Y90 in the OBL

First, Dr. Brower describes the IR/DR makeup of his practice and partnerships with surrounding hospitals. Inland Imaging’s collaboration with the Providence healthcare system was formed to provide quality outpatient imaging and avoid duplication and competition of services. Over time, they added interventional services, including interventional oncology procedures, to their joint venture.

The decision to move Y90 from the hospital to the outpatient setting was spurred by the need in the community, availability of more modern imaging equipment, and patient convenience. In 2019, it was not very common to perform Y90 in an OBL. Dr. Brower outlines the steps he took to move these services, starting with building consensus within the group. Next, he explained the benefits of the OBL to the hospital administration, which include freeing up time in the hospital for true emergencies and providing care for patients who prefer the OBL setting. Then, the group proactively reached out to payers and secured written agreements that they would provide coverage. After securing these agreements, they drafted pro formas, searched for adequate sites, and contacted vendors.

Since each state has different regulations for “hot labs” that use radioactive materials, Dr. Brower recommends working with your radiation safety officer to help walk you through the regulations. His OBL has a “mini hot lab” that allows him to draw up the Sirtex dose that he prescribes. Nuclear medicine technicians assist in transporting the radioactive material. Patients have pre-Y90 SPECT mapping close by, at another center.