Actualización en carcinoma diferenciado de tiroides refractario a radioyodo / Update on iodine-refractory differentiated thyroid carcinoma

La terapia con radioyodo constituye un pilar fundamental en la terapia adyuvante de rutina de los pacientes con carcinoma diferenciado de tiroides de alto riesgo. Sin embargo, un porcentaje no despreciable de estos pacientes desarrollaran un estado de refractariedad a este tratamiento, mostrando un peor pronóstico, disminuyendo la supervivencia y la esperanza de vida, lo que demuestra una clara necesidad de explorar distintos abordajes terapéuticos. El tratamiento de los pacientes refractarios al radioyodo sigue siendo un desafío, disponiendo en la actualidad de distintas opciones terapéuticas novedosas que deben ser conocidas por las distintas especialidades relacionadas con el carcinoma diferenciado de tiroides (CDT). El objetivo del presente trabajo es hacer una revisión del CDT refractario al tratamiento con yodo radiactivo, centrándose especialmente en la definición de yodorrefractariedad, destacando su importancia por su elevada mortalidad, e introducir las diferentes opciones terapéuticas disponibles para estos pacientes (AU)

Radioiodine therapy represents a fundamental pillar in the routine adjuvant therapy of patients with high-risk differentiated thyroid carcinoma. However, a non-negligible percentage of these patients will develop iodine refractoriness, showing a worse prognosis, as well a lower survival, which demonstrates a clear need to explore different therapeutic approaches. Iodine refractory patient treatment continues to be a challenge, currently having different novel therapeutic options that should be known by the different specialties related to differentiated thyroid carcinoma (DTC). The aim of this work is to review iodine refractory thyroid carcinoma treatment, focusing especially on the definition of iodine refractoriness, highlighting its importance due to its high mortality, and introducing the different therapeutic options available for these patients (AU)

Update on iodine-refractory differentiated thyroid carcinoma.

Radioiodine therapy represents a fundamental pillar in the routine adjuvant therapy of patients with high-risk differentiated thyroid carcinoma. However, a non-negligible percentage of these patients will develop iodine refractoriness, showing a worse prognosis, as well a lower survival, which demonstrates a clear need to explore different therapeutic approaches. Iodine refractory patient treatment continues to be a challenge, currently having different novel therapeutic options that should be known by the different specialties related to differentiated thyroid carcinoma (DTC). The aim of this work is to review iodine refractory thyroid carcinoma treatment, focusing especially on the definition of iodine refractoriness, highlighting its importance due to its high mortality, and introducing the different therapeutic options available for these patients.

Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases.

OBJECTIVE: To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. MATERIAL AND METHODS: This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. RESULTS: Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8GBq (0.7-6.4GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. CONCLUSIONS: Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines.

Radioembolización en hepatocarcinoma: a propósito de 53 casos / Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases

Objetivo Contribuir con la presentación de los resultados de nuestro estudio a ampliar la evidencia científica sobre el empleo de la radioembolización en el manejo de pacientes con hepatocarcinoma. Material y método Se trata de una revisión retrospectiva realizada en nuestro centro que incluye a 53 pacientes con hepatocarcinoma tratados con radioembolización. Los pacientes fueron clasificados según el algoritmo del BCLC (Barcelona Clinic Liver Cancer) y de forma pormenorizada por su estado funcional siguiendo la clasificación de Child-Pugh. Se realizó un estudio de supervivencia siguiendo la metodología de Kaplan-Meier. Se empleó el método de regresión de Cox para la determinación de parámetros clínicos significativos, incluyendo dosis administradas en los parámetros estudiados. Resultados La serie evaluada comprende a pacientes con una media de edad de 60 años (rango 28-86). Se llevaron a cabo un total de 61 procedimientos. La actividad media administrada fue de 2,8 GBq (0,7-6,4 GBq), administrando una dosis media en tumor de 229,9 Gy (74-425,9 Gy). El tiempo libre de progresión fue de 6,7 meses desde el momento del tratamiento y la supervivencia global fue de 12,8 meses. La clasificación de los pacientes según BCLC (p=0,848) y Child-Pugh (p=0,252) no resultó significativa respecto al tiempo libre de enfermedad. Los parámetros clínicos que resultaron con diferencias significativas en cuanto a supervivencia global fueron los niveles de bilirrubina (p<0.001) y las cifras de transaminasas (GOT) pretratamiento (p=0.022), la subclasificación Child-Pugh (p=0.003) y la dosis recibida por el tumor (p=0,001). Tan solo uno de los pacientes tratados presentó un efecto adverso grave, con fallo hepático posterapia y resultado de muerte... (AU)

