We aimed to investigate the current status of nuclear medicine (NM) services across Africa, including identifying infrastructure gaps, radiopharmaceutical availability, systemic challenges, uneven growth trends, and efforts to improve access. Methods: Data on NM infrastructure, radiopharmaceutical availability, and challenges faced by NM professionals in the region were collected at regional International Atomic Energy Agency (IAEA) training courses, from IAEA databases, and by direct correspondence with NM professionals in the region between September 2024 and September 2025. Results: NM services are available in 29 countries. Seven countries have more than 1 SPECT or SPECT/CT camera per million inhabitants, and 12 countries offer PET/CT services, with no country in the region having more than 1 PET/CT camera per million inhabitants. There are 29 cyclotrons in 11 countries. There has been a 5.58% compound annual growth rate of SPECT or SPECT/CT and 32.8% growth (above global averages) in PET/CT cameras since 2022. 99mTc is available in all countries with NM services, and all, except Burkina Faso, have access to 131I. Prostate-specific membrane antigen imaging is available in 9 countries, and somatostatin receptor type 2 imaging is available in 8 countries. Targeted radiopharmaceutical therapy services are limited to 131I for benign or malignant thyroid disease in most countries. 177Lu-therapies are restricted to 7 countries, and the availability of [131I]MIBG remains limited. Clinical trials with 225Ac and 161Tb are under way. Member states face similar challenges, including high costs of medical equipment and consumables, limited health care infrastructure, low government health care expenditures, weak economies, staff shortages, and limited educational opportunities. Conclusion: Despite challenges, there is clear momentum and NM growth in Africa. Although infrastructure, radiopharmaceutical access, and workforce gaps remain, data show progress. Sustained investment in facilities, training, and regulatory frameworks is essential to achieve equitable access to care. IAEA's regional anchor centers as part of the Rays of Hope initiative exemplifies strategic capacity building, collaboration, and knowledge sharing in the region.

Real-world disparities in access to PSMA-targeted theranostics are poorly characterized. We compared waiting times for PSMA PET/CT and 177Lu-PSMA therapy between centers in Brazil and Europe. Methods: This retrospective multicenter study included 91 patients (50 from Brazil, 41 from Europe) treated with 177Lu-PSMA. Outcomes were days from request to PSMA PET/CT completion (diagnostic access) and days from request to first therapy dose (therapeutic access). Groups were compared using the Mann-Whitney U test. Results: Diagnostic access was similar between Brazil (median, 17.5 d; interquartile range [IQR], 9-34 d) and Europe (median, 19 d; IQR, 14-23 d; P = 0.39). Therapeutic access was significantly delayed in Brazil (median, 59 d; IQR, 54.5-91) compared with Europe (median, 21 d; IQR, 17-31 d; P < 0.01), representing a 2.8-fold longer wait. Conclusion: Despite comparable access to PSMA PET/CT, initiation of 177Lu-PSMA therapy is nearly 3 times slower in Brazil than in Europe. Closing the therapeutic access gap requires targeted investments in radiopharmaceutical supply chains and regulatory efficiency.

Although multiple studies have demonstrated the accuracy of 68Ga-PSMA-11 PET/CT, its ability to predict survival outcomes and treatment response remains unclear. This study assessed the prognostic value of 68Ga-PSMA-11 PET/CT in staging unfavorable intermediate- or high-risk prostate cancer (PCa) in patients who are candidates for radical prostatectomy. Methods: This prospective multicenter trial supported by the International Atomic Energy Agency enrolled 775 patients across 11 countries with newly diagnosed, unfavorable intermediate- or high-risk PCa. Patients underwent 68Ga-PSMA-11 PET/CT, after which their disease was categorized as N0M0 (no involvement of local nodes and no metastases), N1M0 (pelvic lymph node involvement), or NxM1 (distant metastases). These findings were then compared with clinical follow-up data. Results: Biochemical recurrence rates were 35.4% (N0M0), 68.2% (N1M0), and 77.2% (NxM1). Two-year event-free survival rates were 56.6%, 43.9%, and 26.0% in patients with N0M0, N1M0, and NxM1 disease, respectively. Two-year overall survival rates were 99.3% in patients with N0M0 disease, 99.2% in those with N1M0 disease, and 86.8% in those with NxM1 disease (P < 0.001). 68Ga-PSMA-11 PET/CT status was the only significant prognostic factor for survival outcomes. Conclusion: 68Ga-PSMA-11 PET/CT is a robust and independent prognostic marker in patients with unfavorable intermediate- or high-risk PCa and may help tailor treatments and improve outcomes.

