Journal of Medical Imaging and Radiation Sciences最新文献

{"title":"Regulatory Challenges in Europe and Strategies for Novel Targeted-Alpha Therapies: Academic and Industrial Perspectives","authors":"Antero Abrunhosa , Anne Royers-Moes , Phlippe Vanwolleghem , Cristiana Gameiro , Renata Mikolajczak","doi":"10.1016/j.jmir.2026.102276","DOIUrl":"10.1016/j.jmir.2026.102276","url":null,"abstract":"<div><h3>Introduction</h3><div>The emergence of targeted alpha therapies (TAT), notably Astatine-211 (At-211) and Actinium-225 (Ac-225), offers transformative potential for cancers. However, the regulatory landscape for these novel radiolabelled compounds remains fragmented and complex. Both academic and industrial stakeholders face hurdles related to early clinical trials, standardization of specifications and analytical methods, more demanding transport regulations impeding efficient translation from bench to bedside and hindering access to patients.</div></div><div><h3>Objectives</h3><div>This work aims to identify the key regulatory challenges in developing new alpha therapies, considering both academic and industry perspectives, and to propose practical strategies to streamline regulatory processes and speed up clinical translation.</div></div><div><h3>Materials and Methods</h3><div>The current regulatory framework in clinical trials will be presented. The challenges in establishing harmonized specifications will be summarized with the goal of creating pharmacopoeia monographs. Transport regulations and their impacts will be discussed.</div></div><div><h3>Results</h3><div>The EU framework allows flexibility for non-GMP radionuclide use in early-phase academic trials, but national authorities may impose additional requirements.</div><div>From an industry seeking regulatory approval, the master file approach is proposed for radionuclides used in labelling, with the appropriate quality requirements proportional to the application stage - whether early phase clinical trial, late phase or marketing authorization. This pathway streamlines regulatory submissions, enabling harmonized dossiers across different jurisdictions.</div><div>Data on novel alpha-emitting radiolabeled compounds are limited and still evolving. To ensure consistent quality, standardizing specifications and validating methods are crucial, whether radionuclides are used locally or transported. Establishing European Pharmacopoeia monographs as a reference for setting quality standards for clinical trials and beyond would be beneficial. International organizations, such as IAEA, are well-positioned to promote knowledge-sharing and provide training opportunities.</div><div>Lastly, transport of radionuclides and radioactive drugs are subjected to demanding IAEA and EU transport regulations. Recent changes in these regulations will severely restrict shipments, increase costs, and impact patient access.</div></div><div><h3>Conclusion</h3><div>The regulatory pathway for innovative alpha therapies is characterized by fragmentation and evolving requirements. In short, a harmonized European framework and clear guidance are necessary for early-phase academic clinical trials.</div><div>From an industry perspective, seeking marketing authorization approval, the master file approach provides industry with a scalable solution for regulatory compliance.</div><div>Standardization of specification","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102276"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Netrin-1-Targeted Radiotheranostics for the Management of Advanced Solid Tumors","authors":"Maëva Hervieu , Robin Vinck , Maxime Mingot , David Kryza , Sarah Chaib Marie Couderc , Jacqueline Sidi Boumedine , Frank Bruchertseifer , Alfred Morgenstern , Patrick Mehlen , Thomas Walter , Benjamin Gibert","doi":"10.1016/j.jmir.2026.102235","DOIUrl":"10.1016/j.jmir.2026.102235","url":null,"abstract":"<div><h3>Introduction</h3><div>Radioligand therapy (RLT) has emerged as an effective therapeutic modality for the management of disseminated metastatic cancers. Current radiotheranostic strategies predominantly rely on biological vectors targeting membrane-bound, cancer-specific antigens. In this study, we identify the embryonic guidance cue netrin-1, an extracellular matrix-associated protein, as an unexpected and promising target for targeted alpha therapy (TAT). Netrin-1 is upregulated in multiple human malignancies, including metastatic breast and lung cancers, promoting tumor cell survival, proliferation and invasion. Accordingly, the monoclonal antibody NP137 was developed and has undergone initial safety and efficacy evaluation in several Phase I and II trials in patients with advanced solid tumors.