Study of the Impact of Tissue Density Heterogeneities on 3-Dimensional Abdominal Dosimetry: Comparison Between Dose Kernel Convolution and Direct Monte Carlo Methods

Dose kernel convolution (DK) methods have been proposed to speed up absorbed dose calculations in molecular radionuclide therapy. Our aim was to evaluate the impact of tissue density heterogeneities (TDH) on dosimetry when using a DK method and to propose a simple density-correction method. Methods: This study has been conducted on 3 clinical cases: case 1, non-Hodgkin lymphoma treated with I-131-tositumomab; case 2, a neuroendocrine tumor treatment simulated with Lu-177-peptides; and case 3, hepatocellular carcinoma treated with Y-90-microspheres. Absorbed dose calculations were performed using a direct Monte Carlo approach accounting for TDH (3D-RD), and a DK approach (VoxelDose, or VD). For each individual voxel, the VD absorbed dose, D-VD, calculated assuming uniform density, was corrected for density, giving D-VDd. The average 3D-RD absorbed dose values, D-3DRD, were compared with D-VD and D-VDd, using the relative difference Delta(VD/3DRD). At the voxel level, density-binned Delta(VD/3DRD) and Delta(VDd/3DRD) were plotted against rho and fitted with a linear regression. Results: The D-VD calculations showed a good agreement with D-3DRD. Delta(VD/3DRD) was less than 3.5%, except for the tumor of case 1 (5.9%) and the renal cortex of case 2 (5.6%). At the voxel level, the Delta(VD/3DRD) range was 0%-14% for cases 1 and 2, and -3% to 7% for case 3. All 3 cases showed a linear relationship between voxel bin-averaged Delta(VD/3DRD) and density, rho: case 1 (Delta = -0.56 rho + 0.62, R-2 = 0.93), case 2 (Delta = -0.91 rho + 0.96, R-2 = 0.99), and case 3 (Delta = -0.69 rho + 0.72, R-2 = 0.91). The density correction improved the agreement of the DK method with the Monte Carlo approach (Delta(VDd/3DRD) < 1.1%), but with a lesser extent for the tumor of case 1 (3.1%). At the voxel level, the Delta(VDd/3DRD) range decreased for the 3 clinical cases (case 1, -1% to 4%; case 2, -0.5% to 1.5%, and -1.5% to 2%). No more linear regression existed for cases 2 and 3, contrary to case 1 (Delta = 0.41 rho - 0.38, R-2 = 0.88) although the slope in case 1 was less pronounced. Conclusion: This study shows a small influence of TDH in the abdominal region for 3 representative clinical cases. A simple density-correction method was proposed and improved the comparison in the absorbed dose calculations when using our voxel S value implementation.