Guidelines Research Shareable Resources Radiopharmaceutical Therapy Radiopharmaceutical Roundtable RPT in ASTRO Academy AU Status for RPT Learning Collaboratives AU Training Centers for RPT AU Training Center Form Authorized User (AU) Training Program for Radiopharmaceutical Therapy Applicant Information Section 1: Applicant Information Full Name Profession Primary Specialty Primary Specialty: Primary Specialty Radiation Oncology Nuclear Medicine Other Practice Name Practice Address City State Zip Code Email Phone Radiation Safety Section 2: Radiation Safety and Licensing Information Current NRC State/NRC Contact (if applicable) Radiation Safety Officer (RSO) Name RSO Email RSO Phone Section 3: Eligibility and Background Section 3: Eligibility and Background AuthorizedUser 1. Are you currently an Authorized User (AU) for oral administration of sodium iodide I-131? AuthorizedUser Yes No Agreement State 2. Are you currently pursuing AU status for the parenteral administration of a radioactive drug, for example Lu-177? Agreement State Yes No Training Hours Text 3. Have you completed all required training hours, based on NRC or Agreement State requirements for AU Status for parenteral administration of radiopharmaceuticals? Training Hours Radio Buttons Yes No Astro Form Text - Describe your current experience Describe your current experience with radiopharmaceuticals or systemic radiation therapy: Describe your current experience Host Facility Placement Section 2: Host Facility Placement PreferenceChoice West coast East coast Preference2 I acknowledge that I am responsible for my own travel, lodging, and associated expenses. I agree to comply with all facility safety and confidentiality policies during training. Host Facility Checkbox I understand that ASTRO will assign me to a participating accredited radiation oncology facility for the clinical observation portion of the training, however, my preference is to attend: RequiredDocuments Section 4: Required Supporting Documents (attach with submission) SupDocs Curriculum Vitae (CV) Statement of Clinical Interest in Radiopharmaceutical Therapy Letter from Agreement State/NRC confirming that observed cases in this program will meet AU Training & Experience (T&E) requirements Letter from RSO confirming institutional approval and acceptance of observed cases for AU documentation Section 5: Pre-Learning Requirements Section 5: Pre-Learning Requirements MultipleChoice I have reviewed NRC and State requirements for AU Training and Experience (10 CFR 35.390 or equivalent). I will complete the ASTRO “Beyond the Beam” Radiopharmaceutical Therapy Webinar Series (ASTRO will confirm completion). I will review all ASTRO-provided RPT educational materials, including safety, workflow, and documentation resources. FacilityPlacement Section 6: Host Facility Placement Preference I understand that ASTRO will assign me to a participating accredited radiation oncology facility for the clinical observation portion of the training, however, my preference is to attend: CertificationandAcknowledgment Section 7: Certification and AcknowledgmentBy signing below, I confirm that all information provided is accurate and complete. I understand that participation in the AU Training Program does not, by itself, confer Authorized User status for radiopharmaceuticals, and that final authorization is granted only by the NRC or my Agreement State upon review of all required documentation. RSOConfirmation Section 8: RSO Confirmation Checkbox_RSO Letter attached or I confirm that the above applicant is authorized by our practice to participate in the ASTRO AU Training Program for Radiopharmaceutical Therapy. Our practice acknowledges and accepts the observation of three therapeutic cases through this program as part of the applicant’s AU documentation. RSOName Institution Email PhoneNumber RSOSignature AgreementState Section 9: Agreement State/NRC Confirmation (attach letter or complete below) CheckboxAgreementState Letter attached confirming confirmation that ASTRO’ Authorized User Training Program for Radiopharmaceutical Therapy will be accepted as part of the AU Training and Experience requirement under applicable regulations. AgreementStateName Agency
