Radiation Protection and Occupational Exposure on68Ga-PSMA-11–Based Cerenkov Luminescence Imaging Procedures in Robot-Assisted Prostatectomy

Abstract

Cerenkov luminescence imaging (CLI) was successfully implemented in the intraoperative context as a form of radioguided cancer surgery, showing promise in the detection of surgical margins during robot-assisted radical prostatectomy. The present study was designed to provide a quantitative description of the occupational radiation exposure of surgery and histopathology personnel from CLI-guided robot-assisted radical prostatectomy after the injection of68Ga-PSMA-11 in a single-injection PET/CT CLI protocol. Methods: Ten patients with preoperative68Ga-PSMA-11 administration and intraoperative CLI were included. Patient dose rate was measured before PET/CT (n 5 10) and after PET/CT (n 5 5) at a 1-m distance for 4 patient regions (head [A], right side [B], left side [C], and feet [D]). Electronic personal dosimetry (EPD) was used for intraoperative occupational exposure (n 5 10). Measurements included the first surgical assistant and scrub nurse at the operating table and the CLI imager/surgeon at the robotic console and encompassed the whole duration of surgery and CLI image acquisition. An estimation of the exposure of histopathology personnel was performed by measuring prostate specimens (n 5 8) with a germanium detector. Results: The measured dose rate value before PET/CT was 5.3 6 0.9 (average 6 SD) mSv/h. This value corresponds to a patient-specific dose rate constant for positions B and C of 0.047 mSv/hMBq. The average dose rate value after PET/ CT was 1.04 6 1.00 mSv/h. The patient-specific dose rate constant values corresponding to regions A to D were 0.011, 0.026, 0.024, and 0.003 mSv/hMBq, respectively. EPD readings revealed average personal equivalent doses of 9.0 6 7.1, 3.3 6 3.9, and 0.7 6 0.7 mSv for the first surgical assistant, scrub nurse, and CLI imager/surgeon, respectively. The median germanium detector–measured activity of the prostate specimen was 2.96 kBq (interquartile range, 2.23–7.65 kBq). Conclusion: Single-injection68Ga-PSMA-11 PET/CT CLI procedures are associated with a reasonable occupational exposure level, if kept under 110 procedures per year. Excised prostate specimen radionuclide content was below the exemption level for68Ga. Dose rate–based calculations provide a robust estimation for EPD measurements.