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This indicates a potential to increase the administered activity further for individual patients.
In a set of preliminary trials, we verified that the need to increase the administered intensities is also true for the two NMES protocols under investigation (data not shown).
Using formula 4, with, e.g. an intrinsic scan time t of 90 s, this would imply that for patients with a body weight above 120 kg, it is advised not to further increase the administered FDG activity.
Optimization could be performed by either (1) reducing the absorbed dose to critical non-tumor tissues, and hence reduce detrimental side effects, in order to be able to increase the administered activity and thereby obtain better anti-tumor effects and/or (2) increase the therapeutic effects in tumor tissues without increasing the administered activity.
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This effect may be mitigated by further increasing the administered activity or by increasing the acquisition time for heavier patients.
However, to achieve the same increase in NEC by increasing the administered activity, the NECR must be increased by 33% to 5.80 Mcounts/min.
However, increasing the administered activity has been shown to be less effective at improving image quality than the same proportional increase in acquisition time [5].
Figure 3 illustrates why increasing the administered activity is less effective at improving image quality than the same proportional increase in acquisition time, particularly for heavier patients for whom the NECR may already be approaching its peak value.
The current study also showed that the TFF was further improved (0.78) by increasing the administered activity concentration to 9 MBq/mL, but this difference was not statistically significant.
For patients weighing more than 90 kg, increasing the emission acquisition time per bed position rather than increasing the administered FDG activity is recommended to improve image quality.
We postulated that by increasing the administered activity of the radionuclide we can maximise the palliative benefit by delivering ablative doses of ionising radiation to each metastasis.
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