Low-dose-rate iodine-125 seed air kerma strength measurement intercomparison.

PURPOSE: The purpose of this study was to investigate the rate of compliance of air kerma strength (AKS) measurements of iodine-125 (I-125) seeds with international recommendations by departments in Australia and determine the potential impact of noncompliance. METHODS AND MATERIALS: To achieve this aim, we present an intercomparison of AKS measurements for a single I-125 seed performed by 11 radiotherapy departments in Australia. Measurements were performed at two sites, with each participating department traveling to one of the two host sites and measuring the AKS using their own equipment and local protocols. Each of the AKS measurements was compared with each other and the manufacturer-certified AKS. RESULTS: Nine of the 11 participating departments measured AKS fell within ±3% of the manufacturer's calibration certificate value, whereas all participating departments measured AKS within ±5% of the manufacturer's calibration certificate value. The total spread of the measured AKS among the 11 departments was 7.7%. Only two of the 11 participating departments complied with international recommendations and had their well chamber calibrated within the last 2 years. In addition, 2 of the 11 departments used a well chamber calibrated that was calibrated with a different seed model used during the intercomparison, whereas 4 of the 11 departments calibrated their well chamber "in-house" using a factory-calibrated seed provided by the seed manufacturer. CONCLUSIONS: A significant variation in the methods used and frequency of calibration of well chambers were observed among the participating departments. The results of this study support the international recommendations on frequency and methodology of well chamber calibration. Failure to follow these recommendations significantly increases the uncertainty in AKS measurement of I-125 seeds.

The overuse of radioactive iodine in low-risk papillary thyroid cancer patients.

BACKGROUND: The aim of this study was to use current American Thyroid Association (ATA) management guidelines to identify groups who might be at risk of overtreatment with radioactive iodine (RAI) ablation after surgery for low-risk papillary thyroid cancer (PTC). METHODS: PTC patients were identified using the Surveillance, Epidemiology and End Results database. Characteristics of low-risk patients (defined as T1 without metastasis) were compared to those not low-risk. Predictors of receiving RAI for low-risk disease were determined using logistic regression. RESULTS: Of 32,229 cases, 17,286 (53.6%) were low-risk. Low-risk patients, compared to others, were older (mean age 51.3 versus 48.5 years), and more often female (81.6% versus 71.7%), white (69.7% versus 62.0%), and insured (87.6% versus 85.6%)(all p-values < 0.001). Nearly 25% of low-risk patients received RAI. Predictors of overtreatment with RAI included age <45 years (OR: 1.393; 95% CI: 1.250-1.552), age 45-64 years (OR: 1.275; 95% CI: 1.152-1.412), male sex (OR: 1.191; 95% CI: 1.086-1.305), Hispanic (OR: 1.236; 95% CI: 1.110-1.376) and Asian (OR: 1.306; 95% CI: 1.159-1.473) race, and extensive lymphadenectomy (OR: 1.243; 95% CI: 1.119-1.381). CONCLUSION: Low-risk PTC patients were more likely to receive post-surgical RAI when not indicated under ATA guidelines if they were younger, male, Hispanic or Asian, or underwent extensive lymph node surgery. Identification of groups at risk for overtreatment can help impact practice patterns and improve the effective utilization of healthcare resources.

Improved small scale production of iodine-124 for radiolabeling and clinical applications.

