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Yttrium-90 Radiotherapy Korean 환자교육 방사선과 / 영상서비스 이트륨 90 방사선치료법 간종양치료 이책자는이트륨 -90 방사선치료가 무엇이며이치료이후의상황에 대해서설명합니다. 나에게이치료가왜필요합니까? 귀하의담당의들이귀하의간에종양 ( 또는종양들 ) 이있는것을발견했습니다.

1 Yttrium-90 Radiotherapy Korean 환자교육 방사선과 / 영상서비스 이트륨 90 방사선치료법 간종양치료 이책자는이트륨 -90 방사선치료가 무엇이며이치료이후의상황에 대해서설명합니다. 나에게이치료가왜필요합니까? 귀하의담당의들이귀하의간에종양 ( 또는종양들 ) 이있는것을발견했습니다. 이것들은귀하의간에서시작됐거나 ( 아마도간세포암종또는 HCC) 귀하의몸의다른부분으로부터퍼졌을수도있습니다. 간종양치료에는여러가지가있지만환자분에따라가장적합한치료가따로있습니다. 우리의전문팀은이트륨-90 (Y-90) 방사선치료법이지금현재환자분을위한최선의방법이라고믿습니다. Y-90 방사선치료법은종양으로혈액을공급하는혈관안으로직접방사선을보냅니다. 이치료는간종양을완치시키지는않습니다. 하지만, 흔히종양을제어하거나줄어들게합니다. 이치료이후환자분은다른방법들 ( 항암치료나수술과같은 ) 을또한제안받을수도있습니다. 어떻게 Y-90 방사선치료법이작용합니까? 방사선치료는수십년간많은종류의종양을치료하기위하여사용되어왔습니다. 그러나외부에서부터조사해서간종양을죽이기위하여필요한방사능의용량은간의건강한부분을심각하게손상시킬수있습니다. Y-90 는최소한도로침습하는치료입니다. 이것은단지소형의의료기구를사용하고환자분의몸을절개하지않는다는것을뜻합니다. 이것은환자분의신체가일반적인수술을받은이후보다더신속히회복할것이라는뜻입니다. 이치료에서는환자분의종양에혈액을공급하는동맥안으로수백만의작은방사성구슬들이직접주사됩니다. 이구슬들은종양 ( 종양들 ) 주위의혈관에남아있을것입니다. 이것은매우강한방사능이직접적으로종양에도달하게해줍니다. 환자분의건강한부분의간이나내장또는피부와같은다른조직에아주작은영향이미칩니다. 이구슬들은대략 10 일동안방사능을배출하지만주사된이후몇개월동안계속작용을할것입니다.

2 Page 2 방사선과 / 영상서비스 이트륨 -90 방사선치료 어떤구슬들을 Y-90 방사선치료에사용합니까? 이치료를위하여두종류의구슬들을사용할수있습니다 : 떼라스피어스 (TheraSpheres) 와써-스피어스.(SIR-Spheres). 구슬들은플라스틱이나유리로만들어졌습니다. 써-스피어스구슬은종양이결장암에서간으로전이된사람들을위하여식품과약품행정부 (FDA) 에의해서입증된것입니다. 떼라스피어스구슬은간세포암종치료를위한인도주의사용장치 (HUD) 로인가된것입니다. HUD 장치는특정한의료상태가있는적은수의사람들을치료하기위하여인가된장치입니다. 우리는종종의료제품들을처음에인가된목적보다다른질환을위하여사용합니다. 수천명의간종양이있는환자들에게써-스피어스와떼라스피어스두가지다안전하고효과적으로사용되어왔습니다. 우리는환자분에게가장적절한구슬을선택할것입니다. 시술은어떻게시행합니까? Y-90 방사선치료는엑스레이유도를사용하여최소한의침습성시술로간종양을특별히치료하는중재적방사선과의사에의하여실행됩니다. 치료는몇달동안몇단계들 ( 시술들 ) 을거쳐서시행됩니다. 종양 간동맥 간 복강동맥 장동맥 대동맥 도관 추적자또는 Y-90 를입힌구슬을주사하기위해서도관이들어가는부위

