We are doing them all in our practice, hasn't even been a conversation about whether us or Nuc Med. There are good consults to see, as I've seen a few with large mets in the proximal femurs that I've run by Ortho and/or done a short course of EBRT while waiting for Xofigo to process/arrive. Same with spine mets, I often throw in 20/5 if bulky/threatening cord. Med Oncs and certainly Nuc Meds don't think about these local issues as we do.