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. 2024 Feb;25(2):e14157.
doi: 10.1002/acm2.14157. Epub 2023 Oct 11.

AAPM Medical Physics Practice Guideline 14.a: Yttrium-90 microsphere radioembolization

Nathan C Busse  1 , Muthana S A L Al-Ghazi  2 , Nadine Abi-Jaoudeh  3 , Diane Alvarez  4 , Ahmet S Ayan  5 , Erli Chen  6 , Michael D Chuong  7 , William A Dezarn  8 , Shirin A Enger  9 , Stephen A Graves  10 , Robert F Hobbs  11 , Mary Ellen Jafari  12 , S Peter Kim  13 , Nichole M Maughan  14 , Andrew M Polemi  15 , Jennifer R Stickel  1
Affiliations

AAPM Medical Physics Practice Guideline 14.a: Yttrium-90 microsphere radioembolization

Nathan C Busse et al. J Appl Clin Med Phys. 2024 Feb.

Abstract

Radioembolization using Yttrium-90 (90 Y) microspheres is widely used to treat primary and metastatic liver tumors. The present work provides minimum practice guidelines for establishing and supporting such a program. Medical physicists play a key role in patient and staff safety during these procedures. Products currently available are identified and their properties and suppliers summarized. Appropriateness for use is the domain of the treating physician. Patient work up starts with pre-treatment imaging. First, a mapping study using Technetium-99m (Tc-99m ) is carried out to quantify the lung shunt fraction (LSF) and to characterize the vascular supply of the liver. An MRI, CT, or a PET-CT scan is used to obtain information on the tumor burden. The tumor volume, LSF, tumor histology, and other pertinent patient characteristics are used to decide the type and quantity of 90 Y to be ordered. On the day of treatment, the appropriate dose is assayed using a dose calibrator with a calibration traceable to a national standard. In the treatment suite, the care team led by an interventional radiologist delivers the dose using real-time image guidance. The treatment suite is posted as a radioactive area during the procedure and staff wear radiation dosimeters. The treatment room, patient, and staff are surveyed post-procedure. The dose delivered to the patient is determined from the ratio of pre-treatment and residual waste exposure rate measurements. Establishing such a treatment modality is a major undertaking requiring an institutional radioactive materials license amendment complying with appropriate federal and state radiation regulations and appropriate staff training commensurate with their respective role and function in the planning and delivery of the procedure. Training, documentation, and areas for potential failure modes are identified and guidance is provided to ameliorate them.

Keywords: MPPG; Yttrium-90; brachytherapy; hepatic tumors; practice guideline; radioembolization.

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Conflict of interest statement

Members of TG356 listed below attest that they have no potential Conflicts of Interest related to the subject matter or materials presented in this document: Muthana Al‐Ghazi, Ahmet Ayan, Nathan Busse, Erli Chen, Shirin Enger, Stephen Graves, Robert Hobbs, Mary Ellen Jafari, Peter Kim, Nichole Maughan, Andrew Polemi, Jennifer Stickel.

Members of TG356 listed below disclose the following potential Conflict(s) of Interest related to subject matter or materials presented in this document: Nadine Abi‐Jaoudeh and Diane Alvarez received research funding from Sirtex Medical. Michael Chuong served as a speaker for Sirtex Medical. William A. Dezarn served as a consultant to Sirtex Medical.

Figures

FIGURE 1
FIGURE 1
Typical 90Y radioembolization procedure workflow.
FIGURE 2
FIGURE 2
An example of patient release instructions containing the necessary information is shown.
FIGURE 3
FIGURE 3
Example of patient release card.
See this image and copyright information in PMC

References

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