PT  - JOURNAL ARTICLE
AU  - Kao, Yung Hsiang
AU  - Gan, Calvin
AU  - Corlett, Alicia
AU  - Rhodes, Alexander
AU  - Sivaratnam, Dinesh
AU  - Lim, Beng Ghee
TI  - Indirect Lung Absorbed Dose Verification by <sup>90</sup>Y PET/CT and Complete Lung Protection by Hepatic Vein Balloon Occlusion: Proof of Concept
AID  - 10.2967/jnmt.121.263422
DP  - 2022 Sep 01
TA  - Journal of Nuclear Medicine Technology
PG  - 240--243
VI  - 50
IP  - 3
4099  - http://tech.snmjournals.org/content/50/3/240.short
4100  - http://tech.snmjournals.org/content/50/3/240.full
SO  - J. Nucl. Med. Technol.2022 Sep 01; 50
AB  - Postradioembolization lung absorbed dose verification was historically problematic and impractical in clinical practice. We devised an indirect method using 90Y PET/CT. Methods: Conceptually, true lung activity is simply the difference between the total prepared activity minus all activity below the diaphragm and residual activity within delivery apparatus. Patient-specific lung mass is measured by CT densitovolumetry. True lung mean absorbed dose is calculated by MIRD macrodosimetry. Results: Proof of concept is shown in a hepatocellular carcinoma patient with a high lung shunt fraction of 26%, where evidence of technically successful hepatic vein balloon occlusion for radioembolization lung protection was required. Indirect lung activity quantification showed the postradioembolization lung shunt fraction to be reduced to approximately 1% with a true lung mean absorbed dose of approximately 1 Gy, suggesting complete lung protection by hepatic vein balloon occlusion. Conclusion: We discuss possible clinical applications such as lung absorbed dose verification, refining the limits of lung tolerance, and the concept of massive activity radioembolization.