Real estate is rarely part of the radiopharmaceutical investment conversation, but it probably should be. A conventional pharmaceutical company looking for more office, laboratory or warehouse space can lease another building. A nuclear medicine company that needs isotope production, radiopharmaceutical manufacturing or radiopharmacy capacity faces a very different problem.
The building itself may need radiation shielding, specialized ventilation, backup power, cleanrooms, hot cells, radioactive-material storage, waste-handling areas, cyclotron vaults and extensive mechanical systems. Then come the regulatory approvals and radioactive-material licenses required to actually operate the facility. That means nuclear medicine may have something most pharmaceutical sectors do not: strategically valuable specialized real estate.
A recent Cardinal Health project in San Antonio provides a useful example of how quickly the economics change once nuclear medicine moves into a building. Texas construction records show an approximately 7,059-square-foot Cardinal Health PET pharmacy project with an estimated construction cost of $2.75 million. The project includes a cyclotron, nuclear compounding pharmacy, clean work areas and dedicated infrastructure including equipment pads for a generator and chiller.
That equates to nearly $390 of construction cost per square foot before considering the broader value of specialized equipment, licensing and operations. More importantly, the facility isn't interchangeable with an ordinary 7,000-square-foot commercial building. A nuclear pharmacy needs to function simultaneously as a pharmaceutical operation and a radioactive-material facility, changing everything from the floor plan and ventilation to shielding, security, waste handling and workflow. Once that infrastructure exists, the property itself begins to have strategic value.
Cyclotrons make the distinction even clearer. A cyclotron isn't simply a piece of equipment that happens to sit inside a building. Depending on the installation, it can require heavily shielded vaults, substantial electrical and cooling infrastructure, specialized gases, radiation monitoring and adjacent radiochemistry laboratories. A radiopharmacy adds another layer of complexity through cleanrooms, hot cells, quality-control laboratories, dose-preparation areas, radioactive-material storage and systems designed around both pharmaceutical and radiation regulations.
Toronto General Hospital's cyclotron and radiopharmacy project illustrates how extensive that infrastructure can become. The approximately 9,800-square-foot facility required heavy concrete and lead shielding, a cyclotron equipment room, mechanical and electrical support areas, specialized gas infrastructure, QC space, radioactive-waste storage and an integrated radiopharmacy. Once all of that has been engineered, constructed, commissioned and licensed, the building isn't simply real estate anymore. It has become part of the nuclear medicine supply chain.
Telix Pharmaceuticals provides an even more interesting example because it is taking an existing radiopharmacy network and adding new capabilities to it. Telix acquired RLS Radiopharmacies in 2025, giving the company what it describes as the largest radiopharmacy network in the United States. Rather than viewing those locations simply as distribution points, Telix has increasingly positioned the network as part of its broader manufacturing strategy.
That became particularly visible this year when IBA announced an initial order from Telix for four Cyclone KIUBE cyclotrons to be installed at selected RLS locations in the United States. Telix plans to use those locations as part of an expanding radiometal production network.
IBA CEO Olivier Legrain said the agreement represented “an important step forward in advancing access to innovative radiopharmaceuticals.” The significance goes beyond the equipment sale. Telix already controls a network of specialized locations into which additional production capabilities can be installed, meaning the existing real estate effectively becomes a platform for future expansion.
That platform has another characteristic that conventional pharmaceutical manufacturing doesn't always share: geography can be extremely important. F-18 has a half-life of roughly two hours, while other medical isotopes create different distribution windows and logistical constraints. Radiopharmaceutical manufacturing therefore cannot always be concentrated in one enormous factory and shipped globally like tablets.
Facilities need access to hospitals, patients, airports, highways and distribution networks, making a licensed radiopharmacy or cyclotron site in the right metropolitan area potentially much more strategically useful than an otherwise comparable property somewhere else. This is one reason companies including Cardinal Health, RLS/Telix and Jubilant Radiopharma operate distributed radiopharmacy networks rather than relying exclusively on centralized production. In nuclear medicine, location can become part of the product.