3 Page 3 방사선과 / 영상서비스 이트륨 -90 방사선치료 스텝 1: 혈과조영도제작첫단계는혈관조영도제작이라고불리는시술입니다. 이것은 2-4 시간정도걸립니다. 이시술동안 : 환자분은엑스레이테이블에누워계실것입니다. 환자분이느낄단한가지불편한점은국부마취약 ( 감각을둔화시키는약 ) 을환자분의피부에주사할때짧게따가울거라는것입니다. 환자분의사타구니동맥에가느다란플라스틱튜브 ( 도관 ) 를삽입해서간동맥으로들어갈것입니다. 담당의사느이도관이정확한곳으로도달시키기위해서엑스레이를이용할것입니다. 담당의사가어떻게환자분의혈류가간으로들어가는지를보기위하여혈관조영상 ( 엑스레이사진 ) 을시행할것입니다. 이것은우리가 Y-90 치료법이환자분에게가능한지를의사에게알려줄것입니다. 만일혈관조영상에 Y-90 치료법이환자분에게가능한것이아니라고나타나면시술을끝낼것입니다. 만일혈관조영상에 Y-90 치료법의사용가능성이확인되면의사선생님은다음단계로넘어갈것입니다. 의사선생님은가늘은금속선 ( 코일 ) 을사용하여방사선을받지않아야할혈관을차단시킬것입니다. 인체에무해한추적자를환자의간동맥안으로주입할것입니다. 혈관조영도는얼마만큼의추적자가환자분의간의주변조직에들어가는지를보여줍니다. 그런다음, 스캔을하기위하여환자분을핵의학과로모실것입니다. 이스캔은얼마만큼의추적자가환자분의간에서나갔고폐또는다른장기들에들어갔는지를보여줄것입니다. 만일너무많은추적자가간밖의조직안에모여있으면환자분에게는 Y-90 치료법이적합하지않을것이며시술은여기서끝납니다. 만일스캔에환자분의간밖의조직안에조금또는전혀추적자가보아지않으면환자분은 2 단계가허용될것입니다. 스텝 2 : Y-90 주입 1 단계이후 Y-90 치료법이허용되면환자분의방사선에대한정밀한용량이계산될것이고특정한시간에병원으로배달될것입니다. 스텝 1 을마치고약 2 주일후에두번째의외래시술을받을것입니다. 사타구니에있는동맥에한번더도관을넣을것입니다. 지난번과같이환자분의간동맥혈관으로도관이들어갈것입니다. 그런다음, Y-90 를입힌구슬을천천히간동맥안으로투입할것입니다. 이시술은약 1 시간정도걸립니다.

4 Page 4 방사선과 / 영상서비스 이트륨 -90 방사선치료 스텝 3: 2 번쨰 Y-90 주입 ( 필요한경우 ) 우리는흔히스텝 2 를할때간의절반만을치료합니다. 간의다른부분을치료하기위하여두번째 Y-90 주입이필요한사람들은스텝 2 를마치고 4 6 주이후에또하나의 Y-90 주입을받으실것입니다. 스텝 4: 스캔마지막 Y-90 주입약 1 달이후에환자분은자기공명영상 (MRI) 또는컴퓨터단층촬영 (CT) 을받으실것입니다. 이스캔은종양이치료에어떻게반응했는지를보여줄것입니다. 담당의가검사한사진들과혈액검사결과들과전체적인건강상태를검토하실것입니다. 필요하면의사선생님께서다른치료방법에관하여상담하실것입니다. Y-90 주입후에나에게필요한특별한주의사항이있습니까? Y-90 구슬에서발산되는방사능은 ½ 인치미만으로이동합니다. 환자분이받으시는치료종류에따라서치료이후에담당의가활동을제한할수도있습니다. 짧은기간동안다른사람들과의접촉을제한할필요가있을수도있습니다. 위험성이나부작용이있습니까? Y-90 방사선치료이후가장흔한부작용은피로감입니다. 이것은가볍거나심할수도있습니다. 이것은몇주일까지갈수있습니다. 다른부작용포함 : 식욕부진 가벼운복통 미열 메스꺼움증이와같은증상은 1 주에서 2 주정도걸려서천천히사라질것입니다. 아주흔하지는않지만때로는심각한부작용과합병증이있습니다. 담당의가치료를시작하기전에이러한위험성에관하여환자분과상담하실것입니다. 치료를시작하기전에모든질문들의답변을받으십시오. 시술전에 시술하기전날오후에진행담당간호사가전화할것입니다. 만일시술일이월요일이면, 간호사가그전주금요일에전화할것입니다. 간호사는최종적인지시사항과환자분에게있을수도있는질문에대답해드릴것입니다. 이러한지시사항들이나시술에관한세부사항을이해할정도로영어를잘이해하지못하시면되도록빠른시간내에말해주십시오. 우리가환자분을도와드릴수있도록병원통역사를예약해놓을것입니다. 가족이나친구가환자분을위해서통역할수없을수도있습니다.

