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Mercolli L, Bregenzer C, Diemling M, Mingels C, Rominger A, Sari H, Seibel S, Sohlberg A, Viscione M, Caobelli F. Internal dosimetry study of [ 82Rb]Cl using a long axial field-of-view PET/CT. Eur J Nucl Med Mol Imaging 2024; 51:1869-1875. [PMID: 38407598 PMCID: PMC11139737 DOI: 10.1007/s00259-024-06660-7] [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: 12/22/2023] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Long axial field-of-view (LAFOV) positron emission tomography (PET) systems allow to image all major organs with one bed position, which is particularly useful for acquiring whole-body dynamic data using short-lived radioisotopes like 82Rb. METHODS We determined the absorbed dose in target organs of three subjects (29, 40, and 57 years old) using two different methods, i.e., MIRD and voxel dosimetry. The subjects were injected with 407.0 to 419.61 MBq of [82Rb]Cl and were scanned dynamically for 7 min with a LAFOV PET/CT scanner. RESULTS Using the MIRD formalism and voxel dosimetry, the absorbed dose ranged from 1.84 to 2.78 μGy/MBq (1.57 to 3.92 μGy/MBq for voxel dosimetry) for the heart wall, 2.76 to 5.73 μGy/MBq (3.22 to 5.37 μGy/MBq for voxel dosimetry) for the kidneys, and 0.94 to 1.88 μGy/MBq (0.98 to 1.92 μGy/MBq for voxel dosimetry) for the lungs. The total body effective dose lied between 0.50 and 0.76 μSv/MBq. CONCLUSION Our study suggests that the radiation dose associated with [82Rb]Cl PET/CT can be assessed by means of dynamic LAFOV PET and that it is lower compared to literature values.
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Affiliation(s)
- Lorenzo Mercolli
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Carola Bregenzer
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hasan Sari
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Sigrid Seibel
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antti Sohlberg
- Hermes Medical Solutions, Stockholm, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Marco Viscione
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Caobelli
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Gordon S, Chan DLH, Bernard EJ, Eslick ME, Willowson KP, Roach PJ, Engel AF, Maher R, Clarke SJ, Agarwal V, Yasmin L, De Silva M, Mascall S, Conner A, Nevell D, Pavlakis N, Bailey DL. Single-centre experience with peptide receptor radionuclide therapy for neuroendocrine tumours (NETs): results using a theranostic molecular imaging-guided approach. J Cancer Res Clin Oncol 2023; 149:7717-7728. [PMID: 37004598 PMCID: PMC10374703 DOI: 10.1007/s00432-023-04706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
AIM To summarise our centre's experience managing patients with neuroendocrine tumours (NETs) in the first 5 years after the introduction of peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-octreotate (LUTATE). The report emphasises aspects of the patient management related to functional imaging and use of radionuclide therapy. METHODS We describe the criteria for treatment with LUTATE at our centre, the methodology for patient selection, and the results of an audit of clinical measures, imaging results and patient-reported outcomes. Subjects are treated initially with four cycles of ~ 8 GBq of LUTATE administered as an outpatient every 8 weeks. RESULTS In the first 5 years offering LUTATE, we treated 143 individuals with a variety of NETs of which approx. 70% were gastroentero-pancreatic in origin (small bowel: 42%, pancreas: 28%). Males and females were equally represented. Mean age at first treatment with LUTATE was 61 ± 13 years with range 28-87 years. The radiation dose to the organs considered most at risk, the kidneys, averaged 10.6 ± 4.0 Gy in total. Median overall survival (OS) from first receiving LUTATE was 72.5 months with a median progression-free survival (PFS) of 32.3 months. No evidence of renal toxicity was seen. The major long-term complication seen was myelodysplastic syndrome (MDS) with a 5% incidence. CONCLUSIONS LUTATE treatment for NETs is a safe and effective treatment. Our approach relies heavily on functional and morphological imaging informing the multidisciplinary team of NET specialists to guide appropriate therapy, which we suggest has contributed to the favourable outcomes seen.
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Affiliation(s)
- S Gordon
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia
| | - D L H Chan
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - E J Bernard
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - M E Eslick
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - K P Willowson
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - P J Roach
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - A F Engel
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, Australia
| | - R Maher
- Department of Medical Imaging, Royal North Shore Hospital, Sydney, Australia
| | - S J Clarke
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - V Agarwal
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia
| | - L Yasmin
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - M De Silva
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - S Mascall
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - A Conner
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - D Nevell
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
| | - N Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - D L Bailey
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia.
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia.
