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Publications (5)7.4 Total impact

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    ABSTRACT: [(153)Sm]Sm-EDTMP is a radiopharmaceutical used in palliation cares of bone metastases. The purpose of this study is to provide an explicit description of [(153)Sm]Sm-EDTMP pharmacokinetics, adopting a simple three-compartmental model with the analytical expressions calculating the rate constants and determining biodistribution parameters, like radiopharmaceutical uptake and clearance. This biokinetic model allowed us to calculate on an individual basis the dose to bone surface and to red bone marrow and to assess the degree of variability in dosimetric parameters using a fixed administered activity based only on patient weight. In this study twenty patients were enrolled and were treated with [(153)Sm]Sm-EDTMP, administering a fixed activity per kilogram (37 MBq/kg); blood and urine samples were collected during 24 h post treatment. The median value of the administered activity was 2.7 GBq. Blood clearance confirmed that an aliquot of [(153)Sm]Sm-EDTMP rapidly localizes and is retained in bone, while the remainder is rapidly cleared from the blood pool by the urinary system. Our data show a bi-exponential clearance from blood: the rapid component has a half life median value of 6 min (range: 2-24 min), while the slow one has a half life median value of 1.4 h (range: 0.6-5.8 h). Median value of the urinary excretion is 40 (range: 3-75) % of the administered activity. Our model shows the behaviour of a tracer which is distributed in the extracellular space of the body, localized in the skeleton and excreted via glomerular filtration. Half life median values of [(153)Sm]Sm-EDTMP transferring between compartments, T(1/2) (blood→ECF), T(1/2) (ECF→blood) are 7.4 (range: 1.9-37) and 48 (range: 8-408) min, respectively. Median values of half lives of [(153)Sm]Sm-EDTMP clearance through the urine and of uptake into bone are 1.0 (range: 0.1-6.0) and 1.6 (range: 0.6-9.0) h, respectively. Median value of red marrow absorbed dose is 2.1 (range: 0.7-3.5) Gy and 0.8 (range: 0.3-2.1) Gy/GBq, while median value of bone surface absorbed dose is 11.5 Gy (range: 5.0-18.4) and 4.4 (range: 2.3-14.3) Gy/GBq. It is remarkable that there is a really great biological variability within patients, especially considering the excreted activity. The cumulated activity in bone and red marrow doses were significantly higher in prostate cancer, where metastatic bone lesions are osteoblastic, than in breast cancer where metastatic bone lesions are osteolytic or mixed (lytic/blastic). The relevant biological variability in biodistribution and metabolism of [(153)Sm]Sm-EDTMP suggests that the fixed administered activity based on patient weight is not sufficient to optimize the treatment and a better optimization would be reached by using a predictive dosimetry tailored to individual patient characteristics.
    Physica Medica 07/2011; 27(3):144-52. · 1.17 Impact Factor
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    ABSTRACT: The aim of this work is to evaluate the role of different amount of attenuation and scatter on FDG-PET image volume segmentation using a contrast-oriented method based on the target-to-background (TB) ratio and target dimensions. A phantom study was designed employing 3 phantom sets, which provided a clinical range of attenuation and scatter conditions, equipped with 6 spheres of different volumes (0.5-26.5 ml). The phantoms were: (1) the Hoffman 3-dimensional brain phantom, (2) a modified International Electro technical Commission (IEC) phantom with an annular ring of water bags of 3 cm thickness fit over the IEC phantom, and (3) a modified IEC phantom with an annular ring of water bags of 9 cm. The phantoms cavities were filled with a solution of FDG at 5.4 kBq/ml activity concentration, and the spheres with activity concentration ratios of about 16, 8, and 4 times the background activity concentration. Images were acquired with a Biograph 16 HI-REZ PET/CT scanner. Thresholds (TS) were determined as a percentage of the maximum intensity in the cross section area of the spheres. To reduce statistical fluctuations a nominal maximum value is calculated as the mean from all voxel > 95%. To find the TS value that yielded an area A best matching the true value, the cross section were auto-contoured in the attenuation corrected slices varying TS in step of 1%, until the area so determined differed by less than 10 mm² versus its known physical value. Multiple regression methods were used to derive an adaptive thresholding algorithm and to test its dependence on different conditions of attenuation and scatter. The errors of scatter and attenuation correction increased with increasing amount of attenuation and scatter in the phantoms. Despite these increasing inaccuracies, PET threshold segmentation algorithms resulted not influenced by the different condition of attenuation and scatter. The test of the hypothesis of coincident regression lines for the three phantoms used provided no statistical basis for believing that the three lines are not coincident. Calibration curves needed to implement contouring algorithms based on adaptive TS segmentation of PET volumes can be devised in different conditions of attenuation and scatter. This opens the possibility of defining a unified contrast-based method for target delineation in different anatomical districts.
