Three-dimensional personalized dosimetry for ¹⁸⁸Re liver selective internal radiation therapy based on quantitative post-treatment SPECT studies

We demonstrate that accurate patient-specific distributions of microspheres labeled with ¹⁸⁸Re and resulting absorbed doses can be obtained from single-photon emission computed tomography (SPECT) studies performed after ¹⁸⁸Re selective internal radiation therapy when accurate correction methods are employed in image reconstruction. Our quantitative image reconstruction algorithm includes corrections for attenuation, resolution degradations and scatter as well as a window-based compensation for contamination. The procedure has been validated using four phantom experiments containing an 18 ml cylindrical source (82–93 MBq of ¹⁸⁸Re activity) simulating a liver tumor. In addition, we applied our approach to post-therapy SPECT studies of ten patients with progressive primary or metastatic liver carcinomas. Our quantitative algorithm accurately (within 9%) recovered ¹⁸⁸Re activity from four phantom experiments. In addition, for two patients that received three scans, deviations remained consistent between the measured and the reconstructed activities that were determined from studies with differing severity of the dead-time effect. The analysis of absorbed doses for patient studies allowed us to hypothesize that D90 (the minimum dose received by 90% of the tumor volume) may be a reliable metric relating therapy outcomes to the calculated doses. Among several considered metrics, only D90 showed statistically significant correlation with the overall survival. (paper)