ACR–ACNM–ARS–SNMMI PRACTICE PARAMETER FOR LUTETIUM-177 (Lu-177) DOTATATE THERAPY

PREAMBLE

INTRODUCTION

II.

INDICATIONS

III.

QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL

IV.

SPECIFICATIONS OF THE EXAMINATION AND TREATMENT

Clinical Evaluation

IV.

SPECIFICATIONS OF THE EXAMINATION AND TREATMENT

Treatment Procedures for Infusion on Lu-177 DOTATATE

IV.

SPECIFICATIONS OF THE EXAMINATION AND TREATMENT

Post-Therapy Management

DOCUMENTATION

VI.

STATEMENT OF THERAPEUTIC USE OF UNSEALED RADIOPHARMACEUTICAL SOURCES

VII.

EQUIPMENT SPECIFICATIONS

VIII.

RADIATION SAFETY

IX.

QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION

ACKNOWLEDGEMENTS

Writing Committee – members represent their societies in the initial and final revision of this practice parameter

ACR
Sio, Terence Tai-Weng MD, MS, Co-Chair
Solnes, Lilja B MBA, MD, Co-Chair
Freedman, Laura MD
Morris, Zachary MD

ACNM
Bodei, Lisa MD, PhD
Mittra, Erik MD, PhD
Shah, Jagruti

ARS
Hassanzadeh, Comron MD, MPH

SNMMI
Millo, Corina MD
Morgan, Rustain L MD

Committee on Practice Parameters – Nuclear Medicine and Molecular Imaging

(ACR Committee responsible for sponsoring the draft through the process)

Ghesani, Munir V MD, Chair	Subramaniam, Rathan M MBA, MD, MPH, PhD, Chair	Aboian, Mariam MD, PhD	Akin, Esma A MD
Bartel, Twyla B DO, MBA	Dibble, Elizabeth H MD	Gerard, Perry S MD	Karagulle Kendi, A. Tuba MD
Marcus, Charles MD	Mercier, Gustavo A MD, PhD	Peacock, Justin G MD, PhD	Solnes, Lilja B MBA, MD
Surasi, Devaki Shilpa MD	Trout, Andrew T MD	Wong, Terence Z MD, PhD	Zukotynski, Katherine MD, PhD

Committee on Practice Parameters – Radiation Oncology

(ACR Committee responsible for sponsoring the draft through the process)

Chao, Samuel MD, Chair	Berkowitz, Aviva MD	Davis, Brian J MD, PhD	Farach, Andrew M MD
Frank, Steven J MD	Freedman, Laura MD	Garsa, Adam MD	Lo, Simon S. ChB, MB
Morris, Zachary MD	Rabatic, Bryan MD	Schechter, Naomi MD	Sio, Terence Tai-Weng MD, MS
Ziemer, Benjamin MS, PhD

Committee on Practice Parameters and Technical Standards

(ACR Committee responsible for sponsoring the draft through the process)

Caplin, Drew M MD, Chair

Rohren, Eric MD, PhD, Chair, Commission on Nuclear Medicine & Molecular Imaging

Small, William MD, Chair, Commission on Radiation Oncology

Comments Reconciliation Committee

Chen, Melissa MD - CSC, Chair	Moriarity, Andrew MD - CSC, Co-Chair	Bartel, Twyla B DO, MBA	Bodei, Lisa MD, PhD
Caplin, Drew M MD	Chao, Samuel MD	Freedman, Laura MD	Ghesani, Munir V MD
Hassanzadeh, Comron MD, MPH	Millo, Corina MD	Mittra, Erik MD, PhD	Morgan, Rustain L MD
Morris, Zachary MD	Rohren, Eric MD, PhD	Shah, Jagruti	Sio, Terence Tai-Weng MD, MS
Small, William MD	Solnes, Lilja B MBA, MD	Subramaniam, Rathan M MBA, MD, MPH, PhD

