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322 Future directions in radioembolization
van den Hoven, A.F. et al. (2015). Innovation
incatheter design for intra-arterial liver cancer
treatments results in favorable particle-uid
dynamics. J Exp Clin Cancer Res34:74.
Werner, M. et al. (2012). Endovascular brachy-
therapy using liquid beta-emitting rhenium-188 for the treatment of long-segment
femoropopliteal in-stent stenosis. J Endovasc
Ther 19:467–475.
Willowson, K.P., Tapner, M.; QUEST Investigator
Team, Bailey, D.L. (2015). A multicentre
comparison of quantitative (90)Y PET/CT for
dosimetric purposes after radioembolization
with resin microspheres: The QUEST
Phantom Study. Eur J Nucl Med Mol Imaging
42:1202–1222.
Wondergem, M. et al. (2013).
99
mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres
in hepatic radioembolization. J Nucl Med
54:1294–1301.
Zimmermann, A. et al. (1995). Renal pathology
after arterial yttrium-90 microsphere administration in pigs. A model for superselective
radioembolization therapy. Invest Radiol
30:716–723.
Index
A
Aberrant hepatic artery, 13
Absolute activity calibration, 237
Absorbed dose, 88–89, 201
calculating, 93–94
to dierent lobule structures, 206
Acute pancreatitis, 295
ADH, see Antidiuretic hormone
Anatomical tumor response
assessment, 22
Angiogenesis, 61
Angiotensin II, intra-
arterial infusion of
vasoconstrictor, 312
Antidiuretic hormone (ADH),
312–313
Antireux catheter (ARC), 14, 18,
53, 59, 61, 313, 314
AP, see Arterial perfusion
Arterial access, 54
Arterial perfusion (AP), 80
Arterial phase, 11–12
Automated segmentation tools, 101
Autopsy, posttreatment events,
158–159
Average absorbed dose to tumor
(D
), 317–318
avg
Average dose endpoint (D
), 98
avg
B
BED, see Biological eective dose
Biliary eects; see also Radiation
cholecystits
biliary stricture, 294
biloma, 292–293
cholangitis and transient
hyperbilirubinemia,
293–294
Biliary sequelae, 60
Biliary stricture, 294
Biloma, 292–293
Biohazard bags, 162
Biological eective dose (BED),
173–174, 212
Biological repopulation factor
(BRF), 174
Body surface area (BSA), 277,
307–308
for resin microspheres, 98, 105
Breast cancer (BrC), 4
Bremsstrahlung single-photon
emission computed
tomography with
integrated computed
tomography
(Bremsstrahlung SPECT/
CT), 264–266
Bremsstrahlung x-rays, 254
BRF, see Biological repopulation
factor
BSA, see Body surface area
Burial, 158–159
C
Calibrated phantoms,
quantitative imaging,
244–245
C-arm cone beam CT (CBCT),
13–14, 81
CBCT, see C-arm cone beam CT
CCO, see Constrained constructive
optimization
CECT, see Contrast-enhanced CT
Celiac artery stenosis, 56–57
Cell survival curve, 171
CHA, see Common hepatic artery
Chemoembolization, 38, 40–41
hepatocellular carcinoma, 43
metastatic colorectal cancer, 44
Child–Pugh score, 34
Choi criteria, 288–290
Cholangitis, 293–294
Chronic synovitis, 308
Classic hepatic arterial supply, 54
Clusters of microspheres, 4
Coaxial microcatheter technique, 57
Coil embolization, 59
Coil embolotherapy, 58
Colorecta l cancer (CRC), 4, 44–45,
77
Colorectal carcinoma (CRC)
metastasis, 283
Common hepatic artery (CHA),
12–13
Common terminology criteria for
