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Leube J, Gustafsson J, Lassmann M, Salas-Ramirez M, Tran-Gia J. A Deep-Learning-Based Partial-Volume Correction Method for Quantitative 177Lu SPECT/CT Imaging. J Nucl Med 2024:jnumed.123.266889. [PMID: 38637141 DOI: 10.2967/jnumed.123.266889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
With the development of new radiopharmaceutical therapies, quantitative SPECT/CT has progressively emerged as a crucial tool for dosimetry. One major obstacle of SPECT is its poor resolution, which results in blurring of the activity distribution. Especially for small objects, this so-called partial-volume effect limits the accuracy of activity quantification. Numerous methods for partial-volume correction (PVC) have been proposed, but most methods have the disadvantage of assuming a spatially invariant resolution of the imaging system, which does not hold for SPECT. Furthermore, most methods require a segmentation based on anatomic information. Methods: We introduce DL-PVC, a methodology for PVC of 177Lu SPECT/CT imaging using deep learning (DL). Training was based on a dataset of 10,000 random activity distributions placed in extended cardiac-torso body phantoms. Realistic SPECT acquisitions were created using the SIMIND Monte Carlo simulation program. SPECT reconstructions without and with resolution modeling were performed using the CASToR and STIR reconstruction software, respectively. The pairs of ground-truth activity distributions and simulated SPECT images were used for training various U-Nets. Quantitative analysis of the performance of these U-Nets was based on metrics such as the structural similarity index measure or normalized root-mean-square error, but also on volume activity accuracy, a new metric that describes the fraction of voxels in which the determined activity concentration deviates from the true activity concentration by less than a certain margin. On the basis of this analysis, the optimal parameters for normalization, input size, and network architecture were identified. Results: Our simulation-based analysis revealed that DL-PVC (0.95/7.8%/35.8% for structural similarity index measure/normalized root-mean-square error/volume activity accuracy) outperforms SPECT without PVC (0.89/10.4%/12.1%) and after iterative Yang PVC (0.94/8.6%/15.1%). Additionally, we validated DL-PVC on 177Lu SPECT/CT measurements of 3-dimensionally printed phantoms of different geometries. Although DL-PVC showed activity recovery similar to that of the iterative Yang method, no segmentation was required. In addition, DL-PVC was able to correct other image artifacts such as Gibbs ringing, making it clearly superior at the voxel level. Conclusion: In this work, we demonstrate the added value of DL-PVC for quantitative 177Lu SPECT/CT. Our analysis validates the functionality of DL-PVC and paves the way for future deployment on clinical image data.
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Affiliation(s)
- Julian Leube
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany; and
| | | | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany; and
| | - Maikol Salas-Ramirez
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany; and
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany; and
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Schürrle SB, Eberlein U, Ansquer C, Beauregard JM, Durand-Gasselin L, Grønbæk H, Haug A, Hicks RJ, Lenzo NP, Navalkissoor S, Nicolas GP, Pais B, Volteau M, Wild D, McEwan A, Lassmann M. Dosimetry and pharmacokinetics of [ 177Lu]Lu-satoreotide tetraxetan in patients with progressive neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06682-1. [PMID: 38528164 DOI: 10.1007/s00259-024-06682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/08/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE To evaluate the dosimetry and pharmacokinetics of the novel radiolabelled somatostatin receptor antagonist [177Lu]Lu-satoreotide tetraxetan in patients with advanced neuroendocrine tumours (NETs). METHODS This study was part of a phase I/II trial of [177Lu]Lu-satoreotide tetraxetan, administered at a median cumulative activity of 13.0 GBq over three planned cycles (median activity/cycle: 4.5 GBq), in 40 patients with progressive NETs. Organ absorbed doses were monitored at each cycle using patient-specific dosimetry; the cumulative absorbed-dose limits were set at 23.0 Gy for the kidneys and 1.5 Gy for bone marrow. Absorbed dose coefficients (ADCs) were calculated using both patient-specific and model-based dosimetry for some patients. RESULTS In all evaluated organs, maximum [177Lu]Lu-satoreotide tetraxetan uptake was observed at the first imaging timepoint (4 h after injection), followed by an exponential decrease. Kidneys were the main route of elimination, with a cumulative excretion of 57-66% within 48 h following the first treatment cycle. At the first treatment cycle, [177Lu]Lu-satoreotide tetraxetan showed a median terminal blood half-life of 127 h and median ADCs of [177Lu]Lu-satoreotide tetraxetan were 5.0 Gy/GBq in tumours, 0.1 Gy/GBq in the bone marrow, 0.9 Gy/GBq in kidneys, 0.2 Gy/GBq in the liver and 0.8 Gy/GBq in the spleen. Using image-based dosimetry, the bone marrow and kidneys received median cumulative absorbed doses of 1.1 and 10.8 Gy, respectively, after three cycles. CONCLUSION [177Lu]Lu-satoreotide tetraxetan showed a favourable dosimetry profile, with high and prolonged tumour uptake, supporting its acceptable safety profile and promising efficacy. TRIAL REGISTRATION NCT02592707. Registered October 30, 2015.
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Affiliation(s)
| | - Uta Eberlein
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Henning Grønbæk
- Department of Hepatology & Gastroenterology, ENETS Centre of Excellence, Aarhus University Hospital and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Alexander Haug
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Rodney J Hicks
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Central Clinical School, the Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Nat P Lenzo
- GenesisCare, East Fremantle, WA, Australia
- Department of Medicine, Curtin University, Perth, WA, Australia
| | - Shaunak Navalkissoor
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Guillaume P Nicolas
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Ben Pais
- SRT-Biomedical B.V, Soest, Netherlands.
- Ariceum Therapeutics GmbH, Berlin, Germany.
| | | | - Damian Wild
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | | | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
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Salas-Ramirez M, Leube J, Lassmann M, Tran-Gia J. Effect of kilovoltage and quality reference mAs on CT-based attenuation correction in 177Lu SPECT/CT imaging: a phantom study. EJNMMI Phys 2024; 11:21. [PMID: 38407672 DOI: 10.1186/s40658-024-00622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION CT-based attenuation correction (CT-AC) plays a major role in accurate activity quantification by SPECT/CT imaging. However, the effect of kilovoltage peak (kVp) and quality-reference mAs (QRM) on the attenuation coefficient image (μ-map) and volume CT dose index (CTDIvol) have not yet been systematically evaluated. Therefore, the aim of this study was to fill this gap and investigate the influence of kVp and QRM on CT-AC in 177Lu SPECT/CT imaging. METHODS Seventy low-dose CT acquisitions of an Electron Density Phantom (seventeen inserts of nine tissue-equivalent materials) were acquired using various kVp and QRM combinations on a Siemens Symbia Intevo Bold SPECT/CT system. Using manufacturer reconstruction software, 177Lu μ-maps were generated for each CT image, and three low-dose CT related aspects were examined. First, the μ-map-based attenuation values (μmeasured) were compared with theoretical values (μtheoretical). Second, changes in 177Lu activity expected due to changes in the μ-map were calculated using a modified Chang method. Third, the noise in the μ-map was assessed by measuring the coefficient of variation in a volume of interest in the homogeneous section of the Electron Density Phantom. Lastly, two phantoms were designed to simulate attenuation in four tissue-equivalent materials for two different source geometries (1-mL and 10-mL syringes). 177Lu SPECT/CT imaging was performed using three different reconstruction algorithms (xSPECT Quant, Flash3D, STIR), and the SPECT-based activities were compared against the nominal activities in the sources. RESULTS The largest relative errors between μmeasured and μtheoretical were observed in the lung inhale insert (range: 18%-36%), while it remained below 6% for all other inserts. The resulting changes in 177Lu activity quantification were -3.5% in the lung inhale insert and less than -2.3% in all other inserts. Coefficient of variation and CTDIvol ranged from 0.3% and 3.6 mGy (130 kVp, 35 mAs) to 0.4% and 0.9 mGy (80 kVp, 20 mAs), respectively. The SPECT-based activity quantification using xSPECT Quant reconstructions outperformed all other reconstruction algorithms. CONCLUSION This study shows that kVp and QRM values in low-dose CT imaging have a minimum effect on quantitative 177Lu SPECT/CT imaging, while the selection of low values of kVp and QRM reduce the CTDIvol.
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Affiliation(s)
- Maikol Salas-Ramirez
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Julian Leube
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Herrmann K, Rahbar K, Eiber M, Sparks R, Baca N, Krause BJ, Lassmann M, Jentzen W, Tang J, Chicco D, Klein P, Blumenstein L, Basque JR, Kurth J. Renal and Multiorgan Safety of 177Lu-PSMA-617 in Patients with Metastatic Castration-Resistant Prostate Cancer in the VISION Dosimetry Substudy. J Nucl Med 2024; 65:71-78. [PMID: 38050121 PMCID: PMC10755516 DOI: 10.2967/jnumed.123.265448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/10/2023] [Indexed: 12/06/2023] Open
Abstract
In the VISION trial, [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) plus protocol-permitted standard of care significantly improved overall survival and radiographic progression-free survival compared with standard of care alone in patients with prostate-specific membrane antigen-positive metastatic castration-resistant prostate cancer. This VISION dosimetry substudy quantified absorbed doses of 177Lu-PSMA-617 in the kidneys and other organs. Methods: Participants were a separate cohort of 30 nonrandomized patients receiving standard of care plus 177Lu-PSMA-617 at 7.4 GBq per cycle for up to 6 cycles. Blood samples, whole-body conjugate planar image scintigraphy, and abdominal SPECT/CT images were collected. SPECT/CT images were collected at 2, 24, 48, and 168 h after administration in cycle 1 and at a single time point 48 h after administration in cycles 2-6. Outcomes were absorbed dose per unit activity per cycle and cumulative absorbed dose over all cycles. Cumulative absorbed doses were predicted by extrapolation from cycle 1, and calculation of observed values was based on measurements of cycle 1 and cycles 2-6. Safety was also assessed. Results: Mean (±SD) absorbed doses per cycle in the kidneys were 0.43 ± 0.16 Gy/GBq in cycle 1 and 0.44 ± 0.21 Gy/GBq in cycles 2-6. The observed and predicted 6-cycle cumulative absorbed doses in the kidneys were 15 ± 6 and 19 ± 7 Gy, respectively. Observed and predicted cumulative absorbed doses were similar in other at-risk organs. Safety findings were consistent with those in the VISION study; no patients experienced renal treatment-emergent adverse events of a grade higher than 3. Conclusion: The renal cumulative absorbed 177Lu-PSMA-617 dose was below the established limit. 177Lu-PSMA-617 had a good overall safety profile, and low renal radiotoxicity was not a safety concern. Cumulative absorbed doses in at-risk organs over multiple cycles can be predicted by extrapolation from cycle 1 data in patients with metastatic castration-resistant prostate cancer receiving 177Lu-PSMA-617.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium, University Hospital Essen, Essen, Germany;
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | | | | | | | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Walter Jentzen
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Jun Tang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Daniela Chicco
- Advanced Accelerator Applications, a Novartis Company, Turin, Italy
| | - Patrick Klein
- Novartis Institutes for BioMedical Research, East Hanover, New Jersey
| | - Lars Blumenstein
- Novartis Institutes for BioMedical Research, Basel, Switzerland; and
| | | | - Jens Kurth
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany
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Tran-Gia J, Eberlein U, Lassmann M, Mauz-Körholz C, Körholz D, Zuccetta P, Bar-Sever Z, Rosner U, Georgi TW, Sabri O, Kluge R, Piccardo A, Kurch L. Analysis of image data from the EuroNet PHL-C2 trial indicates a potential reduction in injected F-18 FDG activities in children: a proposal to update the EANM Paediatric Dosage Card. Eur J Nucl Med Mol Imaging 2024; 51:405-411. [PMID: 37728668 PMCID: PMC10774179 DOI: 10.1007/s00259-023-06396-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The aim of this work is to provide the currently missing evidence that may allow an update of the Paediatric Dosage Card provided by the European Association of Nuclear Medicine (EANM) for conventional PET/CT systems. METHODS In a total of 2082 consecutive [18F]FDG-PET scans performed within the EuroNet-PHL-C2 trial, the administered [18F]FDG activity was compared to the activity recommended by the EANM Paediatric Dosage Card. None of these scans had been rejected beforehand by the reference nuclear medicine panel of the trial because of poor image quality. For detailed quality assessment, a subset of 91 [18F]FDG-PET scans, all performed in different patients at staging, was selected according to pre-defined criteria, which (a) included only patients who had received substantially lower activities than those recommended by the EANM Paediatric Dosage Card, and (b) included as wide a range of different PET systems and imaging parameters as possible to ensure that the conclusions drawn in this work are as generally valid as possible. The image quality of the subset was evaluated visually by two independent readers using a quality scoring system as well as analytically based on a volume-of-interest analysis in 244 lesions and the healthy liver. Finally, recommendations for an update of the EANM Paediatric Dosage Card were derived based on the available data. RESULTS The activity recommended by the EANM Paediatric Dosage Card was undercut by a median of 99.4 MBq in 1960 [18F]FDG-PET scans and exceeded by a median of 15.1 MBq in 119 scans. In the subset analysis (n = 91), all image data were visually classified as clinically useful. In addition, only a very weak correlation (r = 0.06) between activity reduction and tumour-to-background ratio was found. Due to the intended heterogeneity of the dataset, the noise could not be analysed statistically sound as the high range of different imaging variables resulted in very small subsets. Finally, a suggestion for an update of the EANM Paediatric Dosage Card was developed, based on the analysis presented, resulting in a mean activity reduction by 39%. CONCLUSION The results of this work allow for a conservative update of the EANM Paediatric Dosage Card for [18F]FDG-PET/CT scans performed with conventional PET/CT systems.