AIM: This work describes a small-scale production of iodine-124 using a 16.5 MeV cyclotron, and a subsequent validation of the formulated sodium [124I]iodide solution for routinely clinical applications. METHODS: Iodine-124 (124I) was produced via the 124Te(p, n)124I reaction using a 16.5 MeV GE PETtrace® cyclotron. Irradiation was performed with a pre-prepared solid target consisting of [124Te]TeO2 (99.93%) and Al2O3. Different layer thicknesses, irradiation and extraction parameters were tested. After irradiation at the cyclotron, the shuttle with irradiated material was transferred fully automatically via a tube system to the Comecer ALCEO® Halogen 2.0 extraction unit. Iodine-124 was subsequently extracted in form of sodium [124I]iodide ([124I]NaI) in 0.05 N aqueous NaOH solution, followed by reconstitution and validation for preclinical and clinical uses. RESULTS: Good result was achieved using a beam degradation foil of 500 µm thickness in combination with beam currents between 10 and 15 µA. Under these conditions, up to 150 MBq no-carrier-added [124I]NaI was obtained after a 2 h irradiation time in less than 500 µl 0.05 N NaOH. Isolation of [124I]NaI, including evaporation and extraction at the ALCEO® Halogen EVP unit was accomplished in 90 min 24 h after production (irradiation), the amount of iodine-123 as assessed by gamma-ray spectroscopy was less than 1.5%. The undesirable iodine-125 was not detectable by gamma spectroscopy. The extracted [124I]NaI could be used directly for radiolabeling purposes, and after buffering with phosphate buffered saline (PBS) and sterile filtration for clinical applications. CONCLUSIONS: Through the optimized conditions for irradiation and extraction, iodine-124 was produced in good radiochemical yields and high radionuclide purity. The generated injectable [124I]NaI solution was sterile, non-pyrogenic and ready for preclinical and clinical applications after a sterile filtration through a 0.22 µm membrane filter.

[Preparation, quality control and thyroid molecule imaging of solid-target based radionuclide ioine-124].

OBJECTIVE: To provide useful information for the further production and application of this novel radio-nuclide for potential clinical application. METHODS: 124Te (p,n) 124I nuclide reaction was used for the 124I production. Firstly, the target material, 124TeO2 (200 mg) and Al2O3 (30 mg) mixture, were compressed into the round platinum based solid target by tablet device. HM-20 medical cyclotron was applied to irradiate the solid target slice for 6-10 h with helium and water cooling. Then, the radiated solid target was placed for 12 h (overnight) to decay the radioactive impurity; finally, 124I was be purified by dry distillation using 1 mL/min nitrogen for about 6 hours and radiochemical separation methods. Micro-PET imaging studies were performed to investigate the metabolism properties and thyroid imaging ability of 124I.After 740 kBq 124I was injected intravenously into the tail vein of the normal mice, the animals were imaged with micro-PET and infused with CT. The micro-PET/CT infusion imaging revealed actual state 124I's metabolism in the mice. RESULTS: It was been successfully applied for 200 mg 124TeO2 plating by the tablet device on the surface of platinum. It showed smooth, dense surface and without obviously pits and cracks. The enriched 124Te target was irradiated for 6 to 10 hours at about 12.0 MeV with 20 µA current on HM-20 cyclotron. Then 370-1 110 MBq 124I could be produced on the solid target after irradiation and 370-740 MBq high specific activity could be collected afterdry distillation separation and radio-chemical purification.124I product was finally dissolved in 0.01 mol/L NaOH for the future distribution. The gamma spectrum of the produced 124I-solution showed that radionuclide purity was over 80.0%. The micro-PET imaging of 124I in the normal mice exhibited the thyroid and stomach accumulations and kidney metabolism, the bladder could also be clearly visible, which was in accordance with what was previously reported. To the best of our knowledge, it was the first production of 124I report in China. CONCLUSION: In this study, the preparation of 124TeO2 solid target was successfully carried out by using the tablet device. After irradiation of the 124TeO2 solid target and radio-chemical purification, we successfully produced 370-740 MBq high specific activity 124I by a cyclotron for biomedical application, and micro-PET imaging of 124I in normal mice exhibited the thyroid accumulations. Also, slight uptake in stomach were also monitored with almost nonuptake in other organs in the micro-PET imaging. The production of 124I is expected to provide a new solid target radionuclide for the scientific research and potential clinical application of our country.

123I intercomparison exercises: Assessment of measurement capabilities in UK hospitals.

Three comparison exercises have been performed in 1996, 1999 and 2015 with 123I to assess the UK hospitals measurement capabilities using radionuclide calibrators for this particular radionuclide. The exercise performed in 1996 showed that only 62% of the participants could measure the solution to within 10% of the standardised value and only 28% could measure within 5% of the certificated value. The intercomparison exercise performed in 1999 showed no improvement in the measurement capability, with only 66% of the participants measuring to within 10% of the standardised value. The exercise performed in 2015 showed great improvement in the hospitals measurement capability, 94% of participants reported results within 10% of the certificated activity and 85% of the participants reported results within the 5% of the reported activity. The intercomparison exercises are an important way to identify possible measurement problems within the medical community. Additionally, the intercomparison exercises provide hospitals with traceability to national primary standards and improve measurement capability within the Nuclear Medicine community.

