Absorbed dose coefficients for adult thyroid cancer patients undergoing radioiodine therapy

Enhanced Internal Dosimetry for Alimentary Tract Organs in Nuclear Medicine based on the ICRP Mesh-Type Reference Phantoms

This study introduces a refined approach for more accurately estimating radiation doses to alimentary tract organs in nuclear medicine, by utilizing the ICRP pediatric and adult mesh-type reference computational phantoms (MRCPs) that improved the anatomical representation of these organs. Our initial step involved compiling a comprehensive dataset of electron Specific Absorbed Fractions (SAFs) for all source-target pairs of alimentary tract organs in both adult and pediatric phantoms, calculating SAFs for all cases in the present study only except those computed in the previous study for certain pediatric phantom cases. Subsequently, we determined S values for 1,252 radionuclides, facilitating dosimetry applications. The consistency of target and source masses for alimentary tract organs in the MRCPs with the reference values in ICRP Publication 89 led to noticeable differences in SAF, S values, and consequently, absorbed dose coefficients when compared to the stylized models in ICRP Publication 100. Notably, the S value ratios (MRCP/stylized) for selected radionuclides-11C, 18F, 68Ga, and 131I-ranged from 0.41 to 7.60. Particularly for therapeutic 131I-iodide in thyroid cancer, the use of MRCPs resulted in up to 1.49 times higher absorbed dose coefficients for the colon than those derived from stylized models, while the stomach dose coefficients decreased by a factor of 0.72. The application of our findings promises enhanced, more realistic dosimetry for alimentary tract organs, especially beneficial for radiopharmaceuticals likely to accumulate within these organs.

Radioiodine internal dose coefficients specific for Koreans

This study developed internal dose coefficients for radioiodine, tailored to the Korean population, by incorporating the Korean biokinetic model along with the Korean S values. The observed differences in dose coefficients for Koreans compared to the International Commission on Radiological Protection (ICRP) reference values noticeably varied depending on physical half-lives of iodine isotopes. For longer-lived isotopes such as I-125 and I-129, significant differences in thyroid dose coefficients were observed, with ratios (Korean/ICRP) from 0.30 to 0.55, indicating that actual doses for Koreans can be considerably lower than those evaluated based on the ICRP data. However, for short-lived iodine isotopes, such as I-131, the thyroid dose coefficients were comparable to the ICRP reference values (ratio=0.95-0.98). These comparable dose coefficients resulted from the lower thyroidal iodine uptake in the Korean model being almost entirely offset by the higher thyroid self-absorption S values in the Korean phantoms. Additionally, this study delves into the substantial differences in absorbed dose coefficients for non-thyroidal regions and effective dose coefficients, which arose not only from physiological/anatomical variability but also technical differences in phantom design. The use of Korean-specific dose coefficients is advisable particularly in scenarios predicting elevated doses, yielding a more precise and clinically relevant dose assessment.

Absorbed dose coefficients for pediatric differentiated thyroid cancer patients undergoing radioiodine therapy

The escalating incidence of differentiated thyroid cancer (DTC) in pediatric patients and the resultant growing use of radioactive iodine (RAI) reinforce the need to evaluate radiation exposure to normal tissues and radiation-induced health risks in pediatric patients undergoing RAI therapy. In the current study, we calculated absorbed dose coefficients (i.e. absorbed dose per unit activity administered, mGy MBq-1) specific for pediatric patients with localized DTC undergoing RAI therapy following total thyroidectomy for use in epidemiological studies. We first modified previously-published biokinetic models for adult thyroid cancer patients to achieve a reasonable agreement with iodine biokinetics observed in pediatric patients or design principles addressed in the International Commission on Radiological Protection (ICRP) reference age-specific biokinetic models. We then combined the biokinetic models in conjunction withSvalues derived from ICRP reference pediatric voxel phantoms. The absorbed dose coefficients for pediatric patients were overall greater than those for adults with a ratio (pediatric/adult) up to 11.6 and rapidly decreased with increasing age. The sensitivity analysis showed that the renal clearance rate andSvalues may have the greatest impact on the absorbed dose coefficients with the rank correlation coefficients ranging from -0.53 to -0.82 (negative correlations) and from 0.51 to 0.80 (positive correlations), respectively. The results of the current study may be utilized in clinical or epidemiological studies to estimate organ-specific radiation absorbed doses and radiation-associated health risks among pediatric thyroid cancer patients.

Korean-specific iodine S values for use in internal dosimetry

The use of iodine S values derived using the International Commission Radiological Protection (ICRP) phantoms may introduce significant bias in internal dosimetry for Koreans due to anatomical variability. In the current study, we produced an extensive dataset of Korean S values for selected five iodine radioisotopes (I-125, I-129, I-131, I-133, and I-134) for use in radiation protection. To calculate S values, we implemented Monte Carlo simulations using the Mesh-type Reference Korean Phantoms (MRKPs), developed in a high-quality/fidelity mesh format. Noticeable differences were observed in S value comparisons between the Korean and ICRP reference phantoms with ratios (Korean/ICRP) widely ranging from 0.16 to 6.2. The majority of S value ratios were lower than the unity in Korean phantoms (interquartile range =0.47-1.28; mean = 0.96; median = 0.69). The S values provided in the current study will be extensively utilized in iodine internal dosimetry for Koreans.