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Fragoso Costa P, Shi K, Holm S, Vidal-Sicart S, Kracmerova T, Tosi G, Grimm J, Visvikis D, Knapp WH, Gnanasegaran G, van Leeuwen FWB. Surgical radioguidance with beta-emitting radionuclides; challenges and possibilities: A position paper by the EANM. Eur J Nucl Med Mol Imaging 2024; 51:2903-2921. [PMID: 38189911 PMCID: PMC11300492 DOI: 10.1007/s00259-023-06560-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
Radioguidance that makes use of β-emitting radionuclides is gaining in popularity and could have potential to strengthen the range of existing radioguidance techniques. While there is a strong tendency to develop new PET radiotracers, due to favorable imaging characteristics and the success of theranostics research, there are practical challenges that need to be overcome when considering use of β-emitters for surgical radioguidance. In this position paper, the EANM identifies the possibilities and challenges that relate to the successful implementation of β-emitters in surgical guidance, covering aspects related to instrumentation, radiation protection, and modes of implementation.
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Affiliation(s)
- Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Essen, Germany.
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Computer Aided Medical Procedures and Augmented Reality, Institute of Informatics I16, Technical University of Munich, Munich, Germany
| | - Soren Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Tereza Kracmerova
- Department of Medical Physics, Motol University Hospital, Prague, Czech Republic
| | - Giovanni Tosi
- Department of Medical Physics, Ospedale U. Parini, Aosta, Italy
| | - Jan Grimm
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Wolfram H Knapp
- Department of Nuclear Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gopinath Gnanasegaran
- Institute of Nuclear Medicine, University College London Hospital, Tower 5, 235 Euston Road, London, NW1 2BU, UK
- Royal Free London NHS Foundation Trust Hospital, London, UK
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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2
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Bertani E, Mattana F, Collamati F, Ferrari ME, Bagnardi V, Frassoni S, Pisa E, Mirabelli R, Morganti S, Fazio N, Fumagalli Romario U, Ceci F. Radio-Guided Surgery with a New-Generation β-Probe for Radiolabeled Somatostatin Analog, in Patients with Small Intestinal Neuroendocrine Tumors. Ann Surg Oncol 2024; 31:4189-4196. [PMID: 38652200 DOI: 10.1245/s10434-024-15277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Radio-guided surgery (RGS) holds promise for improving surgical outcomes in neuroendocrine tumors (NETs). Previous studies showed low specificity (SP) using γ-probes to detect radiation emitted by radio-labeled somatostatin analogs. OBJECTIVE We aimed to assess the sensitivity (SE) and SP of the intraoperative RGS approach using a β-probe with a per-lesion analysis, while assessing safety and feasibility as secondary objectives. METHODS This prospective, single-arm, single-center, phase II trial (NCT05448157) enrolled 20 patients diagnosed with small intestine NETs (SI-NETs) with positive lesions detected at 68Ga-DOTA-TOC positron emission tomography/computed tomography (PET/CT). Patients received an intravenous injection of 1.1 MBq/Kg of 68Ga-DOTA-TOC 10 min prior to surgery. In vivo measurements were conducted using a β-probe. Receiver operating characteristic (ROC) analysis was performed, with the tumor-to-background ratio (TBR) as the independent variable and pathology result (cancer vs. non-cancer) as the dependent variable. The area under the curve (AUC), optimal TBR, and absorbed dose for the surgery staff were reported. RESULTS The intraoperative RGS approach was feasible in all cases without adverse effects. Of 134 specimens, the AUC was 0.928, with a TBR cut-off of 1.35 yielding 89.3% SE and 86.4% SP. The median absorbed dose for the surgery staff was 30 µSv (range 12-41 µSv). CONCLUSION This study reports optimal accuracy in detecting lesions of SI-NETs using the intraoperative RGS approach with a novel β-probe. The method was found to be safe, feasible, and easily reproducible in daily clinical practice, with minimal radiation exposure for the staff. RGS might potentially improve radical resection rates in SI-NETs. CLINICAL TRIALS REGISTRATION 68Ga-DOTATOC Radio-Guided Surgery with β-Probe in GEP-NET (RGS GEP-NET) [NCT0544815; https://classic. CLINICALTRIALS gov/ct2/show/NCT05448157 ].
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Affiliation(s)
- Emilio Bertani
- Neuroendocrine Surgery Tumor Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy.
