scholarly journals Radioembolization With Holmium-166 Polylactic Acid Microspheres: Distribution of Residual Activity in the Delivery Set and Outflow Dynamics During Planning and Treatment Procedures

2021 ◽  
pp. 152660282199671
Author(s):  
Robert Drescher ◽  
Philipp Seifert ◽  
Falk Gühne ◽  
René Aschenbach ◽  
Christian Kühnel ◽  
...  
Keyword(s):  
Residual Activity ◽  
Injection Technique ◽  
Flow Profile ◽  
Dose Calibrator ◽  
Transarterial Radioembolization ◽  
Resin Microspheres ◽  
Injection Methods ◽  
Treatment Procedures ◽  
Injection Cycle ◽  
Treatment Activity

Purpose: To evaluate the microsphere outflow dynamics and residual Ho-166 activity during and after transarterial radioembolization planning and treatment procedures, and to assess the distribution and predilection sites of residual activity in the proprietary delivery set and the microcatheter. Materials and Methods: Fifteen planning and 12 therapeutic radioembolization procedures were performed with poly-l-lactic acid microspheres loaded with Ho-166. The amount and distribution of residual activity was assessed by dose calibrator measurements and SPECT imaging. The activity flow profile from the microcatheter was assessed dynamically. For planning procedures, different injection methods were evaluated in order to attempt to decrease the residual activity. Results: The median residual activities for planning and treatment procedures using standard injection methods were 31.2% (range 17.3%–44.1%) and 4.3% (range 3.5%–6.9%), respectively. Planning residual activities could be decreased significantly with 2 injection methods similar to treatment procedures, to 17.5% and 10.9%, respectively ( P = 0.002). Main predilection sites of residual microspheres were the 3-way stopcock and the outflow needle connector. During treatment procedures, more than 80% of the injected activity is transferred during the first 3 injection cycles. Conclusion: After treatment procedures with holmium-loaded microspheres, mean residual activity in the delivery set is reproducibly low and between reported values for glass and resin microspheres. The majority of microspheres is transferred to the patient during the second and third injection cycle. An estimated residual waste of 3% to 4% may be included in the treatment activity calculation. For planning procedures, a modified injection technique should be used to avoid high residual activities.

scholarly journals Radioembolisation with Holmium-166 Polylactic Acid Microspheres: Distribution of Residual Activity and Flow Dynamics During Planning and Treatment Procedures

2020 ◽  
Author(s):  
Martin Freesmeyer ◽  
Philipp Seifert ◽  
Falk Gühne ◽  
Christian Kühnel ◽  
Robert Drescher
Keyword(s):  
Residual Activity ◽  
Flow Dynamics ◽  
Injection Technique ◽  
Dose Calibrator ◽  
Resin Microspheres ◽  
Injection Methods ◽  
The Mean ◽  
Treatment Procedures ◽  
Injection Cycle ◽  
Treatment Activity

Abstract Purpose:To evaluate the application dynamics and residual Ho-166 activity during and after transarterial radioembolisation planning and treatment procedures, and to assess the distribution and predilection sites of residual activity in the proprietary delivery set and microcatheter.Methods:16 planning (Holmium Scout Dose, HSD) and 12 therapeutic radioembolisation (RE) procedures were performed with poly-L-lactic acid (PLLA) microspheres loaded with Ho-166. The amount and distribution of residual activity was assessed by dose calibrator measurements and SPECT imaging. For 8 HSD and 5 RE procedures, the dynamic of the microsphere flow were assessed. For HSD procedures, different injection methods were evaluated. Results:The mean residual activities for HSD and RE procedures were 20.5 +/-9.7% (range 7.2-44.1%) and 4.8 +/-1.2% (range 3.5-6.9%), respectively. HSD residual activity could be decreased significantly with injections methods similar to RE procedures, from 31.2 +/-9.6% to 17.7 +/-6.9% and 15.0 +/-6.0% (p=0.005). Main predilection sites of residual microspheres were the 3-way stopcock (HSD) and the outflow needle connector (RE). During RE procedures, >80% of the injected activity is transferred during the first three injection cycles.Conclusion: After treatment procedures with PLLA microspheres, mean residual activity in the delivery set is reproducibly low and between reported values for glass and resin microspheres. The majority of microspheres is transferred to the patient during the second and third injection cycle. An estimated residual waste of 3%-4% may be included in the treatment activity calculation. For planning procedures, a modified injection technique should be used to avoid high residual activities.

scholarly journals Steroid Injection Using Tendon Excursion for Trigger Finger: Introduction to Injection Methods and Analysis of Treatment Results

