SPHP Radiology Protocols

Radiology Protocols

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Y-90 Treatment

Y-90 Treatment

  1. Preparation
    1. Symbia T open and CT tube warmed up for patient
  2. Isotope Administration
    1. Patient will receive therapeutic radiolabeled spheres of Yttrium-90 (SIR-Spheres).
    2. The dose range is 1-2.6 GBq
    3. The spheres are implanted intra-arterially into a hepatic tumor by injection into a branch of the hepatic artery during an interventional vascular radiology procedure.
  3. Ordering Dose
    1. Go to the website, https://www.sirtex.com/us/clinicians/about-sir-spheres-microspheres/
    2. On the left had side of the screen click the tab, order product.
    3. On the left had side of the screen click the tab, online order form.
    4. For hospital name box, put in St. Peter’s Hospital.
    5. For the Account Number box, put in 1001046.
    6. For the Person Ordering box, put in your name
    7. For the Telephone box, put in 518-525-1820
    8. For the E-mail box, put in your work email
    9. For the treating physician box, put in Dr. Smbat Amirbekian
    10. For the Delivery Address box, put in 317 S. Manning Blvd., Suite 150, Albany, NY 12208.
    11. Delivery contact is the person ordering and department phone number.
    12. For the treatment site address, click the box for same as delivery address.
    13. For the Purchase Order Number, leave blank
    14. For the Patient ID box, put in the patient’s medical record number
    15. For the Referring physician box, put in the ordering physician
    16. For the Request delivery date box, you order the dose the day before treatment except on a Monday or holiday; you order the dose for the day of treatment.
    17. For the treatment date, put the day of treatment for the patient.
    18. For the item number SIR-Y001, Item: SIR-Spheres Y-90 resin microspheres
      (including 1 Accessory Pack*), put a 1 for the quantity. Do not order anything else.
    19. Click the box next to: Submission of this order form constitutes acceptance and consent to adhere to the Sirtex Order and Cancellation Policy. Customer acknowledges that all required steps have been performed prior to ordering (i.e. insurance approval, lab work, etc.). Submission also constitutes that all parties have appropriate licensing in place to handle our product. Thank you for your order. We appreciate your business.
    20. Click the submit button.
    21. Within the hour you should get an email saying the order is placed
    22. Within the day, you should get an email saying the order is accepted.
    23. When the order is accepted, put on the calendar: Ordered, for the patient on the day of treatment. The calendar is on our department registrations desk.
  4. Camera Parameters
  1. Planar Imaging
    1. MELP collimators
    2. Matrix: 256X256
  • Zoom: 1
  1. Camera Preset: Y90
  2. Detector: Both
  3. Supine
  • 10Kcts per image
  1. SPECT Imaging
    1. MELP collimators
    2. Matrix: 128X128
  • Zoom: 1
  1. Energy Window Group B is Y90 (no dash)
  2. Camera Preset: Y90
  3. Detectors: Both
  • Orientation: Head Out
  • Patient position: Supine
  1. Rotation: CW
  2. Start Angle: 0
  3. Degree Rotation: 180
  • Views: 90
  • Time per view: 20 sec
  • Detector configuration: 180
  1. Orbit: Noncircular
  • Mode: Step and shoot
  1. Scanning Protocol
    1. Slide the patient over to the imaging table from the stretcher
    2. Center the patients liver under the camera
    3. Pick the same image icon as the Y90 Mapping to take the planar image.
    4. Take the planar image
    5. After the planar image, perform the SPECT/CT
      1. Make sure the energy window for group B is Y90 (no dash)
    6. When the SPECT/CT is completed slide the patient back to their stretcher
  2. SPECT/CT Reconstruction
    1. Pick the CTAC Proc icon to process the SPECT/CT images.
    2. Nuclear Medicine Parameters
      1. Filtered backprojection
      2. Butterworth cutoff of .45 and order of 5
  • Chang’s attenuation coefficient 0.15
  1. Automatic contours
  2. Projection angel is 2
  3. Edge strength of 0.5
  • Background threshold of 5
  • Kernel 3X3
  1. CT Parameters
    1. Abdomen window
    2. Body 5.0 B30s Med smooth or Body 56.0 B40s Med for hardware
  • 5 mm Slice
  1. Post processing/Display/Archive
    1. All acquired images will be adjusted for optimal viewing and appropriate labeling
    2. All SPECT images will be displayed in coronal, sagittal, and axial planes with and without CT fusion and NM MIP
    3. Images will be sent to the PAC’s system and Syngo Via for archiving/physician review
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