Nuclear medicine technologists (NMTs) will find more opportunities than limitations in the theranostics healthcare economy.
Exposing NMTs to the emerging specialty now not only prepares them for demand but creates institutional knowledge that supports expanding theranostics-based precision medicine, according to Amy Brady and Krystle Glasgow, nuclear medicine and molecular imaging sciences faculty members at the University of Alabama at Birmingham (UAB), two educators who are forging a path.
This article -- Part 7 in AuntMinnie's Rise of theranostics series -- explores perspectives on expanding NMT skills, changing the scope of practice, and training and education in preparation for theranostics in oncology.
Nuclear medicine technologists (NMTs) will find more opportunities than limitations in the theranostics healthcare economy.
Exposing NMTs to the emerging specialty now not only prepares them for demand but creates institutional knowledge that supports expanding theranostics-based precision medicine, according to Amy Brady and Krystle Glasgow, nuclear medicine and molecular imaging sciences faculty members at the University of Alabama at Birmingham (UAB), two educators who are forging a path.
This article -- Part 7 in AuntMinnie's Rise of theranostics series -- explores perspectives on expanding NMT skills, changing the scope of practice, and training and education in preparation for theranostics in oncology.
As AuntMinnie has covered in numerous articles, theranostics strategies include companion molecular imaging and nuclear medicine therapy. The nascent specialty of theranostics has current and potential applications in oncology, using radiopharmaceuticals to both identify and treat cancer.
"Theranostics has moved from a boutique science to becoming commercialized and industrialized," United Theranostics co-founder Eliot Siegel, MD, told AuntMinnie at RSNA 2025. This video, also available as a podcast, provides an overview of the state of theranostics at the end of 2025.
Importantly, infrastructure development in the U.S. -- led by the U.S. Department of Energy and companies such as Shine, Nusano, Niowave, and others -- that enables domestic production of medical and research isotopes means that more radiopharmaceuticals are expected to be accessible beyond 2026.
The initial theranostics wave maintains course for neuroendocrine tumors and prostate cancer, although clinical trial activity targets breast cancer, Alzheimer's disease, and expanded indications for prostate cancer, according to Siegel.
There are more than 300 ongoing clinical trials involving radiopharmaceutical therapy, said Tyler Bradshaw, PhD, of the University of Wisconsin-Madison, who discussed the rise of theranostics with Siegel at the Society for Imaging Informatics in Medicine (SIIM) 2025 meeting. (You can find AuntMinnie's coverage of that conversation here.)
Knowledge gaps
However, with theranostics still mostly practiced inside large academic institutions (see Part 2 of this series) and a few boutique medical practices (see Part 6 of this series) in the U.S., numerous knowledge gaps exist within the broader nuclear medicine community. Nuclear medicine technologists present an early opportunity to begin training and education, especially for therapy.
Amy Brady, program director and faculty of the master of science in nuclear medicine and molecular imaging sciences (NMMIS) program in the School of Health Professions at UAB, explained how the field of nuclear medicine technology is evolving.
For therapy education, Brady and Glasgow at UAB have launched an in-person "Nuclear Medicine Therapy Intensive" boot camp, in partnership with the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
The first week-long session was held in 2024, gained momentum in 2025, and continues in 2026 -- with a wait list, according to Glasgow, who started her career as a certified nuclear medicine technologist (CNMT) but eventually sought a nuclear medicine advanced associate (NMAA) degree, and with Brady co-leads the program.
Krystle Glasgow, a nuclear medicine and molecular imaging sciences faculty member at UAB, explains the motivation behind the therapy intensive, how it works, and who is eligible to participate.
UAB's in-person workshop offers advanced clinical education for theranostics, with didactic instruction and simulation, particularly in relation to radiopharmaceutical preparation and administration, safety practices, and dosimetry. Participants also practice segmentation, explore radiopharmaceutical therapy workflows, and engage with clinical trial experts.
During the in-person "Nuclear Medicine Therapy Intensive" boot camp at UAB in Birmingham, AL, participants practice administering radiopharmaceutical therapies through simulations. Photo courtesy of University of Alabama at Birmingham (UAB).
Clinical coordination
Nuclear medicine technologists, at least for now, are best poised to lead in theranostics clinical coordination, according to Cybil Nielsen, SNMMI Technologist Section (TS) president.
Cybil Nielsen, Society of Nuclear Medicine and Molecular Imaging (SNMMI) technologist section president, explained what nuclear medicine technologists can expect as they enter the field.
There are multiple pathways to become a nuclear medicine technologist, Nielsen told AuntMinnie.