5 Page 5 방사선과 / 영상서비스 이트륨 -90 방사선치료 아마도시술이후 14 일이내에혈액검사가필요할것입니다. 때로는환자분이시술받으러오셨을때혈액검사를합니다. 그날이전에혈액검사가필요하면알려드릴것입니다. 만일과거에조영제 ( 엑스레이염색약 ) 에부작용이나심각한반응이있었으면이책자의마지막장에있는전화번호로진행담당간호사에게전화해서알려주십시오. 환자분은시술받기전에이부작용때문에약을복용해야할필요가있을수도있습니다. 만일환자분의신장기능이비정상이며엑스레이조영제투입이필요하면시술이전과이후에복용하시도록우리가약을처방할수도있습니다. 이약은환자분의신장보호에도움이될것입니다. 만일피를묽게하는약 ( 쿠마딘, 로브녹스, 프래그민, 또는플라빅스와같은 ) 을복용하시면시술하기 3 일에서 9 일전부터약을중단하실필요가있을수도있습니다이것에관하여지시를받으실것입니다. 당뇨병이있어서인슐린을맞거나메트포민 ( 글루코파지 ) 을복용하시면시술받는날들에중단하거나용량을조절하는것에관한설명을받으실것입니다. 진정제 Y-90 주입전에환자분은혈관을통하여진정제 ( 발리움이나몰핀과비슷한 ) 를투여받을것입니다. 이약은환자분을졸리게하고긴장이풀리게하며불편함을덜어줄것입니다. 환자분은깨어있을것입니다. 이것은얕은진정이라고불립니다. 환자분은시술이끝난이후에도한동안졸릴것입니다. 어떤사람들에게는얕은진정사용이안전하지않습니다. 환자분에게이것이사실일경우환자분은전신마취 ( 시술받는동안잠자게하는약 ) 가필요할것입니다. 만일아래종목에해당되면즉시우리에게알려주십시오 : - 과거에간단한시술에전신마취가필요했으면 - 수면무호흡증이나만성호흡문제들 ( 수면시씨팹이나바이팹을사용할수도있음 ) 이있으면 - 높은용량의마약성분의진통제를사용하면 - 심장이나폐나신장에심각한질환이있으면 - 허리나호흡문제로반듯하게 2-3 시간정도누워있을수없으면 - 의료시술을받는동안움직이지않고누워있는것이어려우면 - 체중이 300 파운드 (136 킬로그램 ) 이상나가면

6 Page 6 방사선과 / 영상서비스 이트륨 -90 방사선치료 시술전날얕은진정을준비하기위하여다음의설명을자세히따르십시오 : 시술전날은평상시와같이식사하셔도됩니다. 시술시작 6 시간전부터맑은액체 ( 물, 스프라잇트, 크랜베리쥬스, 또는엷은차와같이투명한 ) 만마실수있습니다. 시술시작 2 시간전부터 : - 아무것도먹거나마시지마십시오. - 약을꼭복용해야하는경우한모금만의물로삼키십시오. - 비타민이나다른보충제들을복용하지마십시오. 그것들은빈속을쓰리게할수있습니다. 집에운전해서모시고갈수있고남은하루를함께집에서보낼수있는책임감이있는성인이꼭있어야합니다. 버스나택시나셔틀을타시거나환자본인이운전해서집에가실수는없습니다. 시술당일 시술받는날그외의평상시의약들을모두복용하십시오. 의사나간호사의지시가없는한약을거르지마십시오. 매번시술을받으러병원에오실때마다복용하는모든약들의목록을가지고오십시오. 병원에서거의하루를보낼예상을하고오십시오. 만일시술시작이지연되면이것은보편적으로예상외의위급한문제가있는다른사람의치료가필요하기때문입니다. 이러한일이발생할경우기다려주심을미리감사드립니다. 진행담당간호사가달리말하지않는한병원 3 층 ( 로비 ) 에있는원무과에접수하십시오. 원무과는로비에있는안내데스크뒷쪽오른편에위치하고있습니다. 의료보조사가갈아입을병원가운과소지품을넣을비닐봉투를드릴것입니다. 이때에화장실을사용하셔도됩니다. 병원직원이시술이전대기소로모실것입니다. 이곳에서간호사가건강평가를할것입니다. 가족이나친구가이곳에서같이있을수있습니다. 정맥도관을넣을것입니다. 수분과약을정맥도관을통해서환자분에게투여할것입니다. 중재방사선과의사가시술에대하여귀하와상담할것이고동의서에이미사인을하지않았을경우사인을요청할것입니다. 그때에질문을할수있을것입니다.

