drugs. To support the transition from administrations of fixed activities to personalised treatments based on patient-specific dosimetry, EFOMP presents a number of recommendations including: increased networking between centres and disciplines to support data collection and development of codes-of-practice; resourcing to support an infrastructure that permits routine patient dosimetry; research funding to support investigation into individualised treatments; inter-disciplinary training and education programmes; and support for investigator led clinical trials. Close collaborations between the medical physicist and responsible practitioner are encouraged to develop a similar pathway as is routine for external beam radiotherapy and brachytherapy. EFOMP's policy is to promote the roles and responsibilities of medical physics throughout Europe in the development of molecular radiotherapy to ensure patient benefit. As the BSS directive is adopted throughout Europe, unprecedented opportunities arise to develop informed treatments that will mitigate the risks of under- or over-treatments.
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Affiliation(s)
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
| | - Klaus Bacher
- Medical Physics, Ghent University, Ghent, Belgium
| | - Carlo Chiesa
- Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Robin de Nijs
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - George C Kagadis
- 3DMI Research Group, Department of Medical Physics, University of Patras, Rion, Greece
| | - Thiago Lima
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Lucerne, Switzerland/Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland
| | | | - Pablo Minguez Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital /Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Stephan Nekolla
- School of Medicine and Health, Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Steffie Peters
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joao Santos
- Medical Physics, Radiobiology and Radiation Protection Group, IPO Porto Research Center, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center & Health Research Network, Porto, Portugal
| | - Bernhard Sattler
- Department of Nuclear Medicine, University of Leipzig Medical Centre, Leipzig, Germany
| | - Caroline Stokke
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway & Department of Physics, University of Oslo, Oslo, Norway
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Paddy Gilligan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Manuel Bardiès
- IRCM, UMR 1194 INSERM, Université de Montpellier and Institut Régional du Cancer de Montpellier (ICM), France & Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier (ICM), France
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7
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Bensiali M, Anizan N, Leboulleux S, Lamart S, Davesne E, Broggio D, Desbrée A, Franck D. Patient-specific biokinetics and hybrid 2D/3D approach integration in OEDIPE software: Application to radioiodine therapy. Phys Med 2023; 113:102462. [PMID: 36424255 DOI: 10.1016/j.ejmp.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The progression of targeted radionuclide therapy requires the development of dosimetry software accounting for patient-specific biokinetics. New functionalities were thus developed in the OEDIPE software, to deal with multiple 3D images or multiple planar images and a SPECT image. MATERIEL & METHOD Methods were implemented to recover patient biokinetics in volumes of interest. If several 3D SPECT images are available, they are registered to a reference CT scan. When several planar images and a single SPECT are available, the planar images are registered to the SPECT and counts of the planar images converted to activity. To validate these developments, six SPECT/CT and planar images of a Jaszczak phantom containing I-131 were acquired at different dates. Cumulated activity was estimated in each sphere using the SPECT/CT images only or the planar series associated to one SPECT/CT. Biokinetics and doses in lesions and in the lungs of a patient treated with I-131 for differentiated thyroid cancer were then estimated using four planar images and a SPECT/CT scan. Whole-body retention data were used to compare the biokinetics obtained from the planar and SPECT data. RESULTS Activities and cumulated activities estimated using OEDIPE in the phantom spheres agreed well with the reference values for both approaches. Results obtained for the patient compared well with those derived from whole-body retention data. CONCLUSION The implemented features allow automatic evaluation of patient-specific biokinetics from different series of patient images, enabling patient-specific dosimetry without the need for external software to estimate the cumulated activities in different VOIs.
