Essentials of Theranostics

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 10, 2026:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Endocrine and Oncology Procedures: 1.50

Radiography: 0.25
Safety: 0.25
Radiation Physics and Radiobiology: 0.25

Registered Radiologist Assistant: 0.25
Safety: 0.25
Patient Safety, Radiation Protection, and Equipment Operation: 0.25

Radiation Therapy: 0.25
Safety: 0.25
Radiation Physics and Radiobiology: 0.25

Outline

1. Introduction
2. Decay Schemes
3. Radiation Biology
4. Radiotheranostic Applications
5. Therapeutic Effect and Toxicity
   1. Type of Radiation Emitted and its Energy
   2. Effective Half-life and Agent Retention
   3. Administered Activity
   4. Agent Distribution
6. Dosimetry
   1. Framework for Dose Calculations
   2. Patient-Specific Factors
   3. Molecular Imaging for Dosimetry
   4. Voxelwise Dosimetry
   5. Clinical Implementation of Dosimetry
7. Posttherapy Radiation Safety
8. Tumor Heterogeneity
   1. Implications of Tumor Heterogeneity
9. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the definition of theranostics
2. understand the significance of tumor heterogeneity
3. identify the radioactive agent used to treat thyroid conditions
4. be familiar with the introduction of theranostics
5. identify the radioactive decay useful for imaging
6. be familiar with positron decay
7. identify which type of DNA damage is more cytotoxic
8. define LET
9. be familiar with radiation with longest range in therapeutic applications
10. define RBE
11. understand the factors for determining the RBE of a radiation type
12. be familiar with the how the rate of radiation dose influences biological outcomes
13. understand the use of targeting agents for both imaging and therapy
14. know which radionuclides can serve as a biological agent
15. be familiar with the emissions from 177 Lu and 131 Iodine
16. understand cell vulnerability to radiation
17. be familiar with the use of tissue weighting factors
18. understand the factors influencing a patient’s susceptibility to developing toxic effects from RPT
19. be familiar with the characteristics of α particles at cell killing
20. identify the theranostic pair for treating neuroendocrine tumors
21. recognize the different clinical implications for ¹⁷⁷Lu and ⁹⁰Y
22. define the physical half-life of a radionuclide
23. define the biological half-life of a radionuclide
24. be familiar with the trade-off associated with higher administrated activity in RPT
25. know what is required for targeted treatment in RPT
26. be familiar with the absorbed dose to tissue in units of gray (Gy)
27. understand the application of a source region
28. identify the maximum tolerable bone marrow dose during ¹³¹I-NaI treatment for thyroid cancer
29. be familiar with the main assumption in organ-level dosimetry when estimating dose absorption
30. be familiar with the patient challenges for calculating dosimetry in a clinical setting
31. understand the NRC radioactive patient release criteria
32. be familiar with tumor heterogeneity
33. be familiar with the VISION trial criteria
34. identify the PFS for patients treated with ¹⁷⁷Lu-PSMA-617 plus SOC in the VISION trial
35. be familiar with the TheraP trial
36. understand eligibility requirements for the TheraP trial
37. be familiar with the ability of PET to identify hypermetabolic disease lacking molecular target expression
38. understand the growth of the field of radiotheranostics