Radiation Safety in a Clinical Setting: Best Practices for Lutetium-177 Pluvicto Treatments

What is “Theranotics”?

At Rhode Island Hospital, the term “Theranostics” is on the rise. Theranostics combines an advanced diagnostic imaging (PET/CT) to detect cancer, and a targeted radioactive therapy to destroy cancer cells in the body (check out this webinar for a deeper dive into the advancements of radiation safety in theranotics). 

The FDA approved Lutetium-177 (Lu-177) vipivotide tetraxetan, also known has Lu-177 Pluvicto, is becoming one of the most frequently performed treatments in Nuclear Medicine. This targeted therapy treats patients with prostate cancer who have prostate-specific membrane antigen (PSMA) positive cancer cells that could have spread or metastasized to other parts of the body. Patients receive this treatment intravenously via infusion (standard dose of 200 mCi) every 6 weeks for a total of 6 treatments. Lu-177 Pluvicto has shown to reduce the growth of tumors and prolong the lives of male patients. Currently, Rhode Island Hospital is performing this therapy on average 3 patients per week, with plans to treat more. 

Lu-177 emits high-energy beta and low-energy gamma particles and has a half-life of approximately 6.7 days, so it is important to have safety guidelines for both the patient and employees performing the treatment. Since Lu-177 emits more beta particles, the exposure from the patient is relatively low due to a lower penetrating power, however, employees wear chest radiation badges and ring dosimeters to monitor their exposure. 

If hospitals or healthcare facilities treat more patients daily, there is more room for safety incidents to occur. To prevent unnecessary contamination and ensure there are no radiation safety incidents, important safety guidelines during the performance of these treatments is necessary.

Practicing ALARA at Rhode Island Hospital

The concept of time, distance and shielding to keep dose as low as reasonably achievable (ALARA) is essential for staff during these treatments. On the day of treatment, a radioactive materials sign “Caution: Radiation Area: Authorized Personnel Only” is posted and the treatment area is restricted to the public. It is important the room floor is lined with absorbent plastic paper for prevention of any spills or drops that could cause fixed contamination. The patient chair arms, and bottom seat is also covered with chucks (absorbent pads) to prevent any contamination during infusion. 

To prevent further contamination, the bathroom floor is also lined as well as the toilet seat cover. Patients are advised to flush twice after bathroom use and male patients are encouraged to sit while urinating to prevent splashing. When the patient has finished their treatment, radiation safety staff will decommission the room by carefully pulling up the plastic tarping from the floor and any additional coverings. 

Radiation surveys with a Geiger-Muller survey meter (similar to the RaySafe 452 Radiation Survey Meter) and wipe tests of multiple areas is performed to ensure the area is free of contamination. The collected waste is then stored for decay in coherence to our waste storage guidelines. The hospitals also require patients to acknowledge they will be radioactive when they leave the facility, and it is important to follow some guidelines for the next few days to prevent unnecessary exposure to family members or the general public. They provide a list of items to follow which includes sleeping alone for the first few days after treatment, limiting prolonged contact with others, avoiding mass transit (bus, train, etc.), and important precautions to take when going to the bathroom at home.

Conclusion

If a hospital or healthcare facility plans to treat patients with Lu-177 Pluvicto, radiation safety incidents could remain low if they are consistent with the safety strategies above. Enforcing strict guidelines, preparing the room for the prevention of contamination, and having exceptional communication between staff and patients is crucial for these treatments and the safety of all involved.

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