Application of the EANM practical guidance on uncertainty analysis for MRT absorbed dose calculations on clinical cases

Abstract Background Internal dosimetry evaluation consists of a multi-step process ranging from imaging acquisition to absorbed dose calculations. Assessment of uncertainty is complicated and, for that reason, it is commonly ignored in clinical routine. However, it is essential for adequate interpretation of the results. Recently, the EANM published a practical guidance on uncertainty analysis for molecular radiotherapy based on the application of the law of propagation of uncertainty. In this study, we investigated the overall uncertainty on a large sample of patient following the EANM guidelines. The aim of this study was to provide an indication of the typical uncertainties that may be expected from performing dosimetry, to determine parameters that have the greatest effect on the accuracy of calculations and to consider the potential improvements that could be made if these effects were reduced. Results Absorbed doses and the relative uncertainties were calculated for a sample of 49 patients and a total of 154 tumours. A wide range of relative dose uncertainty values was observed (14 - 102%). Uncertainties associated to each quantity along the dose calculation chain (i.e. Volume, Recovery Coefficient, Calibration Factor, Activity, Time-Activity Curve Fitting, Cumulated Activity and Absorbed Dose) were estimated. An equation was derived to describe relationship between the uncertainty in the absorbed dose and the volume. The largest source of error was the VOI delineation. By postulating different values of FHWM, the impact of the imaging system spatial resolution on the uncertainties was investigated. Discussion To the best of our knowledge, this is the first analysis of uncertainty in MRT based on a large sample of clinical cases. Wide inter-lesion variability of dose uncertainty was observed. Hence, a proper assessment of the uncertainties associated with the calculations should be considered as a basic scientific standard. A model for a quick estimate of uncertainty without implementing the entire error propagation schema, which may be useful in clinical practice, was presented. Ameliorating spatial resolution may be in future the key factor for accurate absorbed dose assessment.