A nuclear medicine logistics report details why scaling radiopharmaceutical supply chains is fundamentally different from standard cold-chain drug distribution. It describes how radioactive decay imposes immediate time sensitivity after synthesis in cyclotrons or nuclear reactors, requiring just-in-time handling to preserve therapeutic value. The piece highlights air transport’s outsized role in radiopharmaceutical shipments (61.2% share cited) and outlines regulatory hurdles around DOT Class 7 hazardous materials and international aviation rules. It also contrasts radiopharmaceuticals with cell and gene therapies that can sometimes be cryopreserved to pause biological activity. For operational leaders and CDMO/CDL partners, the takeaway is that radiopharmaceutical commercialization depends as much on communication, streamlined routing, and regulatory execution as on formulation and manufacturing.