technologies

A PET scan using a radioactive form of oestrogen that lights up every tumour deposit still carrying the oestrogen receptor, so doctors can see whether metastases across the body will respond to hormone treatment without biopsying each one.

Cancer-seeking molecules carrying the radioactive metal lutetium-177, which delivers short-range radiation to tumours it binds; approved for neuroendocrine tumours and prostate cancer.

A radioactive version of the hormone mimic used for the scan; it homes to neuroendocrine tumour cells and irradiates them from inside.

Like an ADC but with a small targeting peptide instead of an antibody, so it penetrates tumours faster and is cheaper to make.

A drug that finds tumour cells and carries a radioactive atom that irradiates them from inside the body.

A CT scan is a fast 3D X-ray that shows the size and shape of tumours and whether they have spread.

The scanners that find and stage cancer are built by five companies in a dozen factories. Detectors, superconducting magnets and the helium that cools them are the parts that run short.

Proton-rich isotopes for PET scans and some therapies are made by hitting a target with a beam from a cyclotron. Fluorine-18 is made every morning within driving distance of the scanner; gallium-68 comes from either a generator or a cyclotron; copper-64 and zirconium-89 last long enough to ship across a country.

FDG PET is the standard PET scan. A radioactive sugar shows which tissues are burning glucose fast, which most cancers do.

The small radiation detectors that make nuclear medicine and sentinel node surgery work: a pen-sized probe that clicks when the surgeon nears the radioactive lymph node, and the well counter in the hot lab that checks every dose before it is injected.

The particle accelerators and shielded robotic chemistry boxes that make PET tracers in hospital basements and commercial pharmacies.

A scan that shows where a radioactive tracer accumulates, so it images what tumours are doing rather than what they look like.

Making PSMA, FDG, and new tracers under drug-manufacturing rules and delivering them daily.

Scan after two cycles of chemotherapy; if the tumour has gone dark, give less treatment, and if not, give more. Hodgkin lymphoma pioneered this.

PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT.

A prostate-cancer-specific PET scan that finds spread far earlier than CT or bone scan, and tells you whether a matched radioactive drug will work.

The numbers pulled from scans that decide whether a cancer is shrinking, growing or dead: tumour diameters for RECIST, sugar uptake on PET, water movement on MRI; they run every trial and most clinic decisions, and they are only as good as the way the scan was taken.

Using the thyroid's natural appetite for iodine to image and treat thyroid cancer with a radioactive form of it. The oldest theranostic, and now used more selectively than it was.

Bench-top devices that 'milk' a short-lived isotope from a long-lived parent, plus vials of ready-to-label ligand. How most hospitals make PSMA and somatostatin PET tracers without a cyclotron.

A radioactive medicine loses activity every hour, so it is made to order, tested in hours and often injected before the sterility test has finished. The rules for that are different from ordinary drugs, and the handful of plants that make lutetium therapies have had their own shortages.

The factories and courier routes that make and deliver short-lived radioactive tracers to hospitals within hours.

Most of the world's therapeutic and scanning isotopes are made by putting targets into about half a dozen ageing research reactors and flying the product out within days. When two reactors were down at once in 2009 and 2010, hospitals worldwide ran short of the most used scan isotope.

A PET scan using a radioactive hormone mimic that lights up neuroendocrine tumours and shows whether the matching radioactive treatment will work.

SPECT and the bone scan are an older type of nuclear scan, still used for bone metastases and to check where a radioactive drug went after treatment.

A gamma camera with a CT scanner bolted on, so a hot spot on a bone scan or a sentinel-node scan is pinned to the exact bone or lymph node, and the dose from a radioactive drug can be measured after treatment.

Before a surgeon removes part of a lung, the scan is used as an arithmetic tool rather than a picture: it measures what share of the breathing work that piece of lung is actually doing, so the team can predict the patient's lung function after the operation and decide whether they will tolerate it.

Sterile fill-finish is putting the finished drug into vials under sterile conditions. It is a frequent cause of shortages when capacity is tight.

Actinium-225 is the alpha-emitting atom behind the most promising next wave of radioligand therapies, and there is not enough of it. Almost all of it used to come from one decaying stock of thorium in a US national laboratory. New routes use accelerators and old radium.

CAIX PET is a scan using an antibody against a protein almost unique to clear-cell kidney cancer, to tell cancer from benign kidney lumps without a biopsy.

FAPI PET is a PET scan that lights up the scaffolding around almost any solid tumour, including cancers the standard sugar scan misses.

Like radioligand therapy but with alpha particles: far more destructive over a much shorter range, so single cells can be killed with less collateral damage.

Measuring the dose the patient actually receives, with detectors on the skin or the imaging panel behind them, to catch errors before they cause harm.

Dozens of rice-grain-sized radioactive seeds are implanted permanently in the prostate in a single procedure and deliver their dose over months.

A noradrenaline look-alike that neuroblastoma cells swallow: labelled with a small amount of radioactivity it shows the tumour on a scan; with a large amount it treats it.

Nuclear medicine hardware means the scanners themselves: PET/CT, SPECT/CT, and new total-body PET that images the whole body at once.

PET combined with MRI instead of CT, giving biology plus the best soft-tissue detail, at lower radiation dose.

Millions of tiny radioactive glass or resin beads are injected into the liver artery, lodging in the tumour and irradiating it from within.

