MSOR11 Presentation Time: 8:50 AM

Purpose

Lu-177 (Pluvicto) and Ra-223 (Xofigo) have recently been adopted as targeted radiopharmaceutical therapies for castration-resistant prostate cancer patients. Both of these radiopharmaceutical therapies increase life expectancy and improve the prognosis of patients with a relatively simple procedure involving injection. The treatment procedures for Ra-223 and Lu-177 are similar, with Ra-223 administered in up to 6 fractions every 4 weeks, while Lu-177 is administered in the same number of fractions every 6 weeks. Although these treatments could be considered routine procedures in a nuclear medicine department, their implementation poses challenges in a small radiation oncology center due to a lack of staff experience. The purpose of this work is to provide guidance and share experiences for an independent small radiation oncology center preparing to launch such a program.

Materials and Methods

Physicians, physicists, and nurses collaborated as a team in the process, led by a physicist who served as a Radiation Safety Officer (RSO). Effective communication among staff is critical for successful workflow. We followed the Maryland regulations specific to radioactive material licenses consistent with the Federal Nuclear Regulatory Commission. The program build-up involved three phases: obtaining the license, conducting emergency planning and safety training for staff, and equipment acceptance and quality assurance (QA), source logistics, and workflow development. As an example, overall procedures from beginning to the first treatment of Ra-223 are depicted in Figure 1.

Results

Documentation of radiation safety procedures, staff training, acceptance and initial calibration of dose calibrators and well chambers, and workflow development using ARIA® Electronic Medical Record (EMR) were completed for the first treatment. Some steps, such as acceptance and QA of a dose calibrator and a well chamber for calibration contamination checks, may not be familiar to therapy physicists. Therefore, gaining knowledge through site visits and frequent contact with nuclear medicine personnel is essential. As of now, our institution has treated 8 patients with Ra-223, with a total of 29 injections. Among these patients, 3 have completed a total of 6 rounds of injections, all successfully treated without incident. Quality assurance for the injection program included recording prescribed versus actual injection activities, with an average discrepancy of 2.43%, well below the 10% tolerance level. Radiation surveys were conducted after injection to ensure patient safety, with an average maximum radiation exposure rate of 0.32 R/hr on the patient's surface, indicating safe release immediately after injection. We anticipate treating patients with Lu-177 in the near future, with preparations already in place.

Conclusion

Implementation of these therapies requires a team effort involving administrators, physicians, nurses, and physicists. In a small cancer center, a physicist serving as both a RSO and a leader plays a crucial role in establishing and overseeing radiation safety programs and workflow.