Joint EANM, SNMMI and IAEA enabling guide: how to set up a theranostics centre

Abstract

The theranostics concept using the same target for both imaging and therapy dates back to the middle of the last century, when radioactive iodine was first used to treat thyroid diseases. Since then, radioiodine has become broadly established clinically for diagnostic imaging and therapy of benign and malignant thyroid disease, worldwide. However, only since the approval of SSTR2-targeting theranostics following the NETTER-1 trial in neuroendocrine tumours and the positive outcome of the VISION trial has theranostics gained substantial attention beyond nuclear medicine. The roll-out of radioligand therapy for treating a high-incidence tumour such as prostate cancer requires the expansion of existing and the establishment of new theranostics centres. Despite wide global variation in the regulatory, financial and medical landscapes, this guide attempts to provide valuable information to enable interested stakeholders to safely initiate and operate theranostics centres. This enabling guide does not intend to answer all possible questions, but rather to serve as an overarching framework for multiple, more detailed future initiatives. It recognizes that there are regional differences in the specifics of regulation of radiation safety, but common elements of best practice valid globally.

European Association of Nuclear Medicine (EANM) response to the proposed ASTRO’s framework for radiopharmaceutical therapy curriculum development for trainees

“…[1] -on behalf of ASTRO -reflect in their conclusions that collaboration with other specialties, especially the ones at the core of radiopharmaceutical therapies, i.e. nuclear medicine, represented by the SNMMI in the USA, should be considered [10]. Especially since what primarily is at stake is the quality and safety of radiopharmaceutical therapy for the patient.…”

Nearly double the patients and dramatic changes over 14 years of UK MRT: Internal Dosimetry Users Group survey results from 2007 to 2021

“…Capacity both in terms of staffing and facilities but also limits in Environment Agency (EA) permits for radioactive waste accumulation and disposal. Whilst lower volume centres may be able to expand their workload within their EA limits, they would require considerable investment in facilities, staffing and training, including supporting diagnostics (a guide to which can be found in recent EANM guidance [23]). NHS commissioning decisions surrounding 177 Lu-PSMA will therefore play a major role on the UK’s ability to meet the demand for the treatment.…”

Present and future of target therapies and theranostics: refining traditions and exploring new frontiers—highlights from annals of Nuclear Medicine 2021

“…A profound reorganisation should be addressed to adapt the existing healthcare infrastructure to the expected increased demand for radionuclide therapy [54]. A joint EANM, SNMMI and IAEA guide that undertakes these practical issues was recently published, emphasising the urgent need for high-quality theranostics centres in referral hospitals, where dedicated multidisciplinary boards and a highly specialised staff comprehensively manage patients undergoing radionuclide therapies [55].…”