Clinical Best Practices for Radiation Safety During Lutetium-177 Therapy

Abstract

Importance 177 Lu therapy as part of theranostic treatment for cancer is expanding but it can be a challenge for sites with limited radiation protection staff to implement the radiation safety program required for therapeutic nuclear medicine. Objective To increase the adoption of 177 Lu therapy, especially in smaller centers and clinics, by providing a collection of radiation safety best practices and operational experience. To provide a resource for radiation safety officers supporting the implementation of a 177 Lu therapy program. Methods A panel of 11 radiation safety professionals representing sites across Canada and the United States with experience delivering 177 Lu therapy was assembled and discussed their responses to a list of questions focused on the following radiation safety topics: facility layout and design; radiation safety program; and drug management and patient care. Results A comprehensive set of best practice guidelines for clinical radiation safety during 177 Lu therapy has been developed based on the collective operational experience of a group of radiation safety professionals. Significant findings included that 177 Lu therapy is often safely administered in unshielded rooms, that staff radiation exposure associated with 177 Lu therapy is minimal relative to other nuclear medicine programs, and that some relatively simple preparation in advance including papering of common surfaces and planning for incontinence can effectively control contamination during therapy. Conclusion The guidance contained in this paper will assist radiation safety professionals in the implementation of safe, effective 177 Lu therapy programs, even at smaller sites with limited to no experience in therapeutic nuclear medicine.

Leveraging Radiopharmaceutical Programmatic Collaboration for Management of Pretherapy and On-treatment Urinary Incontinence

“…A second gap we have encountered involves the lack of an evidence-based urinary incontinence management guideline for cancer patients undergoing radiopharmaceutical delivery. While professional societies have offered good clinical practice guidelines for patient care with regard to preparation of facilities at treatment center locations (Hope et al 2019; Capon et al 2023), there are no specific individualized recommendations for patient protection when urine contamination of the patient is of primary concern. As such, we have decided upon an assessment-action plan for urinary incontinence dependent on pretherapy patient clinical condition (see details in Table 1).…”

“…Luthenium-177 has a half-life of about 6.5 d, elevating the risk of prolonged contamination if its liquid formulation is spilled, and contamination surveys must be performed prior to clearing treatment locations for upcoming patients. Administration of 177 Lu dotatate necessitates room preparation with prophylactic protective coverings as well as a strong recommendation for an adjoining toilet due to a patient’s desire to void frequently (although a nearby toilet is acceptable as long as it is dedicated to such patients during their stay; Cappon et al 2023). It might be advantageous to have treatment patients change into hospital gowns and slippers upon arrival in order to prevent contamination of personal clothing, shoes, or other possessions (Cappon et al 2023).…”

“…Administration of 177 Lu dotatate necessitates room preparation with prophylactic protective coverings as well as a strong recommendation for an adjoining toilet due to a patient’s desire to void frequently (although a nearby toilet is acceptable as long as it is dedicated to such patients during their stay; Cappon et al 2023). It might be advantageous to have treatment patients change into hospital gowns and slippers upon arrival in order to prevent contamination of personal clothing, shoes, or other possessions (Cappon et al 2023). Institution-specific guidelines for radioactive waste management should be followed under the supervision of a local radiation safety officer (further instruction can be found in Cappon et al 2023).…”

“…It might be advantageous to have treatment patients change into hospital gowns and slippers upon arrival in order to prevent contamination of personal clothing, shoes, or other possessions (Cappon et al 2023). Institution-specific guidelines for radioactive waste management should be followed under the supervision of a local radiation safety officer (further instruction can be found in Cappon et al 2023).…”

Challenges of Deep Learning in Cancers

“…Thirdly, cancer and its treatment drastically impact patients’ quality of life. Treatments such as chemotherapy, radiation therapy, 2 and surgery cause physical and emotional side effects that are debilitating and long-lasting. Fourthly, not all cancer types are preventable.…”