adverse events (CTCAE),
179
Complicated hepatic arterial access,
56–57
Cone-beam computed tomography
(CBCT), 97
Constrained constructive
optimization (CCO), 207
Continuity of care, 269
Contrast-enhanced CT (CECT), 283
Conventional transcatheter arterial
chemoembolization
(cTACE), 38
CRC, see Colorectal cancer
CRC
, see Hot contrast recovery
hot
coecient
CRC metastasis, see Colorectal
carcinoma metastasis
Cremation, 158–159
Cryoablation, 37–38
323
324 Index
cTACE, see Conventional
transcatheter arterial
chemoembolization
CTCAE, see Common Terminology
Criteria for Adverse Events
Cytotoxic chemotherapy, 34
D
D70 dose, 317–318
D
, see Average absorbed dose to
avg
tumor
DE B-TACE , see Drug-eluting bead
TACE
Degradable starch microspheres
(DSM), 315
2-Deoxy-2-
Diuse/focal vascular disease, 56
Diusion-weighted MRI
Digital subtraction angiography
DNA damage, repair process of,
Dosage, 88–89
Dosage cart preparation, 148–151
Dosage delivery
Dose calibrator, 142
Dose deposition around A b source,
Dose heterogeneity, 92
Dose metrics of interest, 317–318
Dose-point kernel (DPK)
Dose–response
Dose-toxicity model, 181
Dose–volume histogram (DVH), 232
18
uoroglucose PET/
CT, 283
(DW-MRI), 283
(DSA), 13
168–169
dosage cart preparation,
148–151
exposure rate measurement of
dosage vials, 148
SIR-Spheres dosage dispensing
and preparation, 144–145
eraSphere dosage dispensing
and preparation, 145–148
203–204
convolution, 253–254
and local deposition method,
259–260
data, 318
function, 180
relationship, 19
DPK convolution, see Dose-point
kernel convolution
Drug-eluting bead TACE
(DEB-TACE), 38, 43, 47
DSA, see Digital subtraction
angiography
DSM, see Degradable starch
microspheres
DVH, see Dose–volume histogram
DW-MRI, see Diusion-weighted
MRI
E
EASL, see European Association for
the Study of the Liver
Eastern Cooperative Oncology
Group (ECOG) scale, 34
ECOG scale, see Eastern
Cooperative Oncology
Group scale
Eective dose, 88–89
Embryological middle hepatic
artery (eMHA), 12–13
Embryological right hepatic artery
(eRHA), 12–13
eMHA, see Embryological middle
hepatic artery
Empiric model, for resin
microspheres, 97–98,
104–105
End-hole microcatheter, 18
EQ, see Equivalent dose
Equivalent dose (EQ), 174
Equivalent uniform biological
eective dose (EUBED),
182
Equivalent uniform dose (EUD), 182
eRHA, see Embryological right
hepatic artery
EUBED, see Equivalent uniform
biological eective dose
EUD, see Equivalent uniform dose
European Association for the Study
of the Liver (EASL),
120–122, 288
EVBT, see Prophylactic
endovascular
brachytherapy
Extended cardiac-torso (XCAT)
phantom simulation, 224
External beam radiotherapy
(EBRT), 41–42, 47, 168,
285
Lyman normal tissue
complication probability,
183–185
principles, 7–8
tolerance doses from, 182–183
Extrahepatic radioembolization, 318
F
Falciform artery, 296
FDA, see Food and Drug
Administration
Femoral artery access, 54
Fibrotic remodeling, 287
FLR hypertrophy, see Future liver
remnant hypertrophy
Folinic acid, uorouracil,
oxaliplatin (FOLFOX)
chemotherapy, 44
Follow-up imaging assessment
criteria in predicting
treatment response,
287–290
investigational follow-up