7 Page 7 방사선과 / 영상서비스 이트륨 -90 방사선치료 시술 간호사가방사선과시술실로모시고갈것입니다. 이간호사는시술받는동안내내곁에있을것입니다. 필요한경우통역사가시술실에같이있거나인터콤을통하여환자분과말하거나들을수있을것입니다. 시술받기위하여납작한엑스레이테이블에누워계실것입니다. 환자분의심장박동을모니터하는것을돕기위하여전선들이몸에붙여질것입니다. 혈압대를팔에차고계실것입니다. 혈압을확인하기위하여그것은때때로부풀것입니다. 방사선과기술자가특별한비누로환자분의사타구니의피부를소독할것입니다. 알레르기가있을경우이사람에게말하십시오. 기술자는의사가작업을할곳의체모를밀어야할수도있습니다. 전의료팀은환자분에게환자분의이름과우리가계획한것이무엇인지를확인하기위하여질문을할것입니다. 이것은환자분의안전을위해서입니다. 그런다음시작하기전에담당간호사가환자분을졸리고차분해지게하는약을투여할것입니다. 시술이후 우리는환자분을짧은기간동안은방사선과에서밀착간호를할것입니다. 그런다음환자분은병원에있는단기입원병동으로옮겨갈것입니다. 그곳에서는다른간호사가환자분을모니터할것입니다. 대부분의경우환자분은먹거나마실수있을것이고환자분의가족은귀하를방문할수도있습니다. 환자분은침대에서 2~6 시간동안누워서쉬셔야할것입니다. 출혈을막기위하여그시간동안사타구니진입부위아래다리를움직이지않고가만히계셔야합니다. 완전히정신이들고먹을수있고화장실을사용할수있고걸을수있을때집에갈수있을것입니다. 이시술이후문제가발생하는것은드믑니다. 그럴경우우리는환자분을모니터하고치료하기위하여병원에계시도록할수도있습니다. 퇴원하기전에간호사는얼마만큼의활동을할수있고절개부위를어떻게관리하는지와다른중요한지시사항을말할것입니다.

8 Page 8 방사선과 / 영상서비스 이트륨 -90 방사선치료 문의사항? 귀하의질문은중요합니다. 질문이나걱정되는것이있을경우담당의나의료제공자에게전화하십시오. UWMC 클리닉직원또한도와드릴수있습니다. 방사선과 / 영상서비스 : 집에가서 타인에게의잠정적인방사선위험성으로인하여환자분은특별한주의를따라야할수도있습니다. 간호사가퇴원을하기전에주의사항을드릴것입니다. 집에가시면그날은편히쉬십시오. 환자분을돕기위하여가족이나친구나간병인이꼭있어야합니다. 많이졸리거나짧은기간동안의기억에이상이생길수도있습니다. 24 시간동안다음과같은것들을하지마십시오 : - 운전이나기계작동을하는것 - 음주 - 중요한개인적인결정을내리거나법적서류에사인하는것 - 다른사람을간호하는책임지는것 다음날에는샤워나목욕을하셔도됩니다. Y-90 치료이후일반적으로통증은경미합니다. 담당의가아세타미노펜 ( 타이레놀 ) 을복용해도된다고할경우이것은아픈것을덜어드릴것입니다. 담당의가환자분의통증이더심하다고예상할경우더강력한진통제의처방을담당의에게서받을것입니다. 식사를할수있게되는대로평상시에복용하는약들을다시시작하십시오. 담당의가처방하거나허용한약들만복용하십시오. 감염이나위궤양을예방하는것을돕는약을받을수도있습니다. 약이다떨어질때까지처방받은약들을모두복용하십시오. 전화해야될상황다음과같은상황이발생할경우즉시전화하십시오 : 사타구니상처부위에서출혈이나거나부종이생김 상처부위아래쪽다리에전과달리차갑거나아프거나감각이둔화됨 새로이복통이일어남 구토증이나열이나거나오한이남 연락처중재방사선과진행담당간호사 시술예약 업무외시간 ( 오후 5 시부터오전 7 시사이 ) 과주말과휴일중재방사선과당직펠로우를요청하십시오 응급상황일경우 Box N.E. Pacific St. Seattle, WA 가장가까운응급실로직접가시거나 을부르십시오. 우리직원과통화될때까지 기다리지마십시오. University of Washington Medical Center Yttrium-90 Radiotherapy for Liver Tumors Korean Published/Clinician Review: 02/2012 Translation by UWMC Interpreter Services Reprints on Health Online:

