Unsealing the Source: Scope of Practice for Radiopharmaceuticals/Unsealed Sources Among U.S. Radiation Oncologists.

PURPOSE/OBJECTIVE(S) To survey the utilization, interest in, and barriers to implementation of radiopharmaceuticals/unsealed sources amongst U.S. radiation oncologists. MATERIALS/METHODS An anonymous, voluntary survey directed towards attending radiation oncologists was distributed via social media platforms (Twitter, LinkedIn, SDN, Facebook). Questions assessed practice characteristics, radiopharmaceutical prescribing patterns (Iodine-131, Radium-223, Yttrium-90, Sumarium-153, Strontium-89, Phosphorous-32, "other"), prescribing interest level, and perceived barriers to implementation. Non-parametric χ2 test was used for correlation statistics. RESULTS Of the 120 respondents, 112 practiced in the U.S and were included for this analysis. Years of practice was broadly distributed with 30% (n = 34) of attendings in practice > 10 years, 21% (n = 23) 6-10 years, 25% (n = 28) 3-5 years, and 24% (n = 27) 0-2 years. Practice type included academic-main site amongst 39% (n = 44), academic-satellite in 18% (n = 20), and private practice/other in 43% (n = 48) of attendings. Forty-four percent (n = 49) of attendings served populations of > 500K, 22% (n = 25) 200-500K, 25% (n = 28) 100-200K, and 9% (n = 10) 0.05) association was noted between practice type, practice location, years of practice, or practice volume with utilization of any radiopharmaceuticals/unsealed sources. The majority (55%, n = 61) of attending radiation oncologists responded they would like to actively prescribe more radiopharmaceuticals/unsealed sources, while 30% (n = 31) were indifferent and 18% (n = 20) answered "no." Perceived barriers to implementation were varied but broadly categorized into treatment infrastructure (43%, n = 48), interspecialty relations (42%, n = 47), lack of training (21%, n = 24), and financial considerations (17%, n = 19). CONCLUSION Almost half of surveyed U.S. radiation oncologists reported prescribing at least one radiopharmaceuticals/unsealed source, of which Ra-223 was the most common. The majority expressed interest in prescribing additional radiopharmaceuticals/unsealed sources. Wide-ranging barriers to implementation exist, most commonly interspecialty relations, treatment infrastructure, lack of training, and financial considerations.