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Therapeutic Nuclear Medicine pp 361–377Cite as

Radioembolization: Concepts and Procedures

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Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Clinica Universidad De Navarra, Avenida De Pío XII, 36, 31008, Pamplona, Spain

    Javier Arbizu, Puy Garrastachu, Macarena Rodriguez-Fraile & Inés Domínguez-Prado

  2. Interventional Radiology, Department of Radiology, Clinica Universidad De Navarra, Avenida De Pío XII, 36, 31008, Pamplona, Spain

    José I. Bilbao

  3. Liver Unit, Department of Internal Medicine, Clinica Universidad De Navarra, Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (Ciberehd), Avenida De Pío XII, 36, 31008, Pamplona, Spain

    Mercedes Iñarrairaegui & Bruno Sangro

Authors
  1. Javier Arbizu
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  2. José I. Bilbao
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  3. Puy Garrastachu
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  4. Macarena Rodriguez-Fraile
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  5. Inés Domínguez-Prado
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  6. Mercedes Iñarrairaegui
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  7. Bruno Sangro
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Corresponding author

Correspondence to Javier Arbizu .

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Editors and Affiliations

  1. THERANOSTICS Center for Molecular, Radiotherapy and Molecular Imaging, ENETS Center of Excellence, Bad Berka, Germany

    Richard P. Baum

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Arbizu, J. et al. (2013). Radioembolization: Concepts and Procedures. In: Baum, R. (eds) Therapeutic Nuclear Medicine. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_793

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  • DOI: https://doi.org/10.1007/174_2012_793

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  • Print ISBN: 978-3-540-36718-5

  • Online ISBN: 978-3-540-36719-2

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