Curriculum standards

Knowledge guides

LG19: Radionuclide therapies / Theranostics

Epidemiology, pathophysiology, and clinical sciences

Trainees will have indepth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management and outcomes.

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Diseases suitable for therapeutic nuclear medicine and Theranostics
Evolving application and technology, including limitations
Indications and roles of therapeutic nuclear medicine treatment options relevant to different treatment settings
Link between radioisotope and radiopharmaceutical efficacy and other treatment modalities and the impact on treatment planning, including altered disease microenvironments, radiosensitising agents, and regulation of molecular target
Molecular target and properties suitable for therapeutic nuclear medicine
Personalised care and disease heterogeneity, and roles of dual or multi-tracer Theranostics imaging, as well as multi-modality therapy, combination, or sequential approaches
Radiopharmaceutical- and radiation-related side effects / toxicity, including general and organ specific, both acute and chronic, including cumulative radiation dose limitation to critical organs
Radiopharmacy, radionuclide therapy, and radioligand therapy, and recognition of Theranostics pairs
Selection of radioisotope and radioligand based on disease types, patient factors, properties, and target molecules

PCH

Impact of therapy on the patient and family:
- age of patient
- child-friendly environment
- continence and disposal of radioactive waste
- method of administration
Radiation precautions and impact on family members
Theranostics for the treatment of:
- neuroblastoma
- thyroid cancer

Theranostics imaging including PET and planar / SPECT imaging

Clinical trials

Adherence to trial protocols
Conflicts in care decisions or wishes
Consenting for trials
Escalation pathways for deviations
Identification of trial-suitable candidates
Liaising closely with clinical trial units

Collaboration and longitudinal care

Appropriate restaging and surveillance protocols
Common and less common side effects of radioligand therapies
Incidental findings identified through Theranostics imaging during therapy
Patient reassessment imaging modalities and surveillance schedule
Post-therapy imaging, clinical, and biochemical monitoring
Response assessments to determine durability of treatments, treatment pauses, and criteria for re-treatment
Pain management, advanced care planning, recognition of terminal decline and end-of-life care

Diagnostic and assessment

Different disease imaging phenotypes and relationship with disease behaviour and heterogeneity, in context of Theranostics
Imaging interpretation of anatomical correlated structural imaging, PET, scintigraphic planar, and SPECT, including imaging phenotypes recognition and imaging features quantifications assessment, relevant to treatment suitability and planning
Incorporate clinical assessment and biomarkers to guide personalised treatment decision and planning
Interpretation and application of imaging features quantification to guide personalised treatment decision and planning, including dosimetry and response assessment
Suitability assessment through recognition of disease heterogeneity, including molecular target through relevant nuclear medicine Theranostics imaging

Patient-centred consideration

Cultural, geographical, psychological, and socioeconomic factors in the accessibility and suitability of therapeutic nuclear medicine treatment modalities
Effects and adverse events related to radioisotopes and radiopharmaceuticals therapy, including prompts for emergency escalation
Identify individualised patient condition, risk factors, and comorbidities relevant to therapeutic nuclear medicine, including radiation exposure and contamination risks

Therapeutic and management

Administration logistics of therapy and radiation safety practice, including:
- management of patients during treatment and observation periods
- management of potential radiation contamination
- radiation shielding of staff
Appropriate preparations in consideration of patients’ conditions, disease types, risk factors, specific radioisotope or radiopharmaceutical, and, if applicable, concurrent treatments
Infusion extravasation, radiation contamination, and reaction
Management of administrations or applications of therapeutic radioisotopes and radiopharmaceuticals appropriate for disease types and in line with radiation safety practice
Personalised, multidisciplinary treatment plans and dosing to individual patients, disease response pattern, toxicity, and post-treatment imaging data, including dosimetry and biomarkers
Radiopharmaceutical- and radiation-related toxicities, including general and organ specific, as well as treatment related adverse events

Quality control considerations

Impact of supply chain availability, and shelf life on treatment planning
Quality control of radioisotope, radiopharmaceutical, and imaging data, including verification of QC of each radiopharmaceutical batch
Radiation safety guidelines and regulatory requirements
Awareness of published recommendations for Theranostics service and facility design and relevant regulatory requirements