Objective To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. Material and methods This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. Results Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8 GBq (0.7-6.4 GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. Conclusions Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines. (AU)

Terapia con péptidos radiomarcados con [177Lu]Lu-DOTA-TATE / Peptide receptor radionuclide therapy with [177Lu]Lu-DOTA-TATE

Esta formación pretende presentar, de forma clara y de fácil comprensión, la biología de los tumores neuroendocrinos (TNE), las características de los receptores de somatostatina, cómo debe realizarse la selección de pacientes candidatos a terapia con péptidos radiomarcados (PRRT), si el paciente cumple los criterios para beneficiarse del tratamiento con los mínimos efectos adversos posibles, el protocolo de administración, seguimiento y evaluación de respuesta. También, se desarrollan los estudios de imagen funcional necesarios para explorar la biología del tumor e individualizar el tratamiento, que constituyen la piedra angular para el desarrollo de la teragnosis.Se están desarrollando ensayos clínicos para definir mejor la posición de PRRT dentro del amplio panorama terapéutico y, entre las perspectivas de futuro, hay varias líneas de investigación para mejorar la tasa de respuesta objetiva y la supervivencia con PRRT, centradas en el desarrollo de nuevos agonistas y antagonistas del receptor de somatostatina, nuevos radionúclidos y terapias combinadas radiosensibilizantes.En conclusión, la PRRT es un tratamiento bien tolerado, seguro y con efectos secundarios agudos, generalmente leves y autolimitados, que constituye una gran herramienta terapéutica que debe secuenciarse en el mejor momento de la evolución de la enfermedad de los pacientes con TNE. Los pacientes candidatos a la PRRT deben ser valorados siempre por un comité clínico multidisciplinar (AU)

This continuing education aims to present in a clear and easy-to-understand way, the biology of neuroendocrine tumors (NETs), the characteristics of somatostatin receptors, the selection of patients for radiolabelled peptide therapy (PRRT), the inclusion criteria to benefit from treatment with the minimum possible adverse effects, the administration protocol, follow-up and response evaluation. The functional imaging studies necessary to explore the biology of the tumor and to individualize the treatment are also carried out, and constitute the cornerstone for the development of teragnosis.Clinical trials are being developed to better define the position of PRRT within the broad therapeutic options, and among the future perspectives, there are several lines of research to improve the objective response rate and survival with PRRT, focused on the development of new agonists and somatostatin receptor antagonists, new radionuclides and radiosensitizing combination therapies.In conclusion, PRRT is a great therapeutic, well-tolerated and safe tool with generally mild and self-limited acute side effects, that must be sequenced at the best moment of the evolution of the disease of patients with NET. Candidate patients for PRRT should always be evaluated by an multidisciplinary clinical committee (AU)

Peptide receptor radionuclide therapy with [177Lu]Lu-DOTA-TATE.

This continuing education aims to present in a clear and easy-to-understand way, the biology of neuroendocrine tumors (NETs), the characteristics of somatostatin receptors, the selection of patients for radiolabelled peptide therapy (PRRT), the inclusion criteria to benefit from treatment with the minimum possible adverse effects, the administration protocol, follow-up and response evaluation. The functional imaging studies necessary to explore the biology of the tumor and to individualize the treatment are also carried out, and constitute the cornerstone for the development of teragnosis. Clinical trials are being developed to better define the position of PRRT within the broad therapeutic options, and among the future perspectives, there are several lines of research to improve the objective response rate and survival with PRRT, focused on the development of new agonists and somatostatin receptor antagonists, new radionuclides and radiosensitizing combination therapies. In conclusion, PRRT is a great therapeutic, well-tolerated and safe tool with generally mild and self-limited acute side effects, that must be sequenced at the best moment of the evolution of the disease of patients with NET. Candidate patients for PRRT should always be evaluated by a multidisciplinary clinical committee.

Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases. / Radioembolización de hepatocarcinomas: a propósito de 53 casos.

OBJECTIVE: To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. MATERIAL AND METHODS: This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. RESULTS: Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8 GBq (0.7-6.4 GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. CONCLUSIONS: Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines.

Uso del 177Lu-DOTATATE como terapia en carcinomas de tiroides yodorrefractarios / Use of 177Lu-dotatate in the treatment of iodine refractory thyroid carcinomas

Ante un paciente con cáncer diferenciado de tiroides, el protocolo de tratamiento estándar a seguir es cirugía, ablación con 131Iodo (131I) de restos tiroideos y supresión de TSH. Pero en algunos casos, el tratamiento con 131I no es efectivo y deja de ser una opción terapéutica debido a la desdiferenciación celular con pérdida de la captación de 131I. Como otras opciones, se puede recurrir a tratamiento sistémico, si bien los pacientes no siempre son respondedores, pudiendo progresar la enfermedad y quedando sin opciones terapéuticas. Los tumores endocrinos pueden expresar receptores de la somatostatina, lo que se ha utilizado tanto para el diagnóstico como para su tratamiento mediante el marcaje de los análogos de la somatostatina con isótopos radiactivos. Presentamos el caso de una paciente con carcinoma folicular de tiroides yodorrefractario, con expresión de receptores de la somatostatina, tratada con 177Lu-DOTATATE, con excelente respuesta clínica y analítica (AU)

In a patient with a differentiated thyroid cancer the standard treatment protocol to be followed is surgery, ablation of thyroid remnants with 131Iodine (131I), and TSH suppression. However, the treatment with 131I is not effective in some cases, and it no longer becomes a therapeutic option due to cell de-differentiation with loss of 131I uptake. Systemic treatment can be used as other options, although patients are not always responsive; thus, the disease may progress and therapeutic options may run out. Endocrine tumours may express somatostatin receptors,and this characteristic has been used, not only for diagnosis, but also for their treatment through somatostatin analogue labelling with radioactive isotopes. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin receptors expression, treated with 177Lu-DOTATATE, showing an excellent clinical and analytical response (AU)

Más allá del nomograma de Briganti: individualización de la linfadenectomía utilizando la biopsia selectiva del ganglio centinela durante la prostatectomía radical por cáncer de próstata / Beyond the Briganti nomogram: Individualisation of lymphadenectomy using selective sentinel node biopsy during radical prostatectomy for prostate cancer

Objetivo: Validar la técnica de biopsia selectiva de ganglio centinela en el diagnóstico y estadificación del cáncer de próstata de riesgo intermedio y alto mediante comparación con la linfadenectomía extendida convencional (eLFD) en un estudio prospectivo longitudinal y comparativo. Métodos: Hemos aplicado la técnica a 45 pacientes. Previa inyección intraprostática de 99mTc-nanocoloide y SPECT-TC preoperatoria, se han extraído los ganglios centinela guiados con gammacámara portátil Sentinella® y sonda detectora de rayos gamma laparoscópica. Se completó la eLFD para establecer el valor predictivo negativo de la técnica. Resultados: La SPECT-TC mostró depósitos del radiotrazador fuera del territorio de la eLFD en el 73% de los pacientes y la gammasonda laparoscópica en el 60%. La media de focos activos por paciente en la SPECT-TC fue de 4,3 y con gammasonda laparoscópica de 3,2. La media de ganglios linfáticos centinelas extraídos fue 4,3 (0-14), el 26% fuera del territorio de la eLFD. En 10 pacientes (22%) se encontraron ganglios metastásicos, 6/40 (15%) cuando la prostatectomía fue el tratamiento primario. En todos los casos con ganglios metastásicos hubo, al menos, un ganglio centinela positivo. Se encontraron ganglios centinela metastásicos fuera del territorio de la eLFD en 3/10 pacientes (30%). La sensibilidad fue del 100%, la especificidad del 94,73%, el valor predictivo positivo del 81,81% y el valor predictivo negativo del 100%. Conclusión: La biopsia selectiva del ganglio centinela es superior a la eLFD en el diagnóstico de afectación ganglionar, y puede evitar la eLFD cuando no se encuentren ganglios centinela metastásicos (85%), con las consecuentes ventajas funcionales

