Ep. 553 Dosimetry University Part II: Understanding Partition and Voxel-Based Approaches with Dr. Tyler Sandow and Dr. Nima Kokabi

BSA, MIRD, or voxel-based dosimetry? Join us for part 2 of Dosimetry University where interventional oncologists Dr. Tyler Sandow, Dr. Nima Kokabi, and Dr. Kavi Krishnasamy explore and debate the critical nuances of a successful Y90 procedure, covering dosing methods, lung shunt management, and when to incorporate other therapeutic approaches. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/ Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS The episode begins with a discussion on methodologies for calculating lung shunt fractions using planar imaging versus SPECT CT. The physicians highlight the implications of various dosimetry models, including BSA (Body Surface Area), MIRD (Medical Internal Radiation Dose), and voxel-based dosimetry for determining prescribed activity. Drawing on their clinical experience, they address the management of high lung shunt fraction cases and the application of therapeutic strategies like TACE (Transarterial Chemoembolization) and SBRT (Stereotactic Body Radiotherapy). The conversation also covers the roles of cryoablation and microwave ablation in treating centrally located lesions. The episode concludes with a case study emphasizing the importance of individualized dosimetry planning. --- TIMESTAMPS 00:00 - Introduction01:05 - Lung Shunt Calculation Methods06:42 - BSA, MIRD, and Voxel-Based Dosimetry16:03 - High Lung Shunt Management30:02 - Case Study: Liver Tumor Treatment34:10 - Cryo vs Microwave: A Safer Option?35:42 - Y-90 Procedure: Imaging and Techniques43:35 - Dosimetry and Dose Calculations51:10 - Post-Treatment Analysis and Outcomes57:51 - Transplant Considerations and Aggressive Treatments58:18 - Conclusion and Final Thoughts