<h3>Purpose/Objective(s)</h3> Here we present guidance to radiation oncology centers in establishing theranostic treatments. Theranostics are radiopharmaceuticals with diagnostic and therapeutic attributes. They are composed of a vector which binds to a target receptor, a linker which connects the vector to the radioisotope and a radioisotope. Theranostics treatment is a multifaceted process including radiation safety, licensing, clinical workflow and supply management. <h3>Materials/Methods</h3> Radiation safety in theranostics requires the management of personnel/patient radiation exposure, decay in storage and disposal of radioactive materials. Decay in storage must satisfy NRC § 35.92. A dedicated toilet is preferable due to renal excretion. NRC § 20.2003 renders excreta from patients exempt from sanitary sewerage restrictions. ALARA-consistent protocols must be implemented to manage personnel, patient and caregiver exposures including: internal contamination, patient education, discharge criteria, and management of time/distance/shielding during preparation, treatment and cleanup. Licensing: An Authorized User and a Radioactive Material License are required and activity usage limits for each isotope must be consistent with the licensing for the site. Table 1 lists common isotopes to consider with varying radiation safety, licensing, etc. requirements. Staff education is paramount for clinical workflow and supply management. Protocols, checklists, and documentation for the concerted efforts of CNMTs, nurses, physics, and attending are imperative for procedures and contingencies. Required equipment: infusion pumps, specialized tubing/connectors, pharmaceuticals, amino acids, contamination control, spill kits, dedicated treatment room, remote patient monitoring, radiation monitoring, radiation survey tools, radiation shielding, dose calibrator, and imaging equipment (e.g., SPECT, Gamma camera, PET CT, etc.). <h3>Results</h3> Adherence to these guidelines allowed successful treatment of patients with <sup>177</sup>Lu, <sup>233</sup>Ra and <sup>90</sup>Y. Dosimetry and radiation survey data confirm successful implementation of rad safety procedures. <sup>177</sup>Lu – treated patients were surveyed at one meter hourly to assess uptake/excretion of <sup>177</sup>Lu and to confirm safe discharge. Data from radiation monitoring and radiation surveys for treatments will be presented. <h3>Conclusion</h3> A theranostics program can be safely established through an organized effort which considers the factors presented here – radiation safety, licensing, clinical workflow and supply management.