Preparation, quality control and thyroid molecule imaging of solid-target based radionuclide ioine-124 / 北京大学学报(医学版)

OBJECTIVE@#To provide useful information for the further production and application of this novel radio-nuclide for potential clinical application.@*METHODS@#124Te (p,n) 124I nuclide reaction was used for the 124I production. Firstly, the target material, 124TeO2 (200 mg) and Al2O3 (30 mg) mixture, were compressed into the round platinum based solid target by tablet device. HM-20 medical cyclotron was applied to irradiate the solid target slice for 6-10 h with helium and water cooling. Then, the radiated solid target was placed for 12 h (overnight) to decay the radioactive impurity; finally, 124I was be purified by dry distillation using 1 mL/min nitrogen for about 6 hours and radiochemical separation methods. Micro-PET imaging studies were performed to investigate the metabolism properties and thyroid imaging ability of 124I.After 740 kBq 124I was injected intravenously into the tail vein of the normal mice, the animals were imaged with micro-PET and infused with CT. The micro-PET/CT infusion imaging revealed actual state 124I's metabolism in the mice.@*RESULTS@#It was been successfully applied for 200 mg 124TeO2 plating by the tablet device on the surface of platinum. It showed smooth, dense surface and without obviously pits and cracks. The enriched 124Te target was irradiated for 6 to 10 hours at about 12.0 MeV with 20 μA current on HM-20 cyclotron. Then 370-1 110 MBq 124I could be produced on the solid target after irradiation and 370-740 MBq high specific activity could be collected afterdry distillation separation and radio-chemical purification.124I product was finally dissolved in 0.01 mol/L NaOH for the future distribution. The gamma spectrum of the produced 124I-solution showed that radionuclide purity was over 80.0%. The micro-PET imaging of 124I in the normal mice exhibited the thyroid and stomach accumulations and kidney metabolism, the bladder could also be clearly visible, which was in accordance with what was previously reported. To the best of our knowledge, it was the first production of 124I report in China.@*CONCLUSION@#In this study, the preparation of 124TeO2 solid target was successfully carried out by using the tablet device. After irradiation of the 124TeO2 solid target and radio-chemical purification, we successfully produced 370-740 MBq high specific activity 124I by a cyclotron for biomedical application, and micro-PET imaging of 124I in normal mice exhibited the thyroid accumulations. Also, slight uptake in stomach were also monitored with almost nonuptake in other organs in the micro-PET imaging. The production of 124I is expected to provide a new solid target radionuclide for the scientific research and potential clinical application of our country.

Re-establishment of normal radioactive iodine uptake reference range in the era of universal salt iodization in the Indian population.

BACKGROUND & OBJECTIVES: The reference radioactive iodine uptake (RAIU) values established in the 1970s in the era of widespread iodine deficiency were relatively high. Now, after four decades of successful Universal Salt Iodization (USI) programme in India, there is a need to re-establish these reference ranges. The present study was aimed to quantify the two-hour and 24-h RAIU values in iodine sufficient euthyroid individuals and validate the results in Graves' and Hashimoto's thyroiditis patients. METHODS: In this prospective study conducted from April 2012 to September 2013, euthyroid volunteers who consented for the investigations were enrolled in the study. Treatment-naive Graves' disease and Hashimoto's thyroiditis patients were recruited from the outpatient clinic. The investigations included neck ultrasonography, thyroid function tests, thyroglobulin (Tg), anti-Tg and anti-thyroid peroxidase antibody and urinary iodine concentration. RESULTS: Three different groups comprising 110 euthyroid volunteers, 38 Graves' and 17 Hashimoto's thyroiditis patients were enrolled in the study. The mean 2-h RAIU values for the euthyroid group, Hashimoto's thyroiditis and Graves' patients were 3.83±2.77, 4.22±3.41 and 32.67±15.93 per cent, and mean 24-h RAIU values were 12.75±5.51, 11.66±9.55 and 61.85±12.9 per cent, respectively. The mean thyroid volumes were 7.63±2.72, 7.81±1.67 and 20.76±12.56 ml for the euthyroid, Hashimoto's thyroiditis and Graves' disease groups and the mean spot urinary iodine concentrations were 9.0, 7.8 and 13.9 µg/dl in the three groups, respectively. The new reference range (95% confidence interval) for two-hour was 1-7 per cent and 24-h was 7-18 per cent. INTERPRETATION & CONCLUSIONS: Compared to the previous values, there was a considerable decrease in the RAIU values in euthyroid individuals. This was further corroborated with increase in the urinary iodine concentration and decrease in thyroid volume, attributed to successful USI programme. Further studies with a large sample from different parts of India need to be done to confirm these findings.

