This review provides a critical and forward-looking analysis of established PET positron-emitting radionuclides—11C (carbon-11),13N(nitrogen-13), 15O(oxygen-15), 18F(fluorine-18), 68Ga (gallium-68),82Rb(rubidium-82)—alongside some less widely adopted positron emitters—44Sc (scandium-44), 64Cu (copper-64), 86Y (yttrium-86), 89Zr (zirconium-89), 124I(iodine-124)—examining the scientific, technological and operational factors influencing their clinical translation and applicability. Particular emphasis is placed on the role of nuclear properties as a key factor in radionuclide selection and development. For each radionuclide, the relevant aspects, including nuclear decay characteristics, production routes and logistical modalities, are discussed in terms of their impact on PET diagnostic performance and sustainability. The review summarizes recent technological advances designed to mitigate supply chain limitations that affect established positron emitters and discusses critical challenges related to other promising PET radionuclides, such as production scalability and dosimetric implications. Finally, ongoing developments in hybrid imaging platforms and multiparametric PET systems are briefly addressed, illustrating how these innovations are redefining diagnostic accuracy and accelerating the evolution of PET toward increasingly personalized clinical strategies.
Maria Letizia Terranova (Mon,) studied this question.