Breast cancer is not just a disease; it is a global crisis that continues to claim lives, especially in low- and middle-income countries (LMICs), where late-stage diagnosis is the norm rather than the exception. Unlike high-income countries (HICs), where early detection has significantly improved survival rates, women in LMICs face an uphill battle against fragmented healthcare systems, limited diagnostic tools, cultural barriers, and financial constraints. The very technologies that revolutionized screening in HICs remain out of reach for many, leaving millions vulnerable to preventable deaths. This article calls for bold leadership and coordinated global efforts to ensure that every woman, regardless of geography or socio-economic status, has access to life-saving early detection and treatment, in addition to highlighting the urgent need for equitable breast cancer screening in LMICs and exploring innovative approaches that have the potential to transform early detection and improve outcomes. Decentralized diagnostic hubs, artificial intelligence (AI)-powered imaging, mobile screening units, and public-private partnerships are emerging as viable solutions to bridge the gap. Moreover, creative financing models and culturally tailored awareness campaigns offer hope for overcoming financial and social barriers. We can drive a paradigm shift towards equity in cancer care by reimagining breast cancer screening through technology and community engagement.

Cardiovascular diseases (CVDs) remain among the leading causes of both health and economic burdens worldwide. Myocardial Perfusion Imaging (MPI) performed using Single Photon Emission Computed Tomography (SPECT) or, more recently, Positron Emission Tomography (PET), has long served as a cornerstone in the diagnosis and management of coronary heart disease (CHD). However, rising healthcare costs and rapidly advancing imaging technologies have prompted re-evaluation of nuclear cardiology’s cost-effectiveness, making careful selection of imaging modalities essential. In this review, an economic evaluation of imaging in CHD has been undertaken, summarizing the most relevant studies on the cost-effectiveness of various imaging modalities. The heterogeneity in data - largely related to institutional resources, operator expertise, clinical setting (inpatient vs. outpatient), healthcare system, and reimbursement structure - does not yet allow definitive conclusions on the cost-effectiveness of each individual modality. Therefore, a well-structured multimodality imaging approach appears to provide greater diagnostic and economic value, offering both improved clinical outcomes and more efficient resource utilization.

Rationale: Rechallenge peptide receptor radionuclide therapy (PRRT) is a valid therapeutic option for patients with advanced/metastatic neuroendocrine tumors (NETs) who previously benefited from initial PRRT. In this context, [18F]FDG PET may serve as a prognostic marker. This multicenter 10-year survival study aims to evaluate the prognostic implications of [18F]FDG PET and PRRT-induced changes in NET patients undergoing rechallenge PRRT. Methods: This retrospective multicenter study included 100 patients (median age: 54 years, range: 29-83) treated with rechallenge PRRT. All patients underwent [68Ga]Ga-DOTA-TOC/TATE/NOC and [18F]FDG PET/CT prior to the first PRRT period, 3-4 months after PRRT, and every 6-9 months thereafter. Metabolic status and its changes (no change vs. FDG+/FDG- vs. FDG-/FDG+) before the first PRRT period and at each restaging were recorded and correlated to baseline characteristics, time to progression (TTP), and overall survival (OS). Results: In 43 out of 100 patients, the primary tumor site was the pancreas; the liver was involved in more than 90% of patients. Biopsies revealed G1 NET in 16%, G2 NET in 66%, and G3 NET in 18% of cases. Before the first PRRT period, 50% of patients were FDG-positive. Following the first PRRT period, 27 patients exhibited a change in metabolic status: 20 converted to FDG-negative, whereas 7 became FDG-positive. After the second PRRT period, metabolic status changed in 41 patients, with 25 converting to FDG-negative and 16 to FDG-positive. Metabolic status after the first period was significantly correlated with NET grade (p = 0.009). The correlation persisted also after rechallenge (p < 0.001), suggesting that FDG positivity increased progressively in G3 NET patients (p = 0.020). The presence of bone metastases statistically correlated with FDG positivity before (p < 0.001) and after (p = 0.001) the first PRRT period. Multivariate Cox regression analysis revealed NET G3 and FDG status after the first PRRT course as independent factors for shorter TTP. After a median follow-up time of 117.6 months (range: 38.4-180 months), 37 patients had died. Multivariate Cox regression analysis revealed FDG positivity after the first (p < 0.001) and second (p < 0.001) periods of PRRT as independent predictors of poor OS. Conclusions: Assessing [18F]FDG status before PRRT and during follow-up after treatment enables prediction of TTP and OS, even in patients considered for rechallenge PRRT. Standardizing the use of dual-tracer imaging in patients receiving PRRT seems a valuable approach to improve clinical decision-making in NET patients.

