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Chaib S, Tylski P, Lachachi C, Keniza T, Levigoureux E. Dosimetric Considerations for 177Lu-DOTATATE Therapy in a Patient With Chronic Renal Failure Under Hemodialysis. Clin Nucl Med 2024:00003072-990000000-01100. [PMID: 38739496 DOI: 10.1097/rlu.0000000000005262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
ABSTRACT This case report explores the use of 177Lu-DOTATATE in a hemodialysis patient. For the first time, this study assesses the average dose received by the bone marrow, the primary organ at risk, using an original double estimation method through independently acquired imaging and biological samples counting data. Despite elevated doses, the absorbed doses to the bone marrow (0.662-0.740 Gy) were within safe limits. Radiation protection measurements for staff were also compliant. This work supports that effective early dialysis and systematic personalized dosimetry are crucial for hemodialysis patients undergoing 177Lu-PRRT due to their variability (residual excretion, treatment history, etc).
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Li H, Liu H, Zhang W, Lin X, Li Z, Zhuo W. Radiation levels outside a patient undergoing 177Lu-PSMA radioligand therapy. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021504. [PMID: 38537256 DOI: 10.1088/1361-6498/ad3835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
Understanding the spatial distribution of radiation levels outside of a patient undergoing177Lu radioligand therapy is not only helpful for conducting correct tests for patient release, but also useful for estimation of its potential exposure to healthcare workers, caregivers, family members, and the general public. In this study, by mimicking the177Lu-labeled prostate-specific membrane antigen radioligand therapy for prostate cancers in an adult male, the spatial distribution of radiation levels outside of the phantom was simulated based on the Monte Carlo software of Particle and Heavy Ion Transport System, and verified by a series of measurements. Moreover, the normalized dose rates were further formulized on the three transverse planes representing the heights of pelvis, abdomen and chest. The results showed that the distributions of radiation levels were quite complex. Multi-directional and multi-height measurements are needed to ensure the external dose rate to meet the release criteria. In general, the radiation level was higher at the horizontal plane where the source was located, and the levels in front and behind of the body were higher than those of the left and right sides at the same height. The ratio of simulated dose rates to measured ones ranged from 0.82 to 1.19 within 1 m away from the body surface in all directions. Based on the established functions, the relative root mean square deviation between the calculated and simulated values were 0.21, 0.25 and 0.23 within a radius of 1 m on the pelvis, abdomen and chest transverse planes, respectively. It is expected that the results of this study would be helpful for guiding the test of extracorporeal radiation to determine the patient's release, and of benefit to estimate the radiation exposure to others.
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Affiliation(s)
- Huan Li
- Institute of Radiation Medicine, Fudan University, Shanghai 200032, People's Republic of China
| | - Haikuan Liu
- Institute of Radiation Medicine, Fudan University, Shanghai 200032, People's Republic of China
| | - Weiyuan Zhang
- Institute of Radiation Medicine, Fudan University, Shanghai 200032, People's Republic of China
| | - Xin Lin
- Institute of Radiation Medicine, Fudan University, Shanghai 200032, People's Republic of China
| | - Zhiling Li
- Institute of Radiation Medicine, Fudan University, Shanghai 200032, People's Republic of China
| | - Weihai Zhuo
- Institute of Radiation Medicine, Fudan University, Shanghai 200032, People's Republic of China
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Taylor L, Meades R, Quigley AM, Toumpanakis C, Goodlad C, Davenport A. Dosing lutetium Lu 177-dotatate for a hemodialysis patient. Hemodial Int 2024; 28:247-252. [PMID: 38448766 DOI: 10.1111/hdi.13144] [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: 10/12/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
Lu177-dotatate (Lutathera™) is a radioactive drug approved for the treatment of adults with gastro-entero-pancreatic neuroendocrine tumors and is predominantly renally excreted. Currently all patients receive 7400 MBq (200 mCi), and there are no guidelines for treating hemodialysis patients. We measured radioactivity prior to and post administration of two cycles of Lu177-dotatate in a hemodialysis patient, and radiation exposure to staff. We reduced the standard 7400 MBq by 33% for the first cycle and patient radioactivity fell by 40% following postdilution hemodiafiltration started 6 h post dosing, and by 45% for the second cycle and radioactivity fell by 47% with postdilution hemodiafiltration started 5 h post administration. By reducing the initial administered radioactivity, coupled with early dialysis, and choosing postdilution hemodiafiltration we were able to achieve radioactivity retention curves similar to those from patients with normal renal function receiving the standard administration of 7400 MBq.
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Affiliation(s)
- Lindsay Taylor
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Richard Meades
- Department of Nuclear Medicine, Royal Free Hospital, London, UK
| | | | - Christos Toumpanakis
- Centre for Gastroenterology & Neuroendocrine Tumour Unit - ENETS Centre of Excellence of Royal Free Hospital, London, UK
| | - Catriona Goodlad
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
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Riveira-Martin M, Struelens L, Muñoz Iglesias J, Schoonjans W, Tabuenca O, Nogueiras JM, Salvador Gómez FJ, López Medina A. Radiation exposure assessment of nuclear medicine staff administering [ 177Lu]Lu-DOTA-TATE with active and passive dosimetry. EJNMMI Phys 2023; 10:70. [PMID: 37962683 PMCID: PMC10645926 DOI: 10.1186/s40658-023-00592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The use of lutetium-177 (177Lu)-based radiopharmaceuticals in peptide receptor nuclear therapy is increasing, but so is the number of nuclear medicine workers exposed to higher levels of radiation. In recent years, [177Lu]Lu-DOTA-TATE has begun to be widely used for the treatment of neuroendocrine tumours. However, there are few studies evaluating the occupational radiation exposure during its administration, and there are still some challenges that can result in higher doses to the staff, such as a lack of trained personnel or fully standardised procedures. In response, this study aims to provide a comprehensive analysis of occupational doses to the staff involved in the administration of [177Lu]Lu-DOTA-TATE. RESULTS A total of 32 administrations of [177Lu]Lu-DOTA-TATE (7.4 GBq/session) carried out by a physician and a nurse, were studied. In total, two physicians and four nurses were independently monitored with cumulative (passive) and/or real-time (active) dosemeters. Extremity, eye lens and whole-body doses were evaluated in terms of the dosimetric quantities Hp(0.07), Hp(3) and Hp(10), respectively. It was obtained that lead aprons reduced dose rates and whole-body doses by 71% and 69% for the physicians, respectively, and by 56% and 68% for the nurses. On average, normalised Hp(10) values of 0.65 ± 0.18 µSv/GBq were obtained with active dosimetry, which is generally consistent with passive dosemeters. For physicians, the median of the maximum normalised Hp(0.07) values was 41.5 µSv/GBq on the non-dominant hand and 45.2 µSv/GBq on the dominant hand. For nurses 15.4 µSv/GBq on the non-dominant and 13.9 µSv/GBq on the dominant hand. The ratio or correction factor between the maximum dose measured on the hand and the dose measured on the base of the middle/ring finger of the non-dominant hand resulted in a factor of 5/6 for the physicians and 3/4 for the nurses. Finally, maximum normalised Hp(3) doses resulted in 2.02 µSv/GBq for physicians and 1.76 µSv/GBq for nurses. CONCLUSIONS If appropriate safety measures are taken, the administration of [177Lu]Lu-DOTA-TATE is a safe procedure for workers. However, regular monitoring is recommended to ensure that the annual dose limits are not exceeded.
