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BACKGROUND: Targeted Radionuclide Therapy (TRT) is a fast-growing fieldgarnering much interest, however, dosimetry calculation techniques remainrelatively simple. PURPOSE: To introduce egs_mird, a new Monte Carloapplication built in EGSnrc which allows users to model full patient tissue anddensity (using clinical CT images) and radionuclide distribution (usingclinical PET images) for fast and detailed TRT dose calculation. METHODS: Thenovel application egs_mird is introduced, including its structure and variationreduction approaches. A new egs++ source class egs_internal_source and amodified version of egs_radionuclide_source are described. The new code iscompared to other MC calculations of S-value kernels, along withself-validation using the electron Fano test. Full patient prostate 177Lu TRTcancer treatment simulations are performed using a single set of patient DICOMCT and [18F]-DCFPyL PET data. RESULTS: Good agreement is found between S-valuekernels calculated using egs_mird and those found in the literature. The Fanotest is satisfied to 0.1%. Patient prostate, rectum, bone marrow, and bladderdose volume histogram results did not vary significantly when using thetrack-length estimator and not modelling electron transport, modelling bonemarrow explicitly (rather than using generic tissue compositions), and reducingactivity to voxels containing partial or full calcifications to half or none,respectively. Simulations using the track-length estimator can be completed inunder 15 minutes. CONCLUSION: This work shows egs mird to be a reliable MC codefor computing TRT doses as realistically as the patient CT and PET data allow,supporting the use of egs mird for dose calculations in TRT.

Fast full patient and radioisotope Monte Carlo simulations of targeted radionuclide therapy: introducing egs_mird