Career pathways for those interested in becoming a nuclear medicine technologist.
"It's very advantageous that we have these multiple career pathways because it does allow that option for most people to get into the field, which is really what we need right now because we have a huge shortage of technologists," Nielsen said.
However, there is still much to do for theranostics pioneers in the U.S.
SNMMI wants NMTs retitled as technologists and therapists, contending that the new title would delineate the difference between someone who is not responsible for the diagnosis and treatment of patients and someone who has the education, training, experience, and critical thinking to perform diagnostic and therapeutic procedures on patients and be fully integrated in patient management teams.
The society has proposed that NMTs move from the category of health technologists and technicians to healthcare practitioners and technical occupations.
Regardless of the outcome, SNMMI has said the current definition in the Standard Occupational Classification (SOC) is not accurate and must be updated. To that end, the society has proposed the following:
"A highly specialized healthcare professional who prepares and administers radioactive drugs, known as radiopharmaceuticals, performs patient imaging procedures using diagnostic imaging equipment, accomplishes computer processing and image enhancement, provides images, data analysis, and patient information to the physician, administers doses of radiation to patients internally to treat medical conditions. Illustrative examples: Certified Nuclear Medicine Technologist and Therapist, Nuclear Cardiology Technologist, Radioisotope Technologist."
The SOC current definition is this:
"Prepare, administer, and measure radioactive isotopes in therapeutic, diagnostic, and tracer studies using a variety of radioisotope equipment. Prepare stock solutions of radioactive materials and calculate doses to be administered by radiologists. Subject patients to radiation. Execute blood volume, red cell survival, and fat absorption studies following standard laboratory techniques. Illustrative examples: Certified Nuclear Medicine Technologist, Nuclear Cardiology Technologist, Radioisotope Technologist."
Licensure laws
SNMMI has also drawn attention to state licensure requirements, Nielsen added.
Nuclear medicine technologists work in community hospitals, outpatient centers, private practice clinics, and academic medical centers. There is support for certification, but there is a disconnect between certification and licensure, Nielsen said of a 2025 SNMMI-TS survey.
Only about 30 states require that technologists be licensed in order to practice nuclear medicine technology, she said.
"SNMMI believes that all states should require credentialing through some type of licensure law," she said. "Most technologists think that there is a national law that says everybody has to be credentialed, but there is not. Without that requirement, there is a risk of hiring somebody who is not adequately credentialed, especially when we don't have enough technologists.”
State activity
SNMMI's regulatory team has been following state-by-state developments that affect nuclear medicine technologists. In a January 2026 update to AuntMinnie, the society highlighted the following:
- The Health Occupations Revision Act of 2023 has established Washington, DC, as a licensure district. The implementation process is underway, and licensure requirements are forthcoming.
- A licensure bill in North Carolina (HB 590) passed the North Carolina House in June 2025 and awaits a Senate hearing.
- In Minnesota, the American Society of Radiologic Technologists (ASRT) is now leading a coalition, which includes SNMMI and other imaging societies, to bring licensure to that state. A bill could be introduced by spring 2026.
In Texas, regulations for nuclear medicine technologists were moved from 22 TAC §194 to 22 TAC §186. SNMMI said this change "introduced new language that allows registered nurses (RNs) and physician assistants (PAs) to perform dangerous and hazardous procedures previously limited to certified radiologic professionals."
"Unlike the previous code, the updated language in §186 does not clarify the education, training, or certification requirements for RNs and PAs performing hazardous procedures such as fluoroscopy, radiation therapy, and nuclear medicine (including PET and CT)," SNMMI said, adding its concern about patient safety and scope of practice (SOP) creep. SNMMI planned to contact the Texas Hospital Board to seek clarification on the changes.
- In Louisiana, the Louisiana State Radiologic Technology Board of Examiners (LSRTBE) proposed amending Title 46 of the Louisiana Professional and Occupational Standards rules regarding recognition of the Nuclear Medicine Technologist Certification Board’s CT [NMTCB(CT)] exam. SNMMI submitted comments in support of this change and is awaiting a state decision.
NMT education
The number of students entering nuclear medicine technology educational programs has been fluctuating over the past 25 years. The ASRT has been tracking activity.
ASRT research surveys track the estimated total number of students entering nuclear medicine technology programs. Numbers have fluctuated.ASRT
While the good news is that the vacancy rate for NMTs has actually decreased from 14.5% in 2023 to 12.6% in 2025, the U.S. Bureau of Labor Statistics (BLS) projects that the total employment of nuclear medicine technologists will decline by 1% overall between 2023 and 2033, despite industry insiders' robust outlook. Reasons for this are not well known.
