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Dosimetry during iodine-131 therapy — a technical point of view from a single centre’s own experience
, 1, 1, 1, 1
Affiliations- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Abstract
Background: Nuclear medicine uses radionuclides in medicine for diagnosis, staging, therapy, and monitoring the response to therapy. The application of radiopharmaceutical therapy for the treatment of certain diseases is well-established, and the field is expanding. Internal dosimetry is multifaceted and includes different workflows, as well as various calculations based on patient- specific dosimetry.
Aim: The objective of this study was to introduce the technical issues which might occur during iodine-131 (131I) dosimetry performed in nuclear medicine departments.
Material and methods: Retrospective analysis was performed on a group of 44 patients with papillary thyroid cancer who between May 2021 and October 2021 underwent a 131I treatment: 80–100 mCi (2200–3700 MBq, based on the previous medical history and stage of the disease). Patients underwent a series of 131I therapy scans using gamma camera Discovery NM 670 CT. Whole body scan (WBS) was performed 2, 4, 24 and 48 hours after 131I administration. Additionally, after 24 hours of single photon emission computed tomography/ computed tomography, two fields of view (SPECT/CT 2-FOV) were performed from the mid-head to the bladder.
Results: During the dosimetry procedure, several issues arise. Firstly, after receiving therapeutic doses of 131I, patients should remain in their rooms until the appropriate activity is achieved before being transported to the diagnostic room. Secondly, the walls between examination rooms meet the requirements for accurate diagnosis but not for therapy, leading to the occurrence of artefacts in patients examined behind the wall, potentially influencing the examination results. Thirdly, personnel in the control room also experience additional exposure (10 times greater than in the case of standard diagnostic procedure).
Conclusions: The dosimetry in patients in whom therapeutic procedures are performed with the use of isotopes is mandatory according to Polish and European law, technical issues which occur during the dosimetry procedures might influence the organization of the work in departments.
Abstract
Background: Nuclear medicine uses radionuclides in medicine for diagnosis, staging, therapy, and monitoring the response to therapy. The application of radiopharmaceutical therapy for the treatment of certain diseases is well-established, and the field is expanding. Internal dosimetry is multifaceted and includes different workflows, as well as various calculations based on patient- specific dosimetry.
Aim: The objective of this study was to introduce the technical issues which might occur during iodine-131 (131I) dosimetry performed in nuclear medicine departments.
Material and methods: Retrospective analysis was performed on a group of 44 patients with papillary thyroid cancer who between May 2021 and October 2021 underwent a 131I treatment: 80–100 mCi (2200–3700 MBq, based on the previous medical history and stage of the disease). Patients underwent a series of 131I therapy scans using gamma camera Discovery NM 670 CT. Whole body scan (WBS) was performed 2, 4, 24 and 48 hours after 131I administration. Additionally, after 24 hours of single photon emission computed tomography/ computed tomography, two fields of view (SPECT/CT 2-FOV) were performed from the mid-head to the bladder.
Results: During the dosimetry procedure, several issues arise. Firstly, after receiving therapeutic doses of 131I, patients should remain in their rooms until the appropriate activity is achieved before being transported to the diagnostic room. Secondly, the walls between examination rooms meet the requirements for accurate diagnosis but not for therapy, leading to the occurrence of artefacts in patients examined behind the wall, potentially influencing the examination results. Thirdly, personnel in the control room also experience additional exposure (10 times greater than in the case of standard diagnostic procedure).
Conclusions: The dosimetry in patients in whom therapeutic procedures are performed with the use of isotopes is mandatory according to Polish and European law, technical issues which occur during the dosimetry procedures might influence the organization of the work in departments.
Keywords
dosimetry; iodine therapy; guidelines; single photon emission tomography/computed tomography
About this articleTitle
Dosimetry during iodine-131 therapy — a technical point of view from a single centre’s own experience
Journal
Issue
Vol 27 (2024): Continuous Publishing
Article type
Research paper
Pages
1-5
Published online
2024-03-26
Page views
178
Article views/downloads
149
DOI
Pubmed
Bibliographic record
Nucl. Med. Rev 2024;27:1-5.
Keywords
dosimetry
iodine therapy
guidelines
single photon emission tomography/computed tomography
Authors
Wioletta Chalewska
Paulina Cegla
Anna Moczulska
Edyta Strzemecka
Agata Sackiewicz
Marek Dedecjus
References (15)- Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3): 209–249.
- Olson E, Wintheiser G, Wolfe KM, et al. Epidemiology of thyroid cancer: a review of the national cancer database, 2000-2013. Cureus. 2019; 11(2): e4127.
- Wojciechowska U, Didkowska J. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie – Państwowy Instytut Badawczy. http://onkologia.org.pl/raporty/ (9.09.2023).
- Haugen B, Alexander E, Bible K, et al. 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26(1): 1–133.
- King AD. Imaging for staging and management of thyroid cancer. Cancer Imaging. 2008; 8(1): 57–69.
- Czepczynski R, Woliński K, Czepczyński R, et al. Nuclear medicine in the diagnosis of the benign thyroid disease. Nucl Med Rev . 2012; 15(2): 113–119.
- Brauckhoff K, Biermann M. Multimodal imaging of thyroid cancer. Curr Opin Endocrinol Diabetes Obes. 2020; 27(5): 335–344.
- Hoang JK, Branstetter BF, Gafton AR, et al. Imaging of thyroid carcinoma with CT and MRI: approaches to common scenarios. Cancer Imaging. 2013; 13(1): 128–139.
- Obwieszczenie Ministra Zdrowia w sprawie ogłoszenia wykazu wzorcowych procedur radiologicznych z zakresu medycyny nuklearnej. Dz. U. 23 Grudnia 2014 r. Warszawa, p: 318-324.
- Rozporządzenie Ministra Zdrowia z dnia 3 kwietnia 2017r. w sprawie warunków bezpiecznego stosowania promieniowania jonizującego dla wszystkich rodzajów ekspozycji medycznej (Dz.U. z 2017 r., poz. 884).
- Dyrektywa Rady 2013/59/Euratom z dnia 5 grudnia 2013 roku ustanawiająca podstawowe normy bezpieczeństwa w celu ochrony przed zagrożeniami wynikającymi z narażenia na działanie promieniowania jonizującego oraz uchylająca dyrektywy 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom i 2003/122/Euratom 2003.
- Dziennik Ustaw Rzeczpospolitej Polskiej, Obwieszczenie Marszałka Sejmu Rzeczpospolitej Polskiej w spawie ogłoszenia jednolitego tekstu ustawy – Prawo atomowe, Poz. 623, Warszawa 6 kwietnia 2021.
- Mora-Ramirez E, Santoro L, Cassol E, et al. Comparison of commercial dosimetric software platforms in patients treated with Lu-DOTATATE for peptide receptor radionuclide therapy. Med Phys. 2020; 47(9): 4602–4615.
- Huizing DMV, Peters SMB, Versleijen MWJ, et al. A head-to-head comparison between two commercial software packages for hybrid dosimetry after peptide receptor radionuclide therapy. EJNMMI Phys. 2020; 7(1): 36.
- Konijnenberg M, Herrmann K, Kobe C, et al. 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(1): 67–72.