</div></div><div><h3>Objectives</h3><div>We proposed that NP137 could be radiolabeled to determine its tumor accumulation and understand its pharmacodynamics. We therefore hypothesized that radiolabeling NP137 with alpha or beta emitters could overcome some of the resistance observed in monother</div></div><div><h3>Materials and Methods</h3><div>The expression of netrin-1 was evaluated in patient tumor sections by immunohistochemistry experiments. Preclinical models of mouse and human cancer cell lines were selected using immunoblots. Immuno-SPECT/CT imaging with either [111In]In-labeled NP137 or control IgG was performed at 24, 48, 72 and 96 hours in mice bearing subcutaneous netrin-1-positive tumors to assess tumor uptake and biodistribution. For therapeutic applications, NP137 underwent comprehensive characterization and its radiolabeling with Actinium-225 ([225Ac]Ac-DOTAGA-NP137) and Lutetium-177 ([177Lu]Lu-DOTA-NP137) was optimized. Efficacy studies were conducted 7 days after tumor engraftment using a single intravenous dose to assess treatment effects on tumor growth and median survival (MS) in mice bearing recalcitrant 4T1, EMT6 or H358 tumor models. Systemic toxicity was also evaluated by monitoring body weight, hematological parameters, and liver and renal function.</div></div><div><h3>Results</h3><div>Radiochemical purity >95% was achieved for all radionuclides following radiolabeling and purification. SPECT/CT imaging and ex vivo biodistribution of [111In]In-DOTAGA-NP137 in mice bearing 4T1 tumors demonstrated high tumor uptake, reaching 23.4 ± 6.9 %ID/g at 96 h post-injection. A single administration of either 15 kBq of [225Ac]Ac-DOTAGA-NP137 or 7 MBq of [177Lu]Lu-DOTA-NP137 induced significant tumor regression and significantly improved MS in disseminated 4T1, EMT6 and H358 models compared with non-radiolabeled controls, without significant body weight loss or hematological toxicity. Notably, [225Ac]Ac-DOTAGA-NP137 demonstrated superior therapeutic efficacy compared with its [177Lu]Lu-labeled counterpart in the H358 model.</div></div><div><h3>Conclusion</h3><div>These findings highlight NP137 as a promising radioimmunoconjugate ","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102235"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board/Masthead","authors":"","doi":"10.1016/S1939-8654(26)00025-1","DOIUrl":"10.1016/S1939-8654(26)00025-1","url":null,"abstract":"","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102211"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake redistribution after targeted alpha therapy - use of sodium perchlorate as a blocking agent causes both decreased and increased organ uptakes of free astatine-211","authors":"Tom Angelo Back , Emma Hilda Aneheim , Holger Jan Jensen , Stig Harald Palm","doi":"10.1016/j.jmir.2026.102247","DOIUrl":"10.1016/j.jmir.2026.102247","url":null,"abstract":"<div><h3>Introduction</h3><div>Alpha-emitter astatine-211 (At-211; t½=7.2h)) is currently under clinical investigation for targeted alpha therapies (TAT). In our previous phase I trial, most patients received a blocking agent (sodium perchlorate) which reduced uptake of possible free At-211 in thyroid. In this current study, we examine how use of a blocking agent affects the biodistribution of free 211At in mice.</div></div><div><h3>Objectives</h3><div>The aim was to predict how use of a blocking agent affects the biodistribution of free At-211 that results from in-vivo degradation of a targeted compound used for cancer therapy in patients.</div></div><div><h3>Materials and Methods</h3><div>Mice with (n=6) and without (n=6) pretreatment with sodium perchlorate (170 mg/kg at 24h and 1h before injection) was given free 211At. We then attempted to trace the fate of all injected activity. Whole-body content was measured with a dose calibrator. Urine and feces were continuously collected and measured in a gamma-well counter. Three of each group were dissected at 6h and the remainder at 10h. Organs were immediately collected and measured for activity. All remaining body parts were also measured in the counter.