methods, 290–291
18
role of
Fdg-PET/CT, 290
Food and Drug Administration
(FDA), 5, 67, 136
4Rs of radiation biology, 170–171
Fractional uptake (FU), 99
FSU, see Functional subunits
FU, see Fractional uptake
Functional subunits (FSU), 180
Functional tumor response
assessment, 22–23
Future liver remnant (FLR)
hypertrophy, 117–119,
124–126
G
Gastroduodenal artery (GDA),
12–13
coil embolization, 58
Gastrointestinal nontarget
embolization, 295
Gastrointestinal stromal tumors
(GIST), 288
Index 325
Gastrointestinal ulceration, 60
Geometric template, for survey
meter measurement, 148
GIST, see Gastrointestinal stromal
tumors
Glass microspheres (eraSphere),
9, 66, 308
treatment planning, 98–99, 105
Glidesheath, 54
H
HCC, see Hepatocellular carcinoma
Hepatic abscess, 295
Hepatic arterial anatomy, 12, 54–56
Hepatic arterial tree modeling,
207–208
Hepatic atrophy, 286
Hepatic malignancy, 34
Hepatic radioembolization, 3–8
catheter types and particle-uid
dynamics, 18
dose–response relationship, 19
imaging of therapeutic
microsphere distribution,
18–19
laboratory toxicity, 19–20
medication and periprocedural
care, 17
postembolization syndrome, 21
pretreatment workup, 11–17
treatment, 17–19
treatment-related laboratory and
clinical toxicity, 19–21
treatment technique, 17–18
tumor response assessment,
21–23
types of microspheres and
radionuclides, 8–11
with yttrium-90 (
microspheres, 281
Hepatic structure, blood outow in,
200–201
Hepatic toxicity, 211–212, 291–292
dose threshold for, 94
model, application of, 212–215
Hepatocellular carcinoma (HCC),
4, 42–44, 67, 70, 282
liver transplantation, 35–36
particle embolization, 38
Hepatocyte proliferation, 115
90
Y)
Hepatopulmonary shunting, 59–60
Holmium-166 microspheres, 10–11,
82
Hormonal therapy, 34–35
Hot contrast recovery coecient
(CRC
), 238
hot
Human serum albumin (HSA), 67,
310
Hypertrophy, 193–194
I
IAEA Basic Safety Standards, see
International Atomic
Energy Agency (IAEA)
Basic Safety Standards
ICC, see Intrahepatic
cholangiocarcinoma
IEC, see International
Electrotechnical
Commission
Imaging of complications
biliary eects, 292
hepatic abscess, 295
hepatic toxicity, 291–292
Imaging protocol, 69–71
Imaging surveillance protocols,
282–283
Immediate postadministration,
radiation safety treatment
in IR suite, 154–155
Individual hepatic arterial anatomy,
12–13
Inert particle embolization, 38
Internal pair production of
230–231
International Atomic Energy
Agency (IAEA) Basic
Safety Standards, 233
International Electrotechnical
Commission (IEC), 224
Interventional radiology (IR), 135
Intra-arterial access, 13
Intra-arterial infusion, of
vasoconstrictor
angiotensin II, 312
Intrahepatic arterial distribution,
56
Intrahepatic biliary tree, 292
Intrahepatic cholangiocarcinoma
(ICC), 4, 47
90
Y,
Intralobule dosimetry, in translation
invariant trapping
from Monte Carlo simulations,
204–205
from Russell’s law, 205–206
Intraprocedural imaging, 13–15
Intratumoral dose heterogeneity, 92
Ionizing radiation, 169
IR, see Interventional radiology
IRE, see Irreversible electroporation
Irreversible electroporation (IRE),
38
K
Killed lobule fraction (KF), 212
L
LDM, see Local deposition method
