IR Embolization Calculator
Lipiodol emulsions, NBCA glue ratios, DEB-TACE bead sizing, drug dosing and vessel-size guidance for interventional radiology
Medical Disclaimer
- This is a reference tool only. All drug dosing, embolization ratios, and volumes must be verified against institutional protocols.
- Adjust for individual patient factors: liver/renal function, prior therapy, coagulation status, BSA.
- Maximum Lipiodol per session is generally 15 mL (some protocols allow up to 20 mL with caution).
- Always confirm with fluoroscopy and angiography before injection.
- Not a substitute for clinical judgment or attending supervision.
SatMix Protocol: Dissolve drug in sterile saline (0.9% NaCl) or water for injection. Mix vigorously with Lipiodol via 3-way stopcock (>=20 exchanges, 40+ for finer droplets). Target water-in-oil emulsion confirmed by drape test.
Volume Rule: Lipiodol = 1-3 mL per cm tumor diameter based on vascularity. Use the smaller of tumor-based or prep-based volume. Never exceed 15 mL Lipiodol per session.
Droplet Rule: Target 70-100 um droplets for optimal tumor microvasculature occlusion + portal venule penetration via arterioportal shunts.
Mixing Exchanges & Droplet Size: 10 exchanges ~150-200 um; 20 exchanges ~100-150 um; 40 exchanges ~70-100 um; 60+ exchanges ~50-70 um.
| Drug | Standard Dose | Max Dose | Lipiodol Solubility | Key Toxicity |
|---|---|---|---|---|
| Doxorubicin | 30-60 mg | 75 mg/m2 | Moderate | Cardiotoxicity |
| Cisplatin | 50-100 mg | 100 mg/m2 | Low | Nephrotoxicity |
| Epirubicin | 40-60 mg | 90 mg/m2 | Moderate | Less cardiotoxic |
| Mitomycin C | 6-10 mg | 20 mg/m2 | Low | Myelosuppression |
| Miriplatin | 60-120 mg | 120 mg | High (lipophilic) | Neutropenia |
| Irinotecan | 100-200 mg | 350 mg/m2 | Moderate | Diarrhea, cholinergic |
Bead Selection Rule: Select beads 1/3 to 1/10 of the target vessel diameter. For standard HCC, 100-300 um beads are preferred for segmental and subsegmental branches (2-4 mm).
Volume Estimation: Target bead volume = tumor volume x 0.3-0.5 (compression factor). For a 3 cm tumor (~14 mL), use 4-7 mL of hydrated beads. One 2 mL vial of DC Bead typically hydrates to ~4-6 mL.
Drug Loading: DC Bead loads doxorubicin at ~25-37.5 mg/mL. DC Bead IR loads irinotecan at ~100 mg/mL. HepaSphere loads epirubicin at ~25-50 mg/mL after hydration.
Injection Technique: Inject slowly under fluoroscopy. Stop when antegrade flow ceases (stasis). Avoid reflux. Do not exceed 10 mL total bead suspension per injection to prevent aggregation.
| Bead Type | Drug | Loading Capacity | Standard Dose | Hydration | Key Notes |
|---|---|---|---|---|---|
| DC Bead (100-300) | Doxorubicin | 25-37.5 mg/mL | 50-100 mg | Non-ionic contrast | Load 30-60 min before use |
| DC Bead IR (100-300) | Irinotecan | 100 mg/mL | 100-200 mg | Non-ionic contrast | For colorectal mets |
| HepaSphere (50-100) | Epirubicin | 25-50 mg/mL | 40-60 mg | Saline or contrast | Expands 4x after hydration |
| HepaSphere (100-300) | Doxorubicin | 25-50 mg/mL | 50-100 mg | Saline or contrast | Compressible microspheres |
| LifePearl (100-300) | Doxorubicin | 25 mg/mL | 50-75 mg | Non-ionic contrast | Uniform size distribution |
| Tandem (75-150) | Doxorubicin | 30 mg/mL | 50-75 mg | Non-ionic contrast | Resorbable gelatin |
Loading Protocol: Mix drug with non-ionic contrast (e.g., Visipaque 320) in a 10 mL syringe. Attach to bead vial via 3-way stopcock. Agitate gently for 30-60 minutes. Verify complete loading by clear supernatant.
Contraindications: Bil >3x ULN, main portal vein thrombosis without collaterals, active infection, ECOG >2. Use caution with bilobar disease.
| Vessel | Flow | Ratio | NBCA% | Use Case |
|---|---|---|---|---|
| >5 mm | High | 1:1 - 1:2 | 33-50% | Large artery, bleed |
| 2-5 mm | Normal | 1:2 - 1:4 | 20-33% | Segmental |
| 1-2 mm | Low | 1:4 - 1:6 | 14-20% | Subsegmental |
| <1 mm | Sluggish | 1:6 - 1:10 | 9-14% | Distal / AVM |
Critical Safety: Flush catheter with 5% dextrose (D5W) only. Never use saline or heparin - ionic contact causes premature polymerization and catheter entrapment.