</div></div><div><h3>Results</h3><div>At 6h after injection, the highest uptake for the un-blocked mice was seen for thyroid, stomach, salivary glands and lungs (431, 45, 12 and 10 %IA/g, respectively). For the blocked mice, the highest uptake was found in lungs, thyroid, spleen and kidneys with 13, 13, 6.5 and 4.8 %IA/g, respectively. At 10h, it was thyroid, stomach, lungs and salivary glands (189, 37, 9.5, 6.7 %IA/g) for the unblocked mice; and thyroid, lungs, spleen and stomach (14, 10, 4.6, 4.5 %IA/g) for the blocked mice. Highest reduction in organ uptake following block was seen for thyroid, stomach and salivary glands (60-97% reduction in %IA/g). Highest increase due to block was seen for kidneys and blood (22-25% increase). At 10h, the cadaver remainders (without organs) of unblocked mice contained 46% of all injected activity (%IA), while for the blocked mice the remainder activity was 37 %IA. Collected up to 10h, the combined total urine from unblocked mice accounted for 30 %IA, but for the blocked mice the activity accounted for urine was only 11%. Amounts in collected feces were negligible. At 10h, the percentage of injected activity that could not be accounted for was 30% for the un-blocked and 24% for the blocked group.</div></div><div><h3>Conclusion</h3><div>Using sodium perchlorate as a blocking agent before TAT with At-211 reduced the activity in organs known for elevated uptake of free At-211 (thyroid, salivary glands and stomach) but it also increased the uptake in other organs, e.g. kidney, blood, lungs. This finding was unexpected and warrants further investigations in the setting of TAT with At-211.</div></div><div><h3>Funding Acknowledgements</h3><div>Swedish Scientific Council, Sweden</div><div>Swedish Cancer Society, Swede","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102247"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of 18F-AlF-NOTA-Octreotide PET/CT in Assessing Recurrent Carotid Body Paraganglioma and Peptide Receptor Radionuclide Therapy Eligibility","authors":"Marilack Viana D´Assunção Marques Loureiro, Renata Christian Martins Felix","doi":"10.1016/j.jmir.2026.102324","DOIUrl":"10.1016/j.jmir.2026.102324","url":null,"abstract":"<div><h3>Case Description</h3><div>A 49-year-old woman presented with a three-month history of cervicalgia and paroxysmal adrenergic symptoms, including pressure lability, agitation, and palpitations, followed by recent-onset dizziness. Her pertinent history included surgical resection of a functional bilateral carotid body paraganglioma (PGL), Shamblin classification IIID and IIE, five years earlier and a family history of PGL, with fatal outcomes in her father and brother. Physical examination was unremarkable, with a blood pressure of 108/76 mmHg. Biochemical workup, including urinary metanephrines, was within normal limits. Concomitant medication included antihypertensives (e.g., Atenolol, Losartan/HCTZ), neuromodulators for pain (e.g., Amitriptyline, Gabapentin), and other symptomatic controllers. The diagnostic investigation began with a cervical MRI (November/2023), which showed no evidence of a lesion. However, subsequent ¹¹¹In-pentetreotide scintigraphy (February/2024) identified a focal area of anomalous radiotracer uptake in the left pericarotid region. This finding was further characterized with 18F-AlF-NOTA-Octreotide (18F-OC) PET/CT performed 10 days later, which identified a corresponding 6.0 mm focus of intense radiopharmaceutical uptake (SUVmax 18.4; Krenning score 4). The scan also detected two additional minute hypermetabolic foci: one in the high level IIa right carotid space (0.5 mm, SUVmax 4.9; Krenning score 3) and another in the contralateral high level IIa left carotid space (0.5 mm, SUVmax 7.2; Krenning score 3).</div></div><div><h3>Discussion</h3><div>Carotid body (PGL) has a reported malignancy potential of approximately 12%. Although this risk is relatively low, its non-negligible nature highlights the critical need for accurate diagnostic workup and prolonged monitoring. ¹⁸F-OC PET/CT emerged as an essential tool in this case, demonstrating high sensitivity and specificity for the detection of somatostatin receptor-expressing lesions. By providing an integrated metabolic and structural profile, this imaging technique not only enables precise lesion localization and refined staging but also helps identify patients likely to benefit from targeted therapies, such as Peptide Receptor Radionuclide Therapy (PRRT), thereby influencing clinical outcome.