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Keane G, van Rooij R, Lam M, Kappadath SC, Kovan B, Leon S, Dreher M, Fowers K, de Jong H. An international phantom study of inter-site variability in Technetium-99m image quantification: analyses from the TARGET radioembolization study. EJNMMI Phys 2024; 11:46. [PMID: 38809320 DOI: 10.1186/s40658-024-00647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Personalised multi-compartment dosimetry based on [99mTc]Tc-MAA is a valuable tool for planning 90Y radioembolization treatments. The establishment and effective application of dose-effect relationships in yttrium-90 (90Y) radioembolization requires [99mTc]Tc-MAA SPECT quantification ideally independent of clinical site. The purpose of this multi-centre phantom study was to evaluate inter-site variability of [99mTc]Tc-MAA imaging and evaluate a standardised imaging protocol. Data was obtained from the TARGET study, an international, retrospective multi-centre study including 14 sites across 8 countries. The impact of imaging related factors was estimated using a NEMA IQ phantom (representing the liver), and a uniformly filled cylindrical phantom (representing the lungs). Imaging was performed using site-specific protocols and a standardized protocol. In addition, the impact of implementing key image corrections (scatter and attenuation correction) in the site-specific protocols was investigated. Inter-site dosimetry accuracy was evaluated by comparing computed Lung Shunt Fraction (LSF) measured using planar imaging of the cylindrical and NEMA phantom, and contrast recovery coefficient (CRC) measured using SPECT imaging of the NEMA IQ phantom. RESULTS Regarding the LSF, inter-site variation with planar site-specific protocols was minimal, as determined by comparing computed LSF between sites (interquartile range 9.6-10.1%). A standardised protocol did not improve variation (interquartile range 8.4-9.0%) but did improve mean accuracy compared to the site-specific protocols (5.0% error for standardised protocol vs 8.8% error for site-specific protocols). Regarding the CRC, inter-system variation was notable for site-specific SPECT protocols and could not be improved by the standardised protocol (CRC interquartile range for 37 mm sphere 0.5-0.7 and 0.6-0.8 respectively), however the standardised protocol did improve accuracy of sphere:background determination. Implementation of key image corrections did improve inter-site variation (CRC interquartile range for 37 mm sphere 0.6-0.7). CONCLUSION Eliminating sources of variability in image corrections between imaging protocols reduces inter-site variation in quantification. A standardised protocol was not able to improve consistency of LSF or CRC but was able to improve accuracy.
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Affiliation(s)
- Grace Keane
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
| | - Rob van Rooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands
| | - Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands
| | - S Cheenu Kappadath
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bilal Kovan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Stephanie Leon
- Department of Radiology, University of Florida, Gainesville, FL, USA
| | | | - Kirk Fowers
- Boston Scientific Corporation, Marlborough, MA, USA
| | - Hugo de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands
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Pistone D, Italiano A, Auditore L, Mandaglio G, Campenní A, Baldari S, Amato E. Relevance of artefacts in 99mTc-MAA SPECT scans on pre-therapy patient-specific 90Y TARE internal dosimetry: a GATE Monte Carlo study. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac6b0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/27/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. The direct Monte Carlo (MC) simulation of radiation transport exploiting morphological and functional tomographic imaging as input data is considered the gold standard for internal dosimetry in nuclear medicine, and it is increasingly used in studies regarding trans-arterial radio-embolization (TARE). However, artefacts affecting the functional scans, such as reconstruction artefacts and motion blurring, decrease the accuracy in defining the radionuclide distribution in the simulations and consequently lead to errors in absorbed dose estimations. In this study, the relevance of such artefacts in patient-specific three-dimensional MC dosimetry was investigated in three cases of 90Y TARE. Approach. The pre-therapy 99mTc MacroAggregate Albumin (Tc-MAA) SPECTs and CTs of patients were used as input for simulations performed with the GEANT4-based toolkit GATE. Several pre-simulation SPECT-masking techniques were implemented, with the aim of zeroing the decay probability in air, in lungs, or in the whole volume outside the liver. Main results. Increments in absorbed dose up to about +40% with respect to the native-SPECT simulations were found in liver-related volumes of interest (VOIs), depending on the masking procedure adopted. Regarding lungs-related VOIs, decrements in absorbed doses in right lung as high as −90% were retrieved. Significance. These results highlight the relevant influence of SPECT artefacts, if not properly treated, on dosimetric outcomes for 90Y TARE cases. Well-designed SPECT-masking techniques appear to be a promising way to correct for such misestimations.