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Affiliation(s)
- Mercedes Riveira-Martin
- Genetic Oncology, Radiobiology and Radiointeraction Research Group, Galicia Sur Health Research Institute (IISGS), Vigo, Spain.
- Department of Radiology, Rehabilitation and Physiotherapy, Medicine School, Complutense University of Madrid, Madrid, Spain.
| | | | - José Muñoz Iglesias
- Nuclear Medicine Department (SERGAS), Meixoeiro Hospital, University Hospital of Vigo, Vigo, Spain
| | | | - Olga Tabuenca
- Nuclear Medicine Department (SERGAS), Meixoeiro Hospital, University Hospital of Vigo, Vigo, Spain
| | - José Manuel Nogueiras
- Nuclear Medicine Department (GALARIA), Meixoeiro Hospital, University Hospital of Vigo, Vigo, Spain
| | | | - Antonio López Medina
- Medical Physics and RP Department (GALARIA), Meixoeiro Hospital, University Hospital of Vigo, Vigo, Spain
- Department of Functional Biology and Health Sciences, University of Vigo, Vigo, Spain
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Okuhata K, Monzen H, Nakamura Y, Takai G, Nagano K, Nakamura K, Kubo K, Hosono M. Effectiveness of shielding materials against 177Lu gamma rays and the corresponding distance relationship. Ann Nucl Med 2023; 37:629-634. [PMID: 37596439 DOI: 10.1007/s12149-023-01860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE The purpose of this study is to determine the dose reduction of different shielding materials at various distances from a 177Lu photon radiation source. METHODS Two protective aprons with lead equivalent thicknesses of 0.25 mm and 0.35 mm and tungsten-containing rubber (TCR) were used as shielding materials. A vial containing 177Lu was sealed in a lead container so that a narrow beam went out through a 3 mm-diameter hole. The dose rate was measured at distances of 0, 10, 50, 100, and 200 cm from the source using a NaI scintillation survey meter to obtain the rate of dose reduction. TCR was tested with thicknesses ranging from 0.3 to 1.0 mm at 0.1 mm intervals and from 1.0 to 4.0 mm at 0.5 mm intervals. RESULTS At distances of 0, 10, 50, 100, and 200 cm, the dose reduction for the lead equivalent thickness of 0.25 mm were 32.7%, 54.5%, 93.1%, 97.9%, and 99.6%, respectively; and for the lead equivalent thickness of 0.35 mm were 53.4%, 70.6%, 95.6%, 98.9%, and 99.6%, respectively. Without any shielding, the dose rate decreased by 34.4% at 10 cm and by 88.8% at 50 cm from the radiation source. The dose reduction for the TCR thickness of 3.5 mm was 89.8% at 0 cm and 93.3% at 10 cm. The TCR thickness of 0.4 mm provided a dose reduction comparable to or greater than that of the 0.25 mm lead equivalent, whereas the TCR thickness of 1.0 mm or greater provided a dose reduction comparable to that of the 0.35 mm lead equivalent. CONCLUSIONS Achieving a reduction of 95% or more requires the 0.25 mm lead equivalent for a distance of 100 cm, the 0.35 mm lead equivalent for 50 cm, the TCR thickness of 0.3 mm for 100 cm, or the TCR thickness of 0.9 mm for 50 cm. Without wearing a protective apron, a reduction of approximately 95% is observed at distances greater than 100 cm. These findings would be useful for medical staff engaging in related activities.
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Affiliation(s)
- Katsuya Okuhata
- Department of Radiology, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka-shi, Osaka, 5530003, Japan.
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Onohigashi, Osakasayama-shi, Osaka, 5898511, Japan
| | - Yasunori Nakamura
- Department of Radiology, University Hospital, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Go Takai
- Department of Radiology, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka-shi, Osaka, 5530003, Japan
| | - Keiji Nagano
- Department of Radiology, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka-shi, Osaka, 5530003, Japan
| | - Kenji Nakamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Onohigashi, Osakasayama-shi, Osaka, 5898511, Japan
| | - Kazuki Kubo
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Onohigashi, Osakasayama-shi, Osaka, 5898511, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2 Onohigashi, Osakasayama-shi, Osaka, 5898511, Japan
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Monserrat Fuertes T, Santos Zorrozua B, Rodeño Ortiz de Zarate E, Peinado Montes MÁ, Vigil Díaz C, Mínguez Gabiña P. Individualisation of radiation protection recommendations for patients treated with [ 177Lu]Lu-DOTA-TATE. EJNMMI Phys 2023; 10:50. [PMID: 37665476 PMCID: PMC10477145 DOI: 10.1186/s40658-023-00570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND As for any other nuclear medicine treatment, patients treated with [177Lu]Lu-DOTA-TATE should be given some radiation protection recommendations after being discharged to limit the dose received by family members and public. The restriction periods will depend on the remaining activity at the time of discharge, the washout rate and patients' personal conditions. The activity in patients' whole-body follows a bi-exponential behaviour. At the time of discharge only the first part of the time-activity curve is known. However, the second phase of the bi-exponential curve should be known to individualize the time of restrictions. The main purpose of this prospective study was to establish a simple method for calculating the restriction periods based on measurements taken before discharge. METHODS The whole-body time-activity curve was calculated for 20 patients from dose-rate measurements performed during the first week post-administration. An effective decay time [Formula: see text] was calculated from a mono-exponential fit performed with the 6 h and 24 h measurements and compared with the effective decay time [Formula: see text] obtained from the mono-exponential fit performed with the 24 h, 48 h and 168 h measurements. The differences between them were calculated and the 95th percentile of these differences was used as a correction factor for [Formula: see text]. A modified effective decay [Formula: see text] was obtained by adding the correction factor to [Formula: see text] and the restriction periods for each patient was calculated. The whole body activity washout between the first and the fourth treatment cycles of 16 patients was also compared. RESULTS The comparison of the whole-body activity curves between the first and the fourth cycle of the treatment for 16 patients would indicate that the recommendations on radiation protection determined from the first cycle could reasonably be used for the remaining cycles in most patients. The values of [Formula: see text] and [Formula: see text] obtained for the 20 patients were significantly different. The 95th percentile of the differences between [Formula: see text] and [Formula: see text] was 46 h, which is thus the time to be added to [Formula: see text] so as to determine the restriction periods. CONCLUSIONS The proposed method makes it possible to calculate the restriction periods for patients treated with [177Lu]Lu-DOTA-TATE before they leave the hospital in a conservative and individualized way.
