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Table 1 Recommendations for diagnostic reporting of post-radioembolization 90 Y PET/CT

From: Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting

Item Recommendation
Continuity of care Post-radioembolization 90Y PET/CT is best reported by the same attending nuclear medicine physician who has followed through the entire planning-therapy continuum from exploratory angiography, predictive dosimetry, to 90Y radioembolization.
PET display threshold setting for non-target 90Y activity detection For detection of non-target 90Y activity, the operator should actively adjust the upper PET visual display threshold setting to deliberately increase the background noise to moderate levels.
Criteria for technical success 1. 90Y activity present in the majority of targeted tumors, or good overall activity coverage of large targeted tumors; and
2. The absence of clinically significant non-target 90Y activity; and
3. All findings are in keeping with pre-therapy radiation planning expectations.
Criteria for a technically unsuccessful 90Y radioembolization 1. The complete, or near-complete absence of 90Y activity in the majority of targeted tumors, or poor overall activity coverage of large targeted tumors; or
2. The presence of any non-target 90Y activity where 90Y PET dose quantification predicts a high likelihood of clinically significant radiation toxicity; or
3. Any other situation where the 90Y activity biodistribution is adversely inconsistent with pre-therapy radiation planning expectations.
Criteria for non-target 90Y activity 1. Non-random pattern of activity distribution; and
2. Conforms morphologically to an untargeted anatomical structure on CT; with or without
3. A plausible vascular etiology to account for its presence.
Criteria for noise spikes 1. Small, discrete, ovoid activity foci; and
2. Random pattern of distribution which do not conform to underlying anatomy on CT; and
  3. No plausible vascular etiology to account for its presence.