9 Patient Education Yttrium-90 Radiotherapy Treatment for liver tumors This handout explains what Yttrium-90 radiotherapy is and what to expect when you have it done. Why do I need this treatment? Your doctors have found a tumor (or tumors) in your liver. These may have started in your liver (most likely hepatocellular carcinoma, or HCC) or spread to it from another part of your body. There are many treatments for liver tumors, but certain ones work best for certain people. Our team of experts believes that Yttrium-90 (Y-90) radiotherapy is the best option for you at this time. Y-90 radiotherapy sends radiation directly into the blood vessels that feed the tumors. This treatment does not cure liver tumors. But, it often controls or shrinks them. After this therapy, other options (such as chemotherapy or surgery) may also be advised for you. How does Y-90 radiotherapy work? Radiation therapy has been used for decades in the treatment of many types of tumors. But, the doses of external radiation needed to kill liver tumors would seriously harm the healthy parts of the liver. Y-90 is a minimally invasive treatment. This means that only small medical tools are used and your body is not opened up. This means your body will recover more quickly than it would after regular surgery. In this treatment, millions of tiny radioactive beads are injected directly into the arteries that supply blood to your tumor. These beads will stay in the blood vessels around your tumor(s). This allows very strong radiation to reach the tumors directly. There is very little effect on healthy parts of your liver or other tissues in the area such as your intestines or skin. The beads emit radiation for about 10 days, but they will keep working for several months after they are injected.

10 Page 2 Yttrium-90 Radiotherapy What beads are used in Y-90 radiotherapy? Two types of beads can be used for this treatment: TheraSpheres and SIR-Spheres. The beads are made of either plastic or glass. SIR-Spheres are approved by the Food and Drug Administration (FDA) for people with tumors in the liver that have spread from colon cancer. TheraSphere is approved as a humanitarian use device (HUD) to treat hepatocellular carcinoma. An HUD is a device that has been approved for treating a small number of people with a specific health condition. We often use medical products for a different disease than they were first approved for. Both TheraSpheres and SIR-Spheres have been used safely and effectively in thousands of patients with liver tumors. We will choose the type of bead that will work best for you. How is the procedure done? Y-90 radiotherapy is done by an interventional radiologist, a doctor who specializes in treating liver tumors with minimally invasive procedures done using X-ray guidance. The treatment is done in several steps (procedures) over the course of a few months. Insertion site for catheter that is used to inject tracer or place beads coated with Y-90

11 Page 3 Yttrium-90 Radiotherapy Step 1: Mapping Angiogram Step 1 is a procedure called a mapping angiogram. It takes 2 to 4 hours. During this procedure: You will lie on an X-ray table. The only discomfort you will feel is a short burning sensation when the local anesthetic (numbing medicine) is applied to your skin. A small plastic tube (catheter) is put into an artery in your groin and threaded to the liver arteries. X-rays will help your doctor guide this catheter to the right place. Angiograms (X-ray pictures) are done to help your doctor see how blood flows to your liver. This will tell your doctor if we can use Y-90 therapy for you. - If the angiogram shows that Y-90 therapy is not possible for you, the procedure will end. - If the angiogram confirms that Y-90 therapy is possible, your doctor will go ahead with the next steps. Your doctor will use small metal wires (coils) to block off blood vessels that should not receive radiation. A harmless tracer agent will be injected into your liver arteries. A mapping angiogram shows how much tracer enters the tissues around your liver Then, you will be taken to the nuclear medicine department down the hall for a scan. This scan will show how much of the tracer has left your liver and entered your lungs or other organs. - If too much tracer gathers in the tissue outside your liver, Y-90 treatment will not work for you, and the procedure ends here. - If the scan shows little or no tracer in the tissue outside your liver, you will be approved to go to Step 2. Step 2: Y-90 Infusion If you are approved for Y-90 therapy after Step 1, your precise dose of radiation will be calculated and delivered to the hospital at a specific time. About 2 weeks after Step 1, you will have a second outpatient procedure. You will have another catheter placed in the artery in your groin. Like the last time, the catheter will be threaded to your liver. Then, the beads coated with Y-90 will be slowly injected into your liver artery. This procedure takes about 1 hour.

