Activity Delivery and Radiation Exposure in ¹⁷⁷ Lu-Based Therapies: Prospective Evaluation of a Single-Puncture Closed System with Programmable Infusion

Radiopharmaceutical therapies often require various manipulations of the activity vial before administration. Increased manipulation increases vial contamination and radiation exposure risk. This study evaluates a single-puncture, closed-system method using a ChemoClave-linked infusion pump (referred to as CLIP) to reduce exposure and automate workflow when delivering ¹⁷⁷Lu-based therapies. Methods: A prospective study compared manual syringe withdrawal to the CLIP system over two 4-mo periods. The primary outcome was staff radiation exposure. Secondary outcomes included preparation time, residual activity, and staff satisfaction. Other methods were not evaluated because previous studies had already reported their dose savings compared with manual syringe withdrawal. Results: Sixty-nine administrations were analyzed for both radiation exposure and residual activity (24 manual, 45 CLIP). The CLIP system achieved substantial reductions in radiation exposure: chest doses decreased 85% (1.10 to 0.16 mrem/administration, P < 0.001) and finger doses decreased 91% (7.79 to 0.68 mrem/administration, P < 0.001). Delivery consistency improved significantly, with the coefficient of variation decreasing from 77% to 23%. Preparation time remained comparable (201 ± 15 s vs. 202 ± 12 s). Conclusion: Single-puncture closed-system technology provides exceptional potential for the reduction of radiation exposure (85%–91%) while improving delivery consistency and maintaining efficiency. These results support consideration as a new standard method for ¹⁷⁷Lu administration.