</div></div><div><h3>Conclusion</h3><div>This case highlights the transformative impact of ¹⁸F-OC PET/CT, a recently introduced tool in our country, on clinical practice. The technique provided critical incremental diagnostic information over anatomical MRI and biochemical workup, by detecting occult multifocal recurrence and excluding distant metastatic disease in a single scan. This had a direct management impact, proving essential for precise staging and long-term management of PGL.</div></div><div><h3>Ethical Criteria</h3><div>The authors have no conflict of interest. This case report was conducted in accordance with the ethical principles of the Declaration of Helsinki. W","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102324"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective 18-membered macrocycles for Ac-225 binding","authors":"EKATERINA MATAZOVA , BAYIRTA EGOROVA , ANNA PASHANOVA , Oksana Tarasenko , ANASTASIA ZUBENKO , STEPAN KALMYKOV","doi":"10.1016/j.jmir.2026.102263","DOIUrl":"10.1016/j.jmir.2026.102263","url":null,"abstract":"<div><h3>Introduction</h3><div>The most in-demand direction in nuclear medicine today is targeted alpha therapy (TAT). It applies alpha emitters with high linear energy transfer (LET), such as Ac-225, together with Bi-213, which is formed from Ac-225 decay. Alpha particles induce higher cytotoxicity compared to beta particles. Hence, alpha particles can overcome the resistance of certain tumors. Moreover, due to their shorter range, their use in metastatic therapy results in lower dose rates for healthy tissues. Together with the high specificity of monoclonal antibodies, radioimmunotherapy with alpha-emitters is a very selective and effective way of treatment. However, monoclonal antibodies are heat-sensitive. Hence, it is necessary to use chelating agents that bind the radionuclide like Ac-225 at room temperature with high speed and yield.</div></div><div><h3>Objectives</h3><div>A series of new 18- and 21-membered macrocyclic ligands containing either benzene, pyridine, or cyclohexane were studied. Their complexing ability with Ac(III) was investigated. The stability of the resulting complexes with Ac-225 in vitro was evaluated</div></div><div><h3>Materials and Methods</h3><div>Thin layer chromatography was used to control the radiochemical purity of the studied complexes. The stability of the complexes was studied in vitro (fetal bovine serum with 1:10 dilution). The radioactivity measurements were performed by measuring Bi-213 activity after equilibrium had been reached.</div></div><div><h3>Results</h3><div>Complexes of Ac-225 with the studied series of ligands were formed within minutes at room temperature, which is an advantage compared with the macrocyclic chelators currently used in radiopharmaceuticals.</div><div>All chelators were labeled under identical conditions (1 mM ligand, pH 8), and their in vitro stability was then assessed. The weakest Ac-225 binding was observed for the 18- and 21-membered macrocycles carrying diacetate pendant arms and a benzyl ring in the macrocyclic framework. Replacing the acetate groups with picolinate groups led to a modest increase in stability, more noticeable for the 18-membered macrocycle. Within this 18-membered group of chelators, we also examined diacetate and dipicolinate derivatives in which the benzyl ring was substituted with a pyridine ring. As before, picolinate groups provided better Ac(III) binding, and the switch from a benzene to a pyridine ring did not significantly affect stability.</div><div>The 18-crown-6 scaffold generally showed a more favorable interaction with Ac(III). A similar improvement was seen when the benzyl ring in the dipicolinate derivative was replaced with a cyclohexane moiety, giving the most stable complex among the ligands with two pendant arms. This ligand, CADPA-18, together with the 18-azacrown-6 chelator bearing four acetate groups, BATA, showed outstanding stability of their Ac-225 complexes in fetal bovine serum (1:10 dilution), remaining intact even after 17","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102263"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel chelators for Pb-212 and Ra-223 as potential components for radiopharmaceuticals for cancer therapy","authors":"LIUBOV ZAMURUEVA , BAYIRTA EGOROVA , ANASTASIA ZUBENKO , ANNA