Journal of nuclear medicine technology最新文献

The field of theranostics is experiencing rapid growth, driven by the expanding pipeline of radiopharmaceutical therapies and increasing clinical demand. This paper provides a comprehensive overview of the current financial landscape, coding and reimbursement strategies, and long-term planning considerations required to financially support clinical theranostics programs in the United States. Emphasis is placed on accurate Current Procedural Terminology and Healthcare Common Procedure Coding System coding, engagement with stakeholders, and the importance of compliance, billing accuracy, and infrastructure investment. Key areas such as dosimetry, amino acid infusion billing, Evaluation and Management codes, and leverage of 340B pricing are explored. The paper also outlines tools and resources available to support correct coding and operational success and provides guidance for projecting a 5-y budget necessary for scaling programs to meet anticipated global market growth of and patient demand for theranostics. The goal is to equip nuclear medicine and theranostics professionals and hospital leaders with practical insights for building financially viable and sustainable theranostics programs that can meet future demand.

Theranostics-a rapidly advancing field that integrates diagnostic imaging with targeted radiotherapy-holds great promise for revolutionizing cancer care. As this paradigm expands, a major challenge to its success lies in building and sustaining a skilled workforce, particularly in radiopharmaceutical development and delivery. A critical yet underrecognized member of this workforce is the nuclear pharmacist (also referred to as a radiopharmacist). Traditionally tasked with the preparation and dispensing of radiopharmaceuticals, nuclear pharmacists are increasingly stepping into clinical roles, especially in academic and theranostic-focused centers. These professionals bring expertise in radiochemistry, pharmacology, regulatory compliance, and patient care-making them uniquely suited to support the growing complexity of theranostic therapies. This article highlights the evolution of radiopharmacy, the specialized training of clinical nuclear pharmacists, and their expanding role in patient-centered care. Emphasizing collaborative practice models and future educational pathways, we argue that integrating clinical nuclear pharmacists into theranostic teams will enhance safety, efficiency, and therapeutic outcomes in this transformative area of medicine.

The rapid expansion of radiopharmaceutical therapy, fueled by new radiopharmaceuticals approved by the Food and Drug Administration and novel theranostic approaches, has created an urgent demand for advanced training beyond foundational nuclear medicine education. To address this gap, the University of Alabama at Birmingham and the Society of Nuclear Medicine and Molecular Imaging launched the Nuclear Medicine Therapy Intensive in 2024. Designed for practicing nuclear medicine technologists and nuclear medicine advanced associates, this program integrates didactic instruction, simulation-based learning, interprofessional collaboration, and innovative capstone experiences (e.g., a nuclear medicine therapy escape room). Participants engage in activities that strengthen their knowledge in radiation safety, dosimetry, patient eligibility, communication, and clinical trial literacy while applying skills in hands-on therapy simulations. Preassessment and postassessment results from 2024 and 2025 cohorts demonstrated marked gains in knowledge and confidence, with most graduates directly working with theranostics services at their institutions. The weeklong intensive serves as a model for preparing professionals to deliver radiopharmaceutical therapies safely and effectively and with patient-centered excellence.

Theranostics, the combination of diagnostic and therapeutic nuclear medicine, has revolutionized the field by offering patient-specific, targeted treatment options. Although the concept dates back to the early use of radioiodine to treat thyroid disorders, modern theranostics encompasses a wide range of diseases and options and is becoming an integral component of precision medicine. Despite rapid advancement, significant barriers, such as geographic disparities, workforce shortages, regulatory burden, inadequate infrastructure, high costs, and low awareness, among providers and patients limit equitable patient access to theranostic services. Overcoming these barriers will require coordinated action among health care institutions, policymakers, educators, and professional societies to harmonize standards, support workforce expansion, and develop flexible, scalable models of care and training. By uniting stakeholder efforts, embracing innovation, and prioritizing equity, the field can fulfill the promise of theranostics and ensure that these therapies reach all patients.