Differentiated Thyroid Cancer-Treatment: State of the Art.

Differentiated thyroid cancer (DTC) is a rare malignant disease, although its incidence has increased over the last few decades. It derives from follicular thyroid cells. Generally speaking, the prognosis is excellent. If treatment according to the current guidelines is given, cases of recurrence or persistence are rare. DTC requires special expertise by the treating physician. In recent years, new therapeutic options for these patients have become available. For this article we performed a systematic literature review with special focus on the guidelines of the American Thyroid Association, the European Association of Nuclear Medicine, and the German Society of Nuclear Medicine. For DTC, surgery and radioiodine therapy followed by levothyroxine substitution remain the established therapeutic procedures. Even metastasized tumors can be cured this way. However, in rare cases of radioiodine-refractory tumors, additional options are to be discussed. These include strict suppression of thyroid-stimulating hormone (also known as thyrotropin, TSH) and external local radiotherapy. Systemic cytostatic chemotherapy does not play a significant role. Recently, multikinase or tyrosine kinase inhibitors have been approved for the treatment of radioiodine-refractory DTC. Although a benefit for overall survival has not been shown yet, these new drugs can slow down tumor progression. However, they are frequently associated with severe side effects and should be reserved for patients with threatening symptoms only.

A comparative study of 129I content in environmental standard materials IAEA-375, NIST SRM 4354 and NIST SRM 4357 by Thermal Ionization Mass Spectrometry and Accelerator Mass Spectrometry.

Iodine environmental measurements have consistently been validated in the literature using the standard material IAEA-375, soil collected approximately 160 miles northeast of Chernobyl, which is currently the only soil/sediment material with a certified 129I activity. IAEA-375 has not been available for purchase since approximately 2010. Two other standard materials that are available (NIST SRM 4354, freshwater lake sediment and NIST SRM 4357, ocean sediment) have certified activities for a variety of radionuclides but not for 129I. This paper reports a comparison of TIMS and AMS data for all three standards.

[Procedure guidelines for radioiodine therapy of differentiated thyroid cancer. Version 4]. / Radioiodtherapie beim differenzierten Schilddrüsenkarzinom. Verfahrensanweisung - Version 4 (Stand 30.10.2015).

The procedure guideline for radioiodine therapy of differentiated thyroid cancer (version 4) was developed in the consensus of a representative expert group. This fulfils the level S1 (first step) within the AWMF classification of Clinical Practice Guidelines (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Germany). This procedure guideline completed the guideline for surgical management of thyroid cancer (level S2) with the aspects from nuclear medicine. Controversies over ablative radioiodine therapy in small papillary thyroid cancers and in minimally invasive follicular cancer without angioinvasion, over empirical standard doses for ablative radioiodine therapy, and over the kind of TSH-stimulation were described and the guideline formulated a corridor of good clinical practice. The text has included the recent results from the National Cancer database and the SEER database (both from the USA), indicating that the ablative radioiodine therapy has improved the survival rate even in low risk patients. Such a statistically significant benefit can be detected only by a national cancer registry with long-term follow-up data.

Measurement of (124)I.

The paper describes the measurements performed at IFIN-HH regarding the creation of a Romanian (124)I standard, consisting of: absolute standardization of the solution by the application of the 4πß(PC)-γ coincidence method; Calibration of the CENTRONIC IG12/20A ionization chamber with a standardised solution and comparison with a calculated efficiency; γ-ray spectrometry activity measurement and determination of the impurity levels; Comparison of the results of the three methods.