PASHANOVA , STEPAN KALMYKOV","doi":"10.1016/j.jmir.2026.102262","DOIUrl":"10.1016/j.jmir.2026.102262","url":null,"abstract":"<div><h3>Introduction</h3><div>The radioisotope Pb-212, which daughter isotope Bi-212 is an alpha emitter, is used in radiopharmaceuticals as an in vivo generator, allowing longer exposure time of tumor cells to radiation. Currently, molecules with Pb-212/Bi-212 have reached the stage of clinical trials using only chelator - TCMC. The complex with this chelator is obtained by heating, which limits its use with a number of temperature-sensitive biomolecules. In addition, part of the daughter radionuclide is released from the composition of the complex, causing irradiation of healthy tissues in the body. Radium is widely used in therapy in its chloride form. Targeted therapy based on vector molecules will greatly expand the use of this radionuclide if an effective chelator is found. Macropa has shown stability in vitro and in vivo, but has not yet been applied in radiopharmaceuticals. Therefore, the effective chelators for lead and radium are being researched.</div></div><div><h3>Objectives</h3><div>In our study complexes of lead and radium cations with new benzoazacrown ethers possessing varied number of chelating groups, including variation in azacrown cavity size. Complexation with these ligands occurred instantly at room temperature. Long-lived i</div></div><div><h3>Materials and Methods</h3><div>The long-lived lead isotope Pb-210 was obtained from the solution of parent Ra-226 with its daughters. Thin layer chromatography was used to control the bound fraction of radionuclide. The stability of the complexes was studied in biologically relevant media (solutions of microelements, isotonic solution of NaCl and a nine-fold excess of serum proteins). To analyze the stability of the most effective complexes in vivo, biodistribution studies in mice were performed and compared with cation blank solution.</div></div><div><h3>Results</h3><div>Lead and radium radionuclide complexes with a radiochemical purity >90% can be prepared at room temperature in ≤2 minutes, which is an advantage over currently used in radiopharmaceuticals macrocyclic chelators.</div><div>Complexes of BA3Pic, BATA, and BADPA-18 chelators with lead isotopes are stable in vitro (2 days in a nine-fold excess of blood serum) and are also inert in vivo, being almost completely eliminated from mice body within 6 hours. Although complexes with the well-known chelator DOTA are stable with lead isotopes, when using the isotope Pb-212, approximately one-third of the bismuth (35%) is released from the complex, which was observed within 4 hours in our experiments. For BA3Pic, BATA, and BADPA-18 chelators, this value is significantly lower – 13, 6, and 12%, respectively.</div><div>Complexes of chelators BADPA-21 and CADPA-18 with radium isotopes are stable in vitro (2 days in a nine-fold excess of blood serum).</div></div><div><h3>Conclusion</h3><div>All the studied ligands form stable complexes with lead and radium cations and are suitable for further studies with the Pb-212/Bi-212 and Ra-2","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102262"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Theranostics in Uruguay: Establishment of a Multidisciplinary Unit at CUDIM, Uruguay","authors":"Juan Pablo Gambini, Eduardo Savio, Javier Giglio, Juan Angel Vazquez, Gustavo Burroso, Nicolas Niell, Gerardo dos Santos, Omar Alonso, Juan Pablo Leiva, Marisa Fazzino, Alarico Rodriguez","doi":"10.1016/j.jmir.2026.102308","DOIUrl":"10.1016/j.jmir.2026.102308","url":null,"abstract":"<div><h3>Introduction</h3><div>Theranostics, the integrated use of molecular imaging and targeted radionuclide therapy, is transforming precision oncology worldwide. In Uruguay, the Uruguayan Center for Molecular Imaging (CUDIM) has created a dedicated multidisciplinary Theranostics Unit to optimize delivery, follow-up, evaluation, and clinical interaction with prescriptors, as well as expanding access to advanced radionuclide therapies. Although national integration across other national institutions and key stakeholders is still in progress, it is advisable to develop a strong international collaborations with such as ARCAL programs of the International Atomic Energy Agency, the International Centers for Precision Oncology (ICPO) and the Oncidium Foundation to support have accelerated implementation, capacities training, and research innitiatives with a suitable and well trained workforce in this emerging field.