Accurate staging of unfavorable intermediate- or high-risk prostate cancer (PCa) is essential for treatment decisions. Conventional imaging often fails to detect lymph node, bone, and visceral metastases, and for this purpose 68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT is clinically used. This prospective, multicenter, International Atomic Energy Agency-supported trial evaluated the accuracy of 68Ga-PSMA-11 PET/CT for initial staging compared with MRI and histopathology and the impact of 68Ga-PSMA-11 PET/CT on determining surgical eligibility. Methods: In a prospective, international study supported by the International Atomic Energy Agency, 775 patients with high-risk or unfavorable intermediate-risk PCa from 12 centers across 11 countries-including low-, middle-, and high-income settings, scheduled for radical prostatectomy based on conventional imaging (including bone scanning and pelvic MRI) underwent 68Ga-PSMA-11 PET/CT before treatment. PET and MRI findings were compared with radical prostatectomy histopathology, and the impact of PET on radical prostatectomy was assessed. Results: 68Ga-PSMA-11 PET/CT detected metastatic disease (M1) in 20.4% of cases, altering management and preventing prostatectomy in 24.0%. The accuracy for seminal vesicle invasion was 90.1% for 68Ga-PSMA-11 PET/CT versus 57.3% for MRI, and for lymph node metastases it was 91.1% for 68Ga-PSMA-11 PET/CT versus 69.7% for MRI. In 13.1% of patients (78/593), there were discordant results between 68Ga-PSMA-11 PET/CT and histopathology. 68Ga-PSMA-11 PET/CT had false-negative lymph node findings in 8.6% of cases, with the most clinically significant being 4.5% of patients incorrectly staged as N0. False-positive lymph node findings at 68Ga-PSMA-11 PET/CT occurred in 4.5% of patients. Conclusion: 68Ga-PSMA-11 PET/CT significantly improves staging accuracy, reducing the indication for prostatectomy and impacting treatment decisions. These findings, from a broad international cohort including low-, middle-, and high-income countries, support the global adoption of 68Ga-PSMA-11 PET/CT into standard staging protocols for high-risk PCa.

Diagnostic imaging is central to clinical decision-making across many care pathways, yet the expertise needed to use these images well is unevenly distributed across health systems, with workforce limitations identified as a major barrier to equitable access, particularly in low- and middle-income countries. Digital education has emerged as one response to this gap, offering scalability, asynchronous and just-in-time access, and the cost-efficiency required for global deployment. This paper examines the digital education portfolio of the International Atomic Energy Agency’s Nuclear Medicine and Diagnostic Imaging Section, hosted mainly on the open-access Human Health Campus, which in 2025 recorded approximately 45,800 active users and 150,000 views across 159 countries. The portfolio combines structured e-learning courses, interactive webinars, virtual conference access through the Livestream programme, and a broader repository of publications, teaching cases, and reference resources, supported by an internal e-learning framework and learning management system infrastructure. Partnerships with international scientific societies further extend the reach of expert knowledge and professional exchange. The paper argues that these initiatives are best understood not as content delivery alone but as a coordinated strategy to support diagnostic quality at the level of the practising physician, extending access to expertise and strengthening the conditions for better practice, while remaining a complement to, rather than a substitute for, supervised clinical training.