- Division of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Francesco Mattana
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mahila E Ferrari
- Division of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Eleonora Pisa
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Riccardo Mirabelli
- Istituto Nazionale di Fisica Nucleare INFN, Sezione di Roma, Rome, Italy
- Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, Rome, Italy
| | - Silvio Morganti
- Istituto Nazionale di Fisica Nucleare INFN, Sezione di Roma, Rome, Italy
| | - Nicola Fazio
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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3
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Collarino A, Florit A, Bizzarri N, Lanni V, Morganti S, De Summa M, Vizzielli G, Fanfani F, Mirabelli R, Ferrandina G, Scambia G, Rufini V, Faccini R, Collamati F. Radioguided surgery with β decay: A feasibility study in cervical cancer. Phys Med 2023; 113:102658. [PMID: 37603908 DOI: 10.1016/j.ejmp.2023.102658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE Radioguided surgery (RGS) is a technique that helps the surgeon to achieve a tumour resection as complete as possible, by means of the intraoperative detection of particles emitted by a radiotracer that bounds to tumoural cells. This study aimed to investigate the applicability of β-RGS for tumour resection and margin assessment in cervical cancer patients preoperatively injected with [18F]FDG, by means of Monte Carlo simulations. METHODS Patients were retrospectively included if they had a recurrent or persistent cervical cancer, underwent preoperative PET/CT to exclude distant metastases and received radical surgery. All PET/CT images were analysed extracting tumour SUVmax, background SUVmean and tumour-to-non-tumour ratio. These values were used to obtain the expected count rate in a realistic surgical scenario by means of a Monte Carlo simulation of the β probe, assuming the injection of 2 MBq/kg of [18F]FDG 60 min before surgery. RESULTS Thirty-eight patients were included. A measuring time of ∼2-3 s is expected to be sufficient for discriminating the tumour from background in a given lesion, being this the time the probe has to be over the sample in order to be able to discriminate tumour from healthy tissue with a sensitivity of ∼99% and a specificity of at least 95%. CONCLUSION This study presents the first step towards a possible application of our β-RGS technique in cervical cancer. Results suggest that this approach to β-RGS could help surgeons distinguish tumour margins from surrounding healthy tissue, even in a setting of high radiotracer background activity.
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Affiliation(s)
- Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Anita Florit
- Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicolò Bizzarri
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio Lanni
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvio Morganti
- National Institute of Nuclear Physics (INFN), Section of Rome, Rome, Italy
| | - Marco De Summa
- PET/CT Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vizzielli
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Mirabelli
- National Institute of Nuclear Physics (INFN), Section of Rome, Rome, Italy; Department of Basic and Applied Sciences for Engineering, Sapienza Università di Roma, Rome, Italy.
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Faccini
- National Institute of Nuclear Physics (INFN), Section of Rome, Rome, Italy; Physics Department, Sapienza Università di Roma, Rome, Italy
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4
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Mirabelli R, Morganti S, Cartoni A, De Simoni M, Faccini R, Fischetti M, Giordano A, Scotognella T, Solfaroli-Camillocci E, Collamati F. Characterization and optimization of a β detector for 18F radio-guided surgery. Phys Med 2023; 108:102545. [PMID: 37021607 DOI: 10.1016/j.ejmp.2023.102545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
Radio-Guided Surgery (RGS) is a nuclear medicine technique to support the surgeon during surgery towards a complete tumor resection. It is based on intraoperative detection of radiation emitted by a radio-pharmaceutical that bounds selectively to tumoral cells. In the past years, an approach that exploits β- emitting radiotracers has been pursued to overtake some limitations of the traditional RGS based on γ emission. A particle detector dedicated to this application, demonstrating very high efficiency to β- particles and remarkable transparency to photons, has been thus developed. As a by-product, its characteristics suggested the possibility to utilize it with β+ emitting sources, more commonly in use in nuclear medicine. In this paper, performances of such detector on 18F liquid sources are estimated by means of Monte Carlo simulations (MC) and laboratory measurements. The experimental setup with a 18F saline solution comprised a "positron signal" spot (a 7 × 10 mm cylinder representing the tumor residual), and a surrounding "far background" volume, that represented for the detector an almost isotropic source of annihilation photons. Experimental results show good agreement with MC predictions, thus confirming the expected performances of the detector with 18F, and the validity of the developed MC simulation as a tool to predict the gamma background determined by a diffuse source of annihilation photons.
