The Role of Lung Density in the Voxel-Based Dosimetry of 90Y-TARE Evaluated with the Voxel S-Value (VSV) Method and Fast Monte Carlo Simulation

Author:

Capotosti Amedeo12ORCID,Moretti Roberto1ORCID,Vaccaro Maria3ORCID,Ribeiro Cintia De Almeida3,Placidi Lorenzo1ORCID,Nardini Matteo1ORCID,Meffe Guenda1,Cusumano Davide1ORCID,Zagaria Luca1,De Risi Marina1,Perotti Germano1ORCID,Leccisotti Lucia1ORCID,De Spirito Marco13ORCID,Iezzi Roberto1ORCID,Indovina Luca1ORCID

Affiliation:

1. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy

2. Dipartimento di Ingegneria dell’Informazione, Università di Padova, 35122 Padova, Italy

3. Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

Abstract

(1) Background: In 90Y-TARE treatments, lung-absorbed doses should be calculated according to the manufacturer’s instructions, using the MIRD-scheme. This scheme is derived from the assumption that 90Y-microspheres deliver the dose in a water-equivalent medium. Since the density of the lungs is quite different from that of the liver, the absorbed dose to the lungs could vary considerably, especially at the liver/lungs interface. The aim of this work is to compare the dosimetric results obtained by two dedicated software packages implementing a water-equivalent dose calculation and a Monte Carlo (MC) simulation, respectively. (2) Methods: An anthropomorphic IEC phantom and a retrospective selection of 24 patients with a diagnosis of HCC were taken into account. In the phantom study, starting from a 90Y-PET/CT acquisition, the liver cavity was manually fixed with a uniform activity concentration on PET series, while the lung compartment was manually expanded on a CT series to simulate a realistic situation in which the liver and lungs are adjacent. These steps were performed by using MIM 90Y SurePlan. Then, a first simulation was carried out with only the liver cavity filled, while a second one was carried out, in which the lung compartment was also manually fixed with a uniform activity concentration corresponding to 10% lung shunt fraction. MIM 90Y SurePlan was used to obtain Voxel S-Value (VSV) approach dose values; instead, Torch was used to obtain MC approach dose values for both the phantom and the patients. (3) Results: In the phantom study, the percentage mean dose differences (∆D%) between VSV and MC in the first and second simulation, respectively were found to be 1.2 and 0.5% (absolute dose variation, ∆D, of 0.7 and 0.3 Gy) for the liver, −56 and 70% (∆D of −0.3 and −16.2 Gy) for the lungs, and −48 and −60% (∆D of −4.3 and −16.5 Gy) for the Liver/Lungs Edge region. The patient study reports similar results with ∆D% between VSV and MC of 7.0%, 4.1% and 6.7% for the whole liver, healthy liver, and tumor, respectively, while the result was −61.2% for the left lung and −61.1% for both the right lung and lungs. (4) Conclusion: Both VSV and MC allowed accurate radiation dose estimation with small differences (<7%) in regions of uniform water-equivalent density (i.e., within the liver). Larger differences between the two methods (>50%) were observed for air-equivalent regions in the phantom simulation and the patient study.

Publisher

MDPI AG

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