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To perform patient-specific, blood-based red-marrow dosimetry, dose conversion factors (the S factors in the MIRD formalism) have to be scaled by patients' organ masses. The dose to red marrow includes both self-dose and cross-irradiation contributions. Linear mass scaling for the self-irradiation term only is usually applied as a first approximation, whereas the cross-irradiation term is considered to be mass independent. Recently, the need of a mass scaling correction on both terms, not necessarily linear and dependent on the radionuclide, has been highlighted in the literature. S-factors taking into account different mass adjustments of organs are available in the OLINDA/EXM code. In this paper, a general algorithm able to fit the mass-dependent factors S(rm<--tb) and S(rm<--rm) is suggested and included in a more general equation for red-marrow dose calculation. Moreover, parameters to be considered specifically for therapeutic radionuclides such as (131)I, (90)Y and 177Lu are reported. The red-marrow doses calculated by the traditional and new algorithms are compared for (131)I in ablation therapy (14 pts), 177Lu- (13 pts) and (90)Y- (11 pts) peptide therapy for neuroendocrine tumours, and (90)Y-Zevalin therapy for NHL (21 pts). The range of differences observed is as follows: -36% to -10% for (131)I ablation, -22% to 5% for 177Lu-DOTATATE, -9% to 11% for (90)Y-DOTATOC and -8% to 6% for (90)Y-Zevalin. All differences are mostly due to the activity in the remainder of the body contributing to cross-irradiation. This paper quantifies the influence of mass scaling adjustment on usually applied therapies and shows how to derive the appropriate parameters for other radionuclides and radiopharmaceuticals.

A brief overview is provided of the history of the development of internal dose methods for use in nuclear medicine. Basic methods of internal dosimetry and the systems that have been developed for use in nuclear medicine are described. The development of the MIRD system and the International Radiopharmaceutical Dosimetry Symposium series is outlined. The evolution of models and tools for calculating dose estimates is reviewed. Current efforts in developing more patient-specific methods, particularly for use in therapy calculations, development of small scale and microdosimetry techniques, and of relating internal radiation doses to observed biological effects are described and evaluated.

A fundamental function of the thyroid is to extract iodine from the blood, synthesize it into thyroid hormones, and release it into the circulation under feedback control by pituitary-secreted hormones. This capability of the thyroid, termed as functionality, can in principle be related to the severity of hyperthyroidism in individual patients. In this paper the uptake and release of 131I by the thyroid following the administration of 131I therapy for Graves' disease has been theoretically studied. The kinetics of iodine in the thyroid and blood have been evaluated using a two-compartment model. This simplified model appears to be adequate for dosimetry purposes and allows one to correlate levels of increased thyroid functionality (hyperthyroidism) with clinically measurable kinetic parameters. An expression has been derived for the rate of change of thyroid mass following therapy; this has the same form as an empirical relationship described in an earlier work. A method is presented for calculation of the amount of radioiodine activity to be administered to individual patients in order to achieve the desired final functionality of the gland. The activity to be administered is based on measurements of 131I kinetics after the administration of a 'low-activity' (1850 kBq) tracer for treatment planning.