REFERENCES

1. [35507413] Love C, Desai NB, Abraham T, et al. ACR-ACNM-ASTRO-SNMMI Practice Parameter for Lutetium-177 (Lu-177) DOTATATE Therapy. American Journal of Clinical Oncology. 45(6):233-242, 2022 06 01.
2. [-3197650] American College of Radiology. ACR-AAPM-ACNM-SNMMI Technical Standard for Therapeutic Procedures Using Radiopharmaceuticals. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=153+&releaseId=2
3. [34793718] Strosberg JR, Caplin ME, Kunz PL, et al. 177Lu-Dotatate plus long-acting octreotide versus high-dose long-acting octreotide in patients with midgut neuroendocrine tumours (NETTER-1): final overall survival and long-term safety results from an open-label, randomised, controlled, phase 3 trial. Lancet Oncol. 2021 Dec;22(12):S1470-2045(21)00572-6.
4. [18565894] Yao JC, Hassan M, Phan A, et al. One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008 Jun 20;26(18):3063-72.
5. [31306159] Perri G, Prakash LR, Katz MHG. Pancreatic neuroendocrine tumors. Curr Opin Gastroenterol. 2019 Sep;35(5):468-477.
6. [37046665] Sulciner ML, Clancy TE. Surgical Management of Pancreatic Neuroendocrine Tumors. Cancers (Basel). 2023 Mar 28;15(7):2006.
7. [36585339] Kandathil A, Subramaniam RM. Gastroenteropancreatic Neuroendocrine Tumor Diagnosis: DOTATATE PET/CT. PET Clin. 2023 Apr;18(2):S1556-8598(22)00088-8.
8. [34010146] Kesavan M, Grover P, Lam WS, Claringbold PG, Turner JH. Long-term hematologic toxicity of 177Lu-octreotate-capecitabine-temozolomide therapy of GEPNET. Endocr Relat Cancer. 2021 Jun 20;28(7):521-527.
9. [6395400] Zamfir G, Rugina V, Mihail G. The role of certain socio-sanitary factors in conditioning the quality of man's life. Part One. Sante Publique (Bucur). 1984;27(2):125-40.
10. [35776234] Espinosa-Olarte P, La Salvia A, Riesco-Martinez MC, Anton-Pascual B, Garcia-Carbonero R. Correction to: Chemotherapy in NEN: still has a role?. Rev Endocr Metab Disord. 2022 Oct;23(5):1103-1104.
11. [35939200] Agarwal P, Mohamed A. Systemic Therapy of Advanced Well-differentiated Small Bowel Neuroendocrine Tumors Progressive on Somatostatin Analogues. Curr Treat Options Oncol. 2022 Sep;23(9):1233-1246.
12. [28263217] Hamiditabar M, Ali M, Roys J, et al. Peptide Receptor Radionuclide Therapy With 177Lu-Octreotate in Patients With Somatostatin Receptor Expressing Neuroendocrine Tumors: Six Years' Assessment. Clin Nucl Med. 2017 Jun;42(6):436-443.
13. [18445841] Kwekkeboom DJ, de Herder WW, Kam BL, et al. Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0,Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol. 26(13):2124-30, 2008 May 01.
14. [25273832] Bodei L, Kidd M, Paganelli G, et al. Long-term tolerability of PRRT in 807 patients with neuroendocrine tumours: the value and limitations of clinical factors. Eur J Nucl Med Mol Imaging. 2015 Jan;42(1):5-19.
15. [29497803] Garske-Román U, Sandström M, Fröss Baron K, et al. Prospective observational study of 177Lu-DOTA-octreotate therapy in 200 patients with advanced metastasized neuroendocrine tumours (NETs): feasibility and impact of a dosimetry-guided study protocol on outcome and toxicity. Eur J Nucl Med Mol Imaging. 2018 Jun;45(6):970-988.
16. [35389069] Clement D, Navalkissoor S, Srirajaskanthan R, et al. Efficacy and safety of 177Lu-DOTATATE in patients with advanced pancreatic neuroendocrine tumours: data from the NETTER-R international, retrospective study. European Journal of Nuclear Medicine & Molecular Imaging. 49(10):3529-3537, 2022 08.