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Chiesa C, Sjogreen-Gleisner K, Walrand S, Strigari L, Flux G, Gear J, Stokke C, Gabina PM, Bernhardt P, Konijnenberg M. EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres. EJNMMI Phys 2021; 8:77. [PMID: 34767102 PMCID: PMC8589932 DOI: 10.1186/s40658-021-00394-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/21/2021] [Indexed: 11/27/2022] Open
Abstract
The aim of this standard operational procedure is to standardize the methodology employed for the evaluation of pre- and post-treatment absorbed dose calculations in 90Y microsphere liver radioembolization. Basic assumptions include the permanent trapping of microspheres, the local energy deposition method for voxel dosimetry, and the patient-relative calibration method for activity quantification.The identity of 99mTc albumin macro-aggregates (MAA) and 90Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99mTc-MAA predictions and actual 90Y microsphere distributions for lesions is discussed. Absorbed dose predictions to whole non-tumoural liver are considered more reliable and the basic predictors of toxicity. Treatment planning based on mean absorbed dose delivered to the whole non-tumoural liver is advised, except in super-selective treatments.Given the potential mismatch between MAA simulation and actual therapy, absorbed doses should be calculated both pre- and post-therapy. Distinct evaluation between target tumours and non-tumoural tissue, including lungs in cases of lung shunt, are vital for proper optimization of therapy. Dosimetry should be performed first according to a mean absorbed dose approach, with an optional, but important, voxel level evaluation. Fully corrected 99mTc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99mTc-MAA SPECT may be used. This offers better planning quality than non dosimetric methods such as Body Surface Area (BSA) or mono-compartmental dosimetry. Quantitative 90Y bremsstrahlung SPECT can be used if dedicated correction methods are available.The proposed methodology is feasible with standard camera software and a spreadsheet. Available commercial or free software can help facilitate the process and improve calculation time.
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Affiliation(s)
- Carlo Chiesa
- Nuclear Medicine Unit, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Stephan Walrand
- Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain, Brussels, Belgium
| | - Lidia Strigari
- Medical Physics Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Pablo Minguez Gabina
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Peter Bernhardt
- Department of Radiation Physics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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166Ho microsphere scout dose for more accurate radioembolization treatment planning. Eur J Nucl Med Mol Imaging 2021; 47:744-747. [PMID: 31875243 DOI: 10.1007/s00259-019-04617-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nodari G, Popoff R, Riedinger JM, Lopez O, Pellegrinelli J, Dygai-Cochet I, Tabouret-Viaud C, Presles B, Chevallier O, Gehin S, Gallet M, Latournerie M, Manfredi S, Loffroy R, Vrigneaud JM, Cochet A. Impact of contouring methods on pre-treatment and post-treatment dosimetry for the prediction of tumor control and survival in HCC patients treated with selective internal radiation therapy. EJNMMI Res 2021; 11:24. [PMID: 33687596 PMCID: PMC7943673 DOI: 10.1186/s13550-021-00766-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of the contouring methods on dose metrics and their predictive value on tumor control and survival, in both situations of pre-treatment and post-treatment dosimetry, for patients with advanced HCC treated with SIRT. METHODS Forty-eight patients who underwent SIRT between 2012 and 2020 were retrospectively included in this study. Target volumes were delineated using two methods: MRI-based contours manually drawn by a radiologist and then registered on SPECT/CT and PET/CT via deformable registration (Pre-CMRI and Post-CMRI), 99mTc-MAA-SPECT and 90Y-microspheres-PET 10% threshold contouring (Pre-CSPECT and Post-CPET). The mean absorbed dose (Dm) and the minimal absorbed dose delivered to 70% of the tumor volume (D70) were evaluated with both contouring methods; the tumor-to-normal liver uptake ratio (TNR) was evaluated with MRI-based contours only. Tumor response was assessed using the mRECIST criteria on the follow-up MRIs. RESULTS No significant differences were found for Dm and TNR between pre- and post-treatment. TNR evaluated with radiologic contours (Pre-CMRI and Post-CMRI) were predictive of tumor control at 6 months on pre- and post-treatment dosimetry (OR 5.9 and 7.1, respectively; p = 0.02 and 0.01). All dose metrics determined with both methods were predictive of overall survival (OS) on pre-treatment dosimetry, but only Dm with MRI-based contours was predictive of OS on post-treatment images with a median of 23 months for patients with a supramedian Dm versus 14 months for the others (p = 0.04). CONCLUSION In advanced HCC treated with SIRT, Dm and TNR determined with radiologic contours were predictive of tumor control and OS. This study shows that a rigorous clinical workflow (radiologic contours + registration on scintigraphic images) is feasible and should be prospectively considered for improving therapeutic strategy.
