Challenges and practicalities in the clinical implementation of Lutetium 177 for therapeutic nuclear medicine: a technologist’s perspective

Objectives: FDA approval of Lutetium177 (Lu177) treatment of neuroendocrine tumor is pending. Lu177 therapy is logistically different than any other currently used radionuclide therapeutic agent. We aim to present a technologist’s perspective on potential challenges related to the implementation of Lu177 therapy including developing an institution’s policy, identifying needed location/space, supplies, and staff requirements.

Methods: A Lu177 treatment regimen consists of 4 intravenous infusions of 200 mCi at 8 week intervals. Each therapeutic infusion is 4-6 hours, consists of the Lu177 infusion along with an infusion of amino acids and requires nursing supervision. During this process, to reduce radiation exposure, the patient must walk to the restroom every thirty minutes with an IV pole to void. The technologists met with the Authorized Users (AU), the Radiation Safety Officer (RSO), and the other staff involved to review the requirements of radiation safety, workflow, and protocol of this therapy.

Results: The radioactive materials license is to be amended. It was determined that Lu177 administration would ideally occur in our PET division due to department layout and patient flow. While the general nuclear medicine department has an injection room suited for therapeutic use, the restroom is not in close proximity, which is a radiation safety concern. In our PET center, there are 2 comfortable injection rooms used for long uptake periods located next to a restroom dedicated for radioactive patients. Due to the stated length of the Lu177 therapy session, the PET diagnostic schedule will be reduced on Lu177 therapy days. Lu177 therapies will be scheduled in coordination with other departments including oncology; pharmacy for obtaining amino acids; and nursing for the administration of IV fluids and vital sign monitoring. After the infusion is completed and the injection room is cleaned, radioactive waste will be moved to long term storage. Conclusion: Lu177 therapy is an exciting new development in the field of radionuclide therapy: however, its implementation brings new challenges to meet both radiation safety and protocol requirements. Space, workflow, and staffing must all be considered. Lu177 therapies will involve the coordination of AUs, the RSO, technologists, nursing staff, pharmacist, and logistics personnel. Having a successful Lu177 therapy program requires team work to develop site-specific and tailored solutions.