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Assessment of Simplified Blood Dose Protocols for the Estimation of the Maximum Tolerable Activity in Thyroid Cancer Patients Undergoing Radioiodine Therapy Using 124I

In high-activity radioiodine therapies for differentiated thyroid cancer, blood dosimetry has been developed to estimate the maximum tolerable activity (MTA) of 131I that can be safely administered without leading to toxic effects. The reference protocol involves a series of both blood sampling (BS) and whole-body counting (WC) over a period of several days. The aim of this retrospective study was to identify simplified protocols without an appreciable loss of accuracy. Methods: Data from 211 thyroid cancer patients who received 124I blood dosimetries were retrospectively analyzed. BS and WC acquired at approximately 1–2, 4, 24, 48, and 96 h or longer after 124I administration were included. This dataset was used to determine the reference MTA and estimations based on a reduced number of combined data from BS and respective WC. MTA estimates were also determined on the basis of either BS or WC alone using some simplifying assumptions in the dosimetry approach. A simplified protocol was considered equivalent to the reference protocol if the estimates of 95% of the MTAs were within the ±20% range and the absolute maximum percentage deviation did not exceed the limit of 30% in a few cases. Lin’s concordance correlation analysis was applied to assess the protocol’s agreements. Results: Two equivalent protocols were identified that included both BS and respective WC acquired at only 3 time points (1–2, 24 or 48, and ≥96 h). Further equivalent protocols with only 3 blood samples drawn at similar time points were discovered for patients, who had undergone at least 1 radioiodine therapy. For all equivalent protocols, deviations of the mean absolute percentage MTA were below 9% and Lin’s concordance correlation coefficients of 0.95 or greater were found, indicating almost excellent agreement (according to Partik’s criteria). Conclusion: The pretherapy blood dosimetry protocol can be substantially shortened and may be beneficial to patients and patient management while reducing the radiation exposure to medical staff.