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Review
. 2022 Nov;61(4):579-596.
doi: 10.1007/s00411-022-01000-5. Epub 2022 Oct 14.

Heterogeneity of dose distribution in normal tissues in case of radiopharmaceutical therapy with alpha-emitting radionuclides

Wei Bo Li  1 , Céline Bouvier-Capely  2 , Clarita Saldarriaga Vargas  3   4 , Michelle Andersson  3   5 , Balázs Madas  6
Affiliations
Review

Heterogeneity of dose distribution in normal tissues in case of radiopharmaceutical therapy with alpha-emitting radionuclides

Wei Bo Li et al. Radiat Environ Biophys. 2022 Nov.

Abstract

Heterogeneity of dose distribution has been shown at different spatial scales in diagnostic nuclear medicine. In cancer treatment using new radiopharmaceuticals with alpha-particle emitters, it has shown an extensive degree of dose heterogeneity affecting both tumour control and toxicity of organs at risk. This review aims to provide an overview of generalized internal dosimetry in nuclear medicine and highlight the need of consideration of the dose heterogeneity within organs at risk. The current methods used for patient dosimetry in radiopharmaceutical therapy are summarized. Bio-distribution and dose heterogeneities of alpha-particle emitting pharmaceutical 223Ra (Xofigo) within bone tissues are presented as an example. In line with the strategical research agendas of the Multidisciplinary European Low Dose Initiative (MELODI) and the European Radiation Dosimetry Group (EURADOS), future research direction of pharmacokinetic modelling and dosimetry in patient radiopharmaceutical therapy are recommended.

Keywords: Alpha-emitter; Dose heterogeneity; Normal tissue, bone marrow; Patient dosimetry; Radiopharmaceutical therapy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Upper panel: ICRP voxel phantom of spongiosa in lumbar spine and cranium (ICRP 2009). Lower panel: from bone to bone marrow phantom (Hobbs et al. 2012), A Structure of upper arm bone (humeri) which shows the spongiosa, the medullary cavity and the cortical bone; B Spongiosa which shows the trabecular bone, red bone marrow, yellow bone marrow and the endosteum; C Mathematical phantom model for red bone marrow, which shows the trabecular marrow cavity and the osteoprogenitor cells (blue), hematopoietic stem and progenitor cells (brown), and adipose cells (white). Figures reproduced with permission by ICRP and IOP Publishing
Fig. 2
Fig. 2
Left: path-length bone marrow model (Whitwell and Spiers ; Beddoe et al. 1976). Right: 3D marrow tissues model (Watchman et al. 2005). Upper right pannel not drawn to scale. Figures reproduced with permission by IOP Publishing and SNMMI
Fig. 3
Fig. 3
A NURBS-type 3D surface model (in green colours) within the trabecular spongiosa regions of the femoral head and neck; B 2D micro-CT images of spongiosa regions; C shallow marrow (50 mm depth layer) from trabecular surface along the inner cortical surfaces of the medullary cavity of the D diaphysis (shaft) (Hough et al. 2011). Figures reproduced with permission by IOP Publishing
See this image and copyright information in PMC

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