Diagnostic Imaging Insights
Cancer is the second-leading cause of death in the United States.1 Its treatment is complicated because different cancers behave in different ways. A single treatment rarely works for everyone. However, a new approach called theranostics is changing how providers diagnose and treat cancer.
Theranostics combines diagnostic radiopharmaceutical imaging to find cancer and targeted radioactive therapy to treat it.2 This method is already improving outcomes for many patients and is expected to play a larger role in cancer care moving forward.
Theranostics allow clinicians to see what they treat and treat what they see.3
Some NETs express somatostatin receptors (SSTR2). A PET scan using dotatate linked to a radioactive tracer identifies the tumor. The same molecule with a therapeutic isotope is then used to deliver radiation to the cancer cells, minimizing damage to healthy tissue.
The concept of theranostics isn’t new. In 1921, Marie Curie explored the use of radium in cancer treatment.4 In the 1940s, Dr. Saul Hertz developed the use of radioactive iodine (I-131) to treat thyroid conditions. The FDA approved this therapy in 1951, making it the first dual-purpose radiopharmaceutical: I-123 for imaging and I-131 for treatment.4 Today, theranostics is becoming recognized as the fifth pillar of cancer treatment, alongside surgery, chemotherapy, radiation therapy and immunotherapy.3
Theranostics is now making significant strides in prostate cancer care. Advanced prostate cancers often express a protein called prostate-specific membrane antigen (PSMA). PSMA PET scans can detect these tumors. If positive, patients may be eligible for Lutetium-177 vipivotide tetraxetan, a targeted therapy that binds to PSMA and delivers radiation to the cancer cells.
After therapy:
Theranostics is growing rapidly. According to Sg2, radiopharmaceutical therapy is projected to grow by 20% over the next decade.5 This growth is fueled by:
These modalities are essential for staging, treatment planning and evaluating response. In many cases, they provide clearer confirmation of drug delivery than lab values.
Clinical trial activity is increasing, opening more opportunities for patients to access emerging therapies and for institutions to participate in research. Technologists and providers involved in trials can benefit from the Society of Nuclear Medicine and Molecular Imaging Clinical Trials Network Research Series, which provides tools and training to support best practices.2
In the U.S., the following radiopharmaceutical therapies are approved by the FDA:
Many ongoing trials aim to expand these therapies to other cancers, with the goal of making treatment more precise and less toxic.
As adoption grows, health systems will need to invest in infrastructure, staffing and process improvements to support theranostics effectively. Some common challenges and potential solutions are listed below:
Access to PET/CT, PET/MRI and SPECT remain a limiting factor. Imaging bottlenecks can delay treatment.
Action steps:
Theranostics adds complexity to the supply chain due to short isotope half-lives, as well as a demand that exceeds the current supply.
Action steps:
Theranostics requires collaboration across disciplines. Medical oncologists need familiarity with nuclear imaging and radiopharmaceuticals. Nuclear medicine physicians should understand cancer treatment pathways. There’s also rising demand for nuclear medicine technologists, dosimetrists, pharmacists, radiologists and radiation safety officers to collaborate.
Action steps:
Fragmented referral processes can delay or prevent access to therapy.
Action steps:
Best practice: Form a Theranostics Tumor Board to improve patient selection and promote coordination across specialties.
Theranostics is reshaping the future of cancer care. By combining imaging and treatment into a single, personalized approach, it offers clinicians a powerful new way to treat patients more precisely and effectively. Vizient aims to bring providers value in this space through its partnerships with market-leading radiopharmacies, as well as with manufacturers of radiopharmaceuticals. Vizient also has a vast network of subject matter experts, both internally and across the industry.
For health systems and providers, the path forward will require investments in infrastructure, workforce development and collaborative care models. However, the reward is significant: better outcomes, safer therapies and the opportunity to lead in delivering the next generation of cancer treatment.
Lindsay Williams is a healthcare leader and expert in nuclear medicine and radiopharmaceuticals, currently serving as Portfolio Executive at Vizient, where she specializes in theranostics, contrast media, and advanced imaging technologies. Lindsay brings nearly 20 years of clinical, educational, and operational experience, demonstrating a passion for improving patient care, fostering innovation, and mentoring the next generation of healthcare professionals. Media...
As a senior associate on the intelligence team, Setu Shah develops thought leadership to help members navigate the current and future landscape of cancer care delivery. She translates the impact of national trends, emerging drugs and therapeutics, and service line distribution and optimization into strategic and business development considerations for health system leaders. She earned a Master of Public Health...
Janna Laton is a highly accomplished professional in radiopharmaceuticals and medical devices. With an MBA and multiple certifications in molecular imaging, Janna has led groundbreaking initiatives in nuclear medicine, oncology sales, and theranostics. She's a national sales leader, an award-winning industry expert, and a trusted advisor in the healthcare field.
