Estimation of Patient Dose from Radiopharmaceuticals Using Voxel Models

3D calculation of absorbed dose for 131I-targeted radiotherapy: a Monte Carlo study

Various methods, such as those developed by the Medical Internal Radiation Dosimetry (MIRD) Committee of the Society of Nuclear Medicine or employing dose point kernels, have been applied to the radiation dosimetry of (131)I radionuclide therapy. However, studies have not shown a strong relationship between tumour absorbed dose and its overall therapeutic response, probably due in part to inaccuracies in activity and dose estimation. In the current study, the GATE Monte Carlo computer code was used to facilitate voxel-level radiation dosimetry for organ activities measured in an (131)I-treated thyroid cancer patient. This approach allows incorporation of the size, shape and composition of organs (in the current study, in the Zubal anthropomorphic phantom) and intra-organ and intra-tumour inhomogeneities in the activity distributions. The total activities of the tumours and their heterogeneous distributions were measured from the SPECT images to calculate the dose maps. For investigating the effect of activity distribution on dose distribution, a hypothetical homogeneous distribution of the same total activity was considered in the tumours. It was observed that the tumour mean absorbed dose rates per unit cumulated activity were 0.65E-5 and 0.61E-5 mGY MBq(-1) s(-1) for the uniform and non-uniform distributions in the tumour, respectively, which do not differ considerably. However, the dose-volume histograms (DVH) show that the tumour non-uniform activity distribution decreases the absorbed dose to portions of the tumour volume. In such a case, it can be misleading to quote the mean or maximum absorbed dose, because overall response is likely limited by the tumour volume that receives low (i.e. non-cytocidal) doses. Three-dimensional radiation dosimetry, and calculation of tumour DVHs, may lead to the derivation of clinically reliable dose-response relationships and therefore may ultimately improve treatment planning as well as response assessment for radionuclide therapy.

Electron specific absorbed fractions for the adult male and female ICRP/ICRU reference computational phantoms

The calculation of radiation dose from internally incorporated radionuclides is based on so-called absorbed fractions (AFs) and specific absorbed fractions (SAFs). SAFs for monoenergetic electrons were calculated for 63 source regions and 67 target regions using the new male and female adult reference computational phantoms adopted by the ICRP and ICRU and the Monte Carlo radiation transport programme package EGSnrc. The SAF values for electrons are opposed to the simplifying assumptions of ICRP Publication 30. The previously applied assumption of electrons being fully absorbed in the source organ itself is not always true at electron energies above approximately 300-500 keV. High-energy electrons have the ability to leave the source organ and, consequently, the electron SAFs for neighbouring organs can reach the same magnitude as those for photons for electron energies above 1 MeV. The reciprocity principle known for photons can be extended to electron SAFs as well, thus making cross-fire electron SAFs mass-independent. To quantify the impact of the improved electron dosimetry in comparison to the dosimetry using the simple assumptions of ICRP Publication 30, absorbed doses per administered activity of three radiopharmaceuticals were evaluated with and without explicit electron transport. The organ absorbed doses per administered activity for the two evaluation methods agree within 2%-3% for most organs for radionuclides with decay spectra having electron energies below a few hundred keV and within approximately 20% if higher electron energies are involved. An important exception is the urinary bladder wall, where the dose is overestimated by 60-150% using the simplified ICRP 30 approach for the radiopharmaceuticals of this study.

Paired organs-should they be treated jointly or separately in internal dosimetry?

PURPOSE

Size, shape, and the position of paired organs are different in abdomen. However, the counterpart organs are conventionally treated jointly together in internal dosimetry. This study was performed to quantify the difference of specific absorbed fraction of organs in considering paired organs jointly like single organs or as two separate organs.

METHODS

Zubal phantom and GATE Monte Carlo package were used to calculate the SAF for the self-absorption and cross-irradiation of the lungs, kidneys, adrenal glands (paired organs), liver, spleen, stomach, and pancreas (single organs). The activity was assumed uniformly distributed in the organs, and simulation was performed for monoenergetic photons of 10, 50, 100, 500, 1000 keV and mono-energetic electrons of 350, 500, 690, 935, 1200 keV.

RESULTS

The results demonstrated that self-absorption of left and right counterpart organs may be different depending upon the differences in their masses. The cross-irradiations between left-to-right and right-to-left counterpart organs are always equal irrespective of difference in their masses. Cross-irradiation from the left and right counterpart organs to other organs are different (4-24 times in Zubal phantom) depending on the photon energy and organs. The irradiation from a single source organ to the left and right counterpart paired organs is always different irrespective of activity concentration.

CONCLUSIONS

Left and right counterpart organs always receive different absorbed doses from target organs and deliver different absorbed doses to target organs. Therefore, in application of radiopharmaceuticals in which the dose to the organs plays a role, counterpart organs should be treated separately as two separate organs.© 2011 American Association of Physicists in Medicine.

New calculations for internal dosimetry of beta-emitting radiopharmaceuticals

The calculation of absorbed dose from internally incorporated radionuclides is based on the so-called specific absorbed fractions (SAFs) which represent the fraction of energy emitted in a given source region that is absorbed per unit mass in a specific target organ. Until recently, photon SAFs were calculated using MIRD-type mathematical phantoms. For electrons, the energy released was assumed to be absorbed locally ('ICRP 30 approach'). For this work, photon and electron SAFs were derived with Monte Carlo simulations in the new male voxel-based reference computational phantom adopted by the ICRP and ICRU. The present results show that the assumption of electrons being locally absorbed is not always true at energies above 300-500 keV. For source/target organ pairs in close vicinity, high-energy electrons escaping from the source organ may result in cross-fire electron SAFs in the same order of magnitude as those from photons. Examples of organ absorbed doses per unit activity are given for (18)F-choline and (123)I-iodide. The impact of the new electron SAFs used for absorbed dose calculations compared with the previously used assumptions was found to be small. The organ dose coefficients for the two approaches differ by not more than 6 % for most organs. Only for irradiation of the urinary bladder wall by activity in the contents, the ICRP 30 approach presents an overestimation of approximately 40-50%.

Diversification of existing reference phantoms in nuclear medicine: Calculation of specific absorbed fractions for 21 mathematical phantoms and validation through dose estimates resulting from the administration of (18)F-FDG

Current dose assessment in nuclear medicine patient studies relies on published S-values, which are, in turn, based on calculated specific absorbed fractions (SAFs) available for a limited number of anthro-pomorphic computational phantoms. In order to take the individual physiognomy of patients more into account, this study aimed to broaden the supply of phantoms and their respective SAFs. An ensemble of 21 mathematical phantoms was submitted to the Monte Carlo Code MCNP4c2 for the purpose of calculation of SAFs for annihilation radiation. These values were incorporated into an internal dose assessment following the Medical Internal Radiation Dose (MIRD) schema and relying on published biokinetic data for intravenous administration of (18)F-FDG. The results were compared with data from the ICRP, MIRD reports and concurrent calculations with OLINDA/EXM. A very good agreement with sources relying on the SAFs of Cristy and Eckerman (i.e., the ICRP and OLINDA/EXM) was observed, with the absorbed dose in lung being the only exception. In the case of dose to red marrow, the King Spiers factors were omitted in the three-factor approximation, which led to a precise accordance with the Cristy/Eckerman values. Summarizing, one can say that the coincidence with published data justifies the method chosen and demonstrates successfully the expansion of available reference phantoms for dose assessment in nuclear medicine.