Quality assurance issues for therapeutic application of radioactive microspheres

The use of radioactive microspheres for the treatment of hepatic cancer is a procedure that raises unique quality assurance (QA) concerns. The greatest of these concerns is the coordination of the responsibilities among the medical team members from interventional radiology, radiation oncology, nuclear medicine, and medical physics. A single QA practice and procedure guidance document does not currently exist that addresses the range of issues of concern for radioactive microspheres. A small sampling of QA issues of concern include imaging QA, procedure-specific imaging protocols, detector calibration, activity measurement, radiation safety, patient dose calculations, and patient-specific QA. Some of the items listed have historically been the responsibility of a single team member, and other items have been concerns for all. A procedural overview of the therapeutic application of radioactive microspheres is presented to illustrate the broad, team-based QA approach necessary to safely and effectively deliver this type of treatment. From this overview, the reader will be able to customize the local QA protocol to meet the local division of responsibilities.