Theranostics in Nuclear Medicine in the Era of Precision Oncology

An overview as well as advanced concepts and future applications are presented of the pairing of diagnostic biomarkers with therapeutic agents that share a specific target in diseased cells.

Course ID: Q00658 Category:
Modalities: , , , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Nuclear Medicine Technology: 3.50
Procedures: 3.50
Radionuclides and Radiopharmaceuticals: 1.00
Endocrine and Oncology Procedures: 2.50


  1. Introduction
  2. Contextualization of Nuclear Theranostics
  3. Classic Theranostic Agents
    1. Radioiodine for Differentiated Thyroid Cancer
      1. Rationale and Clinical Aspects
      2.  131I-MIBG for Neural Crest-Derived Tumors
      3. Rationale and Clinical Aspects
      4. Neuroblastoma
      5. Pheochromocytoma and Paraganglioma
    2. Bone-Seeking Therapeutic Radiopharmaceuticals
  4. From Classic to Modern Theranostic Agents
    1. Somatostatin Analog Radioligands
      1. Rationale and Clinical Aspects
    2. PSMA Radioligands for Prostate Cancer
      1. Rationale and Clinical Aspects
    3. Bone-Seeking Agents Revisited
    4. Hepatic Radioembolization
  5. FDG: The Antitheranostic Agent
  6. Advantages and Limitations of Theranostics
    1. Advantages
    2. Limitations
  7. Perspectives
  8. Recently Introduced Agents
  9. Combining Theranostics with Other Diagnostic and Treatment Modalities
  10. Dosimetry
  11. Conclusion


Upon completion of this course, students will:

  1. identify the year in which Paul Ehrlich proposed the concept of the “magic bullet”
  2. identify the year in which the approach of theranostics was first proposed
  3. describe the criteria that determine the imaging or therapeutic capability of radioisotopes
  4. describe the types of radiation used for therapeutic nuclear medicine applications
  5. identify isotopes that emit both electromagnetic and particulate radiation
  6. list the therapeutic agents used for prostate cancer
  7. list the diseases that are treated with 90Y-labeled therapeutic agents
  8. list examples of diagnostic or therapeutic components that comprise hybrid theranostic pairs
  9. list the diseases that are managed using theranostic pairs associated with chemokine receptor type 4
  10. identify the year in which radioactive iodine treatment for hyperthyroidism began
  11. identify the physical half-life of 131I
  12. identify the most used iodine radioisotope for diagnostic scintigraphy in the United States
  13. describe the modality of choice for treating differentiated thyroid cancer in the postoperative setting
  14. list the MIBG radiopharmaceuticals that are limited to use for diagnostic purposes only
  15. identify the radioisotope that requires thyroid blocking with potassium iodide prior to use
  16. describe the disease-free survival at 5 years for most patients with stage IV neuroblastoma
  17. describe the type of radiation associated with the bone-seeking agents rhenium-186 HEDP, rhenium-188 HEDP, samarium-153 EDTMP, and strontium-89 chloride
  18. list the bone-seeking therapeutic radiopharmaceuticals that are calcium analogs
  19. identify the year in which the US Food and Drug administration approved the use of OctreoScan as an imaging radiopharmaceutical
  20. describe the radiation emissions from 111In that led to its use in the first PRRT procedures in 1992
  21. list the DOTA-chelated peptides that were used in the first study of PRRT with 90Y
  22. identify the year in which 68Ga-labeled SSTR analogs emerged
  23. describe the most common noncutaneous cancer in males
  24. describe the percentage of prostate cancer patients that develop metastatic disease
  25. identify the cancer type for which 223Ra has been used to treat bone metastases
  26. list the radioisotopes that have a similar mechanism of uptake as 223Ra
  27. list the radiopharmaceuticals that are necessary to predict uptake of therapeutic radioisotopes by metastatic lesions
  28. describe the composition of currently available radioactive microspheres
  29. list the negative outcomes that are avoided by accurate placement of microspheres in the tumor region
  30. identify the common molecular feature that is imaged by FDG PET/CT
  31. list the cancer types for which FDG PET is a component of the theranostic algorithms
  32. list the imaging system parameters that are limitations associated with the diagnostic portion of theranostic pairs
  33. list the PET radiotracers for which there are currently no clear and sufficiently studied criteria for response assessment
  34. describe the assessment standards for treatment response applied to anatomic imaging
  35. identify the PET radiotracer for which PERCIST 1.1 criteria applies
  36. describe the unit of measurement for the dose of radiation energy absorbed by a determined tissue
  37. list the diagnostic PET agents used in clinical trials for neuroendocrine tumors
  38. identify the clinical trial that compared radiotherapy to best supportive care in patients with prostate cancer
  39. describe the approximate radiation dose limit to the kidneys in patients without risk factors for renal toxicity
  40. describe the approximate radiation dose limit to the bone marrow