Optimizing Radiation Protection in ¹⁷⁷Lu-Based Radiopharmaceutical Therapy: The Need for Standardized Internal Dosimetry

Radiopharmaceutical therapy (RPT) with Lutetium-177 (¹⁷⁷Lu) has revolutionized targeted cancer treatment, offering theranostic capabilities that integrate diagnosis and therapy. However, ensuring radiation safety for patients, healthcare workers, and the environment remains a critical challenge. This study examines radiation protection measures and regulatory requirements for ¹⁷⁷Lu-based RPT in Canada, focusing on Canadian Nuclear Safety Commission (CNSC) licensing, compliance protocols, and quality assurance measures to mitigate radiation exposure risks.

A key component of patient safety in nuclear medicine is internal dosimetry, which plays a crucial role in optimizing treatment efficacy while minimizing radiation exposure to healthy tissues. Despite advancements in nuclear medicine, many treatment protocols continue to rely on fixed-dose approaches, leading to suboptimal therapeutic outcomes. This research explores the challenges and incentives of patient-specific dosimetry, including barriers such as cost, lack of standardized protocols, and dose-response uncertainties. Additionally, it evaluates different dose prescription algorithms, comparing fixed dosing, Maximum Tolerated Absorbed Dose (MTAD), and Prescribed Tumor-Absorbed Dose (PTAD) approaches in clinical applications.

The findings underscore the urgent need for standardized internal dose assessment software platforms to enhance personalized treatment planning and radiation protection strategies. The absence of a universal dosimetry framework has led to inconsistencies in dose calculations, impacting the accuracy of therapeutic radiation delivery. Future advancements should focus on developing a limited number of commercially available dosimetry platforms that are accessible across nuclear medicine departments. These platforms must ensure consistent, reproducible results for target organ absorbed doses, total body effective doses, and dose volume histograms. Furthermore, adopting a standardized data format (e.g., DICOM) will improve interoperability, enabling seamless data exchange across clinics and institutions. Implementing these improvements will enhance patient safety, maximize therapeutic benefits, and minimize radiation-related risks in the evolving field of radiopharmaceutical therapy.