Determination of impurities in (124)I samples by high resolution gamma spectrometry.

(124)I is a radionuclide used in the diagnosis of tumors. The National Health Agency requires identification and activity measurement of impurities. Using gamma spectrometry with an efficiency calibrated high-purity germanium detector, impurities (125)I and (126)I in an (1)(24)I production sample were identified. Activity ratios of (125)I and (126)I to (124)I were approximately 0.5% and 98%, respectively.

(Mis)use of (133)Ba as a calibration surrogate for (131)I in clinical activity calibrators.

Using NIST-calibrated solutions of (131)Ba and (131)I in the 5mL NIST ampoule geometry, measurements were made in three NIST-maintained Capintec activity calibrators and the NIST Vinten 671 ionization chamber to evaluate the suitability of using (133)Ba as a calibration surrogate for (131)I. For the Capintec calibrators, the (133)Ba response was a factor of about 300% higher than that of the same amount of (131)I. For the Vinten 671, the Ba-133 response was about 7% higher than that of (131)I. These results demonstrate that (133)Ba is a poor surrogate for (131)I. New calibration factors for these radionuclides in the ampoule geometry for the Vinten 671 and Capintec activity calibrators were also determined.

Current status and future needs for standards of radionuclides used in positron emission tomography.

Positron Emission Tomography (PET) is being increasingly used as a quantitative technique for detecting disease and monitoring patient progress during treatment. To ensure the validity of the quantitative information derived from the imaging data, it is imperative that all radioactivity measurements that are part of the imaging procedure be traceable to national or international standards. This paper reviews the current status of standards for positron emitting radionuclides (e.g., (18)F, (68)Ge/(68)Ga, and (124)I) and suggests needs for future work.

Experimental determination of dosimetry parameters for Sinko (125)I seed source using a modified polystyrene phantom.

Successful treatment for permanent implant brachytherapy is based on accurate measurement of dosimetry parameters for the seed sources. Literature describes the application of various types of phantom to determine the AAPM TG-43 dosimetry parameters for permanent implant seeds. Previously we created a new type of phantom used to measure the dosimetry parameters of a high dose-rate (192)Ir source. In this study, we modified the phantom to suit to a common type of (125)I seed source (Sinko BT-125-1). The dose-rate constant, radial dose function and anisotropy function of this source were measured in detail and compared with the published values of other similar in-design (125)I seed sources. The experimental results exhibit fairly small measurement uncertainties and good self-consistency. The modified phantom is demonstrated on the measurement of dosimetry parameters for the Sinko BT-125-1 (125)I seed, however, it could easily be used for similar measurements of other permanent implantation seed sources.

The traceability chain of 131I measurements for nuclear medicine in Cuba.

The national traceability chain for (131)I activity measurements performed in nuclear medicine in Cuba is described. At the highest (primary) level, liquid scintillation counting employing the CIEMAT/NIST method is used; at the secondary level, a secondary standard radionuclide calibrator is utilized that allows for a quick and simple transference of the measurement unit to the tertiary level of end-users' instruments. The equivalence of Cuban standards and the assessment of measurement uncertainties at the end-user level are determined through the results of measurement comparisons.

Standardization of 125I and 109Cd by the photon-photon coincidence method in PTKMR-BATAN.

A photon-photon coincidence system was constructed for the standardization of (125)I and (109)Cd in PTKMR-BATAN, Indonesia. Two NaI(Tl) detectors of 76 mm diameter × 6mm thickness with 0.5mm aluminum window were used, which were positioned approximately symmetrically to the source holder. The electronic chain was almost the same as for a 4πß-γ system. The CANBERRA Multiport II multi channel analyzer was used for energy calibration and a Philips type PM3092 oscilloscope for visualization of the pulses. A polyethylene plastic was used as the source substrate for the (125)I and (109)Cd samples. The activity of a (125)I solution was measured by the photon-photon coincidence and the efficiency extrapolation method (Schrader and Walz, 1987), whereas the activity of a (109)Cd solution was determined by a tracer method using (125)I (Schrader, 2006). The result of the (125)I activity showed good agreement with the result of measurements using a calibrated ionization chamber, and the result of (109)Cd also showed good agreement with the measurements result using a LEGe detector.

