All about Y-90 radio-embolic therapy: Practice patterns and patient safety

Learning Objectives Technologic advances have enabled the delivery of targeted therapies for the treatment of malignancies. Selective Internal Radiation Therapy [SIRT] utilizes microspheres impregnated with beta-emitting radionuclides to deliver embolic radiation to tumors. This “transarterial brachytherapy” regimen has tremendous potential in treating late-stage inoperable liver disease, but nevertheless depends on effective coordination between Interventional Radiologists, Nuclear Medicine Physicians, Radiopharmacists and clinical support staff. As such, practitioners must understand and appreciate pertinent aspects of radiation biology, dosimetry, radiation safety, embolotherapy and interdepartmental management. This exhibit aims to: 1. Illustrate the key steps for planning and carrying out optimal therapy. 2. Underscore proccess and communication flows required for efficient execution. 3. Highlight quality and safety measures for patients as well as health care personnel during and after therapy.

This poster will provide an overview of the principles of radioembolic therapy, as well as the imaging modalities utilized throughout this regimen, including angiography, CT, PET, gamma planar, and SPECT imaging. Special attention will be paid to the basis of SIRT, explaining the important role of the liver's dual blood supply, and the differing radiobiology of tumor versus healthy tissue. Next, treatment planning is introduced, including angiography, both dianostic in the case of arterial mapping and therapeutic, through selective coil embolization. Following will be a discussion of how hepatico-systemic shunting is evaluated with radiolabelled macroaggregated albumin to minimize non-target radiation. Next, the techniques of dose preparation and delivery will be demonstrated. In addition to a primary focus on imaging, this project aims to give the reader an appreciation for the degree of coordination, cooperation, and communication required for optimizing safety and impact of this therapeutic regimen