Measuring, from scans taken after each dose, how much radiation a radioligand actually delivers to the tumour and to kidneys and marrow, so treatment can be personalised.

Site-specific conjugation and linker chemistry decide exactly where and how many payloads attach to the antibody, which determines how safe and effective an ADC is.

Where the radioactive atoms for imaging and therapy actually come from: ageing reactors, new accelerators, and a scramble for actinium.

HER2 PET is a PET scan using radiolabelled trastuzumab or smaller HER2 binders to map HER2 across all metastases at once.

PET scans built from radiolabelled antibodies or their fragments, to see any protein an antibody can reach, including immune cells inside tumours.

A PET tracer that measures how much of the DNA repair enzyme PARP a tumour has, to predict response to PARP inhibitors.

Attaching a radioactive atom to an antibody, so an ADC's targeting is used to deliver radiation instead of chemotherapy.

Turning ordinary CT, MRI and PET scans into hundreds of measured features of shape and texture that computers relate to tumour biology and outcome.

A rare alpha-emitting halogen that can be attached to antibodies and small molecules like iodine, tested in leukaemia conditioning and brain and ovarian cancer.

Adding a PARP or ATR inhibitor to a radioactive drug so the tumour cannot repair the damage the radiation causes.

An experimental PET scan that shows whether a tumour carries the TROP2 protein, so doctors could pick the right ADC before giving it.

Actinium-225 releases four alpha particles as it decays, but the daughters escape and irradiate the kidneys and salivary glands. Nanocarriers try to hold them in place.

Auger-electron therapy uses radioactive atoms such as iodine-125 or terbium-161 that release cascades of low-energy electrons travelling only nanometres to micrometres, so they kill a cell only if the atom sits on or inside its DNA and spare the neighbours. Terbium-161 can replace lutetium-177 in existing PSMA ligands; true nuclear delivery remains preclinical.

Scanners sensitive enough to image the whole body in seconds at a fraction of the radiation dose, which raises the question of whether healthy people should be scanned at all.

Computer software trained on thousands of scans can now automatically outline tumours on PET and SPECT images in seconds instead of the 30-45 minutes it takes a doctor, though a specialist still checks the result.

Attaching a small chemical 'hook' that grips the body's own albumin protein makes a radioactive drug stay in the bloodstream for longer, so more of it reaches the tumour before it is cleared out through the kidneys.

When an alpha-emitting radioactive drug decays inside the body, the recoil kick is so strong that the leftover radioactive fragment breaks loose from the drug and can drift to organs like the kidneys, causing side effects the original drug was never meant to cause.

A shielded robotic 'chemistry-in-a-box' machine mixes and purifies radioactive drugs behind thick walls, so staff never have to handle dangerous, highly radioactive liquids by hand.

Many everyday radioactive scan drugs come as a freeze-dried powder in a sealed vial; the hospital pharmacy just adds the freshly produced radioactive solution and the finished injectable drug forms in minutes, no chemistry lab required.

DOTA is a small ring-shaped molecule that grips a radioactive metal atom tightly inside its cage, so the metal stays attached to the drug instead of drifting off into the body.

A compact column loaded with a long-lasting parent isotope lets a PET radiopharmacy produce fresh gallium-68, used in scans such as PSMA and DOTATATE PET, on demand without needing a cyclotron.

Radioactive drugs are made and handled behind thick walls of lead, tungsten or concrete inside sealed, negative-pressure boxes with built-in robot arms, so the radiation stays contained and staff outside stay safe.

Macropa is a newer ring-shaped molecule built specifically to grip large radioactive metal atoms, such as the alpha-emitter actinium-225, quickly and at room temperature, which older molecules like DOTA cannot do well.

A shielded column device lets hospitals 'milk' the world's most-used medical radioisotope, technetium-99m, fresh every day from a longer-lived parent isotope that is shipped to them from a reactor.

Powerful computer simulations trace millions of individual particles of radiation as they fly through a virtual copy of a patient's body, giving the most detailed and realistic estimate of exactly how much radiation dose each organ and tumour actually receives.

Instead of attaching radioactivity directly to a slow-moving antibody, doctors first inject the antibody alone, let it find the tumour and clear from the blood over some days, then inject a small fast-clearing radioactive tag that clicks onto the antibody only where it has stuck to the tumour.

Modern gamma-camera scans can now be turned into maps of exactly how much radioactivity (in becquerels) sits in each part of the body, not just a picture, which is what lets doctors calculate a real radiation dose to a tumour or organ.

A radiohybrid molecule carries two possible attachment points, one for a fast PET-friendly radioactive fluorine tag and one for a radioactive metal used for treatment, so the imaging and treatment versions of the drug are chemically identical twins.

Before any radioactive drug is given to a patient, a quick chemistry test checks that the radioactive atom is properly and completely attached to the drug molecule, rather than floating free, because free radioactivity goes to the wrong place in the body.

Sarcophagine is a cage-shaped molecule that locks copper atoms inside so tightly that the copper cannot escape once the imaging or treatment dose is made, even inside the body.

After a radioactive treatment injection, patients are scanned two or three times over about a week so doctors can calculate exactly how much radiation dose the tumour and organs like the kidneys actually received, and adjust future doses if needed.

A generator produces a very short-lived radioactive potassium-like tracer on demand at the bedside, allowing a heart PET scan to be finished in minutes without needing an on-site cyclotron.