Comparison of internal dosimetry factors for three classes of adult computational phantoms with emphasis on I-131 in the thyroid

Dosimetric evaluation of 123I (Iodide) and 99mTc (Pertechnetate) in the thyroid of neonates using Cristy-Eckerman and Segars anatomical representations

Using the MIRD formalism, and the Cristy-Eckeman and Segars anthropomorphic representations, the absorbed dose in the thyroid of newborns, was calculated when ¹²³I (iodide) and ^99mTc (pertechnetate) are used during the diagnostic procedures. The dose results will allow exploring the dosimetric impact generated by the use of these radiopharmaceutical compounds and the use of two representations. Regardless the radiopharmaceutical compound and the anthropomorphic representation is the thyroid self-dose is the greatest, due to electrons emitted during the ¹²³I and ^99mTc radioisotopes. The relative difference in total dose to the newborn thyroid gland using the Cristy-Eckerman and Segars anthropomorphic representations for the compounds ¹²³I(iodide) and ^99mTc(pertechnetate) is 1.82%, and 1.33%, respectively. Regardless of the radiopharmaceutical compound, the replacement of Cristy-Eckerman by Segars phantom does not reflect significant changes in the estimated absorbed dose to the newborn thyroid. Regardless of the anthropomorphic representation, the lowest absorbed dose in newborn's thyroid is obtained when using ^99mTc (pertechnetate) is used due to the residence times.

Stylized versus voxel phantoms: quantification of internal organ chord length distances

Dosimetric calculations, whether for radiation protection or nuclear medicine applications, are greatly influenced by the use of computational models of humans, called anthropomorphic phantoms. As anatomical models of phantoms have evolved and expanded, thus has the need for quantifying differences among each of these representations that yield variations in organ dose coefficients, whether from external radiation sources or internal emitters. This work represents an extension of previous efforts to quantify the differences in organ positioning within the body between a stylized and voxel phantom series. Where prior work focused on the organ depth distribution vis-à-vis the surface of the phantom models, the work described here quantifies the intra-organ and inter-organ distributions through calculation of the mean chord lengths. The revised Oak Ridge National Laboratory stylized phantom series and the University of Florida/National Cancer Institute voxel phantom series including a newborn, 1-, 5-, 10- and 15 year old, and adult phantoms were compared. Organ distances in the stylized phantoms were computed using a ray-tracing technique available through Monte Carlo radiation transport simulations in MCNP6. Organ distances in the voxel phantom were found using phantom matrix manipulation. Quantification of differences in organ chord lengths between the phantom series displayed that the organs of the stylized phantom series are typically situated farther away from one another than within the voxel phantom series. The impact of this work was to characterize the intra-organ and inter-organ distributions to explain the variations in updated internal dose coefficient quantities (i.e. specific absorbed fractions) while providing relevant data defining the spatial and volumetric organ distributions in the phantoms for use in subsequent internal dosimetric computations, with prospective relevance to patient-specific individualized dosimetry, as well as informing machine learning definition of organs using these reference models.

Body-size-dependent Iodine-131Svalues

In a recent epidemiologic risk assessment on late health effects of patients treated with radioactive iodine (RAI), organ/tissue doses of the patients were estimated based on iodine-131Svalues derived from the reference computational phantoms of the International Commission on Radiological Protection (ICRP). However, the use of theSvalues based on the reference phantoms may lead to significant biases in the estimated doses of patients whose body sizes (height and weight) are significantly different from the reference body sizes. To fill this critical gap, we established a comprehensive dataset of body-size-dependent iodine-131Svalues (r_T← thyroid) for 30 radiosensitive target organs/tissues by performing Monte Carlo dose calculations coupled with a total of 212 adult male and female computational phantoms in different heights and weights. We observed that theSvalues tend to decrease with increasing body height; for example, theSvalue (gonads ← thyroid) of the 160 cm male phantom is about 3 times higher than that of the 190 cm male phantom at the 70 kg weight. We also observed that theSvalues tend to decrease with increasing body weight for some organs/tissues; for example, theSvalue (skin ← thyroid) of the 45 kg female phantom is about two times higher than that of the 130 kg female phantom at the 160 cm height. For other organs/tissues, which are relatively far from the thyroid, in contrast, theSvalues tend to increase with increasing body weight; for example, theSvalue (bladder ← thyroid) of the 45 kg female phantom is about 2 times lower than that of the 130 kg female phantom. Overall, the majority of the body-size-dependentSvalues deviated to within 25% from those of the reference phantoms. We believe that the use of body-size-dependentSvalues in dose reconstructions should help quantify the dosimetric uncertainty in epidemiologic investigations of RAI-treated patients.

