$^{18}$F-PSMA-1007 salivary gland dosimetry: Comparison between different methods for dose calculation and assessment of inter- and intra-patient variability

TL;DR

This study compares various dosimetry methods for salivary gland dose calculation after 18F-PSMA-1007 injection in prostate cancer patients, highlighting significant variability and the importance of patient-specific data.

Contribution

It systematically evaluates and compares different dosimetry approaches, including Monte Carlo, spherical, and ellipsoidal models, for salivary gland dose assessment in a clinical setting.

Findings

All methods underestimate doses compared to Monte Carlo.

Significant inter- and intra-patient variability in salivary gland doses.

Accounting for cross irradiation improves dose estimation accuracy.

Abstract

Dosimetry of salivary glands (SGs) is usually implemented using simplified calculation approaches and approximated geometries. Our aims were to compare different dosimetry methods to calculate SGs absorbed doses (ADs) following 18F-PSMA-1007 injection, and to assess the AD variation across patients and single SG components. Five patients with prostate cancer recurrence underwent PET/CT acquisitions of the head and neck, 0.5, 2 and 4 hours after 18F-PSMA-1007 injection. Parotid and submandibular glands were segmented on CT to derive SGs volumes and masses, while PETs were used to derive Time-Integrated Activity Coefficients. Average ADs to single SG components or total SG (tSG) were calculated with the following methods: i) direct Monte Carlo (MC) simulation with GATE/GEANT4; ii) spherical model (SM) of OLINDA/EXM 2.1, adopting either patient-specific or standard ICRP89 organ masses (SMstd); iii) ellipsoidal model (EM); iv) MIRD approach with organ S-factors from OLINDA/EXM 2.1 and OpenDose collaboration, with or without contribution from cross irradiation originating outside the SGs. The maximum percent AD difference across SG components ({\delta}max) and across patients ({\Delta}max) were calculated. Compared to MC, ADs to single SG components were significantly underestimated by all methods (average relative differences between -14.5% and -30.4%). Using MC, SM and EM, {\delta}max were never below 25% (up to 113%). {\delta}max up to 702% were obtained with SMstd. Concerning tSG, results within 10% of the MC were obtained only if cross irradiation from the remainder of the body or from the remainder of the head was accounted for. The {\Delta}max ranged between 58% and 78% across patients. Specific masses of single SG components should always be considered given their large intra- and inter- patient variability.