That raises a valuation question that receives surprisingly little attention. When a company acquires a radiopharmacy, isotope-production site or radiopharmaceutical manufacturer, how much of the value comes from its current revenue and equipment, and how much comes from the fact that the facility already exists?
Replacing an established site can mean finding appropriate real estate, obtaining zoning approvals, engineering radiation shielding, installing specialized mechanical systems, buying equipment, securing radioactive-material licenses, validating pharmaceutical manufacturing processes and hiring personnel capable of operating it. That process can take years and consume millions of dollars before the first commercial dose leaves the building. An existing facility potentially compresses that timeline considerably, which means that in a rapidly expanding industry, time itself can become part of the asset value.
There are signs that institutional real-estate investors understand the broader value of highly specialized oncology facilities. In June, Remedy Medical Properties and Kayne Anderson Real Estate acquired the 48,776-square-foot Tennessee Oncology Proton Center in Franklin, Tennessee. Proton therapy is different from radiopharmaceutical production, but the underlying real-estate economics are instructive because the facility contains heavily shielded treatment vaults and specialized infrastructure that would be extraordinarily expensive to reproduce.
Remedy described proton therapy centers as among the most complex outpatient oncology facilities in healthcare real estate because of their specialized infrastructure and capital requirements. That same principle applies, at a different scale, to nuclear medicine facilities. A radiopharmacy containing hot cells, cleanrooms and isotope-handling infrastructure has already solved problems a conventional medical building hasn't, while a cyclotron facility has solved even more of them.
This could become increasingly relevant as consolidation accelerates across radiopharma. When Novartis acquired Advanced Accelerator Applications and Mariana Oncology, Eli Lilly acquired Point Biopharma, Bristol Myers Squibb acquired RayzeBio or Telix acquired RLS, investors naturally focused on pipelines, intellectual property, revenue and strategic capabilities. Physical infrastructure, however, can also matter.
Telix's RLS acquisition is particularly instructive because the company is now using that network to build additional capabilities. Existing locations can support new cyclotrons, radiometal production and potentially future therapeutic distribution. In other words, Telix didn't merely acquire today's radiopharmacy business; it acquired physical nodes that can potentially support tomorrow's radiopharmaceutical network.
That possibility may become increasingly important as the industry tries to solve one of its largest structural challenges: getting radioactive drugs from production facilities to patients quickly enough to use them.
The nuclear medicine industry has spent enormous amounts of capital building infrastructure over several decades. Hospitals, radiopharmacies, academic medical centers and isotope producers already operate cyclotrons, hot cells, radiochemistry laboratories and licensed radioactive-material facilities across the country. Some of those assets were built for an earlier generation of nuclear medicine but may now have entirely new uses.
An existing PET radiopharmacy could potentially add production capabilities, a research cyclotron could be upgraded, an established nuclear pharmacy could become part of a therapeutic distribution network, and a facility originally designed around conventional diagnostic isotopes could potentially be modified for emerging radiometals. Not every location will be suitable and conversions can still require substantial investment, but the alternative — constructing everything from scratch — can be considerably more difficult.
Radiopharma is forcing investors to think about pharmaceutical infrastructure differently. A hot cell isn't simply equipment, a cyclotron isn't simply a machine and a radiopharmacy isn't simply a distribution center. Together they form a specialized physical network that determines where radioactive drugs can be produced, prepared and delivered.
Cardinal Health is investing millions in relatively small specialized facilities, Telix is adding IBA cyclotrons to its RLS radiopharmacy network, and institutional real-estate investors such as Remedy Medical Properties and Kayne Anderson are demonstrating how specialized radiation-heavy oncology facilities can become investable real-estate assets. As nuclear medicine grows, that raises a much larger question: What is an existing, licensed, strategically located nuclear medicine facility actually worth?
The answer may turn out to be considerably more than the building itself, because some of the most valuable infrastructure in the emerging nuclear medicine economy may already be built.
