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Multiple vertebrae improves precision in image-based bone marrow absorbed dose estimation in [177Lu]Lu-DOTATATE
Katja Smits1, Frida Westerbergh2, Jens Hemmingsson2
1Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gula Stråket 2B, 413 45, Gothenburg, Sweden. katja.smits@gu.se.
EJNMMI Physics
|May 9, 2026
Summary
Including multiple lesion-free vertebrae improves precision for bone marrow absorbed dose calculations in radionuclide therapy. Careful selection of vertebrae is crucial to avoid bias from nearby high-uptake areas.
Area of Science:
- Nuclear Medicine
- Medical Physics
- Radiotherapy
Background:
- Bone marrow dosimetry is critical for radionuclide therapy but not routinely performed.
- High noise and limited vertebrae in calculations lead to uncertain absorbed dose estimates.
- This study investigates factors affecting image-based bone marrow absorbed dose calculations.
Purpose of the Study:
- To evaluate the impact of the number of vertebrae on bone marrow absorbed dose precision.
- To assess the influence of partial volume effects and reconstruction parameters.
- To analyze absorbed dose calculations in patients treated with [177Lu]Lu-DOTATATE.
Main Methods:
- Analyzed bone marrow absorbed dose estimates and precision using 1 to 6 vertebrae in 16 patients.
- Evaluated phantom data (Lung-Spine and XCAT) with varying noise levels and volumes.
- Assessed the effect of reconstruction parameters (subsets, iterations) on dose calculations.
Main Results:
- Increasing vertebrae from 1 to 6 reduced coefficient of variation (COV) from 34% to 6.2%.
- Reconstruction parameter changes had minimal impact (0.1%) on absorbed dose.
- Smaller phantom volumes (4 mL) showed higher noise sensitivity (COV 36%) than larger volumes (16 mL, COV 17%).
- Decreased recovery was observed in vertebrae near high-uptake regions in the XCAT phantom.
Conclusions:
- Multiple lesion-free vertebrae enhance precision in bone marrow absorbed dose calculations.
- Careful vertebrae selection is vital to prevent bias from high-uptake areas.
- Partial volume correction can improve accuracy by mitigating spill-out effects.
