Dose Coefficients Research Articles

Estimation of the Effective Radiation Dose in Nuclear Medicine Workers from Dhaka by Measuring Radioactivity in Urine Sample Resulting from Internal Exposure

This study estimates the effective doses and activity concentration from 151 urine samples which are collected from 15 (Fifteen) occupational workers at National Institute of Nuclear Medicine and Allied Science (NINMAS) in Dhaka, Bangladesh. The radioactivity concentration in urine sample is due to intake of I-131, Tc-99m and F-18. The samples have been analyzed using High Purity Germanium (HPGe) detector. The radioactivity of I-131 and Tc-99m was found 0.91 ± 0.26 BqL-1 to 504.49 ± 6.03 BqL-1 and 0.15 ± 0.21 BqL-1 to 191.19 ± 6.98 BqL-1 respectively. Radioactivity of F-18 was found from 0.031 ± 0.022 BqL-1 to 0.282 ± 0.065 BqL-1. The effective doses of occupational workers have been also calculated using the radioactivity concentration and the dose coefficient according to ICRP publication 78. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 64−80

Machine learning-enhanced stochastic uncertainty and sensitivity analysis of the ICRP human respiratory tract model for an inhaled radionuclide

The International Commission on Radiological Protection (ICRP) has developed the reference Human Respiratory Tract Model (HRTM), detailed in ICRP Publications 66 and 130, to estimate the deposition and clearance of inhaled radionuclides. These models utilize reference anatomical and physiological parameters for particle deposition (PD). Biokinetic models further estimate retention and excretion of internalized particulates, aiding the derivation of inhalation dose coefficients (DC). This study aimed to assess variability in deterministic131I biokinetic and dosimetry models through stochastic analysis using the updated HRTM from ICRP Publication 130. The complexities of the ICRP PD model were reconstructed into a new, independent computational model. Comparison with reference data for total PD fractions for reference worker, solely a nose breather, covering activity median aerodynamic diameters from 0.3μm to 20μm, showed a 1.04% relative and 0.7% absolute difference, demonstrating good agreement with ICRP deposition fractions. The deterministic DC module was reconstructed in Python and expanded for stochastic analysis, systematically expanding deposition components from HRTM and assigning probability distribution functions to uncertain parameters. These were integrated into an in-house stochastic radiological exposure dose calculator, utilizing latin hypercube sampling. A case of an occupational radionuclide intake was explored, in which biodistribution and committed effective DC (CEDC) were computed for131I type F, considering a lognormal particle size distribution with a median of 5μm. Results showed the published ICRP reference CEDC marginally exceeds the 75th percentile of observed samples, with log-gamma distribution as the best-fit probability distribution. A Random Forest regression model with SHapley Additive exPlanations was employed for sensitivity analysis to predict feature importance. The analysis identified the HRTM particle transport rates scaling factor, followed by the aerodynamic deposition efficiency in the alveolar interstitial region as the most impactful parameters. This study offers a unique stochastic approach on inhaled particulate metabolism, enhancing radiation consequence management, medical countermeasures, and dose reconstruction for epidemiological studies.

Development and justification of a method for presenting radiation risks associated with medical exposure of patients