Preparation: Aspirate NBCA from ampule into a new plastic syringe, add Lipiodol, cap immediately. Use within 10 minutes. Inject continuously without pause; withdraw catheter within ~3 seconds of completion.
Active Bleeding: Use higher NBCA concentration (1:1 to 1:2) with rapid injection. Consider balloon occlusion or coil-assisted delivery to prevent distal migration.
Catheter Entrapment:
- Use non-detachable end-hole catheter or balloon catheter
- Never let glue polymerize inside catheter lumen
- Keep total injection time < 3 seconds
- Have retrieval snare ready if using detachable tip
Nontarget Embolization:
- Confirm catheter position with contrast before each injection
- Use roadmap or CBCT guidance when available
- Consider coil or plug-assisted retrograde transvenous approach
- Embolize proximal to dangerous collaterals first
| Drug | Standard Dose | Max Dose | Notes |
|---|---|---|---|
| Doxorubicin | 30-60 mg | 75 mg/m2 | Most common; cardiotoxicity limit |
| Cisplatin | 50-100 mg | 100 mg/m2 | Nephrotoxic; hydrate pre/post |
| Epirubicin | 40-60 mg | 90 mg/m2 | Less cardiotoxic than doxorubicin |
| Mitomycin C | 6-10 mg | 20 mg/m2 | Myelosuppressive; single use vial |
| Miriplatin | 60-120 mg | 120 mg | Lipophilic platinum; hepatic extraction |
| Irinotecan | 100-200 mg | 350 mg/m2 | Colorectal mets; diarrhea risk |
Dosing Principle: Calculate Lipiodol volume by both methods and use the smaller volume to avoid overdose and Lipiodol toxicity.
Tumor-based: Lipiodol (mL) = tumor diameter (cm) x blood supply factor (typically 1-3x).
Preparation-based: Lipiodol (mL) = aqueous volume x Lipiodol ratio (e.g., 5 mL x 3 = 15 mL).
BSA Adjustment: For doxorubicin and epirubicin, consider BSA-based dosing. Max doxorubicin cumulative = 450-550 mg/m2 lifetime.
| Vessel Type | Diameter | Optimal Particle | cTACE Droplet | NBCA Target | Risk if Oversized |
|---|---|---|---|---|---|
| Hepatic artery | 4-6 mm | 300-500 um | 150-200 um | 1:1 - 1:2 | Proximal occlusion, nontarget |
| Segmental branch | 2-4 mm | 100-300 um | 100-150 um | 1:2 - 1:4 | Segmental infarct |
| Subsegmental | 1-2 mm | 70-100 um | 70-100 um | 1:4 - 1:6 | Microinfarcts, abscess |
| Terminal arteriole | 0.5-1 mm | 40-70 um | 50-70 um | 1:6 - 1:10 | Portal penetration, biloma |
| Tumor neovessels | 20-100 um | 20-50 um | 30-50 um | N/A | Systemic shunting |
Droplet:Vessel Ratio: Keep droplet diameter < 50% of vessel diameter to avoid reflux. Ideal ratio is ~0.3-0.4 (droplet 30-40% of vessel).
Portal Penetration: Droplets < 50 um can pass through arterioportal shunts into portal venules. This is desired for cTACE (dual embolization) but risky with NBCA (permanent portal occlusion).
Mixing Exchanges & Droplet Size: 10 exchanges ~150-200 um; 20 exchanges ~100-150 um; 40 exchanges ~70-100 um; 60+ exchanges ~50-70 um.
cTACE (Lipiodol + Chemo):
- HCC with preserved liver function (Child A/B)
- Target: 70-100 um droplets for microvascular occlusion
- Advantage: Dual arterial + portal venule embolization
- Contraindicated: Main portal vein thrombosis, biliary obstruction
DEB-TACE:
- HCC and liver metastases
- Target: 100-300 um beads based on tumor size
- Advantage: Predictable drug elution, no Lipiodol limit
- Caution: Post-embolization syndrome common
NBCA Glue:
- AVMs, high-flow fistulas, active bleeding
- Target: Vessel-specific ratio for controlled penetration
- Advantage: Permanent occlusion, rapid hemostasis
- Caution: Catheter entrapment, nontarget embolization
Particle Embolization (PVA/Embospheres):
- Uterine fibroids, AVMs, trauma, pre-op devascularization
- Target: Size 100-700 um based on vessel diameter
- Advantage: Controlled, repeatable injections
- Caution: Re-canalization possible with PVA
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