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This work aims to investigate the accuracy of quantitative SPECT imaging of$^{177}$Lu in the presence of $^{90}$Y, which occurs in dual-isotoperadiopharmaceutical therapy (RPT) involving both isotopes. We used the GATEMonte Carlo simulation toolkit to conduct a phantom study, simulating spheresfilled with $^{177}$Lu and $^{90}$Y placed in a cylindrical water phantom thatwas also filled with activity of both radionuclides. We simulated multiplephantom configurations and activity combinations by varying the location of thespheres, the concentrations of $^{177}$Lu and $^{90}$Y in the spheres, and theamount of background activity. We investigated two different scatter windowwidths to be used with triple energy window (TEW) scatter correction. We alsocreated multiple realizations of each configuration to improve our assessment,leading to a total of 540 simulations. Each configuration was imaged using asimulated Siemens SPECT camera. The projections were reconstructed using thestandard 3D OSEM algorithm, and errors associated with $^{177}$Lu activityquantification and contrast-to-noise ratios (CNRs) were determined. In allconfigurations, the quantification error was within $\pm$6% of the no-$^{90}$Ycase, and we found that quantitative accuracy may slightly improve when$^{90}$Y is present because of reduction of errors associated with TEW scattercorrection. The CNRs were not significantly impacted by the presence of$^{90}$Y, but they were increased when a wider scatter window width was usedfor TEW scatter correction. The width of the scatter windows made a small butstatistically significant difference of 1-2% on the recovered $^{177}$Luactivity. Based on these results, we can conclude that activity quantificationof $^{177}$Lu and lesion detectability is not degraded by the presence of$^{90}$Y.

$^{177}$Lu SPECT Imaging in the Presence of $^{90}$Y: Does $^{90}$Y Degrade Image Quantification? A Simulation Study