Dr. Laura Ravasi of KAX Medical and Radiopharmaceutical Consulting

This presentation is the 13th in the Nuclear Presentation Series.

Scaling precision radiotheranostics: smart Isotope production with Small Modular reactors.

Recent advances in nuclear medicine have accelerated the integration of diagnostic and therapeutic functions through theranostics, enabling precision oncology tailored to molecular targets. Radiopharmaceuticals labeled with beta-emitters such as lutetium‑177 (¹⁷⁷Lu) and emerging alpha‑emitters like actinium‑225 (²²⁵Ac) have demonstrated significant clinical impact, particularly in neuroendocrine and prostate cancers. More than 22,000 patients worldwide have been treated with ¹⁷⁷Lu‑DOTATATE (Lutathera) since its approval, while over 35,000 men with metastatic castration‑resistant prostate cancer have received ¹⁷⁷Lu‑PSMA‑617 (Pluvicto), illustrating the transformative reach and scalability of targeted radionuclide therapy.

However, global isotope production capacity lags behind clinical demand. The supply of key isotopes remains constrained by aging research reactors, short half-lives necessitating near real-time logistics, and the chemical complexity of alpha‑emitter purification—most critically for ²²⁵Ac. With dozens of theranostic agents progressing through phase II–III trials, projected isotope requirements are expected to at least triple by 2030, risking treatment delays and geographic inequities in access to care.

Small modular reactors (SMRs) offer a dual‑use solution by exploiting excess neutron flux for isotope generation within irradiation channels while simultaneously producing low-carbon electricity. This approach could decentralize isotope supply, stabilize production costs, and enhance energy‑health sector synergies. When combined with harmonized dosimetry standards, digital tracking systems, and adaptive regulatory frameworks, SMR-enabled isotope co‑production may secure a resilient radiotheranostic supply chain and sustain the transition of nuclear medicine into an essential pillar of precision oncology.

Biography:

Dr. Laura Ravasi is an Italian nuclear medicine physician and biotech executive specializing in targeted radiopharmaceuticals and theragnostics, with extensive experience across academia, pre-clinical imaging, and industry drug development. 

She currently works as Medical and Scientific Advisor at KAX Medical and Radiopharmaceutical Consulting Sàrl in Geneva, following senior roles at ITM, Telix Pharmaceuticals, Advanced Accelerator Applications, and academic posts in Milan, Saclay, Lille, and at the U.S. National Institutes of Health.