Scout and treatment procedures
intrahepatic and extrahepatic activity, extrahepatic deposition, coil-embolized
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Patients who fulfill the selection criteria at the screening visit will first receive a preparatory angiography and scout dose within four weeks. During angiography, the hepatic arterial vasculature is carefully assessed with digital subtraction angiography and C-arm CT. One or multiple injection positions are chosen that will cover the intended liver volume whilst minimizing the chance of activity deposition in non-target organs (e.g., intestines, pancreas). In the unlikely event that a vessel poses a threat to possible extrahepatic deposition of microspheres, it will be coil-embolized.Then, a scout dose of After administration of the scout dose, the patient will be transferred to the SPECT/CT and will be subjected to scintigraphy to assess intrahepatic and extrahepatic activity. Both planar imaging of the thorax and abdomen will be performed, as well as SPECT/CT of the abdomen. Images will be evaluated qualitatively and quantitatively. The angiography, scout dose administration and SPECT/CT are performed during a one-day visit.The following formulas are used to calculate the activity needed during the actual treatment [Lastly, the tumour-to-non tumour liver tissue liver tissue ratio (Besides predicting the distribution within the perfuse lobe, the scout dose serves to exclude any extrahepatic deposition during the actual treatment. It is as such a safety procedure. Notably, estimated lung shunting of more than 30 Gy based on the post-scout SPECT/CT is a contraindication for treatment dose. Activity in the falciform ligament, portal lymph nodes and gallbladder is accepted.If the scout dose does not reveal any contraindications, patients will undergo 