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Conventional Hepatic Volumetry May Lead to Inaccurate Segmental Yttrium-90 Radiation Dosimetry



To compare radioembolization treatment zone volumes from mapping cone beam CT (CBCT) versus planning CT/MRI and to model their impact on dosimetry.


Y90 cases were retrospectively identified in which intra-procedural CBCT angiograms were performed. Segmental and lobar treatment zone volumes were calculated with semi-automated contouring using Couinaud venous anatomy (planning CT/MRI) or tumor angiosome enhancement (CBCT). Differences were compared with a Wilcoxon signed-rank test. Treatment zone-specific differences in segmental volumes by volumetric method were also calculated and used to model differences in delivered dose using medical internal radiation dosimetry (MIRD) at 200 and 120 Gy targets. Anatomic, pathologic, and technical factors likely affecting segmental volumes by volumetric method were evaluated.


Forty segmental and 48 lobar CBCT angiograms and corresponding planning CT/MRI scans were included. Median Couinaud- and CBCT-derived segmental volumes were 281 and 243 mL, respectively (p = 0.005). Differences between Couinaud and CBCT lobar volumes (right, left) were not significant (p = 0.24, p = 0.07). Couinaud overestimated segmental volumes in 28 cases by a median of 98 mL (83%) and underestimated in 12 cases by median 69 mL (20%). At a 200 Gy dose target, Couinaud estimates produced median delivered doses of 367 and 160 Gy in these 28 and 12 cases. At a 120 Gy target, Couinaud produced doses of 220 and 96 Gy. Proximal vs. distal microcatheter positioning, variant arterial anatomy, and tumor location on or near segmental watersheds were leading factors linked to volumetric differences.


Use of CBCT-based volumetry may allow more accurate, personalized dosimetry for segmental Y90 radioembolization.

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  1. 1.

    Khajornjiraphan N, Thu NA, Chow PKH. Yttrium-90 microspheres: a review of its emerging clinical indications. Liver cancer. 2015;4(1):6–15.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Saini A, Wallace A, Alzubaidi S, et al. History and evolution of Yttrium-90 radioembolization for hepatocellular carcinoma. J Clin Med. 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Salem R, Thurston KG. Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol. 2006;17(8):1251–78.

    Article  PubMed  Google Scholar 

  4. 4.

    Malhotra A, Liu DM, Talenfeld AD. Radiation segmentectomy and radiation lobectomy: a practical review of techniques. Tech Vasc Interv Radiol. 2019;22(2):49–57.

    Article  PubMed  Google Scholar 

  5. 5.

    Biederman DM, Titano JJ, Bishay VL, et al. Radiation segmentectomy versus TACE combined with microwave ablation for unresectable solitary hepatocellular carcinoma Up to 3 cm: a propensity score matching study. Radiology. 2017;283(3):895–905.

    Article  PubMed  Google Scholar 

  6. 6.

    Padia SA, Johnson GE, Horton KJ, et al. Segmental Yttrium-90 radioembolization versus segmental chemoembolization for localized hepatocellular carcinoma: results of a single-center, retrospective, propensity score-matched study. J Vasc Interv Radiol. 2017;28(6):777-785.e1.

    Article  PubMed  Google Scholar 

  7. 7.

    Biederman DM, Titano JJ, Korff RA, et al. Radiation segmentectomy versus selective chemoembolization in the treatment of early-stage hepatocellular carcinoma. J Vasc Interv Radiol. 2018;29(1):30-37.e2.

    Article  PubMed  Google Scholar 

  8. 8.

    Salem R, Padia SA, Lam M, et al. Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging. 2019;46(8):1695–704.

    Article  PubMed  Google Scholar 

  9. 9.

    Toskich BB, Liu DM. Y90 Radioembolization dosimetry: concepts for the interventional radiologist. Tech Vasc Interv Radiol. 2019;22(2):100–11.

    Article  PubMed  Google Scholar 

  10. 10.

    Kim SP, Cohalan C, Kopek N, Enger SA. A guide to (90)Y radioembolization and its dosimetry. Phys Med. 2019;68:132–45.

    Article  PubMed  Google Scholar 

  11. 11.

    Bastiaannet R, Kappadath SC, Kunnen B, Braat AJAT, Lam MGEH, de Jong HWAM. The physics of radioembolization. EJNMMI Phys. 2018;5(1):22.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Cardarelli-Leite L, Chung J, Klass D, et al. Ablative transarterial radioembolization improves survival in patients with HCC and portal vein tumor thrombus. Cardiovasc Intervent Radiol. 2020;43(3):411–22.

    Article  PubMed  Google Scholar 

  13. 13.

    Lau W-Y, Kennedy AS, Kim YH, et al. Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres. Int J Radiat Oncol Biol Phys. 2012;82(1):401–7.

    Article  PubMed  Google Scholar 

  14. 14.

