Manual on the proper use of meta-[(211)At] astato-benzylguanidine ([(211)At] MABG) injections in clinical trials for targeted alpha therapy (1st edition)

In this manuscript, we present the guideline for use of meta-[(211)At] astatobenzylguanidine ([(211)At] MABG), a newly introduced alpha emitting radiopharmaceutical to the up-coming World’s first clinical trial for targeted alpha therapy (TAT) at Fukushima Medical University in Japan, focusing on radiation safety issues in Japan. This guideline was prepared based on a study supported by the Ministry of Health, Labour, and Welfare, and approved by the Japanese Society of Nuclear Medicine on Oct. 5th, 2021. The study showed that patients receiving [(211)At] MABG do not need to be admitted to a radiotherapy room and that TAT using [(211)At] MABG is possible on an outpatient basis. The radiation exposure from the patient is within the safety standards of the ICRP and IAEA recommendations for the general public and caregivers or patient’s family members. In this guideline, the following contents are also included: precautions for patients and their families, safety management associated with the use of [(211)At] MABG, education and training, and disposal of medical radioactive contaminants. TAT using [(211)At] MABG in Japan should be carried out according to this guideline. Although this guideline is based on the medical environment and laws and regulations in Japan, the issues for radiation protection and evaluation methodology presented in this guideline are useful and internationally acceptable as well.