3-D Image-Based Dosimetry in Radionuclide Therapy

Radionuclide therapy is the use of radioactive drugs for internal radiotherapy, mainly for the treatment of metastatic disease. As opposed to systemic cancer therapies in general, the use of radioactively labeled drugs results not only in a targeted therapy but also the possibility of imaging the distribution of the drug during therapy. From such images, the absorbed doses delivered to tumors and organs at risk can be calculated. Calculation of the absorbed dose from 3-D images such as single-photon emission computed tomography (SPECT)/CT, and in some cases positron emission tomography (PET)/CT, relies on image-based activity quantification. Quantification is accomplished by modeling the physics involved in the image-formation process, and applying image-processing methods. From a time-sequence of such quantitative images, the absorbed doses are then calculated. Although individual-patient dosimetry is a standard component of other forms of radiotherapy, it is still overlooked in the majority of radionuclide therapies. In this review, we summarize the physical and technical problems that need to be addressed in image-based dosimetry. The focus is on SPECT, since most of the radionuclides used are single-photon emitters, although the use of PET is also discussed. Practical issues of relevance for the practical implementation of personalized dosimetry in radionuclide therapy are also highlighted