Medical isotopes are the core material basis for nuclear medicine diagnosis and treatment, and their target technology directly determines the yield, purity, and cost of isotopes. The global supply chain of medical isotopes has long relied on aging research reactors in Europe and America, facing the risk of supply interruption. In China, the self-sufficiency rate for key isotopes such as ⁹⁹Mo and 1⁷⁷Lu is less than 5%, with clinical demand heavily dependent on imports, making it urgent to break through technical bottlenecks. This paper systematically reviews the design principles of medical isotope targets, the global production status, and China’s development progress. It focuses on analyzing the technical pathways of low-enriched uranium (LEU) fission targets and accelerator-based liquid/solid targets, and compares the production capacity and industrial chain gaps of major isotopes between China and other countries. The results show that China has achieved phased breakthroughs in LEU target technology, but low automation level, inefficient separation and purification, and dependence on imported key materials still restrict industrialization. Suggestions include accelerating the construction of dedicated reactors, promoting industry-university-research collaboration, developing new target materials and intelligent manufacturing technologies, and building a green, independent, and controllable supply system. This review provides strategic references for the high-quality development of China’s medical isotope industry.