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Affiliation(s)
- Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Uta Eberlein
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | - Dieter Körholz
- Department of Paediatric Oncology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Pietro Zuccetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padua, Padua, Italy
| | - Zvi Bar-Sever
- Schneider Children's Medical Center, Petach Tikva, Israel
| | - Ute Rosner
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | | | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
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Wild D, Grønbæk H, Navalkissoor S, Haug A, Nicolas GP, Pais B, Ansquer C, Beauregard JM, McEwan A, Lassmann M, Pennestri D, Volteau M, Lenzo NP, Hicks RJ. A phase I/II study of the safety and efficacy of [ 177Lu]Lu-satoreotide tetraxetan in advanced somatostatin receptor-positive neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2023; 51:183-195. [PMID: 37721581 PMCID: PMC10684626 DOI: 10.1007/s00259-023-06383-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE We present the results of an open-label, phase I/II study evaluating the safety and efficacy of the novel somatostatin receptor (SSTR) antagonist [177Lu]Lu-satoreotide tetraxetan in 40 patients with previously treated, progressive neuroendocrine tumours (NETs), in which dosimetry was used to guide maximum administered activity. METHODS This study was conducted in two parts. Part A consisted of 15 patients who completed three cycles of [177Lu]Lu-satoreotide tetraxetan at a fixed administered activity and peptide amount per cycle (4.5 GBq/300 µg). Part B, which included 25 patients who received one to five cycles of [177Lu]Lu-satoreotide tetraxetan, evaluated different administered activities (4.5 or 6.0 GBq/cycle) and peptide amounts (300, 700, or 1300 μg/cycle), limited to a cumulative absorbed radiation dose of 23 Gy to the kidneys and 1.5 Gy to the bone marrow. RESULTS Median cumulative administered activity of [177Lu]Lu-satoreotide tetraxetan was 13.0 GBq over three cycles (13.1 GBq in part A and 12.9 GBq in part B). Overall, 17 (42.5%) patients experienced grade ≥ 3 treatment‑related adverse events; the most common were lymphopenia, thrombocytopenia, and neutropenia. No grade 3/4 nephrotoxicity was observed. Two patients developed myeloid neoplasms considered treatment related by the investigator. Disease control rate for part A and part B was 94.7% (95% confidence interval [CI]: 82.3-99.4), and overall response rate was 21.1% (95% CI: 9.6-37.3). CONCLUSION [177Lu]Lu-satoreotide tetraxetan, administered at a median cumulative activity of 13.0 GBq over three cycles, has an acceptable safety profile with a promising clinical response in patients with progressive, SSTR-positive NETs. A 5-year long-term follow-up study is ongoing. TRIAL REGISTRATION ClinicalTrials.gov, NCT02592707. Registered October 30, 2015.
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Affiliation(s)
- Damian Wild
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland.
| | - Henning Grønbæk
- Department of Hepatology & Gastroenterology, ENETS Centre of Excellence, Aarhus University Hospital and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Shaunak Navalkissoor
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Alexander Haug
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Guillaume P Nicolas
- Division of Nuclear Medicine, ENETS Centre of Excellence, University Hospital Basel, Basel, Switzerland
| | - Ben Pais
- SRT-Biomedical B.V., Soest, Netherlands
- Ariceum Therapeutics GmbH, Berlin, Germany
| | | | | | | | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Nat P Lenzo
- GenesisCare, East Fremantle, Australia
- Department of Medicine, Curtin University, Perth, Australia
| | - Rodney J Hicks
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
- Department of Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia
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Tran-Gia J, Denis-Bacelar AM, Ferreira KM, Robinson AP, Bobin C, Bonney LM, Calvert N, Collins SM, Fenwick AJ, Finocchiaro D, Fioroni F, Giannopoulou K, Grassi E, Heetun W, Jewitt SJ, Kotzasarlidou M, Ljungberg M, Lourenço V, McGowan DR, Mewburn-Crook J, Sabot B, Scuffham J, Sjögreen Gleisner K, Solc J, Thiam C, Tipping J, Wevrett J, Lassmann M. On the use of solid 133Ba sources as surrogate for liquid 131I in SPECT/CT calibration: a European multi-centre evaluation. EJNMMI Phys 2023; 10:73. [PMID: 37993667 PMCID: PMC10665282 DOI: 10.1186/s40658-023-00582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/25/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Commissioning, calibration, and quality control procedures for nuclear medicine imaging systems are typically performed using hollow containers filled with radionuclide solutions. This leads to multiple sources of uncertainty, many of which can be overcome by using traceable, sealed, long-lived surrogate sources containing a radionuclide of comparable energies and emission probabilities. This study presents the results of a quantitative SPECT/CT imaging comparison exercise performed within the MRTDosimetry consortium to assess the feasibility of using 133Ba as a surrogate for 131I imaging. MATERIALS AND METHODS Two sets of four traceable 133Ba sources were produced at two National Metrology Institutes and encapsulated in 3D-printed cylinders (volume range 1.68-107.4 mL). Corresponding hollow cylinders to be filled with liquid 131I and a mounting baseplate for repeatable positioning within a Jaszczak phantom were also produced. A quantitative SPECT/CT imaging comparison exercise was conducted between seven members of the consortium (eight SPECT/CT systems from two major vendors) based on a standardised protocol. Each site had to perform three measurements with the two sets of 133Ba sources and liquid 131I. RESULTS As anticipated, the 131I pseudo-image calibration factors (cps/MBq) were higher than those for 133Ba for all reconstructions and systems. A site-specific cross-calibration reduced the performance differences between both radionuclides with respect to a cross-calibration based on the ratio of emission probabilities from a median of 12-1.5%. The site-specific cross-calibration method also showed agreement between 133Ba and 131I for all cylinder volumes, which highlights the potential use of 133Ba sources to calculate recovery coefficients for partial volume correction. CONCLUSION This comparison exercise demonstrated that traceable solid 133Ba sources can be used as surrogate for liquid 131I imaging. The use of solid surrogate sources could solve the radiation protection problem inherent in the preparation of phantoms with 131I liquid activity solutions as well as reduce the measurement uncertainties in the activity. This is particularly relevant for stability measurements, which have to be carried out at regular intervals.
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Affiliation(s)
- Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | | | | | | | - Christophe Bobin
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - Lara M Bonney
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas Calvert
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester, UK
| | - Sean M Collins
- National Physical Laboratory, Hampton Road, Teddington, UK
- School of Mathematics and Physics, University of Surrey, Guildford, UK
| | | | - Domenico Finocchiaro
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Federica Fioroni
- Medical Physics Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | | | - Elisa Grassi
- Medical Physics Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Warda Heetun
- National Physical Laboratory, Hampton Road, Teddington, UK
| | - Stephanie J Jewitt
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maria Kotzasarlidou
- Nuclear Medicine Department, "THEAGENIO" Anticancer Hospital, Thessaloniki, Greece
| | | | - Valérie Lourenço
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - Daniel R McGowan
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Benoit Sabot
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - James Scuffham
- Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Jaroslav Solc
- Czech Metrology Institute, Okruzni 31, 638 00, Brno, Czech Republic
| | - Cheick Thiam
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - Jill Tipping
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jill Wevrett
- Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Rühm W, Yu H, Clement C, Ainsbury EA, Andresz S, Bryant P, Chapple CL, Croüail P, Damilakis J, Ermacora MG, Eurajoki T, Gering F, Molyneux-Hodgson S, Hupe O, Impens N, Lassmann M, Martins JO, Mazzoni LN, Mogg C, Morgan J, Perko T, Pinak M, Santos J, Stritt N, Tanner R, Turcanu C, Vermeersch F. ICRP workshop on the review and revision of the system of radiological protection: a focus on research priorities-feedback from the international community. J Radiol Prot 2023; 43. [PMID: 37669663 DOI: 10.1088/1361-6498/acf6ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/07/2023]
Abstract
In September 2022, the International Commission on Radiological Protection (ICRP) organised a workshop in Estoril, Portugal, on the 'Review and Revision of the System of Radiological Protection: A Focus on Research Priorities'. The workshop, which was a side event of the European Radiation Protection Week, offered an opportunity to comment on a recent paper published by ICRP on areas of research to support the System of Radiological Protection. Altogether, about 150 individuals participated in the workshop. After the workshop, 16 of the 30 organisations in formal relations with ICRP provided written feedback. All participants and organisations followed ICRP's view that further research in various areas will offer additional support in improving the System in the short, medium, and long term. In general, it was emphasised that any research should be outcome-focused in that it should improve protection of people or the environment. Many research topics mentioned by the participants were in line with those already identified by ICRP in the paper noted above. In addition, further ideas were expressed such as, for example, that lessons learned during the COVID-19 pandemic with regards to the non-radiological social, economic and environment impacts, should be analysed for their usefulness to enhance radiological protection, and that current protection strategies and application of current radiological protection principles may need to be adapted to military scenarios like those observed recently during the military conflict in the Ukraine or the detonation of a nuclear weapon. On a broader perspective, it was discussed how radiation research and radiological protection can contribute towards the Sustainable Development Goals announced by the United Nations in 2015. This paper summarises the views expressed during the workshop and the major take home messages identified by ICRP.
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Affiliation(s)
- Werner Rühm
- Federal Office for Radiation Protection, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
| | - Hyungjoon Yu
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada
| | - Christopher Clement
- International Commission on Radiological Protection, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada
| | | | - Sylvain Andresz
- Nuclear Evaluation Protection Centre (CEPN), 28, Rue de la Redoute, Fontenay-aux-Roses 92260, France
| | - Peter Bryant
- Sizewell C, 90 Whitfield Street, London W1T 4EZ, United Kingdom
- Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
| | - Claire-Louise Chapple
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, United Kingdom
- International Radiation Protection Association
| | - Pascal Croüail
- Nuclear Evaluation Protection Centre (CEPN), 28, Rue de la Redoute, Fontenay-aux-Roses 92260, France
| | - John Damilakis
- University of Crete, School of Medicine, 71003 Iraklion, Crete, Greece
| | - Marcela G Ermacora
- Ibero-American Forum of Radiological and Nuclear Regulatory Agencies (FORO)
| | | | - Florian Gering
- Federal Office for Radiation Protection, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
| | - Susan Molyneux-Hodgson
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4RJ, United Kingdom
| | - Oliver Hupe
- Physikalisch-Technische Bundesanstalt (PTB), Bundesallee 100, 38116 Braunschweig, Germany
| | - Nathalie Impens
- Belgian Nuclear Research Centre SCK CEN, Boeretang 200, B-2400 Mol, Belgium
| | - Michael Lassmann
- Department of Nuclear Medicine, University Würzburg, Würzburg, Germany
| | - João O Martins
- Ibero-American Forum of Radiological and Nuclear Regulatory Agencies (FORO)
| | | | - Christopher Mogg
- OECD Nuclear Energy Agency, 46, Quai Alphonse Le Gallo, 92100 Boulogne-Billancourt, France
| | - Julie Morgan
- United Kingdom Health and Security Agency (UKHSA), Didcot OX11 0RQ, United Kingdom
| | - Tanja Perko
- Belgian Nuclear Research Centre SCK CEN, Boeretang 200, B-2400 Mol, Belgium
| | - Miroslav Pinak
- International Atomic Energy Agency, Vienna International Centre, PO Box 100, A-1400 Vienna, Austria
| | - Joana Santos
- Polytechnique University of Coimbra, ESTESC-Coimbra Health School, Medical Imaging and Radiotherapy, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal
| | - Nicolas Stritt
- Swiss Federal Office of Public Health (SFOPH), CH-3003 BERN, Switzerland
| | - Rick Tanner
- UKHSA, Chilton, Didcot, Oxon OX11 0RQ, United Kingdom
| | - Catrinel Turcanu
- Belgian Nuclear Research Centre SCK CEN, Boeretang 200, B-2400 Mol, Belgium
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Leube J, Horn M, Hartrampf PE, Buck AK, Lassmann M, Tran-Gia J. PSMA-PET improves deep learning-based automated CT kidney segmentation. Z Med Phys 2023:S0939-3889(23)00095-8. [PMID: 37666698 DOI: 10.1016/j.zemedi.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/13/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
For dosimetry of radiopharmaceutical therapies, it is essential to determine the volume of relevant structures exposed to therapeutic radiation. For many radiopharmaceuticals, the kidneys represent an important organ-at-risk. To reduce the time required for kidney segmentation, which is often still performed manually, numerous approaches have been presented in recent years to apply deep learning-based methods for CT-based automated segmentation. While the automatic segmentation methods presented so far have been based solely on CT information, the aim of this work is to examine the added value of incorporating PSMA-PET data in the automatic kidney segmentation. METHODS A total of 108 PET/CT examinations (53 [68Ga]Ga-PSMA-I&T and 55 [18F]F-PSMA-1007 examinations) were grouped to create a reference data set of manual segmentations of the kidney. These segmentations were performed by a human examiner. For each subject, two segmentations were carried out: one CT-based (detailed) segmentation and one PET-based (coarser) segmentation. Five different u-net based approaches were applied to the data set to perform an automated segmentation of the kidney: CT images only, PET images only (coarse segmentation), a combination of CT and PET images, a combination of CT images and a PET-based coarse mask, and a CT image, which had been pre-segmented using a PET-based coarse mask. A quantitative assessment of these approaches was performed based on a test data set of 20 patients, including Dice score, volume deviation and average Hausdorff distance between automated and manual segmentations. Additionally, a visual evaluation of automated segmentations for 100 additional (i.e., exclusively automatically segmented) patients was performed by a nuclear physician. RESULTS Out of all approaches, the best results were achieved by using CT images which had been pre-segmented using a PET-based coarse mask as input. In addition, this method performed significantly better than the segmentation based solely on CT, which was supported by the visual examination of the additional segmentations. In 80% of the cases, the segmentations created by exploiting the PET-based pre-segmentation were preferred by the nuclear physician. CONCLUSION This study shows that deep-learning based kidney segmentation can be significantly improved through the addition of a PET-based pre-segmentation. The presented method was shown to be especially beneficial for kidneys with cysts or kidneys that are closely adjacent to other organs such as the spleen, liver or pancreas. In the future, this could lead to a considerable reduction in the time required for dosimetry calculations as well as an improvement in the results.