Red Marrow Absorbed Dose Calculation in Thyroid Cancer Patient Using a Simplified Excel Spreadsheet

Objectives:

Absorbed dose to red marrow (D_rm) can be calculated using blood dosimetry. However, this method is laborious and invasive. Therefore, image-based dosimetry is the method of choice. Nonetheless, the commercial software is expensive. The goal of this work was to develop a simplified excel spreadsheet for image-based radioiodine red marrow dosimetry.

Methods:

The serial whole-body images (acquired at 2^nd, 6^th, 24^th, 48^th, and 72^th hours) of 29 patients from the routine pretherapeutic dosimetry protocol were retrospectively reanalyzed. The commercial OLINDA/EXM image-based dosimetry software was used to calculate the whole-body time-integrated activity coefficient (TIAC_WB) and D_rm [in terms of absorbed dose coefficient (d_rm)]. For the simplified excel spreadsheet, the whole-body count was obtained from the vendor-supplied software. Then, the TIAC_WB was computed by a fitting time-activity curve using an Excel function. S factor was taken from other publications and scaled according to the patient-specific mass. A comparison of the TIAC_WB and d_rm from both methods was done using a non-inferiority test using a paired t-test or the Wilcoxon signed-rank test.

Results:

The TIAC_WB showed no significant difference between both methods (p=0.243). The calculated D_rm from a simplified Excel spreadsheet was assumed to be statistically non-inferior to the commercial OLINDA/EXM image-based dosimetry software with the non-inferiority margin of 0.02 (p<0.05).

Conclusion:

The dose assessment from a simplified Excel spreadsheet is feasible and relatively low cost compared to the commercial OLINDA/EXM image-based dosimetry software.

INVESTIGATION OF THE INFLUENCE OF THYROID LOCATION ON IODINE-131 S VALUES

The use of iodine-131 S values based on reference computational phantoms with fixed thyroid model may lead to significant dosimetric errors in patients who may have different thyroid location from the reference phantoms. In the present study, we investigated individual thyroid location variation by examining the computed tomography image sets of 40 adult male and female patients. Subsequently, the thyroid location of the adult male and female mesh-type reference phantoms of the International Commission on Radiological Protection (ICRP) was adjusted to match each the highest, mean and the lowest locations of the thyroid observed in this dataset. The thyroid-adjusted phantoms were implemented into the Geant4 Monte Carlo code to calculate thyroid location-dependent iodine-131 S values (rT ← thyroid) for a total of 30 target regions. The maximum variation among the observed thyroid locations was 39 mm and 36 mm for male and female patients, respectively. The mean thyroid locations of both male and female patients showed a good agreement with the ICRP reference phantoms. The thyroid location-dependent Iodine-131 S values were significantly different from the reference phantoms for most target regions by up to a factor of 3. The use of thyroid location-dependent S values in dose reconstructions should help quantify the dosimetric uncertainty in epidemiologic investigations of patients receiving iodine-131 therapy for hyperthyroidism and thyroid cancer.

A Monte Carlo-based analytic model of neutron dose equivalent for a mevion gantry-mounted passively scattered proton system for craniospinal irradiation

PURPOSE

To calculate in- and out-of-field neutron spectra and dose equivalent, using Monte Carlo (MC) simulation, for a Mevion gantry-mounted passively scattered proton system in craniospinal irradiation. An analytical model based on the MC calculations that estimates in- and out-of-field neutron dose equivalent from proton Craniospinal irradiation (CSI) was also developed.

