Performance evaluation of Gallium-68 radiopharmaceuticals production using liquid target PETtrace 800 cyclotron.

Due to increased demand, cyclotron has an expanding role in producing Gallium-68 (68Ga) radiopharmaceuticals using solid and liquid targets. Though the liquid target produces lower end-of-bombardment activity compared to the solid target, our study presents the performance of 68Ga radiopharmaceuticals production using the liquid target by evaluating the end-of-bombardment activity and the end-of-purification activity of [68Ga]GaCl3. We also present the effect of increasing irradiation time, which significantly improves the end-of-synthesis yield. From the result obtained, the end-of-bombardment activity produced was 4.48 GBq, and the [68Ga]GaCl3 end-of-purification activity produced was 2.51 GBq with below-limit metallic impurities. Increasing the irradiation time showed a significant increase in the end-of-synthesis activity from 1.33 GBq to 1.95 GBq for [68Ga]Ga-PSMA-11 and from 1.13 GBq to 1.74 GBq for [68Ga]Ga-DOTA-TATE. Based on the improvements made, the liquid target production of 68Ga radiopharmaceuticals is feasible and reproducible to accommodate up to 5 patients per production. In addition, this work also discusses the issues encountered, together with the possible corrective and preventative measures.

Does Single Computed Tomography Attenuation Correction able to Surrogate Serial Computed Tomography Attenuation Correction in Single-Photon Emission Computed Therapy Imaging for Peptide Receptor Radionuclide Therapy Dosimetry Result?

Peptide Receptor Radionuclide Therapy (PRRT) is the administration of a radionuclide, such as the Lu-177 label, along with a pharmaceutical agent to destroy the lesion cell. The first cycle of Lu-177 DOTA-TATE is an excellent way to estimate radionuclide uptake for organs at risk. To estimate the absorbed dose for a kidney, serial SPECT-CT imaging with up to five sets is required. In general, serial CT on patients would result in additional external exposure and extra time consuming, especially for low dose CT such as cone beam CT technology. However, by introducing a new method, such as optimized single CT (24 h) to perform with serial SPECT attenuation correction, additional external exposure from serial CT exposure could be reduced. Aims: The purpose of this study is to assess the agreement between single CT scanning as CT attenuation Correction with serial CT scanning for serial SPECT imaging as well as estimated absorbed dose to the organ at risk. Settings and Design: During the first cycle of Lu177-DOTA-TATE, all patients should undergo internal dosimetry technique using SPECT-CT imaging with a PHILIP Brightview XCT gamma camera. The quantifications of SPECT images are being used to measure the uptake activity to the organ. In this investigation, Partik's categorical grading criteria are being used to convert the numeric value of Lin's concordance coefficient into an ordinal scale. Method: Total of 9 patients at our institution was administered with Lu177-DOTA-TATE enroll in this study. SPECT-CT data were acquired using automatic body contouring with a total of 48 angular views at steps of 6° (15 s/projections). The pixel size is 4.66 x 4.66 x 4.66 mm, the images size set to one, and SPECT data has been acquired for three-bed positions extending from the abdomen to the thorax region. Low-dose CT imaging performed at an X-ray tube voltage of 120 kVp. Results: Our current result demonstrated by single CT scanning for SPECT attenuation shown the excellent agreement with standard serial CT imaging for organs at risk such as kidney 0.999, spleen 0.9951, liver 0.9951 and bladder 0.9972. Conclusions: When compared to the previous method, patients benefit significantly more from this study, such as lower CT exposure.

The quantification of PET-CT radiotracers to determine minimal scan time using quadratic formulation.