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Affiliation(s)
- Julian Leube
- University Hospital Würzburg, Department of Nuclear Medicine, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.
| | - Matthias Horn
- University Hospital Würzburg, Department of Nuclear Medicine, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Philipp E Hartrampf
- University Hospital Würzburg, Department of Nuclear Medicine, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Andreas K Buck
- University Hospital Würzburg, Department of Nuclear Medicine, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Michael Lassmann
- University Hospital Würzburg, Department of Nuclear Medicine, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Johannes Tran-Gia
- University Hospital Würzburg, Department of Nuclear Medicine, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
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Taprogge J, Vergara-Gil A, Leek F, Abreu C, Vávrová L, Carnegie-Peake L, Schumann S, Eberlein U, Lassmann M, Schurrat T, Luster M, Verburg FA, Vallot D, Vija L, Courbon F, Newbold K, Bardiès M, Flux G. Normal organ dosimetry for thyroid cancer patients treated with radioiodine as part of the multi-centre multi-national Horizon 2020 MEDIRAD project. Eur J Nucl Med Mol Imaging 2023; 50:3225-3234. [PMID: 37300572 PMCID: PMC10256579 DOI: 10.1007/s00259-023-06295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Dosimetry is rarely performed for the treatment of differentiated thyroid cancer patients with Na[131I]I (radioiodine), and information regarding absorbed doses delivered is limited. Collection of dosimetry data in a multi-centre setting requires standardised quantitative imaging and dosimetry. A multi-national, multi-centre clinical study was performed to assess absorbed doses delivered to normal organs for differentiated thyroid cancer patients treated with Na[131I]I. METHODS Patients were enrolled in four centres and administered fixed activities of 1.1 or 3.7 GBq of Na[131I]I using rhTSH stimulation or under thyroid hormone withdrawal according to local protocols. Patients were imaged using SPECT(/CT) at variable imaging time-points following standardised acquisition and reconstruction protocols. Whole-body retention data were collected. Dosimetry for normal organs was performed at two dosimetry centres and results collated. RESULTS One hundred and five patients were recruited. Median absorbed doses per unit administered activity of 0.44, 0.14, 0.05 and 0.16 mGy/MBq were determined for the salivary glands of patients treated at centre 1, 2, 3 and 4, respectively. Median whole-body absorbed doses for 1.1 and 3.7 GBq were 0.05 Gy and 0.16 Gy, respectively. Median whole-body absorbed doses per unit administered activity of 0.04, 0.05, 0.04 and 0.04 mGy/MBq were calculated for centre 1, 2, 3 and 4, respectively. CONCLUSIONS A wide range of normal organ doses were observed for differentiated thyroid cancer patients treated with Na[131I]I, highlighting the necessity for individualised dosimetry. The results show that data may be collated from multiple centres if minimum standards for the acquisition and dosimetry protocols can be achieved.
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Affiliation(s)
- Jan Taprogge
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK.
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Alex Vergara-Gil
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM Université Paul Sabatier, Toulouse, France
| | - Francesca Leek
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Carla Abreu
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Lenka Vávrová
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Lily Carnegie-Peake
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Sarah Schumann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Tino Schurrat
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Frederik A Verburg
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Delphine Vallot
- IUCT Oncopole, Av. Irène Joliot-Curie, 31100, Toulouse, France
| | - Lavinia Vija
- IUCT Oncopole, Av. Irène Joliot-Curie, 31100, Toulouse, France
| | | | - Kate Newbold
- Thyroid Unit, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
| | - Manuel Bardiès
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM Université Paul Sabatier, Toulouse, France
- Institut de Recherches en Cancérologie de Montpellier, UMR 1194, INSERM Université de Montpellier, 34298, Montpellier, France
| | - Glenn Flux
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK
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Salas-Ramirez M, Maigne L, Fois G, Scherthan H, Lassmann M, Eberlein U. Radiation-induced double-strand breaks by internal ex vivo irradiation of lymphocytes: Validation of a Monte Carlo simulation model using GATE and Geant4-DNA. Z Med Phys 2023:S0939-3889(23)00089-2. [PMID: 37599196 DOI: 10.1016/j.zemedi.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023]
Abstract
This study describes a method to validate a radiation transport model that quantifies the number of DNA double-strand breaks (DSB) produced in the lymphocyte nucleus by internal ex vivo irradiation of whole blood with the radionuclides 90Y, 99mTc, 123I, 131I, 177Lu, 223Ra, and 225Ac in a test vial using the GATE/Geant4 code at the macroscopic level and the Geant4-DNA code at the microscopic level. METHODS The simulation at the macroscopic level reproduces an 8 mL cylindrical water-equivalent medium contained in a vial that mimics the geometry for internal ex vivo blood irradiation. The lymphocytes were simulated as spheres of 3.75 µm radius randomly distributed, with a concentration of 125 spheres/mL. A phase-space actor was attached to each sphere to register all the entering particles. The simulation at the microscopic level for each radionuclide was performed using the Geant4-DNA tool kit, which includes the clustering example centered on a density-based spatial clustering of applications with noise (DBSCAN) algorithm. The irradiation source was constructed by generating a single phase space from the sum of all phase spaces. The lymphocyte nucleus was defined as a water sphere of a 3.1 µm radius. The absorbed dose coefficients for lymphocyte nuclei (dLymph) were calculated and compared with macroscopic whole blood absorbed dose coefficients (dBlood). The DBSCAN algorithm was used to calculate the number of DSBs. Lastly, the number of DSB∙cell-1∙mGy-1 (simulation) was compared with the number of radiation-induced foci per cell and absorbed dose (RIF∙cell-1∙mGy-1) provided by experimental data for gamma and beta emitting radionuclides. For alpha emitters, dLymph and the number of α-tracks∙100 cell-1∙mGy-1 and DBSs∙µm-1 were calculated using experiment-based thresholds for the α-track lengths and DBSs/track values. The results were compared with the results of an ex vivo study with 223Ra. RESULTS The dLymph values differed from the dBlood values by -1.0% (90Y), -5.2% (99mTc), -22.3% (123I), 0.35% (131I), 2.4% (177Lu), -5.6% (223Ra) and -6.1% (225Ac). The number of DSB∙cell-1∙mGy-1 for each radionuclide was 0.015 DSB∙cell-1∙mGy-1 (90Y), 0.012 DSB∙cell-1∙mGy-1 (99mTc), 0.014DSB∙cell-1∙mGy-1 (123I), 0.012 DSB∙cell-1∙mGy-1 (131I), and 0.016 DSB∙cell-1∙mGy-1 (177Lu). These values agree very well with experimental data. The number of α-tracks∙100 cells-1∙mGy-1 for 223Ra and 225Ac where 0.144 α-tracks∙100 cells-1∙mGy-1 and 0.151 α-tracks∙100 cells-1∙mGy-1, respectively. These values agree very well with experimental data. Moreover, the linear density of DSBs per micrometer α-track length were 11.13 ± 0.04 DSB/µm and 10.86 ± 0.06 DSB/µm for 223Ra and 225Ac, respectively. CONCLUSION This study describes a model to simulate the DNA DSB damage in lymphocyte nuclei validated by experimental data obtained from internal ex vivo blood irradiation with radionuclides frequently used in diagnostic and therapeutic procedures in nuclear medicine.
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Affiliation(s)
| | - Lydia Maigne
- Laboratoire de Physique de Clermont, University of Clermont Auvergne, Clermont, France
| | - Giovanna Fois
- Laboratoire de Physique de Clermont, University of Clermont Auvergne, Clermont, France
| | - Harry Scherthan
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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12
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Kratochwil C, Fendler WP, Eiber M, Hofman MS, Emmett L, Calais J, Osborne JR, Iravani A, Koo P, Lindenberg L, Baum RP, Bozkurt MF, Delgado Bolton RC, Ezziddin S, Forrer F, Hicks RJ, Hope TA, Kabasakal L, Konijnenberg M, Kopka K, Lassmann M, Mottaghy FM, Oyen WJG, Rahbar K, Schoder H, Virgolini I, Bodei L, Fanti S, Haberkorn U, Hermann K. Joint EANM/SNMMI procedure guideline for the use of 177Lu-labeled PSMA-targeted radioligand-therapy ( 177Lu-PSMA-RLT). Eur J Nucl Med Mol Imaging 2023; 50:2830-2845. [PMID: 37246997 PMCID: PMC10317889 DOI: 10.1007/s00259-023-06255-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/25/2023] [Indexed: 05/30/2023]
Abstract
Prostate-specific membrane antigen (PSMA) is expressed by the majority of clinically significant prostate adenocarcinomas, and patients with target-positive disease can easily be identified by PSMA PET imaging. Promising results with PSMA-targeted radiopharmaceutical therapy have already been obtained in early-phase studies using various combinations of targeting molecules and radiolabels. Definitive evidence of the safety and efficacy of [177Lu]Lu-PSMA-617 in combination with standard-of-care has been demonstrated in patients with metastatic castration-resistant prostate cancer, whose disease had progressed after or during at least one taxane regimen and at least one novel androgen-axis drug. Preliminary data suggest that 177Lu-PSMA-radioligand therapy (RLT) also has high potential in additional clinical situations. Hence, the radiopharmaceuticals [177Lu]Lu-PSMA-617 and [177Lu]Lu-PSMA-I&T are currently being evaluated in ongoing phase 3 trials. The purpose of this guideline is to assist nuclear medicine personnel, to select patients with highest potential to benefit from 177Lu-PSMA-RLT, to perform the procedure in accordance with current best practice, and to prepare for possible side effects and their clinical management. We also provide expert advice, to identify those clinical situations which may justify the off-label use of [177Lu]Lu-PSMA-617 or other emerging ligands on an individual patient basis.
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Affiliation(s)
- Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147, Essen, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University Munich (TUM), 81675, Munich, Germany
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, VIC, Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph R Osborne
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Amir Iravani
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Phillip Koo
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Liza Lindenberg
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Richard P Baum
- Curanosticum Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, Wiesbaden, Germany
| | - Murat Fani Bozkurt
- Hacettepe University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño (La Rioja), Spain
| | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Flavio Forrer
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Rodney J Hicks
- The University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging / Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Levent Kabasakal
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Mark Konijnenberg
- Radiology & Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - Klaus Kopka
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
- Technical University Dresden, School of Science, Faculty of Chemistry and Food Chemistry; German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT) Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, RWTH Aachen University Medical Faculty, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Wim J G Oyen
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Milan, Italy
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Heiko Schoder
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Lisa Bodei
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ken Hermann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147, Essen, Germany
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Robinson AP, Calvert N, Tipping J, Denis-Bacelar AM, Ferreira KM, Lassmann M, Tran-Gia J. Development of a validation imaging dataset for Molecular Radiotherapy dosimetry multicenter intercomparison exercises based on anthropomorphic phantoms. Phys Med 2023; 109:102583. [PMID: 37062101 PMCID: PMC10165308 DOI: 10.1016/j.ejmp.2023.102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023] Open
Abstract
Validation of a Molecular Radiotherapy (MRT) dosimetry system requires imaging data for which an accompanying "ground truth" pharmacokinetic model and absorbed dose calculation are known. METHODS We present a methodology for production of a validation dataset for image based 177Lu dotatate dosimetry calculations. A pharmacokinetic model is presented with activity concentrations corresponding to common imaging timepoints. Anthropomorphic 3D printed phantoms, corresponding to the organs at risk, have been developed to provide SPECT/CT and Whole Body imaging with known organ activities corresponding to common clinical timepoints. RESULTS Results for the accuracy of phantom filling reproduce the activity concentrations from the pharmacokinetic model for all timepoints and organs within measurement uncertainties, with a mean deviation of 0.6(8)%. The imaging dataset, ancillary data and phantoms designs are provided as a source of well characterized input data for the validation of clinical MRT dosimetry systems. CONCLUSIONS The combination of pharmacokinetic modelling with the use of anthropomorphic 3D printed phantoms are a promising procedure to provide data for the validation of Molecular Radiotherapy Dosimetry systems, allowing multicentre comparisons.
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Affiliation(s)
- Andrew P Robinson
- National Physical Laboratory, Teddington, TW11 0LW, United Kingdom; Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom; Schuster Laboratory, School of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, United Kingdom.
| | - Nick Calvert
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
| | - Jill Tipping
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
| | | | | | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
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Salas-Ramirez M, Lassmann M, Eberlein U. GATE/Geant4-based dosimetry for ex vivo in solution irradiation of blood with radionuclides. Z Med Phys 2023; 33:46-53. [PMID: 35623943 PMCID: PMC10082371 DOI: 10.1016/j.zemedi.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
To establish a dose-response relationship between radiation-induced DNA damage and the corresponding absorbed doses in blood irradiated with radionuclides in solution under ex vivo conditions, the absorbed dose coefficient for 1 ml for 1 h internal ex vivo irradiation of peripheral blood (dBlood) must be determined. dBlood is specific for each radionuclide, and it depends on the irradiation geometry. Therefore, the aim of this study is to use the Monte Carlo radiation transport code GATE/Geant4 to calculate the mean absorbed dose rates for ex vivo irradiation of blood with several radionuclides used in Nuclear Medicine. METHODS The Monte Carlo simulation reproduces the irradiation geometry of a blood sample of 7 ml mixed with 1 ml of a water equivalent radioactive solution in an 8 ml vial. The simulation was performed for ten different radionuclides: 18F, 68Ga, 90Y, 99mTc, 123I, 124I, 131I, 177Lu, 223Ra, and 225Ac. Two sets of simulations for each radionuclide were performed with 1x109 histories. The first set was simulated with a mass density of 1.0525 g/cm3 of the blood plus water mixture. The second set of simulations was performed with a mass density of 1 g/cm3 for comparison with previous studies. RESULTS The values of dBlood for ten radionuclides were calculated. The values range from 10.23 mGy∙ml∙MBq-1 for 99mTc to 15632.02 mGy∙ml∙MBq-1 for 225Ac. The maximum relative change compared to previous studies was 13.0% for 124I. CONCLUSION This study provides a comprehensive set of absorbed dose coefficients for 1 ml for 1 h internal ex vivo irradiation of peripheral blood in a special vial geometry and radionuclides typically used in Nuclear Medicine. Furthermore, the method proposed by this work can be easily adapted to a variety of internal irradiation conditions and serve as a reference for future studies.
