Hannah Phelps Presentation

Hannah Phelps MSNMT R.T.(R)(N), ARRT

y90 Radioembolization therapy

risks and benefits of procedure

Steps of Drawing the dose

Pre-Procedure mapping

Isotope used

WHAT IS y90 RADIOEMBOLIZATION?

Index

• Also known as Selective Internal Radiation Therapy (SIRT)

• Delivers localized, high doses of radiation directly into a tumor's blood supply

• Emits radiation to slow the tumor's growth

• Palliative treatment

• Used to treat unresectable Hepatocellular Carcinoma (HCC) or secondary metastatic tumors of the liver

• Uses Yttrium 90 (Y90) radioactive beads (microspheres)

Y90 RADIOEMBOLIZATION

https://consultqd.clevelandclinic.org/liver-radioembolization-doubles-survival-time

https://nuclearsupplies.co.nz/products/sir-spheres%C2%AE-y-90-microspheres

Y90

• Half Life: 64.2 hrs or 2.67 days

• Beta radiation emmiter

• Two types of Y90 microspheres:
• Sir-SpheresR: biocompatible, resin based
• Thera-SpheresR: glass beads

Isotope Used For Therapy

Y90 Mapping

• Lung shunting study
• Performed prior to treatment
• Very similar process
• Radiologists will essentially map the blood flow to the tumor; often placing coils or embolizations as they go
• Deliberate to limit blood flow so that maximal dose goes to the desired location

• Tc99m MAA
• particulate
• similar in size to microspheres

• 4-5 mCi

• Images obtained:
• Ant/Post Lung statics
• Ant/Post Liver statics
• SPECT images of liver (if requested)
• ROI's are drawn and percentage of lung shunting is determined based on counts

Y90 Mapping Study

If >20% shunts to lungs, further embolization may be needed

Y90 Mapping Study

• Y90 dose
• Accessory pack
• V-Vial
• V-Vial holder
• Patient Delivery set
• Gloves
• Calculator
• Y90 dose worksheets

• Emesis basin
• Alcohol prep
• 25 ga needles (3)
• Micron filters (3)
• 3 ml syringe
• Sterile water
• Mayo jar
• Lucite shield
• Syringe shield
• Hemostats
• Survey Meter

Supplies Needed

• Place Micron filters on 25g needles
• Vent dose, sterile water & V-Vial

• Draw 2 opposing lines on top of V-Vial

Drawing the Dose

• Draw line at 3 ml on V-Vial

Drawing the Dose

• Shake dose for 30 seconds
• Measure and record dose

STOP! TIME FOR MATH

PLEASE REFER TO WORKSHEETS PROVIDED

• Inject dose into V-Vial
• Draw sterile water to reach desired volume (3ml)

• Shake dose for 30 seconds
• Remeasure and record dose

Drawing the Dose

• Insert 3ml syringe into center of dose and jet.
• Draw up desired volume.

• Use survey meter to measure radioactivity at 90 degree intervals
• Record findings

• Place V-Vial holder into mayo jar inside of lucite shield

Drawing the Dose

• Place stopper on top of V-Vial holder

https://www.sirtex.com/ap/products/sir-spheres-y-90-resin-microspheres/resources/

GUESS WHAT?MORE MATH!

PLEASE REFER TO WORKSHEETS PROVIDED

• Shows dispursment of Y90 microspheres in the liver
• Images obtained:
• Ant/Post Liver Statics
• SPECT Liver
• PET/CT may be requested depending on radiologist

Post Y90 Nuclear Imaging

Risks

• Infection

• Ulcers in stomach or duodenum

• Liver failure

• Secondary radiation effects in lungs

• Minimally invasive

• Fewer side effects

• Improves quality of life

• Can enable curative surgery or liver transplant

• Can be used in addition to other cancer treatments

• Radiation exposure to others is limited

Benefits

References

Wang, J., & Wu, C. (2018). Radioembolization with Yttrium-90: A review of its clinical applications and advances. Journal of Nuclear Medicine, 59(5), 727-736. Retrieved August 31, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840049/

Digirad. (n.d.). Y-90 therapy nuclear medicine information. Retrieved August 31, 2024, from https://www.digirad.com/y90-therapy-nuclear-medicine-information/

Eary, J. F., & Metcalf, R. A. (2014). Radioembolization for treatment of liver cancer. Journal of Nuclear Medicine, 55(3), 423-432. Retrieved August 31, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042917/

RadiologyInfo.org. (n.d.). Radioembolization. Retrieved August 31, 2024, from https://www.radiologyinfo.org/en/info/radioembol

Parker, D. S., & Burch, D. (2010). Dosimetry and clinical applications of radioembolization with Yttrium-90. Journal of Nuclear Medicine, 51(6), 869-880. Retrieved August 31, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036309/

Mayo Clinic Health System. (n.d.). Targeted radiation therapy. Retrieved August 31, 2024, from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/targeted- radiation-therapy

Sirtex. (n.d.). SIR-Spheres® Y-90 resin microspheres. Retrieved from https://sirtex.com

Global Medical Solutions NZ. (n.d.). SIR-Spheres® Y-90 Microspheres. Retrieved from Global Medical Solutions NZ

Cleveland Clinic. (April 15, 2014). Liver Radioembolization Doubles Survival Time. Retrieved from Cleveland Clinic Health Library