Intraoperative gamma cameras for radioguided surgery: Technical characteristics, performance parameters, and clinical applications

Tsuchimochi, Makoto; Hayama, Koremasa

doi:10.1016/j.ejmp.2012.05.002

Cited by 97 publications

(74 citation statements)

References 93 publications

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“…Established methods use a combination of a g-emitting tracer with a g-radiation-detecting probe (11,12). Because g radiation can traverse large amounts of tissue, any uptake of the tracer in nearby healthy tissue represents a non-negligible background level, often preventing the use of this technique.…”

mentioning

confidence: 99%

Toward Radioguided Surgery with β⁻ Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma

et al. 2014

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A novel radioguided surgery (RGS) technique for cerebral tumors using β − radiation is being developed. Checking for a radiotracer that can deliver a β − emitter to the tumor is a fundamental step in the deployment of such a technique. This paper reports a study of the uptake of 90 Y-DOTATOC in meningiomas and high-grade gliomas (HGGs) and a feasibility study of the RGS technique in these types of tumor. Estimates were performed assuming the use of a β − probe under development with a sensitive area 2.55 mm in radius to detect 0.1-mL residuals. Methods: Uptake and background from healthy tissues were estimated on 68 Ga-DOTATOC PET scans of 11 meningioma patients and 12 HGG patients. A dedicated statistical analysis of the DICOM images was developed and validated. The feasibility study was performed using full simulation of emission and detection of the radiation, accounting for the measured uptake and background rate. Results: All meningioma patients but one with an atypical extracranial tumor showed high uptake of DOTATOC. In terms of feasibility of the RGS technique, we estimated that by administering a 3 MBq/kg activity of radiotracer, the time needed to detect a 0.1-mL remnant with 5% false-negative and 1% falsepositive rates is less than 1 s. Actually, to achieve a detection time of 1 s the required activities to administer were as low as 0.2-0.5 MBq/kg in many patients. In HGGs, the uptake was lower than in meningiomas, but the tumor-to-nontumor ratio was higher than 4, which implies that the tracer can still be effective for RGS. It was estimated that by administering 3 mBq/kg of radiotracer, the time needed to detect a 0.1-mL remnant is less than 6 s, with the exception of the only oligodendroma in the sample. Conclusion: Uptake of 90 Y-DOTATOC in meningiomas was high in all studied patients. Uptake in HGGs was significantly worse than in meningiomas but was still acceptable for RGS, particularly if further research and development are done to improve the performance of the β − probe. Radi oguided surgery (RGS) helps the surgeon evaluate the completeness of a tumor resection while minimizing the amount of healthy tissue removed (1). The surgeon is provided with vital and real-time information on the location and extent of the lesion and can assess the resection margins. The technique uses a radiolabeled tracer preferentially taken up by the tumor to discriminate cancerous tissue from healthy organs, as well as a probe (2) sensitive to the emission released by the tracer to identify in real time the targeted tumor focus. The radiopharmaceutical is administered to the patient before surgery.Current clinical applications of RGS are radioimmunoguided surgery for colon cancer (3,4), complete sentinel-node mapping for malignant melanoma (5) and breast cancer (6,7), and detection of parathyroid adenoma (8) and bone tumors (such as osteoid osteoma). There are also clinical studies on applications in neuroendocrine tumors (9,10).Established methods use a combination of a g-emitting tracer with a g-radiation-detec...

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Toward Radioguided Surgery with β⁻ Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma

et al. 2014

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“…Yarı-iletken kristallerin düşük voltajda uzun süre kullanımı polarizasyon fenomeni nedeni ile zaman içerisinde enerji duyarlılığında azalmaya neden olmaktadır. Bu sorunu engellemek için voltajın periyodik olarak kesilmesi ile yüksek performans sağlanmaktadır (43).…”

