SPECT/CT image‐based dosimetry for Yttrium‐90 radionuclide therapy: Application to treatment response

Potrebko, P; Shridhar, Ravi; Biagioli, Matthew C.; Sensakovic, William F.; Andl, George; Poleszczuk, Jan; Fox, Timothy

doi:10.1002/acm2.12400

Cited by 10 publications

(17 citation statements)

References 23 publications

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“…Accurate absolute quantification of radiotracer distribution is essential for dosimetry aimed at personalized radionuclide therapy and may improve prediction of therapy response, prevention of toxicity effects, and treatment follow-up [1,2]. Both positron emission tomography (PET) and single-photon emission computed tomography (SPECT) hold the promise for absolute radioactivity quantification.…”

Section: Introductionmentioning

confidence: 99%

Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study

et al. 2019

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Absolute quantification of radiotracer distribution using SPECT/CT imaging is of great importance for dosimetry aimed at personalized radionuclide precision treatment. However, its accuracy depends on many factors. Using phantom measurements, this multi-vendor and multi-center study evaluates the quantitative accuracy and inter-system variability of various SPECT/CT systems as well as the effect of patient size, processing software and reconstruction algorithms on recovery coefficients (RC). Methods: Five SPECT/CT systems were included: Discovery™ NM/CT 670 Pro (GE Healthcare), Precedence™ 6 (Philips Healthcare), Symbia Intevo™, and Symbia™ T16 (twice) (Siemens Healthineers). Three phantoms were used based on the NEMA IEC body phantom without lung insert simulating body mass indexes (BMI) of 25, 28, and 47 kg/m 2. Six spheres (0.5-26.5 mL) and background were filled with 0.1 and 0.01 MBq/mL 99m Tc-pertechnetate, respectively. Volumes of interest (VOI) of spheres were obtained by a region growing technique using a 50% threshold of the maximum voxel value corrected for background activity. RC, defined as imaged activity concentration divided by actual activity concentration, were determined for maximum (RC max) and mean voxel value (RC mean) in the VOI for each sphere diameter. Inter-system variability was expressed as median absolute deviation (MAD) of RC. Acquisition settings were standardized. Images were reconstructed using vendor-specific 3D iterative reconstruction algorithms with institute-specific settings used in clinical practice and processed using a standardized, in-house developed processing tool based on the SimpleITK framework. Additionally, all data were reconstructed with a vendor-neutral reconstruction algorithm (Hybrid Recon™; Hermes Medical Solutions). Results: RC decreased with decreasing sphere diameter for each system. Intersystem variability (MAD) was 16 and 17% for RC mean and RC max , respectively. Standardized reconstruction decreased this variability to 4 and 5%. High BMI hampers quantification of small lesions (< 10 ml). Conclusion: Absolute SPECT quantification in a multi-center and multi-vendor setting is feasible, especially when reconstruction protocols are standardized, paving the way for a standard for absolute quantitative SPECT.

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Section: Introductionmentioning

confidence: 99%

Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study

et al. 2019

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“…where A =activity, LSF = lung shunt fraction, T 1/2 = 90 Y half-life, E avg = average β-particle energy per disintegration (0.935 MeV), C voxel = counts within voxel, ΔV = voxel volume, ρ = tissue density, and C total = total counts within the patient [15]. The calculated dose in a given voxel is the voxel value divided by the total counts multiplied by a constant.…”

Section: Discussionmentioning

confidence: 99%

“…An assumption of the LDM model is that all the energy from β-particle decay is locally within the same voxel [15]. WFBH method uses a 5x5x5 scattering kernel to consider the effects on neighboring voxels.…”

Section: Discussionmentioning

confidence: 99%

“…There is a general consensus on the bene ts of accurate image based post-TARE dosimetry among researchers in the eld but a lack of information on best practices using commercially available software makes implementation across intuitions di cult [1,2,4,15]. Recently there have been advancements in understanding the promising nature of post-TARE 90 Y positron emission tomography (PET) image based dosimetry, however it needs to be noted that not all institutions may have the feasibility to obtain 90 Y PET images post-TARE.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective SPECT/CT Dosimetry Following Transarterial Radioembolization

