From Reading to Treating: How Theranostics Is Redefining Radiology

When you ask someone in the hospital what a diagnostic radiologist does, whether it's a medical student, a nurse, or a physician, the answer is always the same: they read the scans. Radiologists are often described as the backbone of the hospital, quietly reading CTs, MRIs, and X-rays behind the scenes so other physicians can better understand their patients' conditions and determine the best course of treatment. However, the traditional medical view of radiologists as only diagnostic experts is changing due to recent technological advancements. An emerging area of patient management where radiologists and nuclear medicine physicians are taking a leading role is in theranostics, which is a field emerging from nuclear medicine and nuclear radiology. This field combines molecular imaging with targeted radiotherapy, allowing radiologists to both identify and treat diseases based on specific biological markers⁴.

The first step of theranostics requires the administration of radiotracers by medical professionals which connect to specific targets throughout the body. The tracer accumulation locations throughout the body become visible through PET and CT scans which help determine patient suitability for starting treatment. The radiologist establishes the correct therapeutic radiotracer dose for the patient after reviewing imaging results and assessing their medical condition. The application of theranostics continues to expand across multiple medical conditions, demonstrating its increasing importance in image-guided treatment^4.

One of the early applications of theranostics is the management of prostate cancer. Radiologists employ Ga-68 PSMA PET/CT scans to detect prostate-specific membrane antigen (PSMA), which prostate cancer cells typically overexpress. The patient becomes eligible for Lu-177 PSMA therapy when cancer cells show elevated levels of the Ga-68 marker as depicted by the scan results¹. The treatment delivers radiation to cancer cells through the same targeting system, which provides precise delivery while protecting healthy tissues. Throughout the procedure, a radiologist interprets the scan, confirms treatment eligibility, and alters the radiation dose to fit the patient’s individual needs³. It’s a powerful example of how radiology can play a direct role in cancer care.

Theranostics has emerged directly from nuclear radiology principles as the method employs PET/CT and SPECT/CT scans to track drug movement in the body while also requiring extensive knowledge of disease mechanisms. The advanced skills of radiologists make them the most appropriate professionals to lead this field⁴.

Radiology students who want to enter the field will find that theranostics offer a unique chance to diagnose diseases and make treatment decisions. The field unites nuclear medicine, oncology and radiology to create new approaches for cancer management. The professionals in this field perform molecular scan reviews and administer radiopharmaceuticals, while tracking treatment outcomes as well as working closely with oncologists and surgeons⁵.

As a medical student with a passion for radiology, I have developed an interest in how the field has expanded into new areas past traditional image interpretation. The field of theranostics enables radiologists to participate in precision medicine by making treatment decisions after interpreting images². With cutting-edge technology, new therapies, and rising patient demand, there’s never been a better time as now for students to explore this field.

References

1. Ahmadi Afshar-Oromieh, A. et al. “Prostate Cancer Theranostics with 177Lu-PSMA.” Seminars in Nuclear Medicine, vol. 54, no. 4, 2024, doi:10.1053/j.semnuclmed.2024.02.007.
2. Faruqui, Syed H. A. et al. “Exposing the Rad to Radionuclide: Why Early Education in Theranostics Matters.” Insights into Imaging, Wiley, 2024, doi:10.1002/ird3.106.
3. Baum, Richard P. et al. “PSMA Radiotheranostics in Prostate Cancer: Principles, Practice.” Radiographics, RSNA, 2024, doi:10.1148/rg.240080.
4. Basu, Sandip et al. “Current Status and Future Perspectives of Nuclear Medicine in Theranostics.” Biomedicines, vol. 13, no. 5, 2025, p. 1132, doi:10.3390/biomedicines13051132.
5. Society for Theranostics Education Committee. “Guiding Principles on the Education and Practice of Theranostics.” European Journal of Nuclear Medicine and Molecular Imaging, vol. 51, no. 7, 2024, doi:10.1007/s00259-024-06657-2.