Correlation between external exposure and activity in patients undergoing 131I thyroid cancer therapy

Thyroid Biokinetics for Radioactive I-131 in Twelve Thyroid Cancer Patients via the Refined Nine-Compartmental Model

The thyroid biokinetic model of radioactive I-131 was re-evaluated using a refined nine-compartmental model and applied to twelve thyroid cancer patients. In contrast to the simplified four-compartmental model regulated by the ICRP-56 report, the revised model included nine compartments specified in the ICRP-128 report, namely, oral, stomach, body fluid, thyroid, whole body, liver, kidney, bladder, and remainder (i.e., the whole body minus kidney and bladder). A self-developed program run in MATLAB was designed to solve the nine first-order simultaneous linear differential equations. The model was realized in standard and simplified versions. The latter neglected two feedback paths (body fluid to oral, i31, and kidney to the whole body, i87) to reduce computations. Accordingly, the biological half-lives for the major compartments (thyroid and body fluid + whole body) were 36.00 ± 15.01, 15.04 ± 5.63, 34.33 ± 15.42, and 14.83 ± 5.91 of standard and simplified version. The correlations between theoretical and empirical data for each patient were quantified by the dimensionless AT (agreement) index and, the ATtot index integrated each individual AT of a specific organ of one patient. Since small AT values indicated a closer correlation, the obtained range of ATtot (0.048 ± 0.019) proved the standard model’s reliability and high accuracy, while the simplified one yielded slightly higher ATtot (0.058 ± 0.023). The detailed outcomes among various compartments of twelve patients were calculated and compared with other researchers’ work. The correlation results on radioactive I-131 evolution in thyroid cancer patients’ bodies are instrumental in viewpoint of radioactive protection of patients and radiological personnel.

Individualised dosimetry in patients with differentiated thyroid cancer based on external dose-rate. Optimisation of the number of measurements

OBJECTIVES

To compare the results of individual dosimetry in differentiated thyroid cancer patients treated with (131)I at our centre with the established limits and dosimetry results of published studies. Analysis of the optimal number of measurements necessary to reduce the impact of dosimetry for the comfort of the patient and, secondly, on the workload of health workers.

MATERIAL AND METHODS

Dosimetry was performed in the Nuclear Medicine Department of the University and Polytechnic Hospital La Fe, on 29 patients suffering from differentiated thyroid cancer and treated with activities between 1.02 and 5.51 GBq (mean 2.68 GBq) of (131)I. The Spanish Society of Medical Physics (SEFM) protocol was used, based on measurements of external dose rate adjusted to a bi-exponential curve according to a two compartment model. Different dosimetries were performed on each patient, taking different selections of the available measurements in order to find the optimal number.

RESULTS

Results are well below the dosimetry limits, and are consistent with those obtained in other centres. The number of measurements can be reduced from 5, as proposed in the SEFM protocol, to 4 without significant loss of accuracy. Further reducing measures may be justified in individual cases.

CONCLUSIONS

The values obtained for the dosimetry quantities are significantly below the established limits. A reduction in measurements can be assumed at the cost of a moderate increase in uncertainty, benefiting the patient.

Measurement and analysis of patient attenuation correction factor during radioiodine therapy

The calculated dose rate from the radioiodine therapy patient should normally include a factor accounting for the attenuation and scatter of patient body tissues. The attenuation factor is currently neglected, and not applied in operational radiation protection. Realistic estimation of radiation dose rate levels from radioiodine therapy patients when properly performed will reduce operational cost and optimise institutional radiation protection practice. In this work, the existence of a patient body tissue attenuation factor is verified by comparing the dose rates measured from the radioiodine capsules immediately before administration with those measured from the patient immediately after administration. The correlation between the factors suspected to influence the patient body tissue attenuation and the measured dose rates from the patient normalised per unit activity is statistically analysed. The calculated attenuation correction factor based on authors' measurements was (0.55 ± 0.17). The measured dose rate per unit of radioactivity from the patient showed a negative correlation with their body mass index.

131I activity in urine to the sewer system due to thyroidal treatments

In nuclear medicine, estimating the radioactivity contained in the urine of patients treated with I and discharged to the environment could prevent the exposure of a population to radioactive effluents and the pollution of the aquatic environment with ionizing radiation. This can be a regulatory requirement (as in Spain) or requested by the sewer authority. Seventy-nine differentiated thyroid cancer cases (undergone as inpatients) and 187 hyperthyroidism cases (undergone as outpatients) were treated in our hospital with I throughout the year 2009. In hyperthyroidism treatments, the effective elimination constant was used to calculate the corresponding discharged activity in the urine, giving an activity level always below 0.7 GBq. In differentiated thyroid cancer treatments, patient's urine was collected in storage tanks during the hospitalization. Measurements of external exposure at 1 m made every day were used to calculate the activity contained in the urine. The tank activity was always below 15 GBq, but always higher than 2 GBq. Obtained results show that effective doses to sewage workers, received from liquid discharges, can only be reduced to less than 10 μSv if storage tanks are installed. Without tanks, 157 μSv can be reached, above the constrain dose used in nuclear installations (100 μSv). Our calculations may be helpful to the regulatory authority to review the clinical radiation waste normative, especially in countries where the discharges are released directly into public sewage plants.