胜肽受體放射性核種治療藥物：177Lutetium-DOTATATE（Lutathera®）於2021年底引進台灣台大癌醫中心醫院，針對胃腸胰神經內分泌腫瘤的患者進行治療，未來陸續有其他間醫院有望進行此項治療。而患者在接受核醫藥物的治療或診斷時，由於177Lu本身核種的物理特性與目前核醫治療大宗的131I類似，藥物皆會在體內、外產生輻射劑量，相關的防護問題一直是核醫學範疇內相當重要的議題。本研究分別針對177Lu-DOTATATE核醫藥物產生之體內劑量與體外輻射曝露進行計算評估，建立一套完整且具系統性之分析方法，並將結果與131I治療作比較分析。
針對體內劑量評估問題，本研究以現行核醫界常用之 MIRD方法為基礎，利用蒙地卡羅程式與擬人數值假體分別進行比吸收分率與 S 值之計算，以驗證程式與假體使用方法的可靠度。另選用 OLINDA/EXM 與 MIRDcalc 兩個程式針對兩種有興趣之放射性核種：177Lu及131I標記藥物評估患者接受單次診療時可能獲得之全身有效劑量，結果若是依據真實的藥物分佈，則單次注射7400 MBq之177Lu標記藥物造成患者之全身有效劑量約為0.02-1.09 Sv；而單次注射1110-7400 MBq之131I標記藥物造成患者扣除甲狀腺之全身有效劑量約為0.03-2.26 Sv。
於體外輻射曝露之防護上，本研究透過台大癌醫中心177Lu治療的三位患者之量測數據回顧，考慮到藥物於體內除了核種的物理衰變，尚有藥物動力學造成的生物衰變，利用四種不同的擬合方法計算出177Lu在人體內之有效半衰期，其結果比131I低2-4倍左右；於注射藥物後各個時間點之1公尺處測量之劑量率也比131I低了數倍。另外，本研究更參考一般常用之幾何較為簡單的點、線射源模型以及模擬兩種藥物分佈，發現射源模型計算值與測量值間之落差可能主要來自於環境散射劑量的貢獻。三位鎦-177患者若套用碘-131治療之法規外釋標準，均可採取門診治療，然而尚需以病患的健康安全為最大考量。在實務應用上，病患其體外曝露對於陪病家屬造成的劑量評估至關重要。

PRRT drugs: 177Lutetium-DOTATATE (Lutathera®) was introduced to Taiwan at 2021 for the treatment of patients with GEP-neuroendocrine tumors. When patients receive radiopharmaceuticals for treatment or diagnosis, due to 177Lu’s physical properties, radiation will generate doses inside and outside the body. This study calculated and evaluated the internal dose and external radiation exposure of 177Lu-DOTATATE, established a complete and systematic analysis method, and compared the results with 131I treatment.
Aiming at the problem of internal dose assessment, this study is based on the MIRD method, which is commonly used in the nuclear medicine community. Uses the Monte Carlo program and the anthropomorphic phantom to calculate the specific absorption fraction and S value, to verify the program and the use of the reliability of the method. In addition, two programs , OLINDA/EXM and MIRDcalc, are used to evaluate the effective dose that obtained by patients. Based on a single injection of 177Lu-labeled drug and 131I-labeled drug, patients receive effective dose of about 0.024-1.09 Sv, and 0.03-0.22 Sv.
Regarding the protection of radiation exposure, this study reviewed the measurement data of three patients treated with 177Lu in the NTUCC. The effective half-life of 177Lu in the human body was calculated by different fitting methods, and the result was about 2-4 times lower than that of 131I. The dose rate measured at 1 meter at each time point was also several times lower than that of 131I . In addition, this study used point and line source models compared with simulation. It is found that the difference between the calculated and the measured value may mainly come from environmental scattering dose. In practical applications, it is important to evaluate cumulative dose of family members.

摘要----i
Abstract----ii
誌謝----iii
目錄----iv
表目錄----vi
圖目錄----x
第一章 緒論----1
1.1 前言----1
1.2 文獻回顧----2
1.3 研究目的與動機----4
1.4 鎦-177物理特性及鎦-177-DOTATATE藥物特性----6
第二章 核子醫學概論及劑量理論----9
2.1 核子醫學----9
2.2 輻射劑量單位----11
2.3 體內劑量----13
2.4 體外曝露----17
第三章 研究材料與方法----22
3.1 擬人假體及MCNP程式介紹----22
3.1.1 擬人假體介紹----22
3.1.2 MCNP程式介紹----24
3.2 核醫藥物分佈----26
3.3 體內劑量計算----31
3.3.1 比吸收分率與S值之計算----31
3.3.2 體內劑量評估程式----37
3.4 體外曝露計算及測量----41
3.4.1 點、線射源計算模型----42
3.4.2 MCNP 6.2與擬人假體模擬----45
3.4.3 台大癌醫中心分院鎦-177-DOTATATE之劑量率測量----46
第四章 結果與討論----51
4.1 體內劑量計算結果----51
4.1.1 比吸收分率與S值之計算結果----51
4.1.2 器官等價劑量及全身有效劑量評估----75
4.2 體外曝露計算及測量結果----104
4.2.1 點、線射源計算模型結果比較----104
4.2.2 MCNP 6.2與擬人假體模擬結果比較----108
4.2.3鎦-177-DOTATATE治療之劑量率測量數據分析----110
4.3 實務應用----125
4.3.1 病患之劑量----125
4.3.2 陪伴家屬之劑量----127
第五章 結論與未來工作----129
5.1 體內劑量評估----129
5.2 體外曝露評估----130
5.3 未來工作----131
致謝----132
參考文獻----133

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