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Affiliation(s)
- M Bensiali
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, Fontenay-aux-Roses, France
| | - N Anizan
- Gustave Roussy and Université Paris-Saclay, Medical Physics Department, Villejuif, France; Gustave Roussy and Université Paris-Saclay, Nuclear Medicine Department, Villejuif, France
| | - S Leboulleux
- Gustave Roussy and Université Paris-Saclay, Nuclear Medicine Department, Villejuif, France
| | - S Lamart
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, Fontenay-aux-Roses, France.
| | - E Davesne
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, Fontenay-aux-Roses, France; Laboratoire Radioprotection et Santé, Commissariat à l'Energie Atomique et aux Energies Alternatives, INSTN/UES/LRS, Gif-sur-Yvette, France
| | - D Broggio
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, Fontenay-aux-Roses, France
| | - A Desbrée
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, Fontenay-aux-Roses, France
| | - D Franck
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, Fontenay-aux-Roses, France
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Pistone D, Amato E, Auditore L, Baldari S, Italiano A. Updating 90Y Voxel S-Values including internal Bremsstrahlung: Monte Carlo study and development of an analytical model. Phys Med 2023; 112:102624. [PMID: 37354805 DOI: 10.1016/j.ejmp.2023.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE Internal Bremsstrahlung (IB) is a process accompanying β-decay but neglected in Voxel S-Values (VSVs) calculation. Aims of this work were to calculate, through Monte Carlo (MC) simulation, updated 90Y-VSVs including IB, and to develop an analytical model to evaluate 90Y-VSVs for any voxel size of practical interest. METHODS GATE (Geant4 Application for Tomographic Emission) was employed for simulating voxelized geometries of soft tissue, with voxels sides l ranging from 2 to 6 mm, in steps of 0.5 mm. The central voxel was set as a homogeneous source of 90Y when IB photons are not modelled. For each l, the VSVs were computed for 90Y decays alone and for 90Y + IB. The analytical model was then built through fitting procedures of the VSVs including IB contribution. RESULTS Comparing GATE-VSVs with and without IB, differences between + 25% and + 30% were found for distances from the central voxel larger than the maximum β-range. The analytical model showed an agreement with MC simulations within ± 5% in the central voxel and in the Bremsstrahlung tails, for any l value examined, and relative differences lower than ± 40%, for other distances from the source. CONCLUSIONS The presented 90Y-VSVs include for the first time the contribution due to IB, thus providing a more accurate set of dosimetric factors for three-dimensional internal dosimetry of 90Y-labelled radiopharmaceuticals and medical devices. Furthermore, the analytical model constitutes an easy and fast alternative approach for 90Y-VSVs estimation for non-standard voxel dimensions.
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Affiliation(s)
- Daniele Pistone
- Department of Biomedical and Dental Sciences and of Morphologic and Functional Imaging (BIOMORF), University of Messina, Messina, Italy; INFN, National Institute for Nuclear Physics, Section of Catania, Catania, Italy
| | - Ernesto Amato
- Department of Biomedical and Dental Sciences and of Morphologic and Functional Imaging (BIOMORF), University of Messina, Messina, Italy; INFN, National Institute for Nuclear Physics, Section of Catania, Catania, Italy; Health Physics Unit, University Hospital "Gaetano Martino", Messina, Italy.
