The Supply Chain Conundrum.

For most end users-physicians and patients-access to radiopharmaceuticals, and by extension, radionuclides, remains a real conundrum. Temporary reactor shutdowns, which result in the unavailability of certain routinely used radiolabeled drugs, often come as unexpected disruptions. Although the radiopharmaceutical industry has to be considered as mature, it has yet to fully adapt to the rapidly growing demand. Due to the natural decay of radioactive materials, daily production is mandatory, preventing the industry from constituting large reserves, on the contrary to conventional drugs. However, major investments are currently under way, with expectations that most challenges will be resolved by 2030. These developments send a clear message: the advancement of new radiopharmaceuticals is only viable if radionuclide accessibility is ensured on a large scale. As a result, the radiopharmaceuticals entering the market between 2030 and 2040 will rely on approximately a dozen radionuclides, whose availability for large-scale use will be secured. This short list presented here highlights that, given the time and investment required to establish a reliable production network, all other radionuclides should, at this stage, be considered solely for research purposes or classified as exotic.