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

Esma A. Akin, Department of Radiology, The George Washington University Medical Center, Washington, DC.
Paul E. Wallner, 146 Sarazen Drive, Moorestown.
Sindu Alexander, University of California Irvine, UC Irvine Radiology, Nuclear Medicine, Orange.
Parul Barry, UPMC Hillman Cancer Center and University of Pittsburgh School of Medicine, Pittsburgh.
Patrick M. Colletti, Keck School of Medicine of USC, Radiology, USC PET Center.
Curtiland Deville, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD.
Phillip H. Kuo, Department of Radiology, City of Hope National Medical Center, Duarte, CA.
Amar Kishan, University of California, Los Angeles, Los Angeles.
Zachary Morris, Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Philipose G. Mulugeta, Hospital of the University of Pennsylvania.
Neeta Pandit-Tasker, Memorial Sloan Kettering Cancer Center, New York, NY.
Bryan M. Rabatic, TriHealth Cancer and Blood Institute, Radiation Oncology, Cincinnati, OH.
Babak Saboury, United Theranotics.
Navesh Sharma, WellSpan Health, Radiation Oncology, York, PA.
Munir V. Ghesani, Chief Medical Officer, United Theranostics, Princeton, NJ.
Rathan M. Subramaniam, The University of Notre Dame Australia Radiology and Nuclear Medicine, Darlinghurst, NSW, Australia.
William Small, Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University, Chicago, Maywood, IL.
Naomi R. Schechter, South Florida Proton Therapy Institute, Delray Beach, FL.

Document Type

Journal Article

Publication Date

8-25-2025

Journal

American journal of clinical oncology

DOI

10.1097/COC.0000000000001245

Keywords

radium-223; radium-223 practice parameter; radium-223 therapy

Abstract

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.

Department

Radiology

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