In an effort to shed light on the current situation of theranostics and theranostics training, several NM specialists from across the Arab World authoring this report provide relevant and updated data summarized herein (Table 1). For countries lacking a known point of contact, the most recent data available or inferable from the literature (e.g., WHO 2020 cancer country profiles) is displayed.

For each country, the availability of “simple” or “advanced” theranostics is displayed with simple theranostics defined as the theranostic use of iodine 131I as conventional and commonly used therapy while “advanced theranostics” refer to the general theranostic use of ligands labeled with 177Lu, 90Y, and/or alpha emitters as surrogates for the broader use of more modern forms of theranostics. The availability of independent/sufficient local training in the use of at least simple theranostics is also displayed as well as the numbers of NM physicians practicing (or eligible to practice) at least one type of theranostics and those locally trained to practice the type(s) of theranostics. The respective total numbers for the entire Arab World are also provided.

As expected, the majority of countries (17/22) currently have at least simple theranostics services and at least one NM physician available. Sudan and Yemen, which used to employ only simple theranostics as late as early 2023, no longer do so due to local conflicts that have disabled nuclear medicine services in those countries [14]. Comoros and Djibouti data are inferred using a combination of data made available by Grigoryan et al. in 2022 as well as the most recent relevant IAEA news announcements [15, 16]. In Mauritania’s case data is also inferred from available 2022 literature [16, 17].

Half of the Arab world (11/22) lacks any form of 177Lu or 90Y theranostics, and 19/22 (~ 86%) do not provide any alpha emitter therapy. The distribution of their availability can be predicted when considering the cost of services and the distribution of income in the region. In countries where GDP is not as limited, the numbers of physicians and advanced services rise.

Countries with the most NM physicians tend to have local training but, overall, there remains a lack of reliance on local training throughout the region with only 9/22 countries (~ 41%) offering one or more local training programs. Overall, 369 of the practicing 654 physicians (~ 56%) are locally trained. This is perhaps multifactorial, resulting from a lack of resources or justification to invest in establishing dedicated training programs, and/or the traditional societal mindset of undervaluing local training and overvaluing training in more developed countries abroad. However, the situation is gradually changing, likely owing to the increased global interest in theranostics and increased demand.

Regulation of certification and NM practice in the Arab World is currently not standardized. Certification is obtained either through an academic institute directly (as is the case in Lebanon) or by the few certifying boards that exist, including the Jordanian Board of Nuclear Medicine and the Kuwaiti Board of Nuclear Medicine. The available theranostics and molecular imaging training programs for NM or radiology physicians in the Arab World range in length from 2 to 5 years. For example, the accepted program in Lebanon is a two-year higher specialization after completing a five-year diagnostic radiology residency. It is also a two-year higher specialty fellowship program for board-certified radiologists in Saudi Arabia. On the other hand, in Syria and Kuwait, a five-year standalone NM program is the standard.

Though not the focus of this editorial, no discussion about nuclear medicine or theranostics can be considered complete without mentioning the other team members that are as crucial for safe practice of theranostics. These include technologists, physicists, and pharmacists. Adequate training for these specialties is just as important, and this fact has been recognized by several Arab countries that have established structured training programs particularly for medical physicists and technologists like Morocco, Egypt, Jordan, and Kuwait. However, there is still a regional as well as global shortage of all such specialties when considering the number of physicians and imaging devices available [16, 18, 19].