Abstract
The EANM Dosimetry Committee Series “Standard Operational Procedures for Pre-Therapeutic Dosimetry” (SOP) provides advice to scientists and clinicians on how to perform patient-specific absorbed dose assessments. This particular SOP describes how to tailor the therapeutic activity to be administered for radioiodine therapy of benign thyroid diseases such as Graves’ disease or hyperthyroidism. Pretherapeutic dosimetry is based on the assessment of the individual 131I kinetics in the target tissue after the administration of a tracer activity. The present SOP makes proposals on the equipment to be used and guides the user through the measurements. Time schedules for the measurement of the fractional 131I uptake in the diseased tissue are recommended and it is shown how to calculate from these datasets the therapeutic activity necessary to administer a predefined target dose in the subsequent therapy. Potential sources of error are pointed out and the inherent uncertainties of the procedures depending on the number of measurements are discussed. The theoretical background and the derivation of the listed equations from compartment models of the iodine kinetics are explained in a supplementary file published online only.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Stokkel MP, Handkiewicz Junak D, Lassmann M, Dietlein M, Luster M. EANM procedure guidelines for therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging. 2010;37:2218–28.
European Union. Council Directive 97/43/EURATOM on health protection of individuals against the dangers of ionising radiation in relation to medical exposure. Luxembourg: Council of the European Union; 1997. Available from: http://ec.europa.eu/energy/nuclear/radioprotection/doc/legislation/9743_en.pdf.
Salvatori M, Luster M. Radioiodine therapy dosimetry in benign thyroid disease and differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2010;37:821–8.
Lassmann M, Chiesa C, Flux G, Bardies M. EANM Dosimetry Committee guidance document: good practice of clinical dosimetry reporting. Eur J Nucl Med Mol Imaging. 2011;38:192–200.
Hammes J, Pietrzyk U, Schmidt M, Schicha H, Eschner W. GATE based Monte Carlo simulation of planar scintigraphy to estimate the nodular dose in radioiodine therapy for autonomous thyroid adenoma. Z Med Phys. 2011;21:290–300.
Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetric analysis of thyroid lobes by real-time ultrasound. Dtsch Med Wochenschr. 1981;106:1338–40.
Schlögl S, Werner E, Lassmann M, Terekhova J, Muffert S, Seybold S, et al. The use of three-dimensional ultrasound for thyroid volumetry. Thyroid. 2001;11:569–74.
Nygaard B, Nygaard T, Court-Payen M, Jensen LI, Soe-Jensen P, Gerhard Nielsen K, et al. Thyroid volume measured by ultrasonography and CT. Acta Radiol. 2002;43:269–74.
van Isselt JW, de Klerk JM, van Rijk PP, van Gils AP, Polman LJ, Kamphuis C, et al. Comparison of methods for thyroid volume estimation in patients with Graves’ disease. Eur J Nucl Med Mol Imaging. 2003;30:525–31.
Reinartz P, Sabri O, Zimny M, Nowak B, Cremerius U, Setani K, et al. Thyroid volume measurement in patients prior to radioiodine therapy: comparison between three-dimensional magnetic resonance imaging and ultrasonography. Thyroid. 2002;12:713–7.
Canzi C, Zito F, Voltini F, Reschini E, Gerundini P. Verification of the agreement of two dosimetric methods with radioiodine therapy in hyperthyroid patients. Med Phys. 2006;33:2860–7.
Strigari L, Sciuto R, Benassi M, Bergomi S, Nocentini S, Maini CL. A NTCP approach for estimating the outcome in radioiodine treatment of hyperthyroidism. Med Phys. 2008;35:3903–10.
Eschmann SM, Reischl G, Bilger K, Kupferschläger J, Thelen MH, Dohmen BM, et al. Evaluation of dosimetry of radioiodine therapy in benign and malignant thyroid disorders by means of iodine-124 and PET. Eur J Nucl Med Mol Imaging. 2002;29:760–7.
Matheoud R, Canzi C, Reschini E, Zito F, Voltini F, Gerundini P. Tissue-specific dosimetry for radioiodine therapy of the autonomous thyroid nodule. Med Phys. 2003;30:791–8.
Szebeni A, Beleznay E. New simple method for thyroid volume determination by ultrasonography. J Clin Ultrasound. 1992;20:329–37.
Andermann P, Schlögl S, Mader U, Luster M, Lassmann M, Reiners C. Intra- and interobserver variability of thyroid volume measurements in healthy adults by 2D versus 3D ultrasound. Nuklearmedizin. 2007;46:1–7.
