When Miami Cancer Institute (MCI) became one of the first practices in the United States to achieve the new radiopharmaceutical therapy (RPT) designation through ASTRO’s APEx – Accreditation Program for Excellence®, it was more than a milestone — it was a statement of where radiation oncology and medical physics are heading. In a recent discussion, leaders from MCI shared how accreditation helped their practice, supported their multidisciplinary collaborations, and elevated the role of physics and dosimetry in a rapidly growing field.
Accreditation as a Journey, Not a Destination
For Minesh P. Mehta, MD, chair of radiation oncology at MCI, accreditation has always been about more than recognition. “Growing a high-quality, academically oriented, evidence-based practice with the patient at the center has been our focus for the last decade,” he explained. “Once you put the patient at the center, high quality, high consistency, and error-free delivery become the hallmarks of every treatment. Accreditation is the measurable yardstick that ensures you reach those goals.”
Unlike one-time certifications, the APEx process is intentionally designed as an ongoing journey of quality improvement. Dr. Mehta emphasized how accreditation helped the team to rebuild processes, rethink workflows, and document standards across the system, including satellite facilities. That rigor, he noted, produced value even before the final certificate was granted: “The process itself elevated our quality. The accreditation just confirmed it.”
Radiopharmaceutical Therapy: A Growing Frontier
When MCI returned for reaccreditation, RPT was added as a new APEx designation. For Mehta, the timing was perfect:
“We saw significant growth in the RPT space. Our numbers were going up year on year. This is an area where multiple specialties — medical oncology, nuclear medicine, diagnostic radiology, and radiation oncology — all want to participate, which makes it especially challenging to maintain consistency. And because errors in this space can easily harm patients, standards and quality become even more critical.”
This complexity underscored the importance of accreditation. RPT, he explained, is radiation therapy at its core — it simply uses a molecular carrier to deliver a radioactive payload. “Just as surgery belongs in surgery and chemotherapy belongs in medical oncology, radiation therapy, including radiopharmaceutical therapy, belongs in radiation oncology,” he said. “That’s where expertise in dose and toxicity mitigation resides.”
Building Multidisciplinary Trust
Adeel Kaiser, MD, noted that MCI began with internal processes to ensure safety and consistency, then deliberately expanded to include colleagues in nuclear medicine, medical oncology, and molecular imaging. The team formalized organizational charts, established leadership structures, and created workflows to balance the needs of each specialty.
The result was not competition, but collaboration. “It’s not a turf war,” Dr. Mehta emphasized. “It’s about doing the right thing for patients. Everyone understood that radiopharmaceutical therapy is both a targeting tool and a radiation delivery tool. Radiation oncologists are positioned to manage both the risks of overdosing and the consequences of underdosing. But that doesn’t diminish the critical contributions of our colleagues in imaging, oncology, and other fields.”
This open, inclusive practice framework helped gain buy-in across specialties. As Dr. Kaiser put it, “We all play different roles, like members of a seasoned football team. The goalie doesn’t abandon the net to score goals, and the striker doesn’t stay back all game to defend. Respecting each specialty’s strengths has made our program stronger.”
The Physics Perspective: Dosimetry at the Center
For medical physicists, the growing role of RPT presents both challenges and opportunities. Ranjini Tolakanahalli, PhD, director of photon physics at MCI, highlighted the unique contribution of physics in this field:
“Dosimetry is only growing within radiopharmaceutical therapy. Dose calculation engines, dose summation, and understanding distribution across lesions are becoming central to patient management. Radiation oncology, with its established infrastructure in physics and dosimetry, is equipped to handle these challenges, especially as patient volumes increase.”
Unlike external beam radiation therapy (EBRT), radiopharmaceuticals deliver non-uniform doses, with some lesions receiving higher or lower levels of radiation. Physics plays a key role in identifying these patterns and integrating solutions, such as supplementing with EBRT or stereotactic body radiation therapy (SBRT), to support comprehensive care.
Dr. Tolakanahalli added that accreditation sharpened this focus: “APEx holds us to high standards of documentation, workflow and quality assurance. Preparing for accreditation highlighted gaps we didn’t realize existed and gave us a chance to tighten those processes. It was a learning experience that improved care before surveyors even arrived.”
Accreditation in Action: Patient Safety and Market Leadership
At the micro level, APEx accreditation improved workflows, documentation and patient safety protocols. For example, MCI developed new ways to communicate radiation exposure to hospital staff unfamiliar with RPT, ensuring safety during admissions or procedures. They also refined patient education, strengthening informed consent processes around dosimetry and potential risks.
Accreditation also had external benefits. Pharmaceutical companies and partner institutions recognized the credibility of APEx Accreditation, which bolstered MCI’s ability to secure clinical trials and collaborations. “It immediately gets their attention,” Mehta said. “It signals quality, consistency and trustworthiness — critical factors for trials that demand rigorous data.”
For Dr. Kaiser, accreditation also strengthened MCI’s leadership in Florida and beyond: “We wanted to be among the leaders in our state. Being first in the country validated our efforts and gave us recognition among referring physicians and peers.”
Lessons for the Field
As RPT continues to grow, practices nationwide are grappling with how to organize programs, balance specialties, and maintain patient safety. Industry itself, Dr. Mehta observed, often struggles to understand the wide variation in how hospitals deliver RPT —sometimes through nuclear medicine, sometimes through oncology, and sometimes through hybrid theranostic centers.
MCI’s example shows the value of fostering multidisciplinary collaboration. It also demonstrates the central role of medical physics in ensuring safe, effective and adaptive treatment strategies.
Looking Ahead
Both Drs. Tolakanahalli and Kaiser stressed that accreditation is not as daunting as it may seem. “The process may look rigorous, but APEx has made it easy to follow,” Dr. Tolakanahalli said. “It’s designed to walk you through identifying gaps and improving quality, not to punish you.”
Dr. Kaiser added that future iterations of accreditation could incorporate emerging best practices and white papers on RPT workflow. “Recommendations from recent literature, like the paper by Zoberi et al. in Practical Radiation Oncology,1 offer valuable guidance. Integrating those insights into accreditation would strengthen the entire field. We have also published our own lutetium workflow2 to make the start-up process easier for new radiopharmaceutical therapy programs.”
Ultimately, MCI leaders see accreditation as both a framework for internal improvement and a platform for external recognition. For Dr. Mehta, the goal remains constant: “This isn’t about territory. It’s about ensuring patients get the safest, highest quality care possible. Accreditation helps us get there.”
References
- Zoberi, JE, Charara, Y, Clements, J et al. Quality and Safety Considerations for radiopharmaceutical therapy in the Radiation Oncology Environment: An ASTRO Safety White Paper. Pract Rad Onc. Published April 4, 2025. DOI: 10.1016/j.prro.2025.03.006
- George SC, Tolakanahalli R, Aguirre S, et al. A single-institution experience with 177Lu RPT workflow improvements and qualifying the SPECT/CT imaging for dosimetry. Front Oncol. 2024 Feb 26;14:1331266. doi: 10.3389/fonc.2024.1331266. Erratum in: Front Oncol. 2024 Apr 12;14:1410818. doi: 10.3389/fonc.2024.1410818. PMID: 38469241; PMCID: PMC10925616.
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