Establishing a safe, comprehensive radium 223 dichloride practice

2637 Objectives According to the National Cancer Institute, prostate cancer is the most common cancer in the United States, with over 200,000 new cases diagnosed annually. Fifteen percent of men will get prostate cancer at some point in their lifetime. While prognosis tends to be good, bone is one of the most common sites for spread of this disease. Radium 223 dichloride was approved for treatment of bone metastases from prostate cancer in the U.S. in 2013. The objective was to establish a radium practice meeting all radiation safety requirements while satisfying the referring physicians and patients. Methods As a tertiary care center with a strong emphasis in cancer treatment, there was significant interest in this new therapy from referring physicians. The first requirement was to get radium added to the Radioactive Material License. Next, any potential users needed to be added to the Authorized User list. The dose was added to the List of Approved Doses. A Written Directive needed to be created. The dose calibrator setting was established using a NIST dose. This step must be repeated annually. A protocol needed to be written, incorporating safe handling of this alpha emitter. The order codes were set up; changes in isotope billing in 2015 required modification of this process. Finally, introduction of the workflow to the Radiation Oncologists had to occur in order to ensure a smooth process for all involved. Results To date, 106 treatments have been successfully administered: 12 patients have completed the 6 injection treatment plan, 3 patients stopped early due to disease progression, and 7 patients are undergoing treatment. No immediate complications were seen at the time of injection. A state inspection did not result in any concerns. Conclusions With careful planning and attention to detail, a successful radium practice can be established. Ongoing efforts are needed to ensure any changes, such as the recent billing adjustments, are incorporated. Offering this therapy requires little initial financial output, making it feasible for many departments to start, irregardless of the size of the patient population.