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A Pan-European Project Establishing Metrology for Clinical Implementation of Dosimetry in Molecular Radiotherapy

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A Pan-European Project Establishing Metrology for Clinical Implementation of Dosimetry in Molecular Radiotherapy MRTDosimetry: a pan-European project establishing metrology for clinical implementation of dosimetry in molecular radiotherapy Dr Andrew Robinson National Physical Laboratory, UK The University of Manchester, UK The Christie NHS Foundation Trust, UK MRTDosimetry: a pan-European project establishing metrology for clinical implementation of dosimetry in molecular radiotherapy Dr Andrew Robinson National Physical Laboratory, UK The University of Manchester, UK The Christie NHS Foundation Trust, UK Molecular Radiotherapy (MRT) National Physical Laboratory - 20th May 2019 Molecular Radiotherapy (MRT) Radiopharmaceutical Administered γ-rays are imaged Nucleus Decays β- γ-rays β- hits nearby cells and damages National Physicalor Laboratory kills them - 20th May 2019 Molecular Radiotherapy (MRT) Radiopharmaceutical Administered γ-rays are imaged Nucleus Decays β- γ-rays β- hits nearby cells and damages National Physicalor Laboratory kills them - 20th May 2019 Metastatic Castration-Resistant Prostate Cancer 225Ac Kratochwil et al, EANM 2016 National Physical Laboratory - 20th May 2019 What is Metrology? “Metrology is the science of measurement, embracing both experimental and theoretical determinations at any level of uncertainty in any field of science and technology.” National Physical Laboratory - 20th May 2019 What is Metrology? BIPM “Metrology is the science of Primary measurement, embracing both Standards National Metrology experimental and theoretical Institute Secondary determinations at any level of Standards uncertainty in any field of science and technology.” Calibration Reference Laboratories Standards End Measurements Users Uncertainty increases down the traceability chain National Physical Laboratory - 20th May 2019 International Equivalence BIPM BIPM BIPM BIPM Primary Standards Primary Standards Primary Standards Primary Standards Secondary Standards Secondary Standards Secondary Standards Secondary Standards Reference Standards Reference Standards Reference Standards Reference Standards Measurements Measurements Measurements Measurements National Physical Laboratory - 20th May 2019 Ambassador Bridge (USA to Canada) Øresund Bridge (Denmark to Sweden) Three Countries Bridge New Europe Bridge National(France Physicalto Germany Laboratory to Switzerland) - 20th May 2019 (Bulgaria to Romania) Ambassador Bridge (USA to Canada) (Not a real bridge!) Øresund Bridge (Denmark to Sweden) Three Countries Bridge New Europe Bridge National(France Physicalto Germany Laboratory to Switzerland) - 20th May 2019 (Bulgaria to Romania) Traceability in Nuclear Medicine From NIST SP 811 National Physical Laboratory - 20th May 2019 Traceability in Nuclear Medicine From NIST SP 811 National Physical Laboratory - 20th May 2019 Traceability in Nuclear Medicine A primary standard in metrology is a standard that is sufficiently accurate such that it is not calibrated by or subordinate to other standards. Primary standards are defined via other quantities like length, mass and time. Primary standards are used to calibrate secondary measurement standards. National Physical Laboratory - 20th May 2019 Measurements (and calculations) in MRT Patient Administration Secondary Standards (Hospital calibrator) Primary Radioactivity Standards National Physical Laboratory - 20th May 2019 Measurements (and calculations) in MRT Calibration Reconstruction Quantitative SPECT/CT SPECT Imaging Patient Administration VOI definition Secondary Standards Time Activity (Hospital calibrator) Patient-specific Curve optimisation Primary Radioactivity Absorbed dose Standards calculation Nuclear Data National Physical Laboratory - 20th May 2019 Measurements (and calculations) in MRT ui ui Calibration Reconstruction u ui i Quantitative SPECT/CT SPECT Imaging u u Patient i i Administration VOI definition u Secondary ui u(Dose) i Standards Time Activity (Hospital calibrator) Patient-specific Curve optimisation u Primary ui i Radioactivity Absorbed dose Standards calculation Nuclear Data National Physical Laboratory - 20th May 2019 Metrology and MRT? National Physical Laboratory - 20th May 2019 The Need 5190 National Physical Laboratory - 20th May 2019 85 National Physical Laboratory - 20th May 2019 8 National Physical Laboratory - 20th May 2019 National Physical Laboratory - 20th May 2019 MetroMRT June 2012 - May 2015 “The MetroMRT project was a watershed in that it is the first time that the disciplines of clinical science and metrology have combined to solve the problem of individual patient dosimetry in molecular radiotherapy, and to bring it into line with all other modalities of radiotherapy.” ▪ Activity Measurement ▪ Quantitative