METHODS

The MCNPX MC code was used to simulate a Mevion S250 proton therapy system. The simulated proton depth doses and profiles for pristine and spread-out Bragg peaks were benchmarked against the measured data. Previous measurements using extended-range Bonner spheres were used to verify the calculated neutron spectra and dose equivalent. Using the benchmarked results as a reference condition, a correction-based analytical model was reconstructed by fitting the data to derive model parameters at 95% confidence interval. Sensitivity analysis of brass aperture opening, thickness of the Lucite (PMMA) range compensator, and modulation width was performed to obtain correction parameters for nonreference conditions.

RESULTS

For the neutron dose equivalent per therapeutic proton dose, the MCNPX calculated dose equivalent matched the measured values to within 8%. The benchmarked neutron dose equivalent at the isocenter was 41.2 and 20.8 mSv/Gy, for cranial and spinal fields, respectively. For in- and out-of-field neutron dose calculations, the correction-based analytical model showed up to 17% discrepancy compared to the MC calculations. The correction factors may provide a conservative estimation of neutron dose, especially for depth ≤ 5 cm and regions underneath the brass aperture.

CONCLUSION

The proposed analytical model can be used to estimate the contribution of the neutron dose to the overall CSI treatment dose. Moreover, the model can be employed to estimate the neutron dose to the implantable cardiac electronic devices.

S VALUES FOR NEUROIMAGING PROCEDURES ON KOREAN PEDIATRIC AND ADULT HEAD COMPUTATIONAL PHANTOMS

Over the past decades, the application of single-photon emission computed tomography and positron emission tomography in neuroimaging has markedly increased. In the current study, we used a series of Korean computational head phantoms with detailed cranial structures for 6-, 9-, 12-, 15-y-old children and adult and a Monte Carlo transport code, MCNPX, to calculate age-dependent specific absorbed fraction (SAF) for mono-energetic electrons ranging from 0.01 to 4 MeV and S values for seven radionuclides widely used in nuclear medicine neuroimaging for the combination of ten source and target regions. Compared to the adult phantom, the 6-y phantom showed up to 1.7-fold greater SAF (cerebellum < cerebellum) and up to 1.4-fold greater S values (vitreous body < lens) for 123I. The electron SAF data, combined with our previous photon SAF data, will facilitate absorbed dose calculations for various cranial structures in patients undergoing neuroimaging procedures.

Red bone marrow dose estimation using several internal dosimetry models for prospective dosimetry-oriented radioiodine therapy

The aim of the present study was to review the available models developed for calculating red bone marrow dose in radioiodine therapy using clinical data. The study includes 18 patients (12 females and six males) with metastatic differentiated thyroid cancer. Radioiodine tracer of 73 ± 16 MBq ¹³¹I was orally administered, followed by blood sampling (2 ml) and whole-body scans (WBSs) done at several time points (2, 6, 24, 48, 72, and ≥ 96 h). Red bone marrow dose was estimated using the OLINDA/EXM 1.0, IDAC-Dose 2.1, and EANM models, the models developed by Shen and co-workers, Keizer and co-workers and Siegel and co-workers, and Traino and co-workers, as well as the single measurement model (SMM). The results were then compared to the standard reference model Revised Sgouros Model (RSM) reported by Wessels and co-workers. The mean dose deviations of the Traino, Siegel, Shen, Keizer, OLINDA/EXM, EANM, SMM, and IDAC-Dose 2.1 models from the RSM were - 17%, - 24%, 6%, - 29%, - 15%, 40%, 48%, and - 8%, respectively. The statistical analysis demonstrated no significant difference between the results obtained with the RSM and with those obtained with the Shen, Traino, OLINDA/EXM, and IDAC-Dose 2.1 models (t test; p_value > 0.05). However, a significant difference was found between RSM doses and those obtained with the EANM, SMM, and Keizer models (t test; p_value < 0.05). The correlation between red marrow dose from the SMM and EANM models was modest (R² = 0.65), while the crossfire dose calculated with the OLINDA/EXM and IDAC-Dose 2.1 models were in good agreement with each other and with the reference model. The findings obtained indicate that most of the dosimetry models can be used for a reliable dosimetry, and the calculated total body doses can be considered as a reliable non-invasive option for a conservative activity planning. In addition, the excellent performance of the IDAC-Dose 2.1 model will be of particular importance for a practical and accurate dosimetry, with the advantages of allowing for the use of realistic advanced phantoms and updated dose fractions, and of providing information about the blood dose contribution to the red bone marrow.