The practical implementation of radiation protection principles in the medical exposure of patients often tends to fall into one of two extremes: either excessive simplification of the methodology for assessing radiation health detriment, or its excessive complexity. An example of an excessively simplified approach is the assessment of radiation risk to patients using effective dose and radiation damage coefficients (nominal risk coefficients) as presented in Norms of the Radiation Safety NRB-99/2009. An example of an unjustifiably complex approach can be considered Tables 1-2 in MR 2.6.1.0215-20 "Assessment of radiation risk to patients during X-ray diagnostic radiological examinations," which indicate "lifetime risk values of death taking into account harm from reduced quality of life due to cancer of various organs and tissues and genetic effects from medical examinations" for a wide range of medical diagnostic X-ray radiological examinations in five-year age groups of patients. The main shortcomings of the simplified approach can be considered the lack of differences in risk assessment between individuals of different sexes and ages, although the fact of higher radiosensitivity in children compared to adults and in women compared to men can be considered universally recognized. The risk assessment approach proposed in MR 2.6.1.0215-20 addresses these shortcomings. However, in the view of the authors of this study, it offers an unnecessarily detailed picture considering uncertainties inherent in risk assessments at low doses, as well as uncertainties in the method of interpopulation transfer of radiation risk proposed by the International Commission on Radiological Protection. The aim of this study was to develop and justify a simpler and more straightforward method of presenting information on radiation risks associated with medical X-ray radiological examinations, free from the main drawbacks of the two aforementioned methods. To achieve this goal, radiation risks were calculated using two methods (using effective dose and using the risk model of the International Commission on Radiological Protection). A comparative analysis of the calculation results was conducted with estimates presented in Tables 1-2 of MR 2.6.1.0215-20. As a result of the analysis, an original applied method for presenting qualitative characteristics of radiation risks was developed for use in prescribing X-ray radiological examinations and informing patients about potential health risks. The practical outcome of the study is the formation of a table of radiation risks associated with conducting studies on patients from the Russian population, using the developed method of presenting information on radiation risks.

Preclinical Evaluation of 226Ac as a Theranostic Agent: Imaging, Dosimetry, and Therapy.

226Ac (t½ = 29.37 h) has been proposed as a theranostic radioisotope leveraging both its diagnostic γ-emissions and therapeutic α-emissions. 226Ac emits 158 and 230 keV γ-photons ideal for quantitative SPECT imaging and acts as an invivo generator of 4 high-energy α-particles. Because of these nuclear decay properties, 226Ac has potential to act as a standalone theranostic isotope. In this proof-of-concept study, we evaluated a preclinical 226Ac-radiopharmaceutical for its theranostic efficacy and present the first 226Ac-targeted α-therapy study. Methods: 226Ac was produced at TRIUMF and labeled with the chelator-peptide bioconjugate crown-TATE. [226Ac]Ac-crown-TATE was selected to target neuroendocrine tumors in male NRG mice bearing AR42J tumor xenografts for SPECT imaging, biodistribution, and therapy studies. A preclinical SPECT/CT scanner acquired quantitative images reconstructed from both the 158 and the 230 keV emissions. Mice in the biodistribution study were euthanized at 1, 3, 5, 24, and 48 h after injection, and internal radiation dosimetry was derived for the tumor and organs of interest to establish appropriate therapeutic activity levels. Mice in the therapy study were administered 125, 250, or 375 kBq treatments and were monitored for tumor size and body condition. Results: We present quantitative SPECT images of the invivo biodistribution of [226Ac]Ac-crown-TATE, which showed agreement with ex vivo measurements. Biodistribution studies demonstrated high uptake (>30%IA/g at 5 h after injection) and retention in the tumor, with an estimated mean absorbed dose coefficient of 222 mGy/kBq. [226Ac]Ac-crown-TATE treatments significantly extended the median survival from 7 d in the control groups to 16, 24, and 27 d in the 125, 250, and 375 kBq treatment groups, respectively. Survival was prolonged by slowing tumor growth, and no weight loss or toxicities were observed. Conclusion: This study highlights the theranostic potential of 226Ac as a standalone therapeutic isotope in addition to its demonstrated diagnostic capabilities to assess dosimetry in matched 225Ac-radiopharmaceuticals. Future studies will investigate maximum dose and toxicity to further explore the therapeutic potential of 226Ac-radiopharmaceuticals.