| | - Lucrezia Auditore
- Department of Biomedical and Dental Sciences and of Morphologic and Functional Imaging (BIOMORF), University of Messina, Messina, Italy; INFN, National Institute for Nuclear Physics, Section of Catania, Catania, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and of Morphologic and Functional Imaging (BIOMORF), University of Messina, Messina, Italy; Nuclear Medicine Unit, University Hospital "Gaetano Martino", Messina, Italy
| | - Antonio Italiano
- INFN, National Institute for Nuclear Physics, Section of Catania, Catania, Italy; Department of Mathematical and Computational Sciences, Physics Sciences and Earth Sciences (MIFT), University of Messina, Messina, Italy
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Hoog C, Verrecchia-Ramos E, Dejust S, Lalire P, Sezin G, Moubtakir A, El Farsaoui K, Caquot PA, Guendouzen S, Morland D, Papathanassiou D. Implementation of xSPECT, xSPECT bone and Broadquant from literature, clinical survey and innovative phantom study with task-based image quality assessment. Phys Med 2023; 112:102611. [PMID: 37329742 DOI: 10.1016/j.ejmp.2023.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/19/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
OBJECTIVE From patient and phantom studies, we aimed to highlight an original implementation process and share a two-years experience clinical feedback on xSPECT (xS), xSPECT Bone (xB) and Broadquant quantification (Siemens) for 99mTc-bone and 177Lu-NET (neuroendocrine tumors) imaging. METHODS Firstly, we checked the relevance of implemented protocols and Broadquant module on the basis of literature and with a homogeneous phantom study respectively. Then, we described xS and xB behaviours with reconstruction parameters (10i-0mm to 40i-20mm) and optimized the protocols through a blinded survey (7 physicians). Finally, the preferred 99mTc-bone reconstruction was assessed through an IEC NEMA phantom including liquid bone spheres. Conventional SNR, CNR, spatial resolution, Q.%error, and recovery curves; and innovative NPS, TTF and detectability score d' were performed (ImQuest software). We also sought to review the adoption of these tools in clinical routine and showed the potential of quantitative xB in the context of theranostics (Xofigo®). RESULTS We showed the need of optimization of implemented reconstruction algorithms and pointed out a decay correction particularity with Broadquant. Preferred parameters were 1s-25i-8mm and 1s-25i-5mm for xS/xB-bone and xS-NET imaging respectively. The phantom study highlighted the different image quality especially for the enhanced spatial resolution xB algorithm (1/TTF10%=2.1 mm) and showed F3D and xB shared the best performances in terms of image quality and quantification. xS was generally less efficient. CONCLUSIONS Qualitative F3D still remains the clinical standard, xB and Broadquant offer challenging perspectives in theranostics. We introduced the potential of innovative metrics for image quality analysis and showed how CT tools should be adapted to fit nuclear medicine imaging.
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Affiliation(s)
| | | | | | - Paul Lalire
- Nuclear Medicine Department, Institut Godinot, Reims, France
| | - Ghali Sezin
- Nuclear Medicine Department, Institut Godinot, Reims, France
| | | | | | | | | | - David Morland
- Nuclear Medicine Department, Institut Godinot, Reims, France; UFR de médecine, université de Reims-Champagne Ardenne, 1, rue Cognacq-Jay, 51095 Reims cedex, France; CReSTIC Centre de recherche en sciences et technologies de l'information et de la communication, EA 3804, université de Reims-Champagne Ardenne, Moulin de la Housse, BP 1039, 51687 Reims Cedex 2, France
| | - Dimitri Papathanassiou
- Nuclear Medicine Department, Institut Godinot, Reims, France; UFR de médecine, université de Reims-Champagne Ardenne, 1, rue Cognacq-Jay, 51095 Reims cedex, France; CReSTIC Centre de recherche en sciences et technologies de l'information et de la communication, EA 3804, université de Reims-Champagne Ardenne, Moulin de la Housse, BP 1039, 51687 Reims Cedex 2, France
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10
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Gear J, Stokke C, Terwinghe C, Gnesin S, Sandström M, Tran-Gia J, Cremonesi M, Cicone F, Verburg F, Hustinx R, Giovanella L, Herrmann K, Gabiña PM. EANM enabling guide: how to improve the accessibility of clinical dosimetry. Eur J Nucl Med Mol Imaging 2023; 50:1861-1868. [PMID: 37086275 PMCID: PMC10287783 DOI: 10.1007/s00259-023-06226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
Dosimetry can be a useful tool for personalization of molecular radiotherapy (MRT) procedures, enabling the continuous development of theranostic concepts. However, the additional resource requirements are often seen as a barrier to implementation. This guide discusses the requirements for dosimetry and demonstrates how a dosimetry regimen can be tailored to the available facilities of a centre. The aim is to help centres wishing to initiate a dosimetry service but may not have the experience or resources of some of the more established therapy and dosimetry centres. The multidisciplinary approach and different personnel requirements are discussed and key equipment reviewed example protocols demonstrating these factors are given in the supplementary material for the main therapies carried out in nuclear medicine, including [131I]-NaI for benign thyroid disorders, [177Lu]-DOTATATE and 131I-mIBG for neuroendocrine tumours and [90Y]-microspheres for unresectable hepatic carcinoma.
