Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres.

OBJECTIVE: To review the technical feasibility of resin microsphere (SIR-Spheres®) yttrium-90 radioembolization prescribed using the medical internal radiation dose (MIRD) model. METHODS: All radioembolization procedures for hepatic malignancies using resin microspheres with MIRD model between November 2015 and February 2019 were included in this IRB-approved study (n = 60). Student's T test was used to compare prescribed activity based on MIRD and BSA models. Adverse events were assessed immediately, 30 days, and 6 months post-treatment. RESULTS: Sixty radioembolizations were performed in 54 patients (age 68 ± 9 years, 48-87 years, 35% female). Mean prescribed activity calculated by the MIRD model (target absorbed dose 120-200 Gy for primary and 80-200 Gy for metastatic liver cancers) was 1.7 GBq (0.3-6.4) compared with 0.6 GBq (0.12-2.1) if BSA had been used (p < 0.0001). The prescribed activity was successfully delivered in 93% (56/60) treatments. Prophylactic embolization and anti-reflux catheters were used in 20% (12/60) and 5% (3/60) treatments, respectively. No immediate post-procedural complications occurred. Abdominal pain was the most common clinical Grade 3 CTCAE in 30 days (10%) and 6 months (12%). Radiation pneumonitis occurred in 3 (5%) patients but no radiation-induced gastric ulcer or radiation-induced liver disease occurred. CONCLUSION: MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry with resin microspheres. MIRD prescribed activity with target absorbed doses up to 200 Gy can be successfully administered without prophylactic embolization in selected patients. KEY POINTS: •MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry for radioembolization. •MIRD dosimetry can be used for yttrium-90 resin microsphere radioembolization with acceptable safety profile.

Quality and Efficiency Improvement Tools for Every Radiologist.

In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis.

Appendicitis during pregnancy with a normal MRI.

Abdominal pain frequently represents a diagnostic challenge in the acute setting. In pregnant patients, the gravid abdomen and concern for ionizing radiation exposure further limit evaluation. If undiagnosed, appendicitis may cause disastrous consequences for the mother and fetus. We present the case of a pregnant female who was admitted for right lower quadrant abdominal pain. Advanced imaging of the abdomen and pelvis was interpreted to be either indeterminate or normal and a diagnosis of acute appendicitis was made on purely clinical grounds. This patient's management and a literature review of diagnostic techniques for acute appendicitis during pregnancy are discussed.

Colloquium paper: patterns of biodiversity and endemism on Indo-West Pacific coral reefs.

Diversity of the primary groups of contemporary Indo-West Pacific coral reef organisms, including mantis shrimps (stomatopod crustaceans), peaks in the Indo-Australian Archipelago (IAA), reaches a lower peak in East Africa and Madagascar [Indian Ocean continental (IOC)], and declines in the central Indian Ocean (IO) and Central Pacific (CP). Percent endemism in stomatopods (highest in the IAA, high in the IOC, lower in regions adjacent to centers, and moderate in the CP) correlates positively with species diversity (this varies with scale) and inversely with species body size. Because it constrains reproductive traits and dispersal, body size is a reliable indicator of speciation and extinction potential in reef stomatopods and probably most marine organisms. Assemblages are dominated by small-sized species in the IAA and IOC. Both speciation and extinction likely are high, resulting in especially high endemism (small ranges reflect both originating and disappearing species) in these regions. Rates of speciation exceed extinction, yielding centers of diversity (especially in the IAA). Dispersal slows speciation and extinction in areas adjacent to these centers. Body size declines toward the CP, especially in atoll environments. Here the wheels of speciation and extinction again spin rapidly but in the opposite direction (extinction > speciation), yielding low diversity and moderate endemism. We conclude that life histories, dispersal, and speciation/extinction dynamics are primary agents that mold patterns of diversity and endemism. Historical factors, currents, productivity, and species diversity itself (through ecological interactions) also influence these patterns, in some cases by altering body size.