Objective: To validate the technique of selective sentinel node biopsy for diagnosing and staging intermediate to high-risk prostate cancer by comparing the technique with conventional extended lymphadenectomy (eLFD) in a prospective, longitudinal comparative study. Methods: We applied the technique to 45 patients. After an intraprostatic injection of 99mTc-nanocolloid and preoperative single-photon emission computed tomography (SPECT/CT), we extracted the sentinel lymph nodes, guided by a portable Sentinella® gamma camera and a laparoscopic gamma-ray detection probe. The eLFD was completed to establish the negative predictive value of the technique. Results: SPECT/CT showed radiotracer deposits outside the eLFD territory in 73% of the patients and the laparoscopic gamma probe in 60%. The mean number of active foci per patient was 4.3 in the SPECT/CT and 3.2 in the laparoscopic gamma probe. The mean number of extracted sentinel lymph nodes was 4.3 (0-14), with 26% outside the eLFD territory. The lymph nodes were metastatic in 10 patients (22%), 6/40 (15%) when the prostatectomy was the primary treatment. In all cases with metastatic lymph nodes, there was at least one positive sentinel node. Metastatic sentinel lymph nodes were found outside the eLFD territory in 3/10 patients (30%). The sensitivity was 100%, the specificity was 94.73%, the positive predictive value was 81.81%, and the negative predictive value was 100%. Conclusion: Selective sentinel node biopsy is superior to eLFD for diagnosing lymph node involvement and can avoid eLFD when metastatic sentinel lymph nodes are not found (85%), with the consequent functional advantages

Use of 177Lu-dotatate in the treatment of iodine refractory thyroid carcinomas. / Uso del 177Lu-DOTATATE como terapia en carcinomas de tiroides yodorrefractarios.

In a patient with a differentiated thyroid cancer the standard treatment protocol to be followed is surgery, ablation of thyroid remnants with 131Iodine (131I), and TSH suppression. However, the treatment with 131I is not effective in some cases, and it no longer becomes a therapeutic option due to cell de-differentiation with loss of 131I uptake. Systemic treatment can be used as other options, although patients are not always responsive; thus, the disease may progress and therapeutic options may run out. Endocrine tumours may express somatostatin receptors,and this characteristic has been used, not only for diagnosis, but also for their treatment through somatostatin analogue labelling with radioactive isotopes. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin receptors expression, treated with 177Lu-DOTATATE, showing an excellent clinical and analytical response.

Beyond the Briganti nomogram: Individualisation of lymphadenectomy using selective sentinel node biopsy during radical prostatectomy for prostate cancer. / Más allá del nomograma de Briganti: individualización de la linfadenectomía utilizando la biopsia selectiva del ganglio centinela durante la prostatectomía radical por cáncer de próstata.

