Theranostic Activity of Nitric Oxide-Releasing Carbon Quantum Dots
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Biochemistry & Molecular Biology↗
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Theranostic Radiopnictogens: 71 As, 72 As, and 119 Sb (Final Technical Report)
This project has developed new methods for the cyclotron production of medically relevant radionuclides 71 As and 119 Sb. Arsenic and antimony are chemically homologous elements (group 5A, also known as the pnictogens) that have radionuclides that are of considerable interest within nuclear medicine. Such radiopnictogens include the potentially therapeutic radionuclides 119 Sb (t 1/2 = 38 h) that decays with the emission of 24.5 low energy, high potency electrons per decay with little concomitant photon radiation and 77 As (t 1/2 = 39 h) that decays with average beta energy of 230 keV and diagnostic nuclides 71 As (t 1/2 = 65 h, 28% β+) and 72 As (t 1/2 = 26 h, 80% β+) for positron emission tomography (PET). This work has had major success developing new methods for the cyclotron production and radiochemical isolation of 71 As, supporting parallel developments for 119 Sb, and assessing the chemical similarities between these two homologous radionuclides. This project brought into collaboration two universities with complimentary skill sets, proficiencies, expertise, and facilities: the University of Wisconsin (UWisc) and the University of Missouri (Mizzou). Professors Ellison and Engle have experience in the small cyclotron production and radiochemical isolation of radionuclides, including 72 As and 119 Sb. Their recently developed metallurgic methods for fabricating cyclotron targets have great potential to expand and allow for the biomedical cyclotron production of long- lived, lower positron energy 71 As. Professors Hennkens and Jurisson have significant experience in the reactor production, radiochemical isolation, and biological functionalization of radioarsenic. Recent development of trithiol-based chelator molecules for functionalizing radioarsenic provide a platform for the investigation of the fundamental challenges of the promising low-energy-electron emitter, 119 Sb. Through their positions within their respective University’s graduate schools, the PIs and Co-Is effectively trained of graduate students and postdoctoral researchers in nuclear and radiochemistry, sub-specialties specifically identified in the Department of Energy (DOE) Office of Science Isotope Program long-range plan. Annual laboratory research visits for students between UWisc and Mizzou provided essential broad-field experience and scientific networking that is critical for maintaining their path along the training pipeline to productive careers in isotope production. This research collaboration has provided significant benefits to the DOE University Isotope Network and radionuclide-using researchers around the country.
07 ISOTOPE AND RADIATION SOURCES↗
Evaluation of Candidate Theranostics for 227 Th/ 89 Zr Paired Radioimmunotherapy of Lymphoma
227 Th is a promising radioisotope for targeted α-particle therapy. It produces 5 α-particles through its decay, with the clinically approved 223 Ra as its first daughter. There is an ample supply of 227 Th, allowing for clinical use; however, the chemical challenges of chelating this large tetravalent f-block cation are considerable. Using the CD20-targeting antibody ofatumumab, we evaluated chelation of 227 Th 4+ for α-particle–emitting and radiotheranostic applications. Methods: We compared 4 bifunctional chelators for thorium radiopharmaceutical preparation: S-2-(4-Isothiocyanatobenzyl)-1,4,7,10-tetraazacyclododecane tetraacetic acid (p-SCN-Bn-DOTA), 2-(4-isothicyanatobenzyl)-1,2,7,10,13-hexaazacyclooctadecane-1,4,7,10,13,16-hexaacetic acid (p-SCN-Bn-HEHA), p-isothiacyanatophenyl-1-hydroxy-2-oxopiperidine-desferrioxamine (DFOcyclo*-p-Phe-NCS), and macrocyclic 1,2-HOPO N-hydroxysuccinimide (L804-NHS). Immunoconstructs were evaluated for yield, purity, and stability in vitro and in vivo. Tumor targeting of the lead 227 Th-labeled compound in vivo was performed in CD20-expressing models and compared with a companion 89 Zr-labeled PET agent. Results: 227 Th-labeled ofatumumab-chelator constructs were synthesized to a radiochemical purity of more than 95%, excepting HEHA. 227 Th-HEHA-ofatumumab showed moderate in vitro stability. 227 Th-DFOcyclo*-ofatumumab presented excellent 227 Th labeling efficiency; however, high liver and spleen uptake was revealed in vivo, indicative of aggregation. 227 Th-DOTA-ofatumumab labeled poorly, yielding no more than 5%, with low specific activity (0.08 GBq/g) and modest long-term in vitro stability (<80%). 227 Th-L804-ofatumumab coordinated 227 Th rapidly and efficiently at high yields, purity, and specific activity (8 GBq/g) and demonstrated extended stability. In vivo tumor targeting confirmed the utility of this chelator, and the diagnostic analog, 89 Zr-L804-ofatumumab, showed organ distribution matching that of 227 Th to delineate SU-DHL-6 tumors. Conclusion: Commercially available and novel chelators for 227 Th showed a range of performances. The L804 chelator can be used with potent radiotheranostic capabilities for 89 Zr/ 227 Th quantitative imaging and α-particle therapy.
