A strategy for estimating radiation dose to the blood in outpatient settings in differentiated thyroid cancer therapy with 131 I-NaI

Although standard operational procedures for pre-therapeutic dosimetry already exist for the determination of the maximum safe activity to treat differentiated thyroid cancer patients, empiric activity administration of I is still the most frequent way of treatment. In this way, the absorbed dose to the blood/bone marrow remains unknown. In this work, we present a strategy to estimate radiation dose to the blood in an outpatient setting. A mobile application was developed, which together with an off-the-shelf compact semiconductor radiation detector allows the determination of whole-body time-integrated activity coefficients. The methodology was tested in a cohort of 79 differentiated cancer patients who received therapeutic I activities. Post-therapeutic whole-body time-integrated activity coefficients were compared against pre-therapeutic estimates in a subset of 13 patients. The 95% limits of agreement between pre whole-body and post whole-body time integrated activity coefficients were [-14.4; 6.6] h when considering outliers and [-6.2; 3.6] h without outliers. A high dispersion in blood dose coefficients was found, with a four-fold difference between the highest and lower values. Blood doses were significantly higher for patients treated with dosimetrically guided activities than for empirical activities (median dose = 118 vs. 49 cGy, respectively). Blood dose coefficients were significantly lower for patients prepared with recombinant human thyroid stimulating hormone (rhTSH) than for patients prepared with thyroid hormone withdrawal. A low correlation between blood dose and administered activity was found in empirically treated patients (R = 0.26). We successfully implemented a post-therapeutic internal dosimetry methodology for differentiated thyroid cancer therapy with I, which allows to estimate dose to the blood from outpatient measurements with mobile devices. The proposed methodology avoids the need of daily visits to the nuclear medicine department, thus reducing the burden for the patient and for the staff.