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The Biodistribution (II): Human

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Nuclear Medicine Radiation Dosimetry

Abstract

The measurement of the distribution and excretion of the radionuclide following the administration of a radiopharmaceutical is necessary in order to evaluate the consequential internal radiation dosimetry. This chapter reviews various in vivo and in vitro means of acquiring these data. The conjugate-view method used commonly in planar scintigraphy is derived and the various compensatory techniques to account for attenuation and photon scatter are derived and examined. Quantitative single-photon emission computed tomography (SPECT) which, due to current limitations in technology, is limited to absorbed dose evaluations of small anatomical volumes is reviewed as are the corrections required for scatter and attenuation. Positron emission tomography (PET) is inherently quantitative and its greater sensitivity compared to SPECT permits whole-body biodistributions of positron-emitting radionuclides to be measured. The principles of PET data acquisition are reviewed in the context of the nuclear medicine physicist designing a protocol for a whole-body biodistribution measurement. Finally, quantitative bremsstrahlung imaging of β-emitting therapeutic radionuclides is a most challenging endeavor, and one which is not frequently performed. A review of the methodologies is provided.

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Notes

  1. 1.

    Excretion of activity through sweat and saliva is rarely measured and would only be done for a specific purpose such as estimating the radioactive contamination from a subject having received a high administered activity of a long-lived therapeutic radionuclide (e.g., 131I).

  2. 2.

    It is desired to know if there are significant differences between the biodistribution derived from the healthy volunteer cohort and those of patients that could affect the dosimetry estimate for the latter. As Phase II subjects are patients with disease, they are unlikely to be able to tolerate as complete an assessment of the biodistribution as performed in Phase I. Hence, comparison of the measurements of the rate at which activity is cleared from blood and/or is excreted can assist in assessing if the biodistribution is significantly changed in the diseased cohort.

  3. 3.

    Everitt (1994) has challenged this last assertion by suggesting that the use of meta-analysis means that there are few clinical studies with insufficient numbers of subjects that cannot help to resolve important clinical questions.

  4. 4.

    This is not quite so true for short-lived radioisotopes, such as 11C, excreted through the urinary pathway. If the physical half-life of the isotope is much less than the time between urinary bladder voids, the activity of the urinary bladder contents can be determined more directly through in vivo imaging.

  5. 5.

    For activity measurements for biodistribution and dosimetry studies alone, there is no reason that blood samples cannot be arterial, should kinetic modeling using an arterial input function be concurrent as in a PET study.

  6. 6.

    The patient would receive a higher administered activity in order to allow a diagnostic-quality image. Hence, the usual optimization of benefit versus exposure risk used in medical practice would apply.

  7. 7.

    In principle, conjugate-view scintigraphy could be performed with a single-headed gamma camera: one view whole-body scan, followed by a rotation of the gamma camera head by 180o and a subsequent scan of the conjugate-view. However, error is introduced as the biodistributions of both views were not acquired at the same time. The error would be greatest at early times postinjection when still in the distribution phase.

  8. 8.

    A gamma camera typically acts as a paralysable system.

  9. 9.

    While selecting the detector’s energy discriminator to accept only the high-energy photon components will avoid this mechanism of scatter contribution, this comes at the impractical cost of thicker and heavier collimators.

  10. 10.

    The condition of an atrophic kidney with compensatory hypertrophy in the contralateral kidney, which is not unknown, would make this method unusable.

  11. 11.

    See, for example, Bailey (2003) for a description of the scintillation light photon-electron conversion detection element.

  12. 12.

    A scattered coincidence is, strictly speaking, a “true” coincidence as both detections arise from the same annihilation event, even though an incorrect LoR results. For the purpose of discussion here, a “true” coincidence is defined as that arising from the pair of unscattered photons created by the same electron–positron annihilation.

  13. 13.

    Although caution is required in the substitution approach as the vector conjugated with the therapeutic radionuclide may have differing biokinetics than when conjugated with the diagnostic radionuclide.

  14. 14.

    Recall from Chap. 7 that bremsstrahlung from α particles with kinetic energies typically used in nuclear medicine is negligible.

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McParland, B.J. (2010). The Biodistribution (II): Human. In: Nuclear Medicine Radiation Dosimetry. Springer, London. https://doi.org/10.1007/978-1-84882-126-2_14

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