Radiation exposure of the operators in the preparation and administration of yttrium-90 microspheres in the treatment of malignant hepatic lesions: What is the risk?

In spite of the hazard due to the radiation exposure, preparation of 90Y- and 177Lu-labelled radiopharmaceuticals is still mainly performed using manual procedures. In the present study the performance of a commercial automatic synthesizer based on disposable cassettes for the labelling of 177Lu- and 90Y-DOTA-conjugated biomolecules (namely, DOTATOC and PSMA-617) was evaluated and compared to a manual and a semiautomated approach. The dose exposure of the operators was evaluated as well. More than 300 clinical preparations of both 90Y- and 177Lu-labelled radiopharmaceuticals have been performed using the three different methods. The mean radiochemical yields for 90Y-DOTATOC were 96.2±4.9%, 90.3±5.6%, and 82.0±8.4%, while for 177Lu-DOTATOC they were 98.3% ± 0.6, 90.8% ± 8.3, and 83.1±5.7% when manual, semiautomated, and automated approaches were used, respectively. The mean doses on the whole hands for yttrium-90 preparations were 0.15±0.4 mSv/GBq, 0.04±0.1 mSv/GBq, and 0.11±0.3 mSv/GBq for manual, semiautomated, and automated synthesis, respectively, and for lutetium-177 preparations, they were 0.02±0.008 mSv/GBq, 0.01±0.03 mSv/GBq, and 0.01±0.02 mSv/GBq, respectively. In conclusion, the automated approach guaranteed reliable and reproducible preparations of pharmaceutical grade therapeutic radiopharmaceuticals in a decent RCY. The radiation exposure of the operators remained comparable to the manual approach mainly due to the fact that a dedicated shielding was still not available for the system.

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Aspects of images in magnetic resonance of liver tumors treated with transarterial selective internal radiotherapy with yttrium-90

Einstein (São Paulo) ◽

10.1590/s1679-45082017rc4015 ◽

2017 ◽

Vol 16 (1) ◽

Author(s):

Breno Boueri Affonso ◽

Joaquim Maurício da Motta-Leal-Filho ◽

Francisco de Assis Cavalcante Jr. ◽

Francisco Leonardo Galastri ◽

Rafael Noronha Cavalcante ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Radiation Therapy ◽

Magnetic Resonance ◽

Selective Internal Radiation Therapy ◽

Resonance Imaging ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy ◽

Hepatic Lesions ◽

Yttrium 90

ABSTRACT Transarterial selective internal radiation therapy with yttrium-90, also known as radioembolization, is a therapy based on the administration of resin or glass microspheres loaded with the radioisotope yttrium-90, via selective arterial catheterization of tumor-feeding vessels. It is classified as a type of locoregional therapy and its main goal is to treat patients with primary or secondary hepatic lesions that are unresectable and not responsive to other therapies. Since it is a new technology still restricted to very few hospitals in Brazil, but used in patients throughout the country, it is necessary to demonstrate the main aspects of hepatic lesions treated with selective internal radiation therapy found in magnetic resonance imaging, and to make specific considerations on interpretation of these images. The objective of this report is to demonstrate the main aspects of magnetic resonance imaging of unresectable primary or secondary hepatic lesions, in patients submitted to transarterial selective internal radiation therapy.

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Radioembolization of unresectable primary and secondary hepatic malignancies using yttrium-90: The University of Texas at Houston experience.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.311 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 311-311

Author(s):

I. M. Subbiah ◽

P. Cen ◽

R. Tanikella ◽

K. W. Bryant ◽

V. J. Liaw ◽

...

Keyword(s):

