Background Information:

What are the other Names for the Procedure?

• Radioembolization for HCC
• Radioembolization for Hepatocellular Carcinoma
• Radioembolization Yttrium-90

What is Radioembolization (Y90) radiology procedure? (General Explanation)

• Radioembolization (Y90) procedure is mostly used to treat liver cancers. It uses two procedures called embolization and radiation therapy
  • Radiation therapy consists of using ionizing radiation to kill or shrink the tumors
  • Embolization is used to block blood flow in which blood vessels or vascular malformations are blocked-off           
• Radioembolization consists of using microspheres that are placed in the blood vessels providing nutritional support to the tumor. These microspheres are filled with radioactive material. Once these microspheres reach the tumor site, high dose radiation is delivered to the tumor(s)

What part of the Body does the Procedure involve?

• Radioembolization is used to treat liver cancers; thus, liver is often involved in the procedure
• It is also used to treat metastasized cancers; thus, various parts of the body could be involved

Why is the Radioembolization (Y90) radiology procedure Performed?

• Radioembolization is used to treat primary liver cancers and metastasized liver cancers spread to other parts of the body
• The procedure is also used for palliative treatment to relieve the symptoms of cancer, by slowing down the tumor growth or shrinking the tumor

What is the Equipment used? (Description of Equipment)

The following equipment is used in Radioembolization:

• X-ray equipment
  • Fluoroscopy uses X-rays and converts them into real-time video images
  • It is used for image guidance, to scan the blood vessels feeding the tumors         
• Catheter: It is a very thin and long plastic tube
• Microspheres: These are small beads containing radioactive material

What are the Recent Advances in the Procedure?

There have been no recent advances in the Radioembolization procedure.

What is the Cost of performing the Radioembolization (Y90) radiology procedure?

The cost of Radioembolization procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Radioembolization procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25655623 (assessed on 3/4/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25636420 (assessed on 3/4/2015)

Prior to Radioembolization (Y90) radiology procedure:

How does the Radioembolization (Y90) radiology procedure work?

The Radioembolization procedure works in the following manner:

• Liver gets blood supply from two sources - the portal vein and the hepatic artery
  • Portal vein supplies 75% of blood supply to the liver and rest of the 25% is supplied by the hepatic artery
  • Liver tumors mostly get their blood supply from the hepatic artery
  • Microspheres used in Radioembolization are sent through the hepatic artery, so that most of the healthy liver tissues supplied by portal vein are not damaged    
• A contrast material is injected into the blood vessels and real-time imaging with fluoroscopy is used to visualize blood supply to the tumor
• The catheter is advanced into the blood vessel to the tumor site. Once the catheter reaches the tumor site, microspheres are inserted into the catheter and advanced to the tumor site
• Once the microspheres reach the tumor site, they deliver high dose of radiation to the tumor cells. These microspheres also block the blood flow to the tumor thus stop the nutrition and oxygen received by the tumors
• The radiation from the microspheres decreases and eventually disappears in about a month’s time

How is the Radioembolization (Y90) radiology procedure Performed?

• Before the actual Radioembolization procedure is performed, an arteriogram is performed to visualize the upper abdominal arteries and to check blood flow to the tumor. During the arteriogram, some of the arteries to the stomach and the  going to the stomach and duodenum are sealed so that the microspheres with radioactive isotope do not end up in those organs
• On the day of the procedure, the patient is asked to lie down on the examination table in a supine position. Various monitors are placed to monitor the patient’s vital signs
• An IV line is inserted into the patient’s arm vein for giving sedation, if needed
• The catheter insertion site is shaved, cleaned, sterilized, and numbed with a local anesthetic
• A skin incision is made at the catheter insertion site and using image guided fluoroscopy, the catheter is inserted through the skin into the femoral artery (located in the groin area)
• Once the catheter is in the artery, it is advanced into branches of the hepatic artery feeding the tumor. Microspheres filled with radioactive isotopes are injected in the catheter placed in the hepatic artery branches
• The catheter is removed at the end of the procedure and pressure is applied at the insertion site to avoid bleeding

Where is the Procedure Performed?

The Radioembolization procedure is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An interventional radiologist performs the Radioembolization procedure.

How long will the Procedure take?

• The Radioembolization procedure takes about an hour to perform
• It may take longer depending upon the complexity of the procedure and health of the patient

Who interprets the Result?