Dosimetric factors for diagnostic nuclear medicine procedures in a non-reference pregnant phantom

This study evaluates the impact of using non-reference fetal models on the fetal radiation dose from diagnostic radionuclide administration. The six-month pregnant phantoms including fetal models at the 10th and 90th growth percentiles were constructed at either end of the normal range around the 50th percentile and implemented in the Monte Carlo N-Particle code version MCNPX 2.6. This code has then been used to evaluate the ^99mTc S factors of the target organs of interest, as this is the most commonly used radionuclide in nuclear medicine procedures. Substantial variations were observed in the S factors between the 10th/90th percentile phantoms from the 50th percentile phantom, with the greatest difference being 38.6%. When the source organs were in close proximity to, or inside the fetal body, the ^99mTc S factors presented strong statistical correlations with fetal body habitus. The trends observed in the S factors and the differences between various percentiles were justified by the source organs' masses, and chord length distributions. The results of this study showed that fetal body habitus had a considerable effect on fetal dose (on average up to 8.4%) if constant fetal biokinetic data were considered for all fetal weight percentiles. However, a smaller variation on fetal dose (up to 5.3%) was obtained if the available biokinetic data for the reference fetus were scaled by fetal mass.

MCNPX CALCULATIONS OF SPECIFIC ABSORBED FRACTIONS IN SOME ORGANS OF THE HUMAN BODY DUE TO APPLICATION OF 133Xe, 99mTc and 81mKr RADIONUCLIDES

Monte Carlo simulations were performed to evaluate treatment doses with wide spread used radionuclides 133Xe, 99mTc and 81mKr. These different radionuclides are used in perfusion or ventilation examinations in nuclear medicine and as indicators for cardiovascular and pulmonary diseases. The objective of this work was to estimate the specific absorbed fractions in surrounding organs and tissues, when these radionuclides are incorporated in the lungs. For this purpose a voxel thorax model has been developed and compared with the ORNL phantom. All calculations and simulations were performed by means of the MCNP5/X code.

Assessment of the Absorbed Dose in the Kidney of Nuclear Nephrology Paediatric Patients using ICRP Biokinetic Data and Monte Carlo Simulations with Mass-Scaled Paediatric Voxel Phantoms

The aim of this work is to use Monte Carlo simulations and VOXEL phantoms to estimate the absorbed dose in paediatric patients (aged from 2 weeks to 16 y), with normal renal function, to whom technetium-99m-dimercaptosuccinic acid (99mTc-DMSA) was administered, for diagnostic renal scintigraphy purposes; and compare them with values obtained using the International Commission on Radiological Protection (ICRP) methodology. In the ICRP methodology, the cumulated absorbed dose in the kidneys is estimated by multiplying the administered activity with the corresponding given dose coefficients. The other methods were based on Monte Carlo simulations performed on two paediatric voxel phantoms (CHILD and BABY), and another three phantoms, which were modified to suit the mass of the patients' kidneys, and other anatomical factors. Different S-values were estimated using this methodology, which together with solving the ICRP biokinetic model to determine the cumulated activities, allowed for the estimation of absorbed doses different from those obtained with the ICRP method, together with new dose coefficients. The obtained values were then compared. The deviations suggest that the S-values are strongly dependent on the patient's total body weight, which could be in contrast with the ICRP data, which is provided by age, regardless of other anatomical parameters.

Model-based versus specific dosimetry in diagnostic context: comparison of three dosimetric approaches

PURPOSE

The dosimetric assessment of novel radiotracers represents a legal requirement in most countries. While the techniques for the computation of internal absorbed dose in a therapeutic context have made huge progresses in recent years, in a diagnostic scenario the absorbed dose is usually extracted from model-based lookup tables, most often derived from International Commission on Radiological Protection (ICRP) or Medical Internal Radiation Dose (MIRD) Committee models. The level of approximation introduced by these models may impact the resulting dosimetry. The aim of this work is to establish whether a more refined approach to dosimetry can be implemented in nuclear medicine diagnostics, by analyzing a specific case.

