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

Abstract 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 90Y microsphere liver radioembolization. Basic assumptions include the permanent trapping of microspheres, the local energy d...

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Autores principales:	Carlo Chiesa, Katarina Sjogreen-Gleisner, Stephan Walrand, Lidia Strigari, Glenn Flux, Jonathan Gear, Caroline Stokke, Pablo Minguez Gabina, Peter Bernhardt, Mark Konijnenberg
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Radioembolization dosimetry 99mTc-MAA 90Y microspheres Lung shunt Liver dosimetry Tumour dosimetry Medical physics. Medical radiology. Nuclear medicine R895-920
Acceso en línea:	https://doaj.org/article/406d50a8e644438ab40eb26d994ea590
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spelling	oai:doaj.org-article:406d50a8e644438ab40eb26d994ea5902021-11-14T12:27:13ZEANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres10.1186/s40658-021-00394-32197-7364https://doaj.org/article/406d50a8e644438ab40eb26d994ea5902021-11-01T00:00:00Zhttps://doi.org/10.1186/s40658-021-00394-3https://doaj.org/toc/2197-7364Abstract 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 90Y 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 99mTc albumin macro-aggregates (MAA) and 90Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99mTc-MAA predictions and actual 90Y 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 99mTc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99mTc-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 90Y 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.Carlo ChiesaKatarina Sjogreen-GleisnerStephan WalrandLidia StrigariGlenn FluxJonathan GearCaroline StokkePablo Minguez GabinaPeter BernhardtMark KonijnenbergSpringerOpenarticleRadioembolization dosimetry99mTc-MAA90Y microspheresLung shuntLiver dosimetryTumour dosimetryMedical physics. Medical radiology. Nuclear medicineR895-920ENEJNMMI Physics, Vol 8, Iss 1, Pp 1-44 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Radioembolization dosimetry 99mTc-MAA 90Y microspheres Lung shunt Liver dosimetry Tumour dosimetry Medical physics. Medical radiology. Nuclear medicine R895-920
spellingShingle	Radioembolization dosimetry 99mTc-MAA 90Y microspheres Lung shunt Liver dosimetry Tumour dosimetry Medical physics. Medical radiology. Nuclear medicine R895-920 Carlo Chiesa Katarina Sjogreen-Gleisner Stephan Walrand Lidia Strigari Glenn Flux Jonathan Gear Caroline Stokke Pablo Minguez Gabina Peter Bernhardt Mark Konijnenberg EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres
description	Abstract 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 90Y 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 99mTc albumin macro-aggregates (MAA) and 90Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99mTc-MAA predictions and actual 90Y 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 99mTc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99mTc-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 90Y 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.
format	article
author	Carlo Chiesa Katarina Sjogreen-Gleisner Stephan Walrand Lidia Strigari Glenn Flux Jonathan Gear Caroline Stokke Pablo Minguez Gabina Peter Bernhardt Mark Konijnenberg
author_facet	Carlo Chiesa Katarina Sjogreen-Gleisner Stephan Walrand Lidia Strigari Glenn Flux Jonathan Gear Caroline Stokke Pablo Minguez Gabina Peter Bernhardt Mark Konijnenberg
author_sort	Carlo Chiesa
title	EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres
title_short	EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres
title_full	EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres
title_fullStr	EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres
title_full_unstemmed	EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres
title_sort	eanm dosimetry committee series on standard operational procedures: a unified methodology for 99mtc-maa pre- and 90y peri-therapy dosimetry in liver radioembolization with 90y microspheres
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/406d50a8e644438ab40eb26d994ea590
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EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres

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