TABLE 1.

Summary of recommendations for implementing RLT at US Centers.

Minimum requirements Estimate minimum annual caseload to justify offering RLT Obtain institutional radioactive materials license for the specific radioisotopes and total doses of each used Identify authorized user for radioisotopes used in desired RLTs Develop a radiation safety team, including a radiation safety officer Identify and include other key personnel for RLT preparation and administration Nursing staff to help deliver RLT and monitor patients Nuclear medicine technologists to prepare RLTs Pharmacists to coordinate supportive care medications Identify medical oncologists or other providers (radiation oncologists, surgical oncologists, or other specialists depending on tumor type) with whom to partner for RLT referrals and care coordination Identify and prepare the space within the institution for delivery of RLT, including access to patient bathroom

Systems considerations Form a steering committee to guide center setup Establish procedures for patient referral, selection, and care coordination Implement a multidisciplinary treatment team Define procedures for treatment administration and medication management, including all equipment and administration protocols Define protocols for when to treat patients on an outpatient basis and when inpatient treatment may be necessary Implement procedures for decontamination and waste management Establish patient counseling procedures (supplemented with patient educational material) and discharge procedures Define a patient follow‐up strategy by the treating physician, referring physician, or both Determine what changes to patient support logistics will be needed when transitioning from clinical trial to “real‐world” settings Establish procedures for efficient preauthorization and billing

Abbreviations: AU, authorized user; RLT, radioligand therapy; US, United States.