From PET to Prescription: Building a High-Reliability Radiopharmaceutical Service Line

Radiopharmaceuticals turn nuclear physics into a clinical logistics problem: the moment an isotope is created, decay drives the timetable for synthesis, testing, transport, and infusion. This article provides a practical blueprint for health systems to build and scale a high-reliability service line that delivers on that timetable. Using prostate-specific membrane antigen (PSMA) theranostics as an exemplar, we translate half-life constraints for ^18F, 68Ga, 64Cu, 89Zr, and 177Lu into operational design choices spanning cyclotron/generator sourcing, automated synthesis, aseptic processing, and rapid but robust quality control under the FDA. We explain why TLC alone can miss clinically relevant radiolysis products and show how paired HPLC methods, environmental monitoring, and prestaged release packets prevent day-of-care failures. On the clinical side, we align procedure guidelines, emerging posttherapy imaging standards, and pragmatic dosimetry ladders to help teams implement closed-loop, patient-specific planning without overwhelming resources. We also map radiation protection practices for safe outpatient delivery and examine supply-chain realities for 177Lu and 225Ac, emphasizing redundancy and scheduling discipline. The result is an engineering-forward, evidence-anchored roadmap that connects PET images to reliable therapy, thereby improving access, safety, and measurable outcomes.