12 Page 4 Yttrium-90 Radiotherapy Step 3: 2nd Y-90 Infusion (if needed) We often treat only half of the liver in Step 2. People who need a second Y-90 infusion to treat other parts of the liver will have another Y-90 infusion session 4 to 6 weeks after Step 2. Step 4: Scans About 1 month after your last Y-90 infusion, you will have a magnetic resonance imaging (MRI) or computed tomography (CT) scan. This scan will show how the tumors have responded to the treatment. Your doctor will review these scans, your blood test results, and your overall health. They will talk with you about any other treatments, if needed. Are there any special precautions I need to take after the Y-90 infusions? The radiation released by the Y-90 beads travels less than ½ inch. Depending on the type of treatment you receive, your doctor may restrict your activities after treatment. You may need to limit your contact with others for a short time. Are there any risks or side effects? The most common side effect after Y-90 radiotherapy is fatigue. This can be mild or severe. It can last up to a few weeks. Other side effects include: Poor appetite Mild abdominal pain Slight fever Nausea These symptoms should slowly go away over 1 to 2 weeks. There are other much less common but sometimes serious side effects and complications. Your doctors will talk with you about these risks before you start treatment. Please make sure all of your questions are answered before your treatment begins. Before Your Procedure A nurse coordinator will call you the afternoon before your procedure. If your procedure is on a Monday, the nurse will call you the Friday before. The nurse will give you final instructions and answer any questions you have. If you do not understand English well enough to understand these instructions or the details of the procedure, tell us as soon as possible. We will arrange for a hospital interpreter to assist you. A family member or friend may not interpret for you.

13 Page 5 Yttrium-90 Radiotherapy You most likely will need blood tests done within 14 days of your procedure. Sometimes, we do this when you arrive for your procedure. We will let you know if we need a blood sample before that day. If you have had an allergy or bad reaction to contrast (X-ray dye) in the past, please call our nurse coordinators at one of the numbers on the last page of this handout. You may need to take medicine for this allergy before the procedure. If your kidney function is not normal and we need to give you X-ray dye, we may prescribe a medicine for you to take before and after your procedure. This medicine will help protect your kidneys. If you take any blood-thinning medicines (such as Coumadin, Lovenox, Fragmin, or Plavix), you may need to stop taking the medicine for 3 to 9 days before the procedure. You will receive instructions about this. If you have diabetes and take insulin or metformin (Glucophage), you will receive instructions about holding or adjusting your dose for the days your procedures are done. Sedation Before your Y-90 infusions, you will be given a sedative medicine (similar to Valium and morphine) through your IV. This medicine will make you sleepy, help you relax, and lessen your discomfort. You will stay awake. This is called conscious sedation. You will still be sleepy for a while after the procedure. For some people, using conscious sedation is not safe. If this is true for you, you will need anesthesia (medicine to make you sleep during the procedure). Let us know right away if you: - Have needed anesthesia for basic procedures in the past - Have sleep apnea or chronic breathing problems (you might use a CPAP or BiPAP device while sleeping) - Use high doses of narcotic painkiller - Have severe heart, lung, or kidney disease - Cannot lie flat for about 2 to 3 hours because of back or breathing problems - Have a hard time lying still during medical procedures - Weigh more than 300 pounds (136 kilograms)

