Thyroid remnant ablation using 1,110 MBq of I-131 after total thyroidectomy: regulatory considerations on release of patients after unsealed radioiodine therapy.

OBJECTIVES: This study was undertaken to measure the radiation exposure level of caregivers following outpatient NaI (I-131) 1,110 MBq therapy for remnant thyroid ablation after total thyroidectomy in patients with differentiated thyroid cancer, and to evaluate the influence of activities of daily living on radiation exposure level, with the goal of proposing an optimum method of I-131 therapy. METHODS: The study included 37 patients with differentiated thyroid cancer, who had undergone total thyroidectomy and received outpatient based remnant thyroid ablation using NaI (I-131) 1,110 MBq, who were satisfying the following requirements: (1) patients who have no evidence of distant metastases, (2) whose living environments were appropriate for outpatient I-131 (1,110 MBq) therapy, and (3) patients who gave written informed consent. The dose rate at a distance of 1 m from the body surface of the patient at the moment of release was measured using survey meters of the GM type or ionization chamber type. The dose level for the caregiver was measured with a personal dosimeter in all cases. RESULTS: The dose rate at a distance of 1 m from the patient's body surface 1 h after I-131 administration was in the range of 29-115 µSv/h (mean 63.8 µSv/h). The 7-day cumulative effective dose of caregivers was 0.11 ± 0.08 mSv, on an average, in 34 dosimeters. In 31 of 34 dosimeters, cumulative effective dose of caregivers was below 0.2 mSv. Dose levels exceeding 0.2 mSv were recorded in 3 cases (0.21, 0.35 and 0.43 mSv in one case each). These results suggest that the exposure level of family members (caregiver and others) was minimal and is lower than the radiation levels affecting human environments. CONCLUSION: Outpatient-based remnant thyroid ablation with I-131 (1,110 MBq) performed after total thyroidectomy in patients with differentiated thyroid cancer is safe if applied in accordance with the appropriate supervision and guidance by experts with certain qualifications.

Improvement of in-stent lumen measurement accuracy with new high-definition CT in a phantom model: comparison with conventional 64-detector row CT.

The purpose of this study was to evaluate improvement of measurement accuracy of in-stent lumen using coronary stent phantoms on new high-definition CT (HDCT) compared with conventional 64 detector-row CT (MDCT). To estimate the spatial resolution, a high-resolution insert of CATPHAN (The Phantom Laboratory, NY, USA) was scanned by both HDCT (Discovery CT750 HD) and MDCT (LightSpeed VCT). Also, we developed six types of stent phantom, which have 2.5- and 3.0-mm-diameter with three different types of stents (Velocity: Johnson & Johnson, Driver: Medtronic, Multilink-Rx: Guidant). A 50% stenotic segment made of acrylic resin was built at the center inside the stent. Those coronary vessel phantoms were made of acrylic resin and filled with diluted Iodine (350 HU in 120 kVp), and each stent was fixed inside of those vessels. Those phantoms in water-filled tank were scanned on both HDCT and MDCT. The luminal diameter obtained using digital calipers at five different points and the mean luminal diameter (MLD) were calculated. The underestimate ratio (UR) and △UR was defined as follows: UR = [True diameter of stent-MLD]/True diameter of stent; △UR = [MLD at HDCT-MLD at MDCT]/True diameter of stent. The spatial resolution was estimated to be 0.71 mm on MDCT and 0.50 mm on HDCT. At the non-stenotic segments, the △URs were 11.6% (Velocity), 16.4% (Driver) and 7.2% (Multilink) for the 2.5-mm stents, and 14.0% (Velocity), 16.3% (Driver) and 13.3% (Multilink) for the 3.0-mm stents. At the stenotic segment, the △URs were 23.2% (Velocity), 8.0% (Driver) and 13.6% (Multilink) for the 2.5-mm stents, and 20.0% (Velocity), 14.7% (Driver) and 15.3% (Multilink) for the 3.0-mm stents. Superior spatial resolution of HDCT could be promising for more accurate measurement of in-stent diameter.

How accurate is CT morphometry of airway? Phantom and clinical validation study.

OBJECTIVE: To assess the reliability of CT airway measurement using phantom and to evaluate its reproducibility using clinical chest CT images. MATERIALS AND METHODS: The phantom consisted of six tubes with different diameters and wall thicknesses was used. The wall area ratio (%WA) and wall thickness ratio (%WT) were calculated and the difference from the actual value (error ratio) was assessed. In vivo validation was performed with MDCT data of consecutive 10 patients and inter- and intra-rater agreements of the measurement were evaluated. RESULTS: The error ratio of %WA and %WT increased for the phantom tube with a 1mm or thinner wall thickness. The FOV size has an influence on the airway measurement especially for the tube with 1mm wall thickness. Inter-rater reliabilities between two observers for %WA and %WT were excellent and good intra-class correlation coefficient for %WA and %WT were obtained as 0.825 and 0.811, respectively. Intra-rater reliabilities of measurement also showed good intra-class correlation coefficient for %WA and %WT as 0.822 and 0.800, respectively. CONCLUSION: Although the phantom study showed there is a tendency to overestimate the wall area of an airway with a thickness 1mm or less, the software has a potential to be used in assessing longitudinal observation of the same patient, as well as, comparison among different patients due to good intra- and inter-rater reliability.