</div></div><div><h3>Objectives</h3><div>To consolidate a robust and sustainable multidisciplinary theranostics structure at the national level, supported by international partnerships that ensure quality, safety, training, and continuous innovation in targeted molecular therapies.</div></div><div><h3>Materials and Methods</h3><div>The Unit integrates nuclear medicine, oncology, radiopharmacy, physics, radioprotection, and information systems within CUDIM’s GMP-certified environment. Operational protocols were standardized for ¹77Lu-PSMA, ¹77Lu-DOTATATE, and ²²³RaCl2 therapies, having ²²5Ac, 161Tb radiopharmaceuticals and ¹77Lu-FAPI in the pipeline. A centralized patient follow-up system was developed to ensure traceability and safety. Collaboration with IAEA, ICPO and Oncidium enables participation in educational programs, protocol harmonization, and cooperative research aimed at generating regional evidence and training future professionals.</div></div><div><h3>Results</h3><div>The Unit successfully implemented a unified clinical and radiopharmaceutical workflow, reducing treatment delays and ensuring adherence, in agreement with international quality standards. Over 100 therapeutic procedures have been performed with ¹77Lu and ²²³Ra, achieving high response rates and excellent safety profiles (<5% adverse events ≥G3). Continuous internal audits confirmed full compliance with GMP/GDP standards in the radiopharmacy deparment.</div><div>Educational activities and workshops have initiated the training of multidisciplinary teams, while international partnerships expanded visibility and access to cutting-edge knowledge. Two-market authorization were achieved by the Drug Department of the Ministry of Health. The first national registry of theranostic patients was created enabling the basis for clinical research and longitudinal follow-up.</div></div><div><h3>Conclusion</h3><div>The CUDIM Theranostics Unit demonstrates that sustained progress in molecular therapy can be achieved through a multidisciplinary approach enriched by internationa","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102308"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advantages of a Liquid Target for Photonuclear Production of Actinium-225","authors":"Samy Bertrand, SVEN VAN DEN BERGHE, Christophe Malice, Willem Leysen, Dominic Maertens, Stephan Heinitz","doi":"10.1016/j.jmir.2026.102269","DOIUrl":"10.1016/j.jmir.2026.102269","url":null,"abstract":"<div><h3>Introduction</h3><div>Photonuclear activation of radium-226 is emerging as a promising route for large-scale actinium-225 (Ac-225) production to support future Phase 3 clinical trials and commercial deployment. While the simplest approach may appear to use radium in solid form, several technical and operational challenges complicate the use of solid radium targets in high-energy gamma irradiation environments. To ensure long-term preservation of the radium inventory and to enable robust, high-yield production, BLINDING is developing a liquid radium target system as part of its commercial-scale Ac-225 production program.</div></div><div>Photonuclear activation of radium-226 is emerging as a promising route for large-scale actinium-225 (Ac-225) production to support future Phase 3 clinical trials and commercial deployment. While the simplest approach may appear to use radium in solid form, several technical and operational challenges complicate the use of solid radium targets in high-energy gamma irradiation environments. To ensure long-term preservation of the radium inventory and to enable robust, high-yield production, BLINDING is developing a liquid radium target system as part of its commercial-scale Ac-225 production program.</div><div><h3>Objectives</h3><div>To describe the rationale for selecting a liquid radium target for photonuclear activation and to outline the technological advantages over solid target designs in terms of manufacturing, heat management, radiochemical processing, and radium capital prese</div></div><div>To describe the rationale for selecting a liquid radium target for photonuclear activation and to outline the technological advantages over solid target designs in terms of manufacturing, heat management, radiochemical processing, and radium capital prese</div><div><h3>Materials and Methods</h3><div>Solid radium target fabrication typically requires pressing powders or electrodeposition. Both approaches generate unavoidable material losses during handling and processing, conflicting with the need to preserve valuable radium. In addition, the extraction of Ac-225 from solid targets requires phase transitions to convert the solid target into solution before chromatography-based separation can be performed, each step introducing further loss pathways and operational complexity.