227Th↗
Evaluation of 134 Ce/ 134 La as a PET Imaging Theranostic Pair for 225 Ac α-Radiotherapeutics
225 Ac-targeted α-radiotherapy is a promising approach to treating malignancies, including prostate cancer. However, α-emitting isotopes are difficult to image because of low administered activities and a low fraction of suitable γ-emissions. The in vivo generator 134 Ce/ 134 La has been proposed as a potential PET imaging surrogate for the therapeutic nuclides 225 Ac and 227 Th. In this report, we detail efficient radiolabeling methods using the 225 Ac-chelators DOTA and MACROPA. These methods were applied to radiolabeling of prostate cancer imaging agents, including PSMA-617 and MACROPA-PEG 4 -YS5, for evaluation of their in vivo pharmacokinetic characteristics and comparison to the corresponding 225 Ac analogs. Methods: Radiolabeling was performed by mixing DOTA/MACROPA chelates with 134 Ce/ 134 La in NH 4 OAc, pH 8.0, at room temperature, and radiochemical yields were monitored by radio–thin-layer chromatography. In vivo biodistributions of 134 Ce-DOTA/MACROPA.NH 2 complexes were assayed through dynamic small-animal PET/CT imaging and ex vivo biodistribution studies over 1 h in healthy C57BL/6 mice, compared with free 134 CeCl 3 . In vivo, preclinical imaging of 134 Ce-PSMA-617 and 134 Ce-MACROPA-PEG 4 -YS5 was performed on 22Rv1 tumor–bearing male nu/nu-mice. Ex vivo biodistribution was performed for 134 Ce/ 225 Ac-MACROPA-PEG 4 -YS5 conjugates. Results: 134 Ce-MACROPA.NH 2 demonstrated near-quantitative labeling with 1:1 ligand-to-metal ratios at room temperature, whereas a 10:1 ligand-to-metal ratio and elevated temperatures were required for DOTA. Rapid urinary excretion and low liver and bone uptake were seen for 134 Ce/ 225 Ac-DOTA/MACROPA. NH 2 conjugates in comparison to free 134 CeCl 3 confirmed high in vivo stability. An interesting observation during the radiolabeling of tumor-targeting vectors PSMA-617 and MACROPA-PEG 4 -YS5—that the daughter 134 La was expelled from the chelate after the decay of parent 134 Ce—was confirmed through radio–thin-layer chromatography and reverse-phase high-performance liquid chromatography. Both conjugates, 134 Ce-PSMA-617 and 134 Ce-MACROPA-PEG 4 -YS5, displayed tumor uptake in 22Rv1 tumor–bearing mice. The ex vivo biodistribution of 134 Ce-MACROPA.NH 2 , 134 Ce-DOTA and 134 Ce-MACROPA-PEG 4 -YS5 corroborated well with the respective 225 Ac-conjugates. Conclusion: These results demonstrate the PET imaging potential for 134 Ce/ 134 La-labeled small-molecule and antibody agents. The similar 225 Ac and 134 Ce/ 134 La-chemical and pharmacokinetic characteristics suggest that the 134 Ce/ 134 La pair may act as a PET imaging surrogate for 225 Ac-based radioligand therapies.