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
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Ramonaheng K, van Staden JA, du Raan H. Accuracy of two dosimetry software programs for 177Lu radiopharmaceutical therapy using voxel-based patient-specific phantoms. Heliyon 2022; 8:e09830. [PMID: 35865988 PMCID: PMC9293745 DOI: 10.1016/j.heliyon.2022.e09830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/18/2022] [Accepted: 06/24/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Virtual dosimetry using voxel-based patient-specific phantoms and Monte Carlo (MC) simulations offer the advantage of having a gold standard against which absorbed doses may be benchmarked to establish the dosimetry accuracy. Furthermore, these reference values assist in investigating the accuracy of the absorbed dose methodologies from different software programs. Therefore, this study aimed to compare the accuracy of the absorbed doses computed using LundADose and OLINDA/EXM 1.0. Methods The accuracy was based on 177Lu-DOTATATE distributions of three voxel-based phantoms. SPECT projection images were simulated for 1, 24, 96, and 168 h post-administration and reconstructed with LundADose using 3D OS-EM reconstruction. Mono-exponential curves were fitted to the bio-kinetic data for the kidneys, liver, spleen, and tumours resulting in SPECT time-integrated activity (SPECT-TIA). The SPECT-TIA were used to compute mean absorbed doses using LundADose (LND-DSPECT) and OLINDA (OLINDA-DSPECT) for the organs. Pre-defined true activity images, were used to obtain TRUE-TIA and, together with full MC simulations, computed the true doses (MC-DTrue). The dosimetry accuracy was assessed by comparing LND-DSPECT and OLINDA-DSPECT to MC-DTrue. Results Overall, the results presented an overestimation of the mean absorbed dose by LND-DSPECT compared to the MC-DTrue with a dosimetry accuracy ≤6.6%. This was attributed to spill-out activity from the reconstructed LND-DSPECT, resulting in a higher dose contribution than the MC-DTrue. There was a general underestimation (<8.1%) of OLINDA-DSPECT compared to MC-DTrue attributed to the geometrical difference in shape between the voxel-based phantoms and the OLINDA models. Furthermore, OLINDA-DSPECT considers self-doses while MC-DTrue reflects self-doses plus cross-doses. Conclusion The better than 10% accuracy suggests that the mean dose values obtained with LND-DSPECT and OLINDA-DSPECT approximate the true values. The mean absorbed doses of the two software programs, and the gold standard were comparable. This work shall be of use for optimising 177Lu dosimetry for clinical applications.
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Affiliation(s)
- Keamogetswe Ramonaheng
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa
| | - Johannes A van Staden
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa
| | - Hanlie du Raan
- Department of Medical Physics, Faculty of Health Sciences, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa
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Staanum PF, Frellsen AF, Olesen ML, Iversen P, Arveschoug AK. Practical kidney dosimetry in peptide receptor radionuclide therapy using [ 177Lu]Lu-DOTATOC and [ 177Lu]Lu-DOTATATE with focus on uncertainty estimates. EJNMMI Phys 2021; 8:78. [PMID: 34773508 PMCID: PMC8590641 DOI: 10.1186/s40658-021-00422-2] [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: 06/02/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Kidney dosimetry after peptide receptor radionuclide therapy using 177Lu-labelled somatostatin analogues is a procedure with multiple steps. We present the SPECT/CT-based implementation at Aarhus University Hospital and evaluate the uncertainty of the various steps in order to estimate the total uncertainty and to identify the major sources of uncertainty. Absorbed dose data from 115 treatment fractions are reported.
Results The total absorbed dose with uncertainty is presented for 59 treatments with [177Lu]Lu-DOTATOC and 56 treatments with [177Lu]Lu-DOTATATE. For [177Lu]Lu-DOTATOC the mean and median specific absorbed dose (dose per injected activity) is 0.37 Gy/GBq and 0.38 Gy/GBq, respectively, while for [177Lu]Lu-DOTATATE the median and mean are 0.47 Gy/GBq and 0.46 Gy/GBq, respectively. The uncertainty of the procedure is estimated to be about 13% for a single treatment fraction, where the absorbed dose calculation is based on three SPECT/CT scans 1, 4 and 7 days post-injection, while it increases to about 19% if only a single SPECT/CT scan is performed 1 day post-injection. Conclusions The specific absorbed dose values obtained with the described procedure are comparable to those from other treatment sites for both [177Lu]Lu-DOTATOC and [177Lu]Lu-DOTATATE, but towards the lower end of the range of reported values. The estimated uncertainty is also comparable to that from other reports and judged acceptable for clinical and research use, thus proving the kidney dosimetry procedure a useful tool. The greatest reduction in uncertainty can be obtained by improved activity determination, partial volume correction and additional SPECT/CT scans.
