Advanced Y-90 Radioembolization Course

Lesson 1 • Hepatic Vascular Anatomy Review

Details segmental liver anatomy, arterial supply variants, and portal venous relationships. Accurate anatomical knowledge is prerequisite for catheter planning.

Lesson 2 • Patient Selection Criteria

Defines clinical, laboratory, and imaging criteria for candidacy. Proper selection directly determines procedural safety and therapeutic efficacy.

Lesson 3 • Regulatory and Institutional Framework

Outlines radiation licensing requirements, institutional credentialing, and multidisciplinary team roles. Compliance ensures legal operation and patient safety.

Lesson 4 • Tumour Biology and Treatment Rationale

Explains hypervascular tumour biology, arterial preferential flow, and radiobiological sensitivity. Links tumour characteristics to expected Y-90 therapeutic response.

Lesson 1 • Comparative Clinical Evidence

Reviews landmark trials comparing platforms across tumour types and endpoints. Evidence-based selection improves patient outcomes and resource utilisation.

Lesson 2 • Device Selection Decision Framework

Applies clinical variables to a structured decision algorithm for platform choice. Systematic selection reduces variability and optimises treatment planning.

Lesson 3 • Glass Microsphere Platform Overview

Describes specific activity, particle size, and loading characteristics of glass microspheres. High specific activity enables targeted high-dose delivery with fewer particles.

Lesson 1 • Treatment Planning from Mapping Data

Integrates angiographic, cross-sectional, and scintigraphic data into a coherent treatment plan. Comprehensive planning reduces procedural uncertainty and optimises dose delivery.

Lesson 2 • Diagnostic Angiography Techniques

Covers catheter selection, contrast injection rates, and projection angles for hepatic angiography. Angiographic mapping directly informs microsphere delivery planning.

Lesson 3 • Technetium-99m MAA Mapping Procedure

Details Tc-99m MAA injection technique, SPECT/CT acquisition, and lung shunt fraction calculation. MAA mapping is the mandatory safety step before Y-90 administration.

Lesson 4 • Extrahepatic Vessel Identification

Identifies vessels at risk for non-target embolisation including gastric, duodenal, and pulmonary branches. Prophylactic coil embolisation prevents serious complications.

Lesson 1 • Personalised Dosimetry Workflow

Integrates imaging biomarkers, liver function, and dose constraints into a personalised prescription workflow. Personalised dosimetry improves tumour control while limiting toxicity.

Lesson 2 • Partition Model Dosimetry

Teaches tumour-to-normal liver ratio estimation from MAA SPECT and partition model equations. Partition dosimetry enables individualised tumour dose optimisation.

Lesson 3 • Body Surface Area Dosimetry Model

Explains the empirical BSA formula, its assumptions, and clinical application range. BSA dosimetry is simple but lacks individualisation for complex cases.

Lesson 4 • Voxel-Based Dosimetry Approaches

Introduces voxel-level dose mapping using quantitative SPECT and Monte Carlo methods. Voxel dosimetry provides the highest spatial resolution for dose-response analysis.

Lesson 1 • Vascular Access and Catheter Selection

Covers femoral and radial access techniques, sheath selection, and guide catheter positioning. Stable access is foundational to precise microsphere delivery.

Lesson 2 • Microsphere Administration Technique

Details vial preparation, delivery device assembly, and injection rate control for each platform. Controlled delivery prevents reflux, stasis, and non-target embolisation.

Lesson 3 • Procedural Suite Setup and Radiation Safety

Defines room preparation, shielding, personnel dosimetry, and waste management protocols. Proper setup protects staff and ensures regulatory compliance during administration.

Lesson 4 • Catheter Positioning for Delivery

Teaches selective and lobar catheter positioning to match the MAA mapping injection site. Position reproducibility ensures delivered dose matches the planned distribution.

Lesson 1 • Follow-Up Imaging and Lab Protocols

Establishes standardised imaging schedules, laboratory panels, and response assessment timelines. Consistent follow-up enables early detection of response and toxicity.

Lesson 2 • Gastrointestinal Toxicity Recognition

Identifies radiation gastritis, ulceration, and cholecystitis as non-target toxicities. Prompt endoscopic or surgical referral prevents life-threatening complications.

Lesson 3 • Radiation-Induced Liver Disease

Explains RILD pathophysiology, diagnostic criteria, and risk stratification. Early identification and supportive management reduce progression to liver failure.

Lesson 4 • Post-Embolisation Syndrome Management

Defines post-embolisation syndrome features, expected timeline, and pharmacologic management. Distinguishing expected syndrome from serious toxicity guides appropriate intervention.

Lesson 1 • Portal Vein Thrombosis Considerations

Evaluates treatment feasibility, dose modification, and monitoring in patients with portal vein thrombosis. Altered hepatic perfusion requires adjusted dosimetry and heightened toxicity surveillance.

Lesson 2 • Bridge and Downstaging Strategies

Applies Y-90 as a bridge to transplant or to downstage tumours beyond standard criteria. Strategic use of radioembolisation expands curative treatment eligibility.

Lesson 3 • Previously Treated Liver Cases

Manages patients with prior hepatic arterial therapy, ablation, or surgical resection. Prior treatment alters vascular anatomy and liver reserve, requiring individualised planning.

Lesson 4 • Bilobar Disease Treatment Planning

Addresses sequential lobar treatment, interval timing, and liver reserve monitoring for bilobar disease. Staged treatment preserves functional liver volume while achieving whole-liver coverage.

Lesson 1 • Continuous Quality Improvement Cycles

Implements plan-do-study-act cycles to address identified quality gaps in the Y-90 programme. Iterative improvement sustains high performance and adapts to evolving evidence.

Lesson 2 • Clinical Outcome Metrics

Defines overall survival, progression-free survival, and objective response rate as primary endpoints. Standardised metrics enable meaningful comparison across institutions and trials.

Lesson 3 • Program Benchmarking and Accreditation

Compares programme metrics against published benchmarks and accreditation standards. External benchmarking identifies performance gaps and supports institutional credentialing.

Lesson 4 • Complication Tracking and Grading

Applies standardised adverse event grading scales to classify and track Y-90 complications. Systematic grading supports root cause analysis and process improvement.