The accuracy of absorbed dose calculations in personalized internal radionuclide therapy is directly related to the accuracy of the activity (or activity concentration) estimates obtained at each of the imaging time points. MIRD Pamphlet no. 23 presented a general overview of methods that are required for quantitative SPECT imaging. The present document is next in a series of isotope-specific guidelines and recommendations that follow the general information that was provided in MIRD 23. This paper focuses on 177 Lu (lutetium) and its application in radiopharmaceutical therapy. Theradi onuclide 177 Lu (lutetium) has been proven useful in several targeted radionuclide therapies because of its favorable decay characteristics and the possibility of reliable labeling of biomolecules used for tumor targeting. Initially, 177 Lu was used in a colloidal form for interstitial injections for sterilization of peritumoral lymph nodes (1). A second important clinical application of 177 Lu has been for peptide receptor radionuclide therapy (PRRT) with 177 Lu-DOTATATE and other structurally related peptides. The PRRT use in treatment of neuroendocrine tumors (NETs) is motivated by the fact that the carrier peptide, octreotate, shows highaffinity binding to somatostatin receptors, which are overexpressed on the cell surface of many NETs (2-6). Furthermore, 177 Lu has been used in radioimmunotherapy clinical trials to label different kinds of monoclonal antibodies (7-15).There is a growing body of evidence that radionuclide therapy should follow patient-specific planning protocols, similar to those that are being routinely used in external-beam radiation therapy. Recent literature reviews show correlations between absorbed dose and tumor response as well as normal-tissue toxicity (16). Such correlations indicate that treatments should be based on personalized dosimetry, aiming to deliver therapeutically effective absorbed doses to tumors, while keeping doses to organs at risk below the threshold levels for deterministic adverse effects. In clinical PRRT studies, the primary adverse effects have been mainly renal and hematologic toxicities (2,6).Although several studies have reported estimates of absorbed doses (4,7-9,12) for 177 Lu-DOTATATE PRRT and 177 Lu radioimmunotherapy, most of these estimates have been based on planar imaging and conjugate-view activity quantification. Planar imaging, however, is known to have inherent limitations regarding the accuracy of activity quantification (17). As a result, an increasing number of clinical dosimetry protocols currently include 177 Lu SPECT/CT imaging studies (15,(17)(18)(19) because of their superior accuracy. Comparisons of renal dose estimates in 177 Lu-DOTATATE PRRT based on planar imaging and SPECT/CT, for example, have been reported (17,20) and are summarized in Cremonesi et al. (21).This document presents a set of guidelines outlining data acquisition protocols and image reconstruction techniques that are recommended for quantitative 177 Lu SPECT imaging. The guidelines are...