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Radiopharmaceuticals: the basics

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How to advocate for more equitable access to radiopharmaceuticals

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Frequently asked questions

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This toolkit is endorsed by the following organisations:



Introduction to the patient advocacy toolkit


Cancer care has advanced a lot over the years, but some people still do not have access to the most effective diagnosis and treatment options. Radiopharmaceuticals are cancer diagnostics and treatments that administer radioactive material internally. They are a type of theranostic, which means they can be used for both the diagnosis (i.e. imaging and staging) and treatment of cancer and other diseases.

The availability of radiopharmaceuticals varies depending on where you live. Low availability may be due to:

  • limited numbers of healthcare professionals and a lack of trained specialists
  • a lack of facilities (such as scanners or radiation-safe rooms) to administer radiopharmaceuticals
  • an inconsistent supply of radioisotopes (a type of chemical element that releases radiation as it breaks down and becomes more stable).

Many people know very little about radiopharmaceuticals. Some people may have negative ideas about them because they contain radioactive materials, but radiopharmaceuticals have relatively low toxicity and are widely used. For example, about 40 million procedures are performed every year using technetium-99, a radioactive isotope commonly used in radiopharmaceuticals.

We have developed this toolkit for patient advocates, to help you better understand what radiopharmaceuticals are and how you can help advocate for more equitable access to these diagnostics and therapies where you live. We hope the toolkit can play a role in ensuring all people who could benefit from radiopharmaceuticals have access to them as part of their cancer care.

Who is this toolkit for?

The toolkit is for patient advocates and patient organisations working in areas where radiopharmaceuticals are a cancer management option. It is for people who want to know more about radiopharmaceuticals and learn how to advocate for their appropriate use.

How do I use this toolkit?

The toolkit is divided into three sections:

  • Radiopharmaceuticals: the basics. This is an overview of what radiopharmaceuticals are, how they work and who can receive them. You may find that this section helps you explain radiopharmaceuticals to people with cancer and their families, as well as policymakers.
  • How to advocate for more equitable access to radiopharmaceuticals. This section suggests how patient advocates can help overcome some of the barriers to optimal use of radiopharmaceuticals. It includes case studies of how various patient organisations around the world have done this.
  • Radiopharmaceuticals frequently asked questions (FAQs). This section offers answers to some common questions that people ask about radiopharmaceuticals.


A number of terms are currently used to describe radiopharmaceuticals. The use of different terminology may mean that not many people have heard the term ‘radiopharmaceutical’.

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Radiopharmaceutical is a broad term that covers a wide range of therapies and diagnostics that use radioisotopes.

Radioisotopes are an unstable type of chemical element that releases radiation as it breaks down and becomes more stable. Radioisotopes may occur in nature or be made in a laboratory. In medicine, they are used in imaging tests and in treatment. They may also be called radionuclides.

Radiopharmaceuticals can both diagnose and treat disease and are therefore referred to as a theranostic. ‘Theranostics’ is a combination of the terms ‘therapeutics’ and ‘diagnostics’, and describes the combination of using one radioactive compound to identify (diagnose) disease and a second radioactive compound to deliver therapy.

Some uses of radiopharmaceuticals are: molecular radiotherapy, peptide receptor radionuclide therapy (PRRT), positron emission tomography (PET), precision radiotherapy, radioimmunotherapy, radioligand therapy, scintigraphy, single-photon emission computed tomography (SPECT), systemic radiation therapy, targeted alpha therapy, targeted radionuclide therapy and targeted radiotherapy.

Radiopharmaceuticals: the basics

What are radiopharmaceuticals?

Radiopharmaceuticals work by using radioisotopes to image, diagnose and treat a variety of diseases. In all instances, the radioactive isotope gathers in certain cells in the body. Depending on the radiopharmaceutical, the radioisotope may naturally gather in those cells, or it may be directed to them by an accompanying targeting molecule. This gathering of isotopes is used for the following:

  • Imaging and diagnosis: The concentration of radiation in one area aids the detection of cancer using imaging such as PET, SPECT and gamma scans.
  • Treatment and symptom management: The gathering of radioisotopes in sites with cancer cells, whether it occurs naturally or with a targeted molecule, allows radiation to disrupt or destroy them. This is a targeted approach as the radiation mostly impacts cancer cells rather than affecting healthy tissue.

Radiopharmaceuticals are the latest development in a long history of radiation-based therapies. Radioiodine was first used to treat thyroid cancer in the 1940s, and later evolutions included radiotherapy. Imaging using radiopharmaceuticals was then developed in the 1950s, when it involved the administration of sodium iodine to image brain tumours. PET imaging, which allowed for full body internal imaging, followed in the 1970s.

