The production of radiopharmaceuticals is a complex process that requires appropriate infrastructure, leading to the formation of an ecosystem within Rosatom. The nuclear medicine ecosystem includes research centers, manufacturers of radiopharmaceuticals and radioisotopes, equipment manufacturers, and medical institutions. This ecosystem is completely artificial, created not by market motives but by the state. Strict control over nuclear medicine at three levels—within each element of the ecosystem, at the country level through legislative regulation, and at the international level through organizations and treaties (IAEA, EAEU)—ensures high safety and quality of products. However, this system also has some disadvantages, such as limited competition and innovation, as well as dependence on state support. The creation of a closed ecosystem in the field of nuclear medicine allows for effective management of all stages of production and use of radiopharmaceuticals. It contributes to the development of domestic science and technology in this area, ensuring the availability of high-quality medical care based on advanced technologies.