Introducing the GammaPen: All-in-One Gamma Probe for Sentinel Lymph Node Biopsy
-
Aram Radnia
,
Hamed Abdollahzadeh
,
Behnoosh Teimourian
,
Mohammad Hossein Farahani
,
Mohammadreza Ay
Abstract
Purpose: Using an itra-operative gamma probe after injection of radiotracer during surgery helps the surgeon to identify the sentinel lymph node of regional metastasis through the detection of radiation. This work reports the design and specification of an integrated gamma probe (GammaPen), developed by our company.
Materials and Methods: GammaPen is a compact and fully integrated gamma probe. The detector module consists of a thallium-activated Cesium Iodide (CsI (Tl)) scintillator, and a Silicon Photo Multiplier (SiPM), shielded using Tungsten housing. Probe sensitivity, spatial resolution and angular resolution in air and water, and side and back shielding effectiveness were measured to evaluate the performance of the probe based on NEMA NU3 standard.
Results: The sensitivity of the probe in the air/water at distances of 10, 30, and 50 mm is 18784/176800, 3500/3050, and 1575/1104 cps/MBq. The spatial and angular resolutions in the air/scattering medium are 40/47 mm and 77/87 degrees at a 30 mm distance from the probe. The detector shielding effectiveness and leakage sensitivity are 99.91% and 0.09%, respectively.
Conclusion: The results and surgeon experience in the operating room showed that GammaPen can be effectively used for sentinel lymph node localization.
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2- Stoeckli S. J., Steinert H., Pfaltz M., Schmid S. “Sentinel Lymph Node Evaluation in Squamous Cell Carcinoma of the Head and Neck.” Otolaryngology -- Head and Neck Surgery; 125:221–6, 2001.
3- Veronesi U., Paganelli G., Galimberti V., Viale G., Zurrida S., Bedoni M., et al.” Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.” Lancet; 349:1864–7, 1997.
4- Bullock, T., “Surgical treatment—evidence-based and problem-oriented:” Edited by Rene G. Holzheimer, John A. Mannick, München, Germany: W. Zuckschwerdt Verlag Munchen, 2001. 843 pages. Price $99.95, 2002, Elsevier.
5- Jewell, E. L., et al., “Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies.” Gynecologic oncology, 133(2): pp. 274-277, 2014.
6- Borgstein Md, P. J., et al., “Sentinel Lymph Node Biopsy in Breast Cancer: Guidelines and Pitfalls of Lymphoscintigraphy and Gamma Probe Detection.” Journal of the American College of Surgeons, 186(3): pp. 275-283, 1998.
7- O’Hea Md, F. B. J., et al., “Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer Center 1.” Journal of the American College of Surgeons, 186(4): pp. 423-427, 1998.
8- Wengenmair, H. and J. Kopp, “Gamma probes for sentinel lymph node localization: quailty criteria, minimal requirements and quality of commercially available systems.”, Available on www.klinikum-augsburg, 2005. de/index.php/fuseaction/download/lrn_file/gammaprobes. pdf.(Accessed 5 September 2011).
9- Tiourina, T., et al., “Evaluation of surgical gamma probes for radioguided sentinel node localisation.” European journal of nuclear medicine, 25(9): pp. 1224-1231,1998.
10- Classe, J. M., et al., “Prospective Comparison of 3 γ-Probes for Sentinel Lymph Node Detection in 200 Breast Cancer Patients.” Journal of Nuclear Medicine, 46(3): pp. 395-399, 2005.
11- PERKINS, A. C., and A. J. BRITTEN, “Specification and performance of intra-operative gamma probes for sentinel node detection.” Nuclear Medicine Communications, 20(4): pp. 309-314, 1999.
12- Wengenmair, H., J. Kopp, and J. Sciuk, “Quality criteria of gamma probes: requirements and future developments, in The Sentinel Lymph Node Concept.”, Springer, pp. 113-125, 2005.
13- Zamburlini, M., et al., “Comparison of sentinel gamma probes for 99mTc breast cancer surgery based on NEMA NU3-2004 standard.” Nuclear medicine communications, 30(11): pp. 854-861, 2009.