A wide range of radiopharmaceuticals is available. Technetium-99m is the most commonly used radioisotope, often serving as a radiopharmaceutical in PET scans. Radium-223 chloride was one of the first radiopharmaceuticals to be approved for targeted cancer treatment. This video shows how radioligand therapy, another type of radiopharmaceutical, works.

How do radiopharmaceuticals get approved for use?

Once they have gone through clinical trials, all new radiopharmaceuticals must be licensed (authorised) for use by an appropriate regulatory body (such as the FDA in the US, the EMA in Europe, and the MHRA in the UK) before they can be provided in routine clinical care. The relevant national health system or health insurance system also needs to agree to fund the radiopharmaceutical, and it should be included in clinical guidelines. The process for a radiopharmaceutical being approved, funded and recommended is different in every country, but it generally looks like this:

The possibility of radiopharmaceuticals being available to you depends on whether they have been approved where you live and whether their administration is funded.

How can people with cancer receive radiopharmaceuticals as part of their care?

To receive a radiopharmaceutical, a person needs to be seen by a physician who has been specially trained to administer nuclear medicine or radiation-based theranostics.

The pathway by which the person will reach this expert and receive treatment will depend on the set-up of services available locally, and many people will be given tests or treatments before radiopharmaceuticals are used. However, when radiopharmaceuticals are considered, most people will follow a broadly standard pathway:

All medical treatments carry risks. With radiopharmaceuticals, a specific consideration is that they contain radioactive material. International guidelines exist to guide the administration of nuclear medicine to ensure safety and minimise the risk of exposure to radioactivity for healthcare professionals, patients and the general public.

Your doctor will discuss with you the risks associated with radiation before you start your treatment. There will also be ongoing monitoring to ensure that you are not exposed to dangerous levels of radiation.

You can learn more about the risks of exposure to radiopharmaceuticals in the FAQs.

The decision about whether a radiopharmaceutical is appropriate for cancer diagnosis and treatment will depend on each individual patient. It should ideally be discussed by a multidisciplinary team that includes a healthcare professional with appropriate training in nuclear or radiation-based treatments and diagnostics.

How to advocate for more equitable access to radiopharmaceuticals


Radiopharmaceuticals are an important part of cancer care, but certain barriers stand in the way of patient access. Patient advocacy organisations have a huge role in helping overcome these barriers.

We have put together some suggested advocacy activities for organisations to help improve access to radiopharmaceuticals for people who could benefit from them. Every health system works in a different way, so these activities will need to be tailored to your local healthcare environment. Setting clear, realistic goals and timelines for what you want to achieve can help ensure the success of advocacy activities.

The size and capacity of your organisation will influence which activities you can undertake. In general, we recommend that:

  • smaller patient organisations focus on supporting patients directly, offering information and guidance on radiopharmaceuticals; share information where possible; and build relationships with other organisations
  • larger patient organisations create broader advocacy campaigns and engage with decision-makers, with the aim of improving both legislation around radiopharmaceuticals and access to them for people with cancer.

Improving general awareness and understanding of radiopharmaceuticals to help patients make informed choices

Increasing the understanding and awareness of radiopharmaceuticals will help ensure that people who may benefit from them understand how they work and how they differ from other types of cancer care. It will also help people make informed decisions about whether radiopharmaceuticals are the best approach for them, based on their evaluation of the potential risks and benefits.

When developing information materials, look at clinical practice guidelines to see how radiopharmaceuticals are described. Guidelines you may wish to look at include those written by: National Comprehensive Cancer Network, European Society for Medical Oncology, European Association of Urology, European Neuroendocrine Tumor Society, North American Neuroendocrine Tumor Society, British Nuclear Medicine Society, European Association of Nuclear Medicine and Society of Nuclear Medicine & Molecular Imaging.

Boosting healthcare professionals’ recognition of radiopharmaceuticals to ensure they consider them

A patient is usually referred for disease management with radiopharmaceuticals by their primary clinician, such as an oncologist, endocrinologist, urologist or gastroenterologist. This means that these clinicians need to be aware of radiopharmaceuticals.

The administration of radiopharmaceuticals requires a multidisciplinary team featuring a range of specifically trained staff. However, there is a shortage of specialists trained in the provision of radiopharmaceuticals, and existing care teams are often working using outdated care plans. This puts a limit on the extent to which radiopharmaceuticals and nuclear medicine can be integrated into cancer care.

Encouraging political engagement to enable regulatory and legislative change

For large-scale change to happen, politicians, healthcare leaders and decision-makers need to be aware of radiopharmaceuticals and their potential benefits.

