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dc.contributor.authorChiesa, C
dc.contributor.authorSjogreen-Gleisner, K
dc.contributor.authorWalrand, S
dc.contributor.authorStrigari, L
dc.contributor.authorFlux, G
dc.contributor.authorGear, J
dc.contributor.authorStokke, C
dc.contributor.authorGabina, PM
dc.contributor.authorBernhardt, P
dc.contributor.authorKonijnenberg, M
dc.identifier.citationEJNMMI physics, 2021, 8 (1), pp. 77 - ?
dc.description.abstractThe aim of this standard operational procedure is to standardize the methodology employed for the evaluation of pre- and post-treatment absorbed dose calculations in 90 Y 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 99m Tc albumin macro-aggregates (MAA) and 90 Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99m Tc-MAA predictions and actual 90 Y 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 99m Tc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90 Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99m Tc-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 90 Y 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.
dc.format.extent77 - ?
dc.titleEANM dosimetry committee series on standard operational procedures: a unified methodology for <sup>99m</sup>Tc-MAA pre- and <sup>90</sup>Y peri-therapy dosimetry in liver radioembolization with <sup>90</sup>Y microspheres.
dc.typeJournal Article
rioxxterms.typeJournal Article/Review
dc.relation.isPartOfEJNMMI physics
pubs.notesNo embargo
pubs.embargo.termsNo embargo
dc.contributor.icrauthorGear, Jonathanen_US

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