Green Nuclear Medicine and Radiotheranostics.

There is a significantly growing interest in diagnostic and therapeutic radiopharmaceuticals, and it is foreseeable that an unprecedented number of patients will need to be treated with new nuclear medicine therapies. This predicted increase will have potentially significant environmental impacts. In this discussion, we show different areas of impact, as well as possible measures to reduce such impact. These measures may impact areas from the entire supply chain, starting at the production site of medical isotopes, the energy supply needed for production, transportation, and adaption of the injected amounts of radiopharmaceuticals in clinical use. Furthermore, arguments of local versus centralized production, potentially increasing or decreasing nuclear medicine procedures versus other greenhouse gas-emitting medical imaging tests, as well as radiopharmaceutical waste handling implications, are summarized and weighed against the current status. Overall, this summary hopefully serves as a basis for further discussion in the nuclear medicine community, potentially increases awareness of the environmental impact of this exciting medical field, and may even lead to implementation of measures.