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Affiliation(s)
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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15
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Hänscheid H, Lassmann M, Verburg FA. Determinants of target absorbed dose in radionuclide therapy. Z Med Phys 2023; 33:82-90. [PMID: 36376202 PMCID: PMC10068538 DOI: 10.1016/j.zemedi.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
In radionuclide therapy, activity kinetics in tissues determine the absorbed doses administered and thus efficacy and side effects of treatment. The objective of this work was to derive expressions for the parameters affecting the absorbed dose to a target tissue for first-order activity kinetics. The activity uptake results from contributions from the first-pass activity flow through the target tissue preceding systemic equilibration and uptake after distribution of the administered compound in the body. The absorbed dose from uptake after equilibration is the product of the mean energy deposited per decay in the target tissue, the time integral of the plasma activity concentration, the plasma volume flow per unit target tissue mass, the probability of activity removal during passage, and the mean lifetime of activity in the target tissue. Quantitative analysis of the determinants of absorbed dose exemplarily for radioiodine therapy indicates that the high uptake often observed in Graves' disease must be associated with high tissue perfusion and removal probability and that administration of stable iodine increases mean lifetime. For therapies with long residence times of the active compound in the blood, such as radioiodine therapy, the contribution of the first-pass is small compared with uptake after equilibration. The relative first-pass contribution is higher for agents that are rapidly eliminated from the blood pool, such as radiolabelled somatostatin analogues, and may dominate after arterial application. Understanding the determining parameters in radionuclide therapy reveals dose-limiting factors and opens up opportunities to optimise and individualize therapy, potentially improving treatment success rates.
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Affiliation(s)
- Heribert Hänscheid
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Lassmann M, Eberlein U. Comparing absorbed doses and radiation risk of the α-emitting bone-seekers [ 223Ra]RaCl 2 and [ 224Ra]RaCl 2. Front Med (Lausanne) 2023; 9:1057373. [PMID: 36687439 PMCID: PMC9847387 DOI: 10.3389/fmed.2022.1057373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
[223Ra]RaCl2 and [224Ra]RaCl2 are bone seekers, emitting high LET, and short range (< 100 μm) alpha-particles. Both radionuclides show similar decay properties; the total alpha energies are comparable (223Ra: ≈28 MeV, 224Ra: ≈26 MeV). [224Ra]RaCl2 has been used from the mid-1940s until 1990 for treating different bone and joint diseases with activities of up to approximately 50 MBq [224Ra]RaCl2. In 2013 [223Ra]RaCl2 obtained marketing authorization by the FDA and by the European Union for the treatment of metastatic prostate cancer with an activity to administer of 0.055 MBq per kg body weight for six cycles. For intravenous injections in humans a model calculation using the biokinetic model of ICRP67 shows a ratio of organ absorbed dose coefficients (224Ra:223Ra) between 0.37 (liver) and 0.97 except for the kidneys (2.27) and blood (1.57). For the red marrow as primary organ-at-risk, the ratio is 0.57. The differences are mainly caused be the differing half-lives of the decay products of both radium isotopes. Both radionuclides show comparable DNA damage patterns in peripheral blood mononuclear cells after internal ex-vivo irradiation. Data on the long-term radiation-associated side effects are only available for treatment with [224Ra]RaCl2. Two epidemiological studies followed two patient groups treated with [224Ra]RaCl2 for more than 25 years. One of them was the "Spiess study", a cohort of 899 juvenile patients who received several injections of [224Ra]RaCl2 with a mean specific activity of 0.66 MBq/kg. Another patient group of ankylosing spondylitis patients was treated with 10 repeated intravenous injections of [224Ra]RaCl2, 1 MBq each, 1 week apart. In total 1,471 of these patients were followed-up in the "Wick study". In both studies, an increased cancer mortality by leukemia and solid cancers was observed. Similar considerations on long-term effects likely apply to [223Ra]RaCl2 as well since the biokinetics are similar and the absorbed doses in the same range. However, this increased risk will most likely not be observed due to the much shorter life expectancy of prostate cancer patients treated with [223Ra]RaCl2.
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Pouget JP, Konijnenberg M, Eberlein U, Glatting G, Gabina PM, Herrmann K, Holm S, Strigari L, van Leeuwen FWB, Lassmann M. An EANM position paper on advancing radiobiology for shaping the future of nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:242-246. [PMID: 36066665 PMCID: PMC9816280 DOI: 10.1007/s00259-022-05934-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jean-Pierre Pouget
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 208 Rue des Apothicaires, 34298, Montpellier, France.
| | - Mark Konijnenberg
- Radiology & Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | | | - Pablo Minguez Gabina
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Søren Holm
- Department of Nuclear Medicine, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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Dierckx R, Herrmann K, Hustinx R, Lassmann M, Wadsak W, Kunikowska J. Correction to: European Association of Nuclear Medicine (EANM) response to the proposed ASTRO's framework for radiopharmaceutical therapy curriculum development for trainees. Eur J Nucl Med Mol Imaging 2023; 50:630. [PMID: 36374354 DOI: 10.1007/s00259-022-06037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rudi Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Belgium and GIGA‑CRC In Vivo Imaging, University of Liège, Liège, Belgium
| | - Michael Lassmann
- Department of Nuclear Medicine, University Würzburg, Würzburg, Germany
| | - Wolfgang Wadsak
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image‑Guided Therapy, Medical University of Vienna, Vienna, Austria
- Center for Biomarker Research in Medicine (CBmed GmbH), Graz, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, ul. Banacha 1 a, 02‑097, Warsaw, Poland.
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Beykan S, Hänscheid H, Schirbel A, Hahner S, Buck AK, Lassmann M. RADIATION DOSIMETRY OF [123I]IMAZA IN PATIENTS WITH ADRENAL TUMORS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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20
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Hustinx R, Pruim J, Lassmann M, Visvikis D. An EANM position paper on the application of artificial intelligence in nuclear medicine. Eur J Nucl Med Mol Imaging 2022; 50:61-66. [PMID: 36006443 DOI: 10.1007/s00259-022-05947-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/16/2022] [Indexed: 11/04/2022]
Abstract
Artificial intelligence (AI) is coming into the field of nuclear medicine, and it is likely here to stay. As a society, EANM can and must play a central role in the use of AI in nuclear medicine. In this position paper, the EANM explains the preconditions for the implementation of AI in NM and takes position.
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Affiliation(s)
- Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège & GIGA-CRC in vivo Imaging, University of Liège, Liège, Belgium
| | - Jan Pruim
- Medical Imaging Center, Dept. of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
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21
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Leube J, Gustafsson J, Lassmann M, Salas-Ramirez M, Tran-Gia J. Analysis of a deep learning-based method for generation of SPECT projections based on a large Monte Carlo simulated dataset. EJNMMI Phys 2022; 9:47. [PMID: 35852673 PMCID: PMC9296746 DOI: 10.1186/s40658-022-00476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/03/2022] [Indexed: 12/05/2022] Open
Abstract
Background In recent years, a lot of effort has been put in the enhancement of medical imaging using artificial intelligence. However, limited patient data in combination with the unavailability of a ground truth often pose a challenge to a systematic validation of such methodologies. The goal of this work was to investigate a recently proposed method for an artificial intelligence-based generation of synthetic SPECT projections, for acceleration of the image acquisition process based on a large dataset of realistic SPECT simulations. Methods A database of 10,000 SPECT projection datasets of heterogeneous activity distributions of randomly placed random shapes was simulated for a clinical SPECT/CT system using the SIMIND Monte Carlo program. Synthetic projections at fixed angular increments from a set of input projections at evenly distributed angles were generated by different u-shaped convolutional neural networks (u-nets). These u-nets differed in noise realization used for the training data, number of input projections, projection angle increment, and number of training/validation datasets. Synthetic projections were generated for 500 test projection datasets for each u-net, and a quantitative analysis was performed using statistical hypothesis tests based on structural similarity index measure and normalized root-mean-squared error. Additional simulations with varying detector orbits were performed on a subset of the dataset to study the effect of the detector orbit on the performance of the methodology. For verification of the results, the u-nets were applied to Jaszczak and NEMA physical phantom data obtained on a clinical SPECT/CT system. Results No statistically significant differences were observed between u-nets trained with different noise realizations. In contrast, a statistically significant deterioration was found for training with a small subset (400 datasets) of the 10,000 simulated projection datasets in comparison with using a large subset (9500 datasets) for training. A good agreement between synthetic (i.e., u-net generated) and simulated projections before adding noise demonstrates a denoising effect. Finally, the physical phantom measurements show that our findings also apply for projections measured on a clinical SPECT/CT system. Conclusion Our study shows the large potential of u-nets for accelerating SPECT/CT imaging. In addition, our analysis numerically reveals a denoising effect when generating synthetic projections with a u-net. Clinically interesting, the methodology has proven robust against camera orbit deviations in a clinically realistic range. Lastly, we found that a small number of training samples (e.g., ~ 400 datasets) may not be sufficient for reliable generalization of the u-net. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-022-00476-w.
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Affiliation(s)
- Julian Leube
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Johan Gustafsson
- Medical Radiation Physics, Lund, Lund University, Skåne University Hospital, Lund, 221 85, Lund, Sweden
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Maikol Salas-Ramirez
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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22
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Visvikis D, Lambin P, Beuschau Mauridsen K, Hustinx R, Lassmann M, Rischpler C, Shi K, Pruim J. Application of artificial intelligence in nuclear medicine and molecular imaging: a review of current status and future perspectives for clinical translation. Eur J Nucl Med Mol Imaging 2022; 49:4452-4463. [PMID: 35809090 PMCID: PMC9606092 DOI: 10.1007/s00259-022-05891-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/25/2022] [Indexed: 02/06/2023]
Abstract
Artificial intelligence (AI) will change the face of nuclear medicine and molecular imaging as it will in everyday life. In this review, we focus on the potential applications of AI in the field, both from a physical (radiomics, underlying statistics, image reconstruction and data analysis) and a clinical (neurology, cardiology, oncology) perspective. Challenges for transferability from research to clinical practice are being discussed as is the concept of explainable AI. Finally, we focus on the fields where challenges should be set out to introduce AI in the field of nuclear medicine and molecular imaging in a reliable manner.
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Affiliation(s)
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology, Maastricht University Medical Center (MUMC +), Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, GROW - School for Oncology, Maastricht University Medical Center (MUMC +), Maastricht, The Netherlands
| | - Kim Beuschau Mauridsen
- Center of Functionally Integrative Neuroscience and MindLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Nuclear Medicine, University of Bern, Bern, Switzerland
| | - Roland Hustinx
- GIGA-CRC in Vivo Imaging, University of Liège, GIGA, Avenue de l'Hôpital 11, 4000, Liege, Belgium
| | - Michael Lassmann
- Klinik Und Poliklinik Für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kuangyu Shi
- Department of Nuclear Medicine, University of Bern, Bern, Switzerland.,Department of Informatics, Technical University of Munich, Munich, Germany
| | - Jan Pruim
- Medical Imaging Center, Dept. of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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23
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Theisen AL, Lassmann M, Tran-Gia J. Toward a Patient-Specific Traceable Quantification of SPECT/CT-Based Radiopharmaceutical Distributions. J Nucl Med 2022; 63:1108-1116. [PMID: 34795011 PMCID: PMC9258576 DOI: 10.2967/jnumed.121.262925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/01/2021] [Indexed: 01/03/2023] Open
Abstract
Quantitative SPECT/CT imaging is currently the state of the art for peritherapeutic monitoring of radiopharmaceutical distributions. Because of poor resolution, however, the verification of SPECT/CT-based activity distributions is of particular importance. Because of the lack of a ground truth in patient measurements, phantoms are commonly used as a substitute for clinical validation of quantitative SPECT/CT. Because of the time-consuming and erroneous preparation of multicompartment phantoms, such as for the kidney, the usually very complex internal activity distributions are typically replaced by 1- or 2-compartment models. To provide a simplified solution for generating inhomogeneous activity distributions, this work presents a methodology for designing single-compartment phantoms that mimic inhomogeneous spatial activity distributions by using internal filling structures of different volume fractions. Methods: A series of phantoms with different filling structures was designed, 3-dimensionally printed, and measured. After assessing the feasibility of the presented approach in a simple geometry, a set of three patient-specific kidney phantoms was designed on the basis of the contrast-enhanced CT scan of a patient with metastatic castration-resistant prostate cancer. Internal gyroid structures of different wall thicknesses were used in the renal medulla and cortex to reproduce the inhomogeneous activity distribution observed in a peritherapeutic SPECT/CT acquisition 24 h after injection of 177Lu-labeled prostate-specific membrane antigen (apparent activity concentration ratios of 1:1, 1:3.5, and 1:7.5). After 3-dimensional printing, SPECT/CT experiments were performed and the results were compared with the patient data for different reconstruction settings (iterations, subsets, and postfiltering). Results: Good agreement was found between phantom designs and fabricated phantoms (based on high-resolution CT). No internal filling structures were visible in any of the SPECT images, indicating a sufficiently small feature size. Although good visual and quantitative agreement was achieved for certain combinations of filling structure and reconstruction, a histogram analysis indicated an even more complex activity distribution in the patient than represented by the two compartments assumed in our model. Conclusion: The proposed methodology provides patient-specific phantoms mimicking inhomogeneous activity distributions while using a single stock solution, thus simplifying the filling process and reducing uncertainties in the activity determination. This method enables an unprecedented possibility for patient-specific evaluation of radiopharmaceutical uptake, reducing uncertainties in internal dosimetry and individualized treatments.
