The system of accounting and control of dose loads on the lacrimal apparatus during radiotherapy of thyroid cancer

Abstract

BACKGROUND: Lacrimal glands and lacrimal pathways are one of the main undesirable targets during radionuclide therapy using I-131, namely, in 24% of cases, secondary lacrimal pathways obliteration occurs [1]. In the legislation of the Russian Federation in the field of atomic energy use, there are a number of administrative documents obliging to keep records and control of individual radiation doses with the provision of data to the unified system for monitoring individual radiation doses of citizens. At the same time, statistical analysis does not include systematic accounting and control of individual doses of internal radiation to patients, in particular, to the lacrimal apparatus, when using nuclear medicine methods for therapeutic purposes.

AIM: To develop a software and hardware preventive complex — a system for accounting and monitoring dose loads on lacrimal pathways during radioiodotherapy.

MATERIALS AND METHODS: GE Discovery NM/CT 670 imaging systems, GE Discovery NM 630, the Xeleris 4 DR Workstation nuclear Medicine Workstation and the I-131-based radioisotope were used. To exclude the ingress of radioisotope into lacrimal pathways, the use of vasoconstrictive drugs and the use of tear point obturators were considered. The client part of the web service was implemented based on the React JavaScript library. The development of the Backend component was carried out in the Python programming language.

RESULTS: To assess the risk of complications, a method was developed that takes into account the following parameters: age, gender, total administered activity to the patient, the presence of current lacrimation at the time of hospitalization, the presence of menopause (for women) and the accumulation index I-131 in lacrimal pathways. The primary data (anamnesis and prescribed treatment) are entered by the patient's attending physician in the questionnaire during the initial examination. At 72 hours after the introduction of radioisotope, using a molecular imaging system, a medical physicist determines the index of accumulation of radioisotope in lacrimal pathways. Based on the data obtained, the overall risk level of secondary obliteration of the lacrimal tract is determined and, depending on the result obtained, appropriate recommendations are made to the patient. Since the described process is quite time-consuming in a clinical setting, an intelligent medical decision support system has been developed that allows automating the process and minimizing the likelihood of errors.

CONCLUSION: The development of a software and hardware preventive complex will make it possible to prescribe preventive methods with greater efficiency at all stages of the course of treatment in order to minimize the occurrence of adverse events (such as secondary obliteration of the tear ducts), which in turn will improve the quality of life of patients.

Keywords

oncoendocrinology / nuclear medicine / medical physics / ophthalmology / lacrimal apparatus / radioactive iodine / secondary obliteration of the lacrimal tract / web development

References

[1] Yartsev VD, Solodkiy VA, Fomin DK, Borisenko TE, Atkova EL. Clinical and Demographic Characteristics of Tearing in Patients after Radioiodine Ablation for Differentiated Thyroid Cancer. Curr Eye Res. 2021;46(9):1320–1324. doi: 10.1080/02713683.2021.1878229

[2] Yartsev V.D., Solodkiy V.A., Fomin D.K., Borisenko T.E., Atkova E.L. Clinical and Demographic Characteristics of Tearing in Patients after Radioiodine Ablation for Differentiated Thyroid Cancer // Curr Eye Res. 2021. Vol. 46, N 9. P. 1320–1324. doi: 10.1080/02713683.2021.1878229

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