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Lam MGEH, Kappadath SC. Need for a Practical Dosimetry Paradigm That Incorporates Dose Heterogeneity. J Vasc Interv Radiol 2024:S1051-0443(24)00201-X. [PMID: 38432473 DOI: 10.1016/j.jvir.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S Cheenu Kappadath
- Department of Imaging Physics, the University of Texas MD Anderson Cancer Center, Houston, Texas
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Henry EC, Strugari M, Mawko G, Brewer K, Liu D, Gordon AC, Bryan JN, Maitz C, Karnia JJ, Abraham R, Kappadath SC, Syme A. Correction: Precision dosimetry in yttrium-90 radioembolization through CT imaging of radiopaque microspheres in a rabbit liver model. EJNMMI Phys 2023; 10:74. [PMID: 38017227 PMCID: PMC10684432 DOI: 10.1186/s40658-023-00596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Affiliation(s)
- E Courtney Henry
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada.
| | - Matthew Strugari
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Biomedical Translational Imaging Centre, Halifax, NS, Canada
| | - George Mawko
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Department of Medical Physics, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Kimberly Brewer
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Biomedical Translational Imaging Centre, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
- Department of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - David Liu
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Andrew C Gordon
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Jeffrey N Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Charles Maitz
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - James J Karnia
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Robert Abraham
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
- ABK Biomedical Inc., Halifax, NS, Canada
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - Alasdair Syme
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Department of Medical Physics, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
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Lopez BP, Kappadath SC. Monte Carlo-derived 99m Tc uptake quantification with commercial planar MBI: Absolute tumor activity. Med Phys 2023; 50:2985-2997. [PMID: 36583691 PMCID: PMC10175170 DOI: 10.1002/mp.16196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Molecular breast imaging (MBI) of 99m Tc-sestamibi is an emerging adjunct qualitative tool in the detection and diagnosis of breast cancer. PURPOSE This work outlines the development and performance evaluation of a methodology to absolutely quantify tumor 99m Tc activity uptake using a commercially available dual-headed MBI system by implementing corrections for background, scatter, attenuation, and detector characteristics. METHODS A validated Monte Carlo application of a commercial MBI system was used to simulate over 7000 unique acquisitions of spherical and ellipsoidal tumors in breast tissue. Tumor absolute activity was calculated following background, scatter, and attenuation corrections of tumor region of interest counts. The methodology was first optimized using a set of high-uptake spherical tumors, and its accuracy and precision was then assessed in a set of spherical tumors with clinical uptake conditions. Finally, the performance of the activity methodology was evaluated under various bias and uncertainty conditions to better characterize the technique under expected clinical measurement conditions. RESULTS In a test set of images with clinically relevant contrast and noise conditions, the mean ± standard deviation relative error in total tumor activity was 0.5% ± 6.5% (n = 2363) under ideal measurement conditions. Allowing for variability in tumor and background contours and in estimated tumor depths, the expected accuracy of the methodology in clinical practice was 0.5% ± 11.1% (n = 2363), with minimal loss of accuracy for ellipsoidal tumors. CONCLUSIONS Planar MBI photopeak images acquired with standard-of-care protocols can be used to accurately quantify absolute tumor 99m Tc activity with an accuracy and precision of 0.5% ± 11.1%. The reported precision was based on a comprehensive evaluation of random errors and systematic biases.
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Affiliation(s)
- Benjamin P. Lopez
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, United States of America
| | - S. Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, United States of America
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Kokabi N, Arndt-Webster L, Chen B, Brandon D, Sethi I, Davarpanahfakhr A, Galt J, Elsayed M, Bercu Z, Cristescu M, Kappadath SC, Schuster DM. Voxel-based dosimetry predicting treatment response and related toxicity in HCC patients treated with resin-based Y90 radioembolization: a prospective, single-arm study. Eur J Nucl Med Mol Imaging 2023; 50:1743-1752. [PMID: 36650357 PMCID: PMC10119065 DOI: 10.1007/s00259-023-06111-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is an increasing body of evidence indicating Y90 dose thresholds for tumor response and treatment-related toxicity. These thresholds are poorly studied in resin Y90, particularly in hepatocellular carcinoma (HCC). PURPOSE To evaluate the efficacy of prospective voxel-based dosimetry for predicting treatment response and adverse events (AEs) in patients with HCC undergoing resin-based Y90 radioembolization. MATERIALS AND METHODS This correlative study was based on a prospective single-arm clinical trial (NCT04172714), which evaluated the efficacy of low/scout (555 MBq) activity of resin-based Y90 for treatment planning. Partition model was used with goal of tumor dose (TD) > 200 Gy and non-tumoral liver dose (NTLD) < 70 Gy for non-segmental therapies. Single compartment dose of 200 Gy was used for segmentectomies. Prescribed Y90 activity minus scout activity was administered for therapeutic Y90 followed by Y90-PET/CT. Sureplan® (MIM Software, Cleveland, OH) was used for dosimetry analysis. Treatment response was evaluated at 3 and 6 months. Receiver operating characteristic curve determined TD response threshold for objective response (OR) and complete response (CR) as well as non-tumor liver dose (NTLD) threshold that predicted AEs. RESULTS N = 30 patients were treated with 33 tumors (19 segmental and 14 non-segmental). One patient died before the first imaging, and clinical follow-up was excluded from this analysis. Overall, 26 (81%) of the tumors had an OR and 23 (72%) had a CR. A mean TD of 253 Gy predicted an OR with 92% sensitivity and 83% specificity (area under the curve (AUC = 0.929, p < 0.001). A mean TD of 337 Gy predicted a CR with 83% sensitivity and 89% specificity (AUC = 0.845, p < 0.001). A mean NTLD of 81 and 87 Gy predicted grade 3 AEs with 100% sensitivity and 100% specificity in the non-segmental cohort at 3- and 6-month post Y90, respectively. CONCLUSION In patients with HCC undergoing resin-based Y90, there are dose response and dose toxicity thresholds directly affecting outcomes. CLINICAL TRIAL NUMBER NCT04172714.
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Affiliation(s)
- Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Linzi Arndt-Webster
- Division of Interventional Radiology, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Bernard Chen
- Division of Interventional Radiology, Department of Radiology, University of Texas at San Antonio, San Antonio, TX, USA
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Amir Davarpanahfakhr
- Division of Abdominal Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - James Galt
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammad Elsayed
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zachary Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mircea Cristescu
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Cheenu Kappadath
- Division of Interventional Radiology, Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Lopez BP, Kappadath SC. Monte Carlo-derived 99m Tc uptake quantification with commercial planar MBI: Tumor and breast activity concentrations. Med Phys 2023. [PMID: 36625713 DOI: 10.1002/mp.16213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/23/2022] [Accepted: 01/01/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Current molecular breast imaging (MBI) images are limited to qualitative evaluation, not absolute measurement, of 99m Tc uptake in benign and malignant breast tissues. PURPOSE This work assesses the accuracy of previously-published and newly-proposed tumor and normal breast tissue 99m Tc uptake MBI measurements using simulations of a commercial dual-headed planar MBI system under typical clinical and acquisition protocols. METHODS Quantification techniques were tested in over 4000 simulated acquisitions of spherical and ellipsoid tumors with clinically relevant uptake conditions using a validated Monte Carlo application of the GE Discovery NM750b system. The evaluated techniques consisted of four tumor total activity methodologies (two single-detector-based and two geometric-mean-based), two tumor MBI volume methodologies (diameter-based and ROI-based), and two normal tissue activity concentration methodologies (single-detector-based and geometric-mean-based). The most accurate of these techniques were then used to estimate tumor activity concentrations and tumor to normal tissue relative activity concentrations (RC). RESULTS Single-detector techniques for tumor total activity quantification achieved mean (standard deviation) relative errors of 0.2% (4.3%) and 1.6% (4.4%) when using the near and far detector images, respectively and were more accurate and precise than the measured 8.1% (5.8%) errors of a previously published geometric-mean technique. Using these activity estimates and the true tumor volumes resulted in tumor activity concentration and RC errors within 10% of simulated values. The precision of tumor activity concentration and RC when using only MBI measurements were largely driven by the errors in estimating tumor MBI volume using planar images (± 30% inter-quartile range). CONCLUSIONS Planar MBI images were shown to accurately and reliably be used to estimate tumor total activities and normal tissue activity concentrations in this simulation study. However, volumetric tumor uptake measurements (i.e., absolute and relative concentrations) are limited by inaccuracies in MBI volume estimation using two-dimensional images, highlighting the need for either tomographic MBI acquisitions or anatomical volume estimates for accurate three-dimensional tumor uptake estimates.
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Affiliation(s)
- Benjamin P Lopez
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
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Salem R, Padia SA, Lam M, Chiesa C, Haste P, Sangro B, Toskich B, Fowers K, Herman JM, Kappadath SC, Leung T, Sze DY, Kim E, Garin E. Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging 2023; 50:328-343. [PMID: 36114872 PMCID: PMC9816298 DOI: 10.1007/s00259-022-05956-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE In light of recently published clinical reports and trials, the TheraSphere Global Dosimetry Steering Committee (DSC) reconvened to review new data and to update previously published clinical and dosimetric recommendations for the treatment of hepatocellular carcinoma (HCC). METHODS The TheraSphere Global DSC is comprised of health care providers across multiple disciplines involved in the treatment of HCC with yttrium-90 (Y-90) glass microsphere-based transarterial radioembolization (TARE). Literature published between January 2019 and September 2021 was reviewed, discussed, and adjudicated by the Delphi method. Recommendations included in this updated document incorporate both the results of the literature review and the expert opinion and experience of members of the committee. RESULTS Committee discussion and consensus led to the expansion of recommendations to apply to five common clinical scenarios in patients with HCC to support more individualized efficacious treatment with Y-90 glass microspheres. Existing clinical scenarios were updated to reflect recent developments in dosimetry approaches and broader treatment paradigms evolving for patients presenting with HCC. CONCLUSION Updated consensus recommendations are provided to guide clinical and dosimetric approaches for the use of Y-90 glass microsphere TARE in HCC, accounting for disease presentation, tumor biology, and treatment intent.