07 ISOTOPE AND RADIATION SOURCES↗
Synthesis of DOTA-Based 43 Sc Radiopharmaceuticals Using Cyclotron-Produced 43 Sc as Exemplified by [ 43 Sc]Sc-PSMA-617 for PSMA PET Imaging
The implementation of theranostics in oncologic nuclear medicine has exhibited immense potential in improving patient outcomes in prostate cancer with the implementation of [ 68 Ga]Ga-PSMA-11 PET and [ 177 Lu]Lu-PSMA-617 into clinical practice. However, the correlation between radiopharmaceutical biodistributions seen with [ 68 Ga]Ga-PSMA-11 PET imaging and downstream [ 177 Lu]Lu-PSMA-617 therapy remains imperfect. This suggests that prostate cancer theranostics could potentially be further refined through the implementation of true theranostics, tandem pairs of diagnostic and therapeutic radiopharmaceuticals that utilize the same ligand and element, thus yielding identical pharmacokinetics. The radioscandiums are one such group of true theranostic radiopharmaceuticals. The radioscandiums consist of two β+ emitting scandium isotopes ( 43 Sc/ 44 Sc), as well as a β − emitting therapeutic isotope ( 47 Sc), which can all conjugate with PSMA-targeting PSMA-617. This potential has led to extensive investigations into the production of the radioscandiums as well as pre-clinical assessments with several ligands; however, there is a lack of literature extensively describing the complete synthesis of scandium radiopharmaceuticals. which therefore limits the accessibility of radioscandium research in theranostics. As such, this work aims to present an easily translatable protocol for the synthesis of [ 43 Sc]Sc-PSMA-617 from a [ 42 Ca]CaCO 3 starting material, including target formation, nuclear production via 42 Ca(d,n) 43 Sc reaction, chemical separation, radiolabeling, solvent reformulation, and target recycling.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
Production of High Specific Activity 155 Tb, 161 Tb and 203 Pb for Research and Clinical Applications: Effective Target Design, Target Material Recycling and Radioisotope Separation (Final Technical Report)
The overall objectives of this project were (1) to develop methods for the production and separation of a diagnostic and therapeutic or “theranostic” pair of radioisotopes, terbium-155 ( 155 Tb) and terbium-161 ( 161 Tb) and (2) to train graduate students and postdoctoral fellows in technologies and methods used in radionuclide production. Radionuclides can be incorporated into drugs called radiopharmaceuticals that target a specific disease (e.g., cancer). The need for theranostic radionuclides is escalating with the clinical translation of radiopharmaceuticals due to their implementation in personalized medicine, which has demonstrated enhanced patient treatments. High purity and high specific activity radionuclides are critical for theranostic agent development, for example to maintain diagnostic image quality, to minimize radiation dose to the patient, and to increase uptake in the targeted tissue (e.g., tumor), especially in the case of receptor- and antigen-targeted agents. The 155 Tb (diagnostic) and 161 Tb (therapeutic) radioisotopes that were generated through this project are a theranostic pair with demonstrated potential for the development and translation into individualized, targeted, and dosimetry-driven radiotherapies. However, the development of such radiotherapies has been hindered by the lack of a routine and reliable supply of these isotopes in the United States. Methods for the production, separation, and supply of 155 Tb and 161 Tb were investigated and developed in this project. Further, the strong emphasis throughout the project on the training of graduate students and postdoctoral fellows has helped to ensure and enhance the nuclear science workforce through the training of the next generation of highly qualified scientists in nuclear and radiochemistry. This grant also continued a collaboration between scientists at the University of Washington (UW), the University of Missouri (MU) and Brookhaven National Laboratory (BNL). All three institutions were involved in the project, but to different degrees on the various tasks through which the overall objectives were met.
