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Purpose: To develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 ( 90 Y) microspheres transarterial radioembolization ( 90 Y TARE) for primary and metastatic cancers in the liver., Methods and Materials: Members of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90 Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience., Results: The ABS strongly recommends the use of 90 Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of 90 Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting 90 Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90 Y TARE should be carefully considered., Conclusions: ABS consensus for implementing a safe 90 Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies., Competing Interests: Conflicts of Interest Dr. Sharma received honoraria, research grant, and is a consultant for SIRTEX Medical Inc. Dr. Kappadath received honoraria and research funding from Boston Scientific, SIRTEX Medical, and ABK Biomedical. Dr. Choung received honoraria from SIRTEX Medical Inc. Dr Jabbour is a consultant for Merck & Co Inc; Syntactx, IMX Medical; and has grant funding from the NIH and Merck & Co, Inc. Dr Jeyarajah is a consultant for Angiodynamics, SIRTEX Medical Inc., Ethicon. Dr. Liu is a consultant for SIRTEX Medical Inc, Eisai Pharmaceuticals, and a speaker for Astra Zeneca and Eisa Pharmaceuticals. Dr. Meyer has a research grant and honorarium from Varian Medical Systems. Dr. Mikell has a research grant funding from Varian. Dr. Patel is a consultant to SIRTEX Medical and Medtronic Inc. and a speaker for Boston Scientific. Drs. Folkert, Kennedey, Gibbs, Yang, and Mourtada report no conflict of interest., (Copyright © 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

We conducted an evaluation of the intercamera (i.e., between cameras) variability in clinically relevant performance characteristics for Symbia gamma cameras (Siemens Medical Solutions, Malvern, PA) based on measurements made using nine separate systems. The significance of the observed intercamera variability was determined by comparing it to the intracamera (i.e., within a single camera) variability. Measurements of performance characteristics were based on the standards of the National Electrical Manufacturers Association and reports 6, 9, 22, and 52 from the American Association of Physicists in Medicine. All measurements were performed using 99mTc (except 57Co used for extrinsic resolution) and low-energy, high-resolution collimation. Of the nine cameras, four have crystals 3/8 in. thick and five have crystals 5/8 in. thick. We evaluated intrinsic energy resolution, intrinsic and extrinsic spatial resolution, intrinsic integral and differential flood uniformity over the useful field-of-view, count rate at 20% count loss, planar sensitivity, single-photon emission computed tomography (SPECT) resolution, and SPECT integral uniformity. The intracamera variability was estimated by repeated measurements of the performance characteristics on a single system. The significance of the observed intercamera variability was evaluated using the two-tailed F distribution. The planar sensitivity of the gamma cameras tested was found be variable at the 99.8% confidence level for both the 3/8-in. and 5/8-in. crystal systems. The integral uniformity and energy resolution were found to be variable only for the 5/8-in. crystal systems at the 98% and 90% confidence level, respectively. All other performance characteristics tested exhibited no significant variability between camera systems. The measured variability reported here could perhaps be used to define nominal performance values of Symbia gamma cameras for planar and SPECT imaging.