The Current Landscape of Artificial Intelligence in Positron Emission Tomography (PET) Imaging Across the Cancer Continuum

PET scans have long been used in oncology imaging to provide molecular and metabolic information about diseases. The use of artificial intelligence (AI) in PET scans in oncology theranostics has the potential to optimise PET modality and overcome the constraints that PET scans have, such as semi-quantitative metrics, reader subjectivity, and variability across scanners/institutions. Advances in AI and radiomics are overcoming those limitations by deep learning lesion detection, enhancing image reconstruction, and improving noise resolution, which allows ultra-low dose acquisitions, while physics-informed models integrate with PET systems to strengthen interpretability and quantitative accuracy. There are also predictive AI frameworks that link PET imaging biomarkers to therapy response and outcomes, create individualised care and are even able to simulate treatment response and help with treatment planning. However, challenges do exist. Most AI PET studies are retrospective, single-centre, and underpowered (small sample), with limited external validation and inconsistent standardisation (in acquisition, segmentation, and extraction), leading to poor reproducibility and higher performance estimates. Furthermore, ethical considerations, including data protection and transparency, need to be considered before implementation. Federated learning, physics-informed frameworks, and adherence to standardised protocols offer steps towards regulated AI systems. In summary, PET is evolving from an imaging modality to a platform with the integration of deep learning, radiomics and reconstruction capable of predicting treatment response and guiding treatment. With rigorous prospective validation, cross-institutional collaboration, and regulatory standardisation, AI in PET would create an advancement in nuclear medicine imaging in oncology.