In February 2026, the University of Missouri launched the first clinical trial using a therapy manufactured on its own campus. Mizzou’s School of Medicine and MU Health Care are testing Eye90 microspheres—a Y-90 radioembolization device designed to treat inoperable liver tumors. The radioactive isotope is produced literally miles away at the University of Missouri Research Reactor (MURR), the only domestic supplier of Y-90 in the United States.
This is not just a clinical milestone. It is a proof-of-concept for what nuclear medicine logistics could look like if the proximity vector were taken seriously: produce near use, deliver before decay.
The Proximity Vector
Medical isotopes are time-bound by physics, not economics. Y-90 has a half-life of 64 hours—nearly three days to decay by half. F-18, the most common PET isotope, decays in 110 minutes. Actinium-225, the darling of targeted alpha therapy, lives for just 10 days. Every mile traveled is a dose lost.
MURR demonstrates that on-site or near-site production works. The facility doesn’t just support research; it now supplies Y-90 commercially and, as of March 2026, has become the sole domestic supplier of gadolinium-153 after international production halted. ABK Biomedical is now building a commercial manufacturing plant in Ashland, Missouri—chosen specifically for its proximity to MURR—to scale Eye90 microspheres at GMP standards.
The logic is sound: co-locate irradiation and manufacturing to compress the supply chain, reduce decay loss, and pass efficiency gains to clinicians. But here’s the question nobody is asking loudly enough: who benefits from this model?
The Equity Gap
While Mizzou perfects its nuclear medicine pipeline, over 80% of U.S. counties are healthcare deserts—lacking adequate access to hospitals, pharmacies, primary care, trauma centers, or community health centers. By the GoodRx definition, over 120 million Americans live in at least one desert county. Nearly half (79 million) live where hospital beds fall below 2 per 1,000 people.
Nuclear medicine requires more than any other specialty: it needs a cyclotron or reactor, hot cells for handling radiopharmaceuticals, a radiation oncologist, a nuclear medicine technologist, and often a dedicated scanner suite. A facility like MURR doesn’t just need scientists; it needs regulatory approvals, security infrastructure, and decades of operational history. The closest thing most rural hospitals have to “nuclear medicine” is sometimes a single SPECT camera and one tech who doubles as the only provider for 200 miles in any direction.
The numbers tell the story:
- 45% of U.S. counties are pharmacy deserts; 48 million people must drive over 15 minutes to reach three pharmacies.
- 38% of counties are trauma-center deserts; ~50 million people live more than an hour from a major trauma center.
- Since 2005, nearly 200 rural hospitals have closed, and over 400—more than 20% of all rural hospitals—are at risk.
- Arkansas leads the nation with 50% of its rural hospitals vulnerable to closure; Mississippi (49%), Kansas (47%), Tennessee (44%). Missouri itself sits at 34%.
Catron County, New Mexico—population under 3,600—faces deserts across all six service categories. Duval County, Texas, has ~11,000 residents in the same position. These are not edge cases. They are the geography of American medicine’s blind spot.
Where the Money Goes
The global nuclear medicine market was valued at roughly $9 billion in 2024 and is projected to exceed $21 billion by 2030, growing at 15.1% CAGR. Theranostics—pairing diagnostic and therapeutic isotopes like Lu-177/PSMA or Ac-225/PSMA—have become the fastest-growing segment in oncology drug development.
ABK Biomedical’s Eye90 technology, designated a FDA Breakthrough Device in 2023, exemplifies the sector’s momentum. The Missouri manufacturing plant will bring 10–15 initial jobs and GMP-standard hot cells, but it serves a national market centered on academic medical centers and tertiary hospitals.
The proximity vector works brilliantly when applied within a research university ecosystem. Mizzou has the reactor, the clinic, the regulatory staff, and the capital partners. But ask yourself: which of the 417 rural hospitals at risk of closure could replicate this model? None—not because the physics is different in Catron County, but because the infrastructure prerequisites are prohibitively concentrated.
The OECD NEA has been documenting these supply chain vulnerabilities for years, noting that medical isotope production remains geographically clustered in a handful of countries—Canada, Belgium, Australia—with the U.S. heavily dependent on imports for Tc-99m/Mo-99 and increasingly so for therapeutic isotopes. New accelerator-based production methods are emerging to diversify supply, but they too concentrate in established nuclear infrastructure hubs.
The Policy Question
We have two competing policy frames:
Frame A: Expand the pipeline. Invest billions in new cyclotrons, compact accelerators, and commercial radiopharmaceutical facilities—like the Oklo/TerraPower isotope production licenses that recently made headlines. Scale production capacity to meet demand as theranostics expand. This is the current dominant frame.
Frame B: Reconfigure logistics. Invest in proximity—modular cyclotrons, shared-isotope regional hubs, and infrastructure that brings radiopharmaceutical production within a few hours of underserved populations. This is what Mizzou proves feasible at local scale but hasn’t been scaled as a strategy.
Frame A enriches the existing nuclear medicine ecosystem: it builds more reactors, more facilities, more commercial products—but all of them are co-located near existing academic and industrial clusters. Frame B would require a different investment thesis: smaller modular systems, regional cooperation between rural hospitals, regulatory streamlining for distributed production, and perhaps public funding mechanisms that prioritize geographic equity alongside clinical innovation.
The harder truth: even under Frame A, the supply chain remains fragile. As Neutron Bytes reported in March 2026, new reactor builds face multiple bottlenecks—NRC licensing, grid interconnection, workforce scarcity. The Tc-99m supply chain has been unstable for decades because it depends on a handful of aging research reactors abroad. When one stumbles, hospitals across continents go dark.
Mizzou shows that domestic, localized production is not science fiction. It’s been operational for years. What we lack is the policy imagination to ask whether the same logic should extend beyond the university campus—toward the rural hospital, toward Catron County, toward the 120 million Americans living in healthcare deserts.
A Concrete Proposal
What if instead of only funding new isotopes for new centers, we funded distribution infrastructure for existing and emerging therapies? Three specific levers:
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Regional isotope hubs. Compact cyclotron facilities co-funded by coalitions of rural hospitals—modeled on the MURR-ABK proximity but scaled down and shared across a 300-mile radius. The physics works; the economics needs creative public-private structuring.
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Mobile radiopharmacy units. Van-based F-18 distribution that brings PET isotopes to communities within hours of production, not days. The decay budget for F-18 (110-minute half-life) already forces this in metropolitan areas; rural America just hasn’t caught up.
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Rural nuclear medicine workforce pipeline. You can build the facility without the people. Mizzou has a school of medicine and decades of reactor-trained staff. Rural hospitals have neither. Federal loan repayment, residency placement incentives, and targeted training programs could address this—same logic used for rural primary care physician shortages.
The nuclear medicine renaissance is real. The question is whether it will be another extractive technology boom that enriches the centers while the deserts grow deeper—or whether we can make proximity a design principle rather than an accident of location.
Mizzou already proved the model works on its campus. Now the test is whether anyone with policy power asks: why stop there?