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Affiliation(s)
- Guillaume Nodari
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.
| | - Romain Popoff
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.,ImViA Laboratory, IFTIM Team, EA 7535, University of Burgundy, Dijon, France
| | - Jean Marc Riedinger
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
| | - Olivier Lopez
- Department of Vascular and Interventional Radiology, University Hospital Dijon, Dijon, France
| | - Julie Pellegrinelli
- Department of Vascular and Interventional Radiology, University Hospital Dijon, Dijon, France
| | - Inna Dygai-Cochet
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
| | | | - Benoit Presles
- ImViA Laboratory, IFTIM Team, EA 7535, University of Burgundy, Dijon, France
| | - Olivier Chevallier
- ImViA Laboratory, IFTIM Team, EA 7535, University of Burgundy, Dijon, France.,Department of Vascular and Interventional Radiology, University Hospital Dijon, Dijon, France
| | - Sophie Gehin
- Department of Vascular and Interventional Radiology, University Hospital Dijon, Dijon, France
| | - Matthieu Gallet
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France
| | | | - Sylvain Manfredi
- Department of Gastroenterology, University Hospital Dijon, Dijon, France
| | - Romaric Loffroy
- ImViA Laboratory, IFTIM Team, EA 7535, University of Burgundy, Dijon, France.,Department of Vascular and Interventional Radiology, University Hospital Dijon, Dijon, France
| | - Jean Marc Vrigneaud
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.,ImViA Laboratory, IFTIM Team, EA 7535, University of Burgundy, Dijon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France.,ImViA Laboratory, IFTIM Team, EA 7535, University of Burgundy, Dijon, France
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Morán V, Prieto E, Sancho L, Rodríguez-Fraile M, Soria L, Zubiria A, Martí-Climent JM. Impact of the dosimetry approach on the resulting 90Y radioembolization planned absorbed doses based on 99mTc-MAA SPECT-CT: is there agreement between dosimetry methods? EJNMMI Phys 2020; 7:72. [PMID: 33284389 PMCID: PMC7721939 DOI: 10.1186/s40658-020-00343-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prior radioembolization, a simulation using 99mTc-macroaggregated albumin as 90Y-microspheres surrogate is performed. Gamma scintigraphy images (planar, SPECT, or SPECT-CT) are acquired to evaluate intrahepatic 90Y-microspheres distribution and detect possible extrahepatic and lung shunting. These images may be used for pre-treatment dosimetry evaluation to calculate the 90Y activity that would get an optimal tumor response while sparing healthy tissues. Several dosimetry methods are available, but there is still no consensus on the best methodology to calculate absorbed doses. The goal of this study was to retrospectively evaluate the impact of using different dosimetry approaches on the resulting 90Y-radioembolization pre-treatment absorbed dose evaluation based on 99mTc-MAA images. METHODS Absorbed doses within volumes of interest resulting from partition model (PM) and 3D voxel dosimetry methods (3D-VDM) (dose-point kernel convolution and local deposition method) were evaluated. Additionally, a new "Multi-tumor Partition Model" (MTPM) was developed. The differences among dosimetry approaches were evaluated in terms of mean absorbed dose and dose volume histograms within the volumes of interest. RESULTS Differences in mean absorbed dose among dosimetry methods are higher in tumor volumes than in non-tumoral ones. The differences between MTPM and both 3D-VDM were substantially lower than those observed between PM and any 3D-VDM. A poor correlation and concordance were found between PM and the other studied dosimetry approaches. DVH obtained from either 3D-VDM are pretty similar in both healthy liver and individual tumors. Although no relevant global differences, in terms of absorbed dose in Gy, between both 3D-VDM were found, important voxel-by-voxel differences have been observed. CONCLUSIONS Significant differences among the studied dosimetry approaches for 90Y-radioembolization treatments exist. Differences do not yield a substantial impact in treatment planning for healthy tissue but they do for tumoral liver. An individual segmentation and evaluation of the tumors is essential. In patients with multiple tumors, the application of PM is not optimal and the 3D-VDM or the new MTPM are suggested instead. If a 3D-VDM method is not available, MTPM is the best option. Furthermore, both 3D-VDM approaches may be indistinctly used.
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Affiliation(s)
- Verónica Morán
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Elena Prieto
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Madrid, Spain
| | - Macarena Rodríguez-Fraile
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Leticia Soria
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Arantxa Zubiria
- Department of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Josep M Martí-Climent
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain. .,IdisNA, Navarra Institute for Health Research, Pamplona, Spain.