OBJECTIVE: To validate the technique of selective sentinel node biopsy for diagnosing and staging intermediate to high-risk prostate cancer by comparing the technique with conventional extended lymphadenectomy (eLFD) in a prospective, longitudinal comparative study. METHODS: We applied the technique to 45 patients. After an intraprostatic injection of 99mTc-nanocolloid and preoperative single-photon emission computed tomography (SPECT/CT), we extracted the sentinel lymph nodes, guided by a portable Sentinella® gamma camera and a laparoscopic gamma-ray detection probe. The eLFD was completed to establish the negative predictive value of the technique. RESULTS: SPECT/CT showed radiotracer deposits outside the eLFD territory in 73% of the patients and the laparoscopic gamma probe in 60%. The mean number of active foci per patient was 4.3 in the SPECT/CT and 3.2 in the laparoscopic gamma probe. The mean number of extracted sentinel lymph nodes was 4.3 (0-14), with 26% outside the eLFD territory. The lymph nodes were metastatic in 10 patients (22%), 6/40 (15%) when the prostatectomy was the primary treatment. In all cases with metastatic lymph nodes, there was at least one positive sentinel node. Metastatic sentinel lymph nodes were found outside the eLFD territory in 3/10 patients (30%). The sensitivity was 100%, the specificity was 94.73%, the positive predictive value was 81.81%, and the negative predictive value was 100%. CONCLUSION: Selective sentinel node biopsy is superior to eLFD for diagnosing lymph node involvement and can avoid eLFD when metastatic sentinel lymph nodes are not found (85%), with the consequent functional advantages.

Esplenosis abdominal: una entidad frecuentemente infradiagnosticada / Abdominal splenosis: an often underdiagnosed entity

La esplenosis se define como el autotrasplante heterotópico de tejido esplénico como resultado de una rotura del bazo por trauma o cirugía. Es una condición benigna y de hallazgo casual, aunque en ciertas ocasiones las pruebas de imagen puedan orientar a malignidad simulando tumores renales, linfomas abdominales y endometriosis, entre otros. Presentamos el caso de un varón de 42 años al que, tras un estudio por dolor abdominal, se le realiza una resonancia magnética en la que se observan múltiples adenopatías en el abdomen que pueden orientar a un síndrome linfoproliferativo. Como antecedente importante, presenta esplenectomía por trauma abdominal a los 9 años. Tras varios estudios, se decide realizar una gammagrafía con hematíes desnaturalizados marcados con tecnecio-99m que muestra múltiples depósitos patológicos distribuidos por todo el abdomen e, incluso, la pelvis, siendo este hallazgo compatible con esplenosis(AU)

Splenosis is defined as the heterotopic autotransplantation of splenic tissue because of a ruptured spleen due to trauma or surgery. It is a benign and incidental finding, although imaging tests may sometimes orient toward malignancy simulating renal tumors, abdominal lymphomas, endometriosis, among other. We report the case of a 42-year old male in whom a MRI was performed after a study due to abdominal pain. Multiple enlarged lymph nodes were observed in the abdomen, suggestive of lymphoproliferative disease. As an important background, splenectomy was carried out due to abdominal trauma at age 9. After several studies, it was decided to perform a 99mTc-labeled heat-damaged red blood cell scintigraphy that showed multiple pathological deposits distributed throughout the abdomen, and even the pelvis, being consistent with splenosis(AU)

[Abdominal splenosis: an often underdiagnosed entity]. / Esplenosis abdominal: una entidad frecuentemente infradiagnosticada.

Splenosis is defined as the heterotopic autotransplantation of splenic tissue because of a ruptured spleen due to trauma or surgery. It is a benign and incidental finding, although imaging tests may sometimes orient toward malignancy simulating renal tumors, abdominal lymphomas, endometriosis, among other. We report the case of a 42-year old male in whom a MRI was performed after a study due to abdominal pain. Multiple enlarged lymph nodes were observed in the abdomen, suggestive of lymphoproliferative disease. As an important background, splenectomy was carried out due to abdominal trauma at age 9. After several studies, it was decided to perform a (99m)Tc-labeled heat-damaged red blood cell scintigraphy that showed multiple pathological deposits distributed throughout the abdomen, and even the pelvis, being consistent with splenosis.

