|mird-237| — [new]

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The Medical Internal Radiation Dose (MIRD) schema has been a cornerstone of quantitative dosimetry for radionuclide therapy and diagnostic imaging for more than six decades. The introduction of the formalism in 2021—an extension that integrates voxel‑based patient‐specific anatomy, dynamic biokinetic modeling, and Monte‑Carlo transport—has opened new avenues for precise organ‐level and sub‑organ dosimetry. This paper provides a comprehensive review of the MIRD‑237 framework, detailing its theoretical underpinnings, computational implementation, validation studies, and clinical applications. We also discuss current limitations, including uncertainties in time‑activity curve (TAC) acquisition, heterogeneity of micro‑dosimetric distributions, and the need for standardized reporting. Finally, we outline a research agenda to accelerate the translation of MIRD‑237 into routine clinical practice, emphasizing hybrid imaging, artificial intelligence (AI)–driven model personalization, and multicenter registries. |mird-237|

Radiopharmaceutical therapy (RPT) and diagnostic nuclear imaging rely on accurate quantification of absorbed radiation dose to predict therapeutic efficacy and toxicity. Historically, the MIRD formalism (MIRD Pamphlet No. 22) employed S‑values —pre‑computed dose conversion factors based on stylized organ models—to estimate mean organ doses. While robust for population‑averaged assessments, these models neglect patient‑specific anatomy, heterogeneity of radionuclide distribution, and temporal changes in biokinetics. : Providing a background or context helps in