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

The field of theranostics dates back over 80 y, when Hertz and Roberts first used radioactive iodine to treat thyroid disease. Recent theranostic approvals for neuroendocrine tumors and prostate cancer have expanded the use of radiopharmaceutical therapy (RPT), and there is significant near-term potential for further expansion across multiple tumor types. This Society of Nuclear Medicine and Molecular Imaging (SNMMI) position paper emphasizes the leadership role of nuclear medicine and nuclear medicine professionals in the high-quality and safe delivery of RPT through specific training, education, regulatory guidance, and collaborations. The rapidly increasing demand for access to and delivery of radiopharmaceuticals has the potential to spur hundreds of thousands of cycles of RPT, with the resultant need for hundreds of new centers and more experts to deliver these therapies. Such an expansion would involve the entire SNMMI membership, including physicians, technologists, radiochemists, physicists, radiopharmacists, scientists, and allied health professionals. All nuclear medicine team members are accredited by specific training programs covering the selection and use of radiopharmaceuticals for theranostics to minimize risks and tailor procedures to the needs of individual patients. The administration of RPT without appropriate training and experience poses significant risks in terms of patient outcomes, impacting safety, efficacy, and overall quality of care. For over 70 y, SNMMI has set comprehensive standards and clinical guidelines for the entire field of nuclear medicine, including RPT, which undergo continual review and updating. Recently, SNMMI established RPT Centers of Excellence and, in collaboration with the International Accreditation Commission (IAC), an accreditation program for facilities administering RPT. Through the Clinical Trials Network (CTN) and Therapy Clinical Trials Network (TCTN), the SNMMI also supports research and quality assurance for imaging cameras used to evaluate patients receiving RPT in clinical trials. Furthermore, collaborations with other international nuclear medicine societies ensure the continual promotion of best practices and knowledge sharing to advance the field of nuclear medicine globally.