Implementation of a Multidisciplinary Radiopharmaceutical Dosimetry Program: Key Practical Considerations and...

Radiopharmaceutical therapy (RPT) is a multidisciplinary treatment increasingly integrated within both radiation oncology and nuclear medicine departments. Dosimetry is an emerging aspect of RPT clinical practice that can inform prognosis and treatment decisions and facilitate more personalized care. Establishing an institutional RPT dosimetry program requires coordination across clinical, technical, and administrative teams to enable patient-specific absorbed dose calculations. This report summarizes the University of Wisconsin's experience in developing and operationalizing a multidisciplinary clinical RPT dosimetry program, leveraging the strengths of radiation oncology and nuclear medicine physicians, medical physicists, and staff, and offering a practical framework for other institutions.

The program was designed through collaboration among radiation oncology, nuclear medicine, medical physics, radiation safety, and nuclear pharmacy. Core elements include quantitative single-photon emission computed tomography/computed tomography imaging, multitimepoint image registration, voxel-level Monte Carlo dose calculation, and structured multidisciplinary patient review. Standardized quality assurance processes were implemented to ensure accuracy and reproducibility. A billing model was incorporated to streamline authorization and cost recovery among stakeholders.

The University of Wisconsin experience demonstrates that multitimepoint RPT dosimetry is feasible and can be integrated into routine clinical workflows with appropriate infrastructure, interdepartmental coordination, and leadership support. Utilizing the expertise of multiple departments is key to an effective program. Early engagement of stakeholders, harmonized imaging protocols, and streamlined data management are critical to success. Broader adoption may be facilitated with the development of standardized reimbursement models, national quality assurance standards, and educational efforts to prepare radiation oncology and nuclear medicine teams for patient-specific RPT care.