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

James leads one of the region’s most advanced nuclear theranostics programs, using molecular imaging not only to diagnose cancer, but to guide and deliver treatment. This conversation stays grounded in practice: how patients are selected, how imaging drives decisions, and how programs actually get built. In this episode of Rethink Imaging, Chris St. John sits down with Dr. James Cassuto to unpack what theranostics looks like when it’s done right, inside a real health system, serving real patients.

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. Throughout, the focus stays practical: how imaging enables better decisions and better care, today, not someday.

What You’ll Learn:

What theranostics looks like in real-world clinical practice
How molecular imaging guides treatment selection and timing
Why patient selection is central to successful outcomes
How post-therapy imaging changes clinical decision-making
What it takes to launch and scale a theranostics program
How community systems can deliver academic-level care
Where theranostics is headed next and why it matters

Chapters:

[00:00] Why Theranostics Is Changing Cancer Care
[01:31] What Theranostics Actually Is
[03:17] Diagnosing and Treating with the Same Molecular Target
[07:21] Using Imaging to Select the Right Patients
[10:18] Why Community Access Matters
[14:39] Building a Theranostics Program from Scratch
[17:21] How Imaging Shapes Workflow and Staffing
[20:09] Treatment Timing, Monitoring, and Therapy Holidays
[23:47] Expanding Tracers Beyond Their Original Indications
[29:01] Reducing Toxicity and Improving Quality of Life
[30:08] What’s Next for Tracers and Therapies
[33:02] Where to Start If You Want to Build a Program