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Affiliation(s)
- Riad Salem
- Department of Radiology, Northwestern Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, USA.
| | - Siddharth A Padia
- Department of Radiology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo Chiesa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paul Haste
- Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Beau Toskich
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Kirk Fowers
- Boston Scientific Corporation, Marlborough, MA, USA
| | - Joseph M Herman
- Department of Radiation Medicine, Northwell Health, New Hyde Park, NY, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Daniel Y Sze
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Edward Kim
- Department of Interventional Radiology, Mount Sinai, New York City, NY, USA
| | - Etienne Garin
- INSERM, INRA, Centre de Lutte Contre Le Cancer Eugène Marquis, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, 35000, Rennes, France
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Kokabi N, Webster LA, Elsayed M, Switchenko JM, Chen B, Brandon D, Galt J, Sethi I, Cristescu M, Kappadath SC, Schuster DM. Accuracy and Safety of Scout Dose Resin Yttrium-90 Microspheres for Radioembolization Therapy Treatment Planning: A Prospective Single-Arm Clinical Trial. J Vasc Interv Radiol 2022; 33:1578-1587.e5. [PMID: 36075560 PMCID: PMC9834905 DOI: 10.1016/j.jvir.2022.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/09/2022] [Accepted: 08/26/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To compare the accuracy and safety of 0.56 GBq resin yttrium-90 (90Y) (scout90Y) microspheres with those of technetium-99m macroaggregated albumin (MAA) in predicting the therapeutic 90Y (Rx90Y) dose for patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This prospective single-arm clinical trial (Clinicaltrials.gov: NCT04172714) recruited patients with HCC. Patients underwent same-day mapping with MAA and scout90Y. Rx90Y activity was administered 3 days after mapping. Using paired t test and Pearson correlation, the tumor-to-normal ratio (TNR), lung shunt fraction (LSF), predicted mean tumor dose (TD), and nontumoral liver dose (NTLD) by MAA and scout90Y were compared with those by Rx90Y. Bland-Altman plots compared the level of agreement between the TNR and LSF of scout90Y and MAA with that of Rx90Y. The safety of scout90Y was evaluated by examining the discrepancy in extrahepatic activity between MAA and scout90Y. RESULTS Thirty patients were treated using 19 segmental and 14 nonsegmental (ie, 2 contiguous segments or nonsegmental) therapies. MAA had weak LSF, moderate TNR, and moderate TD linear correlation with Rx90Y. Scout90Y had a moderate LSF, strong TNR, strong TD, and very strong NTLD in correlation with those of Rx90Y. Furthermore, the TNR and LSF of scout90Y had a stronger agreement with those of Rx90Y than with those of MAA. In the nonsegmental subgroup, MAA had no significant correlation with the TD and NTLD of Rx90Y, whereas scout90Y had a very strong correlation with both of these factors. In the segmental subgroup, both MAA and scout90Y had a strong linear correlation with the TD and NTLD of Rx90Y. CONCLUSIONS Compared with MAA, scout90Y is a more accurate surrogate for Rx90Y biodistribution for nonsegmental therapies.
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Affiliation(s)
- Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Linzi A Webster
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammad Elsayed
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bernard Chen
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - James Galt
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mircea Cristescu
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - S Cheenu Kappadath
- Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Lopez BP, Mahvash A, Long JP, Lam MGEH, Kappadath SC. Factors modulating 99m Tc-MAA planar lung dosimetry for 90 Y radioembolization. J Appl Clin Med Phys 2022; 23:e13734. [PMID: 35906892 PMCID: PMC9797182 DOI: 10.1002/acm2.13734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To investigate the accuracy and biases of predicted lung shunt fraction (LSF) and lung dose (LD) calculations via 99m Tc-macro-aggregated albumin (99m Tc-MAA) planar imaging for treatment planning of 90 Y-microsphere radioembolization. METHODS AND MATERIALS LSFs in 52 planning and LDs in 44 treatment procedures were retrospectively calculated, in consecutive radioembolization patients over a 2 year interval, using 99m Tc-MAA planar and SPECT/CT imaging. For each procedure, multiple planar LSFs and LDs were calculated using different: (1) contours, (2) views, (3) liver 99m Tc-MAA shine-through compensations, and (4) lung mass estimations. The accuracy of each planar-based LSF and LD methodology was determined by calculating the median (range) absolute difference from SPECT/CT-based LSF and LD values, which have been demonstrated in phantom and patient studies to more accurately and reliably quantify the true LSF and LD values. RESULTS Standard-of-care LSF using geometric mean of lung and liver contours had median (range) absolute over-estimation of 4.4 percentage points (pp) (0.9 to 11.9 pp) from SPECT/CT LSF. Using anterior views only decreased LSF errors (2.4 pp median, -1.1 to +5.7 pp range). Planar LD over-estimations decreased when using single-view versus geometric-mean LSF (1.3 vs. 2.6 Gy median and 7.2 vs. 18.5 Gy maximum using 1000 g lung mass) but increased when using patient-specific versus standard-man lung mass (2.4 vs. 1.3 Gy median and 11.8 vs. 7.2 Gy maximum using single-view LSF). CONCLUSIONS Calculating planar LSF from lung and liver contours of a single view and planar LD using that same LSF and 1000 g lung mass was found to improve accuracy and minimize bias in planar lung dosimetry.
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Affiliation(s)
- Benjamin P. Lopez
- Department of Imaging PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
- University of Texas MD Anderson Cancer Center UT Health Houston Graduate School of Biomedical SciencesHoustonTexasUSA
| | - Armeen Mahvash
- Department of Interventional RadiologyUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - James P. Long
- Department of BiostatisticsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - S. Cheenu Kappadath
- Department of Imaging PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
- University of Texas MD Anderson Cancer Center UT Health Houston Graduate School of Biomedical SciencesHoustonTexasUSA
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Sharma NK, Kappadath SC, Chuong M, Folkert M, Gibbs P, Jabbour SK, Jeyarajah DR, Kennedy A, Liu D, Meyer JE, Mikell J, Patel RS, Yang G, Mourtada F. The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors. Brachytherapy 2022; 21:569-591. [PMID: 35599080 PMCID: PMC10868645 DOI: 10.1016/j.brachy.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/25/2022] [Accepted: 04/14/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 (90Y) microspheres transarterial radioembolization (90Y TARE) for primary and metastatic cancers in the liver. METHODS AND MATERIALS Members of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience. RESULTS The ABS strongly recommends the use of 90Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of 90Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting 90Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90Y TARE should be carefully considered. CONCLUSIONS ABS consensus for implementing a safe 90Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies.
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Affiliation(s)
- Navesh K Sharma
- Department of Radiation Oncology, Penn State Hershey School of Medicine, Hershey, PA
| | - S Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX
| | - Michael Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
| | - Michael Folkert
- Northwell Health Cancer Institute, Radiation Medicine at the Center for Advanced Medicine, New Hyde Park, NY
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | | | | | - David Liu
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | - Rahul S Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gary Yang
- Loma Linda University, Loma Linda, CA
| | - Firas Mourtada
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE; Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA.
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Lopez BP, Rauch GM, Adrada B, Kappadath SC. Functional tumor diameter measurement with Molecular Breast Imaging: development and clinical application. Biomed Phys Eng Express 2022; 8. [PMID: 35917778 DOI: 10.1088/2057-1976/ac85f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022]
Abstract
Purpose:Molecular breast imaging (MBI) is used clinically to visualize the uptake of99mTc-sestamibi in breast cancers. Here, we use Monte Carlo simulations to develop a methodology to estimate tumor diameter in focal lesions and explore a semi-automatic implementation for clinical data.Methods:A validated Monte Carlo simulation of the GE Discovery NM 750b was used to simulate >75,000 unique spherical/ellipsoidal tumor, normal breast, and image acquisition conditions. Subsets of this data were used to 1) characterize the dependence of the full-width at half-maximum (FWHM) of a tumor profile on tumor, normal breast, and acquisition conditions, 2) develop a methodology to estimate tumor diameters, and 3) quantify the diameter accuracy in a broad range of clinical conditions. Finally, the methodology was implemented in patient images and compared to diameter estimates from physician contours on MBI, mammography, and ultrasound imaging.Results:Tumor profile FWHM was determined be linearly dependent on tumor diameter but independent of other factors such as tumor shape, uptake, and distance from the detector. A linear regression was used to calculate tumor diameter from the FWHM estimated from a background-corrected profile across a tumor extracted from a median-filtered single-detector MBI image, i.e., diameter = 1.2 mm + 1.2 x FWHM, for FWHM ≥ 13 mm. Across a variety of simulated clinical conditions, the mean error of the methodology was 0.2 mm (accuracy), with >50% of cases estimated within 1-pixel width of the truth (precision). In patient images, the semi-automatic methodology provided the longest diameter in 94% (60/64) of cases. The estimated true diameters, for oval lesions with homogeneous uptake, differed by ± 5 mm from physician measurements.Conclusion:This work demonstrates the feasibility of accurately quantifying tumor diameter in clinical MBI, and to our knowledge, is the first to explore its implementation and application in patient data.
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Affiliation(s)
- Benjamin P Lopez
- Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, Texas, 77030, UNITED STATES
| | - Gaiane M Rauch
- Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas, 77030, UNITED STATES
| | - Beatriz Adrada
- Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas, 77030, UNITED STATES
| | - S Cheenu Kappadath
- Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, Texas, 77030, UNITED STATES
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Hruska CB, Corion C, de Geus-Oei LF, Adrada BE, Fowler AM, Hunt KN, Kappadath SC, Pilkington P, Arias-Bouda LMP, Rauch GM. SNMMI Procedure Standard/EANM Practice Guideline for Molecular Breast Imaging with Dedicated γ-Cameras. J Nucl Med Technol 2022. [DOI: 10.2967/jnmt.121.264204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kappadath SC, Lopez BP. Organ-level internal dosimetry for intra-hepatic-arterial administration of 99m Tc-macroaggregated albumin. Med Phys 2022; 49:5504-5512. [PMID: 35612924 DOI: 10.1002/mp.15726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE There are no published data on organ doses following intra-hepatic-arterial administration of 99m Tc-macroaggregated-albumin (IHA 99m Tc-MAA) routinely used in 90 Y-radioembolization-treatment planning to assess intra- and extra-hepatic depositions and calculate lung-shunt-fraction (LSF). We propose a method to model the organ doses following IHA 99m Tc-MAA that incorporates three in vivo constituent biodistributions, the 99m Tc-MAA that escape the liver due to LSF, and the 99m Tc-MAA disassociation fraction (DF). METHODS The potential in vivo biodistributions for IHA 99m Tc-MAA are: Liver-Only MAA with all activity sequestered in the liver (LSF = 0&DF = 0), Intravenous MAA with all activity transferred intravenously as 99m Tc-MAA (LSF = 1&DF = 0), and Intravenous Pertechnetate with all activity is transferred intravenously as 99m Tc-pertechnetate (LSF = 0&DF = 1). Organ doses for Liver-Only MAA were determined using OLINDA/EXM 2.2, where liver was modeled as the source organ containing 99m Tc-MAA, while those for Intravenous MAA and Intravenous Pertechnetate were from ICRP 128. Organ doses for the general case can be determined as a weighted-linear-combination of the three constituent biodistributions depending on the LSF and DF. The maximum-dose scenario was modeled by selecting the highest dose rate for each organ amongst the three constituent cases. RESULTS For Liver-Only MAA, the liver as source organ received the highest dose at 98.6 and 126 mGy/GBq for the Adult Male and Adult Female phantoms, respectively; all remaining organs received <27 and <32 mGy/GBq. For Intravenous MAA, the lung as source organ received the highest dose at 66 and 97 mGy/GBq; all remaining organs received <16 and <21 mGy/GBq. The organ with the highest dose for Intravenous Pertechnetate was the upper-large-intestinal wall at 56 and 73 mGy/GBq; all remaining organs received <26 and <34 mGy/GBq. The liver and lung doses for the maximum-dose scenario with 5 mCi (185 MBq) 99m Tc-MAA were estimated at 18.2 and 12.2 mGy, and 23.3 and 17.9 mGy, for the Adult Male and Adult Female phantoms, respectively. CONCLUSION Organ dose estimates following IHA 99m Tc-MAA based on constituent biodistribution models and patient-specific LSF and DF values have been derived. Liver and lung were the organs with highest dose, receiving at most 15 - 25 mGy in the maximum-dose scenario, following 5 mCi IHA 99m Tc-MAA. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- S Cheenu Kappadath
- Department of Imaging Physics UT MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Benjamin P Lopez
- Department of Imaging Physics UT MD Anderson Cancer Center, Houston, Texas, 77030, USA
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Mahvash A, Chartier S, Turco M, Habib P, Griffith S, Brown S, Kappadath SC. A prospective, multicenter, open-label, single-arm clinical trial design to evaluate the safety and efficacy of 90Y resin microspheres for the treatment of unresectable HCC: the DOORwaY90 (Duration Of Objective Response with arterial Ytrrium-90) study. BMC Gastroenterol 2022; 22:151. [PMID: 35346070 PMCID: PMC8962126 DOI: 10.1186/s12876-022-02204-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/09/2022] [Indexed: 01/10/2023] Open
Abstract
Background Selective internal radiation therapy (SIRT) with yttrium-90 (90Y) resin microspheres is an established locoregional treatment option for unresectable hepatocellular carcinoma (HCC), which delivers a lethal dose of radiation to hepatic tumors, while sparing surrounding healthy tissue. DOORwaY90 is a prospective, multicenter, open-label, single arm study, designed to evaluate the safety and effectiveness of 90Y resin microspheres as first-line treatment in patients with unresectable/unablatable HCC. It is unique in that it is the first study with resin microspheres to utilize a personalized 90Y dosimetry approach, and independent review for treatment planning and response assessment.
