Journal article
AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization
Journal of applied clinical medical physics, Vol.25(2), e14157
02/2024
DOI: 10.1002/acm2.14157
PMCID: PMC10860558
PMID: 37820316
Abstract
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‐99 m (Tc‐99 m ) 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.
Details
- Title: Subtitle
- AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization
- Creators
- Nathan C. Busse - Colorado Associates in Medical Physics Denver Colorado USAMuthana S. A. L. Al-Ghazi - University of California, IrvineNadine Abi-Jaoudeh - University of California, IrvineDiane Alvarez - Baptist Hospital of MiamiAhmet S. Ayan - The Ohio State UniversityErli Chen - Cheshire Medical CenterMichael D. Chuong - Miami Heart Research InstituteWilliam A. Dezarn - Wake Forest UniversityShirin A. Enger - McGill UniversityStephen A. Graves - University of IowaRobert F. Hobbs - Johns Hopkins UniversityMary Ellen Jafari - Morristown Medical CenterS. Peter Kim - McGill UniversityNichole M. Maughan - Washington University in St. LouisAndrew M. Polemi - University of VirginiaJennifer R. Stickel - Colorado Associates in Medical Physics Denver Colorado USA
- Resource Type
- Journal article
- Publication Details
- Journal of applied clinical medical physics, Vol.25(2), e14157
- DOI
- 10.1002/acm2.14157
- PMID
- 37820316
- PMCID
- PMC10860558
- NLM abbreviation
- J Appl Clin Med Phys
- ISSN
- 1526-9914
- eISSN
- 1526-9914
- Language
- English
- Electronic publication date
- 10/11/2023
- Date published
- 02/2024
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Radiation Oncology
- Record Identifier
- 9984479555202771
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