Maximum intensity projection showing relative positions of organs and tumors in the simulations with sample activity levels (a). Plot of counts for 2D detector array (b). Red boxes represent detector positions that the algorithm selected for optimal dose estimation. The vest spans about 18 cm of the torso. (Credit: R. Miyaoka et al., University of Washington, Seattle, WA)

A user-friendly vest worn at home uses technology that collects data to tailor personalized therapy for tumor patients. A lightweight, low-cost, wearable, patient-specific technology that will allow organ-specific measurement recordings to be made within the comfort of the patient’s home.

Targeted therapy using lutetium-177 (177Lu)-DOTATATE greatly increases progression-free survival for patients with metastatic, somatostatin-receptor-2 positive neuroendocrine tumors (NETs). While approved by FDA, the FDA package instructions call for patients to receive a standardized protocol, regardless of size or weight. Traditionally, targeted radionuclide therapies are personalized based on dose to the main organs at risk (OAR, e.g., kidneys, liver, spleen).

The standardized 177Lu-DOTATATE treatment protocol in the United States consists of four 200 mCi doses spaced two months apart. Although this is safe for a vast majority of patients, it is less than optimal for most. Studies out of Europe are revealing that tailoring the number of treatment doses based upon the dose-limiting toxicity to the patient’s OAR can more than double the progression-free and overall survival for NET patients undergoing 177Lu-DOTATATE therapy.

Another factor the researchers sought to address is the fact that traditional imaging-based methods for organ dosimetry estimation for 177Lu require three-to-four longitudinal imaging sessions spread over seven days. This is expensive, uses a lot of clinic resources and is burdensome to the patient.

The garment [called a multi-detector personalized home dosimetry (MD PHD) vest] will house 15-20 small radiation detectors, strategically placed within the vest based upon the patient’s own anatomy. In addition to the radiation detectors the vest will be coupled to a compact electronics pack that will acquire the data and send it via WiFi or cellular services to a secure website where medical personnel/software can check the data for quality control in near real-time.

The patient wears the vest for a two-minute data acquisition once a day for seven (and up to 21) days. Based upon these at-home measurements and a single SPECT/CT image taken 24 hours after the therapy administration, organ specific dosimetry will be determined for all of the patient’s OAR.” With the information collected via the vest, physicians would be able to tailor the number of treatments based upon personalized organ dosimetry information.