ICRP Publication 140: Radiological Protection in Therapy with Radiopharmaceuticals

Abstract

Nuclear medicine is the medical application of radioactive tracer technology invented by Hevesy and Paneth in 1913. Radiopharmaceuticals are chemical and biological substances labelled with a radioisotope and approved as drugs for human medical use by the national authority. Pharmaceuticals that accumulate selectively in a tissue, organ, or lesion through physiological and metabolic processes are chosen to be labelled with radioisotopes. Due to the very small quantity of pharmaceutical labelled with a very large amount of radioactivity (high specific activity), radiopharmaceuticals do not reveal effects as drugs. Thus, radiopharmaceuticals are used to deliver radioisotopes to specific parts of the body for diagnostic and therapeutic purposes with radiation.

Radiotheranostics: a roadmap for future development

“…-tetraacetic acid] and others) that trap α ( 223 Ra or 225 Ac) and β emitters ( 177 Lu, 90 Y, or 166 Ho). 16 Similar chemical constructs are used concomitantly for diagnostic PET, single-photon-emission (SPECT)-CT, and MRI, and largely rely on γ or positron emitters ( 90m Tc, 68 Ga, 18 F, or 64 Cu). Planar and SPECT-CT scans can also be obtained with the γ component of 177 Lu and 131 I.…”

“…25 Such malignancies include neuroendocrine tumours, and, to a lesser degree, small-cell lung cancer. The therapeutic part of this approach is 177 Lu-dotatate, with 68 Ga-dotatate as the diagnostic counterpart. Examples of scans of patients who responded or did not respond to this regimen are in figure 3.…”

“…For example, considerations include attention to radiation safety during the application of treatment and in waste management, the limited half-life of the therapy (hours or days compared to months for chemotherapy), and the possibility and need for imaging after radiotheranostic administration. 68 The safe application of radiotheranostics requires a specialised and well-trained team of physicians, radiopharmacists, medical physicists, and nurses to ensure patient safety. 68,69 Clearly defined roles within a team are necessary when it comes to diagnosis, drug preparation, radiation safety, treatment, monitoring, and follow-up.…”

“…68 The safe application of radiotheranostics requires a specialised and well-trained team of physicians, radiopharmacists, medical physicists, and nurses to ensure patient safety. 68,69 Clearly defined roles within a team are necessary when it comes to diagnosis, drug preparation, radiation safety, treatment, monitoring, and follow-up. Strategically aligning all training goals is crucial, particularly in view of the field's expected expansion.…”

Comparison of different calculation techniques for absorbed dose assessment in patient specific peptide receptor radionuclide therapy

“…Radiopharmaceutical therapy (RPT), as defined in ICRP 140 [1], is based on the use of specific pharmaceuticals labelled with radionuclides to deliver a lethal dose of radiation to tumour areas. Radiopharmaceuticals are specifically designed to have high affinity with given tumour sites, so that ionizing radiations, such as particles and photons emitted by the isotopes, may deposit energy inside or close to unhealthy tissues, saving surrounding healthy tissues.…”