TY - JOUR
T1 - An international multi-center investigation on the accuracy of radionuclide calibrators in nuclear medicine theragnostics
AU - Vargas, Clarita Saldarriaga
AU - Bauwens, Matthias
AU - Pooters, Ivo N. A.
AU - Pomme, Stefaan
AU - Peters, Steffie M. B.
AU - Segbers, Marcel
AU - Jentzen, Walter
AU - Vogg, Andreas
AU - van Velden, Floris H. P.
AU - Viol, Sebastiaan L. Meyer
AU - Gotthardt, Martin
AU - Mottaghy, Felix M.
AU - Wildberger, Joachim E.
AU - Covens, Peter
AU - Wierts, Roel
N1 - Funding Information:
The authors kindly thank IDB Holland for providingLu without charge, Andrew Fenwick (NPL) for the helpful discussions regarding the activity standardizations, Reid Townson (National Research Council Canada) for providing simulation data on the reference chambers’ energy dependence, Mikael Hult (JRC) for logistic support, and GE Healthcare for providing packing materials without charge.
Funding Information:
This study was funded by Maastricht University Medical Center and the Belgian Nuclear Research Centre.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/11/23
Y1 - 2020/11/23
N2 - BackgroundPersonalized molecular radiotherapy based on theragnostics requires accurate quantification of the amount of radiopharmaceutical activity administered to patients both in diagnostic and therapeutic applications. This international multi-center study aims to investigate the clinical measurement accuracy of radionuclide calibrators for 7 radionuclides used in theragnostics: Tc-99m, In-111, I-123, I-124, I-131, Lu-177, and Y-90.MethodsIn total, 32 radionuclide calibrators from 8 hospitals located in the Netherlands, Belgium, and Germany were tested. For each radionuclide, a set of four samples comprising two clinical containers (10-mL glass vial and 3-mL syringe) with two filling volumes were measured. The reference value of each sample was determined by two certified radioactivity calibration centers (SCK CEN and JRC) using two secondary standard ionization chambers. The deviation in measured activity with respect to the reference value was determined for each radionuclide and each measurement geometry. In addition, the combined systematic deviation of activity measurements in a theragnostic setting was evaluated for 5 clinically relevant theragnostic pairs: I-131/I-123, I-131/I-124, Lu-177/In-111, Y-90/Tc-99m, and Y-90/In-111.ResultsFor Tc-99m, I-131, and Lu-177, a small minority of measurements were not within 5% range from the reference activity (percentage of measurements not within range: Tc-99m, 6%; I-131, 14%; Lu-177, 24%) and almost none were outside +/- 10% range. However, for In-111, I-123, I-124, and Y-90, more than half of all measurements were not accurate within +/- 5% range (In-111, 51%; I-123, 83%; I-124, 63%; Y-90, 61%) and not all were within +/- 10% margin (In-111, 22%; I-123, 35%; I-124, 15%; Y-90, 25%). A large variability in measurement accuracy was observed between radionuclide calibrator systems, type of sample container (vial vs syringe), and source-geometry calibration/correction settings used. Consequently, we observed large combined deviations (percentage deviation > +/- 10%) for the investigated theragnostic pairs, in particular for Y-90/In-111, I-131/I-123, and Y-90/Tc-99m.Conclusions Our study shows that substantial over- or underestimation of therapeutic patient doses is likely to occur in a theragnostic setting due to errors in the assessment of radioactivity with radionuclide calibrators. These findings underline the importance of thorough validation of radionuclide calibrator systems for each clinically relevant radionuclide and sample geometry.
AB - BackgroundPersonalized molecular radiotherapy based on theragnostics requires accurate quantification of the amount of radiopharmaceutical activity administered to patients both in diagnostic and therapeutic applications. This international multi-center study aims to investigate the clinical measurement accuracy of radionuclide calibrators for 7 radionuclides used in theragnostics: Tc-99m, In-111, I-123, I-124, I-131, Lu-177, and Y-90.MethodsIn total, 32 radionuclide calibrators from 8 hospitals located in the Netherlands, Belgium, and Germany were tested. For each radionuclide, a set of four samples comprising two clinical containers (10-mL glass vial and 3-mL syringe) with two filling volumes were measured. The reference value of each sample was determined by two certified radioactivity calibration centers (SCK CEN and JRC) using two secondary standard ionization chambers. The deviation in measured activity with respect to the reference value was determined for each radionuclide and each measurement geometry. In addition, the combined systematic deviation of activity measurements in a theragnostic setting was evaluated for 5 clinically relevant theragnostic pairs: I-131/I-123, I-131/I-124, Lu-177/In-111, Y-90/Tc-99m, and Y-90/In-111.ResultsFor Tc-99m, I-131, and Lu-177, a small minority of measurements were not within 5% range from the reference activity (percentage of measurements not within range: Tc-99m, 6%; I-131, 14%; Lu-177, 24%) and almost none were outside +/- 10% range. However, for In-111, I-123, I-124, and Y-90, more than half of all measurements were not accurate within +/- 5% range (In-111, 51%; I-123, 83%; I-124, 63%; Y-90, 61%) and not all were within +/- 10% margin (In-111, 22%; I-123, 35%; I-124, 15%; Y-90, 25%). A large variability in measurement accuracy was observed between radionuclide calibrator systems, type of sample container (vial vs syringe), and source-geometry calibration/correction settings used. Consequently, we observed large combined deviations (percentage deviation > +/- 10%) for the investigated theragnostic pairs, in particular for Y-90/In-111, I-131/I-123, and Y-90/Tc-99m.Conclusions Our study shows that substantial over- or underestimation of therapeutic patient doses is likely to occur in a theragnostic setting due to errors in the assessment of radioactivity with radionuclide calibrators. These findings underline the importance of thorough validation of radionuclide calibrator systems for each clinically relevant radionuclide and sample geometry.
KW - Activity measurement
KW - Radionuclide calibrator
KW - Accuracy
KW - Theragnostics
U2 - 10.1186/s40658-020-00338-3
DO - 10.1186/s40658-020-00338-3
M3 - Article
C2 - 33226485
SN - 2197-7364
VL - 7
JO - EJNMMI Physics
JF - EJNMMI Physics
IS - 1
M1 - 69
ER -