FAP imaging in rare cancer entities-first clinical experience in a broad spectrum of malignancies.

PURPOSE: 68 Ga-FAPI (fibroblast activation protein inhibitor) is a rapidly evolving and highly promising radiotracer for PET/CT imaging, presenting excellent results in a variety of tumor entities, particularly in epithelial carcinomas. This retrospective analysis sought to evaluate the potential and impact of FAPI-PET/CT in rare cancer diseases with respect to improvement in staging and therapy, based on tracer uptake in normal organs and tumors. MATERIAL AND METHODS: Fifty-five patients with rare tumor entities, defined by a prevalence of 1 person out of 2000 or less, received a 68 Ga-FAPI-PET/CT scan. Fourteen women and 41 men (median age 60) were included within the following subgroups: cancer of unknown primary (n = 10), head and neck cancer (n = 13), gastrointestinal and biliary-pancreatic cancer (n = 17), urinary tract cancer (n = 4), neuroendocrine cancer (n = 4), and others (n = 7). Tracer uptake was quantified by standardized uptake values SUVmax and SUVmean and the tumor-to-background ratio (TBR) was determined (SUVmax tumor/SUVmean organ). RESULTS: In 20 out of 55 patients, the primary tumor was identified and 31 patients presented metastases (n = 88), characterized by a high mean SUVmax in primary (10.1) and metastatic lesions (7.6). The highest uptake was observed in liver metastases (n = 6) with a mean SUVmax of 9.8 and a high TBR of 8.7, closely followed by peritoneal carcinomatosis (n = 16) presenting a mean SUVmax of 9.8 and an excellent TBR of 29.6. In terms of the included subgroups, the highest uptake regarding mean SUVmax was determined in gastrointestinal and biliary-pancreatic cancer with 9.8 followed closely by urinary tract cancer with 9.5 and head and neck cancer (9.1). CONCLUSION: Due to excellent tumor visualization and, thereby, sharp contrasts in terms of high TBRs in primary and metastatic lesions in different rare malignancies, 68 Ga-FAPI-PET/CT crystallizes as a powerful and valuable imaging tool, particularly with respect to epithelial carcinomas, and therefore an enhancement to standard diagnostics imaging methodologies. The realization of further and prospective studies is of large importance to confirm the potential of FAP imaging in oncology.

Novel FAP ligands enable improved imaging contrast in sarcoma patients due to FAPI-PET/CT.

PURPOSE: A high expression of fibroblast activation protein (FAP) was observed in multiple sarcomas, indicating an enormous potential for PET/CT using 68Ga-radiolabeled inhibitors of FAP (FAPI). Therefore, this retrospective study aimed to evaluate the role of the novel hybrid imaging probe for sarcomas as a first clinical evaluation. METHODS: A cohort of 15 patients underwent 68Ga-FAPI-PET/CT for staging or restaging. The acquisition of PET scans was performed 60 min after administration of 127 to 308 MBq of the tracer. The uptake of 68Ga-FAPI in malignant tissue as well as in healthy organs was quantified by standardized uptake values SUVmean and SUVmax. RESULTS: Excellent tumor-to-background ratios (> 7) could be achieved due to low background activity and high SUVmax in primary tumors (median 7.16), local relapses (median 11.47), and metastases (median 6.29). The highest uptake was found for liposarcomas and high-grade disease (range 18.86-33.61). A high SUVmax (> 10) was observed for clinically more aggressive disease. CONCLUSION: These preliminary findings suggest a high potential for the clinical use of 68Ga-FAPI-PET/CT for patients diagnosed with sarcoma.

Averting cumulative lifetime attributable risk (LAR) of cancer by decontamination of residential areas affected by a large-scale nuclear power plant fallout: time aspects of radiological benefits for newborns and adults.

The averted cumulative lifetime attributable risk (LAR), the residual dose and highest ground deposition of 137Cs complying with a reference dose level of 20 mSv yr-1 to an individual returning after one year to an area contaminated by unfiltered releases of fission products from a nuclear power plant (NPP) were evaluated by applying an existing exposure model designed to compute age- and gender-dependent time-integrated LAR. The model was applied to four types of nuclear fallout scenarios, partly based on data from the Chernobyl and Fukushima releases and from theoretical source terms from Swedish NPPs. For rapid decontamination measures that achieve a 50% relative reduction in external dose rate within 1 year, compliance with the reference level 20 mSv yr-1 can be attained for an initial 137Cs ground deposition of up to 2 MBq m-2 with relaxed food restrictions. This compliance can be attained at even higher ground deposition (up to 4.5 MBq m-2) if using the strict food restrictions employed in Japan after 2011. Considering longer than 1 year return times it was also found that the benefit of implementing decontamination decreases rapidly with time (2-3 years half-time), especially if the fallout has a high initial 134Cs to 137Cs activity ratio and if the ecological half-time of the external dose rate is short (<5 years). Depending on fallout scenario the averted cumulative LAR for newborn girls by decontamination that is achieved after 5 years is only between 6% and 11% of that obtained by evacuation alone during the same time, indicating a rather limited radiological benefit of decontamination if delayed more than a few years. We conclude that decision makers and emergency response planners need to consider that protracted decontamination measures may have limited radiological benefit compared with evacuation in terms of averted future cancer cases, albeit it may have other societal benefits.

