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Safety

Radiation Safety and Counseling

Radiation guidelines for patients

Posttreatment patient safety guidelines
(NANETS/SNMMI consensus and Mayo Clinic recommendations)

Each treatment center will have their own guidelines, but here are some frequently discussed topics when it comes to posttreatment LUTATHERA radiation precautions.

Icon of a person sitting on the toilet

Using the toilet

For at least 3 days, patients should use the toilet in a seated position and flush the toilet twice after use.1

 

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Showering

For at least 7 days, patients should shower daily. Patients should use separate towels and washcloths.1,2

 

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Sleeping

For at least 3 days, patients should sleep in a separate bed and avoid intimate contact.1

 

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Interacting with others

For at least 3 days, patients should use a general distance guideline of no closer than 3 feet for not more than 1 hour per day. They should try to maintain a distance of 6 feet from others and minimize public transportation and use of public facilities.1

 

Radiation guidelines for HCPs and caregivers

HCP and caregiver radiation exposure was tested in a 4-patient, 4-bed outpatient center3

Radiation exposure in HCPs and caregivers following outpatient treatment with Lutetium 177 on the LUTATHERA regimen was tested in an outpatient study with 4 sequentially treated patients in a 4-bed room.3

Exposures to HCPs and caregivers were within ICRP limits (ICRP radiation exposure limit is 20 mSv per year)3,4

A graphic outlining a plane traveling from the state of California to the state of Hawaii.

Exposure to HCPs was similar to that of a flight crew on regular round-trip flights from Los Angeles to Honolulu3,5


Exposure is 14.5 μSv on a 5.2-hour flight from Los Angeles, California to Honolulu, Hawaii.5


Mean whole-body radiation exposures per therapy treatment day with 4 patients when administering Lutetium 177 ranged from 6.8 μSv (nuclear medicine technologist) to 33.2 μSv (nurse).3


Exposure to caregivers


For caregivers, mean total exposure during the day of therapy and at home for a period of up to 5 days was 90 μSv, with a median exposure of 40 μSv and range of 10 μSv to 470 μSv.3

Patients are discharged from the treatment center only when radiation exposure to third parties does not exceed regulatory thresholds3

Seventy-six patients with progressive, metastatic NETs each received 4 cycles of 7.8 GBq of Lutetium 177 at 8-week intervals in an outpatient setting at 1 treatment center. Four patients were treated sequentially on each therapy day in a 4-bed room in the hospital’s day procedure unit, with each patient remaining until radiation exposure was below the release limit. Radiation exposures to HCPs and caregivers were monitored by personal dosimeter. Twenty-five carers were provided with electronic dosimeters. In the nearby staff office with a 50% staff occupancy factor, the mean (range) exposure rate measured on 10 different therapy administration days was 1.6 μSv/h (1.3–2.0 μSv/h), and at the nursing station with 100% staff occupancy it was 3.5 μSv/h (2.9–4.0 μSv/h).3
 
GBq, gigabecquerel; HCPs, health care professionals; ICRP, International Commission on Radiological Protection; μSv, microsievert; mSv, millisievert; NANETS, North American Neuroendocrine Tumor Society; NETs, neuroendocrine tumors; SNMMI, Society of Nuclear Medicine and Molecular Imaging.
References: 1. Hope TA, Abbott A, Colucci K, et al. NANETS/SNMMI procedure standard for somatostatin receptor–based peptide receptor radionuclide therapy with 177Lu-DOTATATE. J Nucl Med. 2019;60(7):937-943. 2. Kendi AT, Halfdanarson TR, Packard A, Dundar A, Subramaniam RM. Therapy with 177Lu-DOTATATE: clinical implementation and impact on care of patients with neuroendocrine tumors. AJR Am J Roentgenol. 2019;213(2):309-317. 3. Calais PJ, Turner JH. Radiation safety of outpatient 177Lu-octreotate radiopeptide therapy of neuroendocrine tumors. Ann Nucl Med. 2014;28(6):531-539. 4. US Department of Health and Human Services: Radiation Emergency Medical Management. International Commission on Radiological Protection (ICRP) Guidance for occupational exposure. Updated May 3, 2024. Accessed June 12, 2024. https://remm.hhs.gov/ICRP_guidelines.htm 5. Friedberg W, Copeland K, Duke FE, O’Brien K III, Darden EB Jr. Radiation exposure during air travel: guidance provided by the Federal Aviation Administration for air carrier crews. Health Phys. 2000;79(5):591-595.