Targeted Radionuclide Therapy

Details

Title

Targeted Radionuclide Therapy

Type

Stage Two

Module code

HPE123

Requirement

Optional

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, critically evaluate and apply their expert knowledge of the scientific, technical and clinical principles underpinning targeted radionuclide therapy. They will be able to apply knowledge and understanding to a wide range of routine and more complex technical and clinical situations in a manner that is consistent with the role and responsibilities of a Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, critically evaluate and apply expert knowledge of targeted radionuclide therapy, including:

• Radiation physics and radiopharmacy:
  • sources of artificial radionuclides for therapy, including nuclear reactors, cyclotron and radionuclide generators;
  • design of radiopharmaceuticals for therapy, including the use of pre- prepared non-radioactive kits and automated synthesis modules;
  • physical, chemical and biological mechanisms for target organ localisation;
  • facilities and techniques for the production of radiopharmaceuticals;
  • regulatory requirements and guidance;
  • quality assurance and quality control of therapy
• Radiation dosimetry of internally deposited radionuclides:
  • MIRD and other organ and tissue dose calculation schemes;
  • collection and analysis of dosimetric data, including biokinetic modelling;
  • physical and mathematical phantoms, including demographic dependence;
  • simulation techniques such as Monte Carlo radiation transport modelling;
  • suborgan, multicellular, cellular and subcellular dosimetry.

• Quantitative nuclear medicine:
  • applications of radiopharmaceuticals and indications for different investigations;
  • non-imaging nuclear medicine techniques, including organ uptake measurement and whole body counting;
  • quantification of treatment volume, activity and activity concentration in planar radionuclide imaging, including the identification of regions of interest and the use of conjugate views;
  • attenuation correction using X-ray CT in SPECT and PET;
  • dead time, partial volume effects, scatter correction, volume segmentation and other factors affecting the uncertainties within image quantification;
  • quantification of treatment volume, activity and activity concentration in SPECT and PET, including identification of volumes of interest and calculation of standardised uptake value (SUV);
  • voxel-based dosimetry;
  • measurement of activity and activity concentration in serial measurements;
  • measurement of post-treatment response.
• Clinical applications of targeted radionuclide radiotherapy:
  • selection of radiopharmaceuticals and radionuclides;
  • radiopharmaceutical delivery, including administration by oral, intravenous and other means;
  • treatment regimens, including combination with external beam radiotherapy;
  • treatment planning and the role of pre-treatment and in-treatment measurements of activity distribution;
  • assessment of response to treatment.

Technical and clinical skills

By the end of this module, through the critical application of knowledge and understanding, the Clinical Scientist in HSST will have mastered a wide range of technical skills related to targeted radionuclide therapy. In addition, they will be able to identify suboptimal areas of practice and recommend improvements. They will:

• Lead the production of radiopharmaceuticals for radionuclide therapy:
  • prepare and dispense therapeutic radiopharmaceuticals for administration to patients by appropriate routes;
  • prepare radioactive standards that may be required for quantitative measurements;
  • perform a comprehensive range of physical and chemical quality control tests on radiopharmaceuticals.
• Operate nuclear medicine equipment and apply additional checks required for use in Targeted Radionuclide Therapy (TRT):
  • use non-imaging counters, gamma cameras, SPECT-CT systems and PET- CT systems to acquire data from known activity in physical phantoms;
  • analyse phantom data to obtain values of count rate per unit activity or activity concentration that may be used to calibrate clinical studies;
  • perform quality control tests on nuclear medicine equipment;
  • analyse and interpret the results of quality control tests and take corrective action as required.
• Lead in ensuring the safety of patients, workers and the public in targeted radionuclide therapy:
  • advise colleagues on the application of relevant regulations and guidance;
  • design and operate treatment facilities for day cases, inpatients and outpatients;
  • supervise post-treatment radioactive decontamination of facilities;
  • manage radioactive waste;
  • use a range of radiation monitors, including those designed to record external dose rate and radioactive contamination;
  • perform risk assessments to identify any special controls measures that may be required and estimate ionising radiation doses to comforters and carers, workers and members of the public;
  • advise Radiation Protection Supervisors on radiation safety, including designation of controlled and supervised areas and writing of local rules.

By the end of the end of this module the Clinical Scientist in HSST will be able to work effectively and make authoritative contributions to patient management within a multidisciplinary clinical team, by applying and critically reflecting on a range of clinical and communication skills related to targeted radionuclide therapy. They will:

• Advise colleagues about the choice of radiopharmaceutical for a particular treatment or pre-treatment investigation.
• Advise colleagues about the administration of therapy radiopharmaceuticals in relation to patient pregnancy.
• Contribute to decisions on whether to treat individuals as day cases, inpatients, or outpatients.
• Plan radiopharmaceutical administrations using pre-treatment non-active trials as required.
• Explain nuclear medicine tests and treatments to patients and provide reassurance as required.
• Administer therapeutic radiopharmaceuticals to patients in accordance with locally agreed scope of practice and advise colleagues on such administrations.
• Advise colleagues and patients of behavioural restrictions following the administration of radiopharmaceuticals.
• Acquire nuclear medicine data from patients using non-imaging counters, gamma cameras, SPECT-CT systems and PET-CT systems.
• Calculate organ and tissue dose from the results of quantitative investigations incorporating calibration data from physical phantoms and simulation techniques using mathematical phantoms.
• Plan radionuclide therapy using measured pre-treatment activity distributions and verify therapy with in-treatment measurements.
• Discuss calculated patient radiation doses with colleagues and advise them about likely therapeutic efficacy and possible radiation toxicity.
• Monitor retained radioactivity and determine time from administration to release in accord with guidelines.
• Design a patient referral form for targeted radionuclide therapy.
• Write local standard operating procedures for patient tests and treatments, taking account of available guidance.
• Support applications by medically and dentally qualified colleagues to the Administration of Radioactive Substances Advisory Committee (ARSAC) for certificates to administer radiopharmaceuticals to humans.

Attitudes and behaviours

By the end of this module the Clinical Scientist in HSST will be expected to consistently demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist and will be able to:

• Apply evidence-based professional practice.
• Display a professional commitment to ethical practice.
• Apply the principles of Good Scientific Practice and professional standards.
• Consistently operate in accordance with relevant current national legislation, policy and guidance.