Hepatocellular Cancer ◽

Absorbed Dose ◽

Liver Lesions ◽

Liver Malignancies ◽

Survival Analyses ◽

Mri Scans ◽

Y90 Radioembolization ◽

Hepatic Lesions ◽

Hepatic Malignancies ◽

Yttrium 90

311 Background: Few effective treatments exist for unresectable hepatic malignant lesions. The objective of this study was to analyze the patient outcomes and toxicities of yttrium-90 (Y90) radioembolization in patients with unresectable primary and secondary hepatic malignancies. Methods: A retrospective review from 3/03 to11/09 of pts with liver malignancies who received Y-90 (TheraSphere and SIR-Spheres) was conducted. Pretreatment CT scans characterized the liver lesions. Hepatic arterial Tc-99m MAA scans showed % lung shunt and liver flow. Postprocedure toxicities (including pt symptoms, lab values) were recorded. CT/MRI scans at 1-, 3-, and 6-month intervals measured tumor response as per RECIST 1.0. The Kaplan-Meier method was used for survival analyses. Results: 50 pts were initially screened, of which 44 pts received 63 Y90 treatments. Mean age was 62y (24 male, 20 female). Of the 44 pts, 15 had hepatocellular cancer (HCC), 2 had intrahepatic cholangiocarcinoma and 27 had liver metastases (10 colorectal, 8 breast, 4 carcinoid, 1 esophagus, 1 lung, 1 gallbladder, 1 pancreas, 1 gastric). Mean tumor size was 10.6 cm (range 2.2-23.5cm), mean tumor absorbed dose was 30.8 mCi (range 7.1-63.5 mCi). Post-procedure symptoms included fatigue (n=21, 47.7%), abdominal pain (n=35, 79.5%), nausea/vomiting (n=12, 27.2%). At 1 month, 20 pts (45.5%) had SD, 14 (31.8%) had PR, and 10 (22.7%) had PD. At 3 months, 25 patients had SD, 10 had PD and 9 pts were in hospice or were deceased. At 6 months, 11 pts had SD. Per RECIST, PD at 1, 3, 6- months were significant predictors of mortality (OR 25, p<0.0002) as was the preprocedure MELD (OR 1.208, p=0.0160). Caucasian pts had a lower overall mortality (OR 1.238, p=0.0363). Survival analyses will be updated. One pt with HCC was successfully downstaged after Y90 and listed for liver transplant; 26 patients were alive at 6-month follow-up. Conclusions: Y90 radioembolization represents a pragmatic option for hepatic lesions malignancies not amenable to resection. With an acceptable safety profile and the promising response on imaging, Y90 warrants further trials into its ideal use in the therapeutic algorithm for unresectable liver lesions. No significant financial relationships to disclose.

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Effectiveness of syringe shieldings using radionuclides in radiation synovectomy

Nuklearmedizin ◽

10.1055/s-0038-1623906 ◽

2003 ◽

Vol 42 (01) ◽

pp. 50-53 ◽

Cited By ~ 2

Author(s):

A. Ebert ◽

K. Reichmann ◽

M. Reinhardt ◽

H. Palmedo ◽

H.-J. Biersack ◽

...

Keyword(s):

Radiation Exposure ◽

Radiological Protection ◽

Radiation Synovectomy ◽

Dose Rates ◽

Lead Layer ◽

Yttrium 90

Summary Aim: The radiation exposure in radiation synovectomy was investigated for technician and therapist using Erbium-169, Rhenium-186 and Yttrium-90 with and without syringe shieldings. Methods: Dose rates were measured in relation to the distance of the syringe containing the radionuclide. Measurements were repeated using syringe shieldings which consist of plastic surrounded by a lead layer. Results: The most relevant radiation exposure arises from Yttrium-90. Using syringe shieldings radiation exposure can be reduced by a factor of thousand. Conclusion: This kind of radiological protection is completely sufficient for the therapist. Concerning the technician preparing the radiopharmaceutics, the limit of the official German dosimetry service (500 mSv) might be exceeded if no special radiological protection is established. Thus, special dosimetry is recommended.

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Patient Radiation Exposure in Transradial versus Transfemoral Yttrium-90 Radioembolization: A Retrospective Propensity Score–Matched Analysis

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.02.011 ◽

2018 ◽

Vol 29 (7) ◽

pp. 936-942 ◽

Cited By ~ 3

Author(s):

Joshua Loewenstern ◽

Colton Welch ◽

Safet Lekperic ◽

Vivian Bishay ◽

Mona Ranade ◽

...

Keyword(s):

Propensity Score ◽

Radiation Exposure ◽

Patient Radiation Exposure ◽

Yttrium 90

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Measurement of radiation exposure dose during Yttrium-90 radioembolization of hepatocellular carcinoma

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.12.255 ◽

2014 ◽

Vol 25 (3) ◽

pp. S90-S91

Author(s):

S. Lee ◽

J. Won ◽

I. Kim ◽

S. Park ◽

M. Kim ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiation Exposure ◽

Exposure Dose ◽

Radiation Exposure Dose ◽

Yttrium 90

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Radioembolization Outside of the Liver

Digestive Disease Interventions ◽

10.1055/s-0041-1726867 ◽

2021 ◽

Author(s):

Mari E. Tanaka ◽

Eric Wehrenberg-Klee

Keyword(s):

Hepatocellular Carcinoma ◽

Breast Carcinoma ◽

Animal Models ◽

Uveal Melanoma ◽

Neuroendocrine Carcinoma ◽

Clinical Success ◽

Transarterial Radioembolization ◽

Hepatic Lesions ◽

The Brain ◽

Yttrium 90

AbstractTransarterial radioembolization (TARE) with yttrium-90 microspheres has emerged as an effective therapy for the treatment of both primary and metastatic hepatic lesions. It has been studied most extensively in hepatocellular carcinoma (HCC) and metastatic colorectal lesions (mCRC). The clinical success of TARE in HCC and mCRC has led to further investigation of expanding treatment to other malignancies involving the liver such as neuroendocrine carcinoma, uveal melanoma, and breast carcinoma, among others. Furthermore, interest in applications of TARE outside of the liver is emerging and small initial studies have been performed primarily in animal models to assess the effects of TARE on other organs such as the brain, stomach, spleen, kidney, and lungs. This review summarizes existing literature on the use of TARE outside of the liver.

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