An international guide on how to set up a theranostics centre

The recent approval of different types of radioligand therapy has led to expectations that demand for the therapy will increase globally, with many countries and regions that have only limited experience being asked to deliver it.¹ In response to this, in 2022, the EANM, the SNMMI and the IAEA developed a joint international guide to help healthcare professionals understand the necessary steps in setting up a theranostics centre.² The organisations targeted the guide at people who are interested in delivering the therapy but have limited experience or understanding of the creation and daily management of a theranostics centre.¹

The guide provides an overarching view of the primary considerations, recognising that there are many differences regionally. It outlines:²

• regulatory logistical and technical considerations and requirements
• radiation protection and radioactive waste requirements
• treatment planning, optimisation and verification
• storage and administration of radioligand therapies
• training and collaboration among medical staff
• lessons learnt from previous experiences and advice on troubleshooting when establishing a theranostics service

The guide emphasises that careful preparation and planning are essential to the successful implementation of radioligand therapy.² It also recognises that radioligand therapy will impact surrounding hospitals, which might not have the infrastructure and expert knowledge of radiation, making good communication and coordination among centres important.²

The guide sets out how users can improve the integration of radioligand therapy into care, outlining the various challenges that they might face and explaining how to overcome them.² The inclusion of these challenges may lead to improvements in care. For example, by highlighting the need for an appropriately skilled and trained workforce, the guide encourages clinicians to advocate for radioligand therapy to be included within training programmes.²

The involvement of the EANM, the IAEA and the SNMMI in the development of the guide means that it serves as a baseline for international and multidisciplinary cohesion. Working jointly allowed specialists with different viewpoints to learn from each other and reach a consensus on what is needed to expand existing theranostics centres and set up new ones.¹ Ultimately, this collaborative working allows the guide to provide a more comprehensive picture. However, while the guide has global relevance, it also recognises the differences in the requirements among countries and the need to consider these.²

The guide was simultaneously published in two journals, emphasising the gap it is filling within the field.¹ Moreover, in the first 4 months, the article received almost 5,000 views.³ The authors of the guide have also received many comments and questions, with some individuals interested in using it to develop additional resources.¹

The development of the guide highlights the importance of inclusivity within the growing field of theranostics.¹ It shows that multidisciplinary collaboration can help in building more comprehensive resources that can better support those who want to deliver radioligand therapy.

Although there are many ongoing initiatives to help integrate radioligand therapy into care, these are often isolated and not shared widely. Therefore, there is a need to bring initiatives together to elicit shared learnings and broader use of this treatment. The guide outlines existing initiatives that can help in setting up a theranostics service. For example, it highlights that the EANM Oncology and Theranostics Committee and the SNMMI Therapy Center of Excellence can help individuals requesting assistance with or information on promoting theranostics at a local level.² It also highlights initiatives such as the advanced European Society for Medical Oncology (ESMO) and EANM course that aims to increase the understanding of theranostics within the oncology community.²

In the future, additional guides will provide more detail on each of the steps in the process, which may include dosimetry and radiobiology.^{1 2}