The origin and reduction of spurious extrahepatic counts observed in 90Y non-TOF PET imaging post radioembolization

On the internal bremsstrahlung accompanyingβ-decay and its potential relevance in the application of radioactive sources

An in-depth analysis of the decay process forβ-emitting radionuclides highlights, for some of them, the existence of high-order effects usually not taken into account in literature as considered negligible in terms of energy and yield, and referred to as Internal Bremsstrahlung (IB). This set ofβ-radionuclides presents, besides theirβspectrum, a continuousγemission due to the Coulomb field braking action on the emitted electron following the decaying nucleus. In this work, we review the theoretical and experimental studies on the IB process focusing on its actual importance for the pureβemitters. It emerges that there is no satisfactory model able to reproduce the experimental IB distribution for most of the investigated beta emitters and the several measurements are sometimes at odds with each other. Moreover, as recently demonstrated, the IB process can give a relevant contribution to the physics of beta emitters thus requiring its inclusion in the physics of the beta decay. A discussion on the importance of considering IB process in both applicative fields such as nuclear medicine, industrial applications, and research or calibration laboratories, and in other relevant fields of particle physics or astrophysics, such as the research on dark matter or neutrino mass, is presented.

A New Method for Optimizing the Size of Axial FOV in TOF-PEM to Improve Performance of the Scanner

Background

Positron Emission Mammography (PEM) is a nuclear medicine imaging tool, playing a significant role in the diagnosis of patients with breast cancer. These days, many research has been done in order to improve the performance of this system.

Objective

This study aims to propose a new method for optimizing the size of axial Field of View (FOV) in PEMs and improving the performance of the systems.

Material and Methods

In this analytical study, a conventional Inveon PET is simulated using GATE in order to validate the simulation. For this simulation, the mean relative difference is 2.91%, showing the precision and correction of simulation and consequently it is benchmarked. In the next step, for design of the new optimized detector, several validated simulations are performed in order to find the best geometry.

Results

The best result is obtained with the axial FOV of 101.7 mm. It has 1.6×1.6×15 mm3 lutetium yttrium orthosilicate (LYSO) crystals. The detector consists of 6 block rings with 30 detector blocks in each ring. In this paper, the performance of the scanner is improved and the geometry is optimized. Sensitivity and scatter fraction of the designed scanner are 4.65% and 21.2%, respectively, also noise equivalent count rate (NECR) is 105.442 kcps.

Conclusion

The results showed 1 up to 3% improvement in the sensitivity of this new detector compared with different PEMs.

Updating 90Y Voxel S-Values including internal Bremsstrahlung: Monte Carlo study and development of an analytical model

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.

Internal Bremsstrahlung, the missing process in beta decay Monte Carlo simulation: The relevance in 32P Dose-Point-Kernel estimation

PURPOSE

In nuclear medicine, Dose Point Kernels (DPKs), representing the energy deposited all around a point isotropic source, are extensively used for dosimetry and are usually obtained by Monte Carlo (MC) simulations. For beta-decaying nuclides, DPK is usually estimated neglecting Internal Bremsstrahlung (IB) emission, a process always accompanying the beta decay and consisting in the emission of photons having a continuous spectral distribution. This work aims to study the significance of IB emission for DPK estimation in the case of ³²P and provide DPK values corrected for the IB photon contribution.

METHODS

DPK, in terms of the scaled absorbed dose fraction, F(R/X₉₀), was first estimated by GAMOS MC simulation using the standard beta decay spectrum of ³²P, F_β(R/X₉₀). Subsequently, an additional source term accounting for IB photons and their spectral distribution was defined and used for a further MC simulation, thus evaluating the contribution of IB emission to DPK values, F_β+IB(R/X₉₀). The relative percent difference, δ, between the DPKs obtained by the two approaches, F_β+IB vs. F_β, was studied as a function of the radial distance, R.

RESULTS

As far as the energy deposition is mainly due to the beta particles, IB photons does not significantly contribute to DPK; conversely, for larger R, F_β+IB values are higher by 30-40% than F_β.

CONCLUSIONS

The inclusion of IB emission in the MC simulations for DPK estimations is recommended, as well as the use of the DPK values corrected for IB photons, here provided.

Yttrium-90 TOF-PET-Based EUD Predicts Response Post Liver Radioembolizations Using Recommended Manufacturer FDG Reconstruction Parameters

Purpose

Explaining why ⁹⁰Y TOF-PET based equivalent uniform dose (EUD) using recommended manufacturer FDG reconstruction parameters has been shown to predict response.

Methods

The hot rods insert of a Jaszczak deluxe phantom was partially filled with a 2.65 GBq ⁹⁰Y - 300ml DTPA water solution resulting in a 100 Gy mean absorbed dose in the 6 sectors. A two bed 20min/position acquisition was performed on a 550ps- and on a 320ps- TOF-PET/CT and reconstructed with recommended manufacturer FDG reconstruction parameters, without and with additional filtering. The whole procedure was repeated on both PET after adding 300ml of water (50Gy setup). The phantom was acquired again after decay by a factor of 10 (5Gy setup), but with 200min per bed position. For comparison, the phantom was also acquired with ¹⁸F activity corresponding to a clinical FDG whole body acquisition.

