On the pre-treatment day the work-up will be conducted which includes a number of tests: an angiogram, a scintigraphy (also known as lung-shunting scan or macroaggregated albumin (MAA) lung perfusion scan) and possibly, a special CT scan called a CT-hepatic angiogram.
After these tests, you can usually go home on the same day.
Occasionally, these tests reveal that a SIRT procedure is not possible because the microspheres cannot be safely delivered to liver tumours without damaging other sensitive tissue.
After the work-up, a small dressing will be placed over the cut in the groin and pressure has to be applied to the site for 10-15 minutes. You will need to stay in bed with a compression tape for at least 6-8 hours to prevent bleeding. Only after, you will be able to go home.
1. Angiogram
The angiogram provides a detailed picture of the blood supply of the liver, which can vary between people.
Before the angiogram, the groin area is numbed with a local anaesthetic and a small cut is made. A soft, flexible catheter (tube) is then inserted through the cut and directed into the hepatic artery via the femoral artery (femoral catheter).
Once the catheter is in place, a contrast medium (dye) is injected through the tube and images of blood vessels are captured using x-rays.
The procedure normally takes about 60-90 minutes but may take longer in some cases.
It might be a little uncomfortable and you may have a feeling of warmth or a slight burning sensation when the contrast medium is injected. The most difficult part is maybe that you have to lie quiet for the procedure. Afterwards, you can resume a normal diet and all normal activities within 8 to 10 hours.
2. Scintigraphy (lung-shunting scan or MAA scan)
Scintigraphy is an imaging method that uses radioactive materials called radiopharmaceuticals or radiotracers to make things visible.
For the MAA scan, the radiotracer technecium which is bound to MAA particles, is injected into the catheter that has been positioned in your hepatic artery. This imitates the SIR-Spheres® Y-90 resin microspheres procedure and allows the medical team to predict where they will lodge on the day of treatment.
A gamma camera and a computer are used to determine the amount and location of radiotracer absorbed by your body by detecting the radiation from the MAA particles. Sometimes some of the radiotracer will pass through the liver into the lung. Your doctor needs to know how much passes through to determine a safe dose of SIR-Spheres Y-90 resin microspheres for you.
You will need to remain still for the brief period of time while the images are taken.
3. CT-hepatic angiogram (or Cone-beam CT)
Sometimes the information given in an angiogram is not sufficient. Your doctor might decide to do an additional test called a CT-hepatic angiogram. Contrast medium is injected through the catheters in the groin, while the CT scan are performed to show the blood vessels in the liver.