Therapy in nuclear medicine practice has a long distinguished history. To use today's phraseology, it is one of modern medicine's early "targeted therapies." By its very nature, nuclear medicine therapy is required to be highly specific and targeted, since it always involves administration of unsealed sources of radioactivity. Since the development of peaceful uses of atomic energy after the second World War, patients with specific disease processes were among the earliest who benefited by these new uses. Standard beta emitting radioisotopes, such as P-32 and I-131, as well as radioisotopes of iron were used in new therapy procedures and seminal physiology studies. Since the 1960s many of these therapies are still in use because of their effectiveness, safety, and lack of competing treatments. Most therapeutic radiopharmaceuticals are available throughout the world and different radioactive sources can be devised for regions that are farther from production facilities or have specific frequencies in disease distributions. As these needs for effective therapies continue to evolve in different world regions, radioactive therapies continue to be cost-effective and adaptable. Perhaps most exciting is the vigorous research and development in new therapeutic radiophar-maceuticals that has been ongoing over the past 20 years.
To practice nuclear medicine and include a therapy aspect of the practice is a challenge for the nuclear medicine physician. One has to be an expert in the most common aspects of nuclear medicine imaging, of course. But to successfully conduct a therapy aspect of the practice with unsealed sources of radioactivity requires a thorough knowledge of the clinical medicine aspects of the disease to be treated. This may involve elements of internal medicine, surgery, radiation oncology, and pediatrics special areas as well. The practitioner must have a complete understanding of the radiochemical and radiopharmaceutical aspects of the therapy agent with the biodistribution and pathophysiology of the disease treated. The physical aspects of imaging to quantitate and understand radiopharmaceutical behavior in a patient, both as a quality control measure and as the basis for dosimetry estimation, is also critical. The culmination of this information synthesis for treatment with radiopharmaceuticals is dosimetry estimation and application in an individual patient. No other aspect of nuclear medicine practice demands such integration of the biological, chemical, physical, and pathological understanding of all these elements applied to patient management. This understanding for the basis of nuclear medicine therapy relies on an ongoing partnership with the patient's referring primary care physician and a careful delineation of patient care responsibilities for the nuclear medicine physician. The nuclear medicine physician must assume care of the patient during the actual treatment phase, and be involved in appropriate patient preparation and follow-up care and integration with the primary care physician-based continuing care. In nuclear medicine therapy, the nuclear medicine physician must assume the leadership role in all these aspects of patient care. This is a demanding role, but also one that provides a fulfilling and stimulating aspect to the professional career of the nuclear medicine physician.
These demands for knowledge and competence on the practicing nuclear medicine physician are the basis for the creation of this book. This book was designed to completely address the most important aspects of nuclear medicine therapy across the breadth of practice. It is first and foremost a handbook where the practitioner can easily obtain relevant practical information on how to plan, carry out, and follow-up a nuclear medicine therapy procedure. Each chapter provides background materials on a procedure for more in-depth information. But most of all, this book indicates what the practicing nuclear medicine physician needs to think about when contemplating or consulting for a nuclear medicine therapy procedure for a patient with a specific problem. The role of the nuclear medicine physician is defined. Also, enough information on requirements for therapy is provided to assist the practitioner in setting up a clinic to perform nuclear medicine-based therapies. These include patient preparation, risks, indications and contraindications for treatment, patient follow-up, and re-treatment considerations. The authors who have prepared the chapters in this book are experienced practitioners who have a complete understanding of their subject area. They have taken into consideration regional and continental variations in practices, where appropriate, and have composed solid reviews for the reader.
In a larger context, our nuclear medicine specialty has long needed such a reference. Many of us are called upon to consider performing a radioactivity-based therapy that we may only perform at long intervals or infrequently. This is a limiting factor for many nuclear physicians in their practice and often limits provision of some of the most important contributions to patient care that therapy with radioactive agents can provide.
Janet F. Eary Winfried Brenner
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