Influence of voxel S factors on three-dimensional internal dosimetry calculations.

Internal dosimetry is a fundamental instrument for the personalization of nuclear medicine therapies, to maximize the therapeutic effect while minimizing the radiation burden to other organs. Three-dimensional (3D) dosimetry can quantify the impact of heterogeneous radiopharmaceutical distributions in organs, lesions and tissues. We analysed the influence of radionuclide voxel S factors in 3D dosimetry of In, Lu and Y, the most used radionuclides in Peptide Receptor Radionuclide Therapy (PRRT). Calculations were carried out for kidneys on a workstation equipped with a software for 3D dosimetry (Imalytics STRATOS, Philips AG), adopting a computational anthropomorphic phantom and, retrospectively, the SPECT-CT image series of a clinical case of PRRT. Two sets of voxel S factors were adopted: the pre-loaded Philips kernels, calculated by direct Monte Carlo simulation, and the ones calculated through a previously proposed analytical approach. Philips In kernel did not account for mono-energetic Auger or Conversion electrons. Results indicate a difference of about -32% in voxel S factors for In in 4.42mm voxel size and around -35% in 4.80mm voxel size, particularly self-dose values; this lead to significant shift in dose histograms and average doses. For Lu and Y, differences are about 2% and 12% for 4.42mm voxels and about -8% and 9% for 4.80mm voxels, respectively, attributable to the different calculation methods of the voxel S factors; this does not lead to significant discrepancies between the two dose histograms. Consequently, voxel S factors must account accurately for all radiations emitted by the nuclide.