Le gastric artery (LGA), 12–13, 54
Le hepatic artery (LHA), 54
LGA, see Le gastric artery
Linear quadratic model, 171–173,
185–189
Linear regression analysis of
exposure rate, 148
Liver
CT/MRI, 11–12
functional anatomy of, 12
hypertrophy, 193
metastasis, 282
radioembolization, scales in,
200–201
resection, 158
transplantation, 35–36, 43, 46
Liver and tumor volumes, 100
automatic and semiautomatic
segmentation, 101
manual segmentation, 101–102
Liver cancer
colorectal cancer, 44–45
hepatic malignancy, 34
hepatocellular carcinoma,
42–44
locoregional therapies, see
Locoregional therapies
neuroendocrine tumor, 45–47
signs and symptoms, 33
systemic therapies, 34–35
transarterial therapy, 38–42
326 Index
LKB model, see Lyman–Kutcher–
Burman model
Lobar therapy, 103–104
Lobectomy dosimetry, 117
Lobules, 200
Local deposition method (LDM),
253, 255–256, 276
and alternative radionuclides,
258–259
dose-point kernel convolution
and, 259–260
validation of, 256–258
Locoregional therapies (LRT), 282
cryoablation, 37–38
irreversible electroporation, 38
liver transplantation, 35–36
microwave and radiofrequency
ablation, 37
resection surgery, 35
Low-volume perihepatic ascites, 287
LSF, see Lung shunt fraction
Lung dosimetry, 71–73
Lung shunt fraction (LSF), 69, 70, 283
Lyman–Kutcher–Burman (LKB)
model, 176–180
Lyman model, 176–180
Lyman normal tissue complication
probability, 183–185
M
99m
TC Macroaggregated albumin
99m
(
TC-MAA), 221–222,
283, 309–310
ow dynamics and particle size
eects, 77–78
imaging, 66–67
imaging protocol, 69–71
lung dosimetry, 71–73
lung shunt fraction evaluation,
76–77
macroaggregated albumin
alternatives, 80–82
nontarget embolization and
radiation penumonitis,
73–76
physical and biological
properties, 67–69
quantication trends, 69
vs. absorbed dose, 78–80
Manual segmentation, 101–102
MC methods, see Monte Carlo
methods
mCRC, see Metastatic colorectal
cancer
Mean absorbed dose
in hepatic structures, 205
tissue, 277
Mean lung dose (MLD), 70–72
Median arcuate ligament
syndrome, 56–57
Median time to progression (TTP),
287
Medical internal radiation dose
(MIRD), 71, 99, 221, 277
Medium-energy (ME) collimator,
223
MELD, see Model for end-stage
liver disease
Metastatic colorectal cancer
(mCRC), 44–45, 95
Microdosimetry, 89–90
Microspheres, 89–91
biodistribution studies in liver,
206–207
distribution, 209–211, 211–212
glass, 9
holmium-166, 10–11
resin, 9–10
transport modeling, 208–209
yttrium-90, 8–9
Microwave (MW) ablation, 37
MIRD, see Medical internal
radiation dose
MLD, see Mean lung dose
Model for end-stage liver disease
(MELD), 34
Modied RECIST (mRECIST), 288
Monte Carlo (MC) methods,
201–203, 252
intralobule dosimetry from,
204–205
mRECIST, see Modied RECIST
N
National Electrical Manufacturers
Association (NEMA)
NU 2-2007 procedure, 235–237
National Institutes of Standards
and Technology (NIST),
U.S., 142–143
Necrotic neuroendocrine tumor
(NET) metastases, 284
NEMA, see National Electrical
Manufacturers
Association
NET, see Neuroendocrine tumor
NET metastases, see Necrotic
neuroendocrine tumor
Neuroendocrine tumor (NET), 4,
45–47
NIST, U.S., see National Institutes
of Standards and
Technology, U.S.