An interventional radiologist interprets the results of the Radioembolization procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Radioembolization procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions such as a heart disease, asthma, diabetes, or kidney disease
• Lab studies are done prior to the procedure to check kidney functions
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the X-ray
• Women should notify the physician if they are pregnant or breastfeeding their child, as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• The patient may be asked to avoid eating or drinking several hours before the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for the Radioembolization procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Radioembolization procedure:

• It is a minimally-invasive procedure
• It has less complications than surgery or liver transplantation
• It may relieve symptoms and pain in patients with inoperable tumors; thus, it can help improve the patient’s quality of life

Following are the risks of the Radioembolization procedure:

• There is a minimal chance of developing cancer if excessive radiation is used
• There is a chance of infection as a small incision is made during the procedure for catheter insertion
• During catheter insertion and maneuver, there is chance of perforating or damaging the blood vessel
• Certain patients are at risk of developing allergic reactions due to contrast material used during the procedure
• If microspheres get lodged at wrong locations, it may cause damage to other organs or healthy tissues, such as causing ulcers in stomach or duodenum

What are the Limitations of the Radioembolization (Y90) radiology procedure?

Following are the limitations of Radioembolization:

• Radioembolization is not a cure of the primary or metastatic cancer. However, it improves survival rate and the quality of life of cancer patients
• The procedure is not used if the patient has abnormal blood clotting, blockage in bile ducts, liver dysfunction, or kidney dysfunction

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Radioembolization procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Radioembolization (Y90) radiology procedure:

What is to be expected during the Radioembolization (Y90) radiology procedure?

The following may be expected during the Radioembolization procedure:

• The patient will feel a slight pain when the needle is inserted into arm vein for IV line
• Catheter insertion site at femoral artery is numbed with local anesthetic, so no pain will be felt
• The patient may feel a slight pressure-like sensation when the catheter is inserted in the femoral artery
• Contrast material used during the procedure may cause a warm sensation
• Some patients may feel some pain when microspheres are injected; but, the pain is only for a brief period
• If the pain persists for more than 8 hours after injection of the microspheres, there are chances that it is lodged at a wrong location and may have caused an ulcer in the stomach or duodenum

What kind of Anesthesia is given, during the Procedure?

Mild sedation or general anesthesia is often used depending upon the Radioembolization procedure being performed.

How much Blood will you lose, during the Procedure?

Since Radioembolization is a minimally-invasive procedure, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Radioembolization (Y90) radiology procedure?

During Radioembolization, if microspheres get inadvertently lodged at other locations, it may cause damage to healthy organs and tissues, or even result in stomach or duodenal ulcers

What Post-Operative Care is needed at the Healthcare Facility after the Radioembolization (Y90) radiology procedure?

No specific post-operative care is needed at the healthcare facility after the Radioembolization procedure.

After the Radioembolization (Y90) radiology procedure:

What is to be expected after the Radioembolization (Y90) radiology procedure?

• The patient remains in the recovery room, until they are advised to return home after the procedure
• One of the most common side effects of the procedure is pain, as blood supply to the treatment area is cut off. Physician may prescribe pain medications for pain relief
• Patient may experience nausea, vomiting, and fever after the procedure. Medications may be prescribed to control these side effects
• Patient may experience lethargy and fatigue for about a week after the procedure. Most of the side effects of Radioembolization resolve in a week or 10 days

When do you need to call your Physician?

Patients may need to call their physicians in the following situations after the Radioembolization procedure:

• If the pain does not resolve with pain medications and continues more than 10 days
• If nausea, vomiting, and fever are severe and do not resolve with medication, or they persist for over 10 days
• If abdominal pain, blood in stool, or dark stools are observed. These symptoms may indicate stomach or intestinal ulcers and should be treated as early as possible

What Post-Operative Care is needed at Home after the Radioembolization (Y90) radiology procedure?

• The patients are advised to limit contact with people for about a week after Radioembolization, as radiation in the patient’s body continues to diminish. For this reason, they should avoid using public transportation, sleeping on the same bed with a partner, or coming into close contact with pregnant women
• The patients may need to visit the physician for a follow-up CT or MRI scan to determine the size of the tumor post-procedure

How long does it normally take to fully recover, from the Procedure?

• Patients may resume their normal activities a day after the Radioembolization procedure. However, they must follow the healthcare provider’s instructions
• Most of the side effects caused by the procedure resolve within a week

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Radioembolization procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the Radioembolization procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Radioembolization (Y90) radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Radioembolization procedure is performed.