17. [28076709] Strosberg J, El-Haddad G, Wolin E, et al. Phase 3 Trial of (177)Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med 2017;376:125-35.
18. [22388631] Kam BL, Teunissen JJ, Krenning EP, et al. Lutetium-labelled peptides for therapy of neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2012 Feb;39 Suppl 1(Suppl 1):S103-12.
19. [20554737] Vegt E, de Jong M, Wetzels JF, et al. Renal toxicity of radiolabeled peptides and antibody fragments: mechanisms, impact on radionuclide therapy, and strategies for prevention. J Nucl Med. 2010 Jul;51(7):1049-58.
20. [36877234] Mitjavila M, Jimenez-Fonseca P, Belló P, et al. Efficacy of [177Lu]Lu-DOTATATE in metastatic neuroendocrine neoplasms of different locations: data from the SEPTRALU study. Eur J Nucl Med Mol Imaging. 2023 Jul;50(8):2486-2500.
21. [33854479] Patel M, Tena I, Jha A, Taieb D, Pacak K. Somatostatin Receptors and Analogs in Pheochromocytoma and Paraganglioma: Old Players in a New Precision Medicine World. [Review]. Frontiers in Endocrinology. 12:625312, 2021.
22. [36723881] Liu Q, Kulkarni HR, Zhao T, et al. Peptide Receptor Radionuclide Therapy in Patients With Advanced Progressive Medullary Thyroid Cancer: Efficacy, Safety, and Survival Predictors. Clin Nucl Med. 2023 Mar 01;48(3):221-227.
23. [37111596] Urso L, Nieri A, Uccelli L, et al. Lutathera® Orphans: State of the Art and Future Application of Radioligand Therapy with 177Lu-DOTATATE. Pharmaceutics. 2023 Mar 31;15(4):1110.
24. [38164150] Richter S, Steenblock C, Fischer A, et al. Improving susceptibility of neuroendocrine tumors to radionuclide therapies: personalized approaches towards complementary treatments. Theranostics. 2024;14(1):17-32.
25. [38271237] Trautwein NF, Hinterleitner C, Kiefer LS, et al. Radiosensitizing Favors Response to Peptide Receptor Radionuclide Therapy in Patients With Highly Proliferative Neuroendocrine Malignancies: Preliminary Evidence From a Clinical Pilot Study. Clin Nucl Med. 2024 Mar 01;49(3):207-214.
26. [38851203] Singh S, Halperin D, Myrehaug S, et al. [177Lu]Lu-DOTA-TATE plus long-acting octreotide versus high-dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet. 2024 Jun 29;403(10446):S0140-6736(24)00701-3.
27. [3384479] Neumann HG. Biomonitoring of aromatic amines and alkylating agents by measuring hemoglobin adducts. Int Arch Occup Environ Health. 1988;60(3):151-5.
28. [36550428] Deshayes E, Assenat E, Meignant L, Bardiès M, Santoro L, Gourgou S. A prospective, randomized, phase II study to assess the schemas of retreatment with Lutathera® in patients with new progression of an intestinal, well-differentiated neuroendocrine tumor (ReLUTH). BMC Cancer. 2022 Dec 22;22(1):1346.
29. [33755166] Kipnis ST, Hung M, Kumar S, et al. Laboratory, Clinical, and Survival Outcomes Associated With Peptide Receptor Radionuclide Therapy in Patients With Gastroenteropancreatic Neuroendocrine Tumors. JAMA Netw Open. 2021 Mar 01;4(3):e212274.
30. [32444368] Strosberg JR, Al-Toubah T, Pellè E, et al. Risk of Bowel Obstruction in Patients with Mesenteric or Peritoneal Disease Receiving Peptide Receptor Radionuclide Therapy. J Nucl Med. 2021 Jan;62(1):69-72.
31. [8099808] Hammond PJ, Wade AF, Gwilliam ME, et al. Amino acid infusion blocks renal tubular uptake of an indium-labelled somatostatin analogue. Br J Cancer. 1993 Jun;67(6):1437-9.
