<p>Nuclear medicine has existed since the 1940s, but the clinical approval of a handful of new radiopharmaceutical agents in the last few years has thrust the field into the spotlight of modern cancer research. Now that radiopharmaceuticals have caught everyone’s attention, what are the future directions in this rapidly growing area? This commentary highlights some of the field’s successes and failures over the last few decades, explores emerging ideas for the next steps in radiopharmaceutical development, and ponders whether we are ready to revisit old ideas using a modern twist.</p> Graphical abstract <p></p>