Results

The 100Gy-setup provided a hot rod sectors image almost as good as the ¹⁸F phantom. However, despite acquisition time compensation, the 5Gy-setup provides much lower quality imaging. TOF-PET based sectors EUDs for the three large rod sectors agreed with the actual EUDs computed with a radiosensitivity of 0.021Gy^-1 well in the range observed in external beam radiotherapy (EBRT), i.e. 0.01-0.04Gy^-1. This agreement explains the reunification of the dose-response relationships of the glass and resin spheres in HCC using the TOF-PET based EUD. Additional filtering reduced the EUDs agreement quality.

Conclusions

Recommended manufacturer FDG reconstruction parameters are suitable in TOF-PET post ⁹⁰Y liver radioembolization for accurate tumour EUD computation. The present results rule out the use of low specific activity phantom studies to optimize reconstruction parameters.

Current Status of Radiopharmaceutical Therapy

In radiopharmaceutical therapy (RPT), a radionuclide is systemically or locally delivered with the goal of targeting and delivering radiation to cancer cells while minimizing radiation exposure to untargeted cells. Examples of current RPTs include thyroid ablation with the administration of ¹³¹I, treatment of liver cancer with ⁹⁰Y microspheres, the treatment of bony metastases with ²²³Ra, and the treatment of neuroendocrine tumors with ¹⁷⁷Lu-DOTATATE. New RPTs are being developed where radionuclides are incorporated into systemic targeted therapies. To assure that RPT is appropriately implemented, advances in targeting need to be matched with advances in quantitative imaging and dosimetry methods. Currently, radiopharmaceutical therapy is administered by intravenous or locoregional injection, and the treatment planning has typically been implemented like chemotherapy, where the activity administered is either fixed or based on a patient's body weight or body surface area. RPT pharmacokinetics are measurable by quantitative imaging and are known to vary across patients, both in tumors and normal tissues. Therefore, fixed or weight-based activity prescriptions are not currently optimized to deliver a cytotoxic dose to targets while remaining within the tolerance dose of organs at risk. Methods that provide dose estimates to individual patients rather than to reference geometries are needed to assess and adjust the injected RPT dose. Accurate doses to targets and organs at risk will benefit the individual patients and decrease uncertainties in clinical trials. Imaging can be used to measure activity distribution in vivo, and this information can be used to determine patient-specific treatment plans where the dose to the targets and organs at risk can be calculated. The development and adoption of imaging-based dosimetry methods is particularly beneficial in early clinical trials. In this work we discuss dosimetric accuracy needs in modern radiation oncology, uncertainties in the dosimetry in RPT, and best approaches for imaging and dosimetry of internal radionuclide therapy.

Enhancement of radiation exposure risk from β-emitter radionuclides due to Internal Bremsstrahlung effect: A Monte Carlo study of 90Y case

Employment of β-decaying radionuclides, used in many fields (industrial, clinical, research) requires a correct assessment of the operators' radiological exposure. Usually, in the dosimetric evaluation, the contribution coming from Internal Bremsstrahlung (IB) accompanying the β-decay is not kept into account; nevertheless, this negligibility does not always appear justified, at least for high-energy β-emitters. By means of Monte Carlo (MC) simulations, we showed how the contribution from IB photons is noteworthy for the evaluation of the overall radiation absorbed dose in the case of ⁹⁰Y source. We evaluated an increase of the absorbed doses, respectively for a point source and the considered receptacles, up to + 34% and + 60% or + 15% and + 28%, depending on the adopted model of IB spectrum. These results demonstrate the relevance of IB phenomenon in radiation protection estimations and suggest extending future theoretical and experimental studies to other β-decaying radionuclides.

Y-90 SPECT ML image reconstruction with a new model for tissue-dependent bremsstrahlung production using CT information: a proof-of-concept study

While the yield of positrons used in Y-90 PET is independent of tissue media, Y-90 SPECT imaging is complicated by the tissue dependence of bremsstrahlung photon generation. The probability of bremsstrahlung production is proportional to the square of the atomic number of the medium. Hence, the same amount of activity in different tissue regions of the body will produce different numbers of bremsstrahlung photons. Existing reconstruction methods disregard this tissue-dependency, potentially impacting both qualitative and quantitative imaging of heterogeneous regions of the body such as bone with marrow cavities. In this proof-of-concept study, we propose a new maximum-likelihood method that incorporates bremsstrahlung generation probabilities into the system matrix, enabling images of the desired Y-90 distribution to be reconstructed instead of the 'bremsstrahlung distribution' that is obtained with existing methods. The tissue-dependent probabilities are generated by Monte Carlo simulation while bone volume fractions for each SPECT voxel are obtained from co-registered CT. First, we demonstrate the tissue dependency in a SPECT/CT imaging experiment with Y-90 in bone equivalent solution and water. Visually, the proposed reconstruction approach better matched the true image and the Y-90 PET image than the standard bremsstrahlung reconstruction approach. An XCAT phantom simulation including bone and marrow regions also demonstrated better agreement with the true image using the proposed reconstruction method. Quantitatively, compared with the standard reconstruction, the new method improved estimation of the liquid bone:water activity concentration ratio by 40% in the SPECT measurement and the cortical bone:marrow activity concentration ratio by 58% in the XCAT simulation.