Objectives Cardiac sarcoidosis can lead to arrhythmias, heart failure, and sudden cardiac death. Positron emission tomography/computed tomography (PET/CT) is crucial for diagnosis and monitoring, yet data from the Middle East and North Africa (MENA) region remain scarce. This study evaluated the role of PET/CT in diagnosing and managing cardiac sarcoidosis at a tertiary referral center in the Middle East. Materials and Methods This retrospective study included 19 patients with biopsy-proven sarcoidosis who underwent fluorine-(18) fluorodeoxyglucose (FDG) PET/CT for suspected cardiac involvement at a tertiary referral medical center in Lebanon between 2014 and 2024. Complementary imaging with echocardiography, cardiac magnetic resonance imaging, and electrocardiography was also analyzed alongside treatment approaches and follow-up outcomes. Results FDG PET/CT identified cardiac involvement in 12 patients, with diffuse or focal FDG uptake patterns correlating with symptom severity and electrocardiographic abnormalities. These patients exhibited higher rates of arrhythmias, conduction abnormalities, and reduced global longitudinal strain and E/A ratio on echocardiography. Cardiac magnetic resonance imaging demonstrated late gadolinium enhancement in most cases with FDG PET/CT-confirmed cardiac sarcoidosis, supporting the presence of myocardial inflammation. Treatment included corticosteroids, immunosuppressive agents, and device implantation in selected cases. Follow-up FDG PET/CT showed significant reductions in FDG uptake, indicating therapeutic response. Conclusion This study underscores the clinical utility of FDG PET/CT in diagnosing and managing cardiac sarcoidosis, particularly in resource-limited settings like the MENA region. FDG PET/CT enabled early detection, guided treatment decisions, and facilitated monitoring of therapeutic response. These findings highlight the need for broader access to FDG PET/CT imaging in the region to optimize patient outcomes.

Resumo Fundamento A doença cardiovascular (DCV) permanece como a principal causa de morte entre mulheres na América Latina e no Caribe (ALC), sendo a doença isquêmica do coração o principal componente. Apesar desse importante impacto, os programas de saúde da mulher na região tradicionalmente priorizaram a prevenção do câncer, frequentemente negligenciando a DCV. Objetivo Analisar a carga de DCV e a distribuição dos fatores de risco cardiovascular entre mulheres na ALC, destacando diferenças relacionadas ao sexo e disparidades regionais. Métodos Este estudo analisou dados epidemiológicos sobre mortalidade por DCV e fatores de risco cardiovascular nos países da ALC, incluindo fatores comportamentais, metabólicos e específicos do sexo feminino, além de comparações com países selecionados fora da região. Resultados As mulheres na ALC apresentaram maior prevalência de sedentarismo, dislipidemia, glicemia de jejum elevada e sobrepeso/obesidade, enquanto o tabagismo foi mais frequente entre os homens. Fatores de risco específicos do sexo feminino – como gravidez na adolescência, parto prematuro, diabetes gestacional e distúrbios hipertensivos da gestação – foram altamente prevalentes, porém sub-reconhecidos, sendo amplamente influenciados por determinantes socioeconômicos. Em 2021, a COVID-19 superou temporariamente a doença isquêmica do coração e o acidente vascular cerebral como principal causa de morte nas Américas (176,7 óbitos por 100.000 habitantes), evidenciando a vulnerabilidade de mulheres com risco cardiometabólico prévio. A mortalidade prematura por DCV variou amplamente: as maiores probabilidades de morte entre 30 e 70 anos foram observadas no Haiti (21,9%) e na Guiana (15,2%), associadas, respectivamente, à hipertensão mal controlada e ao colesterol elevado. Em contraste, o Canadá apresentou a menor mortalidade prematura (1,7%), refletindo sistemas de saúde mais robustos e menor prevalência de fatores de risco metabólicos. Conclusão A DCV continua sendo a principal causa de mortalidade entre mulheres na ALC, caracterizada por importantes disparidades regionais e elevada carga de fatores de risco tradicionais e específicos do sexo feminino. Esses achados reforçam a necessidade urgente de estratégias específicas ao sexo e sensíveis ao contexto, integrando a prevenção cardiovascular às políticas abrangentes de saúde da mulher, superando abordagens centradas exclusivamente no câncer.