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Affiliation(s)
- Anna-Lena Theisen
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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Beykan S, Tran-Gia J, Borup Jensen S, Lassmann M. Is a single late SPECT/CT based kidney 177Lu-dosimetry superior to hybrid dosimetry with sequential multiple time-point whole-body planar scans in combination with an early SPECT/CT? Phys Med 2022; 100:39-50. [PMID: 35724608 DOI: 10.1016/j.ejmp.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/25/2022] [Accepted: 06/11/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim is to assess the impact of different imaging-protocols on image-based kidney dosimetry in 177Lu labelled peptide receptor radiotherapies. METHODS Kidney data of five [177Lu]Lu-OPS201 injected pigs and a 3D printed phantom were used for comparing the absorbed doses and time-integrated activity coefficients calculated based on the following imaging-protocols: A-) multiple time-point SPECT/CTs, B-) multiple time-point planar scans in combination with one SPECT/CT, C-) single time-point SPECT/CT. In addition, the influence of late scan time-points on kidney dosimetry was investigated by sequentially eliminating scan data at > 100 h from the pig/phantom datasets for imaging-protocols A and B. RESULTS Compared to imaging-protocol A, absorbed doses based on imaging-protocols B and C (scans at > 24 h post-injection) were always lower (differences > 34%). The best agreement in absorbed dose was achieved by imaging-protocol C at ∼ 100 h post-injection (difference: 4%). Regarding the phantom/pig experiments, eliminating scan data at > 100 h post-injection increased the time-integrated activity coefficients calculated based on imaging-protocols A and B by up to 83%. CONCLUSION While imaging-protocol A is accurate if scans at >∼100 h are included, it is time-consuming. In addition to being time-consuming, imaging-protocol B shows high differences associated with organ-count overlay, a lack of accuracy concerning the geometric mean based 2D attenuation correction, and 2D background subtraction due to the inhomogeneous and time-varying background contributions. Our findings indicate that dosimetry based on imaging-protocol C, if appropriately performed, provides similar kidney absorbed doses compared to imaging-protocol A, while only a single scan time-point is necessary.
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Affiliation(s)
- Seval Beykan
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Svend Borup Jensen
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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Kayal G, Chauvin M, Mora-Ramirez E, Clayton N, Vergara-Gil A, Tran-Gia J, Lassmann M, Calvert N, Tipping J, Struelens L, Bardiès M. Modelling SPECT auto-contouring acquisitions for 177Lu & 131I molecular radiotherapy using new developments in Geant4/GATE. Phys Med 2022; 96:101-113. [PMID: 35276403 DOI: 10.1016/j.ejmp.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 02/22/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Monte Carlo modelling of SPECT imaging in Molecular Radiotherapy can improve activity quantification. Until now, SPECT modelling with GATE only considered circular orbit (CO) acquisitions. This cannot reproduce auto-contour acquisitions, where the detector head moves close to the patient to improve image resolution. The aim of this work is to develop and validate an auto-contouring step-and-shoot acquisition mode for GATE SPECT modelling. METHODS 177Lu and 131I SPECT experimental acquisitions performed on a Siemens Symbia T2 and GE Discovery 670 gamma camera, respectively, were modelled. SPECT projections were obtained for a cylindrical Jaszczak phantom and a lung and spine phantom. Detector head parameters (radial positions and acquisition angles) were extracted from the experimental projections to model the non-circular orbit (NCO) detector motion. The gamma camera model was validated against the experimental projections obtained with the cylindrical Jaszczak (177Lu) and lung and spine phantom (131I). Then, 177Lu and 131I CO and NCO SPECT projections were simulated to validate the impact of explicit NCO modelling on simulated projections. RESULTS Experimental and simulated SPECT images were compared using the gamma index, and were in good agreement with gamma index passing rate (GIPR) and gammaavg of 96.27%, 0.242 (177Lu) and 92.89%, 0.36 (131I). Then, simulated 177Lu and 131I CO and NCO SPECT projections were compared. The GIPR, gammaavg between the two gamma camera motions was 99.85%, 0.108 for 177Lu and 75.58%, 0.6 for 131I. CONCLUSION This work thereby justifies the need for auto-contouring modelling for isotopes with high septal penetration.
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Affiliation(s)
- Gunjan Kayal
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France; SCK CEN, Belgian Nuclear Research Centre, Boeretang 200, Mol 2400, Belgium.
| | - Maxime Chauvin
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Erick Mora-Ramirez
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France; Universidad de Costa Rica, Escuela de Fisica, CICANUM, San Jose, Costa Rica
| | - Naomi Clayton
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Alex Vergara-Gil
- CRCT, UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Nicholas Calvert
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester, UK
| | - Jill Tipping
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester, UK
| | - Lara Struelens
- SCK CEN, Belgian Nuclear Research Centre, Boeretang 200, Mol 2400, Belgium
| | | | - Manuel Bardiès
- ICM, Département de Médecine Nucléaire, Montpellier, France; IRCM, UMR 1194 INSERM, Université de Montpellier and ICM, Montpellier, France
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Herrmann K, Rahbar K, Eiber M, Krause BJ, Lassmann M, Jentzen W, Blumenstein L, Klein P, Basque JR, Kurth J. Dosimetry of 177Lu-PSMA-617 for the treatment of metastatic castration-resistant prostate cancer: results from the VISION trial sub-study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
97 Background: The phase 3 VISION trial (NCT03511664) evaluated the efficacy and safety of the radioligand [177Lu]Lu-PSMA-617 (177Lu-PSMA-617) in patients with metastatic castration-resistant prostate cancer. 177Lu-PSMA-617 plus protocol-permitted standard of care (SOC) significantly improved overall survival and radiographic progression-free survival of patients compared with SOC alone. The incidence of adverse events (AEs) of grade 3 or above was higher with 177Lu-PSMA-617 than without, but quality of life was not adversely affected. This dosimetry sub-study aimed to quantify the absorbed dose of 177Lu-PSMA-617 in organs at risk of radiotoxicity due to exposure levels or radiosensitivity. Methods: In a sub-study of VISION, dosimetry was performed in a separate cohort of 29 non-randomized participants at four German sites. Eligible patients received 177Lu-PSMA-617 (7.4 GBq per cycle) plus SOC every 6 weeks for a maximum of 6 cycles. Patients underwent planar whole-body scintigraphy scans and single-photon emission computed tomography/computed tomography (SPECT/CT) scans of the upper and lower abdomen at 2, 24, 48 and 168 hours after first administration. Blood and urine samples were collected throughout cycle 1. 177Lu-PSMA-617 dosimetry outcomes were based on biodistribution, assessed using whole-body conjugate planar-image data, SPECT/CT image data, blood assay data and urinary excretion data. Radiation exposure was estimated using Organ Level INternal Dose Assessment/EXponential Modeling (OLINDA/EXM) software code version 2.2. Results were expressed as absorbed dose per unit activity (Gy/GBq) and cumulative estimated absorbed dose (Gy) over all 6 cycles (44.4 GBq cumulative activity) extrapolated from cycle 1 data. Results: Radiation-absorbed doses per unit activity were highest in the lacrimal glands, followed by the salivary glands, with mean values of 2.1 Gy/GBq (standard deviation [SD], 0.47) and 0.63 Gy/GBq (0.36), respectively. The kidneys received 0.43 Gy/GBq (SD, 0.16) and the blood-based red marrow dose was 0.035 Gy/GBq (0.02). The 6-cycle cumulative estimated absorbed dose was 92 Gy (SD, 21) in the lacrimal glands, 28 Gy (16) in the salivary glands, 19 Gy (7.3) in the kidneys and 1.5 Gy (0.90) in the red marrow. In cycle 1, 20% of patients had at least one hematological AE of Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2; no patient experienced any renal AE of CTCAE grade ≥ 2 or any lacrimal gland toxicity, and 2 patients had a grade 1 salivary gland AE. Conclusions: 177Lu-PSMA-617 dosimetry results in this sub-study were consistent with the published ranges, and cycle 1 AEs affecting at-risk organs were infrequent and of low-to-moderate severity. These findings indicate that patients with metastatic castration-resistant prostate cancer receiving 177Lu-PSMA-617 should be at low risk of radiation-induced AEs. Clinical trial information: NCT03511664.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | | | | | | | - Walter Jentzen
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | | | - Patrick Klein
- Novartis Institutes for BioMedical Research, East Hanover, NJ
| | | | - Jens Kurth
- Rostock University Medical Center, Rostock, Germany
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Ostheim P, Miederer M, Schreckenberger M, Nestler T, Hoffmann MA, Lassmann M, Eberlein U, Barsegian V, Rump A, Majewski M, Port M, Abend M. mRNA and small RNA gene expression changes in peripheral blood to detect internal Ra-223 exposure. Int J Radiat Biol 2021; 98:900-912. [PMID: 34882512 DOI: 10.1080/09553002.2021.1998705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Excretion analysis is the established method for detection of incorporated alpha-emitting radionuclides, but it is laborious and time consuming. We sought a simplified method in which changes in gene expression might be measured in human peripheral blood to detect incorporated radionuclides. Such an approach could be used to quickly determine internal exposure in instances of a radiological dispersal device or a radiation accident. MATERIALS AND METHODS We evaluated whole blood samples from five patients with castration-resistant prostate cancer and multiple bone metastases (without visceral or nodal involvement), who underwent treatment with the alpha emitting isotope Radium-223 dichloride (Ra-223, Xofigo®). Patients received about 4 MBq per cycle and, depending on survival and treatment tolerance, were followed for six months. We collected 24 blood samples approximately monthly corresponding to treatment cycle. RESULTS Firstly, we conducted whole genome screening of mRNAs (mRNA seq) and small RNAs (small RNA seq) using next generation sequencing in one patient at eight different time points during all six cycles of Ra-223-therapy. We identified 1900 mRNAs and 972 small RNAs (222 miRNAs) that were differentially up- or down-regulated during follow-up after the first treatment with Ra-223. Overall candidate RNA species inclusion criteria were a general (≥|2|-fold) change or with peaking profiles (≥|5|-fold) at specific points in time. Next we chose 72 candidate mRNAs and 101 small RNAs (comprising 29 miRNAs) for methodologic (n = 8 samples, one patient) and independent (n = 16 samples, four patients) validation by qRT-PCR. In total, 15 mRNAs (but no small RNAs) were validated by methodologic and independent testing. However, the deregulation occurred at different time points, showing a large inter-individual variability in response among patients. CONCLUSIONS This proof of concept provides support for the applicability of gene expression measurements to detect internalized alpha-emitting radionuclides, but further work is needed with a larger sample size. While our approach has merit for internal deposition monitoring, it was complicated by the severe clinical condition of the patients we studied.
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Affiliation(s)
| | - Matthias Miederer
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mathias Schreckenberger
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Manuela A Hoffmann
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Occupational Health & Safety, Federal Ministry of Defense, Bonn, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Vahe Barsegian
- Institute of Nuclear Medicine, Helios Kliniken, Schwerin, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Mattháus Majewski
- Bundeswehr Institute of Radiobiology, Munich, Germany.,Department of Urology, Armed Services Hospital Ulm, Ulm, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Lassmann M, Eberlein U, Gear J, Konijnenberg M, Kunikowska J. Dosimetry for Radiopharmaceutical Therapy: The European Perspective. J Nucl Med 2021; 62:73S-79S. [PMID: 34857624 DOI: 10.2967/jnumed.121.262754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
This review presents efforts in Europe over the last few years with respect to standardization of quantitative imaging and dosimetry and comprises the results of several European research projects on practices regarding radiopharmaceutical therapies (RPTs). Because the European Union has regulatory requirements concerning dosimetry in RPTs, the European Association of Nuclear Medicine released a position paper in 2021 on the use of dosimetry under these requirements. The importance of radiobiology for RPTs is elucidated in another position paper by the European Association of Nuclear Medicine. Furthermore, how dosimetry interacts with clinical requirements is described, with several clinical examples. In the future, more efforts need to be undertaken to increase teaching and standardization efforts and to incorporate radiobiology for further individualizing patient treatment, with the aim of improving the outcome and safety of RPTs.
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Affiliation(s)
- Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany;
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; and
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
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29
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Schumann S, Scherthan H, Pfestroff K, Schoof S, Pfestroff A, Hartrampf P, Hasenauer N, Buck AK, Luster M, Port M, Lassmann M, Eberlein U. DNA damage and repair in peripheral blood mononuclear cells after internal ex vivo irradiation of patient blood with 131I. Eur J Nucl Med Mol Imaging 2021; 49:1447-1455. [PMID: 34773472 PMCID: PMC8940852 DOI: 10.1007/s00259-021-05605-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/26/2021] [Indexed: 01/15/2023]
Abstract
Aim The aim of this study was to provide a systematic approach to characterize DNA damage induction and repair in isolated peripheral blood mononuclear cells (PBMCs) after internal ex vivo irradiation with [131I]NaI. In this approach, we tried to mimic ex vivo the irradiation of patient blood in the first hours after radioiodine therapy. Material and methods Blood of 33 patients of two centres was collected immediately before radioiodine therapy of differentiated thyroid cancer (DTC) and split into two samples. One sample served as non-irradiated control. The second sample was exposed to ionizing radiation by adding 1 ml of [131I]NaI solution to 7 ml of blood, followed by incubation at 37 °C for 1 h. PBMCs of both samples were isolated, split in three parts each and (i) fixed in 70% ethanol and stored at − 20 °C directly (0 h) after irradiation, (ii) after 4 h and (iii) 24 h after irradiation and culture in RPMI medium. After immunofluorescence staining microscopically visible co-localizing γ-H2AX + 53BP1 foci were scored in 100 cells per sample as biomarkers for radiation-induced double-strand breaks (DSBs). Results Thirty-two of 33 blood samples could be analysed. The mean absorbed dose to the blood in all irradiated samples was 50.1 ± 2.3 mGy. For all time points (0 h, 4 h, 24 h), the average number of γ-H2AX + 53BP1 foci per cell was significantly different when compared to baseline and the other time points. The average number of radiation-induced foci (RIF) per cell after irradiation was 0.72 ± 0.16 at t = 0 h, 0.26 ± 0.09 at t = 4 h and 0.04 ± 0.09 at t = 24 h. A monoexponential fit of the mean values of the three time points provided a decay rate of 0.25 ± 0.05 h−1, which is in good agreement with data obtained from external irradiation with γ- or X-rays. Conclusion This study provides novel data about the ex vivo DSB repair in internally irradiated PBMCs of patients before radionuclide therapy. Our findings show, in a large patient sample, that efficient repair occurs after internal irradiation with 50 mGy absorbed dose, and that the induction and repair rate after 131I exposure is comparable to that of external irradiation with γ- or X-rays.
