Multimodality Imaging for Optimized 90Y Radioembolization Therapy

A description of yttrium 90 radioembolization therapy for liver cancer including related multi-modality imaging strategies.

Course ID: Q00578 Category:
Modalities: , , , ,


Satisfaction Guarantee


Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Radionuclides and Radiopharmaceuticals: 0.50
Endocrine and Oncology Procedures: 2.00

Registered Radiologist Assistant: 1.00
Procedures: 1.00
Abdominal Section: 1.00

Radiation Therapy: 1.00
Patient Care: 1.00
Patient and Medical Record Management: 1.00


  1. Introduction
  2. General Principles of 90Y Radioembolization Therapy
    1. What is 90Y
    2. Vehicles Delivering 90Y: resin and Glass Microspheres
    3. Indications and Contraindications for 90Y Therapy
  3. Role of Imaging for 90Y Microsphere Therapy
    1. Preprocedural Cross-sectional Imaging and Patient Evaluation
    2. Combined Preprocedural Angiographic Vascular Mapping and 99mTc-MAA Shunt Examination
    3. 90Y Microsphere Dose Calculation
    4. Therapy Administration: Consolidation of Multidisciplinary Effort
    5. Postprocedural Bremsstrahlung Examination
  4. Multimodality Imaging Patterns: Classification to Improve Targeted Therapy
    1. Multimodality Imaging Approach
    2. Target 90Y Distribution: Complete and Incomplete Imaging Patterns
    3. Nontarget 90Y Distribution: Intrahepatic and Extrahepatic Imaging Patterns
  5. Conclusion


Upon completion of this course, students will:

  1. describe what multidisciplinary preprocedural planning is required for a successful 90Y microspheres treatment
  2. explain the difference between glass based and resin based microspheres
  3. understand how 90Y induces cell death and the minimum absorbed dose required
  4. describe acceptable absorbed dose limits for normal liver and complications that can occur when these limits are exceeded
  5. describe how the specific activity of two different microspheres affect treatment dose
  6. list the FDA indications for 90Y radioembolization
  7. list the contraindications associated with microsphere radioembolization
  8. identify other important pre procedural information necessary for patient selection
  9. explain the rationale for utilizing 99mTcMAA prior to 90Y therapy
  10. recognize the importance for selective angiography of the superior mesenteric artery
  11. describe the considerations taken into account when imaging the left hepatic artery
  12. describe the physical characteristics of 99mTcMAA that allow it to be used as a preplanning surrogate for 90Y therapy
  13. list the technical parameters required for setting up a 99mTcMAA SPECT/CT acquisition
  14. explain how waiting too long after MAA injection can compromise imaging
  15. understand how the addition of SPECT/CT imaging can be of benefit for pretreatment planning
  16. explain how lung shunting impacts 90Y microsphere treatment
  17. describe the advantages associated with cone beam CT when used as an angiographic technique
  18. recognize the benefits of SPECT/CT fusion imaging with the incorporation of an advanced multimodality work station
  19. understand the dose calculation for glass based microspheres and the targeted dose range
  20. describe the methodologies employed to calculate resin based microsphere dose
  21. list the multiple safety procedures that are carried out on the day of therapy
  22. explain how SPECT/CT Bremsstrahlung imaging can be beneficial
  23. list the technical parameters required for a successful 90Y planar and SPECT/CT acquisition
  24. explain how 90Y PET imaging may be employed following therapy
  25. identify how PET/CT or SPECT/CT can categorize patients based on target and nontarget 90Y distributions
  26. list the common sites of nontarget extrahepatic activity
  27. list the options available to the radiologist during pre-therapy imaging to curtail incomplete lesion coverage and/or nontarget distribution
  28. describe what contributes to incomplete distribution of 90Y microspheres and potential corrective measures
  29. explain how substantial incomplete tumoral coverage contributes to a suboptimal 90Y therapeutic response
  30. describe intrahepatic vs extrahepatic nontarget embolization
  31. list potential corrective measures to reduce nontarget embolization
  32. explain how extrahepatic activity to the umbilical region may be difficult to identify
  33. describe a technical imaging maneuver on pre-therapy imaging that may prevent 90Y activity within the umbilical region
  34. explain why 90Y bremsstrahlung imaging can be clinically significant for those patients identified with extrahepatic activity
  35. explain how potential therapeutic complications can be mitigated through a multimodality approach