Korean-specific internal dosimetry data for radioiodine bioassay and evaluation of the dosimetric impact

Our earlier works focused on exploring the Korean iodine biokinetic model and calculating Korean-specific S values and dose coefficients. Building on this foundation, this study extended our efforts to establish an extensive dosimetry dataset for Korean-specific iodine bioassay. We calculated bioassay functions (e.g., thyroid retention and urinary excretion functions), dose-per-content-functions, and content for the specified doses based on the Korean biokinetic model and dose coefficients previously developed. Also, this study provides a comprehensive understanding of the practical impact of using Korean-specific dosimetry data. Compared to the ICRP reference data, the thyroid retention functions for Koreans were significantly lower (for I-131, peaks at 18% vs. 27%). The physical half-lives of radioiodine played a significant role in the differences of dose-per-content-function. For long-lived iodine isotopes such as I-125, the dose-per-content-functions were comparable to ICRP data, whereas for short-lived iodine isotopes such as I-131, the higher values were observed in the Korean data, indicating a greater dose estimation for a given iodine activity measured in the thyroid. Although we revealed the differences between Korean and ICRP reference data, the comprehensive understanding of Korean data suggests that using the Korean-specific data should be considered only when high doses are predicted.

Application of INTDOSKIT tool for assessment of uncertainties on dose coefficients for ingestion of uranium by workers

The International Commission on Radiological Protection (ICRP) has developed the Human Alimentary Tract Model (HATM) to calculate radiation doses from the ingestion of radionuclides for the protection of workers and the public. In parallel, the ICRP's Occupational Intake of Radionuclides (OIR) series provides biokinetic models and dose coefficients based on a reference human, primarily for regulatory purposes. Although these coefficients are not usually checked for uncertainties, the investigation of such uncertainties is crucial to ensure their reliability in radiation protection. This study uses INTDOSKIT, a software tool developed using the R programming language and RStudio as the Integrated Development Environment (IDE), to calculate doses and explore uncertainties following ingestion of U-238 by workers. Two scenarios were investigated: Case I, using the latest HATM model and the systemic uranium model from ICRP publications 100 and 137 respectively, and Case II, based on data from literature, using older ICRP models. In both cases, intake of U-238 in its soluble form (Type F) was modeled and the results were validated using the ICRP OIR dataviewer software. Following validation, uncertainty and sensitivity analyses were performed. In Case I, uncertainties were assigned to the particle transport parameters in both the systemic model model and HATM as well as the uranium uptake fraction into the blood. While in Case II they were limited to the uptake fraction (f1) and the systemic uranium model. A Monte Carlo simulation of 60,000 runs was performed for both cases, sampling model parameters from their respective probability distributions to generate dose distributions. The influence of each parameter on these distributions was also analyzed. Probability distributions were inferred to the calculated dose values using the maximum likelihood estimation method and the Kolmogorov-Smirnov goodness-of-fit. The results showed that for both cases the committed effective dose coefficient, e (50), followed a lognormal distribution. Case I had a geometric mean of 3.2E-08 Sv/Bq and GSD of 2.0, while case II had a slightly lower geometric mean of 3.1E-08 Sv/Bq and GSD of 1.9. Sensitivity analysis showed that the main contributor to dose uncertainty was the fraction of uranium absorbed from the small intestine into the blood. Both cases showed similar trends, with slightly higher results in case I. Overall, this study demonstrates the effectiveness of INTDOSKIT in calculating dose coefficients and analyzing uncertainties. It suggests that while the ICRP reference values remain useful for protection, the incorporation of additional statistical measures and distribution characteristics could further enhance radiation protection strategies.

INTDOSKIT: An R-Code for Calculation of Dose Coefficients and Studying Their Uncertainties.

An R-code, which allows the calculation of the time dependent activity distribution based on ICRP reference models, the number of decays in a commitment period, and the dose coefficients for tissues and organs of the human body, has been developed. R Language was chosen due to its powerful mathematical and statistical modeling features, as well as its graphical capabilities. The developed set of functions and constants (called "INTDOSKIT") can be sourced in R-scripts that define or import the models and calculations to be performed. The code has been tested on models of several radionuclides and was successfully validated against reference data taken from ICRP OIR Data Viewer software. Furthermore, the code has been tested and verified on the modeling of the radioactivity of decay chains using data of the 233Ra model presented by Höllriegl and colleagues. The results of calculations with INTDOSKIT demonstrated that the code is able to reproduce the ICRP bioassay data and dose coefficients. Deviations are a few percent only and are due mainly to rounding in the original data. Lastly, the code is able to handle uncertainty and sensitivity studies as demonstrated by the results in a pilot study of injection of 241Am, which estimated geometric standard deviations (GSD) for dose coefficients ranging between 1.25 (bone-surface) and 1.66 (testes); these results are consistent with those obtained from similar studies done by other researchers who reported GSD values ranging from 1.13 to 1.73.

