Theranostics Deep-Dive

Who this is for

This track is for the resident or attending who wants to practice radioligand therapy, not just know it exists. It runs from the underlying concept through the two established theranostic pairs, into dosimetry, toxicity, and the operational reality of running a program — and ends at the pipeline that is redefining the field.

The concept

• The Therapy Transformation — the field-level shift and the workforce it demands.
• Molecular Imaging & the Theranostic Pair → Theranostics — Overview — the see-and-treat loop.

The two established pairs

Neuroendocrine (SSTR): ⁶⁸Ga-DOTATATE PET to select → ¹⁷⁷Lu-DOTATATE (PRRT) to treat.

Prostate (PSMA): PSMA PET agents to select → ¹⁷⁷Lu-PSMA-617 to treat; refine selection with Discordant PSMA / FDG Disease.

Dose, response & toxicity

• Personalized vs Fixed-Activity Dosimetry and Dosimetry in Theranostics — why absorbed dose, not activity, is the right prescription.
• Theranostics Response Criteria — how to call response.
• Radionuclide Therapy — Eligibility & Toxicity Monitoring — organs at risk and mitigation.

Running it in the real world

• Building & Running a Theranostics Program — facility, license, team, workflow, and the perishable-dose economics.
• Sequencing, Retreatment & Combinations in RPT — where RPT sits among the lines.

The frontier

• Targeted Alpha Therapy (Ac-225, Pb-212) and Emerging Therapeutic Targets & Isotopes — FAP, GRPR, CXCR4, and the alpha pipeline.
• AI & Machine Learning in Nuclear Medicine — why automated dosimetry is the change that makes personalized therapy routine.

The evidence base

Anchor every claim above to the trials that built the field: VISION · PSMAfore · TheraP · ENZA-p · NETTER-1 / NETTER-2 · ALSYMPCA — the full set is in the Landmark Trials chapter.