Occupational Exposure in the Preparation and Administration of Radiopharmaceuticals for Radionuclide Therapies: literature review
DOI:
https://doi.org/10.83356/2026.rr.n19.27Keywords:
Theranostic, [177Lu]Lu-DOTATATE, [131I]-MIBG, Occupational Radiation Exposure, Dosimetry, Radionuclide Therapy, Systematic ReviewAbstract
Introduction: Nuclear Medicine has undergone significant growth in the field of radionuclide therapies, increasing the potential occupational exposure (OcupExp) of professionals involved in the preparation and administration of therapeutic radiopharmaceuticals. The aim is to compile and systematize the available evidence on occupational radiation exposure of healthcare professionals in radionuclide therapies, identifying the main influencing factors and radiation protection strategies.
Methodology: A literature review, according to the PRISMA methodology, was conducted using the PubMed database, including articles published in the last 10 years, up to 28/02/2026. Studies addressing therapies with radiopharmaceuticals labelled with [177Lu] or [131I], OcupExp, dosimetry and administration methods were considered.
Results: Five studies were included. OcupExp varied according to the radionuclide used, administered activity, administration method and radiation protection practices adopted. The results showed that procedures involving greater direct handling of the radiopharmaceutical or closer proximity to the patient tend to be associated with higher exposure, particularly to the extremities. The use of shielding, lead aprons, automated systems or methods that reduce direct contact with the radiopharmaceutical proved relevant in reducing occupational exposure.
Conclusion: OcupExp in radionuclide therapies depends on multiple technical and operational factors. The choice of administration method, optimisation of procedures and strict compliance with radiation protection principles are essential to reduce the dose received by professionals. However, the methodological heterogeneity of the studies limits direct comparison of results, highlighting the need for further investigation..
References
Rojas B, McGowan DR, Gear J, Smith AL, Scott C, Craig AJ, et al. Nearly double the patients and dramatic changes over 14 years of UK MRT: Internal Dosimetry Users Group survey results from 2007 to 2021. Nucl Med Commun. 2024 Jan;45(1):16–23. doi:10.1097/MNM.0000000000001780
Yordanova A, Eppard E, Kürpig S, Bundschuh R, Schönberger S, Gonzalez-Carmona M, et al. Theranostics in nuclear medicine practice. Onco Targets Ther. 2017 Oct 3;Volume 10:4821–8. doi:10.2147/OTT.S140671
Rojas B, Hooker C, McGowan DR, Guy MJ. Five years of molecular radiotherapy growth in the UK. Nucl Med Commun. 2015 Aug 11;36(8):761–5. doi:10.1097/MNM.0000000000000306
Rojas B, Hooker C, McGowan DR, Guy MJ, Tipping J. Eight years of growth and change in UK molecular radiotherapy with implications for the future. Nucl Med Commun. 2017 Mar;38(3):201–4. doi:10.1097/MNM.0000000000000642 PubMed PMID: 28067689.
Rojas B, McGowan DR, Guy MJ, Tipping J, Aldridge M, Gear J. Eighty per cent more patients in 10 years of UK molecular radiotherapy. Nucl Med Commun. 2019 Jul 1;40(7):657–61. doi:10.1097/MNM.0000000000001020 PubMed PMID: 31058745.
White BE, Rous B, Chandrakumaran K, Wong K, Bouvier C, Van Hemelrijck M, et al. Incidence and survival of neuroendocrine neoplasia in England 1995–2018: A retrospective, population-based study. The Lancet Regional Health - Europe. 2022 Dec 1;23:100510. doi:10.1016/j.lanepe.2022.100510 PubMed PMID: 36176500.
Yordanova A, Eppard E, Kürpig S, Bundschuh R, Schönberger S, Gonzalez-Carmona M, et al. Theranostics in nuclear medicine practice. Onco Targets Ther. 2017 Oct 3;Volume 10:4821–8. doi:10.2147/OTT.S140671
Ehrhardt Jr JD, Güleç S. A Review of the History of Radioactive Iodine Theranostics: The Origin of Nuclear Ontology. Mol Imaging Radionucl Ther. 2020 Oct 1;29(3):88–97. doi:10.4274/mirt.galenos.2020.83703 PubMed PMID: 33094571.
Kollaard R, Zorz A, Dabin J, Covens P, Cooke J, Crabbé M, et al. Review of extremity dosimetry in nuclear medicine. Journal of Radiological Protection. 2021 Dec 1;41(4):R60–87. doi:10.1088/1361-6498/ac31a2 PubMed PMID: 34670207.
Riveira-Martin M, Struelens L, Muñoz Iglesias J, Schoonjans W, Tabuenca O, Nogueiras JM, et al. Radiation exposure assessment of nuclear medicine staff administering [177Lu]Lu-DOTA-TATE with active and passive dosimetry. EJNMMI Phys. 2023 Nov 14;10(1):70. doi:10.1186/s40658-023-00592-1 PubMed PMID: 37962683.