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Affiliation(s)
- Peter Frøhlich Staanum
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Anders Floor Frellsen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Marie Louise Olesen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Peter Iversen
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Anne Kirstine Arveschoug
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
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Mora-Ramirez E, Santoro L, Cassol E, Ocampo-Ramos JC, Clayton N, Kayal G, Chouaf S, Trauchessec D, Pouget JP, Kotzki PO, Deshayes E, Bardiès M. Comparison of commercial dosimetric software platforms in patients treated with 177 Lu-DOTATATE for peptide receptor radionuclide therapy. Med Phys 2020; 47:4602-4615. [PMID: 32632928 PMCID: PMC7589428 DOI: 10.1002/mp.14375] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to quantitatively compare five commercial dosimetric software platforms based on the analysis of clinical datasets of patients who benefited from peptide receptor radionuclide therapy (PRRT) with 177Lu‐DOTATATE (LUTATHERA®). Methods The dosimetric analysis was performed on two patients during two cycles of PRRT with 177Lu. Single photon emission computed tomography/computed tomography images were acquired at 4, 24, 72, and 192 h post injection. Reconstructed images were generated using Dosimetry Toolkit® (DTK) from Xeleris™ and HybridRecon‐Oncology version_1.3_Dicom (HROD) from HERMES. Reconstructed images using DTK were analyzed using the same software to calculate time‐integrated activity coefficients (TIAC), and mean absorbed doses were estimated using OLINDA/EXM V1.0 with mass correction. Reconstructed images from HROD were uploaded into PLANET® OncoDose from DOSIsoft, STRATOS from Phillips, Hybrid Dosimetry Module™ from HERMES, and SurePlan™ MRT from MIM. Organ masses, TIACs, and mean absorbed doses were calculated from each application using their recommendations. Results The majority of organ mass estimates varied by <9.5% between all platforms. The highest variability for TIAC results between platforms was seen for the kidneys (28.2%) for the two patients and the two treatment cycles. Relative standard deviations in mean absorbed doses were slightly higher compared with those observed for TIAC, but remained of the same order of magnitude between all platforms. Conclusions When applying a similar processing approach, results obtained were of the same order of magnitude regardless of the platforms used. However, the comparison of the performances of currently available platforms is still difficult as they do not all address the same parts of the dosimetric analysis workflow. In addition, the way in which data are handled in each part of the chain from data acquisition to absorbed doses may be different, which complicates the comparison exercise. Therefore, the dissemination of commercial solutions for absorbed dose calculation calls for the development of tools and standards allowing for the comparison of the performances between dosimetric software platforms.
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Affiliation(s)
- Erick Mora-Ramirez
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, Toulouse, F-31037, France.,INSERM, UMR 1037, Université Toulouse III Paul Sabatier, Toulouse, F-31062, France.,Escuela de Física - CICANUM, Universidad de Costa Rica, San José, 11501-2060, Costa Rica
| | - Lore Santoro
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier, Montpellier, F-34298, France
| | - Emmanuelle Cassol
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, Toulouse, F-31037, France.,INSERM, UMR 1037, Université Toulouse III Paul Sabatier, Toulouse, F-31062, France.,Département de Médecine Nucléaire, Hôpitaux Toulouse, Toulouse, F-31059, France.,Faculté de Médecine Rangueil, Université Toulouse III Paul Sabatier, Toulouse, F-31062, France
| | - Juan C Ocampo-Ramos
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, Toulouse, F-31037, France.,INSERM, UMR 1037, Université Toulouse III Paul Sabatier, Toulouse, F-31062, France
| | - Naomi Clayton
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, Toulouse, F-31037, France.,INSERM, UMR 1037, Université Toulouse III Paul Sabatier, Toulouse, F-31062, France
| | - Gunjan Kayal
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, Toulouse, F-31037, France.,INSERM, UMR 1037, Université Toulouse III Paul Sabatier, Toulouse, F-31062, France.,SCK CEN, Belgian Nuclear Research Centre, Boeretang 200, Mol, BE-2400, Belgium
| | - Soufiane Chouaf
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier, Montpellier, F-34298, France
| | - Dorian Trauchessec
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier, Montpellier, F-34298, France
| | - Jean-Pierre Pouget
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, F-34298, France
| | - Pierre-Olivier Kotzki
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier, Montpellier, F-34298, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, F-34298, France
| | - Emmanuel Deshayes
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier, Montpellier, F-34298, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, F-34298, France
| | - Manuel Bardiès
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, Toulouse, F-31037, France.,INSERM, UMR 1037, Université Toulouse III Paul Sabatier, Toulouse, F-31062, France
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