Table 1.

Classification of radionuclide therapies into standardized and non-standardized modalities with options for prescription and dosimetry, according to the level of compliance to the BSS directive’s optimization principle

Disease	Radionuclide/radiopharmaceutical	Standardized	Prescription (level)	Dosimetry	Guidance report
Benign thyroid disease	[131I]NaI	Yes	Activity (L1) or absorbed dose (L3)	Optional	EANM [19, 24]
Differentiated thyroid cancer	[131I]NaI	Yes	Activity (L1) or absorbed dose (L3)	Optional	EANM [21, 25] MIRD [16]
Neuroblastoma in children	[131I]mIBG	Yes	Activity/BW (L2)/lesion absorbed dose (L3)	Advisable (L2/L3)	EANM [18, 26] MIRD [16]
Neuroendocrine	[131I]mIBG	Yes	Activity (L1)	Optional (L2)	EANM [18, 26] MIRD [16]
	[90Y]Y-DOTATOC (and other 177Lu- or 90Y-labelled SSTR ligands)	No	Activity/BSA (L2) or absorbed dose (L3)	Advisable (L2)	EANM [27] MIRD [12]
	[177Lu]Lu-DOTATATE (Lutathera®)	Yes	Activity (L1)	Optional	EANM [27] MIRD [17]
Bone pain palliation	[89Sr]SrCl2	Yes	Activity (L1)	Not feasible (L1)
	[153Sm]Sm-EDTMP	Yes	Activity (L1)	Optional
	[223Ra]RaCl2 (Xofigo®)	Yes	Activity (L1)	Optional (99mTc/18F)	EANM [28] MIRD [14]
Metastatic liver cancer/colorectal	90Y-microspheres	Yes	Activity/BSA (L1) Absorbed dose (L2/L3)	Optional advisable(L2)	EANM [29]
	166Ho-microspheres	Yes	Absorbed dose (L2/L3)	Required
Pancreatic adenocarcinoma	32P-labelled microparticles	No	Absorbed dose (L3)	Required (volume)
Radiation synoviorthesis	[169Er]Er-citrate [90Y]Y-silicate/citrate [186Re]Re-sulphide	Yes	Activity (L1)	Not feasible Optional (L1)	EANM [30]
Lymphoma	[90Y]Y-ibritumomab tiuxetan (Zevalin®)	Yes	Activity/BW (L1)	Not feasible Optional (111In)	EANM [31] MIRD [32]
	[177Lu]Lu-lilotomab satetraxetan	No	Activity/BW (L2)	Advisable (L2)
Metastatic prostate cancer	[177Lu]Lu-PSMA-ligands	No/yes after MA1	Activity (L1/L2)	Advisable (L2)/optional (L1)1	EANM [33]

¹After marketing authorization by European regulatory authority EMA

BW body weight, BSA body surface area