Imaging infrastructure

Radiopharmaceuticals (RF)

If applicable, who is your supplier for?

Iodine

[131I]I-MIBG

177Lu

Select all available radiopharmaceutical therapies at your institution:

[131I]NaI

[¹³¹I]NaI

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

131I]mIBG

[¹³¹I]mIBG

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

131I-labelled Apamistamab

¹³¹I-labelled Apamistamab

Number of therapies per year

Specify radiopharmaceutical diagnostic used

177Lu]Lu-PSMA-ligant

[¹⁷⁷Lu]Lu-PSMA-ligand

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

177Lu]Lu- SSTR2-ligand

[¹⁷⁷Lu]Lu- SSTR2-ligand

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

90Yttrium citrate

[⁹⁰Y]Yttrium citrate

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

[186Re]Rhenium sulfide

[¹⁸⁶Re]Rhenium sulfide

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

[169Er]Erbium citrate

[¹⁶⁹Er]Erbium citrate

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

[90Y]Y-Ibritumomab tiuxetan

[⁹⁰Y]Y-Ibritumomab tiuxetan

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

90Y- spheres

⁹⁰Y- spheres

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

166Ho- spheres

¹⁶⁶Ho- spheres

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

[223Ra]Radichloride

[²²³Ra]Radichloride

Number of therapies per year(Required)

Specify radiopharmaceutical diagnostic used

List other therapies not listed above, number per year, and the diagnostic used:

Radioprotection

Do you have probe measuring station for uptake measurements?(Required)

Yes

No

Do you have dose rate meter?(Required)

Yes

No

Do you have activity meter with CE certificate and dedicated QA program in place?(Required)

Yes

No

Do you have radiation protection equipment (e.g. contamination monitor)?(Required)

Yes

No

If yes, please describe radiation protection equipment:(Required)

Do you have well counter (or equivalent)?(Required)

Yes

No

Do you have QM system for radionuclide therapies (therapy SOPs, etc.)?(Required)

Yes

No

If yes, describe:(Required)

If no, provide a reason:

Do you have a waste management system(Required)

Yes

No

If yes, provide description:(Required)

If no, provide a reason:

BSS Compliance

What is the level of involvement of the MPE in theranostic procedures?(Required)

Reachable by phone during procedures

Present on site during procedures but not actively involved

Actively involved in the therapy planning and verification of procedures

Closely involved in the decision making on the activities to be administered for the procedures

Are you performing dosimetry on a routine basis?(Required)

Yes

No

Do you have the expertise and capacity to perform dosimetry for specific study purposes?(Required)

Yes

No

Therapies

How many outpatients per month?(Required)

How many hospitalized patients/month?(Required)

Provide details for the following therapies (if applicable)

Iodine-131 low activity

Iodine-131 low activity

Threshold activity (if applicable)

Duration (days)

Release criteria(Required)

Yes

No

If yes, describe what are the release criteria

Iodine-131 high activity

Iodine-131 high activity

Threshold activity (if applicable)

Duration (days)

Release criteria(Required)

Yes

No

If yes, describe what are the release criteria

Luthetium-177

Luthetium-177

Threshold activity (if applicable)

Duration (days)

Release criteria(Required)

Yes

No

If yes, describe what are the release criteria

Actinium-225

Actinium-225

Threshold activity (if applicable)

Duration (days)

Release criteria(Required)

Yes

No

If yes, describe what are the release criteria

List any other therapies with threshold activity, duration in days, and if there are release criteria and what they are:

How many beds for treatment are available at your site?(Required)

Which clinical trials are you performing?(Required)

Phase I

Phase II-III

None but interested in conducting clinical trials

None

Additional comments:

Agree to have the department head name and email published publicly on the EARL web site(Required)

Yes

No

Agree to have the hospital name and the types of theranostics procedure(s) provided a certificate for by EARL, to be published publicly on the EARL web site(Required)

Yes

No

Name

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