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Affiliation(s)
- Teresa Monserrat Fuertes
- Department of Medical Physics and Radiation Protection, Central University Hospital of Asturias, Oviedo, Spain
- Department of Surgery, Radiology and Physical Medicine, Faculty of Medicine and Nursing, UPV/EHU, Bilbao, Spain
| | - Borja Santos Zorrozua
- Scientific Coordination Unit, Biocruces Bizkaia Health Research Institute, Gurutzeta-Cruces University Hospital, Barakaldo, Spain
| | - Emilia Rodeño Ortiz de Zarate
- Department of Nuclear Medicine, Biocruces Bizkaia Health Research Institute, Gurutzeta-Cruces University Hospital, Barakaldo, Spain
| | - Miguel Ángel Peinado Montes
- Department of Medical Physics and Radiation Protection, Central University Hospital of Asturias, Oviedo, Spain
| | - Carmen Vigil Díaz
- Department of Nuclear Medicine, Central University Hospital of Asturias, Oviedo, Spain
| | - Pablo Mínguez Gabiña
- Department of Medical Physics and Radiation Protection, Biocruces Bizkaia Health Research Institute, Gurutzeta-Cruces University Hospital, Gurutzeta Plaza Z/G, 48903, Barakaldo, Bizkaia, Spain.
- Department of Applied Physics, Faculty of Engineering, UPV/EHU, Bilbao, Spain.
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7
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Broggio D, Célier D, Michel C, Isambert A. Contact restriction time after common nuclear medicine therapies: spreadsheet implementation based on conservative retention function and individual measurements. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:021504. [PMID: 36927533 DOI: 10.1088/1361-6498/acc4d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
The increasing use of new radiopharmaceuticals invites us to reconsider some radiation protection issues, such as the contact restriction time that limits public exposure by nuclear medicine patients. Contact restriction time should be patient specific and conservative, and its assessment made easy for clinicians. Here a method is proposed based on conservative estimation of the whole-body retention function and at least one measurement of the patient's dose rate. Recommended values of the retention function are given for eight therapies:131I (Graves' disease, remnant ablation, patient follow-up, meta-iodobenzylguanidine),177Lu-prostate-specific membrane antigen and177Lu-DOTATATE therapies, and90Y and166Ho microsphere injection of the liver. The patient line source model for scaling dose rate from one distance to another is included in the restriction time calculation. The method is benchmarked against published values and the influence of the dose rate scaling and whole-body retention function illustrated. A spreadsheet is provided, along with the source code, with recommended values for the eight therapies. The recommended values can be changed as well as the dose rate scaling function, and other radiopharmaceuticals can be included in the spreadsheet provided retention functions are defined.
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Affiliation(s)
- D Broggio
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SDOS/LEDI, F-92260 Fontenay-aux-Roses, France
| | - D Célier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SER/UEM, F-92260 Fontenay-aux-Roses, France
| | - C Michel
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SER/UEM, F-92260 Fontenay-aux-Roses, France
| | - A Isambert
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE/SER/UEM, F-92260 Fontenay-aux-Roses, France
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8
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Herrmann K, Giovanella L, Santos A, Gear J, Ozgen Kiratli P, Kurth J, Denis-Bacelar AM, Hustinx R, Patt M, Wahl RL, Paez D, Giammarile F, Jadvar H, Pandit-Taskar N, Ghesani M, Kunikowska J. Joint EANM, SNMMI, and IAEA Enabling Guide: How to Set up a Theranostics Center. J Nucl Med 2022; 63:1836-1843. [PMID: 35450957 DOI: 10.2967/jnumed.122.264321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/20/2022] [Indexed: 01/14/2023] Open
Abstract
The theranostics concept using the same target for both imaging and therapy dates back to the middle of the last century, when radioactive iodine was first used to treat thyroid diseases. Since then, radioiodine has become broadly established clinically for diagnostic imaging and therapy of benign and malignant thyroid disease, worldwide. However, only since the approval of SSTR2-targeting theranostics following the NETTER-1 trial in neuroendocrine tumors, and the positive outcome of the VISION trial has theranostics gained substantial attention beyond nuclear medicine. The roll-out of radioligand therapy for treating a high-incidence tumor such as prostate cancer requires the expansion of existing and the establishment of new theranostics centers. Despite wide global variation in the regulatory, financial and medical landscapes, this guide attempts to provide valuable information to enable interested stakeholders to safely initiate and operate theranostic centers. This enabling guide does not intend to answer all possible questions, but rather to serve as an overarching framework for multiple, more detailed future initiatives. It recognizes that there are regional differences in the specifics of regulation of radiation safety, but common elements of best practice valid globally.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Duisburg, Germany; .,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Andrea Santos
- Department of Nuclear Medicine, Hospital Cuf Descobertas, Lisbon, Portugal
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, Sutton, United Kingdom
| | | | - Jens Kurth
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
| | | | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium.,GIGA-CRC in vivo imaging, University of Liège, Liège, Belgium
| | - Marianne Patt
- Department for Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Richard L Wahl
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Application, International Atomic Energy Agency, Vienna, Austria
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Application, International Atomic Energy Agency, Vienna, Austria
| | - Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, University of Southern California, Los Angeles, California
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Munir Ghesani
- Diagnostic, Molecular & Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
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9
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Quo Vadis, Teragnosis? Rev Esp Med Nucl Imagen Mol 2022; 41:341-344. [DOI: 10.1016/j.remnie.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
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10
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Vercher-Conejero JL. Quo Vadis, Teragnosis? Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Bellamy M, Chu B, Serencsits B, Quinn B, Prasad K, Altamirano J, Williamson M, Miodownik D, Abrahams N, Chen F, Bierman D, Wutkowski M, Dauer L. SUBSTANTIAL EXTERNAL DOSE RATE VARIABILITY OBSERVED IN A COHORT OF LU-177 PATIENTS INDEPENDENT OF BMI AND SEX. RADIATION PROTECTION DOSIMETRY 2022; 198:1476-1482. [PMID: 36138119 PMCID: PMC9667277 DOI: 10.1093/rpd/ncac187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/06/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
External dose rates were measured 1 m away from 230 Lu-177 patients to characterise the variability in normalised dose rates as a function of administered activity, body mass index (BMI) and sex. The largest dose rate observed was 0.07 mSv/h associated with an administered activity of 7.2 GBq. Substantial variability was found in the distribution of the normalised dose rate associated that had an average of 0.0037 mSv/h per GBq and a 95% confidence interval of 0.0024-0.0058 mSv/h per GBq. Based on this study, estimating the patient dose rate based on the Lu-177 gamma exposure factor overestimates the dose rate by a factor of 2. A statistically significant inverse relationship was found between the patient dose rate and patient BMI and an empirically derived equation relating these two quantities was reported. On average, male patient dose rates were 3.5% lower than female dose rates, which may be attributed to the larger average BMI of the male patient group.
