Standard Safety Procedure Before Therapeutic Administration of ²²³Ra-Dichloride

²²³Ra-dichloride is an α-emitter therapy approved for the treatment of castration-resistant prostate cancer with symptomatic bone metastases. ²²³Ra-dichloride is the first targeted α-therapy for this indication with evidence of benefit in overall survival. The administration is intravenous, and extravasation can cause severe injuries such as tissue necrosis. To prevent this side effect, some procedures can be performed according to the guideline of the European Association of Nuclear Medicine. Ionizing radiation is a well-established risk factor for the development of cutaneous squamous cell carcinoma, but surprisingly there are few reports of local adverse effects related to extravasation of radiotherapies at the injection sites. Recently, a possible case of cutaneous cancer was observed after ²²³Ra-dichloride extravasation. Methods: To complement the prevention of extravasation, we developed a standardized technique to be performed before the injection of ²²³Ra. Results: Our technique was successfully applied to the study population, and no apparent extravasation was seen. Conclusion: Our study suggests that use of this standardized technique before administration of ²²³Ra is helpful in preventing extravasation during this treatment.