Type:
Educational Exhibit
Keywords:
Education and training, Radionuclide therapy, Ultrasound, Fluoroscopy, Musculoskeletal joint, Interventional non-vascular
Authors:
S. Carbullanca Toledo, J. Ares, I. García Duitama, A. Agustí, A. Solano, I. Espallargas Giménez, E. martinez miralles; Barcelona/ES
DOI:
10.26044/ecr2019/C-0985
Background
Radiosynovectomy (Synonyms: radiosynoviorthesis) is a local treatment method,
indicated in different rheumatological,
acute and chronic processes,
when despite conventional treatment,
for more than 6 months and / or intraarticular infiltrations of corticosteroids,
there is still involvement of some joints,
and when an increase in the dose of these drugs can have serious side effects in the patient (11)
Radiosynoviorthesis consists of the intra-articular injection of a radionuclide,
beta-emitting (10) This technique was used for the first time in 1952 by K.
Fellinger and Schmid for the treatment of chronic synovitis and it was Delbarre in 1968 who introduced the term Radiosynoviorthesis (11)
It is a technique used for more than 50 years for the treatment of resistant synovitis,
of individual joints,
after the failure of long-term systemic treatment and intra-articular steroid injections (8)
Radionuclide must meet a series of criteria
- Enough energy to penetrate and destroy the synovial membrane
- Union to particles of small size that can be phagocytosed by the synovial membrane.
A size of 2 to 10 μm is appropriate (8,10)
- Stable union between the radionuclide and the colloid that allows a homogeneous distribution within the joint space (8,10)
It is generally accepted that a particle size above 300 nm is necessary to minimize spontaneous leakage,
and that particles up to 10,000 nm are absorbed by phagocytosis.
(1) For example,
90Y citrate colloid has a size of particle of approximately 2000 nm,
with a range of 1000-3000 nm (1).
Another important factor to reduce the possibility of leakage (apart from the size of the particles) is the immobilization of the joint after treatment.
Choice of radionuclide
The choice of radionuclide depends on the depth of penetration of the same and the joint to be treated.
They emit a radiation dose of 70 to 100 Gy to the synovial membrane (1,8,11)
In Europe,
3 radioisotopes are authorized: Yttrium-90,
Rhenium-186 and Erbium-169 that meet the physical characteristics suitable for the Radiosynoviorthesis.