    Physica Medica 01/2011; 27(1):44-51. · 1.17 Impact Factor
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    ABSTRACT: The purpose of this study was to analyze the behavior of a contouring algorithm for PET images based on adaptive thresholding depending on lesions size and target-to-background (TB) ratio under different conditions of image reconstruction parameters. Based on this analysis, the image reconstruction scheme able to maximize the goodness of fit of the thresholding algorithm has been selected. A phantom study employing spherical targets was designed to determine slice-specific threshold (TS) levels which produce accurate cross-sectional areas. A wide range of TB ratio was investigated. Multiple regression methods were used to fit the data and to construct algorithms depending both on target cross-sectional area and TB ratio, using various reconstruction schemes employing a wide range of iteration number and amount of postfiltering Gaussian smoothing. Analysis of covariance was used to test the influence of iteration number and smoothing on threshold determination. The degree of convergence of ordered-subset expectation maximization (OSEM) algorithms does not influence TS determination. Among these approaches, the OSEM at two iterations and eight subsets with a 6-8 mm post-reconstruction Gaussian three-dimensional filter provided the best fit with a coefficient of determination R² = 0.90 for cross-sectional areas ≤ 133 mm² and R² = 0.95 for cross-sectional areas > 133 mm². The amount of post-reconstruction smoothing has been directly incorporated in the adaptive thresholding algorithms. The feasibility of the method was tested in two patients with lymph node FDG accumulation and in five patients using the bladder to mimic an anatomical structure of large size and uniform uptake, with satisfactory results. Slice-specific adaptive thresholding algorithms look promising as a reproducible method for delineating PET target volumes with good accuracy.
    Journal of Applied Clinical Medical Physics 01/2011; 12(2):3363. · 0.96 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the impact on lesion detectability of fast imaging protocols using 18F-FDG and a 3-dimensional LSO-based PET/CT scanner. An anthropomorphic thoracic phantom was used simulating the anatomical structures of radioactivity distribution for the upper torso of an underweight patient. Irregularly shaped targets of small dimensions, the zeolites, were located inside the phantom in an unpredictable position for the observers. Target-to background ratios and target dimensions were selected in order to sample the range of detectability. Repeated imaging was performed to acquire PET images with varying emission scan duration (ESD) of 1, 2, 3 and 4 min/bed and background activity concentrations of 10, 5 and 3 kBq/mL in the torso cavity. Three observers ranked the targets and a receiver operating characteristic analysis was performed for each acquisition protocol. Detection performances improved when passing from a short (ESD = 1 min) protocol to longer (ESD C 2 min) protocols. This improvement was established with adequate statistical significance. Short image acquisition times of 1 min/bed using 18F-FDG and the specific scanner model considered in the study lead to reduced lesion detectability and should be avoided also in underweight patients.
    Annals of Nuclear Medicine 11/2010; 25(3):179-88. · 1.41 Impact Factor
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    ABSTRACT: The purpose of this study was to quantify the influence of outside field of view (FOV) activity concentration (A(c)(,out)) on the noise equivalent count rate (NECR), scatter fraction (SF) and image quality of a 3D LSO whole-body PET/CT scanner. The contrast-to-noise ratio (CNR) was the figure of merit used to characterize the image quality of PET scans. A modified International Electrotechnical Commission (IEC) phantom was used to obtain SF and counting rates similar to those found in average patients. A scatter phantom was positioned at the end of the modified IEC phantom to simulate an activity that extends beyond the scanner. The modified IEC phantom was filled with (18)F (11 kBq mL(-1)) and the spherical targets, with internal diameter (ID) ranging from 10 to 37 mm, had a target-to-background ratio of 10. PET images were acquired with background activity concentrations into the FOV (A(c)(,bkg)) about 11, 9.2, 6.6, 5.2 and 3.5 kBq mL(-1). The emission scan duration (ESD) was set to 1, 2, 3 and 4 min. The tube inside the scatter phantom was filled with activities to provide A(c)(,out) in the whole scatter phantom of zero, half, unity, twofold and fourfold the one of the modified IEC phantom. Plots of CNR versus the various parameters are provided. Multiple linear regression was employed to study the effects of A(c)(,out) on CNR, adjusted for the presence of variables (sphere ID, A(c)(,bkg) and ESD) related to CNR. The presence of outside FOV activity at the same concentration as the one inside the FOV reduces peak NECR of 30%. The increase in SF is marginal (1.2%). CNR diminishes significantly with increasing outside FOV activity, in the range explored. ESD and A(c)(,out) have a similar weight in accounting for CNR variance. Thus, an experimental law that adjusts the scan duration to the outside FOV activity can be devised. Recovery of CNR loss due to an elevated A(c)(,out) activity seems feasible by modulating the ESD in individual bed positions according to A(c)(,out).
    Physics in Medicine and Biology 10/2009; 54(19):5861-72. · 2.70 Impact Factor