Nuclear medicine has progressed from an exploratory discipline, historically constrained by limited spatial resolution and qualitative interpretation, into a rigorously quantitative clinical specialty. This evolution represents a systematic conversion of uncertainty into actionable information. Uncertainty that was once implicit and observer-dependent is increasingly measured, modelled, and managed across the full imaging-therapy continuum. Early tracer work established the foundational diagnostic logic of assessing function before structure. Subsequent instrumentation advances, culminating in the contemporary deployment of long axial field-of-view total-body positron emission tomography (PET) and digital cadmium-zinc-telluride detectors, have compressed spatial ambiguity and enabled true dynamic, multi-organ kinetic modelling. Hybrid imaging further reduced uncertainty by coupling functional signals to anatomical context, while artificial intelligence has emerged as a transformative force, enabling synthetic attenuation correction, automated total tumour volume segmentation, and the deployment of 3D vision-language foundation models for multimodal analysis. Parallel progress in radiochemistry and target biology has shifted tracer development toward highly specific receptor and antigen ligands. This momentum catalysed the theranostics revolution, where diagnostic imaging serves as an explicit, quantitative gatekeeper for radiopharmaceutical therapy. As the field transitions into the "Alpha-Era"-characterized by the clinical maturation of targeted alpha therapies-dosimetry and radiobiology have become paramount. To harness this complexity, the discipline is adopting Theranostics Digital Twins, advanced computational frameworks that integrate physiologically-based radiopharmacokinetic models, radiobiological optimizers, and patient-specific multi-omics to predict dose-response and mitigate toxicity. Though modern nuclear medicine has not eliminated biological uncertainty, it has formalized its quantification, establishing a highly personalized and augmented therapeutic paradigm capable of overriding sub-clonal tumour resistance and redefining systemic oncology.

Importance:In recent decades, there has been marked worldwide growth in diagnostic testing for coronary artery disease (CAD), with several common imaging modalities exposing patients to ionizing radiation. Objective:To examine worldwide radiation doses for patients undergoing noninvasive CAD diagnostic testing. Design, Setting, and Participants:This worldwide, cross-sectional study was conducted of radiation dose from noninvasive CAD imaging in 2023, using a consecutive sample of all 19 302 adults undergoing noninvasive CAD diagnostic testing at 742 centers in 101 countries during a single week in October to December 2023. Exposures:Participants underwent CAD testing with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) nuclear cardiac imaging, cardiac computed tomography for coronary artery calcium scoring (CACS), or coronary computed tomography angiography (CCTA). Main Outcomes and Measures:The primary outcomes were radiation effective dose to patients and the percentage of centers with median effective dose less than or equal to 9 mSv, as recommended in guidelines. Results:Of 19 302 patients, 8515 (44%) were females and the median (IQR) age was 63 (54-71) years. Effective dose varied considerably across diagnostic modalities, with median (IQR) effective dose of 1.2 (0.7-2.2) mSv for CACS, 2.0 (1.6-2.4) mSv for PET, 6.5 (3.9-8.6) mSv for SPECT, and 7.4 (3.5-15.5) mSv for CCTA. Significantly more centers performing nuclear cardiology than CCTA (81% vs 56%; P < .001) and patients undergoing nuclear cardiology studies than CCTA (79% vs 56%; P < .001) achieved median dose of less than or equal to 9 mSv. Doses for the same procedure differed significantly between world regions, being lowest in Western Europe (median [IQR], 4.8 [2.3-7.3] mSv for nuclear cardiology and 4.6 [2.4-9.8] mSv for CCTA) and highest in Latin America for nuclear cardiology (median [IQR], 7.8 [5.3-9.7] mSv) and Africa (median [IQR], 25.2 [14.7-35.3] mSv) for CCTA (P < .001 for all). In regression modeling, there was an inverse relationship between country income level and dose. Patient dose was 20% (95% CI, 3.6%-38.4%) higher in low- and middle-income countries than in high-income countries for nuclear cardiology, and as much as 96% (95% CI, 41.7%-170.8%) higher in low- and lower-middle-income countries than in high-income countries for CCTA (P < .001). Marked variation was observed within income levels and world regions. Conclusions and Relevance:Given increasing rates of CAD worldwide, these findings of marked variation in radiation dose to patients from diagnostic testing identify a critical need for training, standardized protocols, and updated equipment to reduce radiation worldwide. This especially affects patients in low- and middle-income countries and patients undergoing CCTA. There are therefore important opportunities to improve the quality of CAD diagnosis for patients across the globe.

