During the European Congress of Radiology 2025, prominent experts examined significant advancements in nuclear medicine, emphasising theranostics, radiotracer safety protocols and clinical trial management methodologies. The discussions underscored the integration of cutting-edge technologies aimed at refining precision medicine and optimising patient safety outcomes.
Theranostic Applications in Clinical Practice
Ana Geão from Hospital CUF Descobertas (Portugal) presented insights on theranostics, an innovative framework that integrates diagnostics and therapeutic interventions to improve precision in cancer management. She elaborated on the etymology of the term, derived from the Greek words for therapy and knowledge, “gnosis.” Geão noted its surge in relevance since the early 2000s, with significant growth in relevant IT publications during this period.
Theranostics utilises radiopharmaceuticals for simultaneous tumour imaging and targeted therapy, relying on identical molecular compounds. “The principle of theranostic is to identify the right molecular probe, diagnostic and therapeutic for the right patient in order to maximise subsequent treatment outcome while minimising the techs technology.” The concept can be traced back to the 1940s when the pioneering use of iodine-131 was used to diagnose and treat thyroid disorders. Advancements in radiochemistry and molecular imaging have broadened the scope of theranostics, particularly in the contexts of neuroendocrine tumours and prostate cancer. The integration of imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) has significantly enhanced imaging precision.
Geão underscored the rapid expansion of the theranostic market, projecting its global size to reach approximately $5.4 billion (€5 billion) by 2030. However, she identified several challenges, including the limited half-life of radiopharmaceuticals, logistical constraints and radiation safety considerations.
Looking ahead, Geão pointed to emerging innovations, stating, “We have to integrate artificial intelligence as well as machine learning to help us not only in design tree but also in the whole process.” She concluded by reaffirming the pivotal role of theranostics in advancing precision medicine.
The Safe Use of Radiotracers: Adopting A Sustainable Approach
Dr. Karen Borg Grima from the University of Malta conducted an in-depth session focused on the safe and sustainable application of radiotracers in the field of nuclear medicine. She underscored the critical need to mitigate radiation exposure for personnel involved in the handling and administration of these tracers, highlighting the risks associated with both internal (ingestion/inhalation) and external (direct contact) radiation exposure.“The hands are the part of the body that will tend to get the most radiation,”she noted, emphasising the necessity of employing protective measures such as tongs, tweezers and syringe shields and minimising direct contact duration.
Effective administration also necessitates rigorous patient preparation protocols, which include confirming patient identity, conducting pregnancy assessments and making necessary medication adjustments. “Answering the patient’s questions prior to administration is very important to avoid again getting a dose for nothing,” she stressed. The use of cannulas was recommended to facilitate efficient injections and thereby decrease superfluous exposure, with staff rotation advised as a strategy to evenly distribute radiation doses among team members.
Dr. Borg Grima elaborated on the significance of shielding, cautioning that unshielded handling could result in radiation exposure levels “nearly 100 times more” compared to those when proper barriers are in place. It is essential to adhere strictly to international standards set by the NRC, IAEA and ICRP, while also ensuring that instruments are well-calibrated and subject to routine quality control assessments.
To further enhance safety, she advocated for the integration of novel shielding materials, the implementation of simulation-based training and ongoing competency evaluations. “Just having a radiographer trained in nuclear medicine and expecting them to know it all for years to come is not acceptable anymore,” she cautioned. Annual risk assessments are crucial for identifying hazards and improving overall workplace safety.
On the sustainability front, Dr. Borg Grima recommended optimising patient appointment scheduling in alignment with daily radioisotope availability, tailoring doses according to patient weight and minimising waste via just-in-time delivery systems. The session concluded with a compelling call for continuous professional development to maintain excellence in nuclear medicine practices.
Optimising Management and Clinical Trials in Nuclear Medicine
Daniela Fonseca Ribeiro from King’s College Hospital (UK) presented an insightful discussion on optimising and managing clinical trials within the realm of nuclear medicine. Her overview encompassed four essential domains: core clinical trial concepts, major ongoing studies, best practices and the pivotal role these trials play in furthering nuclear medicine research.
Ribeiro clarified the distinction between research and clinical trials, asserting, “Research we can do on our daily basis in our daily practise, whether we work at university, whether we work in a hospital. Whereas clinical trials generally have very dedicated facilities.” She elaborated on the responsibilities of sponsors and funders, stating, “A sponsor is an institution or an organisation that takes overall legal responsibility over a trial.” She contrasted the funding and governance structures of commercial versus non-commercial trials, noting that “commercial trials often have significant funding” but “limited governance”, whereas non-commercial trials usually operate with constrained funding and depend on institutional frameworks for governance.
Ribeiro enumerated several significant clinical trials, including the NETTED-2 trial, which evaluates Lutathera in patients with neuroendocrine tumours, and the EPIC-Skin study, which assesses a radium-based cream for the treatment of non-melanoma skin cancer. She also highlighted the TRIP-FX trial, which explores the use of phosphorus-32 therapy for pancreatic cancer delivered endoscopically. The HIT-345 study investigates the efficacy of a novel Alzheimer’s pharmacotherapy, leveraging nuclear medicine tracers to evaluate neuropharmacological interactions. Concurrently, other investigations are examining advanced diagnostic modalities for Alzheimer’s disease, the role of fatty acid metabolism within neural tissues and the impact of psychological stressors on the modulation of dopamine receptor activity.
Emphasising the importance of clinical trial management, Ribeiro articulated the necessity of obtaining regulatory approvals, including ethics clearance, establishing data governance, implementing Standard Operating Procedures (SOPs) and ensuring financial mechanisms are solidified. She strongly advocated for meticulous documentation, stringent quality control measures and the tracking of radiation exposure to comply with safety regulations.
In her closing remarks, Ribeiro highlighted the critical role of clinical trials in advancing the development of novel radiopharmaceuticals, molecular therapies and diagnostic applications, thereby facilitating innovation within nuclear medicine and enhancing patient care outcomes.
The insights presented at ECR 2025 session underscored the transformative potential of nuclear medicine in diagnostics and treatment. With ongoing advancements in theranostics, safety protocols and clinical trial methodologies, the field continues to drive innovation, improving patient outcomes and shaping the future of precision healthcare.
Source & Image Credit: ECR 2025