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Brosch J, Gosewisch A, Kaiser L, Seidensticker M, Ricke J, Zellmer J, Bartenstein P, Ziegler S, Ilhan H, Todica A, Böning G. 3D image-based dosimetry for Yttrium-90 radioembolization of hepatocellular carcinoma: Impact of imaging method on absorbed dose estimates. Phys Med 2020; 80:317-326. [PMID: 33248338 DOI: 10.1016/j.ejmp.2020.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To improve therapy outcome of Yttrium-90 selective internal radiation therapy (90Y SIRT), patient-specific post-therapeutic dosimetry is required. For this purpose, various dosimetric approaches based on different available imaging data have been reported. The aim of this work was to compare post-therapeutic 3D absorbed dose images using Technetium-99m (99mTc) MAA SPECT/CT, Yttrium-90 (90Y) bremsstrahlung (BRS) SPECT/CT, and 90Y PET/CT. METHODS Ten SIRTs of nine patients with unresectable hepatocellular carcinoma (HCC) were investigated. The 99mTc SPECT/CT data, obtained from 99mTc-MAA-based treatment simulation prior to 90Y SIRT, were scaled with the administered 90Y therapy activity. 3D absorbed dose images were generated by dose kernel convolution with scaled 99mTc/90Y SPECT/CT, 90Y BRS SPECT/CT, and 90Y PET/CT data of each patient. Absorbed dose estimates in tumor and healthy liver tissue obtained using the two SPECT/CT methods were compared against 90Y PET/CT. RESULTS The percentage deviation of tumor absorbed dose estimates from 90Y PET/CT values was on average -2 ± 18% for scaled 99mTc/90Y SPECT/CT, whereas estimates from 90Y BRS SPECT/CT differed on average by -50 ± 13%. For healthy liver absorbed dose estimates, all three imaging methods revealed comparable values. CONCLUSION The quantification capabilities of the imaging data influence 90Y SIRT tumor dosimetry, while healthy liver absorbed dose values were comparable for all investigated imaging data. When no 90Y PET/CT image data are available, the proposed scaled 99mTc/90Y SPECT/CT dosimetry method was found to be more appropriate for HCC tumor dosimetry than 90Y BRS SPECT/CT based dosimetry.
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Affiliation(s)
- Julia Brosch
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Astrid Gosewisch
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johannes Zellmer
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Guido Böning
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Radioembolization of hepatocarcinoma with 90Y glass microspheres: treatment optimization using the dose-toxicity relationship. Eur J Nucl Med Mol Imaging 2020; 47:3018-3032. [PMID: 32451604 DOI: 10.1007/s00259-020-04845-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
AIM Transarterial radioembolization (TARE) is, by all standards, a radiation therapy. As such, according to Euratom Directive 2013/59, it should be optimized by a thorough treatment plan based on the distinct evaluation of absorbed dose to the lesions and to the non-tumoural liver (two-compartment dosimetry). Since the dosimetric prediction with 99mTc albumin macro-aggregates (MAA) of non-tumoural liver is much more accurate than the same prediction on lesions, treatment planning should focus on non-tumoural liver rather than on lesion dosimetry. The aim of this study was to determine a safety limit through the analysis of pre-treatment dosimetry with 99mTc-MAA single photon emission computed tomography (SPECT/CT), in order to deliver the maximum tolerable absorbed dose to non-tumoural liver. METHODS Data from intermediate/advanced hepato-cellular carcinoma (HCC) patients treated with 90Y glass microspheres were collected in this single-arm retrospective study. Injection was always lobar, even in case of bilobar disease, to avoid treating the whole liver in a single session. A three-level definition of liver decompensation (LD) was introduced, considering toxicity only in cases of liver decompensation requiring medical action (LD type C, LDC). We report LDC rates, receiver operating characteristic (ROC) analysis between LDC and NO LDC absorbed dose distributions, normal tissue complication probability (NTCP) curves and uni- and multivariate analysis of risk factors associated with toxicity. RESULTS A 6-month timeline was defined as necessary to capture all treatment-related toxicity events. Previous transarterial chemoembolization (TACE), presence or extension of portal vein tumoural thrombosis (PVTT) and tumour pattern (nodular versus infiltrative) were not associated with tolerance to TARE. On the contrary, at the multivariate analysis, the absorbed dose averaged over the whole non-tumoural liver (including the non-injected lobe) was a prognostic indicator correlated with liver decompensation (odds ratio = 4.24). Basal bilirubin > 1.1 mg/dL was a second even more significant risk factor (odds ratio = 6.35). NTCP analysis stratified with this bilirubin cut-off determined a 15% liver decompensation risk at 50 Gy/90 Gy for bilirubin >/< 1.1 mg/dL. These results are valid for a 90Y glass microsphere administration 4 days after the reference time. CONCLUSION Given the low predictive accuracy of 99mTc-MAA on lesion absorbed dose reported by several authors, an optimized TARE with 90Y glass microspheres with lobar injection 4 days after reference time should aim at an absorbed dose averaged over the whole non-tumoural liver of 50 Gy/90 Gy for basal bilirubin higher/lower than 1.1 mg/dL, respectively.
