Biological dosimetry after yttrium-90 citrate colloid radiosynoviorthesis

Summary:

Radiosynoviorthesis (RSO) with the β-particle-emitting nuclide yttrium-90 is an established concept for the treatment of persistent synovitis of the knee joint. The aim of this study was to investigate the biological radiation effect on the basis of a characteristic radiation parameter. Patients, methods: After RSO procedures with yttrium-90 citrate colloid and subsequent immobilisation of the knee, blood specimens of 10 patients were collected immediately before RSO and 11 to 13 days after the intervention. The yield of dicentric chromosomes in the lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. In addition, activity leakage was measured by wholebody bremsstrahlung-scintigraphy. Results: No statistically significant increase in the number of dicentric chromosomes (26 before treatment and 34 after treatment) in 20 192 cells analyzed from the 20 blood samples could be found as a result of RSO. However, the analysis of at least 1000 cells per blood sample demonstrates a tendency for a biological radiation effect in the blood of patients on the basis of this characteristic radiation parameter. Two of the 10 RSO patients had undergone a second RSO using yttrium- 90 citrate, whereby one patient displayed activity transport out of the knee joint, amounting to 6 MBq. Only for him a radiation effect (about 130 mGy per single RSO) could be calculated by biological dosimetry. Conclusion: Since in general, based on the analysis of dicentric chromosomes in at least 1000 lymphocytes per individual, detection limits for groups of persons after long-term exposures to low-LET radiation of 50-100 mGy are possible, we assume that RSO with yttrium-90 should be associated with a low whole-body radiation exposure.

Zusammenfassung:

Ziel: Die Radiosynoviorthese (RSO) mit dem β-strahlenden Nuklid Yttrium-90 ist ein etabliertes Verfahren zur lokalen Therapie entzündlich-rheumatischer Erkrankungen des Kniegelenkes. Wegen der Möglichkeit eines Aktivitätsabtransportes aus dem Kniegelenk wurde in dieser Studie die biologische Strahlenwirkung anhand entstandener Chromosomenschäden analysiert. Patienten, Methoden: Bei der RSO mit Yttrium-90-Zitratkolloid und anschließender Ruhigstellung des Knies wurde bei 10 Patienten direkt vor der Therapie und 11 bis 13 Tage danach Blut entnommen. Zur Analyse der Strahlenexposition wurde die Häufigkeit von dizentrischen Chromosomen in Lymphozyten der ersten Zellteilung in vitro bestimmt. Ergänzend wurde der Aktivitätsabtransport mittels Ganzkörperszintigraphie bestimmt. Ergebnis: In insgesamt 20 192 analysierten Zellen der 20 Blutproben wurde keine signifikante Zunahme der dizentrischen Chromosomen durch die RSO (26 vor und 34 nach der RSO) beobachtet. Die Chromosomenanalyse in mindestens 1000 Zellen pro Blutprobe zeigte aber eine Tendenz für einen biologischen Strahleneffekt. Zwei der 10 Patienten erhielten eine weitere RSO. Bei einem dieser Patienten wurde mittels Ganzkörper-Bremsstrahlenszintigraphie ein Aktivitätsabtransport aus dem Gelenk von ungefähr 6 MBq nachgewiesen. Nur bei ihm konnte aufgrund der erhöhten Anzahl dizentrischer Chromosomen im Blut mittels biologischer Dosimetrie ein Strahleneffekt (130 mGy pro Einzel-RSO) durch die RSO nachgewiesen werden. Schlussfolgerung: Da nach längerfristiger Einwirkung von Low-LET-Strahlung die Analyse dizentrischer Chromosomen in 1000 Zellen pro Individuum ausreicht, um im bestrahlten Kollektiv Strahlendosen von 50 bis 100 mGy nachzuweisen, zeigen unsere Befunde, dass die RSO mit Yttrium- 90 nur zu einer relativ geringen Strahlenexposition der Patienten führt.

Key words:

Yttrium-90 - radiosynoviorthesis - radiation protection - chromosome aberration - biological dosimetry

Schlüsselwörter:

Yttrium-90 - Radiosynoviorthese - Strahlenschutz - Chromosomenaberration - biologische Dosimetrie

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