Exploratory research on the multi-life stages mesh-type model of Caenorhabditis elegans in radiation ecology

To address the lack of effective dose quantification methods for the model organism Caenorhabditis elegans (C. elegans) in radiation ecology research, this study employs remeshing techniques to develop a comprehensive mesh-type model covering multi-life stages, from embryonic to larval (L1, L2, L3, L4) and adulthood. Using these models, Dose Coefficients (DC) for C. elegans in a soil environment under different exposure conditions (external and internal), material settings, and radioactive nuclides (³H, ⁶⁰Co, ⁹⁰Sr, 12⁹I, 1³1I, 1³⁴Cs, 1³⁷Cs) were calculated with the Monte Carlo toolkit Geant4. The results show that the difference in DC, when C. elegans material is set as either biological material or water, is within 5%. Under external exposure conditions, the impact of life stages on the population's average DC is minimal (with a maximum deviation not exceeding 10%). However, the distribution within the population varied significantly across life stages (under external exposure to 137Cs, the dispersion was 12.02% for adults and a considerably higher 60.30% for larvae). The earlier the life stage, the greater the variability in DC distribution within the C. elegans population. Furthermore, correlation analysis indicates a strong relationship between DC and life stages under internal exposure scenarios. The mesh-type model of C. elegans established in this study provides a valuable tool for radiation ecology research and has potential applications in broader research fields.

Validating the application of the revised ICRP’s biokinetic models for organic 14C and organically bound tritium to members of the public

In 2016, the International Commission on Radiological Protection (ICRP) has revised the biokinetic models for carbon and tritium in Publication 134 to calculate the dose coefficients of these radionuclides for workers. The following publication for members of the public is now in the process of revising by the ICRP. According to the draft manuscript published for consultation in 2023, the same models will be adopted for members of the public, although the parameters in these models are not corroborated by the metabolic data of radionuclides in foods. Dose coefficients were estimated using the modified models developed in this study to validate the application of the revised models to members of the public. In the modified models, several parameters were replaced based on the metabolic data of these nuclides in foods and compartments of radio-insensitive tissues were introduced. For these estimations, we utilised the an inhouse program for internal-dose calculation developed by the Japan Atomic Energy Agency. The estimated dose coefficient values for ingestion of organic 14C and organically bound tritium ranged from 3.2×10-11 to 7.6×10-11 Sv Bq-1 and from 3.5×10-11 to 5.4×10-11 Sv Bq-1, respectively. We concluded that the dose coefficient value of 1.6×10-10 Sv Bq-1 obtained by the revised ICRP's carbon model was conservative, while the value of 5.1×10-11 Sv Bq-1 for organically bound tritium was appropriate.&#xD.

Dose estimation in patients from different protocols of 18F-FDG PET/CT studies and analysis of optimization strategies.

This study aimed to evaluate the dose in different protocols of 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (PET/CT) procedure. The retrospective study involves 207 patients with confirmed malignancies who underwent PET/CT. Effective dose (E) from PET was estimated based on injected activity and dose coefficient as per International Commission on Radiation Protection (ICRP) 128. Estimation of E from CT was done utilizing the dose length product (DLP) method and conversion factors as per ICRP 102. There was a significant statistical difference observed in E between different PET/CT protocols (P < .001). E of PET in the whole body (WB) was found to be 4.9±0.9mSv, whereas mean volume computed tomography dose indexvol, DLP, and E of CT in WB were 7.0±0.2mGy, 674.3±80.7mGy.cm, and 10.1±1.2mSv, respectively. No linear correlation was seen between the size-specific dose estimate and E of CT (r=-0.003; P = .978). The total mean E in WB PET/CT was 17.0±1.7mSv. CT dose was contributing more than PET dose in all protocols except brain PET/CT. Optimization strategies can be evaluated only if monitored periodically.

