Why Nuclear Medicine Training Isn’t Keeping Up With Radiopharma Growth

The radiopharma pipeline is growing fast. The training pipeline isn’t.

Investment in radiopharmaceuticals is expanding manufacturing, isotope production, and therapeutic pipelines. But every new asset entering the clinic ultimately depends on something capital cannot produce quickly: people with the specialized expertise to deliver it.

That workforce is already under pressure. In the United States, the number of active ACGME-certified nuclear medicine training programs declined from 86 in 1995 to 36 by 2023.[1] More recently, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) identified workforce development as a strategic priority, with a dedicated Workforce Pipeline Domain focused on gaps across physicians, technologists, scientists, residents, and advanced practice providers.[2]

The implication for radiopharmaceutical development is significant. Clinical capacity cannot expand faster than the workforce required to operate it.

Radiopharma Growth Is Changing the Skills Required

Radiopharmaceutical therapy sits at the intersection of oncology, nuclear medicine, imaging, radiation safety, dosimetry, pharmacy, and patient management.

As Zhang et al. describe, the field now spans diagnostic and therapeutic radionuclides with very different physical characteristics, including β-, α-, and Auger-electron emitters, paired with targeting vectors ranging from small molecules and peptides to antibodies.[3] These differences influence imaging, dosimetry, handling, safety, and clinical implementation.

The workforce therefore needs more than familiarity with administering a radioactive product.

SNMMI has emphasized that safe radiopharmaceutical therapy requires specialized expertise in areas including radiation safety, dosimetry, and patient management.[4] The challenge becomes greater as therapies move into new indications, combination regimens, and potentially earlier stages of disease.

The science is advancing continuously. Training pathways have to absorb those changes while still producing enough professionals to meet routine clinical demand.

A Capacity Problem That Cannot Be Solved Overnight

Workforce constraints behave differently from manufacturing constraints.

Organizations can invest capital in new facilities, equipment, and production capacity. Developing an experienced nuclear medicine physician, technologist, radiopharmacist, or medical physicist takes years.

A joint EANM, SNMMI, and IAEA guide has described access to a skilled, well-trained workforce as one of the greatest unmet needs in expanding radiopharmaceutical therapy, alongside the need to scale healthcare infrastructure.[5] The IAEA has also highlighted substantial variation in nuclear medicine physician training pathways internationally, creating additional heterogeneity in workforce preparation.[6]

This is where the capital misallocation problem becomes visible.

The industry can continue investing upstream in assets, isotope access, and manufacturing. But if investment in education, training, and clinical workforce development does not scale alongside it, downstream clinical capacity can remain constrained.

Theragnostic Insight: A new treatment room without trained personnel is not clinical capacity. Workforce readiness should be evaluated with the same discipline as manufacturing and isotope readiness.

The Gap Extends Beyond Physicians

This is not solely a physician shortage.

Nuclear medicine technologists need current training as new therapies and protocols emerge. Pharmacists increasingly need expertise in radiopharmaceuticals and the complexities of oncology treatment. Medical physicists, radiation safety professionals, research coordinators, nurses, and clinical operations teams all contribute to safe and consistent execution.

The training challenge becomes even more pronounced in clinical trials.

Research adds protocol-specific imaging requirements, investigational product accountability, data collection, regulatory documentation, and sponsor workflows to an already specialized clinical environment. SNMMI has previously noted that nuclear medicine technologists' clinical research responsibilities are often not addressed comprehensively in traditional educational programs.[7]

In other words, increasing the number of professionals is only part of the equation. The field also needs training aligned with how modern radiopharmaceutical trials actually operate.

Workforce Strategy Is Development Strategy

For sponsors, workforce capacity should become part of site strategy much earlier.

A site may have the equipment, licenses, and patient population required for a trial but lack sufficient trained personnel to add another radiopharmaceutical protocol. That constraint may be particularly important as multiple sponsors compete for experienced academic centers.

Expanding into community settings will require an even more deliberate approach: identifying existing capabilities, defining trainable gaps, creating standardized education, and supporting multidisciplinary teams through activation and execution.

There are encouraging signs. SNMMI has expanded education and credentialing efforts, including launching a therapy-focused Theragnostic certificate program for technologists in 2026.[8] Nearly 100 institutions had also been designated as Radiopharmaceutical Therapy Centers of Excellence by late 2024, reflecting broader efforts to establish qualified treatment capacity.[9]

But training needs to scale with the pipeline, not behind it.

What This Means for You

The radiopharmaceutical workforce is becoming part of the industry's development infrastructure.

For biotech and pharma, that means site feasibility should assess personnel capacity and competency alongside equipment and patient access. For healthcare systems, it means workforce development may determine whether radiopharmaceutical therapy becomes a scalable service line. For investors, it means evaluating whether clinical infrastructure is keeping pace with the capital flowing into pipelines and production.

Theragnostic Insights helps development teams anticipate these constraints early—connecting protocol strategy, site capability, workforce readiness, and practical clinical execution.

The industry is investing heavily in what comes next.

The people required to deliver it need to be part of that investment, too.

Mini-Series: Clinical Capacity Crisis

Why Nuclear Medicine Training Isn’t Keeping Up With Radiopharma Growth is part of our Clinical Capacity Crisis: The Hidden Bottleneck in Radiopharma Development series, examining the infrastructure, workforce, site, and operational constraints that could determine how quickly radiopharmaceutical innovation reaches patients.

References

[1] Graham MM, 2023. The Future of Nuclear Medicine in the United States. Journal of Nuclear Medicine, 64(9):1352–1353.

[2] Society of Nuclear Medicine and Molecular Imaging, 2026. SNMMI Workforce Pipeline Domain. Workforce development initiative.

[3] Zhang S, Wang X, Gao X, et al., 2025. Radiopharmaceuticals and their applications in medicine. Signal Transduction and Targeted Therapy, 10:1.

[4] Society of Nuclear Medicine and Molecular Imaging, 2025. Rapid Growth of Radiopharmaceutical Therapy Highlights Need for Expertise. SNMMI.

[5] Herrmann K, et al., 2022. Joint EANM, SNMMI, and IAEA Enabling Guide: How to Set Up a Theranostics Center. Journal of Nuclear Medicine, 63(12):1836–1843.

[6] International Atomic Energy Agency, 2024. Guidance on Setting Up Nuclear Medicine and Diagnostic Imaging Services. IAEA.

[7] SNMMI Clinical Trials Network, 2022. Research Series for Technologists. Pathways Newsletter.

[8] Society of Nuclear Medicine and Molecular Imaging, 2026. SNMMI 2026 Annual Meeting Highlights Transformative Advances in Clinical Practice and Research. SNMMI.

[9] Society of Nuclear Medicine and Molecular Imaging, 2024. SNMMI Radiopharmaceutical Therapy Centers of Excellence Expand Across United States and Canada. SNMMI.

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