A Clinical Trial of The Evaluation of Environmental Exposure in Yttrium 90 Radioembolization

Abstract

Aim: The aim of this study is to measure the dose rate of two different forms of Y-90 microsphere used for radioembolization and to evaluate the results according to radiation safety regularities. Material and Methods: 19 patients were enrolled in study (Age:61±1.5, F/M:12/7). As a result of the evaluation of the physicians, 7 patients were treated with TheraSphere and 12 patients were treated with SIR-Sphere. Dose rate measurements were taken at the stage of activity preparation, injection, radioactive wastes and discharge of patients via electronic dosimeter (ED). Results: The staff was exposed to dose rate of 1,3.10^-4 μSv/MBq.h during activity preparation stage,  2,4.10^-4 μSv/MBq.h in injection stage for Therapshere application. For SIR-spheres application, the staff was exposed to dose rate of 24,5.10^-4 μSv/MBq.h during activity preparation stage, 10,1.10^-4 μSv/MBq.h in injection stage. The average amount of dose received per operation was calculated 0.92±0.48 μSv in TheraSphere and 3.22±0.89 μSv in SIR-Spheres. For discharge of the patients, the average dose rate recorded from 1 m was found 4±0.28 μGy.h^-1 for TheraSphere and 3.2±0.15 μGy.h^-1 for SIR-Spheres. The dose rate of radioactive wastes measured from the surface of the container which contained the radioactive wastes generated after the application was 0.5±0.1 μSv.h^-1 for TheraSphere and 1.1±0.08 μSv.h^-1 for SIR-Spheres. Conclusion: It is emphasized that Y-90 Therasphere application provides radiation safety more than SIR-Spheres because of its closed system, even so both applications shows low dose rate around the patient and short-term storage of radioactive wastes after application would be sufficient.

Keywords

• exposure,radioembolization,yttrium 90,radiation protection

References

1. [1]. Dezarn Wa, Cessna Jt, Dewerd La, Feng W, Gates Vl, Halama J, Et Al. “Recommendations Of The American Association Of Physicists In Medicine On Dosimetry, Imaging, And Quality Assurance Procedures For 90y Microshere Brachytherapy In The Treatment Of Hepatic Malignancies”, Med Phys 2011; 38(8):4824-45.
2. [2]. Ariel Im, Padula G, “Treatment Of Symptomatic Metastatic Cancer To The Liver From Primary Colon And Rectal Cancer By The Intra-Arterial Administration Of Chemotherapy And Radioactive Isotopes”, J Surg Oncol 1978;10:327–336.
3. [3]. Ariel Im, Padula G, “Treatment Of Asymptomatic Metastatic Cancer To The Liver From Primary Colon And Rectal Cancer By The Intra-Arterial Administration Of Chemotherapy And Radioactive Isotopes”, J Surg Oncol 1982;20:151–156.
4. [4]. Howells Cc, Stinauer Ma, Diot Q, Westerly Dc, Schefter Te, Kavanagh Bd, Et Al. “Normal Liver Tissue Density Dose Response In Patients Treated With Stereotactic Body Radiation Therapy For Liver Metastases”. Int J Radiat Oncol Biol Phys 2012;84(3):E441-6.
5. [5]. Murthy R, Nunez R, Szklaruk J, Erwin W, Madoff Dc, Gupta S, Et Al. “Yttrium-90 Microsphere Therapy For Hepatic Malignancy: Devices, Indications, Technical Considerations And Potential Complications”, Radiographics 2005;25(1):S41-55.
6. [6]. Gulec Sa, Mesoloras G, Stabin M. “Dosimetric Techniques In 90y-Microsphere Therapy Of Liver Cancer: The Mird Equations For Dose Calculations”, J Nucl Med 2006;47(7):1209-11.
7. [7]. Shen S, Denardo Gl, Yuan A, Denardo Da, Denardo Sj. “Planar Gamma Camera Imaging And Quantitation Of Yttrium-90 Bremsstrahlung”. J Nucl Med 1994;35(8):1381-9.
8. [8]. Stabin Mg, Eckerman Kf, Ryman Jc, Williams Le. “Bremsstrahlung Radiation Dose In Yttrium-90 Therapy Applications”. J Nuci Med 1994;35:1377-1380.

9. [9]. “Discharge Of Patients Undergoing Treatment With Radioactive Substances Radiation Protection Series Publication No. 4”, Australian Radiation Protection And Nuclear Safety Agency (Arpansa), 2002
10. [10]. https://Ec.Europa.Eu/Energy/Sites/Ener/Files/Documents/097_En.Pdf
11. [11]. http://Www-Pub.Iaea.Org/Mtcd/Publications/Pdf/Pub1254_Web.Pdf
12. [12]. Sarfaraz M, Kennedy As, Cao Zj, Sackett Gd, Yu Cx, Lodge Ma, Et Al. “Physical Aspects Of Yttrium-90 Microsphere Therapy For Nonresectable Hepatic Tumors”. Med Phys 2003;30:199–203.
13. [13]. Aubert B, Guilabert N, Lamon A, Richard M. “Which Protection Against Radiation For New Protocols Of Internal Radiotherapy By Yttrium 90?” Proceedings Of The 6th European Alara Network Workshop. 2002; 34(7): 47–9.
14. [14]. Tosi G. “Report On One Accident Occurred In A Nuclear Medicine Department In Italy”. Proceedings Of The 6th European Alara Network Workshop. 2002; 34(7): 225-244.
15. [15]. ICRP Safety Reports Series No:63, Release Of Patients After Radionuclide Therapy. 2009; ISBN:978–92–0–108909–0, Issn 1020–6450.
16. [16]. Edmonds J, Smart R, Laurent R, Butler P, Brooks P, Hoschir R, Et Al. “A Comparative Study Of The Safety And Efficacy Of Dysprosium-165 Hydroxide Macro-Aggregate And Yttrium-90 Silicate Colloid In Radiation Synovectomy —A Multicentre Double Blind Clinical Trial”, Rheumatology 1994; 33(10): 947-953.
17. [17]. Cremonesi M, Ferrari M, Paganelli G, Rossi A, Chinol M, Bartolomei M, Et Al. “Radiation Protection In Radionuclide Therapies With (90) Y-Conjugates: Risks And Safety”. Eur J Nucl Med Mol Imaging 2006;33(11):1321-7.