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Affiliation(s)
- R Mirabelli
- Department of Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - S Morganti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - A Cartoni
- Department of Chemistry, Sapienza Università di Roma, Rome, Italy
| | - M De Simoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Department of Medical Physics Ludwig-Maximilians- Universität München (LMU) Munich, Germany
| | - R Faccini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Department of Physics, Sapienza Università di Roma, Rome, Italy
| | - M Fischetti
- Department of Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy
| | - A Giordano
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istitute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Scotognella
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - F Collamati
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy.
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5
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Gonzalez‐Montoro A, Vera‐Donoso CD, Konstantinou G, Sopena P, Martinez M, Ortiz JB, Carles M, Benlloch JM, Gonzalez AJ. Nuclear-medicine probes: Where we are and where we are going. Med Phys 2022; 49:4372-4390. [PMID: 35526220 PMCID: PMC9545507 DOI: 10.1002/mp.15690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Nuclear medicine probes turned into the key for the identification and precise location of sentinel lymph nodes and other occult lesions (i.e., tumors) by using the systemic administration of radiotracers. Intraoperative nuclear probes are key in the surgical management of some malignancies as well as in the determination of positive surgical margins, thus reducing the extent and potential surgery morbidity. Depending on their application, nuclear probes are classified into two main categories, namely, counting and imaging. Although counting probes present a simple design, are handheld (to be moved rapidly), and provide only acoustic signals when detecting radiation, imaging probes, also known as cameras, are more hardware-complex and also able to provide images but at the cost of an increased intervention time as displacing the camera has to be done slowly. This review article begins with an introductory section to highlight the relevance of nuclear-based probes and their components as well as the main differences between ionization- (semiconductor) and scintillation-based probes. Then, the most significant performance parameters of the probe are reviewed (i.e., sensitivity, contrast, count rate capabilities, shielding, energy, and spatial resolution), as well as the different types of probes based on the target radiation nature, namely: gamma (γ), beta (β) (positron and electron), and Cherenkov. Various available intraoperative nuclear probes are finally compared in terms of performance to discuss the state-of-the-art of nuclear medicine probes. The manuscript concludes by discussing the ideal probe design and the aspects to be considered when selecting nuclear-medicine probes.
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Affiliation(s)
- Andrea Gonzalez‐Montoro
- Instituto de Instrumentación para Imagen Molecular (I3M)Centro Mixto CSIC Universitat Politècnica de ValènciaValenciaSpain
| | | | | | - Pablo Sopena
- Servicio de Medicina NuclearÁrea clínica de Imagen Médica, La Fe HospitalValenciaSpain
| | | | | | | | - Jose Maria Benlloch
- Instituto de Instrumentación para Imagen Molecular (I3M)Centro Mixto CSIC Universitat Politècnica de ValènciaValenciaSpain
| | - Antonio Javier Gonzalez
- Instituto de Instrumentación para Imagen Molecular (I3M)Centro Mixto CSIC Universitat Politècnica de ValènciaValenciaSpain
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6
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Collamati F, van Oosterom MN, Hadaschik BA, Fragoso Costa P, Darr C. Beta radioguided surgery: towards routine implementation? THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:229-243. [PMID: 34014062 DOI: 10.23736/s1824-4785.21.03358-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional limitations of the patient. Furthermore, the presence of residual tumor tissue following conservative surgical treatment is currently a common cause of locally recurrent cancer or of distant metastases. Reliable intraoperative detection of small cancerous tissue would allow surgeons to selectively resect malignant areas: this task can be achieved by means of image-guided surgery, such as beta radioguided surgery (RGS). EVIDENCE ACQUISITION In this paper, a comprehensive review of beta RGS is given, starting from the physical principles that differentiate beta from gamma radiation, that has already its place in nuclear medicine current practice. Also, the recent clinical feasibility of using Cerenkov radiation is discussed. EVIDENCE SYNTHESIS Despite being first proposed several decades ago, only in the last years a remarkable interest in beta RGS has been observed, probably driven by the diffusion of PET radio tracers. Today several different approaches are being pursued to assess the effectiveness of such a technique, including both beta+ and beta- emitting radiopharmaceuticals. CONCLUSIONS Beta RGS shows some peculiarities that can present it as a very promising complementary technique to standard procedures. Good results are being obtained in several tests, both ex vivo and in vivo. This might however be the time to initiate the trials to demonstrate the real clinical value of these technologies with seemingly clear potential.