METHODS

The authors calculated absorbed doses to various organs in six healthy volunteers administered with flutemetamol ((18)F) injection. Each patient underwent from 8 to 10 whole body 3D PET/CT scans. This dataset was analyzed using a Monte Carlo (MC) application developed in-house using the toolkit gate that is capable to take into account patient-specific anatomy and radiotracer distribution at the voxel level. They compared the absorbed doses obtained with GATE to those calculated with two commercially available software: OLINDA/EXM and STRATOS implementing a dose voxel kernel convolution approach.

RESULTS

Absorbed doses calculated with gate were higher than those calculated with OLINDA. The average ratio between gate absorbed doses and OLINDA's was 1.38 ± 0.34 σ (from 0.93 to 2.23). The discrepancy was particularly high for the thyroid, with an average GATE/OLINDA ratio of 1.97 ± 0.83 σ for the six patients. Differences between STRATOS and GATE were found to be higher. The average ratio between GATE and STRATOS absorbed doses was 2.51 ± 1.21 σ (from 1.09 to 6.06).

CONCLUSIONS

This study demonstrates how the choice of the absorbed dose calculation algorithm may introduce a bias when gamma radiations are of importance, as is the case in nuclear medicine diagnostics.

S values for 131I based on the ICRP adult voxel phantoms

To improve the estimates of organ doses from nuclear medicine procedures using (131)I, the authors calculated a comprehensive set of (131)I S values, defined as absorbed doses in target tissues per unit of nuclear transition in source regions, for different source and target combinations. The authors used the latest reference adult male and female voxel phantoms published by the International Commission on Radiological Protection (ICRP Publication 110) and the (131)I photon and electron spectra from the ICRP Publication 107 to perform Monte Carlo radiation transport calculations using MCNPX2.7 to compute the S values. For each phantom, the authors simulated 55 source regions with an assumed uniform distribution of (131)I. They computed the S values for 42 target tissues directly, without calculating specific absorbed fractions. From these calculations, the authors derived a comprehensive set of S values for (131)I for 55 source regions and 42 target tissues in the ICRP male and female voxel phantoms. Compared with the stylised phantoms from Oak Ridge National Laboratory (ORNL) that consist of 22 source regions and 24 target regions, the new data set includes 1662 additional S values corresponding to additional combinations of source-target tissues that are not available in the stylised phantoms. In a comparison of S values derived from the ICRP and ORNL phantoms, the authors found that the S values to the radiosensitive tissues in the ICRP phantoms were 1.1 (median, female) and 1.3 (median, male) times greater than the values based on the ORNL phantoms. However, for several source-target pairs, the difference was up to 10-fold. The new set of S values can be applied prospectively or retrospectively to the calculation of radiation doses in adults internally exposed to (131)I, including nuclear medicine patients treated for thyroid cancer or hyperthyroidism.

Patient-specific dosimetry using pretherapy [¹²⁴I]m-iodobenzylguanidine ([¹²⁴I]mIBG) dynamic PET/CT imaging before [¹³¹I]mIBG targeted radionuclide therapy for neuroblastoma

PURPOSE

Iodine-131-m-iodobenzylguanidine ([(131)I]mIBG)-targeted radionuclide therapy (TRT) is a standard treatment for recurrent or refractory neuroblastoma with response rates of 30-40 %. The aim of this study is to demonstrate patient-specific dosimetry using quantitative [(124)I]mIBG positron emission tomography/X-ray computed tomography (PET/CT) imaging with a GEometry ANd Tracking 4 (Geant4)-based Monte Carlo method for better treatment planning.

PROCEDURES

A Monte Carlo dosimetry method was developed using the Geant4 toolkit with voxelized anatomical geometry and source distribution as input. The presegmented hybrid computational human phantoms developed by the University of Florida and the National Cancer Institute (UF/NCI) were used as a surrogate to characterize the anatomy of a given patient. S values for I-131 were estimated by the phantoms coupled with Geant4 and compared with those estimated by OLINDA|EXM and MCNPX for the newborn model. To obtain patient-specific biodistribution of [(131)I]mIBG, a 10-year-old girl with relapsed neuroblastoma was imaged with [(124)I]mIBG PET/CT at four time points prior to the planned [(131)I]mIBG TRT. The organ- and tumor-absorbed doses of the clinical case were estimated with the Geant4 method using the modified UF/NCI 10-year-old phantom with tumors and the patient-specific residence time.

