Dosimetry Toolkit

Pr. Martin Schlumberger, MD, PhDHead, Imaging Dpt.Gustave Roussy HospitalVillejuif, France

Marcel Ricard, PhDMedical PhysicistNuclear Medicine Dpt.Gustave Roussy HospitalVillejuif, France

GE Healthcare

©2014 General Electric Company — All rights reserved. *Trademark of General Electric Company.GE, the GE Monogram and imagination at work are trademarks of General Electric Company. GE Healthcare, a division of General Electric Company. ** All third party trademarks are the property of their respective owner.The clinical cases are displayed for educational purposes only and for the benefit of healthcare students and professionals

JB24623FR

GE imagination at work

About GE HealthcareGE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. For more information about GE Healthcare, visit our website at www.gehealthcare.com.

Corporate Headquarters GE Healthcare540 W Northwest HighwayBarrington, IL 60010-3076 USA

Tel: +1 847-277-5000 or1 800-437-1171 or1 800-682-5327 Fax: +1 847-277-5240

European Headquarters GE Healthcare283 rue de la Minière78530 BUCFrance

GE Healthcare

@GEHealthcare

GE Healthcare

GE Healthcare ”“ Our plan is to evaluate “Dosimetry Toolkit” as a quantitative tool in a the follow-up of thyroid cancer patients after iodine 131

EquipmentThe site is equipped with a Discovery* PET/CT 690, a GE Discovery NM/CT 670 and a Discovery 630. Four Xeleris system and 3 AW systems complete this

equipment.

Dosimetry ToolkitThe uptake of iodine 131 measured during radioactive iodine treatment of differentiated thyroid cancer, is a powerful medical indicator of efficacy. Recent technological developments, as hybrid SPECT/CT machines, are designed to improve the reliability of quantification. Regarding these new opportunities, Pr Schlumberger became very interested to evaluate the clinical value of a 3D segmentation tool such as Dosimetry Toolkit.

As Dosimetry Toolkit is dependent on the performance of the gamma camera device, a calibration step is mandatory. All calibrations have been implemented using a high-energy collimator mounted on NM/CT 670 equipped with 5/8" crystal.

Images have been reconstructed after attenuation and scatter corrections using OSEM algorithm (2 iterations, 10 subsets). We performed calibration with three different phantoms. The cylindrical Deluxe Jaszczak Phantom** was used to define de threshold level using refillable spheres. The anthropomorphic Livermore Laboratory phantom was useful to consider realistic situation mimicking normal thyroid remnants or lymph nodes. Finally the Anthropomorphic Torso Phantom** allowed taking into account the spread of radioactivity in case of lung involvement. Following calibration two distinct sensitivity factors (counts/MBq/s) were specified one for soft tissues and one for lungs.

After implementation and calibration of Dosimetry Toolkit, and our phantom-based study, in our experience an accuracy of about 20 % may be reasonably achieved. This value is in good agreement with clinical requirements. Based on our phantom study, in terms of sensitivity, uptakes as low as 0.01 % of the administered activity can be estimated*. Individual results in the clinical arena may vary.

Overview of the siteGustave Roussy is an Oncology comprehensive center which missions are to treat cancer patients, develop new therapeutic procedures and disseminate knowledge in medical and scientific French and international communities. Research and teaching are closely linked. Based on its expertise and advanced medical practices, GR is considered as a reference center in France but also internationally. Gustave Roussy relies on its specific therapeutic innovations, development of personalized medicine, quality and safety of care, always placing the patient at the center of its missions.

Clinical applicationUptake measurements are usually performed 2 or 3 days after iodine 131 administration of 1100 MBq or 3700 MBq for patients who have been prepared with either Thyrogen or withdrawal. Image segmentation was performed both from nuclear medicine images or CT-scans, depending on the type of uptake e.g. lymph node or lung involvement. In all cases, the tools were found easy to use except for images with a poor signal to noise ratio. In that situation the analysis of the images must be entrusted to an experienced observer.

Dosimetry Toolkit has demonstrated its usefulness in the quantification of SPECT/CT images and in the measurement of uptakes following a 131 iodine administration. It has a potential for in vivo data when dosimetric studies are planned. However, actual clinical studies need to be performed.

3D SPECT Segmentation done SPECT images

Quantification on segmented images

These first evaluations showed that Dosimetry Toolkit can help in I131 quantification after treatment of thyroid cancer patients. Tools are compatible with medical requirements when an accuracy of +/- 20% is generally considered as enough accurate to allow the monitoring of thyroid cancer patients 1.

1. Author’s conclusions are solely based on their scientific study and must be evaluated by an medically qualified reader. GE does not necessarily endorse nor support any conclusions or recommendations contained in author’s findings.

Dosimetry Toolkit

Pr. Martin Schlumberger, MD, PhDHead, Imaging Dpt.Gustave Roussy HospitalVillejuif, France

Marcel Ricard, PhDMedical PhysicistNuclear Medicine Dpt.Gustave Roussy HospitalVillejuif, France

GE Healthcare

©2014 General Electric Company — All rights reserved. *Trademark of General Electric Company.GE, the GE Monogram and imagination at work are trademarks of General Electric Company. GE Healthcare, a division of General Electric Company. ** All third party trademarks are the property of their respective owner.The clinical cases are displayed for educational purposes only and for the benefit of healthcare students and professionals

JB24623FR

GE imagination at work

About GE HealthcareGE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients. For more information about GE Healthcare, visit our website at www.gehealthcare.com.

Corporate Headquarters GE Healthcare540 W Northwest HighwayBarrington, IL 60010-3076 USA

Tel: +1 847-277-5000 or1 800-437-1171 or1 800-682-5327 Fax: +1 847-277-5240

European Headquarters GE Healthcare283 rue de la Minière78530 BUCFrance

GE Healthcare

@GEHealthcare

GE Healthcare

GE Healthcare ”“ Our plan is to evaluate “Dosimetry Toolkit” as a quantitative tool in a the follow-up of thyroid cancer patients after iodine 131