Aplicación de los factores de ponderación de la Comisión Internacional de Protección Radiológica 103 en el cálculo de la dosis efectiva asociada a las exploraciones de Medicina Nuclear / Application of ICRP-103 in the calculation of effective dose associated to nuclear medicine tests

ObjetivoRevaluar la dosis efectiva (E) de las exploraciones típicas en Medicina Nuclear teniendo en cuenta los nuevos factores de ponderación de la Comisión Internacional de Protección Radiológica (ICRP) 103 y los datos más actualizados en cuanto a la dosimetría, y relacionar la E con el tiempo equivalente de radiación natural (TERN).Material y métodosSe ha calculado la E asociada a los radiofármacos y a las exploraciones habituales en Medicina Nuclear para las edades: adulto, 15, 10, 5 y 1 año. Se han empleado los datos dosimétricos de ICRP-106, ICRP-80, ICRP-53 y/o prospecto del fabricante.ResultadosSe muestra una relación de datos de E asociada a radiofármacos y exploraciones. Los nuevos factores de ponderación de tejidos dan como resultado un valor disminuido de la E, excepto en aquellos casos que afectan especialmente a la mama, para los que aumenta. La E asociada a las exploraciones de Medicina Nuclear está en el rango de 0,1–60mSv. El TERN va desde unos pocos días a una veintena de años. La E asociada a exploraciones que se realizan en niños es, en general, superior a la E correspondiente en adulto.ConclusionesLos resultados mostrados en este trabajo constituyen una colección actualizada de valores de E para los radiofármacos de uso habitual en Medicina Nuclear. Expresar la E en unidades de TERN ayuda a explicar a los pacientes y al personal sanitario cuestiones relacionadas con la exposición a la radiación asociada a una exploración(AU)

ObjectiveRe-evaluate the effective dose (E) of typical nuclear medicine procedures using the new ICRP-103 weighting factors and the latest dosimetry data and relate E with Background Equivalent Radiation Time (BERT).Material and MethodsEffective dose associated with radiopharmaceuticals and nuclear medicine procedures has been calculated for the following ages: adult, 15, 10, 5 and 1 year. Dosimetry data have been extracted from ICRP-106, ICRP-80, ICRP-53 and/or manufacturer's brochure.ResultsThe relationship of the data of effective dose associated with radiopharmaceuticals and explorations is shown. The new tissue weighting factors result in a decreased value of the effective dose, except in cases that particularly affect the breast, in which it increases. The effective dose associated with nuclear medicine procedures is in the range 0.1–60mSv. BERT ranges from a few days to 20 years. The effective dose associated to tests in children is generally higher than the effective dose for an adult.ConclusionsThe results shown in this paper are an updated collection of effective dose values for commonly used radiopharmaceuticals in nuclear medicine. Expressing the effective dose equivalent time in units of natural radiation helps to explain issues associated with radiation exposure to patients and healthcare personnel(AU)

[Application of ICRP-103 in the calculation of effective dose associated to nuclear medicine tests]. / Aplicación de los factores de ponderación de la Comisión Internacional de Protección Radiológica 103 en el cálculo de la dosis efectiva asociada a las exploraciones de Medicina Nuclear.

OBJECTIVE: Re-evaluate the effective dose (E) of typical nuclear medicine procedures using the new ICRP-103 weighting factors and the latest dosimetry data and relate E with Background Equivalent Radiation Time (BERT). MATERIAL AND METHODS: Effective dose associated with radiopharmaceuticals and nuclear medicine procedures has been calculated for the following ages: adult, 15, 10, 5 and 1 year. Dosimetry data have been extracted from ICRP-106, ICRP-80, ICRP-53 and/or manufacturer's brochure. RESULTS: The relationship of the data of effective dose associated with radiopharmaceuticals and explorations is shown. The new tissue weighting factors result in a decreased value of the effective dose, except in cases that particularly affect the breast, in which it increases. The effective dose associated with nuclear medicine procedures is in the range 0.1-60 mSv. BERT ranges from a few days to 20 years. The effective dose associated to tests in children is generally higher than the effective dose for an adult. CONCLUSIONS: The results shown in this paper are an updated collection of effective dose values for commonly used radiopharmaceuticals in nuclear medicine. Expressing the effective dose equivalent time in units of natural radiation helps to explain issues associated with radiation exposure to patients and healthcare personnel.