Toward the standardization of radiopharmaceutical therapies: a technical note evaluating a clinical dosimetry workflow for single-time-point 177Lu SPECT/CT-based therapies

Purpose The lack of standardized dosimetry workflows in lutetium-177 ( ¹⁷⁷ 177 Lu) radiopharmaceutical therapies results in inconsistent absorbed doses and limits treatment planning. This study aims to evaluate the accuracy and variability of a single-time-point 177 Lu SPECT/CT commercial workflow to help harmonize its protocol. Methods The dosimetry workflow evaluated in this study predominatly followed that of MIM SurePlan TM MRT. 177 Lu SPECT/CT images of a Jaszczak and a NEMA phantoms were acquired in GE 670 DR scanner. Absorbed dose (Gy/MBq/s) was calculated in the background and sphere inserts with varied reconstruction iterations, calibrations, voxel-based dosimetry methods, and target volume segmentations. Ground truth absorbed doses were created using CT images and voxel S-value (VSV) water kernels. The validity of the density-corrected (DC) kernel for use in ground-truth dosimetry evaluations was further investigated. The accuracy and variability of the dosimetry workflow were evaluated using percent error and the coefficient of variation (CV) of mean absorbed doses. Results Mean absorbed dose accuracy improved for both the voxel-based VSV and local deposition (LD) methods until 480 equivalent iterations for all target volumes. DC kernel was found viable for creating reference absorbed doses. The calibration CV was 5.18% when phantom and calibration regions were varied. The VSV method demonstrated absorbed doses that were 10 to 150% higher than those calculated with the LD method. The overall variability in absorbed dose reached up to 84% when reconstruction, calibration, dosimetry, and segmentation methods were varied. Conclusions A single dosimetry workflow has demonstrated markedly large variability in absorbed dose accuracy. By evaluating the accuracy of absorbed dose, our study helped to propose a harmonized MIM SurePlan TM MRT workflow for single-time-point ¹⁷⁷ 177 Lu SPECT/CT-based therapies.