Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12302
Title: Personalized predictive lung dosimetry by technetium-99m macroaggregated albumin SPECT/CT for yttrium-90 radioembolization.
Authors: Kao, Yung Hsiang;Magsombol, Butch M;Toh, Ying;Tay, Kiang Hiong;Chow, Pierce Kh;Goh, Anthony Sw;Ng, David Ce
Affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore ; Department of Nuclear Medicine, Austin Hospital, Level 1, Harold Stokes Building, 145 Studley Rd, Melbourne 3084, Victoria, Australia.
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore ; Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore ; Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, 8 College Rd, Singapore 169857, Singapore.
Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Issue Date: 29-Jun-2014
Citation: Ejnmmi Research 2014; 4(): 33
Abstract: For yttrium-90 ((90)Y) radioembolization, the common practice of assuming a standard 1,000-g lung mass for predictive dosimetry is fundamentally incongruent with the modern philosophy of personalized medicine. We recently developed a technique of personalized predictive lung dosimetry using technetium-99m ((99m)Tc) macroaggregated albumin (MAA) single photon emission computed tomography with integrated CT (SPECT/CT) of the lung as part of our routine dosimetric protocol for (90)Y radioembolization. Its rationales are the technical superiority of SPECT/CT over planar scintigraphy, ease and convenience of lung auto-segmentation CT densitovolumetry, and dosimetric advantage of patient-specific lung parenchyma masses.This is a retrospective study of our pulmonary clinical outcomes and comparison of lung dosimetric accuracy and precision by (99m)Tc MAA SPECT/CT versus conventional planar methodology. (90)Y resin microspheres (SIR-Spheres) were used for radioembolization. Diagnostic CT densitovolumetry was used as a reference for lung parenchyma mass. Pulmonary outcomes were based on follow-up diagnostic CT chest or X-ray.Thirty patients were analyzed. The mean lung parenchyma mass of our Southeast Asian cohort was 822 ± 103 g standard deviation (95% confidence interval 785 to 859 g). Patient-specific lung parenchyma mass estimation by CT densitovolumetry on (99m)Tc MAA SPECT/CT is accurate (bias -21.7 g) and moderately precise (95% limits of agreement -194.6 to +151.2 g). Lung mean radiation absorbed doses calculated by (99m)Tc MAA SPECT/CT and planar methodology are both accurate (bias <0.5 Gy), but (99m)Tc MAA SPECT/CT offers better precision over planar methodology (95% limits of agreement -1.76 to +2.40 Gy versus -3.48 to +3.31 Gy, respectively). None developed radiomicrosphere pneumonitis when treated up to a lung mean radiation absorbed dose of 18 Gy at a median follow-up of 4.4 months.Personalized predictive lung dosimetry by (99m)Tc MAA SPECT/CT is clinically feasible, safe, and more precise than conventional planar methodology for (90)Y radioembolization radiation planning.
Internal ID Number: 25024931
URI: http://ahro.austin.org.au/austinjspui/handle/1/12302
DOI: 10.1186/s13550-014-0033-7
URL: http://www.ncbi.nlm.nih.gov/pubmed/25024931
Type: Journal Article
Subjects: CT lung densitovolumetry
Lung mass
Partition model
Selective internal radiation therapy
Technetium-99m macroaggregated albumin SPECT/CT
Yttrium-90 radioembolization
Appears in Collections:Journal articles

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