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Affiliation(s)
- S Schumann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - H Scherthan
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
| | - K Pfestroff
- Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany
| | - S Schoof
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
| | - A Pfestroff
- Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany
| | - P Hartrampf
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - N Hasenauer
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - A K Buck
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - M Luster
- Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
| | - M Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - U Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
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Soares Machado J, Tran-Gia J, Schlögl S, Buck AK, Lassmann M. Correction to: Biokinetics, dosimetry and radiation risk in infants after 99mTc-MAG3 scans. EJNMMI Res 2021; 11:101. [PMID: 34633591 PMCID: PMC8505585 DOI: 10.1186/s13550-021-00836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J Soares Machado
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - J Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - S Schlögl
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - A K Buck
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - M Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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31
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Hänscheid H, Schirbel A, Hartrampf P, Kraus S, Werner RA, Einsele H, Wester HJ, Lassmann M, Kortüm M, Buck AK. Biokinetics and Dosimetry of [ 177Lu]Lu-Pentixather. J Nucl Med 2021; 63:754-760. [PMID: 34413147 DOI: 10.2967/jnumed.121.262295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
The chemokine receptor CXCR4, which is overexpressed in many solid and hematologic malignancies, can be targeted for radiopeptide therapy via the antagonist Pentixather®. Biokinetics and dosimetry of 177Lu-Pentixather and 90Y-Pentixather were analyzed. Methods: This retrospective study is a standardized reevaluation of data collected for treatment planning. Nineteen patients with complete sets of planar whole-body scans over at least four days and a single SPECT/CT after 200 MBq 177Lu-Pentixather were included. Kinetics were measured in the whole body, in tissues with activity retention, and in 10 individuals in the blood. Time-integrated activity coefficients and tissue absorbed doses were derived. Results: Increased uptake of Pentixather was observed in kidneys, liver, spleen, and bone marrow, inducing median (minimum-maximum) absorbed doses of 0.91 (0.38-3.47), 0.71 (0.39-1.17), 0.58 (0.34-2.26), and 0.47 (0.14-2.33) Gy per GBq 177Lu-Pentixather and 3.75 (1.48-12.2), 1.61 (1.14-2.97), 1.66 (0.97-6.69), and 1.06 (0.27-4.45) Gy per GBq 90Y-Pentixather, respectively. In most tissues, activity increased during the first day after the administration of 177Lu-Pentixather and afterwards decayed with mean effective half-lives of 41 ± 10 (range: 24-64) hours in kidneys and median half-lives of 109, 86, and 92 hours in liver, spleen, and bone marrow, respectively. Maximum uptake per kidney was 2.2% ± 1.0% (range: 0.6%-5.1%). In organs showing no specific uptake, absorbed doses exceeding 0.3 Gy per GBq 90Y-Pentixather are estimated for the urinary bladder and for tissues adjacent to accumulating organs such as the adrenal glands, bone surface, and gallbladder. Dose estimates for tumors and extramedullary lesions ranged from 1.5 to 18.2 Gy per GBq 90Y-Pentixather. Conclusion: In patients with hematologic neoplasms, absorbed doses calculated for bone marrow and extramedullary lesions are sufficient to be effective as an adjunct to high-dose chemotherapies prior to stem cell transplantation.
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Tran-Gia J, Denis-Bacelar AM, Ferreira KM, Robinson AP, Calvert N, Fenwick AJ, Finocchiaro D, Fioroni F, Grassi E, Heetun W, Jewitt SJ, Kotzassarlidou M, Ljungberg M, McGowan DR, Scott N, Scuffham J, Gleisner KS, Tipping J, Wevrett J, Lassmann M. A multicentre and multi-national evaluation of the accuracy of quantitative Lu-177 SPECT/CT imaging performed within the MRTDosimetry project. EJNMMI Phys 2021; 8:55. [PMID: 34297218 PMCID: PMC8302709 DOI: 10.1186/s40658-021-00397-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Patient-specific dosimetry is required to ensure the safety of molecular radiotherapy and to predict response. Dosimetry involves several steps, the first of which is the determination of the activity of the radiopharmaceutical taken up by an organ/lesion over time. As uncertainties propagate along each of the subsequent steps (integration of the time-activity curve, absorbed dose calculation), establishing a reliable activity quantification is essential. The MRTDosimetry project was a European initiative to bring together expertise in metrology and nuclear medicine research, with one main goal of standardizing quantitative 177Lu SPECT/CT imaging based on a calibration protocol developed and tested in a multicentre inter-comparison. This study presents the setup and results of this comparison exercise. METHODS The inter-comparison included nine SPECT/CT systems. Each site performed a set of three measurements with the same setup (system, acquisition and reconstruction): (1) Determination of an image calibration for conversion from counts to activity concentration (large cylinder phantom), (2) determination of recovery coefficients for partial volume correction (IEC NEMA PET body phantom with sphere inserts), (3) validation of the established quantitative imaging setup using a 3D printed two-organ phantom (ICRP110-based kidney and spleen). In contrast to previous efforts, traceability of the activity measurement was required for each participant, and all participants were asked to calculate uncertainties for their SPECT-based activities. RESULTS Similar combinations of imaging system and reconstruction lead to similar image calibration factors. The activity ratio results of the anthropomorphic phantom validation demonstrate significant harmonization of quantitative imaging performance between the sites with all sites falling within one standard deviation of the mean values for all inserts. Activity recovery was underestimated for total kidney, spleen, and kidney cortex, while it was overestimated for the medulla. CONCLUSION This international comparison exercise demonstrates that harmonization of quantitative SPECT/CT is feasible when following very specific instructions of a dedicated calibration protocol, as developed within the MRTDosimetry project. While quantitative imaging performance demonstrates significant harmonization, an over- and underestimation of the activity recovery highlights the limitations of any partial volume correction in the presence of spill-in and spill-out between two adjacent volumes of interests.
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Affiliation(s)
- Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | | | | | - Andrew P Robinson
- National Physical Laboratory, Teddington, UK
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
| | - Nicholas Calvert
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew J Fenwick
- National Physical Laboratory, Teddington, UK
- Cardiff University, Cardiff, UK
| | - Domenico Finocchiaro
- Medical Physics Unit, Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS, Reggio Emilia, Italy
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Federica Fioroni
- Medical Physics Unit, Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Elisa Grassi
- Medical Physics Unit, Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | | | - Stephanie J Jewitt
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maria Kotzassarlidou
- Nuclear Medicine Department, "THEAGENIO" Anticancer Hospital, Thessaloniki, Greece
| | | | - Daniel R McGowan
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | - Nathaniel Scott
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James Scuffham
- National Physical Laboratory, Teddington, UK
- Royal Surrey County Hospital, Guildford, UK
- Department of Physics, University of Surrey, Guildford, UK
| | | | - Jill Tipping
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester, UK
| | - Jill Wevrett
- National Physical Laboratory, Teddington, UK
- Royal Surrey County Hospital, Guildford, UK
- Department of Physics, University of Surrey, Guildford, UK
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Kredel M, Reinhold AK, Wirbelauer J, Muellges W, Kunze E, Rehn M, Wöckel A, Lassmann M, Markus CK, Meybohm P, Kranke P. [Pregnancy and Irreversible Loss of Brain Functions - Case Report]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:526-535. [PMID: 34298572 DOI: 10.1055/a-1203-3031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 29-year-old woman suffered major traumatic brain injury caused by a car accident. As diagnostic measures had revealed an early pregnancy (9th week), treatment on the intensive care unit was continued for 5 months, after unfavourable cerebral prognosis was followed by an irreversible loss of brain function in the 10th week of pregnancy. After assisted vaginal delivery of a healthy child in the 31th week of pregnancy on the critical care unit, organ procurement took place according to the presumed will of the patient. The article presents the details of the critical care therapy and discusses the supportive medical measures. Those measures served primarily to uphold the pregnancy und support the healthy development and delivery of the fetus and only in second instance the organ preservation aiming on organ donation. Necessary measures included maintenance of vital functions, hemostasis of electrolytes, nutrition, treatment of infection, prevention of adverse effects on the fetus, substitution of hormones and vitamins as well as the preparation of a planned or an unplanned delivery.
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Aerts A, Eberlein U, Holm S, Hustinx R, Konijnenberg M, Strigari L, van Leeuwen FWB, Glatting G, Lassmann M. EANM position paper on the role of radiobiology in nuclear medicine. Eur J Nucl Med Mol Imaging 2021; 48:3365-3377. [PMID: 33912987 PMCID: PMC8440244 DOI: 10.1007/s00259-021-05345-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022]
Abstract
With an increasing variety of radiopharmaceuticals for diagnostic or therapeutic nuclear medicine as valuable diagnostic or treatment option, radiobiology plays an important role in supporting optimizations. This comprises particularly safety and efficacy of radionuclide therapies, specifically tailored to each patient. As absorbed dose rates and absorbed dose distributions in space and time are very different between external irradiation and systemic radionuclide exposure, distinct radiation-induced biological responses are expected in nuclear medicine, which need to be explored. This calls for a dedicated nuclear medicine radiobiology. Radiobiology findings and absorbed dose measurements will enable an improved estimation and prediction of efficacy and adverse effects. Moreover, a better understanding on the fundamental biological mechanisms underlying tumor and normal tissue responses will help to identify predictive and prognostic biomarkers as well as biomarkers for treatment follow-up. In addition, radiobiology can form the basis for the development of radiosensitizing strategies and radioprotectant agents. Thus, EANM believes that, beyond in vitro and preclinical evaluations, radiobiology will bring important added value to clinical studies and to clinical teams. Therefore, EANM strongly supports active collaboration between radiochemists, radiopharmacists, radiobiologists, medical physicists, and physicians to foster research toward precision nuclear medicine.
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Affiliation(s)
- An Aerts
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Uta Eberlein
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Sören Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, GIGA-CRC in vivo Imaging, University of Liège, Liège, Belgium
| | - Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Lidia Strigari
- Medical Physics Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerhard Glatting
- Medical Radiation Physics, Department of Nuclear Medicine, Ulm University, Ulm, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
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Schumann S, Eberlein U, Lapa C, Müller J, Serfling S, Lassmann M, Scherthan H. α-Particle-induced DNA damage tracks in peripheral blood mononuclear cells of [ 223Ra]RaCl 2-treated prostate cancer patients. Eur J Nucl Med Mol Imaging 2021; 48:2761-2770. [PMID: 33537837 PMCID: PMC8263441 DOI: 10.1007/s00259-020-05170-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE One therapy option for prostate cancer patients with bone metastases is the use of [223Ra]RaCl2. The α-emitter 223Ra creates DNA damage tracks along α-particle trajectories (α-tracks) in exposed cells that can be revealed by immunofluorescent staining of γ-H2AX+53BP1 DNA double-strand break markers. We investigated the time- and absorbed dose-dependency of the number of α-tracks in peripheral blood mononuclear cells (PBMCs) of patients undergoing their first therapy with [223Ra]RaCl2. METHODS Multiple blood samples from nine prostate cancer patients were collected before and after administration of [223Ra]RaCl2, up to 4 weeks after treatment. γ-H2AX- and 53BP1-positive α-tracks were microscopically quantified in isolated and immuno-stained PBMCs. RESULTS The absorbed doses to the blood were less than 6 mGy up to 4 h after administration and maximally 16 mGy in total. Up to 4 h after administration, the α-track frequency was significantly increased relative to baseline and correlated with the absorbed dose to the blood in the dose range < 3 mGy. In most of the late samples (24 h - 4 weeks after administration), the α-track frequency remained elevated. CONCLUSION The γ-H2AX+53BP1 assay is a potent method for detection of α-particle-induced DNA damages during treatment with or after accidental incorporation of radionuclides even at low absorbed doses. It may serve as a biomarker discriminating α- from β-emitters based on damage geometry.
