MIRD Primer 2022

Absorbed dose and related quantities are the key predictors of the beneficial (therapeutic) effects of radiation and of the risk and/or severity of its adverse effects. The estimation of such dosimetric parameters is challenging, however, particularly for radiopharmaceuticals.

Richly illustrated and thoroughly referenced, the MIRD Primer 2022: A Complete Guide to Radiopharmaceutical Dosimetry is a comprehensive, state-of-the-art guide to radiopharmaceutical dosimetry that reflects the dramatic evolution of the field of nuclear medicine, including molecular imaging and, increasingly, radiopharmaceutical therapy.

The MIRD Primer 2022 serves as

  • a foundation for nuclear medicine and other medical professionals who require a working knowledge of internal radionuclide dosimetry and its radiobiological implications—without having to delve too deeply into the underlying mathematics.
  • an authoritative reference on the latest, complete mathematical formulation of the MIRD schema for those seeking a more rigorous understanding of internal dosimetry.
  • an invaluable teaching tool, with a large number and wide variety of clinically relevant calculational examples.

The historical development of internal dosimetry, uncertainty in dose and radiation risk estimation, currently available dosimetry software, and regulatory aspects of radiopharmaceutical dosimetry are all addressed as well.

Exhaustively revised and greatly expanded from the original MIRD Primer, this book addresses the important distinction between dosimetry for risk assessment in diagnostic imaging versus dosimetry for treatment efficacy and toxicity evaluation in the setting of therapy, including guidance on treatment planning.

Authors: Rachel M. Bartlett, Wesley E. Bolch, A. Bertrand Brill, Yuni K. Dewaraja, Frederic H. Fahey, Darrell R. Fisher, Robert F. Hobbs, Roger W. Howell, Ruby F. Meredith, Joseph G. Rajendran, George Sgouros, Pat Zanzonico 