32. [12582815] Jamar F, Barone R, Mathieu I, et al. 86Y-DOTA0)-D-Phe1-Tyr3-octreotide (SMT487)--a phase 1 clinical study: pharmacokinetics, biodistribution and renal protective effect of different regimens of amino acid co-infusion. Eur J Nucl Med Mol Imaging. 30(4):510-8, 2003 Apr.
33. [18427807] Bodei L, Cremonesi M, Ferrari M, et al. Long-term evaluation of renal toxicity after peptide receptor radionuclide therapy with 90Y-DOTATOC and 177Lu-DOTATATE: the role of associated risk factors. Eur J Nucl Med Mol Imaging. 2008 Oct;35(10):1847-56.
34. [15653656] Valkema R, Pauwels SA, Kvols LK, et al. Long-term follow-up of renal function after peptide receptor radiation therapy with (90)Y-DOTA(0),Tyr(3)-octreotide and (177)Lu-DOTA(0), Tyr(3)-octreotate. J Nucl Med. 2005 Jan;46 Suppl 1():83S-91S.
35. [34242948] Geenen L, Nonnekens J, Konijnenberg M, Baatout S, De Jong M, Aerts A. Overcoming nephrotoxicity in peptide receptor radionuclide therapy using [177Lu]Lu-DOTA-TATE for the treatment of neuroendocrine tumours. Nucl Med Biol. 2021;102-103():S0969-8051(21)00488-1.
36. [34622868] Worbe N, Damian L, Le Cam-Duchez V, Levesque H, Michel P, Quak E. Hemorrhagic disseminated intravascular coagulation after 177Lu-Dotatate in metastatic midgut neuroendocrine tumor: A case report. Medicine (Baltimore). 2021 Oct 08;100(40):e27455.
37. [35307721] Naveed Ahmad JA, Schroeder BB, Ruhoy SM, Kennecke HF, Lin BS. Severe Thrombocytopenia in Patients With Advanced Neuroendocrine Tumor Treated With Peptide Receptor Radioligand Therapy. Clinical Nuclear Medicine. 47(5):409-413, 2022 May 01.
38. [26419852] Bergsma H, Konijnenberg MW, Kam BL, et al. Subacute haematotoxicity after PRRT with (177)Lu-DOTA-octreotate: prognostic factors, incidence and course. Eur J Nucl Med Mol Imaging. 2016 Mar;43(3):453-63.
39. [27353035] Bodei L, Modlin IM, Luster M, et al. Myeloid neoplasms after chemotherapy and PRRT: myth and reality. Endocr Relat Cancer. 2016 Aug;23(8):C1-7.
40. [23389427] Bodei L, Mueller-Brand J, Baum RP, et al. The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2013 May;40(5):800-16.
41. [37080760] Gococo-Benore DA, Kuhlman J, Parent EE, et al. Evaluation of Hepatotoxicity from Peptide Receptor Radionuclide Therapy in Patients with Gastroenteropancreatic Neuroendocrine Tumors and a Very High Liver Tumor Burden. J Nucl Med. 2023 Jun;64(6):880-884.
42. [18210106] de Keizer B, van Aken MO, Feelders RA, et al. Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate. Eur J Nucl Med Mol Imaging. 2008 Apr;35(4):749-55.
43. [30464038] Huang K, Brenner W, Prasad V. Tumor Lysis Syndrome: A Rare but Serious Complication of Radioligand Therapies. J Nucl Med. 2019 Jun;60(6):752-755.
44. [-3197834] American College of Radiology. ACR-AAPM radiation safety officer resources. Available at: https://www.acr.org/-/media/ACR/Files/Radiology-Safety/Radiation-Safety/ACRAAPM-RSO-Resources.pdf?la=en. .
45. [33844446] Foster JH, Sher A, Seghers V, et al. Peptide receptor radionuclide therapy for treatment of metastatic neuroendocrine tumors in children. Pediatric Blood & Cancer. 68(7):e29056, 2021 07.
46. [33835221] Chen L, Navalkissoor S, Quigley AM, et al. 177Lu-DOTATATE in older patients with metastatic neuroendocrine tumours: safety, efficacy and health-related quality of life. Eur J Nucl Med Mol Imaging. 2021 Oct;48(11):3582-3594.
47. [-3198881] 2024, FDA approves lutetium Lu 177 dotatate for pediatric patients 12 years and older with GEP-NETS. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-lutetium-lu-177-dotatate-pediatric-patients-12-years-and-older-gep-nets.
