Charles Yoon Kim MD, Presenter: Consultant, CareFusion Corporation Research Grant, Galil Medical Ltd Consultant, Kimberly-Clark Corporation Consultant, Cryolife, Inc

1) Review range of malignancies treated with Y90 microsphere infusion. 2) Discuss the types of Y90 therapy and dosimetric considerations. 3) Describe the procedures and technical steps involved in Y90 therapy. 4) Recognize pertinent scintigraphic findings associated with Y90 therapy.

Intra-arterial Yttrium-90 (Y90) therapy is an important treatment modality for a variety of hepatic tumors. While numerous types of embolotherapies are employed by interventional radiologists for treatment of cancer, Y90 therapy is unique in its multimodality and multi-procedural nature. Not only does this treatment effect rely on deposited ionizing radiation therapy, but scintigraphic imaging is also an integral component of treatment. Two types of Y90 therapies are available, made by two different manufacturers. The differences between the two types are subtle, but there are differences in administration and manufacturer-recommended dosimetric calculation. These various differences will be highlighted. Y90 therapy is comprised of several steps and is frequently subclassified into a “planning” phase and “treatment” phase. In the planning phase, detailed angiographic imaging is performed to delineate arterial anatomy , determine tumoral distributions, and redistribute vascular flow if indicated. Scintigraphic imaging is an integral component of this planning phase, in order to help identify angiographically occult arterial anomalies, confirm appropriate infusion site, and to quantify the hepatopulmonary shunt fraction. From this information, as well as other factors, the appropriate treatment doses can be determined. In the treatment phase(s), the Y90 dose is administered to the appropriate portions of the liver with subsequent scintigraphic imaging for confirmation. 

Kim, C, Hepatic Artery Infusion Therapy with Y90 Microspheres.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001409.html