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Affiliation(s)
| | - Bae Chu
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Brian Serencsits
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Brian Quinn
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - K Prasad
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - J Altamirano
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Matthew Williamson
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Daniel Miodownik
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Natalie Abrahams
- Siena College, 515 Loudon Road, Loudonville, New York, NY 12211, USA
| | - Fanny Chen
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - David Bierman
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - M Wutkowski
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
| | - Lawrence Dauer
- Department of Medical Physics, Memorial Sloan Kettering, 1275 York Avenue, New York, NY 10065, USA
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12
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Stokke C, Kvassheim M, Blakkisrud J. Radionuclides for Targeted Therapy: Physical Properties. Molecules 2022; 27:molecules27175429. [PMID: 36080198 PMCID: PMC9457625 DOI: 10.3390/molecules27175429] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
A search in PubMed revealed that 72 radionuclides have been considered for molecular or functional targeted radionuclide therapy. As radionuclide therapies increase in number and variations, it is important to understand the role of the radionuclide and the various characteristics that can render it either useful or useless. This review focuses on the physical characteristics of radionuclides that are relevant for radionuclide therapy, such as linear energy transfer, relative biological effectiveness, range, half-life, imaging properties, and radiation protection considerations. All these properties vary considerably between radionuclides and can be optimised for specific targets. Properties that are advantageous for some applications can sometimes be drawbacks for others; for instance, radionuclides that enable easy imaging can introduce more radiation protection concerns than others. Similarly, a long radiation range is beneficial in targets with heterogeneous uptake, but it also increases the radiation dose to tissues surrounding the target, and, hence, a shorter range is likely more beneficial with homogeneous uptake. While one cannot select a collection of characteristics as each radionuclide comes with an unchangeable set, all the 72 radionuclides investigated for therapy—and many more that have not yet been investigated—provide numerous sets to choose between.
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Affiliation(s)
- Caroline Stokke
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4959 Nydalen, 0424 Oslo, Norway
- Department of Physics, University of Oslo, Problemveien 7, 0315 Oslo, Norway
- Correspondence:
| | - Monika Kvassheim
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4959 Nydalen, 0424 Oslo, Norway
- Division of Clinical Medicine, University of Oslo, Problemveien 7, 0315 Oslo, Norway
| | - Johan Blakkisrud
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.O. Box 4959 Nydalen, 0424 Oslo, Norway
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[Anticipating Criteria for Discharge after Lu-177-PSMA Treatment - Discussion of Several Scenarios]. Nuklearmedizin 2022; 61:111-119. [PMID: 35170005 DOI: 10.1055/a-1697-8126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim is to add a pragmatic contribution to the discussion of an algorithm to discharge patients treated with Lu-177-PSMA under the aspect of radiation protection. This also may be applied to therapies with other radioactive tracers in the future. MATERIAL AND METHODS 478 cycles of Lu-177-PSMA-617 (140 patients) were analyzed. The remaining activity in the patient and the dose rate were correlated. From frequent intratherapeutic measurements (biexponential fit) scenarios for discharging patients are deduced. RESULTS Thirty-four per cent of all patients treated with Lu-177-PSMA received 3 to 5 cycles per calendar year. The dose limit of 1 mSv per calendar year (German Law) at a distance of 2 m from the patient would be exceeded in 10 % and 15 % of the treated patients if discharged 72 hours after treatment given 3 and 4 cycles per calendar year, respectively. Mean specific dose rate was 0.00462µSv/(h MBq) at a distance of 1 m. A universal correlation between dose rate and the remaining activity in the patient could not be found. CONCLUSION The multi cycle concept of the therapies with Lu-177 PSMA has to be taken into account prospectively when discharging the patients. Given the physical half-life of Lu-177 an anticipation of 4 treatment cycles per calendar year leads to a clearly arranged, conservative rule.
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Joint EANM, SNMMI and IAEA enabling guide: how to set up a theranostics centre. Eur J Nucl Med Mol Imaging 2022; 49:2300-2309. [PMID: 35403861 PMCID: PMC9165261 DOI: 10.1007/s00259-022-05785-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 01/14/2023]
Abstract
The theranostics concept using the same target for both imaging and therapy dates back to the middle of the last century, when radioactive iodine was first used to treat thyroid diseases. Since then, radioiodine has become broadly established clinically for diagnostic imaging and therapy of benign and malignant thyroid disease, worldwide. However, only since the approval of SSTR2-targeting theranostics following the NETTER-1 trial in neuroendocrine tumours and the positive outcome of the VISION trial has theranostics gained substantial attention beyond nuclear medicine. The roll-out of radioligand therapy for treating a high-incidence tumour such as prostate cancer requires the expansion of existing and the establishment of new theranostics centres. Despite wide global variation in the regulatory, financial and medical landscapes, this guide attempts to provide valuable information to enable interested stakeholders to safely initiate and operate theranostics centres. This enabling guide does not intend to answer all possible questions, but rather to serve as an overarching framework for multiple, more detailed future initiatives. It recognizes that there are regional differences in the specifics of regulation of radiation safety, but common elements of best practice valid globally.
