The
theranostics concept using the same target for both imaging and
therapy dates back to the middle of the last century, when radioactive
iodine was first used to treat
thyroid diseases. Since then, radioiodine has become broadly established clinically for diagnostic imaging and
therapy of benign and malignant
thyroid disease, worldwide. However, only since the approval of SSTR2-targeting
theranostics following the NETTER-1 trial in
neuroendocrine tumors, and the positive outcome of the VISION trial has
theranostics gained substantial attention beyond nuclear medicine. The roll-out of radioligand
therapy for treating a high-incidence
tumor such as
prostate cancer requires the expansion of existing and the establishment of new
theranostics centers. Despite wide global variation in the regulatory, financial and medical landscapes, this guide attempts to provide valuable information to enable interested stakeholders to safely initiate and operate
theranostic centers. This enabling guide does not intend to answer all possible questions, but rather to serve as an overarching framework for multiple, more detailed future initiatives. It recognizes that there are regional differences in the specifics of regulation of radiation safety, but common elements of best practice valid globally.