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van Roekel C, Braat AJAT, Smits MLJ, Bruijnen RCG, de Keizer B, Lam MGEH. Radioembolization. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jafargholi Rangraz E, Coudyzer W, Maleux G, Baete K, Deroose CM, Nuyts J. Multi-modal image analysis for semi-automatic segmentation of the total liver and liver arterial perfusion territories for radioembolization. EJNMMI Res 2019; 9:19. [PMID: 30788640 PMCID: PMC6382918 DOI: 10.1186/s13550-019-0485-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/29/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose We have developed a multi-modal imaging approach for SIRT, combining 99mTc-MAA SPECT/CT and/or 90Y PET, 18F-FDG PET/CT, and contrast-enhanced CBCT for voxel-based dosimetry, as a tool for treatment planning and verification. For radiation dose prediction calculations, a segmentation of the total liver volume and of the liver perfusion territories is required. Method In this paper, we proposed a procedure for multi-modal image analysis to assist SIRT treatment planning. The pre-treatment 18F-FDG PET/CT, 99mTc-MAA SPECT/CT, and contrast-enhanced CBCT images were registered to a common space using an initial rigid, followed by a deformable registration. The registration was scored by an expert using Likert scores. The total liver was segmented semi-automatically based on the PET/CT and SPECT/CT images, and the liver perfusion territories were determined based on the CBCT images. The segmentations of the liver and liver lobes were compared to the manual segmentations by an expert on a CT image. Result Our methodology showed that multi-modal image analysis can be used for determination of the liver and perfusion territories using CBCT in SIRT using all pre-treatment studies. The results for image registration showed acceptable alignment with limited impact on dosimetry. The image registration performs well according to the expert reviewer (scored as perfect or with little misalignment in 94% of the cases). The semi-automatic liver segmentation agreed well with manual liver segmentation (dice coefficient of 0.92 and an average Hausdorff distance of 3.04 mm). The results showed disagreement between lobe segmentation using CBCT images compared to lobe segmentation based on CT images (average Hausdorff distance of 14.18 mm), with a high impact on the dosimetry (differences up to 9 Gy for right and 21 Gy for the left liver lobe). Conclusion This methodology can be used for pre-treatment dosimetry and for SIRT planning including the determination of the activity that should be administered to achieve the therapeutical goal. The inclusion of perfusion CBCT enables perfusion-based definition of the liver lobes, which was shown to be markedly different from the anatomical definition in some of the patients.
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Affiliation(s)
| | - Walter Coudyzer
- Radiology Section, Department of imaging and pathology, UZ Leuven, Leuven, Belgium
| | - Geert Maleux
- Radiology Section, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
| | - Kristof Baete
- Nuclear Medicine, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
| | - Christophe M Deroose
- Nuclear Medicine, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
| | - Johan Nuyts
- Nuclear Medicine, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
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Bastiaannet R, Kappadath SC, Kunnen B, Braat AJAT, Lam MGEH, de Jong HWAM. The physics of radioembolization. EJNMMI Phys 2018; 5:22. [PMID: 30386924 PMCID: PMC6212377 DOI: 10.1186/s40658-018-0221-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/19/2018] [Indexed: 12/11/2022] Open
Abstract
Radioembolization is an established treatment for chemoresistant and unresectable liver cancers. Currently, treatment planning is often based on semi-empirical methods, which yield acceptable toxicity profiles and have enabled the large-scale application in a palliative setting. However, recently, five large randomized controlled trials using resin microspheres failed to demonstrate a significant improvement in either progression-free survival or overall survival in both hepatocellular carcinoma and metastatic colorectal cancer. One reason for this might be that the activity prescription methods used in these studies are suboptimal for many patients.In this review, the current dosimetric methods and their caveats are evaluated. Furthermore, the current state-of-the-art of image-guided dosimetry and advanced radiobiological modeling is reviewed from a physics' perspective. The current literature is explored for the observation of robust dose-response relationships followed by an overview of recent advancements in quantitative image reconstruction in relation to image-guided dosimetry.This review is concluded with a discussion on areas where further research is necessary in order to arrive at a personalized treatment method that provides optimal tumor control and is clinically feasible.