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Affiliation(s)
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Boris A Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Pedro Fragoso Costa
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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7
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Bertani E, Collamati F, Colandrea M, Faccini R, Fazio N, Ferrari ME, Fischetti M, Fumagalli Romario U, Funicelli L, De Simoni M, Mancini-Terracciano C, Mirabelli R, Morganti S, Papi S, Pisa E, Solfaroli-Camillocci E, Spada F, Cremonesi M, Grana CM. First Ex Vivo Results of β --Radioguided Surgery in Small Intestine Neuroendocrine Tumors with 90Y-DOTATOC. Cancer Biother Radiopharm 2021; 36:397-406. [PMID: 33601932 DOI: 10.1089/cbr.2020.4487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: In neuroendocrine tumor (NET), complete surgery could better the prognosis. Radioguided surgery (RGS) with β--radioisotopes is a novel approach focused on developing a new probe that, detecting electrons and operating with low background, provides a clearer delineation of the lesions with low radiation exposition for surgeons. As a first step to validate this procedure, ex vivo specimens of tumors expressing somatostatin receptors, as small intestine neuroendocrine tumor (SI-NET), were tested. Materials and Methods: SI-NET presents a high uptake of a beta-emitting radiotracer, 90Y-DOTATOC. Five SI-NET patients were enrolled after performing a 68Ga-DOTATOC positron emission tomography/computed tomography (CT) and a CT enterography; 24 h before surgery, they received 5 mCi of 90Y-DOTATOC. Results: Surgery was performed as routine. Tumors and surrounding tissue were sectioned in different samples and examined ex vivo with the beta-detecting probe. All the tumor samples showed high counts of radioactivity that was up to a factor of 18 times higher than the corresponding cutoff value, with a sensitivity of 96% and a specificity of 100%. Conclusions: These first ex vivo RGS tests showed that this probe can discriminate very effectively between tumor and healthy tissues by the administration of low activities of 90Y-DOTATOC, allowing more precise surgery.
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Affiliation(s)
- Emilio Bertani
- Division of Digestive Surgery, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | | | - Marzia Colandrea
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Riccardo Faccini
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Nicola Fazio
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Mahila E Ferrari
- Medical Physics, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Marta Fischetti
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Scienze di Base Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | | | - Luigi Funicelli
- Division of Radiology, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Micol De Simoni
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Carlo Mancini-Terracciano
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Riccardo Mirabelli
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Silvio Morganti
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy
| | - Stefano Papi
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Eleonora Pisa
- Division of Pathology, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Elena Solfaroli-Camillocci
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Scuola di specializzazione in Fisica Medica, Sapienza Università di Roma, Roma, Italy
| | - Francesca Spada
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Marta Cremonesi
- Medical Physics, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Chiara M Grana
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
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8
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Feasibility study on the use of CMOS sensors as detectors in radioguided surgery with β -- emitters. Appl Radiat Isot 2020; 165:109347. [PMID: 32938536 DOI: 10.1016/j.apradiso.2020.109347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/16/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
Abstract
Radioguided surgery (RGS) is a medical practice which thanks to a radiopharmaceutical tracer and a probe allows the surgeon to identify tumor residuals up to a millimetric resolution in real-time. The employment of β- emitters, instead of γ or β+, reduces background from healthy tissues, administered activity to the patient, and medical exposure. In a previous work the possibility of using a CMOS Imager (Aptina MT9V011), initially designed for visible light imaging, to detect β- from 90Y or 90Sr sources has been established. Because of its possible application as counting probe in RGS, the performances of MT9V011 in clinical-like conditions were studied.1 Through horizontal scans on a collimated 90Sr source of different sizes (1, 3, 5, 7 mm), we have determined relationships between scan fit parameters and the source dimension, namely A quadratic correlation and a linear dependency of, respectively, signal integrated over scan interval, and maximum signal against source diameter, are determined. Horizontal scan measurements on a source, interposing collimators of different size, aim to determine relationships or correlations between scan fit parameters and source dimension. A quadratic correlation and a linear dependency of, respectively, signal integrated over scan interval, and maximum signal against source diameter are determined. In order to get closer to clinical conditions, agar-agar phantoms containing 90Y with different dimensions and activities were prepared. A 90Y phantom is characterized by a central spot and a ring all around, for simulating both signal (tumor) and background (surrounding healthy tissue). The relationship found between scan maximum and 90Sr source diameter is then exploited to extract the concentration ratio between spot and external ring of the 90Y phantom. This observable, defined as the ratio between the tumor and the nearby healthy tissues uptake simulates the Tumor-to-Non-tumor Ratio (TNR). With the aim of evaluating the sensor's ability to discriminate signal from background relying on the significance parameter, a further 90Y phantom, featuring a well-known and clinical-like activity will mimic the signal only condition. This result is used to extrapolate to different source sizes, after having estimated the background for various TNR. The obtained significance values suggest that the MT9V011 sensor is capable of distinguishing a signal from an estimated background, depending on the interplay among TNR, acquisition time and tumor diameter.