The determination of coefficients for size specific effective dose for adult and pediatric patients undergoing routine computed tomography examinations.

The effective dose resulting from computed tomography (CT) scans provides an assessment of the risk associated with stochastic effects but does not account for the patient's size. Advances in Monte Carlo simulations offer the potential to obtain organ dose data from phantoms of varying stature, enabling derivation of a size-specific effective doses (SEDs) representing doses to individual patients. This study aimed to compute size-specific k-conversion factors for SED in routine CT examinations for adult and pediatric patients of different sizes. Radiation interactions were simulated for adult and pediatric phantom models of various sizes using National Cancer Institute CT version 3.0.20211123. Subsequent calculations of SED were performed, and coefficients for SED were derived, considering the variations in body sizes. The results revealed a strong correlation between effective diameter and weight, observed with size-specific k-conversion factors for adult and pediatric phantoms, respectively. While size-specific k-conversion factors for CT brain remained constant in adults, values for pediatric cases varied. When using the tube current modulation (TCM) system, size-specific k-conversion factors increased in larger phantoms and decreased in smaller ones. The extent of this increase or decrease correlated with the set TCM strength. This study provides coefficients for estimating SEDs in routine CT exams. Software utilizing look-up tables of coefficients can be used to provide dose information for CT scanners at local hospitals, offering guidance to practitioners on doses to individual patients and improving radiation risk awareness in clinical practice.

Skin Absorbed Dose Coefficients for Human Legs from Beta Radiation as a Function of Height

External exposure to skin from beta-emitter radionuclides following severe reactor accidents or nuclear testing can result in beta burning and other health complications. The skin absorbed dose coefficient (SADC) measures the energy deposition into the skin during such accidents. The U.S. Environmental Protection Agency has published several reports to measure the possible energy deposition into the skin in such accidents. However, the most recent SADC published by Federal Guidance Report (FGR) 12 was computed only at one meter above the contaminated surface. Therefore, it was necessary to develop a model to estimate the absorbed dose coefficients for skin at different heights. In this manuscript, Geant4, a Monte Carlo simulator toolkit, was used to estimate the absorbed dose coefficients from electron sources located on the soil surface with energies ranging from 0.1 to 4 MeV. The energy deposited from primary electrons, secondary electrons, and photons in a 50 µm thick layer of epidermis tissue (Basal Cells Layer) located at a depth of 50 µm from the skin surface was estimated at several discrete heights of human leg phantom. More than 40% of the total energy deposited comes from secondary electrons and photons in energy sources of 0.1 and 0.2 MeV on average, but for higher energies, this percentage is less than 1%, which indicates primary electrons are the main source of the deposited energy in the skin. Furthermore, the results showed the energy deposited into skin closer to the ground was 50–100% higher than the previously estimated doses for 1 m above the ground. The results from Geant4 showed a great correlation (R2 = 0.972) with the FGR 12 data at one meter height, and they were aligned with the published values from FGR 12, which validated the simulation results. Therefore, the calculated dose coefficients for different energy sources and different heights could be used in radiation protection measurements.

Impact of contrast agents on organ dosimetry in pediatric diagnostic fluoroscopy: the voiding cystourethrogram.

