Endocrine Abstracts

Patients with neuroendocrine disease now have the option of having peptide receptor radionuclide therapy (PRRT) for both symptomatic treatment and reducing disease progression. Lutetium (¹⁷⁷Lu) oxodotreotide is funded centrally in the UK and several sites have recently begun to provide the treatment for their patients. There are, however, several logistical, operational and regulatory obstacles which must be navigated to ensure the service is both safe and efficient. These include (but are not limited to):

• Submitting a formal business case to include; staffing, radiopharmaceutical cost, consumables, and camera time.

• Ensuring that regulatory and radiation protection aspects are fulfilled, such as;

  º IR(ME)R 2017 (including ARSAC licensing)

  º IRR2017 (including risk assessment, local rules, appropriate shielding, contingency rehearsals, staff dose monitoring, radiation protection advice to the patient, and contamination monitoring)

  º EPR 2016 (to include holding of radioactive materials and any waste produced, including patient excretions)

• Documentation including; procedures and protocols, patient pathways, policies for contingency, such as extravasation, hormonal crisis or sudden illness / death of the patient following treatment, as well as patient information and instructions

• Imaging procedures pre- and post- administration, to include dosimetry and sensitivity measurements

• Calibration of equipment to standards, such as dose calibrators, contamination monitors

• Collaboration with other departments

• Training of all staff, e.g. ward staff caring for inpatients, nursing staff accompanying the patient, nuclear medicine staff imaging, the operator administrating the ¹⁷⁷Lu

• Appropriate room booking, which may be challenging for centres without a dedicated molecular radiotherapy treatment suite

• Room set up and post-discharge decontamination of the room

• Criteria for inpatient/outpatient treatment

The whole team, including the referrers, clinicians, physicists, nurse specialists, technologists, radiologists, etc. must be involved in the planning of the service from the outset, with specific roles and responsibilities detailed. Regular meetings and a ‘cold’ run are strongly recommended to highlight issues prior to treatment of the first patient. Site visits and shared experience are also helpful, particularly learning outcomes from incidents and accidents.