Since its inception in 2012, the Nuclear Medicine Global Initiative (NMGI) of the Society of Nuclear Medicine and Molecular Imaging has played an important role in addressing significant challenges in the field of nuclear medicine and molecular imaging. The first 3 projects were dedicated to standardizing pediatric nuclear medicine practices, addressing the global challenges of radionuclide access and availability, and assessing the educational and training initiatives on theranostics across the globe. These efforts aimed to advance human health, foster worldwide educational collaboration, and standardize procedural guidelines to enhance quality and safety in nuclear medicine practice. In its latest project, NMGI aimed to develop a unified nomenclature for systemic radionuclide therapy in nuclear medicine, addressing the diverse terminology currently used. An online survey was distributed to NMGI member organizations, drawing participation from various geographical locations and disciplines. The survey anonymously collected responses from physicians, physicists, scientists, radiopharmacists, radiopharmaceutical scientists, dosimetrists, technologists, and nurse managers, totaling 240 responses from 30 countries. Findings revealed a prevailing use of the term targeted radionuclide therapy for radionuclide therapy, with 52% of respondents expressing a preference for this term. In contrast, approximately 37% favored "radiopharmaceutical therapy," whereas 11% favored "molecular radionuclide therapy." Other key terms under the umbrella of targeted radionuclide therapy were also discussed to achieve a consensus on terminology. NMGI efforts to standardize terminology in this dynamic and fluid field should improve communication within the field, better reflect the technology used, enable comparison of results, and ultimately lead to improved patient outcomes.

Radiotheranostics represent a cutting-edge advancement in the management of noncommunicable diseases, integrating diagnostic imaging with targeted radiotherapy in a single, personalized approach. Over the past decade, the field has gained substantial momentum, with several radiopharmaceuticals now incorporated into clinical practice, most notably for neuroendocrine tumors and prostate cancer. The pipeline of novel agents continues to grow, offering promising therapeutic options for patients with cancers resistant to conventional therapies. Despite these advances, the broad implementation of radiotheranostics is impeded by several challenges, including logistical constraints, financial limitations, resource scarcity, political instability, and regulatory and educational barriers. Overcoming these obstacles requires coordinated mitigation strategies focused on strengthening education and training, expanding radiopharmaceutical production and development, enhancing research capacity, and establishing robust quality management systems. This review provides a comprehensive overview of the current global landscape of radiotheranostics, identifies key implementation barriers, and offers expert-driven strategies and recommendations from the International Atomic Energy Agency to support sustainable and equitable access to radiotheranostics.