When engaging with policymakers, it’s important to know your topic in detail, prepare answers to the key questions that you are likely to be asked and establish relationships with your locally elected leaders.

When campaigning for legislative change, finding a ‘champion’ for your cause can make a huge difference in raising awareness, building public interest and putting your issue in front of policymakers. This champion could be an expert clinician, a doctor who is in the public eye, a politician, a celebrity with a personal connection to the issue, or a patient (or patient representative) who can eloquently present the issues and lived experience.

Calling for more research to collect better data on the use of radiopharmaceuticals

Limited data are available on the use of radiopharmaceuticals, from both a clinical and an economic perspective. This makes it difficult to plan the ‘best’ way to deliver care and has led to variations in how radiopharmaceuticals are delivered in different countries.

Making sure we have representative data about how many people are eligible to be treated with radiopharmaceuticals, how many are actually receiving them and how many healthcare professionals are available to administer them can help health system leaders understand the evolving demand for the approach and identify any gaps in workforce and technical capacity. They can then use these data to find sustainable ways to invest in radiopharmaceuticals and make informed plans about how to appropriately allocate resources across different locations to ensure equitable access.

Investing in real-world data will largely be a job for the research community and the life sciences industry, but there is still a role for patient advocates.

Case studies

Improving general awareness: Neuroendocrine Cancer UK

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Neuroendocrine Cancer UK (NCUK) is a charity dedicated to providing support and information to people affected by neuroendocrine neoplasms in the UK. It provides resources on radiation-based therapies, including an overview of peptide receptor radionuclide therapy (PRRT, a treatment that uses a radiopharmaceutical), videos on the patient experience of radiopharmaceuticals and their potential benefits, and a list of side effects. NCUK has worked with fellow members of the International Neuroendocrine Cancer Alliance (INCA) to establish awareness-raising campaigns, such as World Neuroendocrine Cancer Day, which takes place every year on 10 November.

Improving general awareness: Oncidium foundation

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The Oncidium foundation is a non-profit, public-benefit organisation that aims to support and accelerate the development of radiotheranostics (a subtype of radiopharmaceuticals) for cancer care globally. Based in Belgium but acting beyond borders, the foundation’s priorities include:

  • raising awareness of radiopharmaceuticals among physicians and people living with cancer
  • investing in research and scholarships
  • financing the development of new radiopharmaceuticals for therapy
  • supporting clinical best practice
  • improving access to treatment for patients regardless of where they live and their financial situation.

Boosting healthcare professionals' recognition: World Association of Radiopharmaceutical and Molecular Therapy (WARMTH)

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WARMTH is a non-profit organisation that aims to advance the science and education of therapeutic nuclear medicine, work towards worldwide access to radiopharmaceuticals, educate healthcare professionals about the use of radiopharmaceuticals and facilitate radiopharmaceutical research. It hosts an annual International Conference on Radiopharmaceutical Therapy, which provides the opportunity to disseminate new advancements in the field.

Encouraging political engagement: NeuroEndocrine Cancer Australia

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NeuroEndocrine Cancer Australia has created a detailed NET National Action Plan to inform decision-makers in Australia about the impact of neuroendocrine tumours. The plan has eight key areas of focus and includes the use of radiopharmaceuticals.

NeuroEndocrine Cancer Australia encourages those who support the plan to contact their local MP, and it provides information on how to do so.

Encouraging political engagement: UK MRT Consortium

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The UK Molecular Radiotherapy Consortium was established in 2022 by clinicians and patient advocates. Molecular radiotherapy (MRT), another term for radiopharmaceuticals, is expected to have an increasingly important role in the evolving oncology landscape. The aim of the MRT Consortium is ‘to support equitable patient access to and safe delivery of evidence-based theranostic MRT across the UK and provide a multidisciplinary forum for all relevant stakeholders engaged in MRT to advance research, knowledge and policy engagement on MRT across the UK’. The consortium has sent a letter to the Secretary of State for Health and Social Care.

Calling for more research: NET Patient Network in Ireland

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The Neuroendocrine Tumour (NET) Patient Network is an advocacy group that is championing for patients to receive the best medical practice and service levels. The network helped support the application for reimbursement of a radiopharmaceutical for the treatment of NETs by submitting a patient submission to the National Centre for Pharmacoeconomics.

The submission outlined the results of a patient survey that highlighted the barriers to treatment, as well as case studies from patients who had received the therapy. Reimbursement for the radiopharmaceutical was approved and is expected to be delivered in early 2023.

You can find out a little more about the NET Patient Network’s activities from our discussion with its chairperson, Mark McDonnell.