The influence of self-absorption on PET and PET/CT shielding requirements.

PURPOSE: The high energy (511 keV) annihilation photons used in positron emission tomography (PET) imaging generally require a substantial amount of lead to protect personnel and the general public from ionizing radiation. A cost-effective design of the PET facility that ensures radiation does not exceed formal dose limits requires accurate estimation of the necessary PET shielding. The American Association of Physicists in Medicine (AAPM) Task Group 108 recently published broad beam transmission factors based on Monte Carlo calculations of 511 keV photons. In this work, an extension to the AAPM model is presented, based on Monte Carlo simulations including the effects of self-absorption on the photon energy spectrum. METHODS: Monte Carlo calculations were performed using MCNPX. The photon energy spectrum after self-absorption was computed by simulating a normal 18FDG activity distribution in an anthropomorphic phantom. This spectrum was used to calculate the dose rate transmission factors for various wall thicknesses of lead, concrete, and iron. The method was validated by measurement and corresponding simulation of the transmission factors of an 18FDG source in air and in PMMA. Furthermore, a method to generate 3D area dose rate maps of PET facilities incorporating the calculated transmission tables is presented and applied to several shielding situations. RESULTS: The calculated self-absorption correction factor and the broad beam transmission factors resulting from Monte Carlo simulations of a monoenergetic point source emitting 511 keV photons were in excellent agreement with the results of the AAPM publication (0.66 vs 0.64 and R2 = 0.999, respectively). However, when all radiation physics, i.e., also the effect of self-absorption on the photon energy spectrum, is included in the Monte Carlo calculations, a substantial reduction in required shielding material was found. For example, including all radiation physics leads to 13.3 mm of lead required to obtain a typical transmission factor of 0.1, instead of 16.0 mm of lead when the AAPM data including only the self-absorption correction factor are used. These findings were confirmed by the experimental measurements. The transmission factors produced in this work can be applied in the same manner as those estimated by AAPM to allow for a cost-effective design of PET and PET/CT facilities without violating radiation safety regulations. CONCLUSIONS: Taking into account the effect of self-absorption on the photon energy spectrum results in more accurate and cost-effective shielding requirement estimations.

Holmium-166 poly(L-lactic acid) microsphere radioembolisation of the liver: technical aspects studied in a large animal model.

OBJECTIVE: To assess the accuracy of a scout dose of holmium-166 poly(L-lactic acid) microspheres ((166)Ho-PLLA-MS) in predicting the distribution of a treatment dose of (166)Ho-PLLA-MS, using single photon emission tomography (SPECT). METHODS: A scout dose (60 mg) was injected into the hepatic artery of five pigs and SPECT acquired. Subsequently, a 'treatment dose' was administered (540 mg) and SPECT, computed tomography (CT) and magnetic resonance imaging (MRI) of the total dose performed. The two SPECT images of each animal were compared. To validate quantitative SPECT an ex vivo liver was instilled with (166)Ho-PLLA-MS and SPECT acquired. The liver was cut into slices and planar images were acquired, which were registered to the SPECT image. RESULTS: Qualitatively, the scout dose and total dose images were similar, except in one animal because of catheter displacement. Quantitative analysis, feasible in two animals, tended to confirm this similarity (r(2) = 0.34); in the other animal the relation was significantly better (r(2) = 0.66). The relation between the SPECT and planar images acquired from the ex vivo liver was strong (r(2) = 0.90). CONCLUSION: In the porcine model a scout dose of (166)Ho-PLLA-MS can accurately predict the biodistribution of a treatment dose. Quantitative (166)Ho SPECT was validated for clinical application.

Clinical effects of transcatheter hepatic arterial embolization with holmium-166 poly(L-lactic acid) microspheres in healthy pigs.

PURPOSE: The aim of this study is to evaluate the toxicity of holmium-166 poly(L-lactic acid) microspheres administered into the hepatic artery in pigs. METHODS: Healthy pigs (20-30 kg) were injected into the hepatic artery with holmium-165-loaded microspheres ((165)HoMS; n=5) or with holmium-166-loaded microspheres ((166)HoMS; n=13). The microspheres' biodistribution was assessed by single-photon emission computed tomography and/or MRI. The animals were monitored clinically, biochemically, and ((166)HoMS group only) hematologically over a period of 1 month ((165)HoMS group) or over 1 or 2 months ((166)HoMS group). Finally, a pathological examination was undertaken. RESULTS: After microsphere administration, some animals exhibited a slightly diminished level of consciousness and a dip in appetite, both of which were transient. Four lethal adverse events occurred in the (166)HoMS group due either to incorrect administration or comorbidity: inadvertent delivery of microspheres into the gastric wall (n=2), preexisting gastric ulceration (n=1), and endocarditis (n=1). AST levels were transitorily elevated post-(166)HoMS administration. In the other blood parameters, no abnormalities were observed. Nuclear scans were acquired from all animals from the (166)HoMS group, and MRI scans were performed if available. In pigs from the (166)HoMS group, atrophy of one or more liver lobes was frequently observed. The actual radioactivity distribution was assessed through ex vivo (166m)Ho measurements. CONCLUSION: It can be concluded that the toxicity profile of HoMS is low. In pigs, hepatic arterial embolization with (166)HoMS in amounts corresponding with liver-absorbed doses of over 100 Gy, if correctly administered, is not associated with clinically relevant side effects. This result offers a good perspective for upcoming patient trials.