    SIR-Spheres Package Insert, SIRTeX Medical Limited

  15. 15.

    TheraSphere Yttrium-90 Microspheres Package Insert, Boston Scientific Corporation

  16. 16.

    Liu DM, Westcott M, Garcia-Monaco R, Abraham R, Gandhi R. Down and dirty with dosimetry: a practical understanding and approach to radioembolization. Endovasc Today. 2016;15(9):70–6.

    Google Scholar 

  17. 17.

    Germain T, Favelier S, Cercueil JP, Denys A, Krausé D, Guiu B. Liver segmentation: practical tips. Diagn Interv Imaging. 2014;95(11):1003–16.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Couinaud C (1954) Liver lobes and segments: notes on the anatomical architecture and surgery of the liver TT—Lobes et segments hépatiques: notes sur l’architecture anatomiques et chirurgicale du foie. Presse Med 62(33): 709–712.

  19. 19.

    Tacher V, Radaelli A, Lin M, Geschwind J-F. How I do it: cone-beam CT during transarterial chemoembolization for liver cancer. Radiology. 2015;274(2):320–34.

    Article  PubMed  Google Scholar 

  20. 20.

    Wang X, Yarmohammadi H, Cao G, et al. Dual phase cone-beam computed tomography in detecting <3 cm hepatocellular carcinomas during transarterial chemoembolization. J Cancer Res Ther. 2017;13(1):38–43.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Pung L, Ahmad M, Mueller K, et al. The role of cone-beam CT in transcatheter arterial chemoembolization for hepatocellular carcinoma: a systematic review and meta-analysis. J Vasc Interv Radiol. 2017;28(3):334–41.

    Article  PubMed  Google Scholar 

  22. 22.

    Gabr A, Riaz A, Johnson GE, et al. Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants. Eur J Nuc Med Mol Imaging. 2020.

    Article  Google Scholar 

  23. 23.

    Kawasaki S, Makuuchi M, Matsunami H, et al. Preoperative measurement of segmental liver volume of donors for living related liver transplantation. Hepatology. 1993;18:1115–20.

    CAS  Article  Google Scholar 

  24. 24.

    Ertreo M, Choi H, Field D, et al. Comparison of cone-beam tomography and cross-sectional imaging for volumetric and dosimetric calculations in resin Yttrium-90 radioembolization. Cardiovasc Intervent Radiol. 2018;41(12):1857–66.

    Article  PubMed  Google Scholar 

  25. 25.

    Elsayed M, Ermentrout RM, Sethi I et al (2020) Incidence of radioembolization-induced liver disease and liver toxicity following repeat 90Y-radioembolization: outcomes at a large tertiary care center. Clin Nucl Med.

  26. 26.

    Riaz A, Awais R, Salem R. Side effects of Yttrium-90 radioembolization. Front Oncol. 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Lam MGEH, Louie JD, Iagaru AH, Goris ML, Sze DY. Safety of repeated Yttrium-90 radioembolization. Cardiovasc Intervent Radiol. 2013;36(5):1320–8.

    Article  PubMed  Google Scholar 

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This study was not supported by any funding.

Author information




S.I.S contributed to conceptualization, data curation, formal analysis, investigation, methodology, resources, software, visualization, writing—original draft, and writing—review/editing. M.M.S was involved in conceptualization, data curation, formal analysis, investigation, methodology, resources, software, visualization, writing—original draft, and writing—review/editing. J.S contributed to data curation, investigation, and writing—review/editing. R.D was involved in methodology, resources, software, visualization, writing—original draft, and writing—review/editing. B.W.C contributed to resources, software, visualization. K.S.L was involved in investigation, writing—review/editing. A.M, B.M, R.A.C, B.J.M., D.C.M contributed to writing—review/editing. A.D.T was involved in conceptualization, methodology, data curation, formal analysis, project administration, investigation, resources, supervision, validation, writing—original draft, and writing—review/editing.

Corresponding author

Correspondence to Adam D. Talenfeld.

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Conflict of Interest

A.D.T receives research funding from SIRTex medical. R.D. is a salaried employee of General Electric. R.A.C is the recipient grants from General Electric, administered by the Association of University Radiologists (GERRAF grant), SIR Foundation, and FDA NEST as well as speaker honoraria from SIRTex and the American College of Surgery. D.C.M is a consultant for Boston, Scientific, General Electric and SIRTex.

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Seth I. Stein and Mohamed M. Soliman shared co-first authors

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Stein, S.I., Soliman, M.M., Sparapani, J. et al. Conventional Hepatic Volumetry May Lead to Inaccurate Segmental Yttrium-90 Radiation Dosimetry. Cardiovasc Intervent Radiol 44, 1973–1985 (2021).

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  • Selective internal radiation therapy
  • Radioembolization
  • Yttrium 90 dosimetry
  • Radiation segmentectomy
  • Liver volumetry