ICRP Task Group 113 is developing reference values of organ and effective dose coefficients for radiography, fluoroscopy, and computed tomography imaging exams. In support of these efforts, our focus is on pediatric diagnostic fluoroscopy. Contrast agents used during clinical examinations are an important consideration of the work undertaken by the Task Group. This work demonstrates the importance of including organ contrast volume concentrations for the calculation of reference organ dose coefficients in the voiding cystourethrogram (VCUG). The ICRP newborn and 15-year female reference phantoms were utilized within the Particle and Heavy Ion Transport code System (PHITS) for the calculation of organ dose coefficients. A pediatric radiologist with over 30 years of clinical experience defined the imaging fields for a VCUG examination consistent with clinical practice. Of these, four imaging fields were selected for investigation. The transport simulations modeled an iodinated contrast solution similar to Bracco Group's 18% weight per volume, cystografin diatrizoate meglumine and typical bladder content was supplemented to make up the remainder volume. Iodinated contrast volumes of 0, 25, 50, 75, and 100 percent concentration by volume were modeled and associated dose coefficients for in-field organs were computed. Organ dose coefficients were calculated for the urinary bladder wall, colon wall, ovaries, and uterus for both female phantoms under irradiation geometries representative of a VCUG examination. Some organ dose coefficients increased with iodine volume in the bladder and other organ dose coefficients decreased as the iodine contrast volume completely filled the bladder (100%). The study results demonstrate for the newborn phantom percent differences in organ dose coefficients varied between 0-10% for the organs of interest, while they varied between 0-22% in the 15-year phantom suggesting the importance of including contrast media in Monte Carlo radiation transport simulations of the VCUG examination.&#xD.

Assessment of the skin contamination dose coefficients for 252Cf radionuclide: Monte Carlo approach

Handling the 252Cf radionuclide source poses a potential hazard of skin surface contamination in case of an unexpected occurrence. Consequently, there is a growing need to establish precise dose conversion coefficients tailored to each type of emitted primary particle and various radionuclides. Nevertheless, the current body of literature does not provide specific data or methodologies for evaluating skin contamination dose and its associated coefficients, particularly with regard to the 252Cf source. Thus, this study aims to quantify the dose rate received by the skin and its associated coefficients after contamination scenario. Utilizing the established MCNPX environment, the Equivalent dose rate and Absorbed dose, along with Skin contamination dose coefficient (SCDC), have been calculated within the skin tissue. Two methodologies, specifically Watt Fission distribution and the Doppler Effect, are proposed to analyze particle spectra within skin phantom, enabling the calculation of Equivalent dose rate. In accordance with ICRP recommendations regarding the optimal depth for assessing skin doses, the designated scoring volume within the skin is located between depths of 50–100 μm. This volume is tasked with evaluating the dose. The SCDC results were entirely consistent with previously published data from MCNPX, with statistical uncertainties of less than 15%, demonstrating the efficacy of the methodologies employed in this study. This research presents an innovative method for generating data related to skin contamination doses. The novel outcomes in the current research facilitate the assessment of skin dose contamination for the targeted radionuclides and radiotherapy purposes due to staff oversight and radiobiological effects.

Enhanced internal dosimetry for alimentary tract organs in nuclear medicine based on the ICRP mesh-type reference phantoms

This study introduces a refined approach for more accurately estimating radiation doses to alimentary tract organs in nuclear medicine, by utilizing the ICRP pediatric and adult mesh-type reference computational phantoms (MRCPs) that improved the anatomical representation of these organs. Our initial step involved compiling a comprehensive dataset of electron Specific Absorbed Fractions (SAFs) for all source-target pairs of alimentary tract organs in both adult and pediatric phantoms, calculating SAFs for all cases in the present study only except those computed in the previous study for certain pediatric phantom cases. Subsequently, we determined S values for 1252 radionuclides, facilitating dosimetry applications. The consistency of target and source masses for alimentary tract organs in the MRCPs with the reference values in ICRP Publication 89 led to noticeable differences in SAF, S values, and consequently, absorbed dose coefficients when compared to the stylized models in ICRP Publication 100. Notably, the S value ratios (MRCP/stylized) for selected radionuclides—11C, 18F, 68Ga, and 131I—ranged from 0.41 to 7.60. Particularly for therapeutic 131I-iodide in thyroid cancer, the use of MRCPs resulted in up to 1.49 times higher absorbed dose coefficients for the colon than those derived from stylized models, while the stomach dose coefficients decreased by a factor of 0.72. The application of our findings promises enhanced, more realistic dosimetry for alimentary tract organs, especially beneficial for radiopharmaceuticals likely to accumulate within these organs.