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9
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Morganti S, Bertani E, Bocci V, Colandrea M, Collamati F, Cremonesi M, De Simoni M, Ferrari E, Fischetti M, Funicelli L, Grana CM, Mancini-Terracciano C, Mirabelli R, Papi S, Pisa E, Solfaroli-Camillocci E, Traini G, Faccini R. Tumor-non-tumor discrimination by a β - detector for Radio Guided Surgery on ex-vivo neuroendocrine tumors samples. Phys Med 2020; 72:96-102. [PMID: 32247965 DOI: 10.1016/j.ejmp.2020.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 01/06/2023] Open
Abstract
This paper provides a first insight of the potential of the β- Radio Guided Surgery (β--RGS) in a complex surgical environment like the abdomen, where multiple sources of background concur to the signal at the tumor site. This case is well reproduced by ex-vivo samples of 90Y-marked Gastro-Entero-Pancreatic Neuroendocrine Tumors (GEP NET) in the bowel. These specimens indeed include at least three wide independent sources of background associated to three anatomical districts (mesentery, intestine, mucose). The study is based on the analysis of 37 lesions found on 5 samples belonging to 5 different patients. We show that the use of electrons, a short range particle, instead of γ particles, allows to limit counts read on a lesion to the sum of the tumor signal plus the background generated by the sole hosting district.The background on adjacent districts in the same specimen/patient is found to differ up to a factor 4, showing how the specificity and sensitivity of the β--RGS technique can be fully exploited only upon a correct measurement of the contributing background. This locality has been used to set a site-specific cut-off algorithm to discriminate tumor and healthy tissue with a specificity of 100% and a sensitivity, on this test data sample, close to 100%. Factors influencing the sensitivity are also discussed. One of the specimens set allowed us evaluate the volume of the lesions, thus concluding that the probe was able to detect lesions as small as 0.04 mL in that particular case.
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Affiliation(s)
- S Morganti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - E Bertani
- Division of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - V Bocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - M Colandrea
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Collamati
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy.
| | - M Cremonesi
- Radiation Research Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M De Simoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
| | - E Ferrari
- Division of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Fischetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy
| | - L Funicelli
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C M Grana
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Mancini-Terracciano
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
| | - R Mirabelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - S Papi
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Pisa
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Solfaroli-Camillocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Scuola di Specializzazione in Fisica Medica, Sapienza Università di Roma, Rome, Italy
| | - G Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - R Faccini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
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10
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Collamati F, Maccora D, Alfieri S, Bocci V, Cartoni A, Collarino A, Simoni MD, Fischetti M, Fratoddi I, Giordano A, Mancini-Terracciano C, Mirabelli R, Morganti S, Quero G, Rotili D, Scotognella T, Solfaroli Camillocci E, Traini G, Venditti I, Faccini R. Radioguided surgery with β - radiation in pancreatic Neuroendocrine Tumors: a feasibility study. Sci Rep 2020; 10:4015. [PMID: 32132632 PMCID: PMC7055212 DOI: 10.1038/s41598-020-61075-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/13/2020] [Indexed: 01/06/2023] Open
Abstract
The possibility to use β- decaying isotopes for radioguided surgery (RGS) has been recently proposed, and first promising tests on ex-vivo samples of Meningioma and intestinal Neuroendocrine Tumor (NET) have been published. This paper reports a study of the uptake of 68Ga-DOTATOC in pancreatic NETs (pNETs) in order to assess the feasibility of a new RGS approach using 90Y-DOTATOC. Tumor and healthy pancreas uptakes were estimated from 68Ga-DOTATOC PET/CT scans of 30 patients with pNETs. From the obtained SUVs (Standardised Uptake Value) and TNRs (Tumor Non tumor Ratio), an analysis algorithm relying on a Monte Carlo simulation of the detector has been applied to evaluate the performances of the proposed technique. Almost all considered patients resulted to be compatible with the application of β--RGS assuming to administer 1.5 MBq/kg of activity of 90Y-DOTATOC 24 h before surgery, and a sampling time of few seconds. In just 2 cases the technique would have required a mildly increased amount of activity or of sampling time. Despite a high physiological uptake of 68Ga-DOTATOC in the healthy pancreas, the proposed RGS technique promises to be effective. This approach allows RGS to find application also in pancreatic diseases, where traditional techniques are not viable.