Methods Eligibility criteria include unresectable/unablatable HCC, Barcelona Clinic Liver Cancer stage A, B1, B2, or C with a maximal single tumor diameter of ≤ 8 cm, and a sum of maximal tumor diameters of ≤ 12 cm, and at least one tumor ≥ 2 cm (long axis) per localized, modified Response Evaluation Criteria in Solid Tumors. Partition model dosimetry is used to determine the optimal dose; the target mean dose to tumor is ≥ 150 Gy. Patients are assessed at baseline and at regular intervals up until 12 months of treatment for response rates, safety, and quality of life (QoL). Post-treatment dosimetry is used to assess dose delivered to tumor and consider if retreatment is necessary. The co-primary endpoints are best objective response rate and duration of response. Secondary endpoints include grade ≥ 3 toxicity, QoL, and incidence of liver resection and transplantation post SIRT. Target recruitment is 100 patients. Discussion The results of this trial should provide further information on the potential use of SIRT with 90Y resin microspheres as first-line therapy for unresectable HCC. Trial registration Clinicaltrials.gov; NCT04736121; date of 1st registration, January 27, 2021, https://clinicaltrials.gov/ct2/show/NCT04736121. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02204-1.
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Henry EC, Strugari M, Mawko G, Brewer K, Liu D, Gordon AC, Bryan JN, Maitz C, Karnia JJ, Abraham R, Kappadath SC, Syme A. Precision dosimetry in yttrium-90 radioembolization through CT imaging of radiopaque microspheres in a rabbit liver model. EJNMMI Phys 2022; 9:21. [PMID: 35312882 PMCID: PMC8938593 DOI: 10.1186/s40658-022-00447-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/02/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To perform precision dosimetry in yttrium-90 radioembolization through CT imaging of radiopaque microspheres in a rabbit liver model and to compare extracted dose metrics to those produced from conventional PET-based dosimetry. MATERIALS AND METHODS A CT calibration phantom was designed containing posts with nominal microsphere concentrations of 0.5 mg/mL, 5.0 mg/mL, and 25.0 mg/mL. The mean Hounsfield unit was extracted from the post volumes to generate a calibration curve to relate Hounsfield units to microsphere concentration. A nominal bolus of 40 mg of microspheres was administered to the livers of eight rabbits, followed by PET/CT imaging. A CT-based activity distribution was calculated through the application of the calibration curve to the CT liver volume. Post-treatment dosimetry was performed through the convolution of yttrium-90 dose-voxel kernels and the PET- and CT-based cumulated activity distributions. The mean dose to the liver in PET- and CT-based dose distributions was compared through linear regression, ANOVA, and Bland-Altman analysis. RESULTS A linear least-squares fit to the average Hounsfield unit and microsphere concentration data from the calibration phantom confirmed a strong correlation (r2 > 0.999) with a slope of 14.13 HU/mg/mL. A poor correlation was found between the mean dose derived from CT and PET (r2 = 0.374), while the ANOVA analysis revealed statistically significant differences (p < 10-12) between the MIRD-derived mean dose and the PET- and CT-derived mean dose. Bland-Altman analysis predicted an offset of 15.0 Gy between the mean dose in CT and PET. The dose within the liver was shown to be more heterogeneous in CT than in PET with an average coefficient of variation equal to 1.99 and 1.02, respectively. CONCLUSION The benefits of a CT-based approach to post-treatment dosimetry in yttrium-90 radioembolization include improved visualization of the dose distribution, reduced partial volume effects, a better representation of dose heterogeneity, and the mitigation of respiratory motion effects. Post-treatment CT imaging of radiopaque microspheres in yttrium-90 radioembolization provides the means to perform precision dosimetry and extract accurate dose metrics used to refine the understanding of the dose-response relationship, which could ultimately improve future patient outcomes.
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Affiliation(s)
- E Courtney Henry
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada.
| | - Matthew Strugari
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Biomedical Translational Imaging Centre, Halifax, NS, Canada
| | - George Mawko
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Department of Medical Physics, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Kimberly Brewer
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Biomedical Translational Imaging Centre, Halifax, NS, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
- Department of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - David Liu
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Andrew C Gordon
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Jeffrey N Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Charles Maitz
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - James J Karnia
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Robert Abraham
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
- ABK Biomedical Inc., Halifax, NS, Canada
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - Alasdair Syme
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Department of Medical Physics, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
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Patel MM, Adrada BE, Lopez B, Candelaria RP, Sun J, Boge M, Mohamed RM, Elshafeey N, Whitman G, Le-Petross HT, Santiago L, Scoggins ME, Lane D, Moseley T, Zylberman G, Saddler J, Leung JWT, Yang WT, Valero V, Kappadath SC, Rauch GM. Abstract P3-02-03: Quantitative molecular breast imaging for early prediction of neoadjuvant systemic therapy response in locally advanced breast cancer patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Increasing use of neoadjuvant systemic therapy (NAT) for early and locally advanced breast cancer led to critical need for development of tools capable of early treatment response assessment after NAT. Tc-99m sestamibi Molecular breast Imaging (MBI) as a functional imaging modality has a promise to detect changes in the tumor prior to anatomical changes detected by mammogram or ultrasound. PURPOSE: To evaluate the ability of quantitative MBI parameters to predict pathologic complete response (pCR) after completion of NAT in breast cancer patients. MATERIALS AND METHODS: Patients with invasive breast cancer (T1-T4, N0-N3, M0) planned for NAT followed by surgery were enrolled in a prospective IRB approved trial. MBI was performed at baseline and after two cycles of NAT. Patient demographic and tumor biology information (Ki-67, HER2, ER/PR) was collected. MBI images were quantified using a novel approach with corrections for scatter and attenuation and regions of interest (ROI) were drawn over tumors to compute three quantitative MBI uptake metrics for correlation with pathologic response: MBI-specific standardized uptake value (SUV), tumor to background ratio (TBR), and tumor volume. Pathologic complete response was determined based on final histopathology report at the time of surgery as absence of the invasive disease in the breast and axillary lymph nodes. MBI metrics at baseline, after 2 cycles of NAT and interval change were correlated with pCR and tumor biology using the Wilcoxon Rank Sum test, Kruskal-Wallis test or Fisher’s exact test. Statistical analysis was carried out using R (version 3.6.3, R Development Core Team). RESULTS: A total of 70 patients with median age 47.5 years (range 30-77) were included in the analysis. Breast cancer subtypes were: HER2 negative (ER/PR+) 35.7% (25/70), HER2 positive (ER/PR +/-) 35.7% (25/70), and triple negative (HER2-, ER/PR-) 28.6% (20/70). Change in SUV after 2 cycles of NAT was higher in patients with pCR compared to those who did not achieve pCR (mean decrease in SUV of 15.57 and 4.83 respectively, p<0.001). Additionally, change in TBR in patients with pCR was also higher compared to patients who did not achieve pCR (mean decreases of 1.14 and 0.56, respectively, p<0.001). No correlation was found between baseline SUV, baseline TBR, change in volume, and pCR. CONCLUSION: MBI-specific SUV and TBR changes after two cycles of NAT correlate and may predict pCR in patients with locally advanced breast cancer. Quantitative MBI parameters are novel promising imaging tools that may help to detect early clinical benefit and optimize management in patients receiving NAT.
Citation Format: Miral M Patel, Beatriz E Adrada, Benjamin Lopez, Rosalind P Candelaria, Jia Sun, Medine Boge, Rania M Mohamed, Nabil Elshafeey, Gary Whitman, MD, Huong T Le-Petross, Lumarie Santiago, Marion E Scoggins, Deanna Lane, Tanya Moseley, Galit Zylberman, Jerica Saddler, Jessica WT Leung, Wei T Yang, Vincente Valero, S Cheenu Kappadath, Gaiane M Rauch. Quantitative molecular breast imaging for early prediction of neoadjuvant systemic therapy response in locally advanced breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-02-03.
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Affiliation(s)
- Miral M Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Benjamin Lopez
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jia Sun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Medine Boge
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rania M Mohamed
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nabil Elshafeey
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary Whitman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Deanna Lane
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Galit Zylberman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jerica Saddler
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Wei T Yang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vincente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Kaseb AO, Kappadath SC, Lee SS, Raghav KP, Mohamed YI, Xiao L, Morris JS, Ohaji C, Avritscher R, Odisio BC, Kuban J, Abdelsalam ME, Chasen B, Elsayes KM, Elbanan M, Wolff RA, Yao JC, Mahvash A. A Prospective Phase II Study of Safety and Efficacy of Sorafenib Followed by 90Y Glass Microspheres for Patients with Advanced or Metastatic Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1129-1145. [PMID: 34527608 PMCID: PMC8437411 DOI: 10.2147/jhc.s318865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The most common cause of death in advanced/metastatic hepatocellular carcinoma (HCC) is liver failure due to tumor progression. While retrospective studies and meta-analyses of systemic therapy combined with liver-directed therapy have been performed, prospective studies of safety/efficacy of antiangiogenesis followed by intra-arterial therapies are lacking. We tested our hypothesis that sorafenib followed by yttrium 90 glass microspheres (90Y GMs) is safe and that survival outcomes may improve by controlling hepatic tumors. Methods We enrolled 38 Child–Pugh A patients with advanced/metastatic HCC. In sum, 34 received sorafenib, followed after 4 weeks by 90Y GMs. Analysis of safety and survival outcomes was performed to assess adverse events, median progression-free survival, and overall survival. Results A total of 34 patients were evaluable: 14 (41.2%) with chronic hepatitis, nine (26.5%) with vascular invasion, and eleven (32.4%) with extrahepatic diseases. Safety analysis revealed that the combination therapy was well tolerated. Grade III–IV adverse events comprised fatigue (n=3), diarrhea (n=2), nausea (n=1), vomiting (n=2), hypertension (n=4), thrombocytopenia (n=1), hyperbilirubinemia (n=1), proteinuria (n=1), hyponatremia (n=1), and elevated alanine or aspartate aminotransferase (n=5). Median progression-free and overall survival were 10.4 months (95% CI 5.8–14.4) and 13.2 months (95% CI 7.9–18.9), respectively. Twelve patients (35.3%) achieved partial responses and 16 (47.0%) stable disease. Median duration of sorafenib was 20 (3–90) weeks, and average dose was 622 (466–800) mg daily. Dosimetry showed similar mean doses between planned and delivered calculations to normal liver and tumor:normal liver uptake ratio, with no significant correlation with adverse events at 3 and 6 months post-90Y treatment. Conclusion This is the first prospective study to evaluate sorafenib followed by 90Y in patients with advanced HCC. The study validated our hypothesis of safety with encouraging efficacy signals of the sequencing treatment, and provides proof of concept for future combination modalities for patients with advanced or metastatic HCC. Clinical Trial Registration Number NCT01900002.