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Affiliation(s)
- Remco Bastiaannet
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - S. Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX 77030 USA
| | - Britt Kunnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Arthur J. A. T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Hugo W. A. M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Halty A, Badel JN, Kochebina O, Sarrut D. Image-based SPECT calibration based on the evaluation of the Fraction of Activity in the Field of View. EJNMMI Phys 2018; 5:11. [PMID: 29766354 PMCID: PMC5953912 DOI: 10.1186/s40658-018-0209-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 03/16/2018] [Indexed: 11/27/2022] Open
Abstract
Background SPECT quantification is important for dosimetry in targeted radionuclide therapy (TRT) and the calibration of SPECT images is a crucial stage for image quantification. The current standardized calibration protocol (MIRD 23) uses phantom acquisitions to derive a global calibration factor in specific conditions. It thus requires specific acquisitions for every clinical protocols. We proposed an alternative and complementary image-based calibration method that allows to determine a calibration factor adapted to each patient, radionuclide, and acquisition protocol and that may also be used as an additional independent calibration. Results The proposed method relies on a SPECT/CT acquisition of a given region of interest and an initial whole-body (WB) planar image. First, the conjugate view of WB planar images is computed after scatter and attenuation correction. 3D SPECT images are reconstructed with scatter, attenuation, and collimator-detector response (CDR) corrections and corrected from apparent dead-time. The field of view (FOV) of the SPECT image is then projected on the corrected WB planar image. The fraction of activity located in the area corresponding to the SPECT FOV is then calculated based on the counts on the corrected WB planar image. The Fraction of Activity in Field Of View (FAF) is then proposed to compute the calibration factor as the total number of counts in the SPECT image divided by this activity. Quantification accuracy was compared with the standard calibration method both with phantom experiments and on patient data. Both standard and image-based calibrations give good accuracy on large region of interest on phantom experiments (less than 7% of relative difference compared to ground truth). Apparent dead-time correction allows to reduce the uncertainty associated with standard calibration from 2.5 to 1%. The differences found between both methods were lower than the uncertainty range of the standard calibration (<3%). In patient data, although no ground truth was available, both methods give similar calibration factor (average difference 3.64%). Conclusions A calibration factor may be computed directly from the acquired SPECT image providing that a WB planar image is also available and if both acquisitions are performed before biological elimination. This method does not require to perform phantom acquisition for every different acquisition conditions and may serve to double check the calibration with an independent factor.
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Affiliation(s)
- Adrien Halty
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, 69008, France. .,Univ Lyon, Centre Léon Bérard, Lyon, 69008, France.
| | | | - Olga Kochebina
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, 69008, France
| | - David Sarrut
- Univ Lyon, INSA-Lyon, Université Lyon 1, CNRS, Inserm, CREATIS UMR 5220, U1206, Lyon, 69008, France.,Univ Lyon, Centre Léon Bérard, Lyon, 69008, France
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Impact of missing attenuation and scatter corrections on 99m
Tc-MAA SPECT 3D dosimetry for liver radioembolization using the patient relative calibration methodology: A retrospective investigation on clinical images. Med Phys 2018; 45:1684-1698. [DOI: 10.1002/mp.12774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/14/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023] Open
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Dewaraja YK, Chun SY, Srinivasa RN, Kaza RK, Cuneo KC, Majdalany BS, Novelli PM, Ljungberg M, Fessler JA. Improved quantitative 90 Y bremsstrahlung SPECT/CT reconstruction with Monte Carlo scatter modeling. Med Phys 2017; 44:6364-6376. [PMID: 28940483 DOI: 10.1002/mp.12597] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 01/07/2023] Open
Abstract
PURPOSE In 90 Y microsphere radioembolization (RE), accurate post-therapy imaging-based dosimetry is important for establishing absorbed dose versus outcome relationships for developing future treatment planning strategies. Additionally, accurately assessing microsphere distributions is important because of concerns for unexpected activity deposition outside the liver. Quantitative 90 Y imaging by either SPECT or PET is challenging. In 90 Y SPECT model based methods are necessary for scatter correction because energy window-based methods are not feasible with the continuous bremsstrahlung energy spectrum. The objective of this work was to implement and evaluate a scatter estimation method for accurate 90 Y bremsstrahlung SPECT/CT imaging. METHODS Since a fully Monte Carlo (MC) approach to 90 Y SPECT reconstruction is computationally very demanding, in the present study the scatter estimate generated by a MC simulator was combined with an analytical projector in the 3D OS-EM reconstruction model. A single window (105 to 195-keV) was used for both the acquisition and the projector modeling. A liver/lung torso phantom with intrahepatic lesions and low-uptake extrahepatic objects was imaged to evaluate SPECT/CT reconstruction without and with scatter correction. Clinical application was demonstrated by applying the reconstruction approach to five patients treated with RE to determine lesion and normal liver activity concentrations using a (liver) relative calibration. RESULTS There was convergence of the scatter estimate after just two updates, greatly reducing computational requirements. In the phantom study, compared with reconstruction without scatter correction, with MC scatter modeling there was substantial improvement in activity recovery in intrahepatic lesions (from > 55% to > 86%), normal liver (from 113% to 104%), and lungs (from 227% to 104%) with only a small degradation in noise (13% vs. 17%). Similarly, with scatter modeling contrast improved substantially both visually and in terms of a detectability index, which was especially relevant for the low uptake extrahepatic objects. The trends observed for the phantom were also seen in the patient studies where lesion activity concentrations and lesion-to-liver concentration ratios were lower for SPECT without scatter correction compared with reconstruction with just two MC scatter updates: in eleven lesions the mean uptake was 4.9 vs. 7.1 MBq/mL (P = 0.0547), the mean normal liver uptake was 1.6 vs. 1.5 MBq/mL (P = 0.056) and the mean lesion-to-liver uptake ratio was 2.7 vs. 4.3 (P = 0.0402) for reconstruction without and with scatter correction respectively. CONCLUSIONS Quantitative accuracy of 90 Y bremsstrahlung imaging can be substantially improved with MC scatter modeling without significant degradation in image noise or intensive computational requirements.