</div><div>Thermally, solid targets exhibit limited heat dissipation, increasing risks of localized overheating under high gamma flux. Their small geometric dimensions restrict the irradiation volume, while the highly divergent gamma field requires the electron beam to be focused onto a small area of the converter, creating high local power densities and complicating cooling of the converter assembly.</div><div>BLINDING developed a liquid radium target allowing the active material to remain in solution throughout irradiation and processing. The liquid phase maximizes thermal conductivity, enables larger irradiation volumes, and allows beam sp","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102269"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radionuclide imaging modalities for temporomandibular joint disorders: A systematic review","authors":"Siddhi Rane,&nbsp;Vijayalaxmi Nimma,&nbsp;Easwaran Ramaswami,&nbsp;Sonali Kadam,&nbsp;Anusree J","doi":"10.1016/j.jmir.2025.102172","DOIUrl":"10.1016/j.jmir.2025.102172","url":null,"abstract":"<div><h3>Background</h3><div>Temporomandibular joint disorders are prevalent, multifactorial conditions that present significant diagnostic challenges. Conventional clinical evaluation and anatomical radiographic imaging provide essential structural information. However, conventional imaging, such as panoramic radiography, CBCT, and MRI, effectively depict anatomical alterations may not identify early metabolic or functional changes of disease. Nuclear medicine imaging serves as a complementary tool, providing functional and molecular insights that allow earlier identification of active pathological changes and improve diagnostic accuracy. Therefore, this review focuses specifically on radionuclide techniques to clarify their distinct diagnostic contribution within the broader TMJ imaging pathway.</div></div><div><h3>Aim</h3><div>This systematic review evaluates the role of nuclear medicine imaging modalities, including bone scintigraphy (planar 2D imaging, SPECT, and SPECT/CT) and molecular imaging (PET and PET/CT), in the diagnosis and activity assessment of TMJ disorders, focusing on imaging patterns, uptake ratios, radiopharmaceutical agents used, and their potential side effects.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across PubMed, Cochrane, Scopus, Google Scholar, Web of Science, and Science Direct. Clinical trials and related studies published on radionuclide imaging in TMJ disorders were included. Data were analysed with emphasis on study population, imaging modalities, radiopharmaceuticals, and diagnostic outcomes.</div></div><div><h3>Results</h3><div>Twenty studies met the inclusion criteria, involving participants aged 8 to 66 years, with a higher prevalence in females. Condylar hyperplasia was the most frequently investigated condition. Planar 2D imaging was the most widely employed technique and consistently demonstrated increased condylar uptake as a key diagnostic indicator. Its frequent use reflects its broad availability, relatively low cost, and high sensitivity for detecting early metabolic activity in the condyle. Advanced modalities such as SPECT, SPECT/CT, PET, and PET/CT were also applied, offering improved localization and molecular-level visualization.</div></div><div><h3>Conclusion</h3><div>Nuclear medicine imaging modalities significantly enhance diagnostic accuracy in TMJ disorders by providing functional and molecular insights beyond conventional imaging. Planar 2D imaging remains the most cost-effective screening tool, while hybrid imaging techniques (SPECT/CT and PET/CT) improve diagnostic precision and should be integrated with clinical expertise to guide effective management strategies.</div></div>","PeriodicalId":46420,"journal":{"name":"Journal of Medical Imaging and Radiation Sciences","volume":"57 2","pages":"Article 102172"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}