Optimizing Radionuclide Selection TAT

Targeted alpha therapy (TAT) is gaining traction in cancer care due to its high linear energy transfer (LET) and ability to eradicate small-volume disease. However, rational selection between alpha-emitters like Actinium- 225 and Bismuth-213 versus beta-emitters like Lutetium-177 remains a challenge, especially when balancing clinical outcomes with physics-driven optimization. In this study, we combine patient imaging data from the VISION trial with Geant4-DNA Monte Carlo simulations to analyze how tumor control probability (TCP) responds to variations in particle range, half-life, and microdistribution. We further develop a decision-support tool that integrates biological heterogeneity, tumor burden, and isotope availability into radionuclide choice. Our results reveal that emitter selection significantly impacts organ-at-risk dose and treatment success. This work highlights the need for a patient-specific, physics-informed approach to radionuclide therapy planning.