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ACR-ACNM-ARS-SNMMI Practice Parameter for the Performance of Therapy With Radium-223 Dichloride.

Esma A Akin¹, Paul E Wallner², Sindu Alexander³

¹Department of Radiology, The George Washington University Medical Center, Washington, DC.

American Journal of Clinical Oncology

|August 25, 2025

Summary

This updated practice parameter provides guidance on radium-223 dichloride therapy for physicians. It covers its use in metastatic cancers, including prostate cancer, and addresses safety and quality control.

Keywords:

radium-223 radium-223 practice parameter radium-223 therapy

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Area of Science:

Nuclear Medicine and Molecular Imaging
Radiation Oncology

Background:

The American College of Radiology (ACR) and affiliated societies have updated their 2019 practice parameter for radium-223 dichloride therapy.
This revision incorporates new research and applications for radium-223 therapy since its initial publication.

Purpose of the Study:

To provide an updated practice parameter for radium-223 dichloride therapy.
To guide physicians in the appropriate use of radium-223 dichloride for various metastatic cancer sites.

Main Methods:

Collaborative revision by the ACR, American College of Nuclear Medicine (ACNM), American Radium Society (ARS), and Society of Nuclear Medicine and Molecular Imaging (SNMMI).
Review of reports published since the 2019 initial practice parameter.
Adherence to the ACR's established process for developing practice parameters and technical standards.

Main Results:

Significant investigation into radium-223 dichloride for numerous metastatic cancer sites beyond hormone-resistant prostate cancer.
The updated parameter addresses physical properties, indications (current and investigative), personnel qualifications, treatment specifications, radiopharmaceutical use, radiation safety, and quality control.

Conclusions:

The updated practice parameter guides credentialed physicians in radium-223 dichloride therapy.
It encompasses all aspects of patient and radioisotope management, including current and emerging indications.