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Marengo M, Martin CJ, Rubow S, Sera T, Amador Z, Torres L. Radiation Safety and Accidental Radiation Exposures in Nuclear Medicine. Semin Nucl Med 2021; 52:94-113. [PMID: 34916044 DOI: 10.1053/j.semnuclmed.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical radiation accidents and unintended events may lead to accidental or unintended medical exposure of patients and exposure of staff or the public. Most unintended exposures in nuclear medicine will lead to a small increase in risk; nevertheless, these require investigation and a clinical and dosimetric assessment. Nuclear medicine staff are exposed to radiation emitted directly by radiopharmaceuticals and by patients after administration of radiopharmaceuticals. This is particularly relevant in PET, due to the penetrating 511 keV γ-rays. Dose constraints should be set for planning the exposure of individuals. Staff body doses of 1-25 µSv/GBq are reported for PET imaging, the largest component being from the injection. The preparation and administration of radiopharmaceuticals can lead to high doses to the hands, challenging dose limits for radionuclides such as 90Y and even 18F. The risks of contamination can be minimized by basic precautions, such as carrying out manipulations in purpose-built facilities, wearing protective clothing, especially gloves, and removing contaminated gloves or any skin contamination as quickly as possible. Airborne contamination is a potential problem when handling radioisotopes of iodine or administering radioaerosols. Manipulating radiopharmaceuticals in laminar air flow cabinets, and appropriate premises ventilation are necessary to improve safety levels. Ensuring patient safety and minimizing the risk of incidents require efficient overall quality management. Critical aspects include: the booking process, particularly if qualified medical supervision is not present; administration of radiopharmaceuticals to patients, with the risk of misadministration or extravasation; management of patients' data and images by information technology systems, considering the possibility of misalignment between patient personal data and clinical information. Prevention of possible mistakes in patient identification or in the management of patients with similar names requires particular attention. Appropriate management of pregnant or breast-feeding patients is another important aspect of radiation safety. In radiopharmacy activities, strict quality assurance should be implemented at all operational levels, in addition to adherence to national and international regulations and guidelines. This includes not only administrative aspects, like checking the request/prescription, patient's data and the details of the requested procedure, but also quantitative tests according to national/international pharmacopoeias, and measuring the dispensed activity with a calibrated activity meter prior to administration. In therapy with radionuclides, skin tissue reactions can occur following extravasation, which can result in localized doses of tens of Grays. Other relevant incidents include confusion of products for patients administered at the same time or malfunction of administration devices. Furthermore, errors in internal radiation dosimetry calculations for treatment planning may lead to under or over-treatment. According to literature, proper instructions are fundamental to keep effective dose to caregivers and family members after patient discharge below the Dose constraints. The IAEA Basic Safety Standards require measures to minimize the likelihood of any unintended or accidental medical exposures and reporting any radiation incident. The relative complexity of nuclear medicine practice presents many possibilities for errors. It is therefore important that all activities are performed according to well established procedures, and that all actions are supported by regular quality assurance/QC procedures.
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Affiliation(s)
- Mario Marengo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
| | - Colin J Martin
- Department of Clinical Physics and Bioengineering, University of Glasgow, UK
| | - Sietske Rubow
- Nuclear Medicine Division, Stellenbosch University, Stellenbosch, South Africa
| | - Terez Sera
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Zayda Amador
- Radiation Protection Department, Centre of Isotopes, Havana, Cuba
| | - Leonel Torres
- Nuclear Medicine Department, Centre of Isotopes, Havana, Cuba
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Meléndez-Alafort L, Ferro-Flores G, Santos-Cuevas C, Ocampo-García B, Turato S, Fracasso G, Bolzati C, Rosato A, De Nardo L. Preclinical dosimetric studies of 177 Lu-scFvD2B and comparison with 177 Lu-PSMA-617 and 177 Lu-iPSMA endoradiotherapeutic agents. Med Phys 2021; 48:4064-4074. [PMID: 33966284 DOI: 10.1002/mp.14936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Internal dosimetry has become a very important tool to evaluate the risks and benefits of new endoradiotherapeutic agents. Nowadays, some of the most successful targeted radionuclide therapy (TRT) agents are 177 Lu-DOTA conjugates based on low molecular weight (LMW) Glu-ureido PSMA inhibitors. It has, however, been demonstrated that the DOTA chelating moiety reduces the internalization of the LMW-PSMA agent and its radiation dose to the tumor. Previously, we reported that 177 Lu-scFvD2B, an antibody-based construct, demonstrated statistically significant higher cell uptake and internalization in LNCaP prostate cancer (PCa) cells (PSMA-positive) when compared to the LMW-PSMA agents, 177 Lu-PSMA-617 and 177 Lu-iPSMA, two of the endoradiotherapeutic agents which currently are the most used in PCa therapy. The aim of this study is to estimate the preclinical 177 Lu-scFvD2B organ and tumor-absorbed doses, and to compare the values with those of 177 Lu-PSMA-617 and 177 Lu-iPSMA. METHODS 177 Lu-scFvD2B, 177 Lu-PSMA-617, and 177 Lu-iPSMA were prepared and their radiochemical purity determined. Biodistribution studies of each radiopharmaceutical were then carried out in healthy mice to define the main source organs (SO) and to calculate the number of disintegrations in each source organs per unit of administered activity (NSO ). Absorbed dose in the main organs were then calculated for each 177 Lu-conjugate by means of OLINDA/EXM 2.1.1 software, using the calculated NSO for both the adult male and the mouse phantoms as program inputs. Images of mice bearing micropulmonary tumors injected with 177 Lu-conjugates were also obtained. Tumor standardized uptake values (SUV) for the different conjugates, obtained from the 3D SPECT image reconstruction of these mice, were used as the number of disintegrations in a tumor site per unit of administered activity (NT ). The tumor-absorbed dose was calculated using the published electron dose S-values for sphere models with diameters ranging from 10 µm to 10 mm and considering a uniform activity distribution and tumor density equivalent to water density. RESULTS All 177 Lu-labeled agents were obtained in high yield (98%). Dosimetric studies carried out using mouse phantoms demonstrated that organ absorbed doses of 177 Lu-scFvD2B were from 1.4 to 2.3 times higher than those for 177 Lu-iPSMA and from 1.5 to 2.6 times higher than those for 177 Lu-PSMA-617. However, the 177 Lu-scFvD2B values of tumor-absorbed doses for all investigated tumor sizes were from 2.8 to 3.0 times greater than those calculated for 177 Lu-iPSMA and 177 Lu-PSMA-617, respectively. Moreover, 177 Lu-scFvD2B showed the highest tumor/kidney ratio when compared to those reported for 177 Lu-albumin conjugates. CONCLUSIONS In this preclinical study, we demonstrated the potential of 177 Lu-scFvD2B as a therapeutic agent for PSMA-expressing tumors, due to its higher tumor-absorbed dose when compared with 177 Lu-LMW agents.
