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Research ArticlePractice Standards

SNMMI Procedure Standard/EANM Practice Guideline for Palliative Nuclear Medicine Therapies of Bone Metastases

Austin R. Pantel, Matthias Eiber, Dmitry D. Beyder, A. Tuba Kendi, Richard Laforest, Isabel Rauscher, Edward B. Silberstein and Matthew P. Thorpe
Journal of Nuclear Medicine Technology September 2023, 51 (3) 176-187; DOI: https://doi.org/10.2967/jnmt.123.265936
Austin R. Pantel
1University of Pennsylvania, Department of Radiology;
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Matthias Eiber
2School of Medicine, Department of Nuclear Medicine, Technische Universität München, Munich, Germany;
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Dmitry D. Beyder
3Barnes-Jewish Hospital, Department of Radiology;
CNMT
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A. Tuba Kendi
4Mayo Clinic Rochester, Department of Radiology;
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Richard Laforest
5Washington University, Department of Radiology, St. Louis;
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Isabel Rauscher
6Technical University of Munich, Department of Nuclear Medicine; and
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Edward B. Silberstein
7University of Cincinnati Medical Center, Cincinnati
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Matthew P. Thorpe
4Mayo Clinic Rochester, Department of Radiology;
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    TABLE 1.

    Summary of Indications, Radiophysical Data, and Administered Activity

    AgentIndicationEmission(s)Physical half-lifeAdministered activity
    89Sr-chlorideRelief of bone pain caused by osseous metastasesβ, rare γ50.5 days148 MBq (4.0 mCi) is recommended; alternative weight-based activity of 1.5-2.2 MBq/kg (40-60 μCi/kg) may be used
    153Sm-lexidronamPain relief in patients with osteoblastic metastases seen on radionuclide bone scanβ, γ1.9 daysWeight-based activity of 37 MBq (1.0 mCi) per kg
    223Ra-dichlorideTreatment of patients with castration-resistant prostate cancer with symptomatic osseous metastases and no known visceral metastatic diseasePredominantly α, with additional β and γ11.4 daysWeight-based activity of 55 kBq (1.49 µCi) per kg
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    TABLE 2.

    89Sr-Chloride Radiation Absorbed Doses (1)

    OrganmGy/MBqrad/mCi
    Bone surface17.063.0
    Red bone marrow11.040.7
    Lower bowel wall4.717.4
    Bladder wall1.34.8
    Testes0.82.9
    Ovaries0.82.9
    Uterine wall0.82.9
    Kidneys0.82.9
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    TABLE 3.

    153Sm-Lexidronam Radiation Absorbed Doses (6,34)

    OrganmGy/MBqrad/mCi
    Bone surface6.825.0
    Red bone marrow1.55.7
    Lower bowel wall0.010.04
    Bladder wall1.03.60
    Testes0.010.02
    Ovaries0.010.03
    Kidneys0.020.07
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    TABLE 4.

    223Ra-Dichloride Radiation Absorbed Doses (11)

    OrganmGy/MBqrad/mCi
    Osteogenic cells11524263
    Red bone marrow139514
    Lower large intestine wall46172
    Colon38142
    Upper large intestine wall32120
    Urinary bladder wall4.015
    Kidneys3.212
    Testes0.080.31
    Ovaries0.491.8
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Journal of Nuclear Medicine Technology: 51 (3)
Journal of Nuclear Medicine Technology
Vol. 51, Issue 3
September 1, 2023
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SNMMI Procedure Standard/EANM Practice Guideline for Palliative Nuclear Medicine Therapies of Bone Metastases
Austin R. Pantel, Matthias Eiber, Dmitry D. Beyder, A. Tuba Kendi, Richard Laforest, Isabel Rauscher, Edward B. Silberstein, Matthew P. Thorpe
Journal of Nuclear Medicine Technology Sep 2023, 51 (3) 176-187; DOI: 10.2967/jnmt.123.265936

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SNMMI Procedure Standard/EANM Practice Guideline for Palliative Nuclear Medicine Therapies of Bone Metastases
Austin R. Pantel, Matthias Eiber, Dmitry D. Beyder, A. Tuba Kendi, Richard Laforest, Isabel Rauscher, Edward B. Silberstein, Matthew P. Thorpe
Journal of Nuclear Medicine Technology Sep 2023, 51 (3) 176-187; DOI: 10.2967/jnmt.123.265936
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  • Article
    • PREAMBLE
    • I. PURPOSE
    • II. DEFINITIONS AND BACKGROUND INFORMATION
    • III. INDICATIONS AND CLINICAL TRIAL EXPERIENCE
    • IV. PROCEDURE
    • V. LIABILITY STATEMENT
    • VI. DISCLOSURE
    • VII. ACKNOWLEDGEMENTS
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