3289 - "Real World Experiences" -- from the Frontlines of a Community Practice Treating with Radiopharmaceuticals

Purpose/Objective(s): Radiopharmaceuticals are growing in applications and administrations. Many radiation oncology practices are beginning to offer this treatment to their patients. We sought to report on the anecdotal experiences noted by a community cancer center providing radiopharmaceutical care.

Materials/Methods: While many serious events are reportable to the institutions and the regulatory bodies, a number of instances occur that are “potentially” serious but never meet the threshold for formal reporting. We report on those instances and the real time problem solving that occurred.

Results: 532 patients were treated with various radiopharmaceuticals including Ra223, I-131, Lu177, and Y-90 by the team during the period of 2022-2024. Most treatments are delivered uneventfully. However, there have been a variety of issues observed during radiopharmaceutical administration: identifying defective tubing, the provision of incorrect tubing, air leaks from inadequate rubber seals, IVs that failed/infiltrated, pump failures, and inadvertent spilled doses. There have been scheduling issues due to delayed delivery of radiopharmaceuticals. There have higher then expected measured residuals. The recent national IV shortage and prior amino acid shortages resulted in process changes. In addition, many patient’s have not honestly reported their urinary control, and the lack of control has led to radiation safety concerns. There have been procedures and processes developed to guide how we deal with these types of events that we feel are worth sharing with the broader community.

Conclusion: In the real world of community practice, a number of events have occurred in the administration of radiopharmaceuticals. These events do not reach level of “reportable” events but are important for the treating team to understand and prepare for. We describe our experiences and the procedures/policies we have put in place to identify and problem solve.