Non–dose-reducing techniques,
60
Nononcologic extrahepatic use, of
radioembolization, 318
Nontarget embolization, 296
Nontarget embolization (NTE),
282, 296
Nontarget radioembolization,
techniques to prevent,
58–59
Nonuniform irradiation, 191–193
Normal liver endpoints, 94–95
Normal response to therapy
radiation lobectomy and
segmentectomy, 286
reduction in tumor size and
changes in liver volume
(beyond 3 months),
285–286
rim enhancement, necrosis,
and pseudoprogression
(0–3 months), 284–285
sequela of portal hypertension
aer therapy, 287
Normal tissue complication
probability (NTCP)
predictions
architecture model, 180–181
clinical cases, with nonuniform
irradiation, 191–193
hypothesis, of uniform
irradiation, 190–191
Lyman model, 176–180
NTCP predictions, see Normal
tissue complication
probability predictions
NTE, see Nontarget embolization
Index 327
O
Oxygen enhancement ratio (OER),
169
P
Parallel architecture model,
180–181
Parasitization, 97
Parasitized arterial perfusion,
57–58
Particle embolization, 38, 39
Particle-uid dynamics, 18
Partition model, 99, 139–140
resin microspheres using,
105–106
PERCIST criteria, see PET
Response Criteria in Solid
Tumors criteria
Percutaneous transluminal
angioplasty (PTA), 309
PET radiotracer, see Positron
emission tomography
radiotracer
PET Response Criteria in Solid
Tumors (PERCIST)
criteria, 290
PHA, see Proper hepatic artery
Planar scintigraphy, 70
Point-spread function (PSF), 257,
258
Portal vein embolization (PVE),
35, 115
Positron emission tomography
(PET), performance
characteristics
absolute activity calibration, 237
degrading factors, 241–243
image reconstruction, 243–244
recovery coecients, 238–241
sensitivity analysis, 235–237
spatial resolution, 237–238
2D and 3D acquisition mode, 236
Positron emission tomography
(PET) radiotracer, 310
Postembolization syndrome, 21, 60
Postprocedural
90
Y single-photon
emission computed
tomography (SPECT/
CT), 295
Postprocedural imaging, in medical
management
of complications, 291–296
follow-up imaging assessment
criteria in predicting
treatment response,
287–291
imaging surveillance protocols,
282–283
normal response to therapy,
284–287
posttreatment
90
Y imaging,
296–298
with prognostic signicance,
283–284
treatment modication with
90
Y PET/CT, 299
Postradioembolization imaging
using diagnostic reporting
90Y PET/CT, see Yttrium-90
positron emission
tomography with
integrated CT
90
(
Y PET/CT)
absorbed doses verication,
275–277
bremsstrahlung SPECT/CT,
264–266
continuity of care, 269
nontarget absorbed dose,
quantication of, 274–275
nontarget activity vs. noise,
270–273
target activity, 269–272
technical failure, 272–274
technical success, 263
Postradioembolization quantitative
imaging, tumor
contouring on, 317
Posttreatment
90
Y imaging
evaluating nontarget
embolization with,
296–297
prognostication with
90
Y PET/
CT, 297–298
Posttreatment patient management
follow-up evaluation, 124
patient care in, 123–124
Preparatory angiography, 13–15
Pretreatment activity calculations,
16–17
Pretreatment workup, for hepatic
radioembolization, 11–12
Progression of disease, 287
Proper hepatic artery (PHA), 12–13,
54
Prophylactic endovascular
brachytherapy (EV BT),
309
Pseudoprogression, 285
PSF, see Point-spread function
PTA, see Percutaneous
transluminal angioplasty
PVE, see Portal vein embolization
Q
Quantitative postradioembolization
imaging technique
accuracy of, 231, 245
activity measurements of
90
Y
chloride, 233–234
activity measurements of
90
Y
microspheres, 234–235
with calibrated phantoms,
244–245
clinical examples of, 245, 246
decay scheme of
90
Y, 230–231
PET specications, see Positron
emission tomography
(PET), performance
characteristics
phantom study analysis,
231–233
Quantitative postradioembolization
imaging, use of, 316–317
QUEST phantom study, 232,
