TY - JOUR
T1 - lung shunt and lung dose calculation methods for radioembolization treatment planning
AU - Cheenu Kappadath, S.
AU - Lopez, Benjamin P.
AU - Salem, Riad
AU - Lam, Marnix G.
N1 - Publisher Copyright:
© 2020 ediZioni MinerVa Medica
PY - 2021/3
Y1 - 2021/3
N2 - Radioembolization, also known as selective internal radiation therapy (SIRT), is firmly established in the management of patients with unresectable liver cancers. advances in normal and tumor liver dosimetry and new knowledge about tumor dose response relationships have helped promote the safe use of higher prescribed doses, consequently transitioning radioembolization from palliative to curative therapy. The lungs are considered a critical organ of risk for radioembolization treatment planning. unfortunately, lung dosimetry has not achieved similar advances in dose calculation methodology as liver dosimetry. current estimations of lung dose are dependent on a number of parameters associated with data acquisition and processing algorithms, leading to poor accuracy and precision. Therefore, the efficacy of curative radioembolization may be compromised in patients for whom the lung dose derived using currently available methods unnecessarily limits the desired administered activity to the liver. We present a systematic review of the various methods of determining the lung shunt fraction (lSf) and lung mean dose (ld). This review encompasses pretherapy estimations and post-therapy assessments of the lSf and ld using both 2d planar and 3d SPecT/cT based calculations. The advantages and limitations of each of these methods are deliberated with a focus on accuracy and practical considerations. We conclude the review by presenting a lexicon to precisely describe the methodology used for the estimation of LSF and LD; specifically, category, agent, modality, contour and algorithm, in order to aid in their interpretation and standardization in routine clinical practice.
AB - Radioembolization, also known as selective internal radiation therapy (SIRT), is firmly established in the management of patients with unresectable liver cancers. advances in normal and tumor liver dosimetry and new knowledge about tumor dose response relationships have helped promote the safe use of higher prescribed doses, consequently transitioning radioembolization from palliative to curative therapy. The lungs are considered a critical organ of risk for radioembolization treatment planning. unfortunately, lung dosimetry has not achieved similar advances in dose calculation methodology as liver dosimetry. current estimations of lung dose are dependent on a number of parameters associated with data acquisition and processing algorithms, leading to poor accuracy and precision. Therefore, the efficacy of curative radioembolization may be compromised in patients for whom the lung dose derived using currently available methods unnecessarily limits the desired administered activity to the liver. We present a systematic review of the various methods of determining the lung shunt fraction (lSf) and lung mean dose (ld). This review encompasses pretherapy estimations and post-therapy assessments of the lSf and ld using both 2d planar and 3d SPecT/cT based calculations. The advantages and limitations of each of these methods are deliberated with a focus on accuracy and practical considerations. We conclude the review by presenting a lexicon to precisely describe the methodology used for the estimation of LSF and LD; specifically, category, agent, modality, contour and algorithm, in order to aid in their interpretation and standardization in routine clinical practice.
KW - Embolization, therapeutic
KW - Gamma cameras
KW - Lung
KW - Microspheres
KW - Radiation dosage
KW - Single photon emission computed tomography computed tomography
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U2 - 10.23736/S1824-4785.20.03287-2
DO - 10.23736/S1824-4785.20.03287-2
M3 - Review article
C2 - 33393753
AN - SCOPUS:85102723284
SN - 1824-4785
VL - 65
SP - 32
EP - 42
JO - Quarterly Journal of Nuclear Medicine and Molecular Imaging
JF - Quarterly Journal of Nuclear Medicine and Molecular Imaging
IS - 1
ER -