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Affiliation(s)
- S Schumann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.
| | - U Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - C Lapa
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.,Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - J Müller
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
| | - S Serfling
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - M Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - H Scherthan
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
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36
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Delis H, Homolka P, Chapple C, Costa P, Attalla E, Lubis L, Sackey T, Fahey F, Lassmann M, Poli G. Developing and implementing a multi-modality imaging optimization study in paediatric radiology: Experience and recommendations from an IAEA coordinated research project. Phys Med 2021; 82:255-265. [DOI: 10.1016/j.ejmp.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
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Konijnenberg M, Herrmann K, Kobe C, Verburg F, Hindorf C, Hustinx R, Lassmann M. EANM position paper on article 56 of the Council Directive 2013/59/Euratom (basic safety standards) for nuclear medicine therapy. Eur J Nucl Med Mol Imaging 2021; 48:67-72. [PMID: 33057773 PMCID: PMC7835146 DOI: 10.1007/s00259-020-05038-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022]
Abstract
The EC Directive 2013/59/Euratom states in article 56 that exposures of target volumes in nuclear medicine treatments shall be individually planned and their delivery appropriately verified. The Directive also mentions that medical physics experts should always be appropriately involved in those treatments. Although it is obvious that, in nuclear medicine practice, every nuclear medicine physician and physicist should follow national rules and legislation, the EANM considered it necessary to provide guidance on how to interpret the Directive statements for nuclear medicine treatments.For this purpose, the EANM proposes to distinguish three levels in compliance to the optimization principle in the directive, inspired by the indication of levels in prescribing, recording and reporting of absorbed doses after radiotherapy defined by the International Commission on Radiation Units and Measurements (ICRU): Most nuclear medicine treatments currently applied in Europe are standardized. The minimum requirement for those treatments is ICRU level 1 ("activity-based prescription and patient-averaged dosimetry"), which is defined by administering the activity within 10% of the intended activity, typically according to the package insert or to the respective EANM guidelines, followed by verification of the therapy delivery, if applicable. Non-standardized treatments are essentially those in developmental phase or approved radiopharmaceuticals being used off-label with significantly (> 25% more than in the label) higher activities. These treatments should comply with ICRU level 2 ("activity-based prescription and patient-specific dosimetry"), which implies recording and reporting of the absorbed dose to organs at risk and optionally the absorbed dose to treatment regions. The EANM strongly encourages to foster research that eventually leads to treatment planning according to ICRU level 3 ("dosimetry-guided patient-specific prescription and verification"), whenever possible and relevant. Evidence for superiority of therapy prescription on basis of patient-specific dosimetry has not been obtained. However, the authors believe that a better understanding of therapy dosimetry, i.e. how much and where the energy is delivered, and radiobiology, i.e. radiation-related processes in tissues, are keys to the long-term improvement of our treatments.
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Affiliation(s)
- Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frederik Verburg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Cecilia Hindorf
- Department of Nuclear Medicine Physics, Skåne University Hospital, Lund, Sweden
| | - Roland Hustinx
- Service de Médecine Nucléaire et d'Imagerie Oncologique, Département de Physique médicale, Université de Liège - GIGA-CRC in vivo imaging, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Michael Lassmann
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Klinik und Poliklinik für Nuklearmedizin, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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Lassmann M, Eberlein U, Tran-Gia J. Multicentre Trials on Standardised Quantitative Imaging and Dosimetry for Radionuclide Therapies. Clin Oncol (R Coll Radiol) 2020; 33:125-130. [PMID: 33277151 DOI: 10.1016/j.clon.2020.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/19/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
The aim of this review is to summarise the efforts undertaken so far to compare or standardise quantitative imaging with gamma cameras across centres for multicentre trials in radionuclide therapies. Overall, 10 studies were identified, five of which were set up as a multicentre effort for standardising and comparing methods for quantitative imaging. One study used positron emission tomography imaging with 124I. In the remaining studies, measurements were carried out with planar imaging, single photon emission computed tomography/computed tomography (SPECT/CT) or a combination of both. Three studies used radioactive calibration sources that were traceable to national standards. Most of the studies were set up in the framework of multicentre clinical trials in an effort to obtain comparable quantification across sites. The use of state-of-the-art SPECT/CT systems and reconstructions has emerged as the method of choice for dosimetry in clinical trials for radionuclide therapies.
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Affiliation(s)
- M Lassmann
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Germany.
| | - U Eberlein
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Germany
| | - J Tran-Gia
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Germany
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Taprogge J, Leek F, Schurrat T, Tran-Gia J, Vallot D, Bardiès M, Eberlein U, Lassmann M, Schlögl S, Vergara Gil A, Flux GD. Setting up a quantitative SPECT imaging network for a European multi-centre dosimetry study of radioiodine treatment for thyroid cancer as part of the MEDIRAD project. EJNMMI Phys 2020; 7:61. [PMID: 33030702 PMCID: PMC7544799 DOI: 10.1186/s40658-020-00332-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022] Open
Abstract
Background Differentiated thyroid cancer has been treated with radioiodine for almost 80 years, although controversial questions regarding radiation-related risks and the optimisation of treatment regimens remain unresolved. Multi-centre clinical studies are required to ensure recruitment of sufficient patients to achieve the statistical significance required to address these issues. Optimisation and standardisation of data acquisition and processing are necessary to ensure quantitative imaging and patient-specific dosimetry. Material and methods A European network of centres able to perform standardised quantitative imaging of radioiodine therapy of thyroid cancer patients was set-up within the EU consortium MEDIRAD. This network will support a concurrent series of clinical studies to determine accurately absorbed doses for thyroid cancer patients treated with radioiodine. Five SPECT(/CT) systems at four European centres were characterised with respect to their system volume sensitivity, recovery coefficients and dead time. Results System volume sensitivities of the Siemens Intevo systems (crystal thickness 3/8″) ranged from 62.1 to 73.5 cps/MBq. For a GE Discovery 670 (crystal thickness 5/8″) a system volume sensitivity of 92.2 cps/MBq was measured. Recovery coefficients measured on three Siemens Intevo systems show good agreement. For volumes larger than 10 ml, the maximum observed difference between recovery coefficients was found to be ± 0.02. Furthermore, dead-time coefficients measured on two Siemens Intevo systems agreed well with previously published dead-time values. Conclusions Results presented here provide additional support for the proposal to use global calibration parameters for cameras of the same make and model. This could potentially facilitate the extension of the imaging network for further dosimetry-based studies.
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Affiliation(s)
- Jan Taprogge
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK. .,The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Francesca Leek
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK.,The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Tino Schurrat
- Department of Nuclear Medicine, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Delphine Vallot
- IUCT Oncopole, Av. Irène Joliot-Curie, 31100, Toulouse, France
| | - Manuel Bardiès
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM, Université Paul Sabatier, Toulouse, France
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Susanne Schlögl
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Alex Vergara Gil
- Centre de Recherches en Cancérologie de Toulouse, UMR 1037, INSERM, Université Paul Sabatier, Toulouse, France
| | | | - Glenn D Flux
- Joint Department of Physics, Royal Marsden NHSFT, Downs Road, Sutton, SM2 5PT, UK.,The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
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Poli GL, Coca M, Torres L, Fahey F, Lassmann M, Chapple CL, Homolka P, Delis H. Developing and Implementing an Imaging Optimization Study in Pediatric Nuclear Medicine: Experience and Recommendations from an IAEA-Coordinated Research Project. J Nucl Med 2020; 62:570-576. [PMID: 32859712 DOI: 10.2967/jnumed.120.244616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
The International Atomic Energy Agency instituted a coordinated research project on the evaluation and optimization of pediatric imaging, addressing the lack of consistency in this field. The purpose was to develop and test an optimization schema for the practices of pediatric radiology and nuclear medicine. Methods: A 5-step optimization schema was developed. Once a protocol optimization is identified, the steps are as follows: identification of the imaging situation; collection of administered-activity data and evaluation of the diagnostic image quality at baseline; comparison of baseline administered activity data with published standards or other benchmarks; identification of intervention, if necessary; and implementation of intervention and evaluation. Results: Within the coordinated research project, two sites considered optimization projects regarding nuclear medicine. In this work, renal imaging using 99mTc-dimercaptosuccinic acid (DMSA) projects are presented as examples. Site 1 acquired its standard 300-s static 99mTc-DMSA studies as 5-frame dynamic studies in 29 children. Frames were added to simulate different levels of administered activity. Image quality was subjectively judged on a 3-point Likert scale. A 30% reduction in administered activity with increased imaging duration (350 s) across all age groups was shown to be acceptable. This reduction was implemented and evaluated in 31 subsequent children, yielding administered activities significantly lower than baseline (mean relative differences of 30%, 37%, and 38% for children aged 0-5, 5-10, and 10-15 y, respectively). Site 2 performed a phantom study to determine the impact of lowering administered activity on image noise, finding that administered activities could be significantly lowered if longer imaging times were used. This led to a 50%-70% reduction from baseline with no loss in image quality. Conclusion: A dose optimization approach was applied successfully for several procedures commonly performed in pediatric nuclear medicine. Results are reported for renal cortical imaging using 99mTc-DMSA, leading to significant reductions in administered activity (and thus radiation dose). This optimization schema can be successfully implemented by nuclear medicine clinics seeking to improve their approach to imaging children.
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Affiliation(s)
- Gian Luca Poli
- Dosimetry and Medical Radiation Physics Section, International Atomic Energy Agency, Vienna, Austria
| | - Marco Coca
- Medscan Nuclear Medicine and PET/CT Center, Concepcion, Chile
| | - Leonel Torres
- Department of Nuclear Medicine, DIC, CENTIS, Havana, Cuba
| | - Frederic Fahey
- Division of Nuclear Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Homolka
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Harry Delis
- Dosimetry and Medical Radiation Physics Section, International Atomic Energy Agency, Vienna, Austria
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41
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Gear J, Chiesa C, Lassmann M, Gabiña PM, Tran-Gia J, Stokke C, Flux G. EANM Dosimetry Committee series on standard operational procedures for internal dosimetry for 131I mIBG treatment of neuroendocrine tumours. EJNMMI Phys 2020; 7:15. [PMID: 32144574 PMCID: PMC7060302 DOI: 10.1186/s40658-020-0282-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
The purpose of the EANM Dosimetry Committee Series on "Standard Operational Procedures for Dosimetry" (SOP) is to provide advice to scientists and clinicians on how to perform patient-specific absorbed dose assessments. This SOP describes image and data acquisition parameters and dosimetry calculations to determine the absorbed doses delivered to whole-body, tumour and normal organs following a therapeutic administration of 131I mIBG for the treatment of neuroblastoma or adult neuroendocrine tumours. Recommendations are based on evidence in recent literature where available and on expert opinion within the community. This SOP is intended to promote standardisation of practice within the community and as such is based on the facilities and expertise that should be available to any centre able to perform specialised treatments with radiopharmaceuticals and patient-specific dosimetry. A clinical example is given to demonstrate the application of the absorbed dose calculations.
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Affiliation(s)
- Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK.
| | - Carlo Chiesa
- Nuclear Medicine, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, 97080, Würzburg, Germany
| | - Pablo Mínguez Gabiña
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, 97080, Würzburg, Germany
| | - Caroline Stokke
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
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42
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Kurth J, Herrmann K, Eiber M, Rahbar K, Heuschkel M, Lassmann M, Jentzen W, Chicco D, Messmann R, Sartor AO, Morris MJ, Krause BJ. Dosimetry of 177Lu-PSMA-617 for the treatment of metastatic castration-resistant prostate cancer: A sub-study of the VISION trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.tps265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS265 Background: Prostate-specific membrane antigen-617 labelled with lutetium-177 (177Lu-PSMA-617) is a promising treatment for patients with metastatic castration-resistant prostate cancer (mCRPC) after treatment with taxane chemotherapy and a novel androgen axis inhibitor. The radiotherapeutic molecule has high PSMA binding affinity, prolonged tumor retention with a rapid kidney clearance, and high tumor-to-background ratio, delivering therapeutically relevant doses of radiation to prostate cancer lesions. A randomized, prospective phase 3 trial to assess the efficacy of 177Lu-PSMA-617 in patients with progressive PSMA-positive mCRPC is ongoing (VISION trial, NCT03511664). However, as with other targeted radionuclide treatment modalities, there may be a risk of radiotoxicity to normal organs. Therefore, estimation of absorbed doses in these organs in a representative manner within the framework of such a study is essential. Methods: As a substudy of the VISION trial, extensive intratherapeutic dosimetry will be performed in a group of 30 patients at four participating German sites. Patients will undergo planar whole-body scintigraphy scans and single-photon emission computed tomography/computerized tomography (SPECT/CT) scans of the upper and lower abdomen at approximately 2, 24, and 48 hours, and 7 days after administration, along with blood sampling and urine collection. SPECT/CT data will be quantitatively reconstructed and a standardized calibration procedure of the imaging and measurement equipment used (SPECT/CT, dose calibrator, well counter) will be performed at all sites according to European Association of Nuclear Medicine (EANM) and Medical International Radiation Dose (MIRD) guidelines [1]. Organ masses will be measured for each patient using CT imaging, if accessible. Absorbed doses for kidneys, liver, spleen, salivary and lacrimal glands, and bone marrow, as well as prostate cancer lesions, will be calculated for each patient following international guidelines [2,3]. References: [1] Ljungberg M et al. J Nucl Med 2016;57:151–62. [2] Siegel JA et al. J Nucl Med 1999;40:37S–61S. [3] Hindorf C et al. Eur J Nucl Med Mol Imaging 2010;37:1238–50. Clinical trial information: NCT03511664.
