LAFOV PET as an enabling platform for pharmacokinetics-informed digital twins

Digital twins (DTs) have emerged as a promising framework for precision medicine and are a key part of current initiatives to digitalize and innovate the healthcare sector. Medical DTs have shown potential to support more effective and efficient patient care, reduce healthcare costs, and enable novel approaches in drug development. Currently, DTs are primarily informed by structural imaging modalities, genetic information, clinical history, and lifestyle factors. These anatomy-driven twins can capture, for example, tumor burden and morphology in cancer, but lack the pharmacological dimension that ultimately shapes response and toxicity. Long axial field-of-view (LAFOV) PET systems now provide a platform capable of measuring dynamic tracer distribution across all major organs within a single examination, thereby enabling pharmacokinetic (PK) studies that could fill the current gap in DT concepts. The extended axial field of view and the resulting high sensitivity enable comprehensive characterization of patient-specific organ kinetics, potentially advancing DTs for preventive and personalized medicine. In this Perspective article, we discuss how LAFOV PET could complement population-based PK modeling and facilitate the development of PK-informed DTs. We explore its potential implications for selected clinical applications and aspects of drug development. Additionally, we discuss current limitations and outline steps required to translate PK-informed DTs into decision-grade tools for clinical use.