Radioembolization Patient Education

Radioembolization Patient Education

Radioembolization Patient Education

If you are scheduled for radioembolization, plan on multiple visits that include:

  • Initial CT scan, MRI and/or PET scan
  • A planning session, including an angiogram, to confirm that radioembolization is a treatment option for you
  • Radioembolization treatment angiogram to one lobe of your liver, one to two weeks following your planning visit
  • Follow-up phone call two weeks after treatment
  • Repeat CT scan, MRI and/or PET scan if needed, and blood tests four weeks after your treatment
  • Return office visit with your interventional radiologist one month after your treatment

Planning session procedure

Do not eat solid food for at least six hours before the procedure. You may have clear liquids early in the morning on the day of the test. Needed medicines may be taken with sips of water.

On the day of your procedure, be sure to bring your medical insurance information, Medicare card and a list of your allergies and current medications. Please leave all valuables such as jewelry, credit cards and money at home. Family members may wish to bring a magazine or book to read while they wait, or they may leave the hospital and return at a later time to pick you up. We do ask for a cell phone or a contact phone number in the event that we need to reach a family member.

After checking in with reception, you and one family member will meet with a nurse, who will bring you to the prep and recovery area. Here, a member of our Interventional Radiology team will review your health history and medications and conduct a short physical exam. We’ll review the procedure, answer any questions you may have and ask you to sign a consent form.

After you’ve changed into a surgical gown, the nurse will take your vital signs and start an IV in your arm. Sometimes a catheter will be placed in your bladder to monitor your urine output. This is removed before you go home.

During the planning session procedure

The nurse will help you lie on an exam table. You will be connected to heart and blood pressure monitors and medication will be given through your IV to help you relax. Your groin area will be shaved and washed with a special soap, and covered with sterile sheets. Numbing medicine will be injected into the area. You will feel some burning as the medicine is given. Once it takes effect, the area will be numb. A small needle is inserted in your groin. Through this needle, a very small tube, called a catheter, is threaded into your femoral artery to your liver. You may feel pressure, but you should not feel any pain.

Once the catheter is in place, contrast dye is injected to allow the physician to see your arteries. You may feel a sudden flushing or warmth, which lasts only a few seconds.

Steps of the angiogram

Your angiogram includes three important steps. Your physician will:

  1. Map your liver anatomy to identify any arteries that may be feeding your tumor.
  2. Look for any small arteries that lead to your stomach or intestines. If these arteries are close to the radiation site, small coils will be inserted to block the blood supply. This prevents any of the radiation beads from getting into your stomach or intestines and causing an ulcer. Other blood vessels take over the work of those vessels that are blocked. Not every patient needs this portion of the procedure.
  3. Macro aggregated albumin (MAA) particles are then injected into your liver. These particles are the same size as the radioembolization microspheres that will be used in your treatment. They contain a radioactive tracer, so your care team can monitor exactly where they go. This helps us know that the particles stay in your liver and will not travel to other organs and cause problems. The MAA particles are harmless proteins that break down on their own and are excreted through your stool and urine within 24 hours.

Following the planning session procedure

After the MAA particles have been injected, the catheter is removed and your wound is closed with a self-dissolving suture. You will lay at a slight incline in bed for two hours. If a suture is not used, firm pressure will be held over the puncture site for 15 minutes, after which you will lie flat in bed with your leg extended for six hours.

Next, a scan is done to trace the location of the MAA particles. During the two-hour scan:

  • You will lie on a firm table with your arms above your head.
  • Your arms will be supported for comfort.
  • The nurse will monitor your condition and make sure you are comfortable.
  • Pain medicine may be given as needed.

After the scan, you will return to the prep and recovery area in Interventional Radiology, where a family member may join you. Your urine catheter and IV will be removed, and your wound will be checked for bleeding. Before going home, the nurse will assist you out of bed and help you to walk.

A few days after your planning procedure, a nurse will confirm an appointment date for your radioembolization treatment. Unless you are contacted, you can assume that your scan was normal and plan to proceed with your treatment.

After discharge

Your complete recovery usually takes seven to 10 days. Following discharge:

  • Limit your activities and get plenty of rest.
  • Do not drive for 24 hours.
  • Begin to resume your normal activities the day after you leave the hospital.
  • Don't engage in physical exertion or heavy lifting (greater than 10 lbs.) for the next three days
  • You may shower at any time, but do not take a bath for seven days.
  • Slowly increase your physical activity.
  • Depending on your job and its demands, you may return to work.
  • Check your temperature twice a day for five days.

Procedure site

As it heals, your puncture site should remain soft and dry. If you notice a small amount of bleeding from the puncture site, please do the following:

  • Immediately lie flat.
  • Apply firm pressure for 15 minutes using a clean cloth or tissue. If possible, have another person apply pressure.
  • After 15 minutes, remove pressure. The wound should be dry and flat without bleeding. Cover the wound with a bandage and notify your doctor of this incident right away.

When to call your physician

Contact your physician if you have:

  • Fever over 101.5 degrees Fahrenheit for more than one day
  • Pain or cramping in the abdomen not relieved by your pain medication
  • Severe, persistent nausea or vomiting
  • Pain at the groin site
  • Redness or red streaks around the skin wound
  • Drainage at the groin site
  • Calf tenderness or pain
  • Numbness or tingling in the foot, thigh or leg
  • Swelling of the ankle and/or foot
  • Increased bruising extending to the thigh, over the buttock and/or groin
  • Color change and/or coolness of the leg or foot
  • Continuous profuse blood streaming from the wound
  • A jet of blood pumping from the puncture wound
  • Quickly increasing swelling of the area around the wound, which may be pulsating

Seek immediate emergency care

While extremely rare, the puncture in your artery could reopen. Immediately apply hard pressure above the puncture would and call 911 if you experience any of the following:

  • Continuous, profuse blood streaming from the wound
  • A jet of blood pumping from the puncture wound
  • Quickly increasing swelling of the area around the wound, which may be pulsating

Radioembolization microsphere treatment

On the day of your radioembolization treatment, only an angiogram is performed. Scans are not needed. The procedure takes about four to six hours, however you will need to arrive one and one-half hours before your appointment.

Your radioembolization procedure is very similar to your planning session angiogram, and you should follow all of the pre- and post-treatment steps outlined above. The difference this time is that radioactive microspheres will be placed in your tumor, instead of the MAA particles used in the planning session.

Following your radioembolization, you be taken to recovery and repeat the same steps as in your planning session. Prior to discharge, your nurse will provide:

  • A schedule of follow-up appointments
  • Written orders for needed scans and blood work
  • Emergency contact phone numbers
  • Medication prescriptions

After discharge, follow the same post-planning session diet, activity and wound care guidelines noted above. Take prescribed medicines as directed.

Follow-up care

Two weeks after your radioembolization treatment, a care team member will call to see how you are feeling. After four weeks, you will have blood tests repeated, along with a repeat CT scan, MRI and/or PET scan.

An interventional radiologist will then meet with you to review your scans and blood work. At that time, it will be decided if a second radioembolization treatment is needed. To help ensure your health and safety, we are able to treat only one lobe of your liver at a time with radioembolization. It you have tumors in both lobes of your liver, you may need a second treatment.