Investigation into the relationship between body surface area and total body potassium using Monte Carlo and measurement

The use of body surface area (BSA) as a means of indexing chemotherapy doses is widespread even though the value of this practice is uncertain. In principle, the body cell mass (BCM) more closely represents the body's metabolic size and this is investigated here as an alternative to BSA; since 98% of body potassium is intracellular the derivation of total body potassium (TBK) via the measurement of 40K in a whole body counter (WBC) will provide a useful normalizing index for metabolic size, potentially avoiding toxicity and underdosing. The Queen Elizabeth Hospital WBC has been used in this study, initially involving single geometrical phantoms and then combinations of these to simulate human body habitus. Monte Carlo N-particle (MCNP) codes were constructed to model the phantoms and simulate the measurements made in the WBC. Efficiency corrections were derived by comparing measurement and modelled data for each detector separately. A method of modelling a person in the WBC as a series of ellipsoids was developed. Twenty-four normal males and 24 females were measured for their 40K emissions. Individual MCNP codes were constructed for each volunteer and the results used in conjunction with the measurements to derive TBK, correcting for body habitus effects and detector efficiencies. An estimate of the component of error arising from sources other than counting, statistics was included by analysing data from the measurement of phantoms. The total residual errors (expressed as coefficients of variation) for males and females were 10.1% and 8.5% respectively. The measurement components were determined to be 2.4% and 2.5%, implying that the biological components were 9.8% and 8.1% respectively. These results suggest that the use of BSA for indexing chemotherapy doses is likely to give rise to clinically significant under- or overdosing.