Safe Use of Radium-223 Dichloride (223racl2) Across a Wide Range of Clinical Scenarios, Incorporating a 10-Year Single-Institution Radiation Safety Experience.

Radium 223Ra dichloride (223RaCl2) is an effective therapeutic radiopharmaceutical presently approved for the treatment of prostate cancer metastatic to bone. It is unique by virtue of being the first alpha-emitting radiopharmaceutical to achieve approval for use in the clinic, reaching this status both in the United States and Europe in 2013. In over ten years of research and approved clinical usage, the authors have encountered very few radiation-safety incidents of concern with 223RaCl2; in this review, they relate their first-hand experience with this radiopharmaceutical and share some lessons learned, including situations of bleeding, surgery and patient demise. The authors first provide a basic review of the relevant physical properties of 223Ra and aspects of its radiobiology, followed by a discussion of the biodistribution of 223RaCl2, the radiopharmaceutical presently approved for clinical use. As would be expected from a primarily alpha emitter, external exposures to staff and family members from patients administered 223Ra are typically low in comparison with exposure from patients who have undergone other nuclear medicine procedures. There still remains potential for health care workers and family members to receive a significant internal exposure, through the ingestion of even minute amounts of activity, so proper handling practices are paramount.