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Affiliation(s)
- Yuni K Dewaraja
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Se Young Chun
- School of Electrical and Computer Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Ravi N Srinivasa
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kyle C Cuneo
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Bill S Majdalany
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Paula M Novelli
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Ljungberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Jeffrey A Fessler
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
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Optimisation of reconstruction, volumetry and dosimetry for 99mTc-SPECT and 90Y-PET images: Towards reliable dose-volume histograms for selective internal radiation therapy with 90Y-microspheres. Phys Med 2017; 39:147-155. [PMID: 28687192 DOI: 10.1016/j.ejmp.2017.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/19/2017] [Accepted: 06/24/2017] [Indexed: 01/10/2023] Open
Abstract
PURPOSE In Selective Internal Radiation Therapy (SIRT), 99mTc-MAA SPECT images are commonly used to predict microspheres distribution but recent works used 90Y-microspheres PET images. Nevertheless, evaluation of the predictive power of 99mTc-MAA has been hampered by the lack of reliable comparisons between 99mTc-SPECT and 90Y-PET images. Our aim was to determine the "in situ" optimisation procedure in order to reliably compare 99mTc-SPECT and 90Y-PET images and achieve optimal personal dosimetry. METHODS We acquired 99mTc-SPECT/CT and 90Y-PET/CT images of NEMA and Jaszczak phantoms. We found the best reconstruction parameters for quantification and for volume estimations. We determined adaptive threshold curves on the volumetric reconstruction. We copied the optimised volumes on the quantitative reconstruction, named here the "cross volumes" technique. Finally, we compared 99mTc-SPECT and 90Y-PET Dose Volume Histograms. RESULTS Our "in situ" optimisation procedure decreased errors on volumes and quantification (from -44.2% and -15.8% to -3.4% and -3.28%, respectively, for the 26.5mL PET phantom sphere). Moreover, 99mTc-SPECT and 90Y-PET DVHs were equivalent only after the optimisation procedure (difference in mean dose <5% for the three biggest spheres). CONCLUSIONS This work showed that a preliminary "in situ" phantom study was necessary to optimise volumes and quantification of 99mTc-SPECT and 90Y-PET images and allowed to achieve a reliable comparison between patient treatment planning and post implant dosimetry, notably by the use of the "cross volumes" technique. Methodology developed in this work will enable robust evaluations of the predictive power of 99mTc-SPECT, as well as dose-response relationship and side effects in SIRT treatments.