Knudsen N, Bols B, Bulow I, Jorgensen T, Perrild H, Ovesen L, et al. Validation of ultrasonography of the thyroid gland for epidemiological purposes. Thyroid. 1999;9:1069–74.
Busemann Sokole E, Plachcinska A, Britten A. Acceptance testing for nuclear medicine instrumentation. Eur J Nucl Med Mol Imaging. 2010;37:672–81.
Busemann Sokole E, Plachcinska A, Britten A, Lyra Georgosopoulou M, Tindale W, Klett R. Routine quality control recommendations for nuclear medicine instrumentation. Eur J Nucl Med Mol Imaging. 2010;37:662–71.
Marinelli LD, Quimby EH, Hine GJ. Dosage determination with radioactive isotopes; practical considerations in therapy and protection. Am J Roentgenol Radium Ther. 1948;59:260–81.
Bockisch A, Jamitzky T, Derwanz R, Biersack HJ. Optimized dose planning of radioiodine therapy of benign thyroidal diseases. J Nucl Med. 1993;34:1632–8.
Di Martino F, Traino AC, Brill AB, Stabin MG, Lazzer M. A theoretical model for prescription of the patient-specific therapeutic activity for radioiodine therapy of Graves’ disease. Phys Med Biol. 2002;47:1493–9.
Jonsson H, Mattsson S. Single uptake measurement for absorbed dose planning for radioiodine treatment of hyperthyroidism. Cancer Biother Radiopharm. 2003;18:473–9.
Rink T, Bormuth FJ, Braun S, Zimny M, Schroth HJ. Concept and validation of a simple model of the intrathyroidal iodine kinetics. Nuklearmedizin. 2004;43:21–5.
Areberg J, Jonsson H, Mattsson S. Population biokinetic modeling of thyroid uptake and retention of radioiodine. Cancer Biother Radiopharm. 2005;20:1–10.
Stabin MG, Sparks RB, Crowe E. OLINDA/EXM: the second-generation personal computer software for internal dose assessment in nuclear medicine. J Nucl Med. 2005;46:1023–7.
Carlier T, Salaun PY, Cavarec MB, Valette F, Turzo A, Bardies M, et al. Optimized radioiodine therapy for Graves’ disease: two MIRD-based models for the computation of patient-specific therapeutic 131I activity. Nucl Med Commun. 2006;27:559–66.
Eckerman K, Endo A. MIRD: Radionuclide data and decay schemes. 2nd ed. New York: Society of Nuclear Medicine; 2008.
Merrill S, Horowitz J, Traino AC, Chipkin SR, Hollot CV, Chait Y. Accuracy and optimal timing of activity measurements in estimating the absorbed dose of radioiodine in the treatment of Graves’ disease. Phys Med Biol. 2011;56:557–71.
Hänscheid H, Lassmann M, Reiners C. Dosimetry prior to I-131-therapy of benign thyroid disease. Z Med Phys. 2011;21:250–7.
Traino AC, Di Martino F, Lazzeri M, Stabin MG. Influence of thyroid volume reduction on calculated dose in radioiodine therapy of Graves’ hyperthyroidism. Phys Med Biol. 2000;45:121–9.
Disclaimer
This guideline intends to guide the user through a series of measurements and calculations which the authors consider to be at present the best and most reproducible practical procedures. It summarizes the views of the authors assisted by the EANM Dosimetry Committee, the EANM Physics Committee, and the EANM Therapy Committee. Not all of the generic recommendations are suitable for all patients in all settings. It remains the responsibility of the physician to select the most adequate procedure for the individual patient. Different procedures may lead to the same or similar results. The recommendations should be taken in the context of good practice of nuclear medicine, and do not substitute for national and international legal or regulatory provisions. The guidelines have been brought to the attention of the National Societies of Nuclear Medicine.
Author information
Authors and Affiliations
Corresponding author
Additional information
G. Flux, L. Strigari and M. Lassmann are members of the EANM Dosimetry Committee; W. Eschner is a member of the EANM Physics Committee; and M. Luster is a member of the EANM Therapy Committee.
Electronic supplementary material
ESM 1
(PDF 252 kb)
Rights and permissions
About this article
Cite this article
Hänscheid, H., Canzi, C., Eschner, W. et al. EANM Dosimetry Committee Series on Standard Operational Procedures for Pre-Therapeutic Dosimetry II. Dosimetry prior to radioiodine therapy of benign thyroid diseases. Eur J Nucl Med Mol Imaging 40, 1126–1134 (2013). https://doi.org/10.1007/s00259-013-2387-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-013-2387-x