Purpose: Liver segmentation for the purpose of pre-treatment planning of hepatic Y90 resin microspheres therapy is not a standardized practice. To that end, a semi-automatic, customizable workflow has been developed within MIM Sureplan® that enables standardization within a clinical practice.
Methods: The clinical workflow at Miami Cancer Institute (MCI) for pre-treatment planning of hepatic Y90 resin microspheres therapy was re-created in the MIM SurePlan platform. Briefly, the original steps were performed manually, utilizing a segmentation software where the liver was drawn on the non-contrast CT of the MAA mapping SPECT/CT. Early and late arterial phase CBCTs for left and right hepatic lobes were then registered to the non-contrast CT. The early phase CBCTs, which determine perfusion paths, were used to delineate left/right lobes, while late phase CBCTs were used for GTV delineation. For select cases, a recently acquired diagnostic contrast CT or MRI may be used for GTV delineation. After these five image registrations, the RT/LT lobe and RT/LT GTV volumes were segmented and their volumes used to calculate the prescribed activity of Sirspheres® for each hepatic lobe. This manual process was designed into a streamlined, semi-automated workflow.
Results: The MIM workflow was designed to standardize the MCI pre-Y90 treatment process. It is robust enough to accommodate several scenarios to best serve the unique needs of the patient, including pauses, stop gaps between major processes, and editing points, as well as flexibility as to which image studies to use for segmentation. An auto-generated volume statistics table is ultimately rendered for activity calculation.
Conclusion: A clinically robust, semi-automated workflow process for pre-treatment of hepatic Y90 resin microspheres therapy has been created in MIM SurePlan. Streamlining the workflow should achieve time-savings and standardization in clinical practice. Consideration should be given to this workflow as a means for standardizing the pre-treatment planning method.
Funding Support, Disclosures, and Conflict of Interest: Dr. Chuong reports receiving honoraria from Sirtex. Dr. Gandhi is a consultant and proctor for Sirtex.