238–240, 244
R
Radiation biology, 115–116
Radiation biology, of
radioembolization,
167–168
4Rs, 170–171
radiobiological models, see
Radiobiological models
repair process, of DNA damage,
168–169
repopulation, 169
Radiation cholangitis, 293
328 Index
Radiation cholecystits, 294
Radiation-induced damage,
171–172
Radiation-induced liver disease
(RILD), 60, 94, 291
Radiation lobectomy, 286
denition, 114–115
dosimetry, 117
and future liver remnant
hypertrophy, 117–119,
124–126
overview, 113–114
patient selection, 116
radiation biology and, 115–116
treatment planning and
delivery, 114
Radiation pneumonitis (RP), 60,
75–76, 296
Radiation release by patients
hospital admission, 157
to public, 156–157
Radiation safety concerns
dosage delivery, 142–151
dosage in interventional
radiology (IR) suite,
152–155
posttreatment events, 158–159
radioactive waste, 159–163
release of radioactive patient,
155–157
written directive for
administration byproduct
material, 136–142
Radiation safety treatment, in
interventional radiology
(IR) suite
administration, assembly of
infusion system, 153–154
immediate postadministration,
154–155
immediate preadministration,
151–153
Radiation segmentectomy, 4, 286
denition, 119–120
outcome data, 120–122
overview, 113–114
patient selection, 120
sample case, 126–128
toxicities, 123
treatment planning and
delivery, 114
Radiation synovectomy, 308–309
Radioactive waste
example procedure
measurements and
calculations, 160–162
residual activity assay, 159–160
storage for decay and disposal,
162–163
Radiobiological models, 181–182
biological eective dose,
173–174
external beam radiotherapy,
see External beam
radiotherapy
linear quadratic model, see
Linear quadratic model
normal tissue complication
probability predictions,
see Normal tissue
complication probability
predictions
tumor control probability,
174–176
various models compared,
189–190
Radioembolization, 38–40
colorectal cancer, 44–45
hepatocellular carcinoma, 43
intrahepatic
cholangiocarcinoma, 47
toxicities and complications,
122–123
Radioembolization-induced liver
disease (REILD), 40, 123,
291–292
Radioembolization prescription
methods, 140–14
Radiofrequency ablation (RFA), 37
Radiolabeled microspheres, 142
Radionuclides, 8–11
RARE, see Renal artery
radioembolization
RCC, see Renal cell carcinoma
RCs, see Recovery coecients
RECIST, see response evaluation
criteria in solid tumors
Recovery coecients (RCs),
238–241
Redistribution of cells, 170
REILD, see Radioembolization-
induced liver disease
Renal artery radioembolization
(RARE), 318
Renal cell carcinoma (RCC), 318
Reoxygenation, of hypoxic tumor
areas, 169–170
Resectability, 193
Resection surgery, 35, 43
Residual activity assay, 159–160
Resin microspheres (SIR-Spheres),
9–10, 66, 308
Response evaluation criteria in
solid tumors (RECIST),
284, 287–288
RFA, see Radiofrequency ablation
RGA, see Right gastric artery
RHA, see Right hepatic artery
RHA, see Right hepatic artery
Right gastric artery (RGA), 54–55,
59, 295
Right hepatic artery (RHA), 54–56
RILD, see Radiation-induced liver
disease
RP, see Radiation pneumonitis
Russell’s law, in translation
invariant trapping,
205–206
S
SBRT, see Stereotactic body
radiation therapy
Scout dose distribution, imaging of,
15–16
Segmental therapy, 106–109
Segmental vascularization, 13
Segmentectomy, 286
dosimetry, 120
Selective internal radiation therapy
(SIRT), 7
Semiautomatic segmentation, 101
Sequela of portal hypertension, 287
SF, see Surviving fraction
SIMIND, see Simulations of
imaging nuclear detectors
Simulations of imaging nuclear
detectors (SIMIND), 224
SIR-Spheres
dosage administration, 153–154
infusion system, 148
prescription, 138–140
strontium-90 impurity in, 163
Index 329
SIRT, see Selective internal
radiation therapy
SMA, see Superior mesenteric
artery
90
