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

Objectives: This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American College of Nuclear Medicine (ACNM), the American Radium Society (ARS), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The document represents an update of the radium-223 therapy practice parameter developed by the societies in 2019. Methods: This practice parameter was revised according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Nuclear Medicine and Molecular Imaging of the ACR Commissions on Nuclear Medicine and Molecular Imaging and the Committee on Practice Parameters - Radiation Oncology of the ACR Commission on Radiation Oncology, in collaboration with the ACNM, the ARS, and the SNMMI. Reports available since the publication of the initial document in 2019 were collected and reviewed. Results: Since the publication of the initial radium-223 practice parameter in 2019, there has been significant investigation of the agent in the management of numerous metastatic cancer sites, in addition to additional studies of its use in metastatic hormone-resistant prostate cancer. This updated document considers physical properties of the agent, current and investigative indications, qualifications and responsibilities of personnel, specifications of the evaluation exam and treatment, the therapeutic use of unsealed radiopharmaceutical sources, radiation safety, and quality control. Conclusions: This updated practice parameter is intended to guide appropriately trained and credentialed physicians performing therapy with radium-223 dichloride. All aspects of patient and radioisotope management are considered, as are current indications and ongoing investigations.