07 ISOTOPE AND RADIATION SOURCES↗
Production of Radioisotopes of Scandium for Imaging and Therapy (Final Report)
The theranostic approach is a powerful technique that enables scientists and physicians to diagnose and treat diseases using the same targeting moiety labeled with radionuclides for imaging and therapy. A challenge behind synthesizing and evaluating these theranostic radiopharmaceuticals lies in the production of suitable radionuclides. This study aimed to investigate the production of high radionuclidic purity 43 Sc from enriched [ 46 Ti]TiO 2 for Positron Emission Tomography (PET) and 47 Sc from enriched [ 50 Ti]TiO 2 for targeted radiotherapy, as well as establish a target recycling technique for continued production of these radionuclides. Methods: Targets were prepared with 100 mg of either enriched [ 46 Ti]TiO 2 or [ 50 Ti]TiO 2 , pressed into pellets, and placed into Ta target holders with a 0.127 mm natTi cover foil. The 46 Ti targets were bombarded with 18 MeV protons at 20 µA for 1.5 h, while 50Ti targets were bombarded with 24 MeV protons at 20 µA for 4 or 8 h. The radioscandium nuclides were purified using branched N, N, N’, N’ -tetra-2-ethylhexyldiglycolamide (DGA) resin. The titanium targets were recycled by precipitating the dissolved Ti collected from the column effluent and wash streams, pH adjustment, vacuum filtration, and then drying the solid at 250 °C prior to reforming the target for the subsequent bombardment. The apparent molar activity of the isolated radioscandiums was analyzed by titration with 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA). The relative imaging performance of 18 F, 43 Sc, and 68 Ga were analyzed with PET images acquired with 30-min static scans. Results: The average radioscandium recovery for 43Sc was 91.7 ± 7.4 %, with a radionuclidic purity of 98.8 %. The average recovery of 47Sc was 89.9 ± 3.9 %, with a radionuclidic purity of 90.8%. The average recovery of enriched TiO2 was 96 ± 4.0 %. The highest apparent molar activity for [43Sc]Sc-DOTA was 23.2 GBq/µmol and 3.39 GBq/µmol for [ 47 Sc]Sc-DOTA. The order of PET resolution from highest to lowest was 18 F > 43 Sc > 68 Ga. Conclusions: This work demonstrates the feasibility of using enriched recycled [ 46 Ti]TiO 2 and [ 50 Ti]TiO 2 targets for the production of the 43 Sc and 47 Sc theranostic isotope pair in high purity.
38 RADIATION CHEMISTRY, RADIOCHEMISTRY, AND NUCLEA↗
Production and radiochemistry of the in vivo PET generator 140 Nd/ 140 Pr as an imaging surrogate for F-block therapeutic radionuclides
Theranostics, a combined approach of diagnostics and therapeutics, often employs F-block therapeutic radionuclides including 225 Ac, 177 Lu, and 161 Tb. While there is a lack of F-block PET imaging radionuclides, the in vivo PET generator pair 140 Nd/ 140 Pr can act as a theranostic imaging counterpart to the F-block therapeutic radionuclides. In this study, we explored the production and separation of high purity 140 Nd via the 141 Pr(p,2n) 140 Nd reaction route. Monoisotopic 141 Pr targets irradiated with 20 MeV protons for 10 min with 10 µA beam current yielded 21.45 ± 0.82 MBq (580 ± 22 µCi) of 140 Nd. A two-step separation method was developed for the purification of 140 Nd from the 141 Pr target material. Recoveries of 27.4 ± 2.1% 140Nd were obtained upon separation with < 20 ppb of 141 Pr target material in the final product. Radiolabeling of Macropa and DOTA chelators with 140 Nd resulted in [ 140 Nd]Nd-Macropa with a molar activity of 74.0 MBq/µmol (2.0 mCi/µmol) and [ 140 Nd]Nd-DOTA with a molar activity of 70.3 MBq/µmol (1.9 mCi/µmol). An imaging study with a phantom indicated the PET spatial resolution of 140 Nd/ 140 Pr was distinguishable down to 2.4 mm. This study sets the stage for the 140 Nd/ 140 Pr in vivo PET generator to be explored in radiopharmaceutical applications.
F-block↗
“Production of High Specific Activity 155 Tb, 161 Tb and 203 Pb for Research and Clinical Applications: Effective Target Design, Target Material Recycling and Radioisotope Separation”
Radioisotopes are essential for the development and application of radiopharmaceuticals that target specific diseases, such as cancer, offering unique potential for precision medicine. The growing demand for theranostic radioisotopes underscores their critical role in personalized medicine, where they enhance diagnostic imaging, minimize patient radiation exposure, and improve targeted tissue uptake, particularly in receptor- and antigen-directed therapies. The theranostic pair terbium-155 (diagnostic) and terbium-161 (therapeutic) holds significant promise for advancing individualized, targeted, and dosimetry-driven radiotherapies. However, the United States currently lacks routine and reliable production of these isotopes. This project made significant progress toward addressing this supply issue by developing production and separation methods for terbium-155 and terbium-161 while also training the next generation of the nuclear and radiochemistry workforce. This grant also strengthened collaboration between scientists at the University of Washington, the University of Missouri and Brookhaven National Laboratory. The research effort focused on evaluating target preparation methods, optimizing irradiation parameters, and refining isolation processes. In addition, the project provided extensive hands-on training to graduate students and postdoctoral fellows, equipping them with expertise in radioisotope production technologies and fostering the growth of the nuclear science workforce.
