Personalised Dosimetry in Radioligand Therapy

Is Personalised Dosimetry the Missing Piece in Radioligand Therapy Development?

The field of radioligand therapy has moved fast. Drugs like lutetium DOTATATE and lutetium PSMA-617 now appear much earlier in the treatment journey. Patient numbers are rising. Clinical teams are asking harder questions.

One question stands out. Does fixed dosing still make sense as the field grows?

Why Fixed Dosing Is Under Pressure

Fixed dosing keeps things simple. Every patient gets the same amount. This makes supply, scheduling and compliance easy to manage.

But it misses a key clinical fact. Two patients can get the same dose and absorb very different levels of radiation. Body size, kidney health and tumour type all affect how the drug moves. Some patients get too little. Others absorb too much to healthy tissue. Neither result is good.

Studies in nuclear medicine journals show wide dose gaps between patients, even when the same amount is given. This data is hard to ignore.

Personalised dosing fixes this. Before or during treatment, the clinical team measures how the drug moves in that patient. They then work out the dose each organ and tumour will get. They adjust the plan to match.

What Is Making This More Practical

Until recently, the barriers were high. Accurate dose planning needed many scans after treatment. This was hard on patients and stretched imaging teams. It also needed physics skills that many sites lacked.

Three things are now changing this. First, modern PET and SPECT scans give solid dose data from fewer time points. A 2025 study in Frontiers in Oncology showed that patient-specific dose planning from a pre-treatment scan is now achievable, before any therapy starts.

Second, AI tools now cut the time needed for complex dose work. Third, software built for these therapies is closing the gap between research and day-to-day clinical use.

New data also shows that a single post-therapy scan may be enough for certain drugs and patient groups. That would cut the workload at treatment centres a great deal.

Can AI Predict the Right Dose in Advance?

The most exciting shift is predictive modelling. The goal is to forecast a patient’s dose from a scan taken before treatment.

If that works, clinicians can set the right dose before the first injection. A 2025 review in Nuclear Medicine and Molecular Imaging put it clearly. Dose work is moving from a post-treatment task to a core part of the upfront plan. It now draws on AI tools, Monte Carlo models and patient-specific kinetic data. Several research groups have shown that pre-therapy PET scans can predict post-treatment dose outcomes with real accuracy for lutetium drugs.

This matters most when patients start therapy earlier. They have more to lose from too low a dose. They also have more healthy tissue to protect. The case for personal dosing grows stronger in that setting.

The Workforce Problem

The clinical case is clear. The workforce challenge is just as real.

Routine dose planning needs clinical physicists with nuclear medicine skills, imaging scientists trained in scan analysis, and sites set up for post-therapy scans. Many centres lack at least one of these.

A Lancet Oncology paper in 2024 named clinical dosimetry a critical talent gap across the sector, along with kinetic modelling and chemistry skills. At the same time, the American Society for Radiation Oncology noted that peak dosimetrist retirement falls between 2025 and 2030. The pool of trained people is shrinking just as demand rises fast.

This talent gap is one of the main blocks to personal dosing entering routine use. The imaging and software tools can exist. Without trained people to use them, the clinical benefit stays out of reach.

Will It Become Standard of Care?

Evidence points to personal dosing becoming standard for a specific patient group. This includes those on high-dose therapies, those with poor kidney health, and those who show early signs of weak response.

For wider groups, single-scan methods and AI prediction may make routine dosing viable without the full imaging burden.

The deciding factor is workforce. Building a pipeline of physicists, nuclear medicine technologists and dosimetry staff to meet rising demand takes years. It needs training, clear career paths and global hiring.

Organisations building radioligand therapy programmes need to plan for this now.

Finding the Right Talent

At Skills Alliance, we work with life sciences firms building radioligand and theranostics programmes. Finding clinical physicists and dosimetry staff with the right experience is hard. The talent pool is small. Most of the best people are not actively looking for a new role.

We know where these professionals are. If you are building a programme and want to talk through your dosimetry talent plan, get in touch at Skills Alliance.

By Jasmine Stewart, Associate Director, Skills Alliance