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  • Chiesa, C.Istituto Nazionale dei Tumori (author)

EANM dosimetry committee series on standard operational procedures: a unified methodology for Tc-99m-MAA pre- and Y-90 peri-therapy dosimetry in liver radioembolization with Y-90 microspheres

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • 2021-11-12
  • Springer Science and Business Media LLC,2021

Numbers

  • LIBRIS-ID:oai:gup.ub.gu.se/311124
  • https://gup.ub.gu.se/publication/311124URI
  • https://doi.org/10.1186/s40658-021-00394-3DOI
  • https://lup.lub.lu.se/record/c85ad542-9eea-4141-8b53-5ce21467330cURI

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  • Language:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • The aim of this standard operational procedure is to standardize the methodology employed for the evaluation of pre- and post-treatment absorbed dose calculations in Y-90 microsphere liver radioembolization. Basic assumptions include the permanent trapping of microspheres, the local energy deposition method for voxel dosimetry, and the patient-relative calibration method for activity quantification.The identity of Tc-99m albumin macro-aggregates (MAA) and Y-90 microsphere biodistribution is also assumed. The large observed discrepancies in some patients between Tc-99m-MAA predictions and actual Y-90 microsphere distributions for lesions is discussed. Absorbed dose predictions to whole non-tumoural liver are considered more reliable and the basic predictors of toxicity. Treatment planning based on mean absorbed dose delivered to the whole non-tumoural liver is advised, except in super-selective treatments. Given the potential mismatch between MAA simulation and actual therapy, absorbed doses should be calculated both pre- and post-therapy. Distinct evaluation between target tumours and non-tumoural tissue, including lungs in cases of lung shunt, are vital for proper optimization of therapy. Dosimetry should be performed first according to a mean absorbed dose approach, with an optional, but important, voxel level evaluation. Fully corrected Tc-99m-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and Y-90 TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected Tc-99m-MAA SPECT may be used. This offers better planning quality than non dosimetric methods such as Body Surface Area (BSA) or mono-compartmental dosimetry. Quantitative Y-90 bremsstrahlung SPECT can be used if dedicated correction methods are available. The proposed methodology is feasible with standard camera software and a spreadsheet. Available commercial or free software can help facilitate the process and improve calculation time.

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  • Sjogreen-Gleisner, KatarinaLund University,Lunds universitet,Medicinsk strålningsfysik, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Nuclear Medicine Physics,Forskargrupper vid Lunds universitet,Medical Radiation Physics, Lund,Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups(Swepub:lu)rafy-ksj (author)
  • Walrand, S.Catholic University of Louvain (author)
  • Strigari, L. (author)
  • Flux, G.Institute of Cancer Research London (author)
  • Gear, J.Institute of Cancer Research London (author)
  • Stokke, C.Oslo university hospital (author)
  • Gabina, Pablo MinguezHospital de Cruces(Swepub:lu)pa5002mi (author)
  • Bernhardt, Peter,1966Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för medicinsk strålningsvetenskap,Institute of Clinical Sciences, Department of Medical Radiation Sciences,Sahlgrenska University Hospital,Sahlgrenska Academy(Swepub:gu)xbernp (author)
  • Konijnenberg, M.Erasmus University Medical Center (author)
  • Istituto Nazionale dei TumoriMedicinsk strålningsfysik, Lund (creator_code:org_t)

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  • In:Ejnmmi Physics: Springer Science and Business Media LLC8:12197-7364

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