07 ISOTOPE AND RADIATION SOURCES↗
Simulation studies of a full-ring, CZT SPECT system for whole-body imaging of 99m Tc and 177 Lu
Single photon emission computed tomography (SPECT) is an imaging modality that has demonstrated its utility in a number of clinical indications. Despite this progress, a high sensitivity, high spatial resolution, multi-tracer SPECT with a large field of view suitable for whole-body imaging of a broad range of radiotracers for theranostics is not available. With the goal of filling this technological gap, we have designed a cadmium zinc telluride (CZT) full-ring SPECT scanner instrumented with a broad-energy tungsten collimator. The final purpose is to provide a multi-tracer solution for brain and whole-body imaging. Our static SPECT does not rely on the dual- and the triple-head rotational SPECT standard paradigm, enabling a larger effective area in each scan to increase the sensitivity. We provide a demonstration of the performance of our design using a realistic model of our detector with simulated body-sized phantoms filled with 99m Tc and 177 Lu. Our SPECT design can resolve 7.9 mm rods for 99m Tc (140 keV) and 9.5 mm for 177 Lu (208 keV) in a hot-rod Derenzo phantom with a 3-min exposure and reach an image contrast of 78% for 99m Tc and 57% for 177 Lu using the NEMA IQ phantom with a 6-min exposure. Our modified scatter correction shows an improved contrast-recovery ratio compared to a standard correction. In this paper, we demonstrate the good performance of our design for whole-body imaging purposes. This adds to our previous demonstration of improved qualitative and quantitative 99m Tc imaging of brain perfusion and 123 I imaging of dopamine transport with respect to state-of-the-art NaI dual-head cameras. We show that our design provides similar IQ and contrast to the commercial full-ring SPECT VERITON for 99m Tc. Regarding 177 Lu imaging of the 208 keV emissions, our design provides similar contrast to that of other state-of-the-art SPECTs with a significant reduction in exposure. In conclusion, the high sensitivity and extended energy range up to 250 keV makes our SPECT design a promising alternative for clinical imaging and theranostics of emerging radionuclides.
73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗
Production and purification of 43Sc and 47Sc from enriched [46Ti]TiO2 and [50Ti]TiO2 targets
Abstract The radioscandium isotopes, 43 Sc and 47 Sc, compose a promising elementally matched theranostic pair that can be used for the development of imaging and therapeutic radiopharmaceuticals with identical structures. This study aimed to investigate the production of high radionuclidic purity 43 Sc from enriched [ 46 Ti]TiO 2 targets and 47 Sc from enriched [ 50 Ti]TiO 2 targets and establish a target recycling technique. Enriched [ 46 Ti]TiO 2 targets were irradiated with 18 MeV protons, and enriched [ 50 Ti]TiO 2 targets were bombarded with 24 MeV protons. 43 Sc and 47 Sc were purified using ion chromatography attaining recovery yields of 91.7 ± 7.4% and 89.9 ± 3.9%, respectively. The average radionuclidic purity for 43 Sc was 98.8 ± 0.3% and for 47 Sc 91.5 ± 0.6%, while the average recovery of enriched titanium target material was 96 ± 4.0%. The highest apparent molar activity for [ 43 Sc]Sc-DOTA was 23.2 GBq/µmol and 3.39 GBq/µmol for [ 47 Sc]Sc-DOTA. This work demonstrates the feasibility of using enriched recycled [ 46 Ti]TiO 2 and [ 50 Ti]TiO 2 targets to produce high purity 43 Sc and 47 Sc as an elementally matched theranostic isotope pair.
