The State of Theragnostics in BRICS Nations: A Data-Driven Multicentre Report

Objectives: Theragnostic integrates diagnostic imaging with targeted radionuclide therapy, offering a precision approach in oncology. The BRICS Multicentre Theragnostic Survey (2025–2026) aimed to evaluate current clinical practices in radionuclide therapy across participating centres within BRICS member and partner countries. The survey aimed to assess clinical activity, patterns of therapeutic radionuclide utilisation, implementation of patient-specific dosimetry, and to identify key logistical, regulatory, infrastructural, and workforce-related challenges. It also sought to define institutional training needs and opportunities for collaborative development in theragnostic applications across the BRICS network. Material and Methods: A multicentre, cross-sectional survey was conducted using a structured questionnaire distributed to nuclear medicine and theragnostic centres across BRICS countries and affiliated partner nations. Aggregated, non-identifiable institutional-level data were collected on clinical workload, radiopharmaceutical targets, therapeutic radionuclides used, clinical indications, dosimetry practices (including SPECT, SPECT/CT, and PET/CT), operational challenges, proposed solutions, and training needs. Data were analysed descriptively. Results: A total of 137 centres from 14 countries participated in the BRICS Multicentre Theragnostic Survey 2026, with the largest contributions from India (n=72, 52.6%) and Indonesia (n=21, 15.3%), followed by South Africa (n=11, 8.0%), Brazil (n=10, 7.3%), China (n=5, 3.6%), Iran (n=4, 2.9%), and Republic of Belarus (n=4, 2.9%). The majority of institutions were private hospitals or clinics (51.1%), followed by academic/university hospitals (26.3%) and government/public hospitals (19.0%). Dedicated theragnostic services were established in 71.3% of centres. Procedure volumes varied widely, with 34.3% of centres performing fewer than 50 procedures per year and only 13.1% exceeding 500 annually. Prostate-specific membrane antigen (PSMA) based theragnostics were offered by 82.3%, and DOTATATE-based therapies by 70.8% of centres. 131 I was the most widely used therapeutic radionuclide (86.1%), followed by 177 Lu (73.7%). The leading clinical indications were thyroid cancer (90.8%), prostate cancer (82.4%), neuroendocrine tumours (70.2%), and bone metastases (60.3%). Patient-specific dosimetry was performed routinely in 8.0% and selectively in 35.8% of centres, while 51.1% reported not performing it at all. SPECT/CT was the predominant imaging modality among those performing dosimetry. Key challenges included limited radionuclide availability (82.4%), reimbursement and funding issues (77.4%), lack of harmonised regulations (72.5%), insufficient trained personnel (67.0%), import/export delays (56.3%), and licensing and authorisation delays (55.9%). Conclusion: This survey reveals substantial heterogeneity in theragnostic implementation across BRICS centres and highlights persistent gaps in radionuclide supply, reimbursement, regulatory harmonisation, infrastructure, and workforce capacity. Without coordinated intervention, current disparities in infrastructure, workforce, and radionuclide supply are likely to widen, limiting equitable access to theragnostic therapies across BRICS nations. Strengthening collaboration through the BRICS network offers a strategic pathway to expand equitable access to safe and effective theragnostic therapies across all disease stages.