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Affiliation(s)
| | - Guillermina Ferro-Flores
- Laboratorio Nacional de Investigación y Desarrollo de Radiofármacos-CONACyT, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac,, 52750, Estado de México, México
| | - Clara Santos-Cuevas
- Laboratorio Nacional de Investigación y Desarrollo de Radiofármacos-CONACyT, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac,, 52750, Estado de México, México
| | - Blanca Ocampo-García
- Laboratorio Nacional de Investigación y Desarrollo de Radiofármacos-CONACyT, Instituto Nacional de Investigaciones Nucleares, Carretera México-Toluca S/N, La Marquesa, Ocoyoacac,, 52750, Estado de México, México
| | - Sofia Turato
- Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35138, Padua, Italy
| | - Giulio Fracasso
- Department of Medicine, University of Verona, Piaz. Le L.A. Scuro 10, 37134, Verona, Italy
| | - Cristina Bolzati
- Institute of Condensed Matter Chemistry and Energy Technologies, ICMATE-CNR, Corso Stati Uniti 4, 35127, Padua, Italy
| | - Antonio Rosato
- Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata 64, 35138, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Gattamelata 64, 35138, Padua, Italy
| | - Laura De Nardo
- Department of Physics and Astronomy, University of Padua, Via Marzolo 8, 35131, Padua, Italy.,INFN, Sezione di Padova, Via Marzolo 8, 35131, Padua, Italy
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Zhang-Yin J, Guilabert N, Kiffel T, Montravers F, Calais P, Lumbroso J, Talbot JN. Patient external dose rate after 177Lu-DOTATATE therapy: factors affecting its decrease and predictive value. Int J Med Sci 2021; 18:2725-2735. [PMID: 34104105 PMCID: PMC8176171 DOI: 10.7150/ijms.58680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/02/2021] [Indexed: 11/08/2022] Open
Abstract
Rationale: Peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE (oxodotreotide) results in external radiation exposure from the patient. In the PREELU observational prospective study, we determined the equivalent dose rate at 1 m of the patient (EDR-1m) for a period following PRRT. The main objective was to predict which patients could be discharged from the hospital at approximately 3 h after the administration of 177Lu-DOTATATE, i.e. at the end of the infusion of amino-acids according to our PRRT protocol. As presenting no undue risk of radiation exposure for the public, those patients could be treated as outpatients or day patients, rather than inpatients. Methods: We sequentially measured EDR-1m facing the sternum and then the pelvis during 50 PRRT in 24 patients with metastatic neuroendocrine tumours, each 30 minutes after ending administration of Lutathera, over at least 180 minutes. Results: 180 minutes after the administration of ca. 7400 MBq of Lutathera, EDR-1m was <40 µSv/h in all cases, and <25 µSv/h in 32 cases (64%). After an overnight hospital stay, EDR-1m was <25 µSv/h in all cases. The EDR-1m value measured facing the sternum was the greatest in about one-fourth of paired measurements. In patients whose creatinine clearance was >96 mL/min/1.73m2, the EDR-1m was most likely (predictive value=90%) to drop below 25 µSv/h within 180 minutes after the administration of Lutathera. In 16 patients who benefited from several PRRT cycles, the creatinine clearance did not decrease significantly from one cycle to the next, probably due to the kidney protection by the amino-acid infusion. The patients whose EDR-1m dropped below 25 µSv/h at 180 minutes during their first PRRT cycle were unlikely (predictive value= 88%) to decease during the following two years. Conclusion: All patients could have been discharged 3 h after administration according to the criterion EDR-1m <40 µSv/h. Using EDR-1m <25 µSv/h as criterion, an extended hospital stay beyond 3 h would have been necessary in around one-third of the PRRT treatments and could be anticipated based on creatinine clearance ≤96 mL/min/1.73m2. EDR-1m <25 µSv/h at 180 min during the first PRRT yielded a strong predictive value on the patient's survival at two years, a finding that should be confirmed in future studies.
