Purpose: Ra-223 has recently been adopted as a targeted radiopharmaceutical therapy for castration resistant prostate cancer patients with bone metastasis. Ra-223 therapy increases life expectancy with a relatively simple procedure involving the injection of Ra-223 for up to 6 fractions every four weeks. This treatment could be a routine procedure in a nuclear medicine department, its implementation is challenging in a small radiation oncology center, due to lack of staff experience. The purpose of this work is to give a guidance and share the experience for an independent small radiation oncology center about to launch the program.
Methods: Physicians, physicists and nurses worked as a team in the process led by a physicist who will serve as RSO. Communication among staffs is critical for a successful workflow. We followed the code of Maryland regulation specific to radioactive material license consistent with federal nuclear regulatory commission. There were three phases of program build-up. It is imperative to obtain the license in the first place for some agreement states submission of detailed documentation of whole radiation safety procedures is essential. Secondly, emergency plan and safety training for the staffs were performed. The last phase involved equipment acceptance and QA, source logistics and workflow development.
Results: The documentation of radiation safety procedures, staff training and acceptance and initial calibration of dose calibrator and well chambers and workflow development using ARIA® EMR were completed for first treatment. At our institution, we have treated 10 fractions of Ra-223 injections without any incident for 5 months since the launch of the program.
Conclusion: The implementation involves team effort of administrators, physicians, nurses and physicists. For a small cancer center, a physicist who also should serve as a RSO plays as a leading role to establish and oversee radiation safety program as well as workflow establishment.