Luhung A, Hasanah A, Ramdhani D. Radiopharmaceutical: An Update and Comparison of Preclinical Investigation Result of Alpha and Beta Emitter Radioisotope. Drug Des Devel Ther. 2026 Feb;Volume 20:1–21. doi:10.2147/DDDT.S570831
Duan H, Iagaru A, Aparici CM. Radiotheranostics - Precision Medicine in Nuclear Medicine and Molecular Imaging. Nanotheranostics. 2022;6(1):103–17. doi:10.7150/ntno.64141 PubMed PMID: 34976584.
Dash A, Knapp FF, Pillai M. Targeted Radionuclide Therapy - An Overview. Curr Radiopharm. 2013 Oct 31;6(3):152–80. doi:10.2174/18744710113066660023 PubMed PMID: 24059327.
Khazaei Monfared Y, Heidari P, Klempner SJ, Mahmood U, Parikh AR, Hong TS, et al. DNA Damage by Radiopharmaceuticals and Mechanisms of Cellular Repair. Pharmaceutics. 2023 Dec 1;15(12):2761. doi:10.3390/PHARMACEUTICS15122761/S1
IAEA. General issues in therapeutic nuclear medicine | International Atomic Energy Agency [Internet]. 2026 [cited 2025 Nov 2]. Available from: https://www.iaea.org/resources/rpop/health-professionals/nuclear-medicine/therapeutic-nuclear-medicine/general-issues
Stokke C, Kvassheim M, Blakkisrud J. Radionuclides for Targeted Therapy: Physical Properties. Molecules. 2022 Sep 1;27(17):5429. doi:10.3390/MOLECULES27175429/S1 PubMed PMID: 36080198.
Abuqbeitah M, Demir M, Uslu-Beşli L, Yeyin N, Sönmezoğlu K. Blood clearance and occupational exposure for 177Lu-DOTATATE compared to 177Lu-PSMA radionuclide therapy. Radiat Environ Biophys. 2018 Mar 17;57(1):55–61. doi:10.1007/s00411-017-0721-6 PubMed PMID: 29149420.
Khalili N, Zakariaee S, Gharebaghi E, Salehi Y, Changizi V. Evaluation of annual staff doses and radiation shielding efficiencies of thyroid shield and lead apron during preparation and administration of 131I, 81Kr, and 99mTc-Labeled radiopharmaceuticals. J Med Signals Sens. 2022 Jan 1;12(1):90. doi:10.4103/jmss.JMSS_45_20
Struelens L, Aalbersberg E, Beels L, Cherbuin N, D’Asseler Y, De Monte F, et al. How much do 68Ga-, 177Lu- and 131I-based radiopharmaceuticals contribute to the global radiation exposure of nuclear medicine staff? EJNMMI Phys. 2024 Nov 14;11(1):95. doi:10.1186/s40658-024-00695-3 PubMed PMID: 39540964.
Donzé C, Rubira L, Santoro L, Viarasakd M, Kotzki PO, Deshayes E, et al. 177Lu-Dotatate administration using an infusion pump or a peristaltic pump: comparison of two methods. European Journal of Hospital Pharmacy. 2024 May 1;31(3):207–11. doi:10.1136/ejhpharm-2022-003489 PubMed PMID: 36100369.
Dash A, Pillai MRA, Knapp FF. Production of 177Lu for Targeted Radionuclide Therapy: Available Options. Nucl Med Mol Imaging. 2015 Jun 17;49(2):85–107. doi:10.1007/s13139-014-0315-z
Ku A, Facca VJ, Cai Z, Reilly RM. Auger electrons for cancer therapy – a review. EJNMMI Radiopharm Chem. 2019 Dec 11;4(1):27. doi:10.1186/s41181-019-0075-2
Jødal L. Beta emitters and radiation protection. Acta Oncol (Madr). 2009 Jan 8;48(2):308–13. doi:10.1080/02841860802245163
Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJG, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008 Oct 1;35(10):1941–59. doi:10.1007/s00259-008-0883-1
Giammarile F, Chiti A, Lassmann M, Brans B, Flux G. EANM procedure guidelines for 131I-meta-iodobenzylguanidine (131I-mIBG) therapy. Eur J Nucl Med Mol Imaging. 2008 May 15;35(5):1039–47. doi:10.1007/s00259-008-0715-3
Giammarile F, Chiti A, Lassmann M, Brans B, Flux G. EANM procedure guidelines for 131I-meta-iodobenzylguanidine (131I-mIBG) therapy. Eur J Nucl Med Mol Imaging. 2008 May 15;35(5):1039–47. doi:10.1007/s00259-008-0715-3 PubMed PMID: 18274745.
He X, Zhao R, Rong L, Yao K, Chen S, Wei B. Answers to if the Lead Aprons are Really Helpful in Nuclear Medicine from the Perspective of Spectroscopy. Radiat Prot Dosimetry. 2016 Sep 9. doi:10.1093/rpd/ncw255
Downloads
Published
Issue
Section
Categories
License
Copyright (c) 2026 Diogo Guerra, Tiago Silva, Susana Valente, Maria J Raminhas Carapinha
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
