3D-Printed Organ-Realistic Phantoms to Verify Quantitative SPECT/CT Accuracy for 177Lu-PSMA-617 Treatment Planning

Background/Objectives: Accurate patient-specific dosimetry is essential for optimizing radiopharmaceutical therapy (RPT), but current tools lack validation in clinically realistic conditions. This work aimed to develop a workflow for designing and fabricating patient-derived, organ-realistic RPT phantoms and evaluate their feasibility for commissioning patient-specific RPT radioactivity quantification. Methods: We used computed tomographic (CT) and magnetic resonance (MR) imaging of representative patients, computer-aided design, and in-house 3D printing technology to design and fabricate anthropomorphic kidney and parotid phantoms with realistic organ spacing, anatomically correct orientation, and surrounding tissue heterogeneities. We evaluated the fabrication process via geometric verification (i.e., volume comparisons) and leak testing (i.e., dye penetration tests). Clinical feasibility testing involved injecting known radioactivities of ¹⁷⁷Lu-PSMA-617 into the parotid and kidney cortex phantom chambers and acquiring SPECT/CT images. MIM SurePlan MRT SPECTRA Quant software (v7.1.2) reconstructed the acquired SPECT projections into a quantitative SPECT image and we evaluated the accuracy by region-based comparison to the known injected radioactivities and determined recovery coefficients for each organ phantom. Results: Phantom fabrication costs totaled < USD 250 and required <84 h. Geometric verification showed a slight systematic expansion (<10%) from the representative patient anatomy and leak testing confirmed watertightness of fillable chambers. Quantitative SPECT imaging systematically underestimated the injected radioactivity (mean error: -17.0 MBq; -13.2%) with recovery coefficients ranging from 0.82 to 0.93 that were negatively correlated with the surface-area-to-volume ratio. Conclusions: Patient-derived, 3D-printed fillable phantoms are a feasible, cost-effective tool to support commissioning and quality assurance for patient-specific RPT dosimetry. The results of this work will support other centers and clinics implementing patient-specific RPT dosimetry by providing the tools needed to comprehensively evaluate accuracy in clinically relevant geometries. Looking forward, widespread accurate patient-specific RPT dosimetry will improve our understanding of RPT dose response and enable personalized RPT dosing to optimize patient outcomes.