Section: Bi̇ntraoperatifgamakameralarunclassified

Sentinel Lymph Node Biopsy: Actual Approaches

Tuncel¹,

Salancı²,

Bozkurt³

2017

Nts

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Öz Abstract GirişKanser yayılımında en önemli yollardan biri lenfatik yayılımdır. On yedinci yüzyılda lenfatik sistemin tanımlanması ve ardından kanserdeki rolünün saptanmaya başlaması ile bu konuda çeşitli çalışmalar yapılmıştır. Bu araştırmaların sonucunda bugün kanserin yerleştiği bölgeye bağlı olarak önce bölgesel lenf bezlerine ilerlediği ve klinik tanıdan çok daha önce bu bölgesel lenf bezlerinde mikrometastazların gerçekleştiği bilinmektedir. Bu bilgi özellikle meme kanseri ve malign melanom gibi kanserlerde sentinel lenf bezi (SLB) kavramının doğmasını sağlamıştır (1). İlk SLB tanımı Cabanas tarafından penil kanserde yapılmıştır (2). Lenfosintigrafinin SLB saptanmasında kullanılması Chiappa ve ark.'nın 1966'da testiküler kanserlerde yaptığı çalışma ile başlamıştır (3). Morton ve ark.'nın 194 malign melanom hastasında lenfosintigrafi kullanılarak lenfatik yayılımın araştırdığı çalışma SLB'nin örneklemesinin önünü açmış olup, günümüzde SLB sintigrafisi rutin uygulama kılavuzlarında yerini almıştır (4). Meme kanserlerinde de Christensen ve ark. ile başlayan çalışmalar koruyucu meme cerrahisi uygulamalarının yaygınlaşmasına ve hastaların daha az cerrahi komplikasyon ile tedavi edilmelerine olanak vermiştir (5). Son yıllarda gelişen görüntüleme ve intraoperatif deteksiyon teknolojileri sayesinde SLB biyopsisinin (SLBB) başarısı ve kullanım sıklığı

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“…To date, established methods make use of a γ-emitting tracer and a γ radiation detecting probe [3,4] or a portable gamma camera [5,6]. Since γ radiation can travel through large amounts of tissue, any uptake of the tracer in nearby healthy tissue represents a non-negligible background, strongly limiting and often preventing the use of this technique.…”

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confidence: 99%

First ex vivo validation of a radioguided surgery technique withβ-radiation.

Camillocci¹,

Schiariti²,

Bocci³

et al. 2016

Physica Medica

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Purpose: A radio-guided surgery technique with β − -emitting radiotracers was suggested to overcome the effect of the large penetration of γ radiation. The feasibility studies in the case of brain tumors and abdominal neuro-endocrine tumors were based on simulations starting from PET images with several underlying assumptions. This paper reports, as proof-of-principle of this technique, an ex-vivo test on a meningioma patient. This test allowed to validate the whole chain, from the evaluation * co-first-author † corresponding author, e-mail: riccardo.faccini@roma1.infn.it Results: we obtained a large signal on the bulk tumor (105 cps) and a significant signal on residuals of ∼0.2 ml (28 cps). We also show that simulations predict correctly the observed yields and this allows us to estimate that the healthy tissues would return negligible signals (≈ 1 cps). This test also demonstrated that the exposure of the medical staff is negligible and that among the biological wastes only urine has a significant activity.Conclusions: This proof-of-principle test on a patient assessed that the technique is feasible with negligible background to medical personnel and confirmed that the expectations obtained with Monte Carlo simulations starting from diagnostic PET images are correct.

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Intraoperative gamma cameras for radioguided surgery: Technical characteristics, performance parameters, and clinical applications

Cited by 97 publications

References 93 publications

Toward Radioguided Surgery with β⁻ Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma

Toward Radioguided Surgery with β⁻ Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma

Sentinel Lymph Node Biopsy: Actual Approaches

First ex vivo validation of a radioguided surgery technique withβ-radiation.

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Intraoperative gamma cameras for radioguided surgery: Technical characteristics, performance parameters, and clinical applications

Cited by 97 publications

References 93 publications

Toward Radioguided Surgery with β− Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma

Toward Radioguided Surgery with β− Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma

Sentinel Lymph Node Biopsy: Actual Approaches

First ex vivo validation of a radioguided surgery technique withβ-radiation.

Contact Info

Product

Resources

About

Toward Radioguided Surgery with β⁻ Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma

Toward Radioguided Surgery with β⁻ Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma