Patient-Specific Dosimetry for [¹³¹I]NaI Therapy in End-Stage Renal Disease: Segmented Time-Activity Analysis, Hemodialysis Clearance, and Radiation Safety.

Authors

Huda Al Saidi, Noura Al Makhmari, Naema Al Maymani, Subhash Chand Kheruka, Anas Al Balushi, Sana Al Rashdi, Tasnim Al Raii, Khulood Al Riyami, Rashid Al Sukaiti

Published in

Journal of nuclear medicine technology. Oct 27, 2026. Epub Oct 27, 2026.

Abstract

[¹³¹I]NaI therapy in patients with end-stage renal disease undergoing hemodialysis is challenging because renal clearance is markedly reduced, systemic retention is prolonged, and hemodialysis produces abrupt changes in activity. Patient-specific dosimetry may support individualized treatment planning and radiation-safety management. Methods: This prospective case series included 5 hemodialysis-dependent patients with end-stage renal disease and differentiated thyroid carcinoma treated with [¹³¹I]NaI under a standardized protocol combining scheduled hemodialysis with serial whole-body and blood measurements with family-dose and occupational radiation assessments. Whole-body activity was analyzed using a measurement-constrained segmented time-activity representation that explicitly accounted for dialysis-associated activity reductions. Blood activity concentration was integrated using trapezoidal integration with terminal monoexponential extrapolation. Whole-body and blood time-integrated activities, residence times, blood absorbed dose, red marrow absorbed dose, the modeled activity corresponding to a 2-Gy blood absorbed dose, postdischarge total effective dose equivalent, and occupational exposure were assessed. Results: Whole-body residence time ranged from 16.45 to 37.85 h, demonstrating substantial interpatient variability. Blood absorbed dose ranged from 0.054 to 0.452 Gy, and modeled red marrow absorbed dose ranged from 0.056 to 0.363 Gy. The modeled activities corresponding to a 2-Gy blood absorbed dose exceeded the administered activities but were not interpreted as evidence of activity escalation. Central postdischarge total effective dose equivalent estimates ranged from 0.13 to 2.47 mSv. All were below the 5-mSv constraint for comforters and caregivers, whereas cases 2 and 3 exceeded the 1-mSv constraint for other family members and had broad propagated uncertainties. Occupational exposure ranged from 5 to 158 μSv per hemodialysis session. Conclusion: In this 5-patient series, hemodialysis-adapted patient-specific dosimetry was feasible, and modeled blood and red marrow doses remained below the selected dosimetric constraint under the administered activities. The dosimetric workflow provides a practical framework for coordinating dosimetry, hemodialysis, and radiation safety but requires validation in larger multicenter prospective studies.

PMID:
42946468
Bibliographic data and abstract were imported from PubMed on 28 Oct 2026.

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