48. [-3197883] American College of Radiology. ACR-ARS Practice Parameter for Radiation Oncology. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=200+&releaseId=2
49. [24434296] Ezziddin S, Attassi M, Yong-Hing CJ, et al. Predictors of long-term outcome in patients with well-differentiated gastroenteropancreatic neuroendocrine tumors after peptide receptor radionuclide therapy with 177Lu-octreotate. J Nucl Med. 55(2):183-90, 2014 Feb.
50. [37189646] Hertelendi M, Belguenani O, Cherfi A, Folitar I, Kollar G, Polack BD. Efficacy and Safety of [177Lu]Lu-DOTA-TATE in Adults with Inoperable or Metastatic Somatostatin Receptor-Positive Pheochromocytomas/Paragangliomas, Bronchial and Unknown Origin Neuroendocrine Tumors, and Medullary Thyroid Carcinoma: A Systematic Literature Review. [Review]. Biomedicines. 11(4), 2023 Mar 27.
51. [3803817] García-Bragado F, Genesca J, Allende H, Jardí R, Lima J. [Replication of the hepatitis B virus in 5 cases of essential mixed cryoglobulinemia]. Gastroenterol Clin Biol. 1986 Nov;10(11):772.
52. [35609558] Raj N, Coffman K, Le T, et al. Treatment Response and Clinical Outcomes of Well-Differentiated High-Grade Neuroendocrine Tumors to Lutetium-177-DOTATATE. Neuroendocrinology. 112(12):1177-1186, 2022.
53. [33803817] Camus B, Cottereau AS, Palmieri LJ, et al. Indications of Peptide Receptor Radionuclide Therapy (PRRT) in Gastroenteropancreatic and Pulmonary Neuroendocrine Tumors: An Updated Review. J Clin Med. 2021 Mar 18;10(6):1267.
54. [38238038] Strosberg JR, Al-Toubah T, El-Haddad G, Reidy Lagunes D, Bodei L. Sequencing of Somatostatin-Receptor-Based Therapies in Neuroendocrine Tumor Patients. J Nucl Med. 2024 Mar 01;65(3):340-348.
55. [-3197671] American College of Radiology. ACR-ACNM-SNMMI-SPR Practice Parameter for the Performance of Neuroendocrine Tumor Scintigraphy. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=92+&releaseId=2
56. [-3197668] American College of Radiology. ACR–ACNM–SNMMI Practice Parameter for the Performance of Gallium-68 and Copper-64 DOTATATE PET/CT Imaging for Neuroendocrine Tumors. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=18+&releaseId=2
57. [35210299] Alsadik S, Gnanasegaran G, Chen L, et al. Safety of Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE in Neuroendocrine Tumor Patients with Chronic Kidney Disease. Journal of Nuclear Medicine. 63(10):1503-1508, 2022 10.
58. [38214130] Mittra ES, Wong RKS, Winters C, Brown A, Murley S, Kennecke H. Establishing a robust radioligand therapy program: A practical approach for North American centers. [Review]. Cancer Medicine. 13(3):e6780, 2024 Feb.
59. [-3197699] American College of Radiology. ACR-ARS Practice Parameter on Informed Consent- Radiation Oncology. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=141+&releaseId=2
60. [31263080] Hope TA, Abbott A, Colucci K, et al. NANETS/SNMMI Procedure Standard for Somatostatin Receptor-Based Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE. J Nucl Med. 2019 Jul;60(7):937-943.
61. [35584377] Hendifar AE, Mehr SH, McHaffie DR. Best Practices for the Coordinated Care of Patients With Neuroendocrine Tumors Undergoing Peptide Receptor Radionuclide Therapy. Pancreas. 2022 Mar 01;51(3):213-218.
62. [35701215] Soulek DK, Mastascusa NJ, Martin ME, Graves SA. Practical Considerations for Implementation of 177Lu-DOTATATE Neuroendocrine Tumor Treatment Programs. J Nucl Med Technol. 2022 Jun 14;():jnmt.122.263813.