14- NEMA, N., “NU 3-2004 Performance measurements and quality control guidelines for non-imaging intraoperative gamma probes.” NEMA National Electrical Manufacturers’ Association, 2004.
15- Crowley, N. J. and H. F. Seigler, “The role of elective lymph node dissection in the management of patients with thick cutaneous melanoma.” Cancer 66(12): pp. 2522-2527, 1990.
16- Stadelmann, W. K., “The role of lymphatic mapping and sentinel lymph node biopsy in the staging and treatment of melanoma.” Clinics in plastic surgery, 37(1): pp. 79-99, 2010.
17- Uren, R. F., et al., “Mammary lymphoscintigraphy in breast cancer. Journal of Nuclear Medicine.”, 36(10): pp. 1775-1779, 1995.
18- Kaplan, W. D., et al., “The three-dimensional localization of internal mammary lymph nodes by radionuclide lymphoscintigraphy.” Journal of nuclear medicine: official publication, Society of Nuclear Medicine, 29(4): pp. 473-478, 1988.
19- Yip, T. C. and G. Ege, “Determination of depth distribution of internal mammary lymph nodes on lateral lymphoscintigraphy.” Clinical radiology, 36(2): pp. 149-152, 1985.
20- Prekeges, J., “Nuclear medicine instrumentation” Jones & Bartlett Publishers, 2012.
21- Thrall, J. H. and H. Ziessman, “Nuclear medicine: the requisites.” Mosby-Year Book, p. 302, 1995.
22- Povoski, S. P., et al., “A comprehensive overview of radioguided surgery using gamma detection probe technology.’ World Journal of Surgical Oncology, vol. 7: no. 11-, 1-63, 2009.
23- Keshtgar, M. R., et al., “The sentinel node in surgical oncology.“ Springer, 2013.
24- Harris, C., et al., “A CsI (Tl)-crystal surgical scintillation probe.” Nucleonics (US) Ceased publication. 14, 1956.
25- Woolfenden, J. and H. Barber, “Radiation detector probes for tumor localization using tumor-seeking radioactive tracers.” American Journal of Roentgenology 153(1): pp. 35-39, 1989.
26- Radnia A., Abdollahzadeh H., Teimourian, B. Farahani M. H., Akbari M. E. and, Ay M. R., “Development and characterization of an all-in-one gamma probe with auto-peak detection for sentinel lymph node biopsy based on NEMA NU3-2004 standard.” Annals of Nuclear Medicine 35 (4), pp. 438-446, 2021.
2- Stoeckli S. J., Steinert H., Pfaltz M., Schmid S. “Sentinel Lymph Node Evaluation in Squamous Cell Carcinoma of the Head and Neck.” Otolaryngology -- Head and Neck Surgery; 125:221–6, 2001.
3- Veronesi U., Paganelli G., Galimberti V., Viale G., Zurrida S., Bedoni M., et al.” Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.” Lancet; 349:1864–7, 1997.
4- Bullock, T., “Surgical treatment—evidence-based and problem-oriented:” Edited by Rene G. Holzheimer, John A. Mannick, München, Germany: W. Zuckschwerdt Verlag Munchen, 2001. 843 pages. Price $99.95, 2002, Elsevier.
5- Jewell, E. L., et al., “Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies.” Gynecologic oncology, 133(2): pp. 274-277, 2014.
6- Borgstein Md, P. J., et al., “Sentinel Lymph Node Biopsy in Breast Cancer: Guidelines and Pitfalls of Lymphoscintigraphy and Gamma Probe Detection.” Journal of the American College of Surgeons, 186(3): pp. 275-283, 1998.
7- O’Hea Md, F. B. J., et al., “Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience at Memorial Sloan-Kettering Cancer Center 1.” Journal of the American College of Surgeons, 186(4): pp. 423-427, 1998.
8- Wengenmair, H. and J. Kopp, “Gamma probes for sentinel lymph node localization: quailty criteria, minimal requirements and quality of commercially available systems.”, Available on www.klinikum-augsburg, 2005. de/index.php/fuseaction/download/lrn_file/gammaprobes. pdf.(Accessed 5 September 2011).