Thompson

Dezarn

2020

Preprint

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Background: Transarterial Radioembolization (TARE) effectively treats unresectable primary and metastatic liver tumors through local injection of Yttrium-90 (90Y) beta particle emitting microspheres. These microspheres implant around the tumor, damaging tumorous cells while sparing healthy liver tissue. Current dosimetry models are highly simplistic and based patient characteristics such as body surface area and fail to consider many important factors. There is a large need for an imaged based dosimetry post-TARE which would improve treatment safety and efficacy. Current post-TARE imaging is 90Y bremsstrahlung SPECT/CT and we study the use of these images for post-TARE dosimetry. Methods: Retrospective image review of 10 patients having a Philips HealthcareTM SPECT/CT following TARE SIR-Spheres® implantation. Emission series with attenuation correction were resampled to 3mm resolution and used to create image based dose distributions. Dose distributions and analysis were performed in MIM Software SurePlanTM utilizing SurePlanTM Local Deposition Method (LDM) and our own dose convolution method (WFBH). We sought to implement a patient specific background subtraction technique prior to dose calculation to make these noisy bremsstrahlung SPECT images suitable for post-TARE dosimetry calculations. Results: On average the percentage of mean background counts to maximum count in the image across all patients was 9.4 ± 4.9% with a maximum of 17.6% and minimum of 2.3%. Absolute dose increased and profile line width decreased as background subtraction value increased. The average value of the LDM and WFBH dose methods were statistically the same. As background subtraction value increased, we found the DVH curves to become unrealistic and distorted.Conclusion: Background subtraction on bremsstrahlung SPECT image had a large effect on post-TARE dosimetry. The background contour we defined provides a systematic estimate to the activity background that accounts for the scanner and patient conditions at the time of the image study and is easily implemented using commercially available software. We found using the mean count in the background contour as a constant subtraction across the entire image gave the most realistic dose distributions. Comparison of dosimetry from background subtracted SPECT images to image based dosimetry obtained via 90Y PET images will be the subject of our next analysis.

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“…The results showed that the positive predictive values, sensitivity, specificity and the accuracy of BS SPECT/CT were 100, 87, 100, and 99%, respectively ( 13 ). Furthermore, BS SPECT/CT after radioembolization is beneficial to evaluate tumor dose-response characteristics and predict treatment response for the management of patients ( 14 ). Potrebko et al.…”

Section: Yttrium-90mentioning

confidence: 99%

Diagnostic Performance of Theranostic Radionuclides Used in Transarterial Radioembolization for Liver Cancer

et al. 2021

Front. Oncol.

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Primary liver tumor with hepatocellular carcinoma accounting for 75–80% of all such tumors, is one of the global leading causes of cancer-related death, especially in cirrhotic patients. Liver tumors are highly hypervascularized via the hepatic artery, while normal liver tissues are mainly supplied by the portal vein; consequently, intra-arterially delivered treatment, which includes transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), is deemed as a palliative treatment. With the development of nuclear technology and radiochemistry, TARE has become an alternative for patients with hepatic cancer, especially for patients who failed other therapies, or for patients who need tumor downstaging treatment. In practice, some radionuclides have suitable physicochemical characteristics to act as radioactive embolism agents. Among them, 90Y emits β rays only and is suitable for bremsstrahlung single photon emission computed tomography (BS SPECT) and positron emission tomography (PET); meanwhile, some others, such as 131I, 153Sm, 166Ho, 177Lu, 186Re, and 188Re, emit both β and γ rays, enabling embolism beads to play a role in both therapy and single photon emission computed tomography (SPECT) imaging. During TARE, concomitant imaging provide additive diagnostic information and help to guide the course of liver cancer treatment. Therefore, we review the theranostic radionuclides that have been used or could potentially be used in TARE for liver cancer and focus on the clinical benefits of diagnostic applications, including real-time monitoring of embolism beads, evaluating irradiation dose, predicting therapy effects, and corresponding adjustments to TARE.

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SPECT/CT image‐based dosimetry for Yttrium‐90 radionuclide therapy: Application to treatment response

Cited by 10 publications

References 23 publications

Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study

Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study

Retrospective SPECT/CT Dosimetry Following Transarterial Radioembolization

Diagnostic Performance of Theranostic Radionuclides Used in Transarterial Radioembolization for Liver Cancer

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