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Affiliation(s)
- Jonathan Gear
- Joint Department of Physics, Royal Marsden NHSFT & Institute of Cancer Research, Sutton, UK.
| | - Caroline Stokke
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Christelle Terwinghe
- Department of Nuclear Medicine, Universitair Ziekenhuis Leuven, Louvain, Belgium
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mattias Sandström
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Sweden & Section of Medical Physics, Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Marta Cremonesi
- Radiation Research Unit, Department of Medical Imaging and Radiation Sciences, Istituto Europeo Di Oncologia, IRCCS, Milan, Italy
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, Neuroscience Research Centre, PET/RM Unit, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
- Nuclear Medicine Unit, University Hospital "Mater Domini, Catanzaro, Italy
| | - Fredrik Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
- GIGA-CRC in Vivo Imaging, University of Liège, Liège, Belgium
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Duisburg, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Pablo Minguez Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
- Department of Applied Physics, Faculty of Engineering, UPV/EHU, Bilbao, Spain
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11
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Robinson AP, Calvert N, Tipping J, Denis-Bacelar AM, Ferreira KM, Lassmann M, Tran-Gia J. Development of a validation imaging dataset for Molecular Radiotherapy dosimetry multicenter intercomparison exercises based on anthropomorphic phantoms. Phys Med 2023; 109:102583. [PMID: 37062101 PMCID: PMC10165308 DOI: 10.1016/j.ejmp.2023.102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023] Open
Abstract
Validation of a Molecular Radiotherapy (MRT) dosimetry system requires imaging data for which an accompanying "ground truth" pharmacokinetic model and absorbed dose calculation are known. METHODS We present a methodology for production of a validation dataset for image based 177Lu dotatate dosimetry calculations. A pharmacokinetic model is presented with activity concentrations corresponding to common imaging timepoints. Anthropomorphic 3D printed phantoms, corresponding to the organs at risk, have been developed to provide SPECT/CT and Whole Body imaging with known organ activities corresponding to common clinical timepoints. RESULTS Results for the accuracy of phantom filling reproduce the activity concentrations from the pharmacokinetic model for all timepoints and organs within measurement uncertainties, with a mean deviation of 0.6(8)%. The imaging dataset, ancillary data and phantoms designs are provided as a source of well characterized input data for the validation of clinical MRT dosimetry systems. CONCLUSIONS The combination of pharmacokinetic modelling with the use of anthropomorphic 3D printed phantoms are a promising procedure to provide data for the validation of Molecular Radiotherapy Dosimetry systems, allowing multicentre comparisons.
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Affiliation(s)
- Andrew P Robinson
- National Physical Laboratory, Teddington, TW11 0LW, United Kingdom; Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom; Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, United Kingdom.
| | - Nick Calvert
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
| | - Jill Tipping
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
| | | | | | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
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12
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Strigari L, Marconi R, Solfaroli-Camillocci E. Evolution of Portable Sensors for In-Vivo Dose and Time-Activity Curve Monitoring as Tools for Personalized Dosimetry in Molecular Radiotherapy. SENSORS (BASEL, SWITZERLAND) 2023; 23:2599. [PMID: 36904802 PMCID: PMC10007630 DOI: 10.3390/s23052599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Treatment personalization in Molecular Radiotherapy (MRT) relies on pre- and post-treatment SPECT/ PET-based images and measurements to obtain a patient-specific absorbed dose-rate distribution map and its evolution over time. Unfortunately, the number of time points that are available per patient to investigate individual pharmacokinetics is often reduced by limited patient compliance or SPECT or PET/CT scanner availability for dosimetry in busy departments. The adoption of portable sensors for in-vivo dose monitoring during the entire treatment could improve the assessment of individual biokinetics in MRT and, thus, the treatment personalization. The evolution of portable devices, non-SPECT/PET-based options, already used for monitoring radionuclide activity transit and accumulation during therapy with radionuclides (i.e., MRT or brachytherapy), is presented to identify valuable ones, which combined with conventional nuclear medicine imaging systems could be effective in MRT. External probes, integration dosimeters and active detecting systems were included in the study. The devices and their technology, the range of applications, the features and limitations are discussed. Our overview of the available technologies encourages research and development of portable devices and dedicated algorithms for MRT patient-specific biokinetics study. This would represent a crucial advancement towards personalized treatment in MRT.
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Affiliation(s)
- Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Raffaella Marconi
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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13
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Development of a voxel S-value database for patient internal radiation dosimetry. Phys Med 2023; 106:102519. [PMID: 36641901 DOI: 10.1016/j.ejmp.2022.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Personalized dosimetry with high accuracy drew great attention in clinical practices. Voxel S-value (VSV) convolution has been proposed to speed up absorbed dose calculations. However, the VSV method is efficient for personalized internal radiation dosimetry only when there are pre-calculated VSVs of the radioisotope. In this work, we propose a new method for VSV calculation based on the developed mono-energetic particle VSV database of γ, β, α, and X-ray for any radioisotopes. METHODS Mono-energetic VSV database for γ, β, α, and X-ray was calculated using Monte Carlo methods. Radiation dose was first calculated based on mono-energetic VSVs for [F-18]-FDG in 10 patients. The estimated doses were compared with the values obtained from direct Monte Carlo simulation for validation of the proposed method. The number of VSVs used in calculation was optimized based on the estimated dose accuracy and computation time. RESULTS The generated VSVs showed a great consistency with the results calculated using direct Monte Carlo simulation. For [F-18]-FDG, the proposed VSV method with number of VSV of 9 shows the best relative average organ absorbed dose uncertainty of 3.25% while the calculation time was reduced by 99% and 97% compared to the Monte Carlo simulation and traditional multiple VSV methods, respectively. CONCLUSIONS In this work, we provided a method to generate the VSV kernels for any radioisotope based on the pre-calculated mono-energetic VSV database and significantly reduced the time cost for the multiple VSVs dosimetry approach. A software was developed to generate VSV kernels for any radioisotope in 19 mediums.
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Bardiès M. Dosimétrie clinique en médecine nucléaire thérapeutique : statut et perspectives. MÉDECINE NUCLÉAIRE 2023. [DOI: 10.1016/j.mednuc.2023.01.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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15
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Marengo M, Infantino A. Assessment of emission data and transmission factors supporting radiation protection in the use of 225Ac. Phys Med 2022; 103:59-65. [DOI: 10.1016/j.ejmp.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022] Open
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16
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Gear J. Milestones in dosimetry for nuclear medicine therapy. Br J Radiol 2022; 95:20220056. [PMID: 35451857 PMCID: PMC10996314 DOI: 10.1259/bjr.20220056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 11/05/2022] Open
Abstract
Nuclear Medicine therapy has reached a critical juncture with an unprecedented number of patients being treated and an extensive list of new radiopharmaceuticals under development. Since the early applications of these treatments dosimetry has played a vital role in their development, in both aiding optimisation and enhancing safety and efficacy. To inform the future direction of this field, it is useful to reflect on the scientific and technological advances that have occurred since those early uses. In this review, we explore how dosimetry has evolved over the years and discuss why such initiatives were conceived and the importance of maintaining standards within our practise. Specific milestones and landmark publications are highlighted and a thematic review and significant outcomes during each decade are presented.
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Affiliation(s)
- Jonathan Gear
- The Joint Department of Physics, The Royal Marsden NHS
Foundation Trust & Institute of Cancer Research,
Sutton, United Kingdom
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