The use of medical isotopes in theranostics for nuclear medicine
In nuclear medicine, theranostics—a fusion of diagnostics and therapeutics—is transforming cancer care. It uses specific radioisotopes to both pinpoint and treat tumors in one integrated approach, enhancing precision and patient outcomes.
Theranostics involves a paired system: one isotope to image the tumor and another one to deliver treatment. Candidates like copper‑64 (diagnostic) and copper‑67 (therapeutic) offer consistent chemistry for both phases, improving targeting accuracy and reducing side effects.
Urenco, a company that specializes in uranium enrichment services and fuel cycle products, leads the way in producing copper isotopes—Cu‑64 and Cu‑67—designed for diagnostic imaging and therapeutic applications. Their efforts represent pioneering progress in isotope production for theranostics.
Theranostics uses a paired system where one isotope images the tumor and the other delivers treatment
A key component of clinical theranostics is the isotope lutetium‑177 (Lu‑177). It is increasingly used in targeted radionuclide therapy, particularly for neuroendocrine tumors. Production is growing in places such as Bruce Power in Canada, using their Isotope Production System (IPS) to scale Lu‑177 output.
Institutions like CERN‑MEDICIS are innovating in the creation of lesser-used lanthanide isotopes—notably samarium‑153 and terbium‑149—which exhibit both diagnostic and therapeutic properties useful in advanced theranostic research.
Research is focused on creating isotopes that can exhibit both diagnostic and therapeutic properties
Despite its promise, theranostics technology still must overcome a few obstacles:
- Production shortage: key isotopes like molybdenum‑99 (^99Mo) (the parent of technetium‑99m) are made at a limited number of aging reactors. Shutdowns—like at the reactor in Petten, Netherlands—have caused global disruptions in imaging capabilities.
- Infrastructure problems: Many regions lack robust manufacturing for short‑lived isotopes, which require rapid use (e.g. within 24 hours of production).
- Regulatory and access barriers: High equipment costs (gamma cameras, PET/SPECT, cyclotrons), coupled with limited workforce or biomarker validation, impede widespread adoption—especially in low‑ and middle‑income countries.
The technology of theranostics must still face a few obstacles such as production shortage, insufficient infrastructure and regulatory and access barriers
Europe is taking steps to address these challenges: the European Commission approved €2 billion in state aid to build a new isotope reactor in the Netherlands, securing future supply of critical isotopes like Mo‑99 and addressing projected post-2030 shortages .
In North America, companies like Shine Technologies are pioneering fusion-driven Mo‑99 production, and Bruce Power continues expanding its commercial Lu‑177 output to supply growing demand for therapy isotopes .
The European Commission has approved a new isotope reactor in the Netherlands to secure future supply of critical isotopes like Mo-99
Source: World Nuclear News
