Abstract Radioligand therapy with lutetium-177 is an effective treatment option for patients with metastatic castration-resistant prostate cancer and metastatic neuroendocrine tumors. In Germany, radiation protection laws require hospitalization with isolation, which may cause capacity problems. Internationally, models show the feasibility of non-inpatient radioligand therapy under strict safety measures. Patient acceptance is crucial for the implementation of flexible care models. This study aimed to assess patient preferences, concerns and requirements for non-inpatient radioligand therapy. An anonymous cross-sectional study was conducted in 46 patients receiving radioligand therapy in a nuclear medicine department. The questionnaire collected demographic and clinical data, treatment preferences, benefits and limitations of various care settings and factors influencing the acceptance of outpatient treatments. Analysis was done descriptively. Most patients (95.7%) valued inpatient monitoring and safety. However, 53.2% of patients preferred a shortened hospital stay and 54.4% of patients rated semi-inpatient care as ideal. Only 8.9% of patients supported a fully outpatient approach. Key barriers to home-based care are radiation exposure and lack of medical supervision. Patients with better performance status showed greater acceptance to non-inpatient models. Educational materials and guaranteed telephone access to clinical staff were identified as important for increasing acceptance. Patients express a strong interest in individualized, flexible radioligand therapy with reliable safety structures. Risk-adapted semi-inpatient models may improve patient-centered care and alleviate pressure on inpatient resources. However, potential risks as radiation exposure to family members and subsequent safety measures need to be explored in controlled trials.
Abstract Positron emission tomography radiopharmaceuticals have short physical half-lives, making transport time a key determinant of their clinical availability. This study evaluated the potential of unmanned aerial vehicle–based transport to improve radiopharmaceutical distribution compared with conventional road transport. Ground- and unmanned aerial vehicle–based transport scenarios were compared within standardized regulatory and radiopharmacy frameworks. Representative distribution routes were analysed, and radioactive decay was modelled using exponential decay kinetics. Activity preservation was evaluated for 18F, 68Ga, and 11C using representative distribution scenarios for 18F-FDG and 68Ga-PSMA. The modelling analysis predicted shorter and more predictable delivery times for unmanned aerial vehicle–based transport than for conventional road transport. The reduced transport duration increased the residual activity available at the time of administration, with the greatest benefit predicted for short-lived radionuclides. In a representative scenario, reducing the transport time from approximately 110 to 70 minutes was associated with increased residual 18F activity from approximately 50 to 64%. A corresponding increase from approximately 33 to 49% was predicted for 68Ga, whereas 11C exhibited the greatest sensitivity to transport time. Unmanned aerial vehicle–based transport could improve positron emission tomography radiopharmaceutical distribution by reducing decay losses, increasing operational flexibility, and enabling higher patient throughput per production batch. Clinical implementation remains limited by regulatory, technical, and environmental challenges. Experimental validation and real-world studies are needed to confirm feasibility.
Abstract Pretherapeutic dosimetry is an essential component of individualized radioiodine therapy. This study aimed to compare radioiodine therapies planned according to the Marinelli equation or DIN 6861-1:2021-11 with regard to the deviation of the planned and achieved thyroid doses in patients with benign thyroid diseases. The relative deviation of the achieved thyroid dose during radioiodine therapy from the pretherapeutically planned dose was analyzed according to the applied dosimetric method. Patient cohorts with goiter, recurrent goiter, disseminated and focal thyroid autonomy and autoimmune thyroid disease were evaluated. The cohorts were compared using the Mann–Whitney U- test. For goiter, recurrent goiter, disseminated thyroid autonomy and focal thyroid autonomy, radioiodine therapies planned according to DIN 6861-1:2021-11 were associated with significantly smaller deviations between the planned and achieved thyroid doses than therapies planned according to the Marinelli equation. Depending on the diagnostic group, the mean relative deviation was approximately 15 to 32 percentage points lower in the DIN cohorts. The DIN cohorts also showed less variability in dose deviations. In patients with autoimmune thyroid disease, no statistically significant differences of the mean relative deviation were observed between the dosimetric methods. However, variability was also lower in the DIN cohorts. The use of DIN 6861-1:2021-11 is associated with improved prediction of the thyroid dose compared with the Marinelli equation and may contribute to more precise individualized planning of radioiodine therapy in patients with benign thyroid diseases.
