Individual dosimetry system for targeted alpha therapy based on PHITS coupled with microdosimetric kinetic model

Background: An individual dosimetry system is essential for the evaluation of precise doses in nuclear medicine. The purpose of this study was to develop a system for calculating not only absorbed doses but also EQDX(alpha/beta) from the PET-CT images of patients for targeted alpha therapy (TAT), considering the dose dependence of the relative biological effectiveness, the dose-rate effect, and the dose heterogeneity. Methods: A general-purpose Monte Carlo particle transport code PHITS was employed as the dose calculation engine in the system, while the microdosimetric kinetic model was used for converting the absorbed dose to EQDX(alpha/beta). PHITS input files for describing the geometry and source distribution of a patient are automatically created from PET-CT images, using newly developed modules of the radiotherapy package based on PHITS (RT-PHITS). We examined the performance of the system by calculating several organ doses using the PET-CT images of four healthy volunteers after injecting F-18-NKO-035. Results: The deposition energy map obtained from our system seems to be a blurred image of the corresponding PET data because annihilation gamma-rays deposit their energies rather far from the source location. The calculated organ doses agree with the corresponding data obtained from OLINDA 2.0 within 20%, indicating the reliability of our developed system. Test calculations by replacing the labeled radionuclide from F-18 to At-211 suggest that large dose heterogeneity in a target volume is expected in TAT, resulting in a significant decrease of EQDX(alpha/beta) for higher-activity injection. Conclusions: As an extension of RT-PHITS, an individual dosimetry system for nuclear medicine was developed based on PHITS coupled with the microdosimetric kinetic model. It enables us to predict the therapeutic and side effects of TAT based on the clinical data largely available from conventional external radiotherapy.

Automated summary

An individual dosimetry system was developed for nuclear medicine based on PHITS coupled with the microdosimetric kinetic model, enabling prediction of therapeutic and side effects of TAT. The system showed reliable performance in calculating organ doses from PET-CT images, with a significant decrease of EQDX(alpha/beta) for higher-activity injections in TAT. The system can utilize clinical data from external radiotherapy to enhance precision in nuclear medicine dosimetry.