A prototype of a portable TDCR system at ENEA

The Importance of Uncertainty Analysis and Traceable Measurements in Routine Quantitative 90Y-PET Molecular Radiotherapy: A Multicenter Experience

Molecular Radiation Therapy (MRT) is a valid therapeutic option for a wide range of malignancies, such as neuroendocrine tumors and liver cancers. In its practice, it is generally acknowledged that there is a need to evaluate the influence of different factors affecting the accuracy of dose estimates and to define the actions necessary to maintain treatment uncertainties at acceptable levels. The present study addresses the problem of uncertainty propagation in 90Y-PET quantification. We assessed the quantitative accuracy in reference conditions of three PET scanners (namely, Siemens Biograph mCT, Siemens Biograph mCT flow, and GE Discovery DST) available at three different Italian Nuclear Medicine centers. Specific aspects of uncertainty within the quantification chain have been addressed, including the uncertainty in the calibration procedure. A framework based on the Guide to the Expression of Uncertainty in Measurement (GUM) approach is proposed for modeling the uncertainty in the quantification processes, and ultimately, an estimation of the uncertainty achievable in clinical conditions is reported.

Test of a digitizer to process the pulse signal from the 3 photomultiplier tubes of a TDCR liquid scintillation counter

The BIPM is developing a new service for international key comparisons in radionuclide metrology. The system, called ESIR, is based on a liquid scintillation counter using the Triple-to-Double Coincidence Ratio (TDCR) technique. The aim is to produce an international reference that can be reproduced over several decades of time in order to compare the calibration capabilities of National Metrology Institutes (NMIs). The maintainability of the electronics performing the signal processing is a challenge. To ensure the long-term sustainability of the electronics, the strategy is to set up redundant systems including at least one digital electronics module. The analogue modules developed in the 1990s and 2000s are less and less maintained and digital electronics are increasingly available on the market. In this context, a digitizer was tested and its suitability for the TDCR measurements compared to the currently used module based on an analogue front-end. This first implementation directly linking the photomultiplier anode to the CAEN digitizer without any analogue preconditioning shows a significant loss of detection efficiency and a lower signal to noise ratio observed on distributions of single photoelectrons. Although the TDCR method can correct for these efficiency losses, the loss of symmetry between the channels is too great to provide a sufficiently robust measurement. The use of low-pass filters upstream of the ADC will be considered to make this digital measurement system more reliable.

Development of a portable TDCR system at NIM, China

In order to meet the demand of on-site measurement for radionuclides, a portable liquid scintillation TDCR system was developed at National Institute of Metrology (NIM), China. The system consists small size TDCR counter for the measurement of liquid scintillation sources, and digital electronics for pulse signal processing. The optical chamber adopts Teflon material with high diffuse reflection efficiency. Two independent signal processing solutions were used here for TDCR counting. One employed the on-line TDCR solution based on FPGA counting module named TDCR-DMCA, and the other adopted the off-line TDCR solution based on a stand-alone desktop digitizer of CAEN. Two solutions are applied to perform coincidence, dead-time and counting operations follow by MAC3 logic. The performance of the TDCR counting system was tested in benchmark comparison with the traditional custom-built TDCR counting system at NIM through activity measurements of ³H, ¹⁴C. Good agreement between these two systems was observed.

64Cu production by 14 MeV neutron beam

64Cu is an emerging radionuclide of great interest in personalized nuclear medicine. It is produced by a cyclotron via the reaction 64Ni(p,n)64Cu. This production method increased during the last decades, because small biomedical cyclotrons can be easily installed close to the nuclear medicine department of a hospital. As a matter of fact, 64Ni is a very expensive target material. For this reason, an alternative 64Cu production method was investigated at ENEA by using the quasi-monochromatic 14 MeV fusion neutron beam made available at the Frascati Neutron Generator (FNG) located at the ENEA – Frascati Research Center. In particular, two nuclear reactions were studied: 65Cu(n,2n)64Cu and 64Zn(n,p)64Cu. The radiochemical analysis of the activated samples was performed at the ENEA-NMLNWM laboratory located in ENEA-Casaccia Research Center. The activity measurements were carried out at the ENEA-INMRI, located in the ENEA-Casaccia Research Center, with high metrological level conditions and by assuring their traceability to the 64Cu primary activity standard here developed and maintained. A prediction of the 64Cu production by means of the high-brilliance 14 MeV neutron source named Sorgentina is also discussed.

Absorbed dose measurements from a 90Y radionuclide liquid solution using LiF:Mg,Cu,P thermoluminescent dosimeters