Y SPECT/CT imaging, 222, 225, 226
Standard arterial anatomy, of adult
liver, 12
Standard end-hole microcatheter, 13
Stasis, 154
Stereotactic body radiation therapy
(SBRT), 8, 42
Superior mesenteric artery (SMA),
12–13
Superior mesenteric artery
technique, 57
Surgical therapy
colorectal cancer, 44
neuroendocrine tumor, 45–46
Surviving fraction (SF) of cells,
172, 173
Systemic therapy
cytotoxic chemotherapy, 34
hepatocellular carcinoma,
43–44
hormonal therapy, 34–35
neuroendocrine tumor, 46
targeted therapy, 35
T
TACE, see Transarterial
chemoembolization
Targeted therapy, 35
TCP, see Tumor control probability
TEDE, see Tot al EDE
erapeutic microsphere
distribution, imaging of,
18–19
eraSphere
day-of-therapy, example of, 161
dosage, administration of, 154
infusion system, 148–149
preparation of, 147
prescription/preparation, 140
ick rim enhancement, 284–285
ree-dimensional (3D) image-
based dosimetry
dose-point kernel convolution,
253–254
local deposition method, see Local
deposition method (LDM)
Monte Carlo method, 252
voxel S-value Medical Internal
Radiation Dose, 254–255
rombosis, risk of, 54
Tissue damage, 171
T:N, see Tumor-to-normal liver ratio
Total EDE (TEDE), 156–157
Toxicity evaluation, 195
Transarterial brachytherapy, 282
Transarterial chemoembolization
(TACE), 38, 47, 60, 115
Transarterial locoregional
therapies, 282
Transarterial therapy, 38–42,
46–47
Transient hyperbilirubinemia,
293–294
Transplant, 158–159
Treatment planning, in
90
Y
radioembolization,
309–311
Treatment planning models,
99–100
TTP, see Median time to
progression
Tumor ablation
colorectal cancer, 45
cryoablation, 37–38
hepatocellular carcinoma, 43
intrahepatic
cholangiocarcinoma, 47
irreversible electroporation, 38
microwave and radiofrequency
ablation, 37
neuroendocrine tumor, 46
Tumor angiogenesis, 312
Tumor control, 176
process of, 171
Tumor control probability (TCP),
174–176
Tumoricidal endpoints, 95
Tumor response assessment,
22–23
Tumor response, to therapy, 282
Tumor targeting, methods to
enhance, 314–315
Tumor-to-normal liver ratio (T:N),
95–97, 277
pharmaceutical methods,
312–313
physical techniques, 313–314
U
U.S. Food and Drug Administration
(USFDA), 116
V
Variable infusion techniques, 286
Vascular considerations
angiogenesis, 61
arterial access, 54
complicated hepatic arterial
access, 56–57
complications, 60–61
hepatic arterial anatomy,
54–56
parasitized arterial perfusion,
57–58
techniques to minimize
hepatopulmonary
shunting, 59–60
techniques to prevent nontarget
radioembolization,
58–59
Vascular endothelial growth factor
(VEGF), 61
VEGF, see Vascular endothelial
growth factor
Volume of interest (VOI) activity,
224
Voxel-based absorbed dose, 204
Voxel S-value (VSV) medical
internal radiation dose
(MIRD) approach,
254–255
W
World Health Organization (WHO)
criteria, 284, 287–288
Worsened portal hypertension,
consequences of, 287
Worsening thrombocytopenia,
287
Written directive, administration
of byproduct material
authorized user, use of
radioactive material,
137–138
radioembolization prescription
methods, 140–141
330 Index
reportable medical event,
141–142
SIR-Spheres prescription,
138–140
eraSphere prescription, 140
yttrium-90 microspheres
absorbed dose-related
properties, 138
X
XCAT phantom simulation, see
Extended cardiac-torso
phantom simulation
Y
Yttrium-90 positron emission
tomography with
integrated CT
90
(
Y PET/CT)
bremsstrahlung SPECT/CT,
264–265, 267
economics of, 277–278
prognostication with,
297–298
technical challenges of, 265,
267–268
treatment modication with,
299
90
Y bremsstrahlung imaging
planar, 222–223
SPECT and SPECT/CT,
223–225
90
Y chloride (90YCl3), activity
measurements, 233–234
90
Y microspheres, 137–138, 282
99m
TC-macroaggregated
albumin vs., 76–80
activity measurements,
234–235
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