63. [38252861] Bennett B, Gardner L, Ryan P. Peptide Receptor Radionuclide Therapy Using 177Lu-DOTATATE: Nursing Roles in Managing Patients With Gastroenteropancreatic Neuroendocrine Tumors. Clin J Oncol Nurs. 2024 Jan 18;28(1):79-87.
64. [-3197835] United States Nuclear Regulatory Commission. NRC policy on release of iodine-131 therapy patients under 10 CFR 35.75 to locations other than private residences. RIS 2011-01. Available at: https://www.nrc.gov/docs/ML1036/ML103620153.pdf.
65. [-3197830] United States Nuclear Regulatory Commission. Consolidated guidance about materials licenses: program-specific guidance about medical use licenses (NUREG-1556, Volume 9, Revision 2). Available at: http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2/.
66. [-3197836] National Council on Radiation Protection and Measurements. NCRP No. 155, management of radionuclide therapy patients. Available at: https://ncrponline.org/publications/reports/ncrp-reports-155/. .
67. [17043624] Bakker WH, Breeman WA, Kwekkeboom DJ, De Jong LC, Krenning EP. Practical aspects of peptide receptor radionuclide therapy with [177Lu][DOTA0, Tyr3]octreotate. Q J Nucl Med Mol Imaging. 2006 Dec;50(4):265-71.
68. [29949416] Mittra ES.. Neuroendocrine Tumor Therapy: 177Lu-DOTATATE. [Review]. AJR Am J Roentgenol. 211(2):278-285, 2018 08.
69. [34933922] Tipnis S, Rieter WJ, Henderson-Suite V, Gordon L. Risk of Radiation Exposure to Clinical Staff from Paracenteses of Large-Volume Chylous Ascites After 177Lu-DOTATATE Infusion. Journal of Nuclear Medicine Technology. 50(3):274-277, 2022 Sep.
70. [30806682] Yu NY, Rule WG, Sio TT, Ashman JB, Nelson KL. Radiation Contamination Following Cremation of a Deceased Patient Treated With a Radiopharmaceutical. JAMA. 2019 Feb 26;321(8):803-804.
71. [33829361] Lodge MA, Solnes LB, Chaudhry MA, Wahl RL. Prospective Within-Patient Assessment of the Impact of an Unlabeled Octreotide Pre-dose on the Biodistribution and Tumor Uptake of 68Ga DOTATOC as Assessed by Dynamic Whole-body PET in Patients with Neuroendocrine Tumors: Implications for Diagnosis and Therapy. Mol Imaging Biol. 2021 Oct;23(5):766-774.
72. [-3197837] Advanced Accelerator Applications. Highlights of prescribing information. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/208700s000lbl.pdf.
73. [37835530] Halfdanarson TR, Mallak N, Paulson S, et al. Monitoring and Surveillance of Patients with Gastroenteropancreatic Neuroendocrine Tumors Undergoing Radioligand Therapy. Cancers (Basel). 2023 Oct 02;15(19):4836.
74. [37987917] Fazio N, Falconi M, Foglia E, et al. Optimising Radioligand Therapy for Patients with Gastro-Entero-Pancreatic Neuroendocrine Tumours: Expert Opinion from an Italian Multidisciplinary Group. Adv Ther. 2024 Jan;41(1):113-129.
75. [38428966] Yadav S, Lawhn-Heath C, Paciorek A, et al. The Impact of Posttreatment Imaging in Peptide Receptor Radionuclide Therapy. J Nucl Med. 2024 Mar 01;65(3):409-415.
76. [-3197882] American College of Radiology. ACR-ARS Practice Parameter for Communication: Radiation Oncology. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=199+&releaseId=2
77. [-3197885] American College of Radiology. ACR–AAPM Technical Standard for Nuclear Medical Physics Performance Monitoring of Gamma Cameras. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=196+&releaseId=2

Appendix A