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Affiliation(s)
- Jules Zhang-Yin
- Nuclear Medicine, GH Tenon-St Antoine and Sorbonne Université, Paris, France
| | - Nadine Guilabert
- Nuclear Medicine and Radiation Safety departments, Gustave Roussy Cancer Campus, Villejuif, France
| | - Thierry Kiffel
- Nuclear Medicine, GH Tenon-St Antoine and Sorbonne Université, Paris, France
| | | | - Phillip Calais
- Clinical Physics, Royal Perth Hospital, Perth, Australia
| | - Jean Lumbroso
- Nuclear Medicine and Radiation Safety departments, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Noël Talbot
- Nuclear Medicine, GH Tenon-St Antoine and Sorbonne Université, Paris, France
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Merrick MJ, Rotsch DA, Tiwari A, Nolen J, Brossard T, Song J, Wadas TJ, Sunderland JJ, Graves SA. Imaging and dosimetric characteristics of 67 Cu. Phys Med Biol 2021; 66:035002. [PMID: 33496267 DOI: 10.1088/1361-6560/abca52] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In recent years the use of beta-emitting radiopharmaceuticals for cancer therapy has expanded rapidly following development of therapeutics for neuroendocrine tumors, prostate cancer, and other oncologic malignancies. One emerging beta-emitting radioisotope of interest for therapy is 67Cu (t1/2: 2.6 d) due to its chemical equivalency with the widely-established positron-emitting isotope 64Cu (t1/2: 12.7 h). In this work we evaluate both the imaging and dosimetric characteristics of 67Cu, as well as producing the first report of SPECT/CT imaging using 67Cu. To this end, 67Cu was produced by photon-induced reactions on isotopically-enriched 68Zn at the Low-Energy Accelerator Facility (LEAF) of Argonne National Laboratory, followed by bulk separation of metallic 68Zn by sublimation and radiochemical purification by column chromatography. Gamma spectrometry was performed by efficiency-calibrated high-purity germanium (HPGe) analysis to verify absolute activity calibration and establish radionuclidic purity. Absolute activity measurements corroborated manufacturer-recommended dose-calibrator settings and no radionuclidic impurities were observed. Using the Clinical Trials Network anthropomorphic chest phantom, SPECT/CT images were acquired. Medium energy (ME) SPECT collimation was found to provide the best image quality from the primary 185 keV gamma emission of 67Cu. Reconstructed images of 67Cu were similar in quality to images acquired using 177Lu. Recovery coefficients were calculated and compared against quantitative images of 99mTc, 177Lu, and 64Cu within the same anthropomorphic chest phantom. Production and clinical imaging of 67Cu appears feasible, and future studies investigating the therapeutic efficacy of 67Cu-based radiopharmaceuticals are warranted.
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Affiliation(s)
- Michael J Merrick
- Department of Radiology, University of Iowa, Iowa City, IA, United States of America. Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States of America
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Meades R, Gnanasegaran G, McCool D. Radionuclide therapy services in an era of COVID-19: the radiation protection challenges, opportunities and considerations. Nucl Med Commun 2021; 42:1-2. [PMID: 33044404 PMCID: PMC7720807 DOI: 10.1097/mnm.0000000000001308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Richard Meades
- Nuclear Medicine Department, Royal Free London NHS Foundation Trust, London, UK
| | | | - Daniel McCool
- Nuclear Medicine Department, Royal Free London NHS Foundation Trust, London, UK
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Zhang YD, Dong Z, Wang SH, Yu X, Yao X, Zhou Q, Hu H, Li M, Jiménez-Mesa C, Ramirez J, Martinez FJ, Gorriz JM. Advances in multimodal data fusion in neuroimaging: Overview, challenges, and novel orientation. AN INTERNATIONAL JOURNAL ON INFORMATION FUSION 2020; 64:149-187. [PMID: 32834795 PMCID: PMC7366126 DOI: 10.1016/j.inffus.2020.07.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/06/2020] [Accepted: 07/14/2020] [Indexed: 05/13/2023]
Abstract
Multimodal fusion in neuroimaging combines data from multiple imaging modalities to overcome the fundamental limitations of individual modalities. Neuroimaging fusion can achieve higher temporal and spatial resolution, enhance contrast, correct imaging distortions, and bridge physiological and cognitive information. In this study, we analyzed over 450 references from PubMed, Google Scholar, IEEE, ScienceDirect, Web of Science, and various sources published from 1978 to 2020. We provide a review that encompasses (1) an overview of current challenges in multimodal fusion (2) the current medical applications of fusion for specific neurological diseases, (3) strengths and limitations of available imaging modalities, (4) fundamental fusion rules, (5) fusion quality assessment methods, and (6) the applications of fusion for atlas-based segmentation and quantification. Overall, multimodal fusion shows significant benefits in clinical diagnosis and neuroscience research. Widespread education and further research amongst engineers, researchers and clinicians will benefit the field of multimodal neuroimaging.
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Affiliation(s)
- Yu-Dong Zhang
- School of Informatics, University of Leicester, Leicester, LE1 7RH, Leicestershire, UK
- Department of Information Systems, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Zhengchao Dong
- Department of Psychiatry, Columbia University, USA
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Shui-Hua Wang
- Department of Information Systems, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- School of Architecture Building and Civil engineering, Loughborough University, Loughborough, LE11 3TU, UK
- School of Mathematics and Actuarial Science, University of Leicester, LE1 7RH, UK
| | - Xiang Yu
- School of Informatics, University of Leicester, Leicester, LE1 7RH, Leicestershire, UK
| | - Xujing Yao
- School of Informatics, University of Leicester, Leicester, LE1 7RH, Leicestershire, UK
| | - Qinghua Zhou
- School of Informatics, University of Leicester, Leicester, LE1 7RH, Leicestershire, UK
| | - Hua Hu
- Department of Psychiatry, Columbia University, USA
- Department of Neurology, The Second Affiliated Hospital of Soochow University, China
| | - Min Li
- Department of Psychiatry, Columbia University, USA
- School of Internet of Things, Hohai University, Changzhou, China
| | - Carmen Jiménez-Mesa
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Javier Ramirez
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Francisco J Martinez
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Juan Manuel Gorriz
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
- Department of Psychiatry, University of Cambridge, Cambridge CB21TN, UK
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Basu S, Chakraborty S, Parghane RV, Kamaldeep, Ranade R, Thapa P, Asopa RV, Sonawane G, Nabar S, Shimpi H, Chandak A, Vimalnath KV, Ostwal V, Ramaswamy A, Bhandare M, Chaudhari V, Shrikhande SV, Sirohi B, Dash A, Banerjee S. One decade of 'Bench-to-Bedside' peptide receptor radionuclide therapy with indigenous [ 177Lu]Lu-DOTATATE obtained through 'Direct' neutron activation route: lessons learnt including practice evolution in an Indian setting. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2020; 10:178-211. [PMID: 32929396 PMCID: PMC7486551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/14/2020] [Indexed: 03/30/2024]
Abstract
The present treatise chronicles one decade of experience pertaining to clinical PRRT services in a large-volume tertiary cancer care centre in India delivering over 4,000 therapies, an exemplar of successful PRRT programme employing indigenous 177Lutetium production and resources. For the purpose of systematic discussion, we have sub-divided the communication into 3 specific parts: (a) Radiopharmaceutical aspects that describes 177Lutetium production through 'Direct' Neutron Activation Route and the subsequent radiolabeling procedures, (b) The specific clinical nuances and finer learning points (apart from the routine standard procedure) based upon clinical experience and how it has undergone practice evolution in our setting and (c) Dosimetry results with this indigenous product and radiation safety/health physics aspects involved in PRRT services. Initiated in 2010 at our centre, the PRRT programme is a perfect example of affordable quality health care delivery, with indigenous production of the radionuclide (177Lu) in the reactor and subsequent radiolabeling of the radiopharmaceutical ([177Lu]Lu-DOTATATE) at the hospital radiopharmacy unit of the centre, which enabled catering to the needs of a large number of patients of progressive, metastatic and advanced Neuroendocrine Neoplasms (NENs) and related malignancies.
