Radioembolization: Concepts and Procedures

  • Javier Arbizu
  • José I. Bilbao
  • Puy Garrastachu
  • Macarena Rodriguez-Fraile
  • Inés Domínguez-Prado
  • Mercedes Iñarrairaegui
  • Bruno Sangro
Part of the Medical Radiology book series (MEDRAD)


Radioembolization (RE) is a form of intravascular brachytherapy that consists in delivering implantable radioactive microspheres into the arteries that feed liver tumors in order to provide a high dose of radiation to tumor nodules irrespective of their number, size, and location, while preserving the non-tumoral liver tissue from receiving a harmful level of radiation. The nature of the procedure using Yttrium-90 RE (Y-90 RE) requires the collaboration of a multidisciplinary team including hepatologists or oncologists, interventional radiologists and nuclear medicine specialists working together in close collaboration. To avoid toxicity, a thorough angiographic evaluation is performed to identify every extrahepatic vessel that may feed the tumors (to assure efficiency), accomplished with Tc-99m labeled macroaggregated albumin (Tc-MAA) injection into the vessel of interest, in order to mimic the microsphere application during the treatment. Both procedures combined are essential to plan the radioembolization (RE) therapy and to detect any occult arteriovenous shunt from the hepatic arterial system to the pulmonary or gastrointestinal venous systems and so identify potentially to calculate the degree of hepatopulmonary shunting, and to detect and eventually occlude every collateral vessel that arising from a hepatic artery may carry microspheres to the GI tract or other extrahepatic organs. With all this information, the treatment is designed and activity is calculated in order to maximize the dose of radiation delivered to liver tumors while safely preserving the non-tumoral parenchyma.


Hepatic Artery Superior Mesenteric Artery Celiac Trunk Common Hepatic Artery Left Gastric Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Javier Arbizu
    • 1
  • José I. Bilbao
    • 2
  • Puy Garrastachu
    • 1
  • Macarena Rodriguez-Fraile
    • 1
  • Inés Domínguez-Prado
    • 1
  • Mercedes Iñarrairaegui
    • 3
  • Bruno Sangro
    • 3
  1. 1.Department of Nuclear MedicineClinica Universidad De NavarraPamplonaSpain
  2. 2.Interventional Radiology, Department of RadiologyClinica Universidad De NavarraPamplonaSpain
  3. 3.Liver Unit, Department of Internal MedicineClinica Universidad De Navarra, Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (Ciberehd)PamplonaSpain

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