Online First 2025-06-26

Positronium imaging was recently proposed to image the properties of positronium atoms in the patient’s body. Positronium properties depend on the size of intramolecular voids and oxygen concentration; therefore, they deliver information different from the anatomic, morphological, and metabolic images. Thus far, the mean ortho-positronium lifetime imaging has been at the center of research interest. The first ex vivo and in vivo positronium lifetime images of humans have been demonstrated with the dedicated J-PET scanner, enabling simultaneous registration of annihilation photons and prompt gamma from β+γ emitters. Annihilation photons are used to reconstruct the annihilation place and time, while prompt gamma is used to reconstruct the time of positronium formation. This review describes recent achievements in the translation of positronium imaging into clinics. The first measurements of positronium lifetime in humans with commercial PET scanners modernized to register triple coincidences are reported. The in vivo observations of differences in ortho-positronium lifetime between tumor and healthy tissues and between different oxygen concentrations are discussed. So far, the positronium lifetime measurements in humans have been completed with clinically available 68Ga, 82Rb, and 124I radionuclides. Status and challenges in developing positronium imaging on a way to a clinically useful procedure are presented and discussed.