Personalized dosimetry of (177)Lu-DOTATATE: A comparison of organ- And voxel-level approaches using open-access images Journal Article
| Authors: | Carter, L. M.; Ocampo Ramos, J. C.; Kesner, A. L. |
| Article Title: | Personalized dosimetry of (177)Lu-DOTATATE: A comparison of organ- And voxel-level approaches using open-access images |
| Abstract: | 177Lu-DOTATATE (Lutathera®) enables targeted radionuclide therapy of neuroendocrine tumors expressing somatostatin receptor type 2. Though patient-specific dosimetry estimates may be clinically important for predicting absorbed dose-effect relationships, there are multiple relevant dosimetry paradigms which are distinct in terms of clinical effort, numerical output and added-value. This work compares three different approaches for 177Lu-DOTATATE dosimetry, including 1) an organ-level approach based on reference phantom MIRD S-values scaled to patient-specific organ masses (MIRDcalc), 2) an organ-level approach based on Monte Carlo simulation in a patient-specific mesh phantoms (PARaDIM), and 3) a 3D approach based on Monte Carlo simulation in patient-specific voxel phantoms. Method. Serial quantitative SPECT/CT images for two patients receiving 177Lu-DOTATATE therapy were obtained from archive in the Deep Blue database. For each patient, the serial CT images were co-registered to the first time point CT using a deformable registration technique aided by virtual landmarks placed in the kidney pelves and the lesion foci. The co-registered SPECT images were integrated voxel-wise to generate time-integrated activity maps. Lesions, kidneys, liver, spleen, lungs, compact bone, spongiosa, and rest of body were segmented at the first imaging time point and overlaid on co-registered integrated activity maps. The resultant segmentation was used for three purposes: 1) to generate patient-specific phantoms, 2) to determine organ-level time-integrated activities, and 3) to generate dose volume histograms from 3D voxel-based calculations. Results. Mean absorbed doses were computed for lesions and 48 tissues with MIRDcalc software. Mean organ absorbed doses and dose volume histograms were obtained for lesions and 6 tissues with the voxel Monte Carlo approach. Lesion- and organ-level absorbed dose estimates agreed within ±26% for the lesions and ±13% for the critical organs, among the different methods tested. Overall good agreement was observed with the dosimetry estimates from the NETTER-1 trial. Conclusions. For personalized 177Lu-DOTATATE dosimetry, a combined approach was determined to be valuable, which utilized two dose calculation methods supported by a single image processing workflow. In the absence of quantitative imaging limitations, the voxel Monte Carlo method likely provides valuable information to guide treatment by considering absorbed dose non-uniformity in lesions and organs at risk. The patient-scaled reference phantom method also provides valuable information, including absorbed dose estimates for non-segmented organs, and more accurate dose estimates for complex radiosensitive organs including the active marrow. © 2021 IOP Publishing Ltd. |
| Keywords: | histology; computerized tomography; tumors; dosimetry; bone; patient treatment; neuroendocrine tumors; phantoms; graphic methods; deformable registration; monte carlo methods; dose-volume histograms; somatostatin receptors; supercomputers; 177lu-dotatate; paradim; phits; personalized dosimetry; mirdcalc; integrated activities; patient-specific mesh; radiosensitive organs; targeted radionuclide therapies |
| Journal Title: | Biomedical Physics and Engineering Express |
| Volume: | 7 |
| Issue: | 5 |
| ISSN: | 2057-1976 |
| Publisher: | IOP Publishing Ltd |
| Date Published: | 2021-09-01 |
| Start Page: | 057002 |
| Language: | English |
| DOI: | 10.1088/2057-1976/ac1550 |
| PUBMED: | 34271565 |
| PROVIDER: | scopus |
| PMCID: | PMC9014836 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2021 -- Source: Scopus |
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