38 RADIATION CHEMISTRY, RADIOCHEMISTRY, AND NUCLEA↗
A full-ring variable-aperture cadmium zinc telluride system for whole-body single photon emission computed tomography: realistic simulations with phantoms
Single photon emission computed tomography (SPECT) is an imaging modality that has demonstrated its utility in a number of clinical indications. Despite this progress, a high sensitivity, high spatial resolution, multi-tracer SPECT with a large field of view suitable for whole-body imaging of a broad range of radiotracers for theranostics is not available. Purpose We have designed a cadmium zinc telluride (CZT) variable-aperture full-ring SPECT scanner instrumented with a broad-energy tungsten collimator intended to fill this technological gap. The final purpose is to provide a multi-tracer solution for brain and whole-body imaging. Our static SPECT scanner breaks the paradigm of the standard dual- and triple-head rotational SPECT systems, utilizing a larger detector area in each scan increasing the sensitivity. We provide a demonstration of the performance of our design using a realistic model of our detector with simulated body-sized 99mTc phantoms. Methods We developed a realistic model of our detector by using a combination of a Geant4 Monte Carlo simulation and a CZT detector response model based on a finite element model. Our approach models the characteristic low-energy tail effect in CZT that noticeably affects the sensitivity and the quality of the scatter correction in CZT detectors. We implement a modified dual energy window scatter correction adapted to include the CZT low-energy tail effect. A dedicated correction is also developed to eliminate the undesirable truncation observed in images given the presence of detector edges and gaps between detectors, due to the non-rotational nature of our device. Corrections for the attenuation, detector response and the presence of collimators are also included. The images are reconstructed using the maximum-likelihood expectation-maximization algorithm implemented in the reconstruction open software STIR. Detector and reconstruction performance are characterized with a Derenzo phantom and a body-sized National Electrical Manufacturers Association (NEMA) Image Quality (IQ) phantom containing 99mTc. Results Our SPECT design can resolve 6.4mm rods in a Derenzo phantom and obtain a good image contrast with the IQ phantom. Explicit testing of the gap and edge correction is provided, showing an excellent performance in eliminating the image truncation artifacts. Our modified scatter correction shows no overestimation of the contrast-recovery ratio for our realistic CZT detector model, as opposed to the cases without correction and with a standard dual-energy window scatter correction. Conclusions In this paper, we further demonstrate the performance of our design for whole-body imaging purposes. This adds to our previous demonstration of improved qualitative and quantitative 99mTc imaging for brain perfusion and 123I imaging for dopamine transport with respect to state-of-the-art NaI dual-head cameras. We show that our design performs similarly to the VERITON SPECT from Spectrum Dynamics, a commercial full-ring CZT SPECT camera, with the potential advantage of the broader energy range of application given by our custom-design tungsten collimators. Here, our device combines high sensitivity and image resolution with a broad-energy imaging application for the purpose of clinical imaging and theranostics of emerging radionuclides.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
High purity 47 Sc production using high-energy photons and natural vanadium targets
We report Scandium-47 ( 47 Sc) is of high value for targeted radiotherapy and theranostics; we report a novel, cost-effective approach to produce extremely high-purity 47 Sc via photonuclear irradiation of natural vanadium. Irradiations at bremsstrahlung end-point energies below 26 and at 38 MeV produce > 99.99% and 98.8 ± 3.1% pure 47 Sc (respectively). Linear scaling of experimental data suggests producing 100+ mCi quantities of 47 Sc may be feasible via this approach. Future research into refinement and scale-up to support pre-clinical and clinical research with this production pathway is recommended.
07 ISOTOPE AND RADIATION SOURCES↗
A heavy-ion production channel of 149 Tb via 63 Cu bombardment of 89 Y
We report the radionuclide 149 Tb (t 1/2 = 4.1 h) is a potential theranostic isotope which can simultaneously be used for targeted-alpha-particle therapy and positron-emission tomography. Feasibility experiments were performed to test a near-symmetric heavy-ion reaction of 63 Cu bombardment on monoisotopic 89 Y. The indirect reaction was studied to avoid isomer production. Offline gamma spectroscopy was used to quantify thick-target physical yields and experimental results show modest agreement to the fusion-evaporation code PACE4. A near-symmetric fission yield was also observed.