In the last few years there has been an increasing interest in the measurement of the absorbed dose from radionuclides, with special attention devoted to molecular radiotherapy treatments. In particular, the determination of the absorbed dose from beta emitting radionuclides in liquid solution poses a number of issues when dose measurements are performed using thermoluminescent dosimeters (TLD). Finite volume effect, i.e. the exclusion of radioactivity from the volume occupied by the TLD is one of these. Furthermore, TLDs need to be encapsulated into some kind of waterproof envelope that unavoidably contributes to beta particle attenuation during the measurement. The purpose of this study is twofold: I) to measure the absorbed dose to water, D_w, using LiF:Mg,Cu,P chips inside a PMMA cylindrical phantom filled with a homogenous ⁹⁰YCl₃ aqueous solution II) to assess the uncertainty budget related to D_w measurements. To this purpose, six cylindrical PMMA phantoms were manufactured at ENEA. Each phantom can host a waterproof PMMA stick containing 3 TLD chips encapsulated by a polystyrene envelope. The cylindrical phantoms were manufactured so that the radioactive liquid environment surrounds the whole stick. Finally, D_w measurements were compared with Monte Carlo (MC) calculations. The measurement of absorbed dose to water from ⁹⁰YCl₃ radionuclide solution using LiF:Mg,Cu,P TLDs turned out to be a viable technique, provided that all necessary correction factors are applied. Using this method, a relative combined standard uncertainty in the range 3.1-3.7% was obtained on each D_w measurement. The major source of uncertainty was shown to be TLDs calibration, with associated uncertainties in the range 0.7-2.2%. Comparison of measured and MC-calculated absorbed dose per emitted beta particle provided good results, with the two quantities being in the ratio 1.08.

Phantom validation of quantitative Y-90 PET/CT-based dosimetry in liver radioembolization

Background

PET/CT has recently been shown to be a viable alternative to traditional post-infusion imaging methods providing good quality images of ⁹⁰Y-laden microspheres after selective internal radiation therapy (SIRT). In the present paper, first we assessed the quantitative accuracy of ⁹⁰Y-PET using an anthropomorphic phantom provided with lungs, liver, spine, and a cylindrical homemade lesion located into the hepatic compartment. Then, we explored the accuracy of different computational approaches on dose calculation, including (I) direct Monte Carlo radiation transport using Raydose, (II) Kernel convolution using Philips Stratos, (III) local deposition algorithm, (IV) Monte Carlo technique (MCNP) considering a uniform activity distribution, and (V) MIRD (Medical Internal Radiation Dose) analytical approach. Finally, calculated absorbed doses were compared with those obtained performing measurements with LiF:Mg,Cu,P TLD chips in a liquid environment.

Results

Our results indicate that despite ⁹⁰Y-PET being likely to provide high-resolution images, the ⁹⁰Y low branch ratio, along with other image-degrading factors, may produce non-uniform activity maps, even in the presence of uniform activity. A systematic underestimation of the recovered activity, both for the tumor insert and for the liver background, was found. This is particularly true if no partial volume correction is applied through recovery coefficients. All dose algorithms performed well, the worst case scenario providing an agreement between absorbed dose evaluations within 20%. Average absorbed doses determined with the local deposition method are in excellent agreement with those obtained using the MIRD and the kernel-convolution dose calculation approach.

Finally, absorbed dose assessed with MC codes are in good agreement with those obtained using TLD in liquid solution, thus confirming the soundness of both calculation approaches. This is especially true for Raydose, which provided an absorbed dose value within 3% of the measured dose, well within the stated uncertainties.

Conclusions

Patient-specific dosimetry is possible even in a scenario with low true coincidences and high random fraction, as in ⁹⁰Y–PET imaging, granted that accurate absolute PET calibration is performed and acquisition times are sufficiently long. Despite Monte Carlo calculations seeming to outperform all dose estimation algorithms, our data provide a strong argument for encouraging the use of the local deposition algorithm for routine ⁹⁰Y dosimetry based on PET/CT imaging, due to its simplicity of implementation.

Comparison of 131I activity measurements at the NCBJ RC POLATOM and the ENEA-INMRI linked to the BIPM SIR system

A bilateral comparison between ENEA-INMRI (Italy) and NCBJ RC POLATOM (Poland) of ¹³¹I-solution activity measurements was organized in the year 2015 and piloted by POLATOM, which provided the sources for the comparison. The ¹³¹I master solution was standardized independently at both institutes by using Liquid Scintillation Counting and ionization chamber techniques. The ¹³¹I master solution was then sent by POLATOM to the BIPM International Reference System (SIR). The comparison was registered as an EURAMET.RI(II)-K2.I-131 key comparison allowing the ENEA-INMRI result to enter in the SIR database.

(18)F primary standard at ENEA-INMRI by three absolute techniques and calibration of a well-type IG11 ionization chamber

A new (18)F primary standardization carried out at ENEA-INMRI by three different absolute techniques, i.e. 4πγNaI(Tl)γ high-efficiency counting, TDCR and 4πβ(LS)-γ[NaI(Tl)] coincidence counting method, allowed the calibration of a fixed well-reentrant IG11 ionization chamber (IC), with an uncertainty lower than 1%, and to check the calibration factor of a portable well-type IC NPL-CRC model, previously calibrated. By the new standard the ENEA-INMRI was linked to the BIPM International Reference System (SIR) through the BIPM SIR Transfer Instrument (SIRTI).

Comparison of (18)F activity measurements at the VNIIM, NPL and the ENEA-INMRI using the SIRTI of the BIPM

In 2014, the first three comparisons of activity measurements of (18)F were carried out at the VNIIM, NPL and the ENEA-INMRI using the BIPM's Transfer Instrument of the International Reference System. The transfer instrument and the NMIs primary measurement methods are briefly described. The degrees of equivalence with the key comparison reference value defined in the frame of the corresponding SIR comparison have been evaluated. World-wide consistency of activity measurements of (18)F is demonstrated.