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Affiliation(s)
- Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Sudipta Chakraborty
- Homi Bhabha National InstituteMumbai, India
- Radiopharmaceuticals Division, BARCMumbai, India
| | - Rahul V Parghane
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Kamaldeep
- Homi Bhabha National InstituteMumbai, India
- Health Physics Division, Bhabha Atomic Research CentreMumbai, India
| | - Rohit Ranade
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Pradeep Thapa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Ramesh V Asopa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Geeta Sonawane
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Swapna Nabar
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Hemant Shimpi
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - Ashok Chandak
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
| | - KV Vimalnath
- Radiopharmaceuticals Division, BARCMumbai, India
| | - Vikas Ostwal
- Homi Bhabha National InstituteMumbai, India
- Department of Medical Oncology, Tata Memorial CentreMumbai, Maharashtra, India
| | - Anant Ramaswamy
- Homi Bhabha National InstituteMumbai, India
- Department of Medical Oncology, Tata Memorial CentreMumbai, Maharashtra, India
| | - Manish Bhandare
- Homi Bhabha National InstituteMumbai, India
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Service, Tata Memorial HospitalMumbai, India
| | - Vikram Chaudhari
- Homi Bhabha National InstituteMumbai, India
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Service, Tata Memorial HospitalMumbai, India
| | - Shailesh V Shrikhande
- Homi Bhabha National InstituteMumbai, India
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Service, Tata Memorial HospitalMumbai, India
| | - Bhawna Sirohi
- Department of Medical Oncology, Tata Memorial CentreMumbai, Maharashtra, India
- Apollo Proton Cancer CentreChennai, India
| | - Ashutosh Dash
- Homi Bhabha National InstituteMumbai, India
- Radiopharmaceuticals Division, BARCMumbai, India
| | - Sharmila Banerjee
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital AnnexeParel, Mumbai, India
- Homi Bhabha National InstituteMumbai, India
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Maughan NM, Kim H, Hao Y, Unangst S, Roach MC, Garcia-Ramirez JL, Amurao M, Luechtefeld D, Abdin K, Altman MB, Banks A, Riepe M, Bovard E, Jenkins S, Zoberi JE. Initial experience and lessons learned with implementing Lutetium-177-dotatate radiopharmaceutical therapy in a radiation oncology-based program. Brachytherapy 2020; 20:237-247. [PMID: 32819853 DOI: 10.1016/j.brachy.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assist radiation oncology centers in implementing Lutetium-177-dotatate (177Lu) radiopharmaceutical therapy for midgut neuroendocrine tumors. Here we describe our workflow and how it was revised based on our initial experience on an expanded access protocol (EAP). METHODS A treatment team/area was identified. An IV-pump-based infusion technique was implemented. Exposure-based techniques were implemented to determine completion of administration, administered activity, and patient releasability. Acute toxicities were assessed at each fraction. A workflow failure modes and effects analysis (FMEA) was performed. RESULTS A total of 22 patients were treated: 11 patients during EAP (36 administrations) and 11 patients after EAP (44 administrations). Mean 177Lu infusion time was 37 min (range 26-65 min). Mean administered activity was 97% (range 90-99%). Mean patient exposures at 1 m were 1.9 mR/h (range 1.0-4.1 mR/h) post-177Lu and 0.9 mR/h (range 0.4-1.8 mR/h) at discharge, rendering patients releasable with instructions. Treatment area was decontaminated and released same day. All patients in the EAP experienced nausea, and nearly half experienced emesis despite premedication with antiemetics. Peripheral IV-line complications occurred in six treatments (16.7%), halting administration in 2 cases (5.6%). We transitioned to peripherally inserted central catheter (PICC)-lines and revised amino acid formulary after the EAP. The second cohort of 11 patients after EAP were analyzed for PICC-line complications and acute toxicity. Nausea and emesis rates decreased (nausea G1+ 61%-27%; emesis G1+ 23%-7%), and no PICC complications were observed. FMEA revealed that a failure in amino acid preparation was the highest risk. CONCLUSION 177Lu-dotatate can be administered safely in an outpatient radiation oncology department.
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Affiliation(s)
- Nichole M Maughan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO.
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Michael C Roach
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jose L Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Max Amurao
- Radiation Safety Division, EH&S Department, Washington University in St. Louis, St Louis, MO
| | - David Luechtefeld
- Radiation Safety Division, EH&S Department, Washington University in St. Louis, St Louis, MO
| | - Kinda Abdin
- Radiation Safety Division, EH&S Department, Washington University in St. Louis, St Louis, MO
| | - Michael B Altman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Alexis Banks
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Mary Riepe
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Erica Bovard
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Samantha Jenkins
- Department of Radiation Oncology, Barnes Jewish Hospital, St. Louis, MO
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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Patient Selection and Toxicities of PRRT for Metastatic Neuroendocrine Tumors and Research Opportunities. Curr Treat Options Oncol 2020; 21:25. [PMID: 32172368 DOI: 10.1007/s11864-020-0711-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OPINION STATEMENT Neuroendocrine tumors (NETs) are a heterogenous group of neoplasms characterized by varied biological hallmarks and behavior, ranging from indolent to aggressive. For many decades, somatostatin analogues and few targeted therapies were available for NETs and these therapies had minimal response rates. However, there have been a number of recent treatment advances. Peptide receptor radionuclide therapy (PRRT) is a novel approach to treatment of NETs and has changed the landscape of treatment for NETs. It is a form of targeted therapy in which a radiolabeled somatostatin analogue delivers radiation specifically to tumor cells expressing the somatostatin receptor.
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Cournane S, McCavana J, Manley M, Gray L, McCann J, Lucey J. Yttrium-90 selective internal radiation therapy, examining dose rates and radiation protection precautions. Phys Med 2019; 65:121-127. [DOI: 10.1016/j.ejmp.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/24/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022] Open
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