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Affiliation(s)
- Jens Kurth
- Rostock University Medical Center, Rostock, Germany
| | | | | | | | | | | | | | - Daniela Chicco
- Advanced Accelerator Applications, a Novartis Company, Turin, Italy
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Salas-Ramirez M, Tran-Gia J, Gbureck U, Kosmala A, Lassmann M. Corrigendum: Quantification of the trabecular bone volume fraction for bone marrow dosimetry in molecular radiotherapy by using a dual-energy (SPECT/)CT (2019 Phys. Med. Biol. 64 205014). Phys Med Biol 2020. [DOI: 10.1088/1361-6560/ab6012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hänscheid H, Lassmann M. Will SPECT/CT Cameras Soon Be Able to Display Absorbed Doses? Dosimetry from Single-Activity-Concentration Measurements. J Nucl Med 2020; 61:1028-1029. [DOI: 10.2967/jnumed.119.239970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022] Open
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Tran-Gia J, Salas-Ramirez M, Lassmann M. What You See Is Not What You Get: On the Accuracy of Voxel-Based Dosimetry in Molecular Radiotherapy. J Nucl Med 2019; 61:1178-1186. [PMID: 31862802 DOI: 10.2967/jnumed.119.231480] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/11/2019] [Indexed: 11/16/2022] Open
Abstract
Improvements in quantitative SPECT/CT have aroused growing interest in voxel-based dosimetry for radionuclide therapies, because it promises visualization of absorbed doses at a voxel level. In this work, SPECT/CT-based voxel-level dosimetry of a 3-dimensional (3D) printed 2-compartment kidney phantom was performed, and the resulting absorbed dose distributions were examined. Additionally, the potential of the PETPVC partial-volume correction tool was investigated. Methods: Both kidney compartments (70% cortex, 30% medulla) were filled with different activity concentrations, and SPECT/CT imaging was performed. The images were reconstructed using varying settings (iterations, subsets, and postfiltering). On the basis of these activity concentration maps, absorbed dose distributions were calculated with precalculated 177Lu voxel S values and an empiric kidney half-life. An additional set of absorbed doses was calculated after applying PETPVC for partial-volume correction of the SPECT reconstructions. Results: SPECT/CT imaging blurs the 2 discrete suborgan absorbed dose values into a continuous distribution. Although this effect is slightly improved by applying more iterations, it is enhanced by additional postfiltering. By applying PETPVC, the absorbed dose values are separated into 2 peaks. Although this leads to a better agreement between SPECT/CT-based and nominal values, considerable discrepancies remain. In contrast to the calculated nominal absorbed doses of 7.8 and 1.6 Gy (in the cortex and medulla, respectively), SPECT/CT-based voxel-level dosimetry resulted in mean absorbed doses of 3.0-6.6 Gy (cortex) and 2.7-5.1 Gy (medulla). PETPVC led to improved ranges of 6.1-8.9 Gy (cortex) and 2.1-5.4 Gy (medulla). Conclusion: Our study showed that 177Lu quantitative SPECT/CT imaging leads to voxel-based dose distributions largely differing from the real organ distribution. SPECT/CT imaging and reconstruction deficiencies might directly translate into unrealistic absorbed dose distributions, thus questioning the reliability of SPECT-based voxel-level dosimetry. Therefore, SPECT/CT reconstructions should be adapted to ensure an accurate quantification of the underlying activity and, therefore, absorbed dose in a volume of interest of the expected object size (e.g., organs, organ substructures, lesions, or voxels). As an example, PETPVC largely improves the match between SPECT/CT-based and nominal dose distributions. In conclusion, the concept of voxel-based dosimetry should be treated with caution. Specifically, one should remember that the absorbed dose distribution is mainly a convolved version of the underlying SPECT reconstruction.
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Affiliation(s)
- Johannes Tran-Gia
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | | | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
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Scherthan H, Lee JH, Maus E, Schumann S, Muhtadi R, Chojowski R, Port M, Lassmann M, Bestvater F, Hausmann M. Nanostructure of Clustered DNA Damage in Leukocytes after In-Solution Irradiation with the Alpha Emitter Ra-223. Cancers (Basel) 2019; 11:cancers11121877. [PMID: 31779276 PMCID: PMC6966434 DOI: 10.3390/cancers11121877] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cancer patients are increasingly treated with alpha-particle-emitting radiopharmaceuticals. At the subcellular level, alpha particles induce densely spaced ionizations and molecular damage. Induction of DNA lesions, especially clustered DNA double-strand breaks (DSBs), threatens a cell's survival. Currently, it is under debate to what extent the spatial topology of the damaged chromatin regions and the repair protein arrangements are contributing. METHODS Super-resolution light microscopy (SMLM) in combination with cluster analysis of single molecule signal-point density regions of DSB repair markers was applied to investigate the nano-structure of DNA damage foci tracks of Ra-223 in-solution irradiated leukocytes. RESULTS Alpha-damaged chromatin tracks were efficiently outlined by γ-H2AX that formed large (super) foci composed of numerous 60-80 nm-sized nano-foci. Alpha damage tracks contained 60-70% of all γ-H2AX point signals in a nucleus, while less than 30% of 53BP1, MRE11 or p-ATM signals were located inside γ-H2AX damage tracks. MRE11 and p-ATM protein fluorescent tags formed focal nano-clusters of about 20 nm peak size. There were, on average, 12 (± 9) MRE11 nanoclusters in a typical γ-H2AX-marked alpha track, suggesting a minimal number of MRE11-processed DSBs per track. Our SMLM data suggest regularly arranged nano-structures during DNA repair in the damaged chromatin domain.
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Affiliation(s)
- Harry Scherthan
- Bundeswehr Institute of Radiobiology, University of Ulm, Neuherbergstraße 11, 80937 München, Germany; (J.-H.L.); (E.M.); (R.M.); (M.P.)
- Correspondence: (H.S.); (M.H.); Tel.: +49-89-992692-2272 (H.S.); +49-6221-549824 (M.H.)
| | - Jin-Ho Lee
- Bundeswehr Institute of Radiobiology, University of Ulm, Neuherbergstraße 11, 80937 München, Germany; (J.-H.L.); (E.M.); (R.M.); (M.P.)
- Kirchhoff-Institute for Physics, Heidelberg University, Im Neuenheimer Feld 227, 69120 Heidelberg, Germany;
| | - Emanuel Maus
- Bundeswehr Institute of Radiobiology, University of Ulm, Neuherbergstraße 11, 80937 München, Germany; (J.-H.L.); (E.M.); (R.M.); (M.P.)
- Kirchhoff-Institute for Physics, Heidelberg University, Im Neuenheimer Feld 227, 69120 Heidelberg, Germany;
| | - Sarah Schumann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (S.S.); (M.L.)
| | - Razan Muhtadi
- Bundeswehr Institute of Radiobiology, University of Ulm, Neuherbergstraße 11, 80937 München, Germany; (J.-H.L.); (E.M.); (R.M.); (M.P.)
| | - Robert Chojowski
- Kirchhoff-Institute for Physics, Heidelberg University, Im Neuenheimer Feld 227, 69120 Heidelberg, Germany;
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, University of Ulm, Neuherbergstraße 11, 80937 München, Germany; (J.-H.L.); (E.M.); (R.M.); (M.P.)
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany; (S.S.); (M.L.)
| | - Felix Bestvater
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
| | - Michael Hausmann
- Kirchhoff-Institute for Physics, Heidelberg University, Im Neuenheimer Feld 227, 69120 Heidelberg, Germany;
- Correspondence: (H.S.); (M.H.); Tel.: +49-89-992692-2272 (H.S.); +49-6221-549824 (M.H.)
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Salas-Ramirez M, Tran-Gia J, Gbureck U, Kosmala A, Lassmann M. Quantification of the trabecular bone volume fraction for bone marrow dosimetry in molecular radiotherapy by using a dual-energy (SPECT/)CT. Phys Med Biol 2019; 64:205014. [PMID: 31519000 DOI: 10.1088/1361-6560/ab4476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A complete characterization of spongiosa (bone marrow plus trabecular bone) is required to calculate the absorbed dose to active bone marrow. Due to the complex microanatomy, it is necessary to apply non-conventional imaging methods in nuclear medicine. The aim of this study is validating a phantomless quantification method using dual-energy quantitative computed tomography (DEQCT) for the quantification of trabecular bone volume fraction for bone marrow dosimetry in molecular radiotherapy. First, a phantomless quantification method (mass fraction method) based on x-ray beam and detector sensitivity was validated in an integrated dual energy SPECT/CT and in a dual source computed tomography (DSCT) system for comparison. The validation was performed in a phantom consisting of different water, fat and hydroxyapatite compositions. Moreover, the European spine phantom (ESP) was used to simulate the spine geometry. Bone mineral content (BMC) of the whole vertebra and bone mineral density (BMD) in the spongiosa region of each phantom vertebra were measured using DEQCT and dual energy x-ray absorptiometry (DEXA). Lastly, BMC was measured in a patient using DEQCT and DEXA. Measured values of hydroxyapatite fraction and nominal values in the homemade phantom showed a good correlation. The relative error remained below 14.2%. Quantification of BMC (in whole vertebra) and BMD (in spongiosa) in the ESP showed a good agreement between measured values and nominal values. The relative error remained between 0.7% and 7.5% for BMCSPECT/CT, 1.1% and 7.7% for BMCDSCT, 5.4% and 32.0 for BMDSPECT/CT, and 59.4% and 10.0% for BMDDSCT. Quantification of BMC in lumbar vertebrae 1 and 2 of a patient showed relative errors of 7.6% and -8.4% between DEXA and DSCT. Our study shows that DEQCT using a mass fraction method (phantomless) enables quantification of hydroxyapatite in a clinical nuclear medicine setting. An overestimation of the hydroxyapatite volume fraction was observed in all quantified regions, in particular in the spongiosa region of ESP. This result might be related to insufficient information about the x-ray spectra and the detector sensitivity function.
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Yonekura Y, Mattsson S, Flux G, Bolch WE, Dauer LT, Fisher DR, Lassmann M, Palm S, Hosono M, Doruff M, Divgi C, Zanzonico P. ICRP Publication 140: Radiological Protection in Therapy with Radiopharmaceuticals. Ann ICRP 2019; 48:5-95. [PMID: 31565950 DOI: 10.1177/0146645319838665] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiopharmaceuticals are increasingly used for the treatment of various cancers with novel radionuclides, compounds, tracer molecules, and administration techniques. The goal of radiation therapy, including therapy with radiopharmaceuticals, is to optimise the relationship between tumour control probability and potential complications in normal organs and tissues. Essential to this optimisation is the ability to quantify the radiation doses delivered to both tumours and normal tissues. This publication provides an overview of therapeutic procedures and a framework for calculating radiation doses for various treatment approaches. In radiopharmaceutical therapy, the absorbed dose to an organ or tissue is governed by radiopharmaceutical uptake, retention in and clearance from the various organs and tissues of the body, together with radionuclide physical half-life. Biokinetic parameters are determined by direct measurements made using techniques that vary in complexity. For treatment planning, absorbed dose calculations are usually performed prior to therapy using a trace-labelled diagnostic administration, or retrospective dosimetry may be performed on the basis of the activity already administered following each therapeutic administration. Uncertainty analyses provide additional information about sources of bias and random variation and their magnitudes; these analyses show the reliability and quality of absorbed dose calculations. Effective dose can provide an approximate measure of lifetime risk of detriment attributable to the stochastic effects of radiation exposure, principally cancer, but effective dose does not predict future cancer incidence for an individual and does not apply to short-term deterministic effects associated with radiopharmaceutical therapy. Accident prevention in radiation therapy should be an integral part of the design of facilities, equipment, and administration procedures. Minimisation of staff exposures includes consideration of equipment design, proper shielding and handling of sources, and personal protective equipment and tools, as well as education and training to promote awareness and engagement in radiological protection. The decision to hold or release a patient after radiopharmaceutical therapy should account for potential radiation dose to members of the public and carers that may result from residual radioactivity in the patient. In these situations, specific radiological protection guidance should be provided to patients and carers.
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Kratochwil C, Fendler WP, Eiber M, Baum R, Bozkurt MF, Czernin J, Delgado Bolton RC, Ezziddin S, Forrer F, Hicks RJ, Hope TA, Kabasakal L, Konijnenberg M, Kopka K, Lassmann M, Mottaghy FM, Oyen W, Rahbar K, Schöder H, Virgolini I, Wester HJ, Bodei L, Fanti S, Haberkorn U, Herrmann K. EANM procedure guidelines for radionuclide therapy with 177Lu-labelled PSMA-ligands ( 177Lu-PSMA-RLT). Eur J Nucl Med Mol Imaging 2019; 46:2536-2544. [PMID: 31440799 DOI: 10.1007/s00259-019-04485-3] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/13/2019] [Indexed: 12/25/2022]
Abstract
Prostate-specific membrane antigen (PSMA) is expressed in most prostate cancers and can be identified by PSMA-ligand imaging, which has already become clinically accepted in several countries in- and outside Europe. PSMA-directed radioligand therapy (PSMA-RLT) with Lutetium-177 (177Lu-PSMA) is currently undergoing clinical validation. Retrospective observational data have documented favourable safety and striking clinical responses. Recent results from a prospective clinical trial (phase II) have been published confirming high response rates, low toxicity and reduction of pain in metastatic castration-resistant prostate cancer (mCRPC) patients who had progressed after conventional treatments. Such patients typically survive for periods less than 1.5 years. This has led some facilities to adopt compassionate or unproven use of this therapy, even in the absence of validation within a randomised-controlled trial. As a result, a consistent body of evidence exists to support efficacy and safety data of this treatment. The purpose of this guideline is to assist nuclear medicine specialists to deliver PSMA-RLT as an "unproven intervention in clinical practice", in accordance with the best currently available knowledge.
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Affiliation(s)
- Clemens Kratochwil
- German Cancer Research Center and Department of Nuclear Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Matthias Eiber
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, California, USA
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro University Hospital and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Samer Ezziddin
- Department of Nuclear Medicine, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Flavio Forrer
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Thomas A Hope
- Department of Abdominal Imaging and Nuclear Medicine, University of California San Francisco, California, USA
| | - Levant Kabasakal
- Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey
| | - Mark Konijnenberg
- Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Klaus Kopka
- German Cancer Research Center and Department of Nuclear Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, Universitätsklinikum Aachen, Aachen, Germany
| | - Wim Oyen
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kambiz Rahbar
- Department of Nuclear Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Hans-Jürgen Wester
- Department of Chemistry, Technische Universität München, Garching, Germany
| | - Lisa Bodei
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Stefano Fanti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Uwe Haberkorn
- German Cancer Research Center and Department of Nuclear Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine
- Universitätsklinikum Essen, Essen, Germany.
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Giovanella L, Lassmann M. Radioiodine dosimetry in advanced thyroid cancer. Q J Nucl Med Mol Imaging 2019; 63:227-228. [PMID: 31333007 DOI: 10.23736/s1824-4785.19.03209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland -
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
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