Improving the reliability of internal dosimetry for uranium workers: Application of the ICRP/OIR uranium model to long-term occupational intakes

In the Occupational Intakes of Radionuclides (OIR) report series, the International Commission on Radiological Protection (ICRP) published updated biokinetic models and dosimetric data associated with the internal exposure of workers, which are consistent with the recommendations of ICRP Publication 103. The present study focused on the application of the new OIR uranium model published in ICRP Publication 137, which is relevant for the interpretation of measurements of activity in the body and in excreta, and for calculating the committed effective dose. The main objective of this study was to assess the impacts of the new OIR biokinetic models and dose coefficients compared with the old ones based on ICRP Publications 60/78/119. CIEMAT and the University of Salamanca in Spain have been working on re-interpreting in vitro bioassay data obtained from workers with long-term exposure to inhaling uranium oxides during the fabrication of nuclear fuel elements using low enriched uranium, which is now classified as OIR type M/S material. The effects on the retention/excretion models and dose coefficients were studied for 234U, 235U, 238U, and the uranium mixture. Committed effective doses were re-assessed using BIOKMOD code by applying the new OIR excretion model and dose coefficients considering acute and/or chronic inhalation intake scenarios. A reduction by roughly a factor of four was obtained compared with former doses based on ICRP Publications 60/78/119, which is an important effect to take into consideration.

A strategy for estimating radiation dose to the blood in outpatient settings in differentiated thyroid cancer therapy with 131I-NaI.

Although standard operational procedures for pre-therapeutic dosimetry already exist for the determination of the maximum safe activity to treat differentiated thyroid cancer patients, empiric activity administration of 131I is still the most frequent way of treatment. In this way, the absorbed dose to the blood/bone marrow remains unknown. In this work, we present a strategy to estimate radiation dose to the blood in an outpatient setting. A mobile application was developed, which together with an off-the-shelf compact semiconductor radiation detector allows the determination of whole-body time-integrated activity coefficients. The methodology was tested in a cohort of 79 differentiated cancer patients who received therapeutic 131I activities. Post-therapeutic whole-body time-integrated activity coefficients were compared against pre-therapeutic estimates in a subset of 13 patients. The 95% limits of agreement between pre whole-body and post whole-body time integrated activity coefficients were [-14.4; 6.6] h when considering outliers and [-6.2; 3.6] h without outliers. A high dispersion in blood dose coefficients was found, with a four-fold difference between the highest and lower values. Blood doses were significantly higher for patients treated with dosimetrically guided activities than for empirical activities (median dose=118vs. 49cGy, respectively). Blood dose coefficients were significantly lower for patients prepared with recombinant human thyroid stimulating hormone (rhTSH) than for patients prepared with thyroid hormone withdrawal. A low correlation between blood dose and administered activity was found in empirically treated patients (R2=0.26). We successfully implemented a post-therapeutic internal dosimetry methodology for differentiated thyroid cancer therapy with 131I, which allows to estimate dose to the blood from outpatient measurements with mobile devices. The proposed methodology avoids the need of daily visits to the nuclear medicine department, thus reducing the burden for the patient and for the staff.

Korean-specific dose coefficients for external environmental exposures: Soil contamination

In this study, we first produced the Korean-specific dose coefficients (DCs) for soil contamination using the Mesh-type Reference Korean Phantoms (MRKPs). The Korean DCs were compared with the values in ICRP Publication 144 produced using the Caucasian-based ICRP reference phantoms to investigate dosimetric impact due to the racial difference (Korean/Asian vs Caucasian). Monte Carlo dose calculations using the Geant4 code were conducted where the photon and electron sources in the phase-space data used for the ICRP-144 DC calculations were irradiated to the MRKPs. For photons, the organ DCs of the MRKPs showed a good agreement with the ICRP-144 DCs (deviations <20 %) for most energies, while significant differences at energies below 0.05 MeV were observed by up to a factor of 55.6 (thymus at 0.015 MeV). For electrons, notable differences in the organ DCs were observed the overall energy region (deviations >20 % for most cases). The effective DCs of the MRKPs showed an excellent agreement with the ICRP-144 DCs for photons (deviations <16 %), whereas notable differences by up to 1.7 times (0.05 MeV) were observed for electrons. The Korean DCs for soil contamination will be beneficially used in dose estimates for Koreans especially in risk assessments.

