Full Text | PDF

Theranostics 2024; 14(9):3404-3422. doi:10.7150/thno.93973 This issue Cite

Review

Theranostic digital twins: Concept, framework and roadmap towards personalized radiopharmaceutical therapies

Hamid Abdollahi^1,2, Fereshteh Yousefirizi², Isaac Shiri^3,4, Julia Brosch-Lenz^2,5, Elahe Mollaheydar^2,6, Ali Fele-Paranj^2,6,7, Kuangyu Shi^8,9, Habib Zaidi^3,10,11,12, Ian Alberts¹³, Madjid Soltani^2,14,15, Carlos Uribe^1,2,13, Babak Saboury^2,16, Arman Rahmim^1,2,6,17✉

1. Department of Radiology, University of British Columbia, Vancouver, Canada.
2. Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, Canada.
3. Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland.
4. Department of Cardiology, University Hospital Bern, Switzerland.
5. Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.
6. Department of Biomedical Engineering, University of British Columbia, Vancouver, Canada.
7. Department of Mathematics, University of British Columbia, Vancouver, Canada.
8. Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
9. Department of Informatics, Technical University of Munich, Munich, Germany.
10. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
11. Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
12. University Research and Innovation Center, Óbuda University, Budapest, Hungary.
13. Department of Molecular Imaging and Therapy, BC Cancer, Vancouver, Canada.
14. Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran.
15. Department of Electrical and Computer Engineering, University of Waterloo, ON, Canada.
16. Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, USA.
17. Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada.

✉ Corresponding author: Arman Rahmim, PhD, DABSNM, FSNMMI, Professor of Radiology, Physics and Biomedical Engineering, University of British Columbia, BC Cancer Research Institute, 675 West 10th Ave.; Office 6-112, Vancouver, BC V5Z 1L3. Email: arman.rahmimca; Phone: 604-675-8262. More

Abstract

Radiopharmaceutical therapy (RPT) is a rapidly developing field of nuclear medicine, with several RPTs already well established in the treatment of several different types of cancers. However, the current approaches to RPTs often follow a somewhat inflexible “one size fits all” paradigm, where patients are administered the same amount of radioactivity per cycle regardless of their individual characteristics and features. This approach fails to consider inter-patient variations in radiopharmacokinetics, radiation biology, and immunological factors, which can significantly impact treatment outcomes. To address this limitation, we propose the development of theranostic digital twins (TDTs) to personalize RPTs based on actual patient data. Our proposed roadmap outlines the steps needed to create and refine TDTs that can optimize radiation dose to tumors while minimizing toxicity to organs at risk. The TDT models incorporate physiologically-based radiopharmacokinetic (PBRPK) models, which are additionally linked to a radiobiological optimizer and an immunological modulator, taking into account factors that influence RPT response. By using TDT models, we envisage the ability to perform virtual clinical trials, selecting therapies towards improved treatment outcomes while minimizing risks associated with secondary effects. This framework could empower practitioners to ultimately develop tailored RPT solutions for subgroups and individual patients, thus improving the precision, accuracy, and efficacy of treatments while minimizing risks to patients. By incorporating TDT models into RPTs, we can pave the way for a new era of precision medicine in cancer treatment.

Keywords: Digital twins, Radiopharmaceutical therapies, Theranostics, Roadmap, Personalized therapy, Precision Medicine

Citation styles

©2025 Ivyspring International Publisher. Terms of use