Radiation dose assessment for I-131 therapy of thyroid cancer using I-124 PET imaging

The goal for this work was to develop a method to determine the feasibility of estimating absorbed dose distribution of I-131 thyroid therapy using I-124 PET images of residual thyroid lesions with the dose constraint of 200 cGy to blood, that is a surrogate for bone marrow toxicity. A dose response study has been carried out on 3 patients with papillary thyroid carcinoma. Those patients were given 15-37 MBq of I-124 along with 74-185 MBq of I-131. PET imaging was performed 2-4 hour and then at 24 hour and either 48 hour, or 72 hour post-infusion. Lesion masses were computed from PET images using an adaptive thresholding technique. The definition of the boundary enabled determination of the iodine activity within the lesion. Time-activity curves were fitted to estimate the cumulated activity and therefore the absorbed dose per MBq administered. Daily blood and total body counts were performed on the patients using a multichannel analyzer with windows set for both I-131 (364 keV) and I-124 (511 keV). Cross-talk corrections from one isotope into the alternate window was determined using a standard of each respective isotope. At maximum-tolerated-activity (MTA) that delivers 200 cGy radiation dose to the blood, the dose to lesions from I-131 varied from 0.04 to 2.44 cGy/MBq (1.57-90.48 rads/mCi) with effective half-lives for I-124 ranging from 0.58 to 1.86 days. The three-dimensional absorbed dose distribution in the thyroid lesions was calculated by convolving the activity values with an I-131 point-source kernel using a Fast Hartley Transform. The calculated mean absorbed dose distribution was displayed as isodose lines on PET images that can be used to refine the amount of administered activity. PET with I-124 may improve the absorbed dose estimates from radioiodine therapy with I-131 in the treatment of thyroid cancer. The capability of estimating I-131 mean absorbed dose distributions from serial I-124 PET images can lead to patient-specific treatment planning for thyroid therapy.