Radiopharmaceutical Therapy: Rapid Growth, Rising Challenges, and the Critical Need for Expertise.

This publication is a Society of Nuclear Medicine and Molecular Imaging (SNMMI) position paper outlining how radiopharmaceutical therapy (RPT)-based theranostics should be implemented and governed as the field rapidly expands beyond thyroid disease into neuroendocrine tumors, prostate cancer, and other malignancies.

Key points:

• Central role of nuclear medicine: RPT should be led by nuclear medicine professionals with specific expertise in radiopharmaceutical selection, dosimetry, imaging, and safety, rather than being treated as a generic systemic therapy.
• Workforce and infrastructure needs: With anticipated large growth in RPT use (hundreds of thousands of treatment cycles and many new treatment centers), there is a pressing need to train additional physicians, technologists, physicists, radiochemists, radiopharmacists, and allied staff.
• Training and competency: All team members must complete accredited training that addresses patient selection, radiopharmaceutical handling, radiation safety, and individualized treatment planning. The paper emphasizes that delivering RPT without appropriate training risks compromised safety, efficacy, and quality of care.
• Standards and guidelines: SNMMI has long provided standards and clinical practice guidelines for nuclear medicine and RPT, which are regularly updated. These form the framework for best practices in patient management and radiation protection.
• Centers of Excellence and accreditation: SNMMI has created RPT Centers of Excellence and, with the International Accreditation Commission, an accreditation program for facilities administering RPT to ensure consistent quality and safety across institutions.
• Support for clinical research: Through the Clinical Trials Network and the Therapy Clinical Trials Network, SNMMI supports clinical trials involving RPT, including quality assurance for imaging systems used to select patients, guide therapy, and assess response.
• Global collaboration: Partnerships with international nuclear medicine societies aim to harmonize standards, share knowledge, and globally elevate best practices for RPT delivery.

Overall, the paper frames RPT as a rapidly expanding, complex therapeutic modality that demands structured training, formal accreditation, robust guidelines, and multidisciplinary collaboration to ensure safe, effective, and high-quality patient care.