OBJECTIVE: 18F is the most extensively used radioisotope in current clinical practices of PET imaging. This selection is based on the several criteria of pure PET radioisotopes with an optimum half-life, and low positron energy that contributes to a smaller positron range. In addition to 18F, other radioisotopes such as 68Ga and 124I are currently gained much attention with the increase in interest in new PET tracers entering the clinical trials. This study aims to determine the minimal scan time per bed position (Tmin) for the 124I and 68Ga based on the quantitative differences in PET imaging of 68Ga and 124I relative to 18F. METHODS: The European Association of Nuclear Medicine (EANM) procedure guidelines version 2.0 for FDG-PET tumor imaging has adhered for this purpose. A NEMA2012/IEC2008 phantom was filled with tumor to background ratio of 10:1 with the activity concentration of 30 kBq/ml ± 10 and 3 kBq/ml ± 10% for each radioisotope. The phantom was scanned using different acquisition times per bed position (1, 5, 7, 10 and 15 min) to determine the Tmin. The definition of Tmin was performed using an image coefficient of variations (COV) of 15%. RESULTS: Tmin obtained for 18F, 68Ga and 124I were 3.08, 3.24 and 32.93 min, respectively. Quantitative analyses among 18F, 68Ga and 124I images were performed. Signal-to-noise ratio (SNR), contrast recovery coefficients (CRC), and visibility (VH) are the image quality parameters analysed in this study. Generally, 68Ga and 18F gave better image quality as compared to 124I for all the parameters studied. CONCLUSION: We have defined Tmin for 18F, 68Ga and 124I SPECT CT imaging based on NEMA2012/IEC2008 phantom imaging. Despite the long scanning time suggested by Tmin, improvement in the image quality is acquired especially for 124I. In clinical practice, the long acquisition time, nevertheless, may cause patient discomfort and motion artifact.

Maximum standardized uptake value from quantitative bone single-photon emission computed tomography/computed tomography in differentiating metastatic and degenerative joint disease of the spine in prostate cancer patients.

OBJECTIVE: Qualitative interpretation in bone scan is often complicated by the presence of degenerative joint disease (DJD), especially in the elderly patient. The aim of this study is to compare objectively 99mTc-MDP tracer uptake between DJD and osseous metastases of the spine using semi-quantitative assessment with SPECT SUV. METHODS: Bone scan with SPECT/CT using 99mTc-MDP was performed in 34 patients diagnosed with prostate carcinoma. SPECT/CT was performed based on our institutional standard guidelines. SUVmax based on body weight in 238 normal vertebrae visualized on SPECT/CT was quantified as baseline. A total of 211 lesions in the spine were identified on bone scan. Lesions were characterized into DJD or bone metastases based on its morphology on low-dose CT. Semi-quantitative evaluation using SUVmax was then performed on 89 DJD and 122 metastatic bone lesions. As most of the bone lesions were small in volume, the effect of partial volume effect (PVE) on SUVmax was also assessed. The corrected SUVmax values were obtained based on the recovery coefficient (RC) method. RESULTS: The mean SUVmax for normal vertebrae was 7.08 ± 1.97, 12.59 ± 9.01 for DJD and 36.64 ± 24.84 for bone metastases. The SUVmax of bone metastases was significantly greater than DJD (p value < 0.05). To assess for diagnostic accuracy, receiver operating characteristic (ROC) curve was performed. The area under the curve (AUC) was found to be fairly high at 0.874 (95% CI 0.826-0.921). The cutoff SUVmax value ≥ 20 gave a sensitivity of 73.8% and specificity of 85.4% in differentiating bone metastases from DJD. The corrected SUVmax for both DJD and bone metastases was smaller with a mean of 6.82 ± 6.02 and 24.77 ± 20.61, respectively. The cutoff SUVmax value was also lower with a value of 10, which gave a sensitivity of 73.8% and specificity of 86.5%. CONCLUSION: SPECT SUVmax was significantly higher in bone metastases than DJD. Semi-quantitative assessment with SUVmax can complement qualitative analysis. A cutoff SUVmax of ≥ 20 can be used to differentiate bone metastases from DJD. Partial volume effect should be taken into consideration in the quantification of small lesion size.