RESUMO
PURPOSE: Patient-specific dosimetry is required to ensure the safety of molecular radiotherapy and to predict response. Dosimetry involves several steps, the first of which is the determination of the activity of the radiopharmaceutical taken up by an organ/lesion over time. As uncertainties propagate along each of the subsequent steps (integration of the time-activity curve, absorbed dose calculation), establishing a reliable activity quantification is essential. The MRTDosimetry project was a European initiative to bring together expertise in metrology and nuclear medicine research, with one main goal of standardizing quantitative 177Lu SPECT/CT imaging based on a calibration protocol developed and tested in a multicentre inter-comparison. This study presents the setup and results of this comparison exercise. METHODS: The inter-comparison included nine SPECT/CT systems. Each site performed a set of three measurements with the same setup (system, acquisition and reconstruction): (1) Determination of an image calibration for conversion from counts to activity concentration (large cylinder phantom), (2) determination of recovery coefficients for partial volume correction (IEC NEMA PET body phantom with sphere inserts), (3) validation of the established quantitative imaging setup using a 3D printed two-organ phantom (ICRP110-based kidney and spleen). In contrast to previous efforts, traceability of the activity measurement was required for each participant, and all participants were asked to calculate uncertainties for their SPECT-based activities. RESULTS: Similar combinations of imaging system and reconstruction lead to similar image calibration factors. The activity ratio results of the anthropomorphic phantom validation demonstrate significant harmonization of quantitative imaging performance between the sites with all sites falling within one standard deviation of the mean values for all inserts. Activity recovery was underestimated for total kidney, spleen, and kidney cortex, while it was overestimated for the medulla. CONCLUSION: This international comparison exercise demonstrates that harmonization of quantitative SPECT/CT is feasible when following very specific instructions of a dedicated calibration protocol, as developed within the MRTDosimetry project. While quantitative imaging performance demonstrates significant harmonization, an over- and underestimation of the activity recovery highlights the limitations of any partial volume correction in the presence of spill-in and spill-out between two adjacent volumes of interests.
RESUMO
In recent years, the volume of diagnostic procedures involving the use of ionizing radiation has rapidly increased. Technological advances in computed tomography (CT) equipment, with the availability of multi-slice acquisition and the introduction of hybrid systems, have made this modality extremely popular among other diagnostic procedures, especially in pediatrics and as a screening procedure for asymptomatic adults. Physicians' major radiation-related concern regarding diagnostic imaging, is possible iatrogenic malignancy. According to major national and international organizations responsible for evaluating radiation risks, there is no low-radiation threshold for inducing cancer. This means that no amount of radiation should be considered absolutely safe. Although, the risk of radiation-induced cancer is much smaller than the risk of cancer from natural sources, it can become a public health concern if large numbers of the population undergo increased numbers of CT screening procedures that may even be of uncertain benefit. In order to reduce the overall radiation dose from CT procedures in the population, it is important to keep radiation dose as low as reasonably achievable, by adjusting scanner parameters separately for each individual. In addition, it is crucial to eliminate the inappropriate referrals for CT tests and choose other diagnostic modalities, such as sonography, magnetic resonance imaging systems, or nuclear medicine procedures. While CT remains an important diagnostic procedure, it is important for health care community to reconsider the indications of a CT scan, especially in children and asymptomatic patients. Physicians who prescribe CT could assess its use on a case-by-case basis. When used prudently and optimally, CT remains a very valuable imaging modalitiy for both children and adults.