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Pacilio M, Ferrari M, Chiesa C, Lorenzon L, Mira M, Botta F, Becci D, Torres LA, Coca Perez M, Vergara Gil A, Basile C, Ljungberg M, Pani R, Cremonesi M. Impact of SPECT corrections on 3D-dosimetry for liver transarterial radioembolization using the patient relative calibration methodology. Med Phys 2017; 43:4053. [PMID: 27370124 DOI: 10.1118/1.4953203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Many centers aim to plan liver transarterial radioembolization (TARE) with dosimetry, even without CT-based attenuation correction (AC), or with unoptimized scatter correction (SC) methods. This work investigates the impact of presence vs absence of such corrections, and limited spatial resolution, on 3D dosimetry for TARE. METHODS Three voxelized phantoms were derived from CT images of real patients with different body sizes. Simulations of (99m)Tc-SPECT projections were performed with the SIMIND code, assuming three activity distributions in the liver: uniform, inside a "liver's segment," or distributing multiple uptaking nodules ("nonuniform liver"), with a tumoral liver/healthy parenchyma ratio of 5:1. Projection data were reconstructed by a commercial workstation, with OSEM protocol not specifically optimized for dosimetry (spatial resolution of 12.6 mm), with/without SC (optimized, or with parameters predefined by the manufacturer; dual energy window), and with/without AC. Activity in voxels was calculated by a relative calibration, assuming identical microspheres and (99m)Tc-SPECT counts spatial distribution. 3D dose distributions were calculated by convolution with (90)Y voxel S-values, assuming permanent trapping of microspheres. Cumulative dose-volume histograms in lesions and healthy parenchyma from different reconstructions were compared with those obtained from the reference biodistribution (the "gold standard," GS), assessing differences for D95%, D70%, and D50% (i.e., minimum value of the absorbed dose to a percentage of the irradiated volume). γ tool analysis with tolerance of 3%/13 mm was used to evaluate the agreement between GS and simulated cases. The influence of deep-breathing was studied, blurring the reference biodistributions with a 3D anisotropic gaussian kernel, and performing the simulations once again. RESULTS Differences of the dosimetric indicators were noticeable in some cases, always negative for lesions and distributed around zero for parenchyma. Application of AC and SC reduced systematically the differences for lesions by 5%-14% for a liver segment, and by 7%-12% for a nonuniform liver. For parenchyma, the data trend was less clear, but the overall range of variability passed from -10%/40% for a liver segment, and -10%/20% for a nonuniform liver, to -13%/6% in both cases. Applying AC, SC with preset parameters gave similar results to optimized SC, as confirmed by γ tool analysis. Moreover, γ analysis confirmed that solely AC and SC are not sufficient to obtain accurate 3D dose distribution. With breathing, the accuracy worsened severely for all dosimetric indicators, above all for lesions: with AC and optimized SC, -38%/-13% in liver's segment, -61%/-40% in the nonuniform liver. For parenchyma, D50% resulted always less sensitive to breathing and sub-optimal correction methods (difference overall range: -7%/13%). CONCLUSIONS Reconstruction protocol optimization, AC, SC, PVE and respiratory motion corrections should be implemented to obtain the best possible dosimetric accuracy. On the other side, thanks to the relative calibration, D50% inaccuracy for the healthy parenchyma from absence of AC was less than expected, while the optimization of SC was scarcely influent. The relative calibration therefore allows to perform TARE planning, basing on D50% for the healthy parenchyma, even without AC or with suboptimal corrections, rather than rely on nondosimetric methods.
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Affiliation(s)
- Massimiliano Pacilio
- Department of Medical Physics, Azienda Ospedaliera San Camillo Forlanini, Rome 00152, Italy
| | - Mahila Ferrari
- Department of Medical Physics, Istituto Europeo di Oncologia, Milan 20141, Italy
| | - Carlo Chiesa
- Department of Nuclear Medicine, Istituto Nazionale Tumori IRCCS Foundation, Milan 20133, Italy
| | - Leda Lorenzon
- Postgraduate School of Medical Physics, "Sapienza" University of Rome, Rome 00185, Italy
| | - Marta Mira
- Post graduate Health Physics School, University of Milan, Milan 20122, Italy
| | - Francesca Botta
- Department of Medical Physics, Istituto Europeo di Oncologia, Milan 20141, Italy
| | - Domenico Becci
- Postgraduate School of Medical Physics, "Sapienza" University of Rome, Rome 00185, Italy
| | - Leonel Alberto Torres
- Department of Nuclear Medicine, Clinical Research Division of the Center of Isotopes (DIC-CENTIS), Havana 11100, Cuba
| | - Marco Coca Perez
- Department of PET-CT and Nuclear Medicine, Imaging Center Medscan-Concepciòn, Concepciòn 4070061, Chile
| | - Alex Vergara Gil
- Department of Nuclear Medicine, Clinical Research Division of the Center of Isotopes (DIC-CENTIS), Havana 11100, Cuba
| | - Chiara Basile
- Department of Medical Physics, Azienda Ospedaliera San Camillo Forlanini, Rome 00152, Italy
| | - Michael Ljungberg
- Department of Medical Radiation Physics, University of Lund, Lund 22100, Sweden
| | - Roberto Pani
- Department of Medico-surgical Sciences and Biotecnologies, "Sapienza" University of Rome, Rome 00185, Italy
| | - Marta Cremonesi
- Department of Medical Physics, Istituto Europeo di Oncologia, Milan 20141, Italy
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Gallio E, Richetta E, Finessi M, Stasi M, Pellerito RE, Bisi G, Ropolo R. Calculation of tumour and normal tissue biological effective dose in 90 Y liver radioembolization with different dosimetric methods. Phys Med 2016; 32:1738-1744. [DOI: 10.1016/j.ejmp.2016.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/25/2023] Open
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