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Affiliation(s)
- Ahmed Omar Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunyoung S Lee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kanwal Pratap Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yehia I Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Morris
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chimela Ohaji
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joshua Kuban
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed E Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth Chasen
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed Elbanan
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Armeen Mahvash
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lopez BP, Guan F, Rauch GM, Kappadath SC. Monte Carlo simulation of pixelated CZT detector with Geant4: validation of clinical molecular breast imaging system. Phys Med Biol 2021; 66. [PMID: 34038878 DOI: 10.1088/1361-6560/ac0588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/26/2021] [Indexed: 11/12/2022]
Abstract
Purpose. Molecular breast imaging (MBI) of99mTc-sestamibi with dual-headed, pixelated, cadmium-zinc-telluride (CZT) detectors is increasingly used in breast cancer care for screening/detecting lesions, monitoring response to therapy, and predicting risk of cancer. MBI as a truly quantitative tool in these applications, however, is limited due the lack of absolute99mTc-sestamibi uptake quantification. To help advance the field of quantitative MBI, we have developed a Monte Carlo simulation application of the GE Discovery NM 750b system.Methods. Our simulation consists of a two-step process using the Geant4 toolkit to model the detector and source geometry and to track photon interactions and a MATLAB script to model the charge transport within the pixelated CZT detector. Simulated detector and detector response model parameters were selected to match measured and simulated standard performance characteristics using various99mTc point-, line-, and film-sources in air. The final model parameters were verified by comparing the count profiles, energy spectra, and region of interest counts between simulated and measured images of a breast phantom with two spherical lesions in 5 cm thick medium of air or water.Results. Final performance characteristics with99mTc sources in air were: (1) energy resolution: 6.1% measured versus 5.9% simulated photopeak full-width at half-maximum (FWHM), (2) spatial resolution: mean error between measured and simulated FWHM of 0.08 mm across 4.4-14.0 mm FWHM range, and (3) sensitivity: 572 cpm/μCi measured versus 567 cpm/μCi simulated (<1% error). Good agreement was observed in the breast phantom line profiles through the spherical lesions and overall energy spectra, with <5% difference in sphere counts between simulated and measured data.Conclusion. A pixelated CZT charge transport and induction model was successfully implemented and validated to simulate imaging with the GE Discovery NM 750b system. This work will enable investigations improving MBI image quality and developing algorithms for uptake quantification.
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Affiliation(s)
- Benjamin P Lopez
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, United States of America
| | - Fada Guan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
| | - Gaiane M Rauch
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America
| | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, United States of America
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Lai SY, Torres-Saavedra PA, Dunlap NE, Beadle BM, Chang SS, Subramaniam RM, Yu JQ, Lowe VJ, Khan SA, Truong MT, Bell D, Liu CZ, Kovalchuk N, Rong Y, Abazeed ME, Kappadath SC, Harris J, Le QT. NRG Oncology HN006: Randomized phase II/III trial of sentinel lymph node biopsy versus elective neck dissection for early-stage oral cavity cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps6093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS6093 Background: Since patients with early-stage oral cavity cancer (OCC; T1-2N0M0; AJCC 8th ed) have a 20-30% rate of occult nodal metastases despite clinical and radiographic assessment, standard of care treatment includes elective neck dissection (END). Many patients have comprehensive surgical management of the regional cervical nodal basin even though the majority of those necks (70-80%) will not contain disease. Assessment of draining first echelon lymph nodes by sentinel lymph node (SLN) biopsy (Bx), a less invasive surgical procedure, may provide an alternative to END, while potentially reducing morbidity and cost. A decisive clinical trial comparing SLN Bx versus END can focus the HNC clinical and research community and resources on establishing the standard of care for management of the neck in early-stage OCC. Methods: In order to address the efficacy of SLN Bx in this population, we recently activated an international multi-institutional phase II/III prospective trial randomizing patients to two surgical arms: SLN Bx and END. PET/CT is an integral imaging biomarker in this trial. A node-negative PET/CT study with central read is required before randomization. Patients with a positive PET/CT central result will remain in a registry to compare imaging findings with final neck pathology. Given the current evidence available regarding morbidity for SLN Bx versus END, the phase II will determine if patient-reported neck and shoulder function and related QOL at 6 months after surgery using the Neck Dissection Impairment Index (NDII) shows a signal of superiority of SLN Bx compared to END. A total of 228 randomized patients with negative PET/CT for potential evaluation of shoulder-related morbidity with difference in 6-month NDII scores (minimum important difference ³7.5; one-sided a = 0.10; 90% power) will serve as the “Go/No-Go” decision to move forward into phase III. The phase III portion is a non-inferiority (NI) trial with disease-free survival (DFS) as the primary endpoint (NI margin hazard ratio 1.34 based on a 5% absolute difference in 2-year DFS; one-sided alpha 0.05; 80% power, and an interim look for efficacy at 67% of the events based on an O’Brien-Fleming boundary). The NDII at 6 months after surgery is a hierarchical co-primary endpoint for the phase III. Target accrual of phase III is 618 PET/CT negative patients, including those randomized in phase II (297 DFS events required for the final analysis). In addition to radiotherapy and imaging credentialing, quality assurance will include central pathology review of all negative SLN Bx cases and surgeon credentialing through an education course and SLN Bx and END case review by the surgical co-chairs. A surgical quality assurance working group will review all trial SLN Bx and END outcomes. As of 02/15/21, 7 patients have been screened and 6 of the planned 228 randomized patients in phase II have been enrolled. Clinical trial information: NCT04333537.
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Affiliation(s)
| | | | - Neal E. Dunlap
- The James Graham Brown Cancer Center at University of Louisville, Louisville, KY
| | | | | | | | | | | | | | | | - Diana Bell
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Yi Rong
- University of California Davis-Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
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Henry EC, Strugari M, Mawko G, Brewer KD, Abraham R, Kappadath SC, Syme A. Post-administration dosimetry in yttrium-90 radioembolization through micro-CT imaging of radiopaque microspheres in a porcine renal model. Phys Med Biol 2021; 66. [PMID: 33784639 DOI: 10.1088/1361-6560/abf38a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/30/2021] [Indexed: 12/27/2022]
Abstract
The purpose of this study is to perform post-administration dosimetry in yttrium-90 radioembolization through micro-CT imaging of radiopaque microsphere distributions in a porcine renal model and explore the impact of spatial resolution of an imaging system on the extraction of specific dose metrics. Following the administration of radiopaque microspheres to the kidney of a hybrid farm pig, the kidney was explanted and imaged with micro-CT. To produce an activity distribution, 400 MBq of yttrium-90 activity was distributed throughout segmented voxels of the embolized vasculature based on an established linear relationship between microsphere concentration and CT voxel value. This distribution was down-sampled to coarser isotropic grids ranging in voxel size from 2.5 to 15 mm to emulate nominal resolutions comparable to those found in yttrium-90 PET and Bremsstrahlung SPECT imaging. Dose distributions were calculated through the convolution of activity distributions with dose-voxel kernels generated using the GATE Monte Carlo toolkit. Contours were computed to represent normal tissue and target volumes. Dose-volume histograms, dose metrics, and dose profiles were compared to a ground truth dose distribution computed with GATE. The mean dose to the target for all studied voxel sizes was found to be within 5.7% of the ground truth mean dose.D70was shown to be strongly correlated with image voxel size of the dose distribution (r2 = 0.90).D70is cited in the literature as an important dose metric and its dependence on voxel size suggests higher resolution dose distributions may provide new perspectives on dose-response relationships in yttrium-90 radioembolization. This study demonstrates that dose distributions with large voxels incorrectly homogenize the dose by attributing escalated doses to normal tissues and reduced doses in high-dose target regions. High-resolution micro-CT imaging of radiopaque microsphere distributions can provide increased confidence in characterizing the absorbed dose heterogeneity in yttrium-90 radioembolization.
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Affiliation(s)
- E Courtney Henry
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Matthew Strugari
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Biomedical Translational Imaging Centre, Halifax, Canada
| | - George Mawko
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada.,Department of Medical Physics, Nova Scotia Health Authority, Halifax, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, Canada
| | - Kimberly D Brewer
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Biomedical Translational Imaging Centre, Halifax, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada.,Department of Biomedical Engineering, Dalhousie University, Halifax, Canada
| | - Robert Abraham
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada.,ABK Biomedical Inc., Halifax, Canada
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Centre, Houston, United States of America
| | - Alasdair Syme
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Department of Medical Physics, Nova Scotia Health Authority, Halifax, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, Canada
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20
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Levillain H, Bagni O, Deroose CM, Dieudonné A, Gnesin S, Grosser OS, Kappadath SC, Kennedy A, Kokabi N, Liu DM, Madoff DC, Mahvash A, Martinez de la Cuesta A, Ng DCE, Paprottka PM, Pettinato C, Rodríguez-Fraile M, Salem R, Sangro B, Strigari L, Sze DY, de Wit van der Veen BJ, Flamen P. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. Eur J Nucl Med Mol Imaging 2021; 48:1570-1584. [PMID: 33433699 PMCID: PMC8113219 DOI: 10.1007/s00259-020-05163-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/08/2020] [Indexed: 12/22/2022]
Abstract
Purpose A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres. Methods A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion Practitioners are encouraged to work towards adoption of these recommendations. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05163-5.
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Affiliation(s)
- Hugo Levillain
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium.
| | - Oreste Bagni
- Nuclear Medicine Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Christophe M Deroose
- Nuclear Medicine, University Hospitals Leuven and Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Arnaud Dieudonné
- Department of Nuclear Medicine, Hôpital Beaujon, AP-HP.Nord, DMU DREAM and Inserm U1149, Clichy, France
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oliver S Grosser
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany and Research Campus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Nima Kokabi
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David M Liu
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - David C E Ng
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Philipp M Paprottka
- Department of Interventional Radiology, Technical University Munich, Munich, Germany
| | - Cinzia Pettinato
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Bruno Sangro
- Clinica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Daniel Y Sze
- Department of Interventional Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Patrick Flamen
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
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21
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Kappadath SC, Lopez BP, Salem R, Lam MG. Lung shunt and lung dose calculation methods for radioembolization treatment planning. Q J Nucl Med Mol Imaging 2021; 65:32-42. [PMID: 33393753 DOI: 10.23736/s1824-4785.20.03287-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Radioembolization, also known as selective internal radiation therapy (SIRT), is firmly established in the management of patients with unresectable liver cancers. Advances in normal and tumor liver dosimetry and new knowledge about tumor dose response relationships have helped promote the safe use of higher prescribed doses, consequently transitioning radioembolization from palliative to curative therapy. The lungs are considered a critical organ of risk for radioembolization treatment planning. Unfortunately, lung dosimetry has not achieved similar advances in dose calculation methodology as liver dosimetry. Current estimations of lung dose are dependent on a number of parameters associated with data acquisition and processing algorithms, leading to poor accuracy and precision. Therefore, the efficacy of curative radioembolization may be compromised in patients for whom the lung dose derived using currently available methods unnecessarily limits the desired administered activity to the liver. We present a systematic review of the various methods of determining the lung shunt fraction (LSF) and lung mean dose (LD). This review encompasses pretherapy estimations and post-therapy assessments of the LSF and LD using both 2D planar and 3D SPECT/CT based calculations. The advantages and limitations of each of these methods are deliberated with a focus on accuracy and practical considerations. We conclude the review by presenting a lexicon to precisely describe the methodology used for the estimation of LSF and LD; specifically, category, agent, modality, contour and algorithm, in order to aid in their interpretation and standardization in routine clinical practice.
