Meeting the Need: Development of a Theranostics-Focused Nuclear Oncology Physics Fellowship

With the emergence of radiotheranostics, radiation oncology practices are adapting to offer new radiopharmaceutical therapies (RPTs), while qualified medical physicists (QMPs) support these programs. However, RPT-specific medical physics training is variable, and heavily dependent on the clinical setting. QMPs may therefore be tasked with supporting RPT programs without adequate training in the subject matter. In 2025, the Nuclear Oncology Division of the Department of Radiation Oncology at Willis Knighton Cancer Center launched a first-of-kind, one-year Nuclear Oncology Physics Fellowship. Here, we detail our program structure and provide a framework for further expansion of nuclear oncology medical physics training.

The fellowship is offered in partnership with three institutions: a large, tertiary community cancer center (hub site), a radiopharmaceutical research institution encompassing GMP isotope and radiopharmaceutical production and clinical and pre-clinical imaging, and a medical physics consulting group. The curriculum is split into twelve rotations covering the core competencies outlined by major certifying bodies. Primary mentors hold board certifications in diagnostic, nuclear medicine, or therapeutic medical physics.

The fellowship may be completed before or after physics residency training, and culminates in a final project, in which the trainee designs a mock theranostics department. The program was verified to meet current training requirements for board certification in nuclear medicine physics. At the time of writing, the program enrolled its first fellow (pre-residency) and recruited its second trainee (post-residency).

The fellowship provides a pathway for QMPs to gain the necessary training to support new theranostics programs. The curriculum may be adapted to accommodate the interests of each trainee and extended to support individuals in other crucial professions within the theranostics space. Future development of RPT-specific training guidelines may influence adjustments to the curriculum and certification processes; however, the current model provides a robust template for necessary QMP training.