Nael M. Khayyat MD, Presenter: Nothing to Disclose

Jessica M. Roberts MMed, Abstract Co-Author: Nothing to Disclose

Kayla Tabbert, Abstract Co-Author: Nothing to Disclose

Richard Nelson Joyrich MD, Abstract Co-Author: Nothing to Disclose

Yttrium-90 radioembolization treatment has shown promise in treating primary and secondary liver tumors that are not amenable to surgical resection. In our university-based hospital , the interventional radiology and nuclear medicine divisions established a treatment program for Y-90. We report on the results of the first 101 treatments in 59 patients.

Treatment records on 59 patients and 101 treatments of Y-90 microspheres were retrospectively reviewed. Lung shunt fractions were determined using hepatic arterial Tc-99m MAA planar and SPECT imaging. Absorbed dose calculations were performed using the MIRD equations. The radiation rates, after treatment, from the patient at the area of the liver, left abdomen and chest were recorded.The nuclear medicine physician determined the administered dose, administered the treatment and monitor any radiation events related to patient, equipment or personnel.

Of the 59 patients, 23 had HCC and 36 had metastatic liver tumors (10 colorectal cancer, 13 carcinoid tumors, 10 miscellaneous tumors). Of the 101 treatments, the dose was administered 55 times to the right hepatic artery, 40 times to the left hepatic artery and 6 times to the middle hepatic artery. Average administered activity was 2.64 GBq (0.22 to 5.24 GBq). Lung shunt fractions of the 59 patients were 4.57% (2%-13.4%). Complications were noticed in 2 treatments. In one treatment, a leak was noticed related to device malfunction. The second event was due to human error; however, this was noticed and fixed immediately. No contamination to room or personnel. The radiation rates, after treatment, from the patient at the area of the liver, left abdomen and chest correlates with the administered dose and the lung shunt. All patients were given identity cards for radiation detectors in airports. The bremsstrahlung radiation may ignite radiation detectors. The attached image demonstrates a bone scan in a patient with recent Y-90 treatment.

Our experience demonstrates no significant complications during treatment administration.There is correlation between post treatment radiation rates from the patient at the area of the liver, left abdomen and chest. This is determined by administered dose, lung shunt and tumor-to-liver perfusion ratios. Utilization of MIRD methodology may improve therapeutic profile in patients who are considered for Y-90 microsphere treatment.

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Khayyat, N, Roberts, J, Tabbert, K, Joyrich, R, Yttrium-90 Microspheres Radioembolization Treatment for Primary and Secondary Liver Malignancies: The Role of the Nuclear Medicine Physician.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9002327.html