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Affiliation(s)
| | - Daria Maccora
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit CRMPG, A. Gemelli Hospital IRCCS of Rome, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Valerio Bocci
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
| | - Antonella Cartoni
- Chemistry Dep of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Micol De Simoni
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Marta Fischetti
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- SBAI Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Ilaria Fratoddi
- Chemistry Dep of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Alessandro Giordano
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Carlo Mancini-Terracciano
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy.
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy.
| | - Riccardo Mirabelli
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
- Centro Studi e Ricerche E. Fermi, Rome, Italy
| | | | - Giuseppe Quero
- Digestive Surgery Unit CRMPG, A. Gemelli Hospital IRCCS of Rome, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Dante Rotili
- Department of Chemistry and Technologies of Drugs of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Teresa Scotognella
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Elena Solfaroli Camillocci
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
- Specialty School of Medical Physics of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Giacomo Traini
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
- Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - Iole Venditti
- Sciences Dep. of "Roma Tre" University, Viale G. Marconi 446, 00146, Rome, Italy
| | - Riccardo Faccini
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
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11
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CdTe compact gamma camera for coded aperture imaging in radioguided surgery. Phys Med 2020; 69:223-232. [DOI: 10.1016/j.ejmp.2019.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 11/20/2022] Open
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12
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Collamati F, Moretti R, Alunni-Solestizi L, Bocci V, Cartoni A, Collarino A, De Simoni M, Faccini R, Fischetti M, Giordano A, Maccora D, Mancini-Terracciano C, Mirabelli R, Scotognella T, Solfaroli-Camillocci E, Traini G, Morganti S. Characterisation of a β detector on positron emitters for medical applications. Phys Med 2019; 67:85-90. [PMID: 31704391 DOI: 10.1016/j.ejmp.2019.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Radio Guided Surgery (RGS) is a technique that helps the surgeon to achieve an as complete as possible tumor resection, thanks to the intraoperative detection of particles emitted by a radio tracer that bounds to tumoral cells. In the last years, a novel approach to this technique has been proposed that, exploiting β- emitting radio tracers, overtakes some limitations of established γ-RGS. In this context, a first prototype of an intraoperative β particle detector, based on a high light yield and low density organic scintillator, has been developed and characterised on pure β- emitters, like 90Y. The demonstrated very high efficiency to β- particles, together with the remarkable transparency to photons, suggested the possibility to use this detector also with β+ emitting sources, that have plenty of applications in nuclear medicine. In this paper, we present upgrades and optimisations performed to the detector to reveal such particles. METHODS Laboratory measurement have been performed on liquid Ga68 source, and were used to validate and tune a Monte Carlo simulation. RESULTS The upgraded detector has an ~80% efficiency to electrons above ~110keV, reaching a plateau value of ~95%. At the same time, the probe is substantially transparent to photons below ~200keV, reaching a plateau value of ~3%. CONCLUSIONS The new prototype seems to have promising characteristics to perform RGS also with β+ emitting isotopes.
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Affiliation(s)
- F Collamati
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - R Moretti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - L Alunni-Solestizi
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, Perugia, Italy
| | - V Bocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - A Cartoni
- Dipartimento di Chimica, Sapienza Università di Roma, Roma, Italy
| | - A Collarino
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy
| | - M De Simoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - R Faccini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - M Fischetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | - A Giordano
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy; Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Roma, Italy
| | - D Maccora
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy; Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Roma, Italy
| | | | - R Mirabelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - T Scotognella
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy
| | - E Solfaroli-Camillocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy; Scuola di Specializzazione in Fisica Medica, Sapienza Università di Roma, Roma, Italy.
| | - G Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - S Morganti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
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