Bringing Advanced Cancer Care to Community Hospitals: Building a Theranostics Program with James Cassuto

Episode notes

Theranostics is moving fast but execution is what separates promise from impact. Dr. James Cassuto joins Rethink Imaging to share how molecular imaging and targeted radiotherapy are being used together to change cancer care at the community level. As Director of Nuclear Medicine at Overlook Medical Center, James has built a program that mirrors academic-quality care without forcing patients to travel for it. In this conversation, he explains how imaging now determines who should receive therapy, who shouldn’t, and when treatment should pause. We talk about tumor heterogeneity, why not all lesions respond the same way, and how post-therapy imaging allows clinicians to make smarter, more humane decisions. James also walks through the realities of launching a theranostics program from internal approvals and radiation safety to staffing, workflows, and financial considerations. He shares how his team uses imaging to extend treatment intervals, improve quality of life, and avoid unnecessary toxicity. The episode also explores emerging use cases, including off-label tracers for brain tumors and the growing role of vascular targeting.