Survey of the performance of commercial dose calibrators for measurement of ¹²³I activity.

UNLABELLED: The accuracy with which (123)I activity is measured by a dose calibrator depends on the composition and geometry of the source. The present study assessed the variability of current commercial dose calibrators in assaying liquid (123)I samples. METHODS: A calibration procedure for (123)I measurement was performed on 177 dose calibrators (11 manufacturers) at 138 sites in North America and Europe. Using the standard (123)I push-button or dial setting, activity in a 5-mL (123)I calibration source in a 10-mL U.S. Pharmacopeia type 1 glass vial (actual activity previously determined using a National Institute of Standards and Technology-traceable standard metrology chamber) was measured. A portion of the source was then transferred to a plastic syringe (10-, 5-, and 3-mL sizes at different sites), and the activity in the syringe was measured. Calibration factors (CFs) for converting the dose calibrator readings to the reference activities were then determined for the vial and the syringes. Data were analyzed for all calibrators combined and based on device manufacturers. Measurements using a copper attenuator (sleeve) were made for a subset of 10 dose calibrators at sites that used these devices in clinical practice. RESULTS: Mean CFs for the different measurements were as follows: 10-mL vial, 1.278; 10-mL syringe, 0.811; 5-mL syringe, 0.815; 3-mL syringe, 0.792. Almost half of the dose calibrators had vial CFs between 1.2 and 1.3 and 10-mL syringe CFs between 0.7 and 0.8, whereas less than 16% of the instruments had uncorrected readings within ±10% of the reference activities. Although there was a wide range of CFs for different calibrators using the copper sleeve, for each unit the CFs for the glass vial and the 10-mL plastic syringe were virtually identical. CONCLUSION: On most commercial dose calibrators, the standard (123)I settings result in significant errors in activity measurements for sources in glass vials and plastic syringes. The difference in ionization chamber detection caused by the container composition (glass vs. plastic) is a much larger source of measurement variation than source volume or geometry.

Comparison of activity measurements in nuclear medicine services in Pernambuco

Intercomparison is an important tool for quality assessment, because equipment performance and procedures are evaluated and compared. In nuclear medicine, this tool is wide utilized to evaluate the ability of the services to measure activities of radiopharmaceuticals which will be administered to the patients in diagnostic or therapeutic procedures. In this work, a comparison program of activity measurements of the 99mTc, 131I, 67Ga and 201Tl radionuclides was established in Pernambuco State, at the Brazilian Northeast, with the aim of evaluating the quality of routine measurements carried out in the NMS. The results in each NMS are sent to the Standard laboratory, which compares these results with the acceptance limits recommended by national regulations. All NMS participants complied with the limit established for the accuracy of measurement (+/-10 percent) and showed that their radionuclide calibrators are adequate for measurement of the activities of radiopharmaceuticals.

A intercomparação é uma importante ferramenta para avaliação da qualidade da medição da atividade de radiofármaco, porque não apenas o desempenho do equipamento é verificado, mas também todo procedimento de medição. Na medicina nuclear, esta ferramenta é amplamente utilizada para avaliar a habilidade dos serviços de medicina nuclear (SMN) na medição da atividade dos radiofármacos que serão administrados aos pacientes para diagnósticos ou procedimentos terapêuticos. Neste trabalho, um programa de intercomparação de medidas de atividades de radiofármacos, utilizando as fontes de 99mTc, 131I, 67Ga e 201Tl, foi estabelecido no estado de Pernambuco, região nordeste do Brasil, com o objetivo de avaliar a qualidade das medições realizadas nos SMN. Os resultados obtidos em cada SMN são enviados ao laboratório padrão, que os compara com os valores de referência recomendados pela norma nacional, verificando o desempenho destes instrumentos. Todos os SMN participantes respeitaram os limites estabelecidos para a exatidão das medidas (+/-10 por cento), demonstrando que os calibradores de radionuclídeos estão adequados/apropriados para a medição de atividades de radiofármacos.