2021 ◽  
Author(s):  
Sang Hyun Ko ◽  
Dong Eun Kim ◽  
Tong Joo Lee
Keyword(s):  
Success Rate ◽  
Steroid Injection ◽  
Treatment Success ◽  
Tendon Sheath ◽  
Trigger Finger ◽  
Injection Technique ◽  
Low Grade ◽  
Complication Rates ◽  
Injection Methods ◽  
Tendon Excursion

Purpose: Local corticosteroid injections are routinely used as first-line treatment for trigger finger. However, accurate delivery of steroids into the tendon sheath is important for the effectiveness of the treatment and the prevention of complications. This study aimed to introduce our steroid injection technique for trigger finger, which uses tendon excursion of the flexor tendon, and evaluate the clinical outcomes in patients who were treated with this technique.Methods: A total of 171 patients with trigger finger who were treated with steroid injections were retrospectively reviewed. The efficacy of injection and complications were investigated. The evaluation of the efficacy was classified into “good,” “fair,” and “poor.” The results were analyzed according to the type of finger and the Quinnell grading system.Results: The total efficacy was 83.6% (good/fair, 143 digits; poor, 28 digits). The treatment success rate for Quinnell grade IV was 43.8% (7 of 16), which was significantly lower than those of Quinnell grades II and III, which were 88.9% (88 of 99) and 87.5% (49 of 56), respectively (II vs. IV, p=0.004; III vs. IV, p=0.010). In four fingers (excluding the thumb), the success rate was significantly higher than that of the thumb (88.2% vs. 75.4%, p=0.048).Conclusion: The steroid injection technique using tendon excursion showed excellent results and low complication rates. In particular, the second to fourth fingers and low-grade fingers showed more effective results.

Long-Term Toxicity after Transarterial Radioembolization with Yttrium-90 Using Resin Microspheres for Neuroendocrine Tumor Liver Metastases

2018 ◽  
Vol 29 (6) ◽  
pp. 858-865 ◽  
Author(s):  
Yuki Tomozawa ◽  
Younes Jahangiri ◽  
Priya Pathak ◽  
Kenneth J. Kolbeck ◽  
Ryan C. Schenning ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Neuroendocrine Tumor ◽  
Transarterial Radioembolization ◽  
Resin Microspheres ◽  
Yttrium 90

Residual activity after radioembolization of liver tumours with 90Y resin microspheres

2014 ◽  
Vol 53 (03) ◽  
pp. 95-98 ◽  
Author(s):  
T. Haslerud ◽  
K. Reichmann ◽  
C. Meyer ◽  
E. Habibi ◽  
R. Fimmers ◽  
...  
Keyword(s):  
Residual Activity ◽  
Total Radioactivity ◽  
Strong Positive Correlation ◽  
Target Dose ◽  
Glass Microspheres ◽  
Liver Tumours ◽  
Positive Correlation ◽  
Ion Chamber ◽  
Resin Microspheres ◽  
Calculated Dose

SummaryThe actual number of resin microspheres is approximately 30-60 times higher than glass microspheres per 3 GBq vial. Thus, radioembolization (RE) with resin microspheres exerts an embolization effect besides the radiation effect. This embolization effect can occasionally cause early back flow of the microspheres before application of the entire calculated dose. To avoid these adverse side effects, RE has to be terminated at an earlier time point. Measurement of the residual activity in the delivery box, which includes the v-vial, tube and catheter, to calculate the achieved target dose is often challenging. The aim of the current study was to establish a post-RE measurement method comparable to the glass microspheres method without unnecessary radiation exposure to the staff and risk of contamination. Methods: Two different measurements were performed. First, total radioactivity in the shipping vial was measured in an ion chamber and then it was put in the delivery box and the radiation was measured from a 30 cm distance from the centre of the box with a dosimeter. The required radioactivity was then transferred to the v-vial, and the shipping vial was measured again. After that, the v-vial was measured from the same distance from the centre of the box with dosimeter. Results: Altogether 62 times the shipping vial with different activities were measured with a significant positive correlation between the amount of the activity measured in the iron chamber and the radiation dose, measured with dosimeter (r2 = 0.98; p < 0.001). There was also a strong positive correlation between these measurements of the v-vial (r2 = 0.98; p < 0.001). Conclusion: With measurement of the residual activity in the delivery box using a dosimeter the percentage of the whole injected activity can be easily calculated. This facilitates the calculation of the actual, achieved target and non-target dose in those cases, where therapy had to be stopped because of eminent flow reversal or obstruction.

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