Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;
German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.
J Nucl Med. 2022 Sep;63(9):1349-1356. doi: 10.2967/jnumed.121.263175. Epub 2021 Dec 16.
Cerenkov luminescence imaging (CLI) was successfully implemented in the intraoperative context as a form of radioguided cancer surgery, showing promise in the detection of surgical margins during robot-assisted radical prostatectomy. The present study was designed to provide a quantitative description of the occupational radiation exposure of surgery and histopathology personnel from CLI-guided robot-assisted radical prostatectomy after the injection of Ga-PSMA-11 in a single-injection PET/CT CLI protocol. Ten patients with preoperative Ga-PSMA-11 administration and intraoperative CLI were included. Patient dose rate was measured before PET/CT ( = 10) and after PET/CT ( = 5) at a 1-m distance for 4 patient regions (head [A], right side [B], left side [C], and feet [D]). Electronic personal dosimetry (EPD) was used for intraoperative occupational exposure ( = 10). Measurements included the first surgical assistant and scrub nurse at the operating table and the CLI imager/surgeon at the robotic console and encompassed the whole duration of surgery and CLI image acquisition. An estimation of the exposure of histopathology personnel was performed by measuring prostate specimens ( = 8) with a germanium detector. The measured dose rate value before PET/CT was 5.3 ± 0.9 (average ± SD) μSv/h. This value corresponds to a patient-specific dose rate constant for positions B and C of 0.047 μSv/h⋅MBq. The average dose rate value after PET/CT was 1.04 ± 1.00 μSv/h. The patient-specific dose rate constant values corresponding to regions A to D were 0.011, 0.026, 0.024, and 0.003 μSv/h⋅MBq, respectively. EPD readings revealed average personal equivalent doses of 9.0 ± 7.1, 3.3 ± 3.9, and 0.7 ± 0.7 μSv for the first surgical assistant, scrub nurse, and CLI imager/surgeon, respectively. The median germanium detector-measured activity of the prostate specimen was 2.96 kBq (interquartile range, 2.23-7.65 kBq). Single-injection Ga-PSMA-11 PET/CT CLI procedures are associated with a reasonable occupational exposure level, if kept under 110 procedures per year. Excised prostate specimen radionuclide content was below the exemption level for Ga. Dose rate-based calculations provide a robust estimation for EPD measurements.
切伦科夫发光成像（CLI）成功地应用于术中环境，作为放射性引导癌症手术的一种形式，在机器人辅助根治性前列腺切除术期间检测手术切缘方面显示出前景。本研究旨在提供一种定量描述在单次注射 Ga-PSMA-11 的 PET/CT CLI 方案后，从 CLI 引导的机器人辅助根治性前列腺切除术的手术和组织病理学人员的职业辐射暴露。10 例接受术前 Ga-PSMA-11 给药和术中 CLI 的患者被纳入研究。在距离患者 1 米处，对 4 个患者区域（头部[A]、右侧[B]、左侧[C]和脚部[D]）进行了 PET/CT 前（ = 10）和 PET/CT 后（ = 5）的患者剂量率测量。术中职业暴露使用电子个人剂量计（EPD）（ = 10）。测量包括手术台上的第一外科助手和刷手护士，以及机器人控制台的 CLI 成像仪/外科医生，涵盖手术和 CLI 图像采集的整个过程。通过使用锗探测器测量前列腺标本（ = 8）来估计组织病理学人员的暴露情况。PET/CT 前测量的剂量率值为 5.3 ± 0.9（平均值 ± 标准差）μSv/h。这对应于 B 和 C 位置的患者特异性剂量率常数为 0.047 μSv/h⋅MBq。PET/CT 后的平均剂量率值为 1.04 ± 1.00 μSv/h。相应的患者特异性剂量率常数值分别为 A 至 D 区域的 0.011、0.026、0.024 和 0.003 μSv/h⋅MBq。EPD 读数显示第一外科助手、刷手护士和 CLI 成像仪/外科医生的个人当量剂量平均值分别为 9.0 ± 7.1、3.3 ± 3.9 和 0.7 ± 0.7 μSv。前列腺标本的中值锗探测器测量的活性为 2.96 kBq（四分位距，2.23-7.65 kBq）。单次注射 Ga-PSMA-11 PET/CT CLI 程序如果每年保持在 110 次以下，则与合理的职业暴露水平相关。切除的前列腺标本放射性核素含量低于 Ga 的豁免水平。基于剂量率的计算为 EPD 测量提供了稳健的估计。
