Cyclotrons operated for Nuclear Medicine and Radiopharmacy in the German speaking D-A-CH countries: An update on current status and trends

Background: Cyclotrons form a central infrastructure and are a resource of medical radionu- clides for the development of new radiotracers as well as the production and supply of clini- cally established radiopharmaceuticals for patient care in nuclear medicine.
Aim: To provide an updated overview of the number and characteristics of cyclotrons that are currently in use within radiopharmaceutical sciences and for the development of radiopharma- ceuticals to be used for patient care in Nuclear Medicine in Germany (D), Austria (A) and Switzerland (CH).
Methods: Publicly available information on the cyclotron infrastructure was (i) consolidated and updated, (ii) supplemented by selective desktop research and, last but not least, (iii) vali- dated by members of the committee of the academic “Working Group Radiochemistry and Radiopharmacy” (AGRR), consisting of radiochemists and radiopharmacists of the D-A-CH countries and belonging to the German Society of Nuclear Medicine (DGN), as well as the Radiopharmaceuticals Committee of the DGN.
Results: In total, 39 cyclotrons were identified that are currently being operated for medical radionuclide production for imaging and therapy in Nuclear Medicine clinics, 29 of them in Germany, 4 in Austria and 6 in Switzerland. The majority of the cyclotrons reported (69%) are operated by universities, university hospitals or research institutions close to a university (clinic), less by/in cooperation with industrial partners (26%) or a (non-university) clinic/PET-center (5%). Most of the cyclotrons (82%) are running with up to 18 MeV proton beams, which is sufficient for the production of the currently most common cyclotron-based radionuclides for PET imaging.
Discussion: The data presented provide an academically-updated overview of the medical cy- clotrons operated for the production of radiopharmaceuticals and their use in Nuclear Medi- cine in the D-A-CH countries. In this context, we discuss current developments and trends with a view to the cyclotron infrastructure in these countries, with a specific focus on organi- sational aspects.