# Dosimetry roadmap: MIRD schema → fixed dosing → personalised, image-based dose

Source: https://nuclide.cc/roadmaps/dosimetry-roadmap/  
Nuclide record `dosimetry-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

Working out how much radiation a treatment actually delivers to a tumour and to healthy organs, rather than just giving everyone the same fixed amount, could let doctors treat some patients more and some less. The tools to do this patient by patient exist and are used in some specialist centres, but most approved radioligand therapies are still given at one fixed dose to everyone.

## Summary

Internal radiation dosimetry has a formal history: the Society of Nuclear Medicine's Medical Internal Radiation Dose (MIRD) Committee was formed in 1965, and its 1968 MIRD Pamphlet No. 1 (Loevinger and Berman) introduced the absorbed-fraction and S-value formalism that still underlies software such as OLINDA. For decades this framework was applied mainly to diagnostic radiopharmaceutical dose estimates rather than to individualising therapy.

Personalised, image-based dosimetry for peptide receptor radionuclide therapy (PRRT) was developed and tested prospectively from the early 2010s, principally by Swedish groups: Sandström et al. and Garske-Román et al. at Uppsala, and Sundlöv et al. at Lund, used SPECT/CT-based kidney dosimetry to vary the number of 177Lu-DOTATATE cycles per patient up to a fixed renal biologically effective dose (27 Gy, with a 40 Gy option in low-risk patients) rather than a fixed four-cycle course. Despite this evidence base, the pivotal trials that led to approval, NETTER-1 for Lutathera (FDA, January 2018) and VISION for Pluvicto (FDA, March 2022), used fixed activities and a fixed number of cycles, and the resulting labels do not require patient-specific dosimetry for in-label use.

The current step is guideline consolidation: the joint EANM/SNMMI procedure guideline for 177Lu-PSMA radioligand therapy (2023) states plainly that fixed dosing was how the drug was approved and that dosimetry is not mandatory in-label, while EANM's 2022 dosimetry-committee recommendations and its 2024 guidance for first-in-human studies push in the opposite direction, calling for patient-specific absorbed-dose calculation as standard practice, especially early in a new drug's development. The emerging and speculative steps are quantitative SPECT/CT and total-body PET made fast and automated enough for routine clinical dosimetry, and trials that prospectively randomise dosimetry-guided dosing against the fixed-activity standard of care.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-22

## Sources

- From the MIRD Committee: history and founding, 1965 (J Nucl Med): https://jnm.snmjournals.org/content/jnumed/50/2/25N.full.pdf
- Sundlöv et al., individualised 177Lu-DOTATATE treatment based on kidney dosimetry (Eur J Nucl Med Mol Imaging 2017): https://pmc.ncbi.nlm.nih.gov/articles/PMC5506097/
- Joint EANM/SNMMI procedure guideline for 177Lu-PSMA-RLT (2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC10317889/

## Connected records

- isotopes: [Lutetium-177](https://nuclide.cc/isotopes/lu-177/)
- technologies: [In vivo dosimetry and patient-specific quality assurance](https://nuclide.cc/technologies/in-vivo-dosimetry/), [Peptide receptor radionuclide therapy (PRRT)](https://nuclide.cc/technologies/prrt/), [Radioligand dosimetry](https://nuclide.cc/technologies/radioligand-dosimetry/), [SPECT/CT](https://nuclide.cc/technologies/spect-ct/), [Total-body PET for screening and ultra-low-dose imaging](https://nuclide.cc/technologies/total-body-pet-screening/)
- terms: [Dosimetry](https://nuclide.cc/terms/dosimetry/), [Gray unit (Gy)](https://nuclide.cc/terms/gray-unit/)
- trials: [NETTER-1](https://nuclide.cc/trials/netter-1/), [VISION](https://nuclide.cc/trials/vision/)
- people: [Clemens Kratochwil](https://nuclide.cc/people/clemens-kratochwil/), [Ken Herrmann](https://nuclide.cc/people/ken-herrmann/)
- targets: [Somatostatin receptor 2](https://nuclide.cc/targets/sstr2/)
- ideas: [Dosimetry-personalised PRRT instead of four fixed cycles](https://nuclide.cc/ideas/idea-net-dosimetry-prrt/), [Total-body PET for personalised radioligand dosing](https://nuclide.cc/ideas/idea-total-body-pet-dosimetry/)
- drugs: [Lutetium-177 dotatate](https://nuclide.cc/drugs/lutathera/), [Lutetium-177 vipivotide tetraxetan](https://nuclide.cc/drugs/pluvicto/)

---
JSON: https://nuclide.cc/api/v1/entities/dosimetry-roadmap.json