Safe Use of Radium-223 Dichloride (223RaCl2) Across a Wide Range of Clinical Scenarios, Incorporating a 10-year Single-Institution Radiation Safety Experience.

Radium 223Ra dichloride (223RaCl2) is an effective therapeutic radiopharmaceutical presently approved for the treatment of prostate cancer metastatic to bone. It is unique by virtue of being the first alpha-emitting radiopharmaceutical to achieve approval for use in the clinic, reaching this status both in the United States and Europe in 2013. In over ten years of research and approved clinical usage, the authors have encountered very few radiation-safety incidents of concern with 223RaCl2; in this review, they relate their first-hand experience with this radiopharmaceutical and share some lessons learned, including situations of bleeding, surgery and patient demise. The authors first provide a basic review of the relevant physical properties of 223Ra and aspects of its radiobiology, followed by a discussion of the biodistribution of 223RaCl2, the radiopharmaceutical presently approved for clinical use. As would be expected from a primarily alpha emitter, external exposures to staff and family members from patients administered 223Ra are typically low in comparison with exposure from patients who have undergone other nuclear medicine procedures. There still remains potential for health care workers and family members to receive a significant internal exposure, through the ingestion of even minute amounts of activity, so proper handling practices are paramount.

Radioactive Seed Localization Versus Wire-Guided Localization for Nonpalpable Breast Cancer: A Cost and Operating Room Efficiency Analysis.

BACKGROUND: This study aimed to compare the cost and resource use between our first-year experience using breast-conserving surgery (BCS) with radioactive seed localization (RSL) and the previous-year standard practice of BCS with wire-guided localization (WGL) for patients with nonpalpable breast cancer at a large Canadian tertiary center. METHODS: For this retrospective cohort study, data for BCS cases with RSL was collected from 1 April 2015 to 31 March 2016 and for BCS cases with WGL from 1 April 2014 to 31 March 2015. RESULTS: The study compared 153 WGL patients with 194 RSL patients. The two groups had no significant demographic differences. The average cost per patient for RSL, including opportunity costs, was $250.90 versus $1130.41 for WGL. Dedicated allocated radiology appointments to RSL increased (9 per day), and fewer radiologists were required for these procedures per day. Patients were transported to the operating room more quickly for RSL procedures (120 vs. 254 min; p < 0.001). Fewer vasovagal reactions occurred after insertion of RSL versus WGL (p = 0.05). No significant differences were observed in terms of surgical time, specimen volume, positive margins, or margin reexcision rates. No significant differences in postoperative complication rates were observed. CONCLUSIONS: In this study, RSL had lower costs than WGL, allowed for more efficient use of radiology scheduling and resources, and had shorter wait times for patients on their day of surgery. In addition, RSL led to fewer vasovagal reactions at insertion. Therefore, RSL should be used instead of WGL given the reduced cost, decreased need of human resources, improved efficiency, and potential benefits to the patient experience.