Foundations of theranostics

Nuclear medicine physicians specialize in the use of radiopharmaceuticals to treat patients and in the diagnostic interpretation of imaging scans. As the designated AU, they may prescribe RLT for patients. They may also be involved in determining patient eligibility, ordering RLTs, administering concomitant medications, monitoring patients for adverse events, and managing side effects.^2-4

Radiation oncologists specialize in the use of ionizing radiation to treat patients with cancer. They may be a referring physician or, as the designated AU, they may prescribe RLT for patients. They may also be involved in determining patient eligibility, ordering RLTs, administering concomitant medications, monitoring patients for adverse events, and managing side effects.^2,3,6

In accordance with the radiation safety protocols set by the RSO and informed by federal and local regulations, the technologist's responsibilities may include ordering RLTs from manufacturers, receiving, documenting, and inspecting doses upon arrival, preparing RLT doses, obtaining intravenous access, administering the RLT under AU supervision, monitoring patients during therapy, performing radiation surveys of the treatment areas, and, upon treatment conclusion, ensuring that the patient’s radiation level is below the threshold established by the RSO prior to discharge.^2,3,7

In accordance with the radiation safety protocols set by the RSO and informed by federal and local regulations, a radiation therapist may be responsible for safe handling and delivery of RLT, monitoring patients for adverse events, performing radiation surveys of the treatment areas, and, upon treatment conclusion, ensuring that the patient’s radiation level is below the threshold established by the RSO prior to discharge.⁸

In accordance with the radiation safety protocols set by the RSO and informed by federal and local regulations, nurses (ie, therapy room or cancer infusion room nurses) may be responsible for safe handling and delivery of RLT,  obtaining intravenous access, administering concomitant medications, and monitoring patients for adverse events.^2,3

Nurse navigators or other outpatient clinic nurses may focus on coordinating RLT activities including patient communication, scheduling, orientation, education, and postdischarge events.³

Medical oncologists may be involved in collaboration with the AU in the day-to-day care and co-management of cancer patients, including referring appropriate patients and monitoring patients during RLT treatment and posttreatment follow-up.^2,3

Surgical oncologists, especially in cancers involving surgical intervention, may be the partner physician referring patients for RLT, ensuring prevention of interference with other planned treatments, providing care coordination, helping to assess treatment tolerance and response to therapy, and managing toxicities.³

Medical physicists (radiation oncology physicists and nuclear medicine physicists) are responsible for overseeing the accreditation and quality control programs for nuclear medicine imaging equipment. As qualified experts, their role includes designing and reviewing quality control programs, testing equipment used for imaging and therapy, and designing structural radiation shielding.³

Nuclear pharmacists ensure the quality, safety, and efficacy of radiopharmaceuticals. They compound and/or prepare radioligand imaging agents and may prepare RLTs, if needed, before administration. As manufactured products typically do not require additional compounding and/or preparation, nuclear pharmacists can sometimes be off-site or outsourced.^2,4

Radiologists may play a crucial role in partnering with oncologists in multidisciplinary cancer care teams, offering expertise in medical imaging for diagnosis, treatment planning, and monitoring of cancer patients. With appropriate certification and training, a radiologist may be an AU.^3,9

Pathologists may assess tissue samples to confirm diagnosis and subsequent biopsies to optimize care.^10-12

For prostate cancer, urologists may play a key role in assessing patients for RLT. They provide expertise on the patient’s urological condition and determine if they are suitable candidates for RLT, typically in collaboration with nuclear medicine physicians and/or radiation oncologists to manage individualized treatment approaches for the patients.^5,10,13

For hormone-related cancers such as gastroenteropancreatic neuroendocrine tumors (GEP-NETs), endocrinologists may play a key role in assessing patients for RLT. They may oversee the patient's RLT treatment plan, monitor hormone levels, and manage potential side effects related to the therapy.^14-16

Other HCPs may include but are not limited to psychologists, palliative care specialists, social workers, primary care providers, genetic counselors, physiologists/dieticians, and other tumor-specific specialists who refer the patient for RLT treatment.^3,10,17