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Affiliation(s)
- S Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, USA -
| | - Benjamin P Lopez
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Riad Salem
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Marnix G Lam
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands
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22
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Kairemo K, Kappadath SC, Joensuu T, Macapinlac HA. A Retrospective Comparative Study of Sodium Fluoride (NaF-18)-PET/CT and Fluorocholine (F-18-CH) PET/CT in the Evaluation of Skeletal Metastases in Metastatic Prostate Cancer Using a Volumetric 3-D Radiomics Analysis. Diagnostics (Basel) 2020; 11:diagnostics11010017. [PMID: 33374148 PMCID: PMC7824105 DOI: 10.3390/diagnostics11010017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
Bone metastases are common in prostate cancer (PCa). Fluorocholine-18 (FCH) and sodium fluoride-18 (NaF) have been used to assess PCa associated skeletal disease in thousands of patients by demonstrating different mechanism of uptake-cell membrane (lipid) synthesis and bone mineralization. Here, this difference is characterized quantitatively in detail. Our study cohort consisted of 12 patients with advanced disease (> 5 lesions) (M) and of five PCa patients with no skeletal disease (N). They had routine PET/CT with FCH and NaF on consecutive days. Skeletal regions in CT were used to co-register the two PET/CT scans. Bone 3-D volume of interest (VOI) was defined on the CT of PET with a threshold of HU > 150, and sclerotic/dense bone as HU > 600, respectively. Additional VOIs were defined on PET uptake with the threshold values on both FCH (SUV > 3.5) and NaF (SUV > 10). The pathologic skeletal volumes for each technique (CT, HU > 600), NaF (SUV > 10) and FCH (SUV > 3.5) were developed and analyzed. The skeletal VOIs varied from 5.03 L to 7.31 L, whereas sclerotic bone VOIs were from 0.88 L to 2.99 L. Total choline kinase (cell membrane synthesis) activity for FCH (TCA) varied from 0.008 to 4.85 [kg] in M group and from 0.0006 to 0.085 [kg] in N group. Total accelerated osteoblastic (bone demineralization) activity for NaF (TBA varied from 0.25 to 13.6 [kg] in M group and varied from 0.000 to 1.09 [kg] in N group. The sclerotic bone volume represented only 1.86 ± 1.71% of the pathologic FCH volume and 4.07 ± 3.21% of the pathologic NaF volume in M group, and only 0.08 ± 0.09% and 0.18 ± 0.19% in N group, respectively. Our results suggest that CT alone cannot be used for the assessment of the extent of active metastatic skeletal disease in PCa. NaF and FCH give complementary information about the activity of the skeletal disease, improving diagnosis and disease staging.
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Affiliation(s)
- Kalevi Kairemo
- Department of Theragnostics, Docrates Cancer Center, 00180 Helsinki, Finland
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA;
- Correspondence:
| | - S. Cheenu Kappadath
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timo Joensuu
- Department of Medical Oncology and Radiotherapy, Docrates Cancer Center, 00180 Helsinki, Finland;
| | - Homer A. Macapinlac
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA;
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23
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Popnoe DO, Ng CS, Zhou S, Kaur H, Kang HC, Loyer EM, Kappadath SC, Jones AK. Comparison of virtual to true unenhanced abdominal computed tomography images acquired using rapid kV-switching dual energy imaging. PLoS One 2020; 15:e0238582. [PMID: 32966278 PMCID: PMC7511018 DOI: 10.1371/journal.pone.0238582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To compare “virtual” unenhanced (VUE) computed tomography (CT) images, reconstructed from rapid kVp-switching dual-energy computed tomography (DECT), to “true” unenhanced CT images (TUE), in clinical abdominal imaging. The ability to replace TUE with VUE images would have many clinical and operational advantages. Methods VUE and TUE images of 60 DECT datasets acquired for standard-of-care CT of pancreatic cancer were retrospectively reviewed and compared, both quantitatively and qualitatively. Comparisons included quantitative evaluation of CT numbers (Hounsfield Units, HU) measured in 8 different tissues, and 6 qualitative image characteristics relevant to abdominal imaging, rated by 3 experienced radiologists. The observed quantitative and qualitative VUE and TUE differences were compared against boundaries of clinically relevant equivalent thresholds to assess their equivalency, using modified paired t-tests and Bayesian hierarchical modeling. Results Quantitatively, in tissues containing high concentrations of calcium or iodine, CT numbers measured in VUE images were significantly different from those in TUE images. CT numbers in VUE images were significantly lower than TUE images when calcium was present (e.g. in the spine, 73.1 HU lower, p < 0.0001); and significantly higher when iodine was present (e.g. in renal cortex, 12.9 HU higher, p < 0.0001). Qualitatively, VUE image ratings showed significantly inferior depiction of liver parenchyma compared to TUE images, and significantly more cortico-medullary differentiation in the kidney. Conclusions Significant differences in VUE images compared to TUE images may limit their application and ability to replace TUE images in diagnostic abdominal CT imaging.
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Affiliation(s)
- D. Olivia Popnoe
- MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, Texas, United States of America
| | - Chaan S. Ng
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Harmeet Kaur
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Hyunseon C. Kang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Evelyne M. Loyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - S. Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - A. Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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24
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Teyateeti A, Mahvash A, Long JP, Abdelsalam ME, Avritscher R, Chasen B, Kaseb AO, Kuban JD, Murthy R, Odisio BC, Teyateeti A, Macapinlac HA, Kappadath SC. Survival Outcomes for Yttrium-90 Transarterial Radioembolization With and Without Sorafenib for Unresectable Hepatocellular Carcinoma Patients. J Hepatocell Carcinoma 2020; 7:117-131. [PMID: 32984089 PMCID: PMC7500841 DOI: 10.2147/jhc.s248314] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To assess the overall survival (OS) and progression-free survival (PFS) of unresectable hepatocellular carcinoma (HCC) patients undergoing yttrium-90 glass–microsphere transarterial radioembolization (TARE) with and without concurrent sorafenib. Methods OS and PFS were analyzed in 55 patients with an intrahepatic tumor (IHT) ≤50% without advanced or aggressive disease features (ADFs), which was referred to presence of infiltrative/ill-defined HCC, macrovascular invasion, or extrahepatic disease treated with only TARE (TARE_alone) and in 74 patients with IHT ≤50% with ADFs or IHT >50% treated with TARE and sorafenib (TARE_sorafenib). Prognostic factors for OS and PFS were identified using univariate and multivariate analyses. Results Median OS and PFS of TARE_alone patients were 21.6 (95% CI 6.1–37.1) and 9.1(95% CI 5.2–13.0) months, respectively, and for TARE_sorafenib patients 12.4 (95% CI 9.1–15.6) and 5.1 (95% CI 2.6–7.5) months, respectively. Better OS was associated with serum AFP <400 (HR 0.27, p=0.02) in TARE_alone, and IHT ≤50% (HR 0.39, p=0.004) and AFP <400 (HR 0.5, p=0.027) in TARE_sorafenib. Unilobar involvement (HR 0.43, p=0.029) and AFP <400 ng/mL (HR 0.52, p=0.015) correlated with better PFS in TARE_alone and TARE_sorafenib, respectively. Adverse events (AEs) were more frequent in TARE_sorafenib than TARE_alone (92.4 vs 80.3%), but only 9.3% were grade 3 or higher AEs. Conclusion TARE_alone provided the most prominent survival benefit in IHT ≤50%–without ADF patients who had unilobar HCC and serum AFP <400 ng/mL. TARE and sorafenib yielded the best outcomes in patients with IHT ≤50% and serum AFP <400 ng/mL, with some additional grade 1–2 AEs compared to TARE only.
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Affiliation(s)
- Ajalaya Teyateeti
- Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Armeen Mahvash
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James P Long
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed E Abdelsalam
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rony Avritscher
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth Chasen
- Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joshua D Kuban
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ravi Murthy
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Achiraya Teyateeti
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Homer A Macapinlac
- Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Thomas MA, Mahvash A, Abdelsalam M, Kaseb AO, Kappadath SC. Planning dosimetry for 90 Y radioembolization with glass microspheres: Evaluating the fidelity of 99m Tc-MAA and partition model predictions. Med Phys 2020; 47:5333-5342. [PMID: 32790882 DOI: 10.1002/mp.14452] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/12/2020] [Accepted: 07/30/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE 99m Tc-MAA-SPECT/CT may be used in 90 Y-glass microsphere radioembolization treatment planning to assess perfused liver volumes and absorbed dose distributions. The partition model (PM) offers a more detailed planning dosimetry option beyond the single-compartment model more traditionally used in 90 Y radioembolization. As 90 Y radioembolization treatments shift toward activities and doses that aim to achieve tumor control, accurate and reliable treatment planning dosimetry for both tumors and normal liver (NL) becomes more critical. In this work, we explore the accuracy and precision of 90 Y dosimetry predictions from pretherapy 99m Tc-MAA and PM. METHODS Both PM and voxel dosimetry models were used to calculate tumor and NL mean doses using both planning 99m Tc-MAA and verification 90 Y-SPECT/CT in this retrospective analysis of hepatocellular carcinoma cases treated with glass microspheres (NCT01900002, n = 32). Linear regression models were developed at first access, and then later correct, the estimates by (a) 99m Tc-MAA for 90 Y voxel dosimetry and (b) 99m Tc-MAA PM for voxel dosimetry, separately for both tumors and NL. Bland-Altman analysis was then used to evaluate the accuracy and precision of the regression model predictions with the mean bias and 95% prediction intervals (PI, ±1.96σ). Two categories of cases were stratified (catheter matched vs catheter unmatched) by establishing the level of 99m Tc-MAA and 90 Y catheter position alignment. Only catheter-matched cases were included in the 99m Tc-MAA vs 90 Y voxel dosimetry comparison, while all cases were used to compare dosimetry models (PM vs voxel). RESULTS Half (16/32) of cases were deemed catheter matched. 99m Tc-MAA could reliably predict NL doses in catheter-matched cases after application of the linear model, with mean bias (PI) of -1% (±31%). PM was equivalent to voxel dosimetry for NL doses with mean bias (PI) of 0% (±1%). Even among catheter-matched cases, 99m Tc-MAA planning for 90 Y tumor voxel doses was poor, overestimating dose by an average of nearly 40%. Upon application of the linear model, 99m Tc-MAA predictions for 90 Y tumor voxel dose were only minimally biased (-4%) but possessed very large PI (±104%). PM predictions for tumor voxel dose using the linear model also showed small bias (-6%) but maintained similarly high PI of ±90%. Cases with tumors representing a large majority (>80%) of the total tumor volume demonstrated the best scenarios for 99m Tc-MAA and PM tumor dose predictions, with mean biases (PI) of -3% (±53%) and -4% (±21%), respectively. CONCLUSION The unconditional use of 99m Tc-MAA to predict 90 Y dosimetry across all cases is not recommended due to: (a) demonstrated the risk of unmatched catheter positions between procedures, and (b) large bias and uncertainty in 99m Tc-MAA predictions in cases with matched catheter locations. However, NL voxel dose predictions with 99m Tc-MAA are clinically viable and either PM or voxel dosimetry can be used to produce equivalent predictions. Both 99m Tc-MAA and PM can provide tumor dose predictions with potential clinical utility, but only in catheter-matched cases and with tumors comprising a clear majority (>80%) of the total tumor volume. These findings stratify the predictive fidelity of 99m Tc-MAA- and PM-based treatment planning for 90 Y dosimetry in improving treatment outcomes.
