Clinical Dosimetry Models and Pathway to Integration in Routine Nuclear Medicine Practice

An increasing interest in radiopharmaceutical therapy (RPT), especially in reference to the theranostic framework incorporating both diagnostic and therapeutic components have been reported. Typically, this "theranostic approach" consists of a "matching pair" of radiopharmaceuticals, comprising a diagnostic partner labelled with positron or gamma-emitting radionuclides and a therapeutic partner labelled with beta or alpha-emitting radionuclides. Due to variability in the biodistribution, uptake, and retention, the therapeutic effectiveness of established and newer radiopharmaceutical therapies may show interpatient and intrapatient variability. As RPT requires the systemic administration of radiopharmaceuticals to patients, their normal organ biodistribution, as well as uptake in tumor tissues, can be mapped using molecular imaging (SPECT and PET) techniques. This allows for the quantification of the fraction of the administered radioactivity (MBq) that reaches the tumor, as well as the normal organs. The administered radioactivity can be modified based upon a patient's body habitus and laboratory parameters to achieve the optimal and desired tumor effect and normal tissue sparing, thereby permitting delivery of an individualized theranostics. This review discusses the RPT and dosimetry practices that are in clinical use, along with other cutting-edge radiopharmaceutical therapies that have shown promising therapeutic efficacies in advanced-stage human malignancies.