Radioligand therapy (RLT) introduces a variable most clinical safety systems were never built to track: absorbed radiation dose, accumulating across cycles, distributed by the patient's own physiology. The relevant safety questions — marrow reserve, renal clearance, cumulative exposure to organs at risk — sit at the intersection of oncology, nuclear medicine, and dosimetry.

This is the dosimetry-safety gap. A pharmacovigilance team trained on small molecules and biologics can process RLT cases competently on paper while missing the through-line that actually governs risk: where the dose is going and what reserve remains. The signal that matters may not look like a classic adverse event at all.

Programs running RLT need safety oversight that is fluent in this language and a monitoring plan that treats dosimetry as a first-class safety input — not an imaging footnote. As more radioligand assets move through the clinic, this fluency stops being optional.