9- Tiourina, T., et al., “Evaluation of surgical gamma probes for radioguided sentinel node localisation.” European journal of nuclear medicine, 25(9): pp. 1224-1231,1998.
10- Classe, J. M., et al., “Prospective Comparison of 3 γ-Probes for Sentinel Lymph Node Detection in 200 Breast Cancer Patients.” Journal of Nuclear Medicine, 46(3): pp. 395-399, 2005.
11- PERKINS, A. C., and A. J. BRITTEN, “Specification and performance of intra-operative gamma probes for sentinel node detection.” Nuclear Medicine Communications, 20(4): pp. 309-314, 1999.
12- Wengenmair, H., J. Kopp, and J. Sciuk, “Quality criteria of gamma probes: requirements and future developments, in The Sentinel Lymph Node Concept.”, Springer, pp. 113-125, 2005.
13- Zamburlini, M., et al., “Comparison of sentinel gamma probes for 99mTc breast cancer surgery based on NEMA NU3-2004 standard.” Nuclear medicine communications, 30(11): pp. 854-861, 2009.
14- NEMA, N., “NU 3-2004 Performance measurements and quality control guidelines for non-imaging intraoperative gamma probes.” NEMA National Electrical Manufacturers’ Association, 2004.
15- Crowley, N. J. and H. F. Seigler, “The role of elective lymph node dissection in the management of patients with thick cutaneous melanoma.” Cancer 66(12): pp. 2522-2527, 1990.
16- Stadelmann, W. K., “The role of lymphatic mapping and sentinel lymph node biopsy in the staging and treatment of melanoma.” Clinics in plastic surgery, 37(1): pp. 79-99, 2010.
17- Uren, R. F., et al., “Mammary lymphoscintigraphy in breast cancer. Journal of Nuclear Medicine.”, 36(10): pp. 1775-1779, 1995.
18- Kaplan, W. D., et al., “The three-dimensional localization of internal mammary lymph nodes by radionuclide lymphoscintigraphy.” Journal of nuclear medicine: official publication, Society of Nuclear Medicine, 29(4): pp. 473-478, 1988.
19- Yip, T. C. and G. Ege, “Determination of depth distribution of internal mammary lymph nodes on lateral lymphoscintigraphy.” Clinical radiology, 36(2): pp. 149-152, 1985.
20- Prekeges, J., “Nuclear medicine instrumentation” Jones & Bartlett Publishers, 2012.
21- Thrall, J. H. and H. Ziessman, “Nuclear medicine: the requisites.” Mosby-Year Book, p. 302, 1995.
22- Povoski, S. P., et al., “A comprehensive overview of radioguided surgery using gamma detection probe technology.’ World Journal of Surgical Oncology, vol. 7: no. 11-, 1-63, 2009.
23- Keshtgar, M. R., et al., “The sentinel node in surgical oncology.“ Springer, 2013.
24- Harris, C., et al., “A CsI (Tl)-crystal surgical scintillation probe.” Nucleonics (US) Ceased publication. 14, 1956.
25- Woolfenden, J. and H. Barber, “Radiation detector probes for tumor localization using tumor-seeking radioactive tracers.” American Journal of Roentgenology 153(1): pp. 35-39, 1989.
26- Radnia A., Abdollahzadeh H., Teimourian, B. Farahani M. H., Akbari M. E. and, Ay M. R., “Development and characterization of an all-in-one gamma probe with auto-peak detection for sentinel lymph node biopsy based on NEMA NU3-2004 standard.” Annals of Nuclear Medicine 35 (4), pp. 438-446, 2021.
| Files | ||
| Issue | Vol 8 No 2 (2021) | |
| Section | Technical Note | |
| DOI | https://doi.org/10.18502/fbt.v8i2.6519 | |
| Keywords | ||
| Gamma Probe Sentinel Lymph Node Performance Evaluation | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Radnia A, Abdollahzadeh H, Teimourian B, Farahani MH, Ay M. Introducing the GammaPen: All-in-One Gamma Probe for Sentinel Lymph Node Biopsy. Frontiers Biomed Technol. 2021;8(2):151-154.