Release Date: November 2022 | 298 pages; includes index
ISBN: 978-0-932004-03-1

Non-Member Price: $154.00

Member Price: $109.00

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  1. 1. Historical Review


  1. 2. Radionuclides

2.1 Radionuclide properties  

2.1.1 Modes of radioactive decay  

2.1.2 Mathematics of radioactive decay

2.2 Sources of data on radionuclide decay schemes  

2.3 Examples of radionuclide decay schemes

2.4 Radiopharmaceutical Properties  


  1. 3. The MIRD Schema for Radiation Dose Calculations

3.1 Overview of internal radiation dosimetry  

3.2 Source and target regions

3.3 Mean absorbed dose rate: Time‐dependent formulation  

3.4 Mean absorbed dose: Time‐independent formulation  

3.5 Dosimetry methods for radiopharmaceutical therapy treatment planning  

3.6 Dosimetry for radiation protection  


  1. 4. Reference Phantoms and Radionuclide S Values


  1. 5. Radiopharmaceutical Kinetics: How Data Are Measured and Analyzed

5.1 Introduction

5.2 Source‐region time‐integrated activity

5.3 Organ and remainder‐of‐body source regions

5.4 Measurement of source-region time-activity data: Imaging methods  

5.4.1 Planar imaging  

5.4.2 Single‐photon emission computed tomography and positron emission tomography  

5.4.3 Planar‐SPECT hybrid imaging  

5.4.4 Data corrections required for quantitative imaging

5.5 Measurement of source‐region time‐activity data: Non‐imaging methods in clinical and preclinical studies  

5.5.1 Probes  

5.5.2 Well counters

5.5.3 Autoradiography  

5.5.4 Alpha cameras: Single-particle autoradiography

5.5.5 Biodistribution studies in small animal models

5.6 Number of measurements and temporal sampling pattern

5.7 Conversion of source‐region time-activity data to time-integrated activities

5.7.1 Analytic curve fitting

5.7.2 Numeric approach: The trapezoidal rule  

5.7.3 Compartmental modeling  


  1. 6. Software Relevant to Medical Internal Radiation Dosimetry

6.1 Software for kinetic analyses

6.2 Software for absorbed‐dose calculations

6.2.1 Organ‐level dosimetry

6.2.2 Point‐kernel approaches to three-dimensional dosimetry

6.2.3 Monte Carlo approaches to three‐dimensional dosimetry

6.2.4 Small‐scale (suborgan to cell‐level) dosimetry

6.3 Software for kinetic analysis and dose calculations


  1. 7. Basic Radiation Biology and Bioeffect Modeling for Nuclear Medicine

7.1 Basic radiation biology: interactions of radiation with matter

7.2 Linear energy transfer and relative biological effectiveness

7.3 DNA damage and repair

7.4 Bystander effect

7.5 Cell death and cell-survival curves

7.6 Biological modifiers of response

7.7 Clinical effects

7.7.1 Stochastic effects: Cancer

7.7.2 Stochastic effects: Cataracts

7.7.3 Stochastic effects: Cardiovascular disease

7.7.4 Stochastic effects: Germ‐cell mutagenesis

7.7.5 Deterministic effects: Teratogenesis

7.7.6 Deterministic effects: Tissue‐specific radiation injury

7.7.7 Deterministic effects: Acute radiation syndromes

7.8 Bioeffect modeling of radionuclide therapy

7.8.1 Cell survival curve models

7.8.2 Biologically effective dose

7.8.3 Biologically effective dose in the MIRD schema

7.8.4 Biologically effective dose, repopulation, repair, and time of integration

7.8.5 Equieffective dose

7.8.6 Relative biological effectiveness

7.8.7 Equivalent uniform dose

7.8.8 Tumor control probability

7.8.9 Normal tissue complication probability and organ models

7.8.10 Cellular and multicellular bioeffect modeling

  1. 8. Uncertainty in Internal Dosimetry and Risk Assessment

8.1 Accuracy, precision, and uncertainty

8.2 Basic statistics

8.3 Uncertainty in model‐based versus patient‐specific dosimetry

8.4 Sources of uncertainty in internal dosimetry

8.4.1 Uncertainty in the administered activity

8.4.2 Uncertainty in measured organ and tumor volumes and masses

8.4.3 Uncertainty in source‐region activity measurements

8.4.4 Uncertainty in calculating time-integrated activities

8.4.5 Uncertainty in the conversion of time-integrated activities to dose

8.4.6 Total absorbed‐dose uncertainty

8.5 Additional considerations for estimating uncertainty in internal dosimetry

8.6 European Association of Nuclear Medicine guidance on uncertainty analysis for absorbed‐dose calculations  

8.7 Uncertainty in radiation risk estimates

  1. 9. Use of Radiopharmaceuticals in Human Research Subjects

9.1 Regulatory approval mechanisms for new radiopharmaceuticals

9.1.1 Radioactive materials licenses

9.1.2 Radioactive Drug Research Committee

9.1.3 Investigational New Drug and Exploratory IND approved radiopharmaceuticals

9 1.4 New Drug Application

9.2 Nonregulatory guidance

9.2.1 International Commission on Radiological Protection

9.2.2 International Commission on Radiation Units and Measurements

9.2.3 National Council on Radiation Protection and Measurements

9.3 Specific information needed in qualifying a new radioactive drug

9.3.1 Preclinical biodistribution studies

9.3.2 Human trial design

  1. 10. Calculated and Methodologic Examples

10.1 Diagnostic dosimetry examples

10.1.1 99mTc-sulfur colloid

10.1.2 82Rubidium-rubidium chloride

10.2 Therapeutic dosimetry examples

10.2.1 Normal organs 90Y-microspheres Peptide-receptor radionuclide radiotherapy 131I-sodium iodide Radioimmunotherapy

10.2.2 Tumors Large tumors: 153Sm-EDTMP Small tumors: 131I-NaI

10.3 Cell‐level dosimetry examples

10.3.1 Cells in suspension in vitro: 125I

10.3.2 Multicellular clusters in vitro: 210Po

10.3.3 Multicellular clusters in vivo: 211At


Appendix 1: Glossary  

Appendix 2: Common Acronyms

Appendix 3: Compilation of Relevant AAPM, EANM, IAEA, ICRU, ICRP, MIRD, NAS, NCRP, and UNSCEAR Publications