RESUMO
PURPOSE: Recently, there has been a growing interest in a methodology for dose planning in radiosynoviorthesis to substitute fixed activity. Clinical practice based on fixed activity frequently does not embrace radiopharmaceutical dose optimization in patients. The aim of this paper is to propose and discuss a dose planning methodology considering the radiological findings of interest obtained by three-dimensional magnetic resonance imaging combined with Monte Carlo simulation in radiosynoviorthesis treatment applied to hemophilic arthropathy. METHOD: The parameters analyzed were: surface area of the synovial membrane (synovial size), synovial thickness and joint effusion obtained by 3D MRI of nine knees from nine patients on a SIEMENS AVANTO 1.5 T scanner using a knee coil. The 3D Slicer software performed both the semiautomatic segmentation and quantitation of these radiological findings. A Lucite phantom 3D MRI validated the quantitation methodology. The study used Monte Carlo N-Particle eXtended code version 2.6 for calculating the S-values required to set up the injected activity to deliver a 100 Gy absorbed dose at a determined synovial thickness. The radionuclides assessed were: 90Y, 32P, 188Re, 186Re, 153Sm, and 177Lu, and the present study shows their effective treatment ranges. RESULT: The quantitation methodology was successfully tested, with an error below 5% for different materials. S-values calculated could provide data on the activity to be injected into the joint, considering no extra-articular leakage from joint cavity. Calculation of effective treatment range could assist with the therapeutic decision, with an optimized protocol for dose prescription in RSO. CONCLUSION: Using 3D Slicer software, this study focused on segmentation and quantitation of radiological features such as joint effusion, synovial size, and thickness, all obtained by 3D MRI in patients' knees with hemophilic arthropathy. The combination of synovial size and thickness with the parameters obtained by Monte Carlo simulation such as effective treatment range and S-value, from which is calculated the injected activity, could be used for treatment planning in RSO. Data from this methodology could be a potential aid to clinical decision making by selecting the most suitable radionuclide; justifying the procedure, fractioning the dose, and the calculated injected activity for children and adolescents, considering both the synovial size and thickness.
Assuntos
Imageamento por Ressonância Magnética , Compostos Radiofarmacêuticos , Planejamento da Radioterapia Assistida por Computador , Humanos , Método de Monte Carlo , Imagens de Fantasmas , Radioisótopos , Dosagem RadioterapêuticaRESUMO
RESUMEN La primera fase del ensayo clínico del anticuerpo monoclonal humanizado h-R3 (Nimotuzumab) marcado con 
, para la radioinmunoterapia de tumores cerebrales malignos fue ejecutada durante el período 2002-2005 en Cuba. El objetivo del trabajo fue analizar los datos de la vigilancia radiológica realizada durante el estudio, con respecto a las dosis estimadas inicialmente. Estas últimas se calcularon para cada nivel de actividad, operación y cantidad total de pacientes, considerando el decaimiento radiactivo del y que una misma persona realizaba todas las operaciones. Se demostró que el riesgo radiológico de la práctica es aceptable. Las hipótesis conservadoras empleadas para los cálculos y el cumplimiento de los procedimientos de seguridad establecidos, determinaron que la exposición medida fuera inferior a la estimada. La realización de este trabajo constituye una referencia para la introducción y desarrollo de la radioinmunoterapia en Cuba.
ABSTRACT The first phase of the clinical trial using the humanized monoclonal antibody h-R3 (Nimotuzumab) labelled with , for radioimmunotherapy of brain malignant was performed during the period 2002-2005 in Cuba. The aim of this work was to analyze data from the radiological surveillance of this research compared to initially estimated doses. These latter were calculated for each activity level, operation and total quantity of patients, considering the radioactive decay of and taking into account that only one person carries out all of the operations. It was demonstrated that the radiation risk of the practice is acceptable. The conservative hypotheses for dose assessment and the compliance with established safety procedures during this trial showed that the measured exposure was lower than that estimated. This paper is a reference useful to introduce and develop the RIT in Cuba.