In this publication the basic principles of radiation physics, imaging and non-imaging instrumentation used, measurement of the administered activity, calibration procedures and methods for obtaining quantitative information on the biodistribution of the radioactive drug to be used with radioisotopes relevant to therapy are specified. It also describes methods for segmentation and registration of images acquired at different time points, strategies for fitting and integration of activity measurements over the time of treatment, absorbed dose calculations and derived dosimetric indexes with methods to estimate the overall uncertainty of different radionuclide therapies. The aim of this book is to fill the existing gaps in education and training of medical physicists on methods for patient-specific dosimetry. The overall objective of this book is to highlight the tools and methodologies to assure that radiopharmaceutical therapy is implemented through a dosimetry-guided individualized treatment approach.

• Chapter 1INTRODUCTION
  • 1.1. Dosimetry for radiopharmaceutical therapy
  • 1.2. Dosimetry for diagnostic versus therapeutic purposes
  • 1.3. Dosimetry for therapy end points
  • 1.4. Radiobiology
  • 1.5. Traceability of measured dosimetry data to primary standards
  • 1.6. Standardization of patient dosimetry protocols
  • 1.7. Uncertainty
• References
• Chapter 2PHYSICS
  • 2.1. Radioactive decay
  • 2.2. Radionuclide emissions
    • 2.2.1. Alpha decay and alpha particles
    • 2.2.2. Beta decay
    • 2.2.3. Electron capture
    • 2.2.4. Gamma photons and internal conversion electrons
    • 2.2.5. Isomeric transition
    • 2.2.6. Characteristic X rays and Auger electrons
    • 2.2.7. Bremsstrahlung
  • 2.3. Radionuclide data
    • 2.3.1. Evolution and establishment of radionuclide data
    • 2.3.2. Radionuclide data for commonly used radionuclides in RPT
  • 2.4. Interaction and transport of photons and charged particles in tissue
    • 2.4.1. Photons
    • 2.4.2. Charged particles
    • 2.4.3. Point-source geometry and X90 for radionuclide emissions
  • 2.5. Absorbed dose for internally distributed radionuclides
• References
• Chapter 3METROLOGY — ACHIEVING ACCURATE AND CONSISTENT ABSORBED DOSE MEASUREMENT
  • 3.1. Primary standards and traceability in radiotherapy
    • 3.1.1. Primary standards of absorbed dose for RPT
    • 3.1.2. Primary and secondary standards of activity for RPT
    • 3.1.3. The principle of establishing traceability
  • 3.2. The formalism of the measurement chain in RPT
  • 3.3. Uncertainty analysis
  • 3.4. Standardization of measurements for RPT dosimetry
  • 3.5. Calibration of activity measurements — reference conditions
    • 3.5.1. Calibration of activity meters
    • 3.5.2. Calibration of SPECT or PET camera systems for quantitative imaging
  • 3.6. Validation of absorbed dose measurements in the clinic
    • 3.6.1. Activity measurements under non-reference conditions
    • 3.6.2. Validation of the calculation of absorbed dose from time-integrated activity
• References
• Chapter 4QUANTIFICATION OF ACTIVITY
  • 4.1. Introduction
  • 4.2. Measurement equipment
    • 4.2.1. Devices for ex vivo measurements
    • 4.2.2. Probe based counting systems
    • 4.2.3. Devices for imaging based measurements
  • 4.3. Tomographic image reconstruction
    • 4.3.1. General concepts
    • 4.3.2. The principles behind back projection
    • 4.3.3. Limitations with filtered back projection
    • 4.3.4. Iterative reconstruction
  • 4.4. Compensation for the main image degrading factors
    • 4.4.1. Photon attenuation
    • 4.4.2. Scatter contribution
    • 4.4.3. Resolution modelling
    • 4.4.4. Random coincidences correction in PET
  • 4.5. Motion correction
  • 4.6. Dead time corrections
  • 4.7. Activity quantification
    • 4.7.1. Conversion of counts to activity
    • 4.7.2. Partial volume correction
• References
• Chapter 5QUANTITATIVE IMAGING OF RADIONUCLIDES RELEVANT TO RADIOPHARMACEUTICAL THERAPY
  • 5.1. Overview