RESULTS

For the newborn model, the Geant4 S values were consistent with the MCNPX S values. The S value ratio of the Geant4 method to OLINDA|EXM ranged from 0.08 to 6.5 of all major organs. The [(131)I]mIBG residence time quantified from the pretherapy [(124)I]mIBG PET/CT imaging of the 10-year-old patient was mostly comparable to those previously reported. Organ-absorbed dose for the salivary glands was 98.0 Gy, heart wall 36.5 Gy, and liver 34.3 Gy, while tumor-absorbed dose ranged from 143.9 to 1,641.3 Gy in different sites.

CONCLUSIONS

Patient-specific dosimetry for [(131)I]mIBG TRT was accomplished using pretherapy [(124)I]mIBG PET/CT imaging and a Geant4-based Monte Carlo dosimetry method. The Geant4 method with quantitative pretherapy imaging can provide dose estimates to normal organs and tumors with more realistic simulation geometry, and thus may improve treatment planning for [(131)I]mIBG TRT.

Organ Dose Estimates for Hyperthyroid Patients Treated with (131)I: An Update of the Thyrotoxicosis Follow-Up Study

The Thyrotoxicosis Therapy Follow-up Study (TTFUS) is comprised of 35,593 hyperthyroid patients treated from the mid-1940s through the mid-1960s. One objective of the TTFUS was to evaluate the long-term effects of high-dose iodine-131 ((131)I) treatment (1-4). In the TTFUS cohort, 23,020 patients were treated with (131)I, including 21,536 patients with Graves disease (GD), 1,203 patients with toxic nodular goiter (TNG) and 281 patients with unknown disease. The study population constituted the largest group of hyperthyroid patients ever examined in a single health risk study. The average number (± 1 standard deviation) of (131)I treatments per patient was 1.7 ± 1.4 for the GD patients and 2.1 ± 2.1 for the TNG patients. The average total (131)I administered activity was 380 ± 360 MBq for GD patients and 640 ± 550 MBq for TNG patients. In this work, a biokinetic model for iodine was developed to derive organ residence times and to reconstruct the radiation-absorbed doses to the thyroid gland and to other organs resulting from administration of (131)I to hyperthyroid patients. Based on (131)I data for a small, kinetically well-characterized sub-cohort of patients, multivariate regression equations were developed to relate the numbers of disintegrations of (131)I in more than 50 organs and tissues to anatomical (thyroid mass) and clinical (percentage thyroid uptake and pulse rate) parameters. These equations were then applied to estimate the numbers of (131)I disintegrations in the organs and tissues of all other hyperthyroid patients in the TTFUS who were treated with (131)I. The reference voxel phantoms adopted by the International Commission on Radiological Protection (ICRP) were then used to calculate the absorbed doses in more than 20 organs and tissues of the body. As expected, the absorbed doses were found to be highest in the thyroid (arithmetic means of 120 and 140 Gy for GD and TNG patients, respectively). Absorbed doses in organs other than the thyroid were much smaller, with arithmetic means of 1.6 Gy, 1.5 Gy and 0.65 Gy for esophagus, thymus and salivary glands, respectively. The arithmetic mean doses to all other organs and tissues were more than 100 times less than those to the thyroid gland. To our knowledge, this work represents the most comprehensive study to date of the doses received by persons treated with (131)I for hyperthyroidism.

