Enhancing Safety and Personalization in Radiopharmaceutical Therapy Through Post-Treatment Imaging

Post-treatment imaging and dosimetry are transforming the landscape of radiopharmaceutical therapy, significantly improving patient safety and enabling more personalized treatment plans. Recent case studies presented at the Society of Nuclear Medicine and Molecular Imaging 2025 Annual Meeting demonstrate how this approach allows clinicians to make more informed decisions, optimize therapy outcomes, and reduce risks.

Traditionally, post-therapy imaging was not a routine part of nuclear medicine. However, by utilizing advanced software to analyze scans performed shortly after treatment and several days later, healthcare providers can accurately measure how radiation doses distribute within the body. For example, in lutetium-based treatments such as ^177Lu-DOTATATE or ^177Lu-PSMA, these scans help identify potential complications—like organ radiation exposure or unexpected disease progression—and guide necessary adjustments.

Case reports from the University of Tennessee Medical Center highlight the importance of this process. One patient was assessed for acute renal failure after receiving Lutathera, where 3D dosimetry revealed the kidney absorbed a safe dose of 5 Gray per session. Another patient’s bowel dose was measured following initial therapy, enabling management of transient bowel obstruction caused by radiation exposure. These insights allow clinicians to fine-tune treatment protocols, improve symptom management, and implement safety measures.

According to Gaby Gillespie, a nuclear medicine specialist involved in these studies, conducting post-therapy imaging for every patient has led to notable improvements in individualized care. These detailed assessments foster safer practices, reduce unnecessary radiation exposure, and help detect unexpected treatment effects early. Gillespie emphasizes that expanding the adoption of post-treatment dosimetry could establish nationwide guidelines, making personalized nuclear medicine accessible even in resource-limited settings.

The implications extend into the broader realm of nuclear medicine and theranostics, where this approach is poised to evolve from solely diagnosing disease to actively guiding patient-specific therapies. As the field advances, integrating post-treatment imaging and dosimetry promises to redefine treatment safety, efficacy, and professional growth within this specialty.