90Y-RE is a minimally invasive procedure similar to chemoembolization that uses radiolabeled glass or resin beads to kill tumor cells while sparing healthy liver tissue.
Percutaneous treatment is performed under the guidance of Angio-CT System, ensuring safety and accuracy of target treatment. We need a still and painless patient. Than we use preemptive analgesia and general anesthesia with IV drug for induction, inhaled and IV agent for maintenance and neuromuscular junction blockers to cause muscle relaxation.
So patient selected during SIRTeam normally arrives in the hybrid operating room with all the necessary instrumental and laboratory tests.
The diagnostic phase include hepatic angiography and intra-arterial protocol CT scan, called Hepatic Arterio-CT, which we developed.
After administration of the trans-microcatheter contrast agent afferent to the target, 3 acquisitions are performed with rapid injection of contrast agent and acquired after four seconds: the first arterial phase, the middle arterial phase and the end arterial phase.
The vascular preparation will be performed with arterial embolization of for example the gastroduodenal artery, cystic artery and right gastric artery, followed by an infusion of albumin macroaggregates marked with metastable technetium 99.
The patient is then transferred to the nuclear medicine unit to perform a scintigraphic examination to simulate what will happen later with the radioisotope.
CT scans of the liver are transferred to a 3D simulation platform that allows them to be transformed into a true anatomical view of the patient. In this way the study of hepatic volume is facilitated, with a detailed identification of the healthy liver, and therefore of the hepatic reserve and lesions usually identified in the middle artery phase, and of the perfused liver which is then subjected to radioembolisation treatment.
This three-dimensional analysis, performed by the Radiographer and the interventional radiologist, is sent to the physicist to calculate the dose.
The therapeutic injection of Ittrio 90 microspheres will then be injected into the patient ten days later, with the microcatheter in the same position in which the Albumin macroaggregates marked with
Technetium were infused.