Theranostic programs are expanding rapidly, creating a growing need to understand how institutions implement [¹⁷⁷Lu]Lu-DOTATATE therapy and [¹⁷⁷Lu]Lu-PSMA-617 therapy in clinical practice. Methods: We distributed a 25-question online survey to U.S. health care institutions that administer ¹⁷⁷Lu therapies. The survey collected data on therapy administration, patient monitoring, imaging protocols, and radiation safety practices. Results: Thirty-five institutions responded. Practices varied widely in administration methods, vital sign monitoring, antiemetic use, and imaging protocols. Most sites infused [¹⁷⁷Lu]Lu-DOTATATE over an average of 30 min via pump or gravity method, whereas [¹⁷⁷Lu]Lu-PSMA-617 was more often administered by hand injection within 10 min. Vital signs were monitored at 91% of [¹⁷⁷Lu]Lu-DOTATATE therapy sites compared with 57% for [¹⁷⁷Lu]Lu-PSMA-617 therapy. Antiemetics were used at 97% of [¹⁷⁷Lu]Lu-DOTATATE sites versus 23% at [¹⁷⁷Lu]Lu-PSMA-617 sites. Posttherapy imaging was performed for 48% of [¹⁷⁷Lu]Lu-DOTATATE therapies and 57% of [¹⁷⁷Lu]Lu-PSMA-617 therapies, with substantial variation in timing and frequency. Conclusion: These results indicate significant variability in clinical theranostics practice in the United States and may result in meaningful differences in patient outcomes and satisfaction. The findings emphasize the necessity for consensus guidelines and standardization. This article also explores key lessons learned from real-world implementation, highlighting the evolving nature of theranostic programs as they expand in clinical practice.

The integration of targeted therapies and diagnostic imaging has significantly advanced the field of nuclear medicine. This article highlights the critical importance of comprehensive training and education in theranostics to ensure high-quality patient care and adherence to regulatory standards. Ongoing education is essential for technologists to adapt to evolving clinical practices and supports institutional goals of staff retention. This article presents a structured approach to training, including standard operating procedures, protocols, and competency assessments specific to ¹⁷⁷Lu-based therapies. A multidisciplinary strategy involving various health care stakeholders is emphasized as central to the success of theranostic practice. Additionally, the article explores key training and onboarding practices and provides guidance on the use of resources from professional organizations to build staff knowledge and confidence. As theranostics continues to expand in clinical application, maintaining compliance across hospital, state, and federal levels is paramount to advancing safety, quality, and efficiency in nuclear medicine.

Radiopharmaceutical services are key in cancer screening, diagnosis, staging, treatment monitoring, detection of remission, and therapy. Unfortunately, due to the high costs of these services, their availability is very limited in developing countries. This study highlights issues related to access to radiopharmaceuticals and imaging equipment in English-speaking African countries. Methods: The study used a cross-sectional, quantitative online survey approach. Results: Findings revealed that only 13 of the 24 English-speaking African countries have nuclear medicine sites; 62% of countries with nuclear medicine sites rely on sole suppliers for ⁹⁹Mo/^99mTc generators. Of these countries, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe procure their generators only from South Africa, whereas Kenya, Mauritius, and Sudan procure theirs solely from European countries and Turkey. Cameroon, Ethiopia, Ghana, Namibia, and Nigeria procure generators from multiple countries. South Africa is the only English-speaking African country that commercializes radiopharmaceuticals and therefore has the greatest access to radiopharmaceuticals in this region. Only 23% of English-speaking African countries having access to PET services and theranostics. Conclusion: Gaps in access to radiopharmaceuticals among English-speaking African countries have been identified and are largely due to the lack of equipment and poor infrastructure. Plans to strengthen access to radiopharmaceuticals in some of the countries in this region are under way. Our survey found that 331,758,822 people from 11 English-speaking African countries from the region have no access to radiopharmaceutical services.

Technologists are increasingly responsible for complex theranostic procedures, yet formal training and standardized protocols remain limited. This article outlines the development and implementation of detailed protocols at Oregon Health & Science University to support patient care, regulatory compliance, staff training, and reproducible workflows for therapy administration and imaging. Protocols were developed through collaboration among technologists, physicians, nurses, and physicists to ensure adaptability and consistency. Key considerations include delineation of responsibilities between nursing and technologist staff and flexibility in administration techniques on the basis of patient needs and institutional resources. The protocols provided herein serve as practical examples for institutions initiating or expanding theranostic services and contribute to broader efforts toward standardization across the field.