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Affiliation(s)
- M Allan Thomas
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Mohamed Abdelsalam
- Department of Interventional Radiology, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ahmed O Kaseb
- Department of GI Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
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Abdelsalam ME, Kappadath SC, Mahvash A. Blood flow diversion using the microvascular plug to avoid non target delivery of radioactive microspheres. Radiol Case Rep 2020; 15:2015-2017. [PMID: 32874402 PMCID: PMC7452059 DOI: 10.1016/j.radcr.2020.07.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022] Open
Abstract
Temporary balloon occlusion techniques have been described to redirect blood flow during hepatic chemo- and radioembolization. A 69 years old male with pathologically proven multifocal hepatocellular carcinoma involving all the liver segments except segments 2 and 3. We temporarily occlude segment 2/3 branch with the microvascular plug (MVP) to safely deliver the Y90 glass microspheres through the multiple small segment 4 branches. Distal occlusion using MVP may provide a valuable, cheaper and readily available tool in cases of unfavorable anatomy to divert blood flow and avoid non target delivery of Chemo or Radioembolic agents.
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Affiliation(s)
- Mohamed E Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston TX 77030-4009, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston TX 77030-4009, USA
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Adrada BE, Moseley T, Kappadath SC, Whitman GJ, Rauch GM. Molecular Breast Imaging-guided Percutaneous Biopsy of Breast Lesions: A New Frontier on Breast Intervention. J Breast Imaging 2020; 2:484-491. [PMID: 33015619 DOI: 10.1093/jbi/wbaa057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 01/29/2023]
Abstract
Molecular breast imaging (MBI) is an increasingly recognized nuclear medicine imaging modality to detect breast lesions suspicious for malignancy. Recent advances have allowed the development of tissue sampling of MBI-detected lesions using a single-headed camera (breast-specific gamma imaging system) or a dual-headed camera system (MBI system). In this article, we will review current indications of MBI, differences of the two single- and dual-headed camera systems, the appropriate selection of biopsy equipment, billing considerations, and radiation safety. It will also include practical considerations and guidance on how to integrate MBI and MBI-guided biopsy in the current breast imaging workflow.
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Affiliation(s)
- Beatriz E Adrada
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - S Cheenu Kappadath
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Gary J Whitman
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
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Braat AJAT, Ahmadzadehfar H, Kappadath SC, Stothers CL, Frilling A, Deroose CM, Flamen P, Brown DB, Sze DY, Mahvash A, Lam MGEH. Radioembolization with 90Y Resin Microspheres of Neuroendocrine Liver Metastases After Initial Peptide Receptor Radionuclide Therapy. Cardiovasc Intervent Radiol 2019; 43:246-253. [PMID: 31646375 PMCID: PMC6965040 DOI: 10.1007/s00270-019-02350-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/12/2019] [Accepted: 10/01/2019] [Indexed: 12/28/2022]
Abstract
Purpose Peptide receptor radionuclide therapy (PRRT) and radioembolization are increasingly used in neuroendocrine neoplasms patients. However, concerns have been raised on cumulative hepatotoxicity. The aim of this sub-analysis was to investigate hepatotoxicity of yttrium-90 resin microspheres radioembolization in patients who were previously treated with PRRT. Methods Patients treated with radioembolization after systemic radionuclide treatment were retrospectively analysed. Imaging response according to response evaluation criteria in solid tumours (RECIST) v1.1 and clinical response after 3 months were collected. Clinical, biochemical and haematological toxicities according to common terminology criteria for adverse events (CTCAE) v4.03 were also collected. Specifics on prior PRRT, subsequent radioembolization treatments, treatments after radioembolization and overall survival (OS) were collected. Results Forty-four patients were included, who underwent a total of 58 radioembolization procedures, of which 55% whole liver treatments, at a median of 353 days after prior PRRT. According to RECIST 1.1, an objective response rate of 16% and disease control rate of 91% were found after 3 months. Clinical response was seen in 65% (15/23) of symptomatic patients after 3 months. Within 3 months, clinical toxicities occurred in 26%. Biochemical and haematological toxicities CTCAE grade 3–4 occurred in ≤ 10%, apart from lymphocytopenia (42%). Radioembolization-related complications occurred in 5% and fatal radioembolization-induced liver disease in 2% (one patient). A median OS of 3.5 years [95% confidence interval 1.8–5.1 years] after radioembolization for the entire study population was found. Conclusion Radioembolization after systemic radionuclide treatments is safe, and the occurrence of radioembolization-induced liver disease is rare. Level of Evidence 4, case series.
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Affiliation(s)
- A J A T Braat
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - H Ahmadzadehfar
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - S C Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C L Stothers
- Department of Radiology and Radiologic Sciences, Vanderbilt University, Nashville, TN, USA
| | - A Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C M Deroose
- Nuclear Medicine, University Hospital Leuven, Leuven, Belgium
| | - P Flamen
- Department of Nuclear Medicine, Jules Bordet Institute, Brussels, Belgium
| | - D B Brown
- Department of Radiology and Radiologic Sciences, Vanderbilt University, Nashville, TN, USA
| | - D Y Sze
- Division of Interventional Radiology, Stanford University, Palo Alto, CA, USA
| | - A Mahvash
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M G E H Lam
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Henry EC, Mawko G, Tonkopi E, Frampton J, Kehoe S, Boyd D, Abraham R, Gregoire M, O’Connell K, Kappadath SC, Syme A. Quantification of the inherent radiopacity of glass microspheres for precision dosimetry in yttrium-90 radioembolization. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab36c2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Olivia Popnoe D, Ng CS, Zhou S, Cheenu Kappadath S, Pan T, Kyle Jones A. Comparison of enhancement quantification from virtual unenhanced images to true unenhanced images in multiphase renal Dual-Energy computed tomography: A phantom study. J Appl Clin Med Phys 2019; 20:171-179. [PMID: 31423728 PMCID: PMC6698809 DOI: 10.1002/acm2.12685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 11/17/2022] Open
Abstract
Multiphase computed tomography (CT) exams are a commonly used imaging technique for the diagnosis of renal lesions and involve the acquisition of a true unenhanced (TUE) series followed by one or more postcontrast series. The difference in CT number of the mass in pre- and postcontrast images is used to quantify enhancement, which is an important criterion used for diagnosis. This study sought to assess the feasibility of replacing TUE images with virtual unenhanced (VUE) images derived from Dual-Energy CT datasets in renal CT exams. Eliminating TUE image acquisition could reduce patient dose and improve clinical efficiency. A rapid kVp-switching CT scanner was used to assess enhancement accuracy when using VUE compared to TUE images as the baseline for enhancement calculations across a wide range of clinical scenarios simulated in a phantom study. Three phantoms were constructed to simulate small, medium, and large patients, each with varying lesion size and location. Nonenhancing cystic lesions were simulated using distilled water. Intermediate (10-20 HU [Hounsfield units]) and positively enhancing masses (≥20 HU) were simulated by filling the spherical inserts in each phantom with varied levels of iodinated contrast mixed with a blood surrogate. The results were analyzed using Bayesian hierarchical models. Posterior probabilities were used to classify enhancement measured using VUE compared to TUE images as significantly less, not significantly different, or significantly higher. Enhancement measured using TUE images was considered the ground truth in this study. For simulation of nonenhancing renal lesions, enhancement values were not significantly different when using VUE versus TUE images, with posterior probabilities ranging from 0.23-0.56 across all phantom sizes and an associated specificity of 100%. However, for simulation of intermediate and positively enhancing lesions significant differences were observed, with posterior probabilities < 0.05, indicating significantly lower measured enhancement when using VUE versus TUE images. Positively enhancing masses were categorized accurately, with a sensitivity of 91.2%, when using VUE images as the baseline. For all scenarios where iodine was present, VUE-based enhancement measurements classified lesions with a sensitivity of 43.2%, a specificity of 100%, and an accuracy of 78.1%. Enhancement calculated using VUE images proved to be feasible for classifying nonenhancing and highly enhancing lesions. However, differences in measured enhancement for simulation of intermediately enhancing lesions demonstrated that replacement of TUE with VUE images may not be advisable for renal CT exams.
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Affiliation(s)
- D. Olivia Popnoe
- MD Anderson Cancer Center UT Health Graduate School of Biomedical SciencesHoustonTexas
- Present address:
Department of Imaging Physics, Medical and Radiation Physics, Inc.San AntonioTexas
| | - Chaan S. Ng
- Department of Diagnostic RadiologyMD Anderson Cancer CenterHoustonTexas
| | - Shouhao Zhou
- Department of BiostatisticsMD Anderson Cancer CenterHoustonTexas
| | | | - Tinsu Pan
- Department of Imaging PhysicsMD Anderson Cancer CenterHoustonTexas
| | - A. Kyle Jones
- Department of Imaging PhysicsMD Anderson Cancer CenterHoustonTexas
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Salem R, Padia SA, Lam M, Bell J, Chiesa C, Fowers K, Hamilton B, Herman J, Kappadath SC, Leung T, Portelance L, Sze D, Garin E. Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging 2019; 46:1695-1704. [PMID: 31098749 DOI: 10.1007/s00259-019-04340-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/17/2019] [Indexed: 12/22/2022]
Abstract
The TheraSphere Global Dosimetry Steering Committee was formed in 2017 by BTG International to review existing data and address gaps in knowledge related to dosimetry. This committee is comprised of health care providers with diverse areas of expertise and perspectives on radiation dosimetry. The goal of these recommendations is to optimize glass microspheres radiation therapy for hepatocellular carcinoma while accounting for variables including disease presentation, tumour vascularity, liver function, and curative/palliative intent. The recommendations aim to unify glass microsphere users behind standardized dosimetry methodology that is simple, reproducible and supported by clinical data, with the overarching goal of improving clinical outcomes and advancing the knowledge of dosimetry.
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Affiliation(s)
- Riad Salem
- Department of Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
| | - Siddharth A Padia
- Department of Radiology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jon Bell
- Department of Radiology, The Christie, Manchester, UK
| | - Carlo Chiesa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumouri, Milan, Italy
| | - Kirk Fowers
- BTG International, West Conshohocken, PA, USA
| | | | - Joseph Herman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | | | - Daniel Sze
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Etienne Garin
- Univ Rennes, INSERM, INRA, Centre de Lutte contre le Cancer Eugène Marquis, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France
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Siman W, Mikell JK, Mawlawi OR, Mourtada F, Kappadath SC. Dose volume histogram-based optimization of image reconstruction parameters for quantitative 90 Y-PET imaging. Med Phys 2018; 46:229-237. [PMID: 30375655 DOI: 10.1002/mp.13269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE 90 Y-microsphere radioembolization or selective internal radiation therapy is increasingly being used as a treatment option for tumors that are not candidates for surgery and external beam radiation therapy. Recently, volumetric 90 Y-dosimetry techniques have been implemented to explore tumor dose-response on the basis of 3D 90 Y-activity distribution from PET imaging. Despite being a theranostic study, the optimization of quantitative 90 Y-PET image reconstruction still uses the mean activity concentration recovery coefficient (RC) as the objective function, which is more relevant to diagnostic and detection tasks than is to dosimetry. The aim of this study was to optimize 90 Y-PET image reconstruction by minimizing errors in volumetric dosimetry via the dose volume histogram (DVH). We propose a joint optimization of the number of equivalent iterations (the product of the iterations and subsets) and the postreconstruction filtration (FWHM) to improve the accuracy of voxel-level 90 Y dosimetry. METHODS A modified NEMA IEC phantom was used to emulate clinically relevant 90 Y-PET imaging conditions through various combinations of acquisition durations, activity concentrations, sphere-to-background ratios, and sphere diameters. PET data were acquired in list mode for 300 min in a single-bed position; we then rebinned the list mode PET data to 60, 45, 30, 15, and 5 min per bed, with 10 different realizations. Errors in the DVH were calculated as root mean square errors (RMSE) of the differences in the image-based DVH and the expected DVH. The new optimization approach was tested in a phantom study, and the results were compared with the more commonly used objective function of the mean activity concentration RC. RESULTS In a wide range of clinically relevant imaging conditions, using 36 equivalent iterations with a 5.2-mm filtration resulted in decreased systematic errors in volumetric 90 Y dosimetry, quantified as image-based DVH, in 90 Y-PET images reconstructed using the ordered subset expectation maximization (OSEM) iterative reconstruction algorithm with time of flight (TOF) and point spread function (PSF) modeling. Our proposed objective function of minimizing errors in DVH, which allows for joint optimization of 90 Y-PET iterations and filtration for volumetric quantification of the 90 Y dose, was shown to be superior to conventional RC-based optimization approaches for image-based absorbed dose quantification. CONCLUSION Our proposed objective function of minimizing errors in DVH, which allows for joint optimization of iterations and filtration to reduce errors in the PET-based volumetric quantification 90 Y dose, is relevant to dosimetry in therapy procedures. The proposed optimization method using DVH as the objective function could be applied to any imaging modality used to assess voxel-level quantitative information.
