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Guidelines recommend segmenting volumes on baseline contrast-enhanced CT (ceCT) and registering to a SPECT\/low-dose CT. However, this conventional approach is vulnerable to spatial misregistration and potential disease progression. This study evaluates a hybrid SPECT\/ceCT-based planning methodology, hypothesising that it yields significantly different dosimetry metrics compared to the conventional workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      Hybrid SPECT\/ceCT was performed in 24 patients with hepatocellular carcinoma. Treatment planning followed both the conventional and hybrid workflow, where delineation was performed directly on SPECT\/ceCT. Quantification of dosimetric and positional differences between volumes from the two workflows was performed using Simplicit\n                      <jats:sup>90<\/jats:sup>\n                      Y (Mirada Medical) and SurePlan Liver Y90 (MIM) software, respectively. Outcomes were evaluated by Bland-Altman analysis and contour intercomparison indices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Direct delineation on SPECT\/ceCT yielded higher index lesion (largest single tumour) doses (6% increased) (mean: 19.5\u00a0Gy, 95% limits of agreement [LoA]: -43.9\u00a0Gy, 83.0\u00a0Gy) and lower normal tissue doses (11% decrease) (mean: -17.6\u00a0Gy 95% LoA: -104.4\u00a0Gy, 69.3\u00a0Gy). Index lesion volume increase between baseline CT and SPECT\/ceCT was 14% (95% LoA: -55.9%, 82.9%). Index lesion dose (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and volume (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) differed significantly between workflows. The median time interval between baseline imaging and SPECT\/ceCT was 6 weeks (IQR: 3.7 to 9.3 weeks). The median deviation of the index lesion between the baseline diagnostic image and hybrid SPECT\/ceCT image was 4.9\u2009\u00b1\u20092.2\u00a0mm and there was an average DICE score of 0.6\u2009\u00b1\u20090.2.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hybrid [99mTc]Tc-MAA SPECT\/ceCT treatment planning is technically feasible and leads to significant differences in dosimetry metrics compared with the conventional method.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-026-08027-6","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T06:34:58Z","timestamp":1783751698000},"page":"7038-7048","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel approach to radioembolization treatment planning using a hybrid [99mTc]Tc-MAA contrast enhanced SPECT\/CT"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9426-6626","authenticated-orcid":false,"given":"Grace","family":"Keane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marnix. 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Marnix G. E. H. Lam, MD, PhD: Is a consultant for Boston Scientific and Terumo and. He receives research support from Boston Scientific, Terumo and Novartis. Maarten L. J. Smits, MD, PhD: Is a consultant for Philips, Terumo and Philips. He is a speaker for Medtronic. Guus Bol, MD, PhD: Institutional scientific grants from Bayer, Servier, and Terumo. Hugo W. A. M. de Jong, PhD: Is a consultant for Boston Scientific and Terumo. Arthur J. A. T. Braat, MD, PhD: Is a consultant for Boston Scientific, Terumo, GE Healthcare, Telix Pharmaceuticals. He receives research support from Boston Scientific, Ariceum Therapeutics, Telix Pharmaceuticals, Siemens Healthineers","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}