Congenital abnormalities of the kidney and urinary tract are amongst the most common in children, often requiring nuclear medicine imaging for diagnosis and treatment planning.Efforts to harmonise paediatric renal scintigraphy have gained momentum, notably through unified guidelines published by the Society of Nuclear Medicine and Molecular Imaging (SNNMI) and the European Association of Nuclear Medicine (EANM). However, despite these guidelines, significant variation in clinical practice persists. Advances in imaging technology have also influenced protocols, with some institutions now incorporating single photon emission computed tomography (SPECT) studies when performing cortical scintigraphy. To assess the current practices, the International Atomic Energy Agency (IAEA) conducted a global survey, revealing substantial variability and gaps in the performance and interpretation of renal studies within countries and globally. This underscores the urgent need for standardization and quality improvement across institutions. The IAEA is uniquely positioned to support the global nuclear medicine community through targeted educational and capacity building initiatives.

Health problems in the Latin American and Caribbean (LAC) region are mainly associated with noncommunicable diseases, with cardiovascular disease and cancer being the leading causes of death. However, knowledge and training opportunities in cardio-oncology, as well as active cardio-oncology groups, are mainly limited to large academic institutions or isolated private groups. To contribute to the implementation of viable strategies to ensure equitable access to care for all, it is essential to understand the current situation. This publication assesses the epidemiological situation of cancer in LAC and discusses the development of cardio-oncology in the region. It analyses the results of the survey on knowledge and medical action in cardio-oncology carried out among a group of physicians involved in the care of oncology patients and proposes recommendations based on the results obtained.

Background Understanding pandemic-related reductions and subsequent recovery of cardiovascular testing in Asia is important for guiding regional public health efforts.Objectives This study sought to evaluate the recovery of cardiovascular testing in Asia 1 year into the COVID-19 pandemic.Methods In this subanalysis of a worldwide survey on the impact of COVID-19 on cardiovascular diagnostic care in April 2020 and April 2021, recovery of testing volume in Asia was compared among subregions, World Bank income groups and imaging modalities.Results Of 669 sites worldwide, 164 sites were in 33 Asian countries. Cardiovascular testing volumes in Asia decreased by 53% from March 2019 to April 2020, then recovered 96% of this decrease by April 2021, compared with 98% recovery in the rest of the world. Eastern Asia and Western and Central Asia reported recovery rates of 123% and 110%, compared with 50% and 80% recovery in Southern and South-eastern Asia. Testing volumes among high-income and upper-middle-income Asian countries recovered to 117% and 121% but remained depressed at 49% and 14% recovery in lower-middle and low-income countries, respectively. Stress ECG, stress echo and stress positron emission tomography studies experienced median reductions of 48%, 35% and 57% in testing volume between March 2019 and April 2021, while volumes of coronary artery calcium, coronary CT angiography and cardiac MR remained stable during this period.Conclusions The recovery of cardiovascular testing in Asia 1 year into the COVID-19 pandemic lagged in the Southern and South-eastern subregions, as well as in lower-income countries. Recovery favoured advanced cardiac imaging modalities over standard stress testing modalities.

The global expansion of theranostics, a field combining molecular imaging and targeted therapy, has accelerated with the Food and Drug Administration approvals of Lutathera and Pluvicto. However, significant challenges hinder equitable access, particularly in low- and middle-income countries (LMICs). These include infrastructure limitations, such as the high cost of gamma cameras, positron emission tomography/computed tomography scanners, cyclotrons, and maintenance, as well as disparities in the availability of radiopharmaceuticals. In LMICs, one single-photon emission computerized tomography scanner may serve 33 million people, compared with 57,000 in high-income countries. Furthermore, shortages of key isotopes like 99Mo and 177Lu highlight vulnerabilities in global supply chains. Staffing and training are critical issues, as delivering theranostic services requires specialized teams that are often scarce in LMICs. The International Atomic Energy Agency (IAEA) addresses these challenges by offering training programs, developing databases like IMAGINE and NUMDAB, and fostering technical cooperation among member states. To improve access to theranostic services, strategies such as using alternative imaging methods and enhancing local radiopharmaceutical production are recommended. The IAEA's Rays of Hope initiative aims to strengthen regional capacities, improve infrastructure, and address the critical shortage of trained professionals. A coordinated global effort is essential to overcome these barriers, reduce costs, and ensure equitable access to theranostics, particularly in resource-limited settings.