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Affiliation(s)
- Wendy Siman
- Department of Radiology, The University of Tennessee Medical Center, Knoxville, TN, USA.,The University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Justin K Mikell
- Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | - Osama R Mawlawi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | | | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
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Abstract
Radioembolization is an established treatment for chemoresistant and unresectable liver cancers. Currently, treatment planning is often based on semi-empirical methods, which yield acceptable toxicity profiles and have enabled the large-scale application in a palliative setting. However, recently, five large randomized controlled trials using resin microspheres failed to demonstrate a significant improvement in either progression-free survival or overall survival in both hepatocellular carcinoma and metastatic colorectal cancer. One reason for this might be that the activity prescription methods used in these studies are suboptimal for many patients.In this review, the current dosimetric methods and their caveats are evaluated. Furthermore, the current state-of-the-art of image-guided dosimetry and advanced radiobiological modeling is reviewed from a physics' perspective. The current literature is explored for the observation of robust dose-response relationships followed by an overview of recent advancements in quantitative image reconstruction in relation to image-guided dosimetry.This review is concluded with a discussion on areas where further research is necessary in order to arrive at a personalized treatment method that provides optimal tumor control and is clinically feasible.
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Affiliation(s)
- Remco Bastiaannet
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - S. Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX 77030 USA
| | - Britt Kunnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Arthur J. A. T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Hugo W. A. M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Kappadath SC, Mikell J, Balagopal A, Baladandayuthapani V, Kaseb A, Mahvash A. Hepatocellular Carcinoma Tumor Dose Response After 90Y-radioembolization With Glass Microspheres Using 90Y-SPECT/CT-Based Voxel Dosimetry. Int J Radiat Oncol Biol Phys 2018; 102:451-461. [DOI: 10.1016/j.ijrobp.2018.05.062] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 12/17/2022]
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Pahlka RB, Kappadath SC, Mawlawi OR. A Monte Carlo simulation of coincidence detection and imaging of gamma-ray cascades with a scintillation camera. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aad572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Balagopal A, Kappadath SC. Characterization of 90 Y-SPECT/CT self-calibration approaches on the quantification of voxel-level absorbed doses following 90 Y-microsphere selective internal radiation therapy. Med Phys 2017; 45:875-883. [PMID: 29172243 DOI: 10.1002/mp.12695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 09/27/2017] [Accepted: 11/19/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE 90 Y-microsphere selective internal radiation therapy (90 Y-SIRT or 90 Y-radioembolization) is used in the management of unresectable liver tumors. 90 Y-SIRT presents a unique situation where the total 90 Y activity inside the liver can be determined with high accuracy (> 95%). 90 Y bremsstrahlung single-photon emission computed tomography (SPECT)/computed tomography (CT) can be self-calibrated to provide quantitative images that facilitate voxel-level absorbed dose calculations. We investigated the effects of different approaches for 90 Y-SPECT self-calibration on the quantification of absorbed doses following 90 Y-SIRT. METHODS 90 Y bremsstrahlung SPECT/CT images of 31 patients with hepatocellular carcinoma, collected following 90 Y-SIRT, were analyzed, yielding 48 tumor and 31 normal liver contours. We validated the accuracy of absorbed doses calculated by a commercial software against those calculated using Monte Carlo-based radiation transport. The software package was used to analyze the following definitions of SPECT volume of interest used for 90 Y-SPECT self-calibration: (a) SPECT field-of-view (FOV), (b) chest-abdomen contour, (c) total liver contour, (d) total liver contour expanded by 5 mm, and (e) total liver contour contracted by 5 mm. Linear correlation and Bland-Altman analysis were performed for tumor and normal liver tissue absorbed dose volume histogram metrics between the five different approaches for 90 Y-SPECT self-calibration. RESULTS The mean dose calculated using the commercial software was within 3% of Monte Carlo for tumors and normal liver tissues. The tumor mean dose calculated using the chest-abdomen calibration was within 2% of that calculated using the SPECT FOV, whereas the doses calculated using the total liver contour, expanded total liver contour, and contracted total liver contour were within 68%, 47%, and 107%, respectively, of doses calculated using the SPECT FOV. The normal liver tissue mean dose calculated using the chest-abdomen contour was within 1.3% of that calculated using the SPECT FOV, whereas the doses calculated using the total liver contour, expanded total liver contour, and contracted total liver contour were within 73%, 50%, and 114%, respectively, of doses calculated using the SPECT FOV. CONCLUSIONS The mean error of < 3% for commercial software can be considered clinically acceptable for 90 Y-SIRT dosimetry. Absorbed dose quantification using 90 Y-SPECT self-calibration with the chest-abdomen contour was equivalent to that calculated using the SPECT FOV, but self-calibration with the total liver contour yielded substantially higher (~70%) dose values. The large biases revealed by our study suggest that consistent absorbed dose calculation approaches are essential when comparing 90 Y-SIRT dosimetry between different clinical studies.
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Affiliation(s)
- Anjali Balagopal
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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37
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Braat AJAT, Kappadath SC, Bruijnen RCG, van den Hoven AF, Mahvash A, de Jong HWAM, Lam MGEH. Adequate SIRT activity dose is as important as adequate chemotherapy dose. Lancet Oncol 2017; 18:e636. [PMID: 29208390 DOI: 10.1016/s1470-2045(17)30811-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rutger C G Bruijnen
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Armeen Mahvash
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
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Siman W, Kappadath SC. Comparison of Step-and-Shoot and Continuous-Bed-Motion PET Modes of Acquisition for Limited-View Organ Scans. J Nucl Med Technol 2017; 45:290-296. [PMID: 29042468 DOI: 10.2967/jnmt.117.195438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/31/2017] [Indexed: 01/20/2023] Open
Abstract
Continuous-bed-motion (CBM) acquisition mode has been made commercially available in PET/CT scanners. CBM mode is designed for whole-body imaging, with a long scan length (multiple axial fields of view [aFOVs]) and short acquisition duration (2-3 min/aFOV). PET/CT has recently been used after 90Y-microsphere therapy to quantify 90Y activity distribution in the liver. Here we compared counting efficiencies along the bed-motion direction (z-axis) between CBM and step-and-shoot (SS) acquisition modes for limited-view organ scans, such as 90Y PET/CT liver studies, that have short scan lengths (≤2 aFOVs) and long acquisition durations (10-30 min/aFOV). Methods: The counting efficiencies, that is, analytic sensitivities, in SS mode (single-aFOV and multiple-aFOV scans) and CBM mode were theoretically derived and experimentally validated using a cylindric 68Ge phantom. The sensitivities along the z-axis were compared between the SS and CBM modes. Results: The analytic and experimental count profiles were in good agreement, validating the analytic models. For fixed scan durations, the overall coincidence counting efficiency in CBM mode was lower (∼60%) than those in SS modes, and the maximum sensitivity in CBM mode was 50% or less of that in 1-aFOV SS mode and 100% or less of that in 2-aFOV SS mode. Conclusion: The ability of CBM mode to tailor-fit the PET/CT scan length and local scan duration is not realized in studies with a short scan length (≤30 cm) and long scan duration (20 min/aFOV for the scanner). SS acquisition mode is preferable to CBM mode for limited-view organ and count-starved scans, such as 90Y PET/CT liver scans, because of the higher counting efficiency of SS mode, which leads to better image quality and quantification precision.
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Affiliation(s)
- Wendy Siman
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee.,University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, Texas; and .,University of Texas Graduate School of Biomedical Sciences, Houston, Texas
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Bache ST, Kappadath SC. Quantitation of tumor uptake with molecular breast imaging. Med Phys 2017; 44:4593-4607. [DOI: 10.1002/mp.12403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 04/28/2017] [Accepted: 04/28/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Steven T. Bache
- Department of Imaging Physics; The University of Texas MD Anderson Cancer Center; Houston TX 77030 USA
| | - S. Cheenu Kappadath
- Department of Imaging Physics; The University of Texas MD Anderson Cancer Center; Houston TX 77030 USA
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Abstract
PURPOSE To develop a practical background compensation (BC) technique to improve quantitative (90)Y-bremsstrahlung single-photon emission computed tomography (SPECT)/computed tomography (CT) using a commercially available imaging system. METHODS All images were acquired using medium-energy collimation in six energy windows (EWs), ranging from 70 to 410 keV. The EWs were determined based on the signal-to-background ratio in planar images of an acrylic phantom of different thicknesses (2-16 cm) positioned below a (90)Y source and set at different distances (15-35 cm) from a gamma camera. The authors adapted the widely used EW-based scatter-correction technique by modeling the BC as scaled images. The BC EW was determined empirically in SPECT/CT studies using an IEC phantom based on the sphere activity recovery and residual activity in the cold lung insert. The scaling factor was calculated from 20 clinical planar (90)Y images. Reconstruction parameters were optimized in the same SPECT images for improved image quantification and contrast. A count-to-activity calibration factor was calculated from 30 clinical (90)Y images. RESULTS The authors found that the most appropriate imaging EW range was 90-125 keV. BC was modeled as 0.53× images in the EW of 310-410 keV. The background-compensated clinical images had higher image contrast than uncompensated images. The maximum deviation of their SPECT calibration in clinical studies was lowest (<10%) for SPECT with attenuation correction (AC) and SPECT with AC + BC. Using the proposed SPECT-with-AC + BC reconstruction protocol, the authors found that the recovery coefficient of a 37-mm sphere (in a 10-mm volume of interest) increased from 39% to 90% and that the residual activity in the lung insert decreased from 44% to 14% over that of SPECT images with AC alone. CONCLUSIONS The proposed EW-based BC model was developed for (90)Y bremsstrahlung imaging. SPECT with AC + BC gave improved lesion detectability and activity quantification compared to SPECT with AC only. The proposed methodology can readily be used to tailor (90)Y SPECT/CT acquisition and reconstruction protocols with different SPECT/CT systems for quantification and improved image quality in clinical settings.
