Lung shunt fraction

Last revised by Liz Silverstone on 3 Apr 2024

The hepato-pulmonary lung shunt fraction (LSF) is a parameter that is used to assess the safety of 90Y transarterial radioembolization/selective internal radiation therapy of liver tumors. Excessive arteriovenous shunting can cause radiation pneumonitis.

The lung shunt fraction = (total lung counts) / (total lung counts + total liver counts). It is usually calculated using 99mTc-MAA. Guidelines suggest a maximum per treatment dose of 30Gy and a maximum total dose of 50Gy.

Compared to SPECT/CT, planar scintigraphy may overestimate lung dose especially in those with left-sided tumors, high LSF and high BMI leading to unnecessary dose reduction 1.

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