Functional liver image guided hepatic therapy (FLIGHT) with hepatobiliary iminodiacetic acid (HIDA) scans

David E. Long, Mark Tann, Ke (Colin) Huang, Gregory Bartlett, James O. Galle, Yukie Furukawa, Mary Maluccio, John A. Cox, Feng Ming (Spring) Kong, Susannah G. Ellsworth

Research output: Contribution to journalArticle

4 Scopus citations


Purpose: Hepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared with standard planning using functional dose-volume histograms. Thresholds predicting for decompensation during follow up are evaluated. Methods and materials: We studied 17 patients who underwent HIDA scans before SBRT. All SBRT cases were replanned using FLIGHT. The following dosimetric endpoints were compared for FLIGHT versus standard SBRT planning: functional residual capacity <15 Gy (FRC15HIDA), mean liver dose (MLD), equivalent uniform dose (EUD), and functional EUD (FEUD). Receiver operating characteristics curves were used to evaluate whether baseline HIDA values, standard cirrhosis scoring, and/or dosimetric data predicted clinical decompensation. Results: Compared with standard planning, FLIGHT significantly improved FRC15HIDA (mean improvement: 5.3%) as well as MLD, EUD, and FEUD (P <.05). Considerable interindividual variations in the extent of benefit were noted. Decompensation during follow-up was associated with baseline global HIDA <2.915%/min/m2, FRC15HIDA <2.11%/min/m2, and MELD ≥11 (P <.05). Conclusions: FLIGHT with HIDA-based parameters may complement blood chemistry-based assessments of liver function and facilitate individualized, adaptive liver SBRT planning.

Original languageEnglish (US)
JournalPractical Radiation Oncology
StateAccepted/In press - Jan 1 2018

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Long, D. E., Tann, M., Huang, K. C., Bartlett, G., Galle, J. O., Furukawa, Y., Maluccio, M., Cox, J. A., Kong, F. M. S., & Ellsworth, S. G. (Accepted/In press). Functional liver image guided hepatic therapy (FLIGHT) with hepatobiliary iminodiacetic acid (HIDA) scans. Practical Radiation Oncology.