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Affiliation(s)
- W Siman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas 77030
| | - J K Mikell
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas 77030
| | - S C Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas 77030
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Siman W, Mawlawi OR, Mikell JK, Mourtada F, Kappadath SC. Effects of image noise, respiratory motion, and motion compensation on 3D activity quantification in count-limited PET images. Phys Med Biol 2016; 62:448-464. [DOI: 10.1088/1361-6560/aa5088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mikell JK, Mahvash A, Siman W, Baladandayuthapani V, Mourtada F, Kappadath SC. Selective Internal Radiation Therapy With Yttrium-90 Glass Microspheres: Biases and Uncertainties in Absorbed Dose Calculations Between Clinical Dosimetry Models. Int J Radiat Oncol Biol Phys 2016; 96:888-896. [PMID: 27623307 DOI: 10.1016/j.ijrobp.2016.07.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/03/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE To quantify differences that exist between dosimetry models used for 90Y selective internal radiation therapy (SIRT). METHODS AND MATERIALS Retrospectively, 37 tumors were delineated on 19 post-therapy quantitative 90Y single photon emission computed tomography/computed tomography scans. Using matched volumes of interest (VOIs), absorbed doses were reported using 3 dosimetry models: glass microsphere package insert standard model (SM), partition model (PM), and Monte Carlo (MC). Univariate linear regressions were performed to predict mean MC from SM and PM. Analysis was performed for 2 subsets: cases with a single tumor delineated (best case for PM), and cases with multiple tumors delineated (typical clinical scenario). Variability in PM from the ad hoc placement of a single spherical VOI to estimate the entire normal liver activity concentration for tumor (T) to nontumoral liver (NL) ratios (TNR) was investigated. We interpreted the slope of the resulting regression as bias and the 95% prediction interval (95%PI) as uncertainty. MCNLsingle represents MC absorbed doses to the NL for the single tumor patient subset; other combinations of calculations follow a similar naming convention. RESULTS SM was unable to predict MCTsingle or MCTmultiple (p>.12, 95%PI >±177 Gy). However, SMsingle was able to predict (p<.012) MCNLsingle, albeit with large uncertainties; SMsingle and SMmultiple yielded biases of 0.62 and 0.71, and 95%PI of ±40 and ± 32 Gy, respectively. PMTsingle and PMTmultiple predicted (p<2E-6) MCTsingle and MCTmultiple with biases of 0.52 and 0.54, and 95%PI of ±38 and ± 111 Gy, respectively. The TNR variability in PMTsingle increased the 95%PI for predicting MCTsingle (bias = 0.46 and 95%PI = ±103 Gy). The TNR variability in PMTmultiple modified the bias when predicting MCTmultiple (bias = 0.32 and 95%PI = ±110 Gy). CONCLUSIONS The SM is unable to predict mean MC tumor absorbed dose. The PM is statistically correlated with mean MC, but the resulting uncertainties in predicted MC are large. Large differences observed between dosimetry models for 90Y SIRT warrant caution when interpreting published SIRT absorbed doses. To reduce uncertainty, we suggest the entire NL VOI be used for TNR estimates when using PM.
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Affiliation(s)
- Justin K Mikell
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy Siman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas
| | - Veera Baladandayuthapani
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Firas Mourtada
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Christiana Care, Newark, Delaware; Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas.
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Mikell J, Cheenu Kappadath S, Wareing T, Erwin WD, Titt U, Mourtada F. Evaluation of a deterministic grid-based Boltzmann solver (GBBS) for voxel-level absorbed dose calculations in nuclear medicine. Phys Med Biol 2016; 61:4564-82. [DOI: 10.1088/0031-9155/61/12/4564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Meier J, Kappadath SC. Characterization of the energy response and backscatter contribution for two electronic personal dosimeter models. J Appl Clin Med Phys 2015; 16:423–434. [PMID: 26699565 PMCID: PMC5691009 DOI: 10.1120/jacmp.v16i6.5549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 08/17/2015] [Accepted: 06/02/2015] [Indexed: 11/23/2022] Open
Abstract
We characterized the energy response of personal dose equivalent (Hp(10) in mrem) and the contribution of backscatter to the readings of two electronic personal dosimeter (EPD) models with radionuclides commonly used in a nuclear medicine clinic. The EPD models characterized were the RADOS RAD-60R, and the SAIC PD-10i. The experimental setup and calculation of EPD energy response was based on ANSI/HPS N13.11-2009. Fifteen RAD-60R and 2 PD-10i units were irradiated using (99m)Tc, (131)I, and (18)F radionuclides with emission energies at 140 keV, 364 keV, and 511 keV, respectively. At each energy, the EPDs output in Hp(10) [mrem] were recorded with 15 inch thick PMMA to simulate backscatter form the torso. Simultaneous free-in-air exposure rate measurements were also performed using two Victoreen ionization survey meters to calculate the expected EPD Hp(10) values per ANSI/HPS N13.11-2009. The energy response was calculated by taking the ratio of the EPD Hp(10) readings with the expected Hp(10) readings and a two-tailed z-test was used to determine the significance of the ratio deviating away from unity. The contribution from backscatter was calculated by taking the ratio of the EPD Hp(10) readings with and without backscatter material. A paired, two-tailed t-test was used to determine the significance of change in EPD Hp(10) readings. The RAD-60R mean energy response at 140 keV was 0.85, and agreed to within 5% and 11% at 364 and 511 keV, respectively. The PD-10i mean energy response at 140 keV was 1.20, and agreed to within 5% at 364 and 511 keV, respectively. On average, in the presence of acrylic, RAD-60R values increased by 32%, 12%, and 14%, at 140, 364, and 511 keV, respectively; all increases were statistically significant. The PD-10i increased by 25%, 19%, and 10% at 140 keV, 364 keV, and 511 keV, respectively; however, only the 140 keV measurement was statistically significant. Although both EPD models performed within the manufacturers' specifications of ± 25% in the energy ranges used, they fell outside of our criteria of 10% at lower energies, suggesting the need to calculate energy-dependent correction factors, depending on the intended EPD use.
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Affiliation(s)
- Joseph Meier
- The University of Texas MD Anderson Cancer Center.
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Mikell JK, Mahvash A, Siman W, Mourtada F, Kappadath SC. Comparing voxel-based absorbed dosimetry methods in tumors, liver, lung, and at the liver-lung interface for (90)Y microsphere selective internal radiation therapy. EJNMMI Phys 2015; 2:16. [PMID: 26501817 PMCID: PMC4538912 DOI: 10.1186/s40658-015-0119-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/07/2015] [Indexed: 11/08/2022] Open
Abstract
Background To assess differences between four different voxel-based dosimetry methods (VBDM) for tumor, liver, and lung absorbed doses following 90Y microsphere selective internal radiation therapy (SIRT) based on 90Y bremsstrahlung SPECT/CT, a secondary objective was to estimate the sensitivity of liver and lung absorbed doses due to differences in organ segmentation near the liver-lung interface. Methods Investigated VBDM were Monte Carlo (MC), soft-tissue kernel with density correction (SKD), soft-tissue kernel (SK), and local deposition (LD). Seventeen SIRT cases were analyzed. Mean absorbed doses (\documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯) were calculated for tumor, non-tumoral liver (NL), and right lung (RL). Simulations with various SPECT spatial resolutions (FHWMs) and multiple lung shunt fractions (LSs) estimated the accuracy of VBDM at the liver-lung interface. Sensitivity of patient RL and NL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ on segmentation near the interface was assessed by excluding portions near the interface. Results SKD, SK, and LD were within 5 % of MC for tumor and NL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯. LD and SKD overestimated RL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ compared to MC on average by 17 and 20 %, respectively; SK underestimated RL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ on average by −60 %. Simulations (20 mm FWHM, 20 % LS) showed that SKD, LD, and MC were within 10 % of the truth deep (>39 mm) in the lung; SK significantly underestimated the absorbed dose deep in the lung by approximately −70 %. All VBDM were within 10 % of truth deep (>12 mm) in the liver. Excluding 1, 2, and 3 cm of RL near the interface changed the resulting RL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ by −22, −38, and −48 %, respectively, for all VBDM. An average change of −7 % in the NL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ was realized when excluding 3 cm of NL from the interface. \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ was realized when excluding 3 cm of NL from the interface. Conclusions SKD, SK, and LD are equivalent to MC for tumor and NL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯. SK underestimates RL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ relative to MC whereas LD and SKD overestimate. RL \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{AD} $$\end{document}AD¯ is strongly influenced by the liver-lung interface.
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Affiliation(s)
- Justin K Mikell
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX, 77030, USA.,The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy Siman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX, 77030, USA.,The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | | | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX, 77030, USA. .,The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.
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Siman W, Silosky M, Kappadath SC. A revised monitor source method for practical deadtime count loss compensation in clinical planar and SPECT studies. Phys Med Biol 2015; 60:1199-216. [DOI: 10.1088/0031-9155/60/3/1199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE This paper evaluates the effects of computed tomography (CT) image noise and artifacts on quantitative single-photon emission computed-tomography (SPECT) imaging, with the aim of establishing an appropriate range of CT acquisition parameters for low-dose protocols with respect to accurate SPECT attenuation correction (AC). METHODS SPECT images of two geometric and one anthropomorphic phantom were reconstructed iteratively using CT scans acquired at a range of dose levels (CTDIvol = 0.4 to 46 mGy). Resultant SPECT image quality was evaluated by comparing mean signal, background noise, and artifacts to SPECT images reconstructed using the highest dose CT for AC. Noise injection was performed on linear-attenuation (μ) maps to determine the CT noise threshold for accurate AC. RESULTS High levels of CT noise (σ ∼ 200-400 HU) resulted in low μ-maps noise (σ ∼ 1%-3%). Noise levels greater than ∼ 10% in 140 keV μ-maps were required to produce visibly perceptible increases of ∼ 15% in (99m)Tc SPECT images. These noise levels would be achieved at low CT dose levels (CTDIvol = 4 μGy) that are over 2 orders of magnitude lower than the minimum dose for diagnostic CT scanners. CT noise could also lower (bias) the expected μ values. The relative error in reconstructed SPECT signal trended linearly with the relative shift in μ. SPECT signal was, on average, underestimated in regions corresponding with beam-hardening artifacts in CT images. Any process that has the potential to change the CT number of a region by ∼ 100 HU (e.g., misregistration between CT images and SPECT images due to motion, the presence of contrast in CT images) could introduce errors in μ140 keV on the order of 10%, that in turn, could introduce errors on the order of ∼ 10% into the reconstructed (99m)Tc SPECT image. CONCLUSIONS The impact of CT noise on SPECT noise was demonstrated to be negligible for clinically achievable CT parameters. Because CT dose levels that affect SPECT quantification is low (CTDIvol ∼ 4 μGy), the low dose limit for the CT exam as part of SPECT/CT will be guided by CT image quality requirements for anatomical localization and artifact reduction. A CT technique with higher kVp in combination with lower mAs is recommended when low-dose CT images are used for AC to minimize beam-hardening artifacts.
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Affiliation(s)
- K W Hulme
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences, Houston, Texas 77030
| | - S C Kappadath
- Department of Imaging Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030 and The University of Texas Graduate School of Biomedical Sciences, Houston, Texas 77030
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Gress DA, Kappadath SC. SU-E-I-06: A Robust and Improved Method of Analysis for Dose Calibrator Linearity Data Based On First Principles. Med Phys 2014. [DOI: 10.1118/1.4887954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mikell J, Mourtada F, Mahvash A, Kappadath SC. Characterization of tumor dose heterogeneity for 90Y microsphere therapies using voxel- based dosimetry. Int J Cancer Ther Oncol 2014. [DOI: 10.14319/ijcto.0202.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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50
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Mikell J, Kappadath SC. Voxel-based partial volume correction for accurate quantitative voxel values. Int J Cancer Ther Oncol 2014. [DOI: 10.14319/ijcto.0202.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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