Simplification of dosimetry in 90Y-radioembolization therapy by dual planar images

Aim: The purpose was to provide practical and effective method for performing 90Y dosimetry with 99mTc-MAA. The impact of scatter and attenuation correction (AC) on the injected 90Y activity and absorbed doses to critical organs was also further target beyond this study.Material and Methods: 18 patients (F: 3, M: 15) were subjected to 90Y therapy. 99mTc-MAA (111-222 MBq) was injected into the targeted liver, followed by a whole-body scan (WBS) with peak-window at 140 keV (15% width), and one down-scatter window. SPECT/CT scan was acquired over the lungs and liver regions. The lung shunt fractions were fashioned from the standard WBS, scatter corrected WBS, only scatter corrected SPECT and SPECT/CT with attenuation and scatter correction. The absorbed doses to tumor and surrounding healthy tissue were estimated with alternative approaches involving AC-SC (SPECT/CT), NoAC-SC (SPECT), NoAC-NoSC+LSF (SC-WBS), AC-SC+LSF (WBS), and NoAC-NoSC+LSF (WBS).Results: The average LSF deviations between the standard LSF and those obtained from AC-SC, NoAC-SC, and SC-WBS was -50% (-29/-71), -32%(-8/-67), and -45%(-13/80), respectively. The prescribed 90Y activity (GBq/Gy) was decreased by a range of 2-11%, 1-9%, and 2-7% with using LSFs from AC-SC, NoAC-SC, SC-WBS images. The absorbed dose to tumour and healthy liver tissue were calculated as 112±90 Gy and 30±18 Gy/GBq by AC-SC (SPECT/CT), 117±108 and 30±22 by NoAC-SC (SPECT), 110±100 and 31±21 Gy/GBq by NoAC-NoSC+LSF (SC-WBS), 106±84 and 28±17 Gy/GBq by AC-SC+LSF (WBS), while the absorbed dose was 90±85 and 28±20 Gy/GBq by using NoAC-NoSC+ LSF (WBS). Overall, no significant difference (p< 0.05) in the tomour and the health liver dose between all the approaches with/and without scatter correction. However, the scatter correction caused a significant difference in the lung shunt fractions (p <0.05).Conclusion: Scatter correction has a significant effect on the lung shunt fractions, planned activity and number of 90Y treatments. However, a minimal or negligible change was occurred on the absorbed dose to tumours and surrounding healthy liver. The good agreement between SPECT/CT approach, and scatter corrected whole-body scan might be practical and effective route for 90Y dosimetry.