BACKGROUND: Currently, the implementation of dosimetry in molecular radiotherapy (MRT) is not well investigated, and in view of the Council Directive (2013/59/Euratom), there is a need to understand the current availability of dosimetry-based MRT in clinical practice and research studies. The aim of this study was to assess the current practice of MRT and dosimetry across European countries. METHODS: An electronic questionnaire was distributed to European countries. This addressed 18 explicitly considered therapies, and for each therapy, a similar set of questions were included. Questions covered the number of patients and treatments during 2015, involvement of medical specialties and medical physicists, implementation of absorbed dose planning, post-therapy imaging and dosimetry, and the basis of therapy prescription. RESULTS: Responses were obtained from 26 countries and 208 hospitals, administering in total 42,853 treatments. The most common therapies were 131I-NaI for benign thyroid diseases and thyroid ablation of adults. The involvement of a medical physicist (mean over all 18 therapies) was reported to be either minority or never by 32% of the responders. The percentage of responders that reported that dosimetry was included on an always/majority basis differed between the therapies and showed a median value of 36%. The highest percentages were obtained for 177Lu-PSMA therapy (100%), 90Y microspheres of glass (84%) and resin (82%), 131I-mIBG for neuroblastoma (59%), and 131I-NaI for benign thyroid diseases (54%). The majority of therapies were prescribed based on fixed-activity protocols. The highest number of absorbed-dose based prescriptions were reported for 90Y microsphere treatments in the liver (64% and 96% of responses for resin and glass, respectively), 131I-NaI treatment of benign thyroid diseases (38% of responses), and for 131I-mIBG treatment of neuroblastoma (18% of responses). CONCLUSIONS: There is a wide variation in MRT practice across Europe and for different therapies, including the extent of medical-physicist involvement and the implementation of dosimetry-guided treatments.

Department of Diagnostic Physics Oslo University Hospital Oslo Norway

Department of Medical Physics and Radiation Protection Gurutzeta Cruces University Hospital Barakaldo Spain

Department of Medical Physics Pammakaristos Hospital Athens Greece

Department of Medical Radiation Physics Clinical Sciences Lund Lund University Lund Sweden

Department of Nuclear Medicine and Endocrinology Motol University Hospital 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Nuclear Medicine and PET Center University Hospital Ghent Belgium

Department of Nuclear Medicine Erasmus MC Rotterdam The Netherlands

Department of Surgical Sciences Radiology Uppsala University Hospital Uppsala Sweden

Joint Department of Physics Royal Marsden Hospital and Institute of Cancer Research Sutton UK

Nuclear Medicine Division Foundation IRCCS Istituto Nazionale Tumori Milan Italy

Nuclear Medicine Sant'Andrea Hospital Department of Surgical and Medical Sciences and Translational Medicine Sapienza University of Rome Rome Italy

School of Engineering Cardiff University Cardiff UK

The Christie NHS Foundation Trust Nuclear Medicine Manchester UK

J Radiol Prot. 2023 Jan 30;43(1). doi: 10.1088/1361-6498/acafef. PubMed

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Dosimetry-based treatment planning for molecular radiotherapy: a summary of the 2017 report from the Internal Dosimetry Task Force