  • 5.2. Imaging surrogate isotopes
    • 5.2.1. Iodine-124
    • 5.2.2. Gallium-68
    • 5.2.3. Technetium-99m
    • 5.2.4. Iodine-123
    • 5.2.5. Indium-111
    • 5.2.6. Barium-133
  • 5.3. Imaging of therapy radionuclides
    • 5.3.1. Iodine-131
    • 5.3.2. Lutetium-177
    • 5.3.3. Rhenium-188
    • 5.3.4. Holmium-166
    • 5.3.5. Samarium-153
    • 5.3.6. Yttrium-90
  • 5.4. Imaging in alpha particle therapies
• References
• Chapter 6ANALYSIS OF TEMPORALLY VARYING DATA
  • 6.1. Temporal changes of activity distributions
  • 6.2. Image registration for determination of the time activity curve
  • 6.3. Organ/tumour quantification for determination of the time activity curve
  • 6.4. Segmenting images for time activity determination in organs and tumours
  • 6.5. Small volume absorbed dose estimates
  • 6.6. Techniques used for determination of the time-integrated activity
  • 6.7. Curve fitting methods for sets of exponential functions
  • 6.8. Optimal timing of data acquisition
  • 6.9. Pharmacokinetic modelling
• References
• Chapter 7ABSORBED DOSE CALCULATION
  • 7.1. Introduction
  • 7.2. Radiation range versus geometry: Penetrating and non-penetrating radiation
  • 7.3. Absorbed dose calculation algorithms
    • 7.3.1. Local energy deposition
    • 7.3.2. Absorbed dose calculation by convolution with point kernels
    • 7.3.3. Monte Carlo modelling of radiation transport
    • 7.3.4. Selecting the absorbed dose calculation algorithm
  • 7.4. Dosimetric approaches
  • 7.5. Summary of absorbed dose calculation approaches
• References
• Chapter 8CLINICAL RADIOBIOLOGICAL MODELLING FOR RADIOPHARMACEUTICAL THERAPY
  • 8.1. Introduction
  • 8.2. Linear–quadratic model
  • 8.3. Discussion
• References
• Chapter 9UNCERTAINTY ANALYSIS
  • 9.1. Introduction
  • 9.2. Terminology
  • 9.3. Propagation of uncertainty
  • 9.4. Sources of uncertainty in RPT dosimetry
  • 9.5. The activity meter
  • 9.6. Time-integrated activity
  • 9.7. Dosimetry based on probe detector measurements
    • 9.7.1. Whole body dosimetry
    • 9.7.2. Thyroid dosimetry
  • 9.8. Image based dosimetry
    • 9.8.1. Activity quantification from tomographic images
    • 9.8.2. Dosimetry for kidneys and lesions in 177Lu-DOTATATE treatments of neuroendocrine tumours based on hybrid SPECT/CT and planar imaging
    • 9.8.3. Technetiumechnetium-99m-MAA SPECT/CT image based predictive dosimetry in 90Y microsphere radioembolization
    • 9.8.4. Post-therapy 90Y PET/CT or bremsstrahlung SPECT/CT imaging based dosimetry in radioembolization
• References
• Chapter 10RADIOPHARMACEUTICAL TREATMENT MODALITIES
  • 10.1. Overview
  • 10.2. Iodine-131
    • 10.2.1. Iodine-131 sodium iodide
    • 10.2.2. Iodine-131 in benign thyroid disease
    • 10.2.3. Iodine-131 in malignant thyroid disease
    • 10.2.4. Iodine-131 mIBG
  • 10.3. Lutetium-177
    • 10.3.1. Lutetium-177
    • 10.3.2. Lutetium-177 labelled somatostatin analogues
    • 10.3.3. Lutetium-177 PSMA
  • 10.4. Radium-223
    • 10.4.1. Radium-223 dichloride
  • 10.5. Yttrium-90
    • 10.5.1. Yttrium-90 labelled microspheres
• References
• Chapter 11IMPLEMENTING DOSIMETRY IN THE CLINIC
  • 11.1. Current status of dosimetry in clinical practice
  • 11.2. Absorbed dose–effect relationship
  • 11.3. Clinical end point: Efficacy and toxicity
  • 11.4. Examples
    • 11.4.1. Different protocols can be used for the same pathology/clinical end point
    • 11.4.2. Very simple protocols can sometimes have a huge impact on patient management
    • 11.4.3. Mean absorbed dose computation may not be sufficient to explain absorbed dose–effect relationships
  • 11.5. Impact of the dosimetry protocol on the conclusions of dose–effect relationships
  • 11.6. Implementing dosimetry: Treatment planning or therapy verification?
    • 11.6.1. Dosimetry for treatment planning
    • 11.6.2. Dosimetry for therapy verification
  • 11.7. Clinical trials
  • 11.8. Conclusions
• References
• DEFINITIONS
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW