Equivalent Dose Rate 1 Meter from Neuroendocrine Tumor Patients Exiting the Nuclear Medicine Department After Undergoing Imaging

Jules Zhang-Yin; Anne-Sophie Dirand; Myriam Sasanelli; Gwenaelle Corrégé; Aude Peudon; Thierry Kiffel; Valérie Nataf; Jérôme Clerc; Françoise Montravers; Jean-Noël Talbot

doi:10.2967/jnumed.116.187138

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TABLE 1

Radiopharmaceuticals and Practical Options at Each Center

Parameter	⁶⁸Ga-DOTATOC	¹⁸F-FDOPA	¹⁸F-FDG	¹¹¹In-pentetreotide	¹²³I-MIBG
Hospital	Tenon	Tenon	Tenon	Cochin	Cochin
Modality	PET/CT	PET/CT	PET/CT	SPECT/CT	SPECT/CT
Radiopharmaceutical	⁶⁸Ga-DOTATOC (Iason) and GalliaPharm (Eckert & Ziegler)	Iasodopa (Iason)	Metatrace (Siemens) or Gluscan (AAA)	Octreoscan (Mallinckrodt)	¹²³I-MIBG (Mallinckrodt) or Adreview (GE Healthcare)
Physical half-life (min)	68	110	110	4,032 (2.8 d)	792 (13.2 h)
Scheduled injected activity	1–2 MBq/kg BM	2.5–3.5 MBq/kg BM	2–3 MBq/kg BM	185 MBq	185 MBq
Scheduled interval between injection and imaging (min)	45–90	10 (MTC) and 60	60–120	1,440 (24 h)	240 and 1,440 (4 and 24 h)
Photonic ray for imaging (keV)	511	511	511	245 and 171	159

BM = body mass; MTC = medullary thyroid cancer.

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TABLE 2

Patients, Imaging Characteristics, and EDR-1m According to Radiopharmaceutical

Parameter	⁶⁸Ga-DOTATOC	¹⁸F-FDOPA	¹⁸F-FDG	¹¹¹In-pentetreotide	¹²³I-MIBG	Comparison
Patients (n)	53	15	13	12	10	χ²: NSD in sex repartition
Male	29	6	8	6	3
Female	24	9	5	6	7
Age (y)	56.7 ± 12.3; 58 (30–76)	60.9 ± 12.1; 61 (29–78)	64.5 ± 17.0; 66 (37–89)	62.1 ± 12.6; 63 (38–81)	51.0 ± 10.2; 53 (30–65)	ANOVA: NSD
Body height (m)	1.70 ± 0.09; 1.71 (1.53–1.96)	1.70 ± 0.09; 1.67 (1.57–1.83)	1.66 ± 0.08; 1.69 (1.51–1.77)	1.70 ± 0.12; 1.72 (1.45–1.86)	1.68 ± 0.10; 1.69 (1.56–1.83)	ANOVA: NSD
Body mass (kg)	72.4 ± 13.8; 71 (49–105)	72.3 ± 13.5; 75 (50–91)	68.4 ± 20.6; 60 (39–120)	72.7 ± 13.7; 73.5 (54–95)	73.3 ± 11.0; 76.5 (58–88)	ANOVA: NSD
Body mass index (kg⋅m⁻²)	24.9 ± 4.27; 24.5 (17.3–37.1)	24.6 ± 4.27; 24.4 (17.2–34.5)	24.6 ± 6.01; 23.9 (15.2–38.7)	25.1 ± 3.79; 24.4 (18.7–30.7)	26.3 ± 4.03; 25.3 (21.3–33.6)	ANOVA: NSD
Injected activity (MBq)	121 ± 23; 122 (80–170)	199 ± 48; 198 (97–262)	176 ± 56; 167 (98–321)	170 ± 7; 170 (158–179)	186 ± 5; 184 (176–194)	⁶⁸Ga-DOTATOC < all others; KW: P <<0.001
Injected activity per kg body mass (MBq/kg)	1.72 ± 0.42; 1.77 (0.89–2.80)	2.74 ± 0.42; 2.83 (1.87–3.27)	2.59 ± 0.38; 2.51 (2.23–3.81)	2.41 ± 0.48; 2.30 (1.77–3.29)	2.58 ± 0.45; 2.43 (2.00–3.27)	⁶⁸Ga-DOTATOC < all others; ANOVA: P < 0.001
Interval between injection and EDR-1m measurement (min)	90 ± 16; 87 (66–126)	114 ± 14; 117 (86–130)	112 ± 39; 95 (82–220)	6.2 ± 3.5; 5 (2–15)	5.7 ± 2.6; 5 (3–10)	PENT & ¹²³I-MIBG < ⁶⁸Ga-DOTATOC < ¹⁸F-FDOPA & ¹⁸F-FDG; KW: P << 0.001
EDR-1m from sternum (μSv/h)	4.73 ± 1.41; 4.75 (2.10–9.10)	9.76 ± 3.61; 9.50 (3.92–17.7)	9.34 ± 3.51; 8.80 (3.50–18.8)	9.56 ± 0.93; 9.43 (8.50–11.0)	4.94 ± 0.31; 4.89 (4.45–5.49)	⁶⁸Ga-DOTATOC & ¹²³I-MIBG < all others; KW: P << 0.001
EDR-1m from bladder (μSv/h)	5.04 ± 1.37; 5.10 (2.13–8.20)	10.2 ± 3.20; 10.1 (4.57–15.8)	10.5 ± 4.28; 9.50 (3.80–21.2)	9.21 ± 1.31; 9.30 (5.81–11.2)	4.41 ± 0.93; 4.68 (2.80–5.65)	⁶⁸Ga-DOTATOC & ¹²³I-MIBG < all others; KW: P << 0.001
EDR-1m from sternum per injected MBq (nSv/h/MBq)	39.4 ± 10.7; 37.7 (21.9–89.7)	51.7 ± 25.1; 45.5 (25.0–116)	54.4 ± 13.8; 57.1 (16.5–71.5)	56.3 ± 4.6; 55.5 (50–64)	26.6 ± 1.5; 26.5 (23.6–29.5)	¹²³I-MIBG < ⁶⁸Ga-DOTATOC & ¹⁸F-FDOPA < ¹⁸F-FDG & PENT; KW: P << 0.001
EDR-1m from bladder per injected MBq (nSv/h/MBq)	41.9 ± 10.0; 41.0 (25.4–88.5)	54.0 ± 23.0; 44.8 (26.1–104)	60.4 ± 15.5; 62.1 (17.9–82.9)	54.3 ± 7.3; 56.0 (34.1–62.5)	23.7 ± 4.9; 25.0 (15.3–29.1)	¹²³I-MIBG < ⁶⁸Ga-DOTATOC < ¹⁸F-FDOPA & PENT < ¹⁸F-FDG; KW: P << 0.001

NSD = no significant difference; KW = Kruskal–Wallis test; PENT = ¹¹¹In-pentetreotide.
Data are mean ± SD, or median followed by range in parentheses.

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TABLE 3

Studies Reporting Measurement of EDR-1m After Injection of ¹⁸F-FDG

¹⁸F-FDG	Present study	Fayad et al. (11)	Demir et al. (12)	Cronin et al. (13)
Patients (n)	13	6	30	75
Injected activity (MBq)			550	323; 297
Mean ± SD	176 ± 56	241 ± 33
Range	98–321	130–311
Median	167
Time between injection and EDR-1m measurement (min)	95	90		113; 116
Mean ± SD	112 ± 39		117 ± 11
Dose rate detector	identiFINDER	AT1123 (APVL Ingénierie)	ESP-2 (Eberline)	Series 1000 (Mini-Instruments)
EDR-1m from sternum (μSv/h)			50	14.7
Mean ± SD	9.34 ± 3.51	6.83 ± 1.58
Range	3.50–18.8			3.5–32
Median	8.80			14
EDR-1m from sternum per injected MBq (μSv/h/MBq)		NA	90	47
Mean ± SD	54.4 ± 13.8
Range	16.5–71.5			13–120
Median	57.1			43

NA = not available.

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TABLE 4

Studies Reporting Measurement of EDR-1m After Injection of ¹¹¹In-Pentetreotide

¹¹¹In-pentetreotide	Present study	Fayad et al. (11)	Morán et al. (14)	Kurtaran et al. (15)
Patients (n)	12	6	2	16
Injected activity (MBq)
Mean ± SD	170 ± 7	119 ± 67		140 ± 40
Range	158–179	105–128	200–220
Time between injection and EDR-1m measurement (min)		15
Mean ± SD	6.2 ± 5
Range			230–240	10–20
Dose rate detector	PDS-100GN-ID	AT1123 (APVL Ingénierie)	MiniTRACE γ (Genitron)	LB 133 (Berthold Technologies)
EDR-1m from sternum (μSv/h)			9.5
Mean ± SD	9.56 ± 0.93	5.5 ± 0.51		2.86 ± 1.22
Range	8.50–11.0
Median	9.43
EDR-1m from sternum per injected MBq (μSv/h/MBq)		NA	43	NA
Mean ± SD	54.3 ± 7.3

NA = not available.

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TABLE 5

Studies Reporting Measurement of EDR-1m After Injection of ¹²³I-MIBG

¹²³I-MIBG	Present study	Ofluoglu et al. (10)
Patients (n)	10	16
Injected activity^* (MBq)	186 ± 5	340 ± 30
Time between injection and EDR-1m measurement (min)	5.7 ± 2.6^*	10
Dose rate detector	PDS-100GN-ID	LB 133 (Berthold Technologies)
EDR-1m^* (μSv/h)	Sternum: 4.94 ± 0.31; bladder: 4.41 ± 0.93	3.7 ± 0.7