Introducing the concept of the isodose for optimisation of decontamination activities in a radioactive fallout scenario.

In the recovery phase after a radioactive release incident, it is important to be able to focus decontamination operations on the areas that contribute most to the radiation dose. Monte Carlo simulations were applied to determine the shielding effect of a building against radiation from various directions, also giving information on the dose contributions at various locations inside the building from specific areas outside. The concept of the isodose was developed to optimise decontamination activities, and was applied as isodose lines to define the smallest areas that lead to a certain dose reduction through decontamination of areas surrounding the building. The shape and position of the isodose lines depend on the building's geometry, wall thickness, and material, and on the observation point inside the building. Calculations have been made with a surface resolution of 1 m2 for four observation points in a modular building, assuming depositions of 137Cs and 60Co on the ground surface and on the roof, as well as 1 cm below the ground surface to represent ground penetration. For example, a ten times as large area would have to be decontaminated to increase the dose reduction from 10% to 30%, if it is assumed that all the contamination is located at a depth of 1 cm.

A Bayesian method to localize lost gamma sources.

A feasibility study of a Bayesian based algorithm for orphan source localization by means of mobile gamma spectrometry is presented. The method was tested on three types of gamma sources (137Cs, 133Ba and 131I) using a HPGe detector mounted on a vehicle. Estimates on source activity and source locations were within 51% and 29% of actual values, respectively. Further studies are required to validate and develop this method for additional source-detector configurations and gamma radiation background conditions.

Radiation doses in Sweden resulting from the Chernobyl fallout: a review.

The risk associated with the Chernobyl fallout is the product of radiation dose and risk factor per dose unit. The radiation doses originate from inhalation of radioactive particles, ground irradiation from deposited nuclides and internal irradiation caused by contaminated food. In Sweden the largest dose contribution is due to external radiation. The deposition has been mapped by aerial measurements and in situ high-resolution gamma measurements at ground level over the whole country. On the basis of these measurements, population-weighted doses for external radiation have been estimated. Whole-body measurements on randomly selected individuals have been performed in order to estimate the average dose from internal irradiation. The collective dose, i.e. the sum of all individual doses, has been estimated to be about 1500 man-Sievert for the first year after Chernobyl and 5000-7000 man-Sievert for a 50-year period. Using a risk factor of 0.02 fatal cancers per man-Sievert the Chernobyl fallout over Sweden might cause 100-200 fatal cancers.

Statistical data evaluation in mobile gamma spectrometry: an optimization of on-line search strategies in the scenario of lost point sources.

There is a potential risk that hazardous radioactive sources could enter the environment, e.g., via satellite debris, smuggled radioactive goods, or lost metal scrap. From a radiation protection point of view there is a need for rapid and reliable methods for locating and identifying sources. The methods could also be used to locate hot spots after radioactive fallout. Carborne and airborne gamma spectrometry systems are suitable for the task. This work focuses on a situation where the radionuclide to search for is known, which is not an unlikely scenario. The possibility that the source is located near a road can be high, and thus motivating a carborne spectrometer system. The main object is to optimize on-line statistical methods in order to achieve a high probability for locating the point source and still have reasonably few false alarms caused by variations in the natural background radiation. Data were obtained from a carborne 3-L NaI(Tl) detector and two point sources located at various distances from the road. The nuclides used were 137Cs and 131I. Spectra were measured stationary on the road. From these measurements we have reconstructed counts in spectral windows applicable to different speed and sampling times; the time 3 s and speeds 32 and 54 km h(-1) are used in this work. The maximum distance a source can be located from the road and still be detected is estimated with four different statistical analysis methods. This distance is called the critical distance, CD. The method is applied on gross counts in the full energy peak spectral window. For each method alarm levels have been calculated from background data obtained in Scania (Skåne), in the south of Sweden. The results show large differences in CD. With the best approach, the two sources could be detected from about 180 m (137Cs, 6 GBq) and 170 m (131I, 4.5 GBq).

Performance of an automated solid-phase red cell adherence system compared with that of a manual gel microcolumn assay for the identification of antibodies eluted from red blood cells.

IgG antibodies coating red blood cells (RBCs) can be removed by elution procedures and their specificity determined by antibody identification studies. Although such testing is traditionally performed using the tube agglutination assay, prior studies have shown that the gel microcolumn (GMC) assay may also be used with comparable results. The purpose of this study was to compare an automated solid-phase red cell adherence (SPRCA) system with a GMC assay for the detection of antibodies eluted from RBCs. Acid eluates from 51 peripheral blood (PB) and 7 cord blood (CB) samples were evaluated by both an automated SPRCA instrument and a manual GMC assay. The concordance rate between the two systems for peripheral RBC samples was 88.2 percent (45 of 51), including cases with alloantibodies (n = 8), warm autoantibodies (n = 12), antibodies with no identifiable specificity (n = 2), and negative results (n = 23). There were six discordant cases, of which four had alloantibodies (including anti-Jka, -E, and -e) demonstrable by the SPRCA system only. In the remaining 2 cases, anti-Fya and antibodies with no identifiable specificity were demonstrable by the GMC assay only. All seven CB specimens produced concordant results, showing anti-A (n = 3), -B (n = 1), maternal anti-Jka (n = 2), or a negative result (n = 1). Automated SPRCA technology has a performance that is comparable with that of a manual GMC assay for identifying antibodies eluted from PB and CB RBCs.