Accredited programs
Advocates for the field have already noticed that the total number of accredited NMT education programs has declined by 26% from 90 to 67 between 2011 and 2023, with the number of graduates declining 31%, according to a report published in August 2025 in the Journal of Nuclear Medicine Technology.
"Unfortunately, the job market changes more quickly than educational institutions and prospective students," explained Jan Winn, executive director of the Joint Review Committee on Educational Programs in Nuclear Medicine Technology (JRCNMT), the accrediting agency for NMT educational programs, in an email to AuntMinnie.
"It takes time for colleges and universities to ramp up enrollment and for new programs to open," Winn noted. "It also requires time for word to spread to prospective students that this is a viable career path with sufficient jobs again."
The JRCNMT collects data -- including graduate numbers -- from programs. Its last report available from August 2025 showed that the number of programs and graduates steadily decreased during the past decade, Winn said, adding that NMT jobs were scarce and students stopped applying to programs.
The Joint Review Committee on Educational Programs in Nuclear Medicine Technology (JRCNMT), the accrediting agency for NMT educational programs, collects data, by year, on the number of programs, number of graduates, and student capacity that all recognized clinical affiliates can accommodate. The current report demonstrates that the number of programs and graduates steadily decreased during the past decade but began trending upward in 2024 in terms of the number of programs and number of graduates.JRCNMT
However, Winn is now seeing a slight increase the number of NMT educational programs, with one new program accredited in 2024 and approximately five programs under development that have sought advice from the JRCNMT and indicated that they plan to seek accreditation. Some programs may not seek accreditation, Winn noted. New data will become available in September 2025.
Program strain
The NMTCB surveys programmatically accredited programs to develop a snapshot of capacity, enrollment, instructional models, accreditation, and challenges. NMTCB board member Sarah Gibbons recently summarized that results show a system with stable but limited capacity, modest enrollment improvements, strong commitment to accreditation, and increasing operational and educational challenges.
"On average, acceptance per program grew slightly from 11 to 12 students over three years, a modest yet notable increase given reported constraints," Gibbons noted in a NMTCB Winter 2026 report published January 15. "A key trend was improved capacity utilization: the filled capacity proportion increased from 71% in 2023 to 79% in 2025 ... indicating better applicant yield and programs enrolling closer to their limits.
NMTCB survey data also indicated strain across programs and highlighted the following six challenges:
- Didactic staffing, especially difficulties in recruiting and retaining qualified faculty.
- Difficulty securing and maintaining clinical sites capable of supporting students, mainly due to staffing shortages at clinical affiliates.
- Attracting students to nuclear medicine technology careers -- low public awareness and competition from other healthcare fields.
- Students' ability to meet clinical procedure competencies.
- Administrative workload related to accreditation as responsibilities often compete with teaching, mentoring, and curriculum development.
- Concerns about student board pass rates and exam prep resources.
Overall, the survey points to a system holding steady on enrollment and accreditation but facing pressures.
More voices
Recognizing the challenges, the newly formed Nuclear Medicine Technologists in Theranostics International Consortium (NMTTIC) may soon begin shaping the path forward as to the necessary qualifications, competencies, and best practice standards for the education and training of NMTs in theranostics and clinical trials.
The NMTTIC's ultimate goal is to secure the NMT's status and suitability for the highly-specialized position of the theranostics professional.
With representatives from the technologist special interest group of the Australian and New Zealand Society of Nuclear Medicine, European Association of Nuclear Medicine Technologists’ Committee, the SNMMI-TS, and nuclear medicine technologist representation from the International Atomic Energy Agency (IAEA), NMTTIC set its course with four aims:
- Define the evolving role of NMTs in theranostics and clinical trials.
- Identify regional enablers and barriers to high-quality care.
- Propose harmonized competencies and education pathways.
- Elevate recognition of NMTs as integral members of the theranostics team.
Final thought
Currently, 11,530 individuals hold the nuclear medicine technology credential from the American Registry of Radiologic Technologists (ARRT), one of the oldest credentialing organizations in the U.S.
Overall, the trendline over the past decade has been stable, indicating that while the field is not experiencing rapid growth, it continues to attract a consistent pool of candidates, ARRT noted in an email to AuntMinnie.
Looking forward, as theranostics gains speed, nuclear medicine technologists may face a defining moment.
The collective efforts now underway -- from therapy intensives to licensure laws and global collaboration -- signal a profession preparing for possibly a new era. And in that era, NMTs could take on a key role that is yet to be determined.
Ultimately, building a capable and sufficient nuclear medicine technologist workforce will be essential for supporting theranostics at scale.