Imaging ▪ Absorbed Dose Calculation & Measurement ▪ Uncertainty Analysis THEAGENIONational Physical Cancer Laboratory Hospital, - 20 Thessalonikith May 2019 10th May 2019 MetroMRT “Dosimetry is difficult, and with no standard methods available the implementation requires a level of commitment that regular non- research clinics cannot afford. So there is a considerable inertia to be overcome before individual MRT dosimetry becomes the standard of care in every clinic.” http://projects.npl.co.uk/metromrt THEAGENIONational Physical Cancer Laboratory Hospital, - 20 Thessalonikith May 2019 10th May 2019 MRTDosimetry June 2016 - May 2019 National Physical Laboratory - 20th May 2019 6 metrology labs 12 clinical partners 15 collaborators 12 countries National Physical Laboratory - 20th May 2019 MRTDosimetry June 2016 - May 2019 Aim: To provide the metrology for the clinical implementation of absorbed dose calculations in Molecular Radiotherapy (MRT). The project builds on the results and outputs from MetroMRT. The focus of this follow-on project is clinical implementation and it is strongly directed by the involvement of leading MRT clinics across Europe as well as building on metrology expertise. National Physical Laboratory - 20th May 2019 Project Structure Calibration Reconstruction Quantitative SPECT/CT SPECT Imaging Patient Administration VOI definition Secondary Standards Time Activity (Hospital calibrator) Patient-specific Curve optimisation Primary Radioactivity Absorbed dose Standards calculation Nuclear Data National Physical Laboratory - 20th May 2019 Project Structure Calibration Reconstruction Quantitative SPECT/CT SPECT Imaging Patient Administration VOI definition Secondary Standards Time Activity (Hospital calibrator) Patient-specific Curve optimisation Primary Radioactivity Absorbed dose Standards calculation Nuclear Data National Physical Laboratory - 20th May 2019 Project Structure Radionuclide Metrology Nuclear Data Transfer instrument Traceable Solid Activity Standards Measurements for high activity Sources (90Y, 166Ho) beta emission National Physical Laboratory - 20th May 2019 Project Structure Accuracy and Dosimetry comparison exercise traceability of dose calculations Physical Monte Carlo Validation Measurements Simulation Computer modelling of time-variable Gel and film dose activity distributions 3D printed “Ground truth” measurements. phantoms Primary standard Solid sources for absorbed dose. Image based quantification of 3D activity distributions Quantitative imaging comparison exercise Radionuclide Metrology Nuclear Data Transfer instrument Traceable Solid Activity Standards Measurements for high activity Sources (90Y, 166Ho) beta emission National Physical Laboratory - 20th May 2019 Final project outcomes The ultimate aim of the project is to encourage and assist European MRT clinics, and those worldwide, to adopt dosimetry as a routine part of patient treatment and to bring MRT into line with other radiotherapy modalities. The project will also support compliance with the EC Directive 2013/59/EURATOM, which states that individual dose planning for radiotherapy patients (including MRT) must be enforced in legislation by EU member states by 6th February 2018. Final publishable report available in August 2019. http://mrtdosimetry-empir.eu/ National Physical Laboratory - 20th May 2019 This Workshop 1st European Workshop on Quantitative Imaging for MRT: Metrology for Clinical Practice ➢ Activity Measurement. Vienna, 5th – 6th April 2017 ➢ Quantitative Imaging. 2nd European workshop on the principles and clinical implementation of dose calculation in MRT Prague, 26th – 27th Sept 2018 ➢ Dosimetry for MRT. 3rd workshop on MRT Dosimetry: Clinical Implementation of ➢ International Guidelines. Personalised Dosimetry in MRT Thessaloniki, 10th May 2019 ➢ Uptake of the outcomes 4th European Workshop on the Clinical Implementation of and the way forward. Dosimetry for MRT Teddington, 20th – 21st May 2019 National Physical Laboratory - 20th May 2019 Teaching Seminars http://training.npl.co.uk/ Day 1: Monday 20th May 2019 12:30 Lunch (F16 CS6 & CS7) Session 2: Quantitative Imaging 13:30 Teaching Seminar: “Calibration and verification of QI” Michael Lassmann and Johannes Tran-Gia, University of Würzburg, Germany (60 min) 14:30 Monte Carlo simulation of SPECT imaging Gunjan Kayal – SCK.CEN, Belgium and INSERM, France (45 min) 15:15 Camera intercomparison for Lu-177 quantification in the Netherlands Steffie Peters - Radboud university medical center, The Netherlands (20 min) 15:35 Imaging and dosimetry for Ho-166 microspheres Gerrit van de Maat - Quirem Medical (20 min) 15:55 Coffee break (F16 CS6 & CS7) Session 3: Dosimetry for MRT 16:30 Teaching Seminar: “Commissioning of a dosimetry platform for MRT” Jill Tipping and Nick Calvert, The Christie NHS Foundation Trust, United Kingdom (60 min) National Physical Laboratory - 20th May 2019 Coffee
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