Toward personalized iodine-131 therapy: A review of dosimetric strategies.

BACKGROUND: Iodine-131 (131I) therapy is a cornerstone of nuclear medicine for thyroid diseases and certain cancers. This review evaluates the transition from empirical to personalized dosimetry, focusing on image-based and AI-driven strategies. METHODS: Following PRISMA guidelines, we analyzed studies from 1980 to 2025 across PubMed, Scopus, and other databases. We examine the core dosimetric frameworks used in 131I therapy, from fixed-activity protocols and the Medical Internal Radiation Dose (MIRD) schema to more sophisticated voxel-based techniques like Dose Point Kernels (DPKs), Voxel S-Values (VSVs), and full Monte Carlo simulations. Each method is discussed in terms of its strengths, limitations, and relevance to different clinical scenarios, especially in the context of metastatic thyroid cancer and neuroblastoma. RESULTS: Advanced methods such as voxel-based dosimetry and Monte Carlo simulations improve dose accuracy, while AI enhances segmentation and real-time planning. Personalized approaches show promise in optimizing therapeutic outcomes and minimizing toxicity, paving the way for standardized theranostic protocols. As the field increasingly incorporates AI, hybrid imaging, and personalized modeling, the objective is to deliver the right dose to the right patient at the right time with minimal risk. CONCLUSION: Standardizing these innovations across clinical practice will be key to ensuring safer, more effective treatments in the era of theranostics and personalized medicine.