Radioembolization is a widely used treatment for non-resectable primary and secondary liver cancer. This handbook addresses the radiation biology, physics, nuclear medicine, and imaging forradioembolization using Yttrium-90 (90Y) microspheres, in addition to discussing aspects related to interventional radiology. The contents reflect on and off-label treatment indications, dose-response relationships, treatment-planning, therapy optimization, radiation safety, imaging follow-up and many other facets of this therapy necessary for both novice and advanced users alike.
- Focuses on the radiation biology, physics, nuclear medicine, and imaging aspects of radioembolization.
- Logically follows the timeline of radioembolization, from treatment planning to treatment and patient follow-up.
- Reflects the interdisciplinary nature of the field, providing interventional radiologists with a basis in the physics and nuclear medicine aspects, which largely determine treatment success vs failure.
- Covers important topics such as post-treatment imaging, alternative and adjuvant therapies.
- Concludes with a chapter on future outlook for intrahepatic and extrahepatic treatment of disease.
INTRODUCTION. Introduction to radioembolization for the treatment of non-resectable liver cancer. PATIENT SELECTION AND TREATMENT PLANNING. Treatment options for patients with primary and secondary liver cancer: An overview of invasive, minimally invasive and non-invasive techniques. Treatment planning part I: Vascular considerations. Treatment planning part II: Procedure simulation using99mTc-MAA. Treatment planning part III: Dosimetric considerations in conventional lobar therapy. Treatment planning part IV: Radioembolization in segmentectomy, lobectomy and future liver remnanthypertrophy. TREATING PATIENTS WITH RADIOEMBOLIZATION. Radiation safety concerns associated with preparing the dose, treating and releasing the patient and managing radioactive waste. The radiationbiology of radioembolization. Glass and resin microspheres: An analysis on a microscopic and macroscopic level. FOLLOWING PATIENTS TREATED WITH RADIOEMBOLIZATION. Quantitative post-radioembolization imaging using Bremsstrahlung SPECT. Quantitative post-radioembolization imaging using PET/CT. Image-based 3-dimensional dosimetry following radioembolization. Diagnostic reporting usingpost-radioembolization imaging. Using post-treatment imaging in the medical management of patients treated with radioembolization. The potential utility of serial therapy in radioembolization: A radiation biologyanalysis. NEW HORIZONS. Future directions in radioembolization for intrahepatic and extrahepatic treatment of disease
Alexander S. Pasciak, PhD, earned a BS in electrical engineering at the University of Washington, MS in health physics and PhD in nuclear engineering at Texas A&M University. In 2010, Dr. Pasciakcompleted a 2-year diagnostic medical physics residency at the University of Texas MD Anderson Cancer Center after which he worked for 5 years as a diagnostic medical physicist at the University of Tennessee Medical Center in Knoxville, Tennessee. Dr. Pasciak maintains a position as an associate professor of radiology at the University of Tennessee and is concurrently pursuing his MD degree at theJohns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Pasciak is active in multiple research endeavors in the fields of interventional radiology and medical physics, and he has publishedpapers in high impact journals. Dr. Pasciak has published 35 articles in peer-reviewed medical journals, presented 62 research abstracts at national meetings, has written 6 book chapters, and has filed 2 patents. He currently serves as principal investigator on three externally funded research grants involving radioembolization. Dr. Pasciak is certified by the American Board of Radiology (ABR) in diagnosticmedical physics and is Mammography Quality Standards Act (MQSA) qualified.
Mark McKinney, MD, earned a medical degree at Loma Linda University School of Medicine in California where he completed a diagnostic radiology residency and interventional radiology fellowship. Dr. McKinney joined the Mayo Clinic in 1993. While at Mayo Clinic in Jacksonville, Florida, he developed the interventional radiology fellowship, mentored residents, made numerous presentations, and authoredmore than 60 peer-reviewed articles, abstracts, and book chapters. From 2008 to 2012 Dr. McKinney was Chair of Radiology at the University of Tennessee Medical Center and initiated the University of Tennessee interventional oncology radioembolization program. Dr. McKinney returned to Mayo Clinic in 2012 and is serving as Chair of Radiology. Dr. McKinney is an associate professor of radiology in theMayo Clinic College of Medicine. Dr. McKinney is a recent past president of the Association of Program Directors in Radiology and is involved in the new interventional radiology residency program.
Yong C. Bradley, MD, is an ABNM and ABR-certified nuclear medicine subspecialist at the University of Tennessee Medical Center in Knoxville, Tennessee. He completed his residency training in radiology at Tripler Army Medical Center in Honolulu, Hawaii, and subsequently completed a 2-year fellowship in nuclear medicine at Brooke Army Medical Center in San Antonio, Texas. Dr. Bradley is a former chief of radiology and nuclear medicine and molecular imaging at the Brooke Army Medical Center, Wilford Hall Medical Center, and San Antonio Military Medical Center. Dr. Bradley has been interested in cancerimaging and therapy for over 20 years. He has been involved in positron emission tomography (PET) and PET/computed tomography (CT) imaging since 1998, when he was first introduced to PET along withradioimmunotherapy. Presently, his interest has been concentrated in liver radioembolization.
"This book will be a valuable resource for anyone already in the field of radioembolisation, whether it be for clinical or scientific guidance, as well as those just starting up and wishing to familiarise themselveswith the procedure. It offers detailed insight into the many facets that contribute to successful therapy, and through its multidisciplinary nature promises be a useful tool in improving safety and efficacy of treatment, and establishing a personalised approach to radioembolisation."
—Dr. Kathy Willowson, The University of Sydney
"An essential book for anybody who is involved or is planning to start Y-90 radioemboliziation, covering state-of-the-art dosimetry approaches using bremsstrahlung SPECT/CT and PET/CT imaging, withexcellent descriptions of advantages and limitations."
—Dr. Karin Knešaurek, Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital
"a comprehensive yet practical study of selective internal radiation therapy. Representing the latest concepts and research relating to radioembolization, the book takes the reader through the basics in a logicaland cohesive manner. The authors have managed to present complex topics and arms of controversy in an objective, scientific and honest manner, allowing the reader to adapt and evolve with the thoughtprocesses behind various advanced therapeutic strategies. This text should be part of a core curriculum for those users starting SIRT, and advanced users alike."
—David Liu, MD, Vancouver Imaging Inc and University of British Columbia
"a well written book on principles and practice of hepatic radioembolization, with excellent emphasis on dosimetry, radiobiology and post-therapy imaging. I strongly recommend this to all physicians engaged in treating liver tumors with radioembolization."
—Sanjeeva Kalva, MD, University of Texas Southwestern Medical Center
"provides a detailed account of the background, logistics, rationale, and key patient selection factors in the use of a multidisciplinary radiation implantation approach to hepatic cancers. The often misunderstoodaspects of 90Y activity planning… are well covered and explained clearly"
—Andrew S. Kennedy, MD, Sarah Cannon Research Institute