IPEM topical report: current molecular radiotherapy service provision and guidance on the implications of setting up a dosimetry service

Abstract

Despite a growth in molecular radiotherapy treatment (MRT) and an increase in interest, centres still rarely perform MRT dosimetry. The aims of this report were to assess the main reasons why centres are not performing MRT dosimetry and provide advice on the resources required to set-up such a service. A survey based in the United Kingdom was developed to establish how many centres provide an MRT dosimetry service and the main reasons why it is not commonly performed. Twenty-eight per cent of the centres who responded to the survey performed some form of dosimetry, with 88% of those centres performing internal dosimetry. The survey showed that a ‘lack of clinical evidence’, a ‘lack of guidelines’ and ‘not current UK practice’ were the largest obstacles to setting up an MRT dosimetry service. More practical considerations, such as ‘lack of software’ and ‘lack of staff training/expertise’, were considered to be of lower significance by the respondents. Following on from the survey, this report gives an overview of the current guidelines, and the evidence available demonstrating the benefits of performing MRT dosimetry. The resources required to perform such techniques are detailed with reference to guidelines, training resources and currently available software. It is hoped that the information presented in this report will allow MRT dosimetry to be performed more frequently and in more centres, both in routine clinical practice and in multicentre trials. Such trials are required to harmonise dosimetry techniques between centres, build on the current evidence base, and provide the data necessary to establish the dose–response relationship for MRT.

Results from an EANM survey on time estimates and personnel responsible for main tasks in molecular radiotherapy dosimetry

“…Regarding the use of the equipment, some of the images acquired for dosimetry may also be used for diagnostics, and some dose-rate measurements may also be used with radiation protection aims, thus reducing the impact of the increase in resources. A recent IPEM report [25] concluded that most UK centres were generally well equipped to perform MRT dosimetry, but that there was a staff shortage for the increase in tasks that MRT dosimetry entails. There are some documents that have reported on times needed to perform dosimetry [27,28].…”

“…However, whilst several dosimetric approaches were included in the report, the resource implications were not thoroughly examined. Current practices of dosimetry for MRT were investigated in a topical report of the Institute of Physics and Engineering in Medicine (IPEM) [25], including the potential barriers in setting up a clinical dosimetry service. It was concluded that in the UK, most medical physics groups are well equipped to provide a simple form of dosimetry service, but in most cases refrain to perform dosimetry routinely by 'lack of clinical evidence and practice' and that more complex dosimetry will require additional staffing.…”

Joint EANM, SNMMI, and IAEA Enabling Guide: How to Set up a Theranostics Center

“…The complexity of the task and the resources required to implement theranostic will vary depending on the respective radiopharmaceutical, application and desired clinical endpoint 24 . Commercial software applications are now available, some of which have FDA/EMA approval and are intended to perform dosimetric evaluation 25 .…”

Joint EANM, SNMMI and IAEA enabling guide: how to set up a theranostics centre

“…The complexity of the task and the resources required to implement theranostics will vary depending on the respective radiopharmaceutical, application and desired clinical end-point [ 23 ]. Commercial software applications are now available, some of which have FDA/EMA approval and are intended to perform dosimetric evaluation [ 24 ].…”