149Tb↗
A Framework for Patient-Centered Pathways of Care for Radiopharmaceutical Therapy: An ASTRO Consensus Document
Radiopharmaceutical therapy (RPT) is an area of projected growth and importance with several agents in clinical use, new agents in late-phase clinical trials, and many others under testing and development. This article proposes a framework for developing pathways of care that can be broadly applied to all RPTs, representing the current status of RPT. It suggests foundational elements for many pathways of care for patients with cancer and concludes with areas in active development and the future horizon for RPT treatment centers. Developing a framework for patient-centered pathways of care is a critical step in establishing RPT as standard therapy for patients with a diverse spectrum of cancers. This expected increase in RPT treatment options will affect a much larger population of patients with complex cancer. It will also require enhanced coordination and collaboration among appropriately qualified personnel with diverse expertise in image acquisition, image interpretation, quantitative imaging, dosimetry calculation, radiation quality assurance and safety as well as oncology care and RPT-induced sequelae and response assessment. The essential role of this evolving RPT care team within multidisciplinary oncology care is a cornerstone of this framework for a patient-centered pathway of care for RPT. Given the status of current RPT practice and the horizon for future applications, this patient-centered pathway of care guidance is timely and should help inform future clinical RPT practice paradigms. A task force was recruited from the Theranostic Working Group of the American Society for Radiation Oncology (ASTRO) in May 2019 with equal representation from the nuclear medicine community. The task force expanded on a framework that was originally conceived by the Working Group for patient-centered care. This framework was developed to incorporate the strengths of both radiation oncologists and nuclear medicine physicians. The manuscript was then developed by the task force and posted on the ASTRO website for a 6-week public comment period ending in July 2020. Comments were adjudicated, and the draft was sent to external organizations for potential endorsement. This document was sent to the ASTRO Board of Directors in October 2020 for approval.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
Prostate Cancer Targeted X-Ray Fluorescence Imaging via Gold Nanoparticles Functionalized With Prostate-Specific Membrane Antigen (PSMA)
The gold nanoparticle (GNP) as a promising theranostic probe has been increasingly studied. The tumor-targeting efficiency of GNPs is crucial to increase the therapeutic ratio. In this study, we developed PSMA-targeted GNPs to enhance GNP uptake in prostate cancer and developed an x-ray fluorescence imaging system to noninvasively monitor and assess GNP delivery.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
Laser-driven production with advanced targets of Copper-64 for medical applications
Radionuclides are of paramount importance in nuclear medicine both for clinical uses and radiopharmaceutical production. Among the others, nuclides suitable for theranostics like Copper-64 are particularly attractive since they can play both a diagnostic and therapeutic role. In the last years, the growing demand for these nuclides stimulated the research of new solutions, along with cyclotrons already in use, for their production. In this respect, a promising alternative is laser-driven proton accelerators based on the interaction of superintense laser pulses with target materials. Because of their potential compactness and flexibility, they are under investigation for several applications ranging from materials science to nuclear medicine. Moreover, the use of advanced Double-Layer targets (DLTs) was identified as a viable route to increase the number and energy of the accelerated protons to satisfy the requirements of demanding applications. In this contribution, we numerically investigate the use of DLT-based laser-driven sources for Copper-64 production. We show that activities relevant to pre-clinical studies can be achieved with an existing 150 TW laser and DLTs. Moreover, we extend the discussion by considering a broad range of laser systems by exploiting a theoretical model. Our results can guide the choice of laser and target parameters for future experimental investigations.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
Positron Emission Intensity in the Decay of 86 gY for Use in Dosimetry Studies
The β + -emitting radionuclide 86 gY (t 1/2 = 14.7 h) forms a matched-pair with the β – -emitting therapeutic radionuclide 90Y (t 1/2 = 2.7 d) for theranostic application in medicine. This approach demands a precise knowledge of the positron emission probability of the PET nuclide which was until recently rather uncertain for 86 gY. In this work, an 86 gY source of high radionuclidic purity was prepared and a direct measurement of the positron emission intensity per 100 decay of the parent (hereafter “positron emission intensity”) was performed using high-resolution HPGe detector γ-ray spectroscopy. The electron capture intensity was also determined as an additional check by measuring the K α and K β X-rays of energies 14.1 and 15.8 keV, respectively, using a low energy HPGe detector. From those measurements, normalized values of 27.2 ± 2.0% for β + -emission and 72.8 ± 2.0% for EC were obtained. These results are in excellent agreement with values recently reported in the literature based on a detailed decay scheme study.
61 RADIATION PROTECTION AND DOSIMETRY↗