Radiation dosimetry of para-chloro-2-[18F]fluoroethyl-etomidate: a PET tracer for adrenocortical imaging

Background[11C]metomidate, a methyl ester analogue of etomidate, is used for positron emission tomography of adrenocortical cancer, and has been tested in recent clinical trials for lateralization in primary aldosteronism (PA). However, in PA, visualization as well as uptake quantification are hampered by the tracer’s rather high non-specific liver uptake, and its overall clinical usefulness is also limited by the short 20-minute half-life of carbon-11. Therefore, we evaluated para-chloro-2-[18F]fluoroethyl-etomidate, [18F]CETO, a fluorine-18 (T1/2=109.8 min) analogue, as a potential new adrenocortical PET tracer. The aim of this study was to assess radiation dosimetry of [18F]CETO.Results[18F]CETO showed a high uptake in adrenal glands, still increasing at 5 h post injection. Adrenal glands (absorbed dose coefficients 0.100 ± 0.032 mGy/MBq in males and 0.124 ± 0.013 mGy/MBq in females) received the highest absorbed dose. The effective dose coefficient was 20 µSv/MBq.Conclusions[18F]CETO has a favourable biodistribution in humans for adrenal imaging. The effective dose for a typical clinical PET examination with 200 MBq [18F]CETO is 4 mSv.Trial registrationClinicalTrials.gov, NCT05361083 Retrospectively registered 29 April 2022. at, URL: https://clinicaltrials.gov/ct2/show/NCT05361083.

Safety and Efficacy of Para-Aminohippurate Coinfusion for Renal Protection During Peptide Receptor Radiotherapy in Patients with Neuroendocrine Tumors.

Para-aminohippurate, also known as p-aminohippuric acid (PAH), is used clinically to measure effective renal plasma flow. Preclinically, it was shown to reduce 177Lu-DOTATOC uptake in the kidneys while improving bioavailability compared with amino acid (AA) coinfusion. We report the safety and efficacy of PAH coinfusion during peptide receptor radiotherapy in patients with neuroendocrine tumors. Methods: Twelve patients with metastatic or unresectable gastroenteropancreatic neuroendocrine tumors received 177Lu-DOTATOC in 33 treatment cycles. Either 8 g of PAH or a mixture of 25 g of arginine and 25 g of lysine were coinfused. Safety was assessed by monitoring laboratory data, including hematologic and renal data, as well as electrolytes obtained before and 24 h after treatment. For radiation dosimetry, whole-body scans were performed at 1, 24, and 48 h and a SPECT/CT scan was performed at 48 h, along with blood sampling at 5 min and 0.5, 2, 4, 24, and 48 h after administration. Absorbed dose estimations for the kidneys and bone marrow were performed according to the MIRD concept. Results: In 15 treatment cycles, PAH was coinfused. No changes in mean creatinine level, glomerular filtration rate, and serum electrolytes were observed before or 24 h after treatment when using PAH protection (P ≥ 0.20), whereas serum chloride and serum phosphate increased significantly under AA (both P < 0.01). Kidney-absorbed dose coefficients were 0.60 ± 0.14 Gy/GBq with PAH and 0.53 ± 0.16 Gy/GBq with AA. Based on extrapolated cumulative kidney-absorbed doses for 4 cycles, 1 patient with PAH protection and 1 patient with AA protection in our patient group would exceed the 23-Gy conservative threshold. The bone marrow-absorbed dose coefficient was 0.012 ± 0.004 Gy/GBq with PAH and 0.012 ± 0.003 Gy/GBq with AA. Conclusion: PAH is a promising alternative to AA for renal protection during peptide receptor radiotherapy. Further research is required to systematically investigate the safety profile and radiation dosimetry at varying PAH plasma concentrations.