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