SPECT/CT-based dosimetry of salivary glands and iodine-avid lesions following (131)I therapy

OBJECTIVE: The purpose was to provide uptake and radiation dose estimates to salivary glands (SG) and pathologic lesions following radioiodine therapy (RIT) of differentiated thyroid cancer patients (DTC). METHODS: A group of DTC patients (n = 25) undergoing (131)I therapy joined this study with varying amounts of therapeutic activity. Sequential SPECT/CT scans were acquired at 4 ± 2, 24 ± 2, and 168 ± 3 h following administration of 3497–9250 MBq 131I. An earlier experiment with Acrylic glass body phantom (PET Phantom NEMA 2012 / IEC 2008) was conducted for system calibration including scatter, partial volume effect and count loss correction. Dose calculation was made via IDAC-Dose 2.1 code. RESULTS: The absorbed dose to parotid glands was 0.04–0.97 Gy/GBq (median: 0.26 Gy/GBq). The median absorbed dose to submandibular glands was 0.14 Gy/GBq (0.05 to 0.56 Gy/GBq). The absorbed dose to thyroid residues was from 0.55 to 399.5 Gy/GBq (median: 21.8 Gy/GBq), and that to distal lesions ranged from 0.78 to 28.0 Gy/GBq (median: 3.12 Gy/GBq). 41% of the thyroid residues received dose > 80 Gy, 18% between 70–80 Gy, 18% between 40–70 Gy, and 23% has dose < 40 Gy. In contrast, 18% of the metastases exhibited a dose > 80 Gy, 9% between 40–60 Gy, and the dose to the vast majority of lesions (64%) was < 40 Gy. CONCLUSION: It was inferred that dose estimation after RIT with SPECT/CT is feasible to apply, together with good agreement with published (124)I PET/CT dose estimates. A broad and sub-effective dose range was estimated for thyroid residues and distal lesions. Moreover, the current methodology might be useful for establishing a dose–effect relationship and radiation-induced salivary glands damage after RIT.