Calculations of S values and effective dose for the radioiodine carrier and surrounding individuals based on Chinese hybrid reference phantoms using the Monte Carlo technique

The S values for the thyroid as the radioiodine source organ to other target organs were investigated using Chinese hybrid reference phantoms and the Monte Carlo code MCNP5. Two radioiodine isotopes (125)I and (131)I uniformly distributed in the thyroid were investigated separately. We compared our S values for (131)I in Chinese phantoms with previous studies using other types of phantoms: Oak Ridge National Laboratory (ORNL) stylized phantoms, International Commission on Radiological Protection (ICRP) voxel phantoms, and University of Florida (UF) phantoms. Our results are much closer to the UF phantoms. For each specific target organ, the S value for (131)I is larger than for (125)I in both male and female phantoms. In addition, the S values and effective dose to surrounding face-to-face exposed individuals, including different genders and ages (10- and 15-year-old juniors, and adults) from an adult male radioiodine carrier were also investigated. The target organ S values and effective dose for surrounding individuals obey the inverse square law with the distance between source and target phantoms. The obtained effective dose data in Chinese phantoms are comparable to the results in a previous study using the UF phantoms. The data generated in this study can serve as the reference to make recommendations for radiation protection of the Chinese patients or nuclear workers.

Internal dosimetry estimates using voxelized reference phantoms for thyroid agents

This work presents internal dosimetry estimates for diagnostic procedures performed for thyroid disorders by relevant radiopharmaceuticals. The organ doses for (131)Iodine, (123)Iodine and (99m)Tc incorporated into the body were calculated for the International Commission on Radiological Protection (ICRP) reference voxel phantoms using the Monte Carlo transport method. A comparison between different thyroid uptakes of iodine in the range of 0-55% was made, and the effect of various techniques for administration of (99m)Tc on organ doses was studied. To investigate the necessity of calculating organ dose from all source regions, the major source organ and its contribution to total dose were specified for each target organ. Moreover, we compared effective dose in ICRP voxel phantoms with that in stylized phantoms. In our method, we directly calculated the organ dose without using the S values or SAFs, as is commonly done. Hence, a distribution of the absorbed dose to entire tissues was obtained. The chord length distributions (CLDs) were also computed for the selected source-target pairs to make comparison across the genders. The results showed that the S values for radionuclides in the thyroid are not sufficient for calculating the organ doses, especially for (123)I and (99m)Tc. The thyroid and its neighboring organs receive a greater dose as thyroid uptake increases. Our comparisons also revealed an underestimation of organ doses reported for the stylized phantoms compared with the values based on the ICRP voxel phantoms in the uptake range of 5-55%, and an overestimation of absorbed dose by up to 2-fold for Iodine administration using blocking agent and for (99m)Tc incorporation.

Computational lymphatic node models in pediatric and adult hybrid phantoms for radiation dosimetry

We developed models of lymphatic nodes for six pediatric and two adult hybrid computational phantoms to calculate the lymphatic node dose estimates from external and internal radiation exposures. We derived the number of lymphatic nodes from the recommendations in International Commission on Radiological Protection (ICRP) Publications 23 and 89 at 16 cluster locations for the lymphatic nodes: extrathoracic, cervical, thoracic (upper and lower), breast (left and right), mesentery (left and right), axillary (left and right), cubital (left and right), inguinal (left and right) and popliteal (left and right), for different ages (newborn, 1-, 5-, 10-, 15-year-old and adult). We modeled each lymphatic node within the voxel format of the hybrid phantoms by assuming that all nodes have identical size derived from published data except narrow cluster sites. The lymph nodes were generated by the following algorithm: (1) selection of the lymph node site among the 16 cluster sites; (2) random sampling of the location of the lymph node within a spherical space centered at the chosen cluster site; (3) creation of the sphere or ovoid of tissue representing the node based on lymphatic node characteristics defined in ICRP Publications 23 and 89. We created lymph nodes until the pre-defined number of lymphatic nodes at the selected cluster site was reached. This algorithm was applied to pediatric (newborn, 1-, 5-and 10-year-old male, and 15-year-old males) and adult male and female ICRP-compliant hybrid phantoms after voxelization. To assess the performance of our models for internal dosimetry, we calculated dose conversion coefficients, called S values, for selected organs and tissues with Iodine-131 distributed in six lymphatic node cluster sites using MCNPX2.6, a well validated Monte Carlo radiation transport code. Our analysis of the calculations indicates that the S values were significantly affected by the location of the lymph node clusters and that the values increased for smaller phantoms due to the shorter inter-organ distances compared to the bigger phantoms. By testing sensitivity of S values to random sampling and voxel resolution, we confirmed that the lymph node model is reasonably stable and consistent for different random samplings and voxel resolutions.