14 Page 6 Yttrium-90 Radiotherapy Day Before Your Procedure To prepare for sedation, follow these instructions closely: The day before your procedure, you may eat as usual. Starting 6 hours before your procedure, you may only have clear liquids (liquid you can see through, such as water, Sprite, cranberry juice, or weak tea). Starting 2 hours before your procedure: - Take nothing at all by mouth. - If you must take medicines, take them with only a sip of water. - Do not take vitamins or other supplements. They can upset an empty stomach. You must have a responsible adult drive you home and stay with you the rest of the day. You may NOT drive yourself home or take a bus, taxi, or shuttle. On the Day of Your Procedure Take all of your other usual medicines on the day of the procedure. Do not skip them unless your doctor or nurse tells you to. Bring a list of all the medicines you take, each time you come to the hospital for one of the steps of this procedure. Please plan to spend most of the day in the hospital. If there is a delay in getting your procedure started, it is usually because we need to treat other people with unexpected and urgent problems. Thank you for your patience if this occurs. Unless the nurse coordinator tells you otherwise, check in at Admitting on the 3rd (main) floor of the hospital. Admitting is to the right and behind the Information Desk in the lobby. A medical assistant will give you a hospital gown to put on and a bag for your belongings. You may use the restroom at that time. A staff member will take you to a pre-procedure area. There, a nurse will do a health assessment. Your family or friend can be with you there. An IV line will be started. You will be given fluids and medicines through the IV. An interventional radiology doctor will talk with you about the procedure and ask you to sign a consent form if this has not already been done. You will be able to ask questions at that time.

15 Page 7 Yttrium-90 Radiotherapy Your Procedure The nurse will take you to the radiology suite. This nurse will be with you for the entire procedure. If needed, an interpreter will be in the room or will be able to talk with you and hear you through an intercom. You will lie on a flat X-ray table for the procedure. Wires will be placed on your body to help us monitor your heart rate. You will have a cuff around your arm. It will inflate from time to time to check your blood pressure. A radiology technologist will clean your skin around your groin area with a special soap. Tell this person if you have any allergies. The technologist may need to shave some hair in the area where the doctor will be working. The entire medical team will ask you to confirm your name and will tell you what we plan to do. This is for your safety. Then, your nurse will give you medicine to make you feel drowsy and relaxed before we begin. After Your Procedure We will watch you closely for a short time in the Radiology department. You will then go to a short-stay unit in the hospital. A different nurse will monitor you there. Most times, you will be able to eat and drink, and your family may visit you. You will need to rest in bed for 2 to 6 hours. You must keep your leg below the groin puncture site perfectly still for that time to control bleeding. When you are fully awake and are able to eat, use the restroom, and walk, you will be able to go home. Problems after this procedure are rare. If they occur, we may need to keep you in the hospital so that we can monitor you or treat you. Before you leave the hospital, your nurse will tell you what activities you can do, how to take care of your incision, and other important instructions.

16 Page 8 Yttrium-90 Radiotherapy Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC clinic staff are also available to help. Radiology/Imaging Services: When You Get Home You may need to follow special precautions because of the potential radiation risk to others. Your nurse will give you these instructions before you leave the hospital. Relax at home for the rest of the day. Make sure you have a family member, friend, or caregiver to help you. You may feel sleepy or have some short-term memory loss. For 24 hours, do not: - Drive a car or use machinery - Drink alcohol - Make important personal decisions or sign legal documents - Be responsible for the care of another person You may shower or bathe the next day. There is usually only minor pain after Y-90 therapy. If your doctor says it is OK for you to take acetaminophen (Tylenol), this should ease any discomfort. If your doctor expects you to have more severe pain, you will receive a prescription for a stronger pain medicine. Resume taking your usual medicines as soon as you start to eat. Take only the medicines that your doctors prescribed or approved. You may be given medicines to help prevent infection or stomach ulcers. Take all of your prescribed drugs until they are finished. When to Call Call us right away if you have: Bleeding or swelling at the groin puncture site New coolness, pain, or decreased sensation in your leg below the puncture site New abdominal pain Vomiting, fever or chills Who to Call Interventional Radiology nurse coordinator Procedure Scheduling After hours (between 5 p.m. and 7 a.m.), and on weekends and holidays Ask for the Interventional Radiology Fellow on call Box N.E. Pacific St. Seattle, WA If You Have an Emergency Go directly to the nearest Emergency Room or call Do not wait to contact one of our staff. University of Washington Medical Center Published/Clinician Review: 02/2012 Reprints on Health Online:

Going Home - Korean

Going Home - Korean Going Home After an illness or injury, some things may change in your life. Make sure you and your family know the answers to these questions before you go home from the hospital. Medicines Am I taking