Cancer has been treated with radiopharmaceuticals for 80 years. A recent NCRI report from the Clinical and Translational Radiotherapy Research Working Group (CTRad) reviews the current status of molecular radiotherapy (MRT) and has highlighted the barriers to, and the opportunities for increased research activities. The report recommends a number of actions to promote this field, which in the dawning age of personalised medicine and theragnostics is of increasing importance, particularly with the clinical introduction of a range of new commercial radiotherapeutics at costs in line with those seen for conventional chemotherapeutics. These recommendations recognise the importance of a multi-disciplinary approach to development and the particular need for investment in radiopharmacies and personalised dosimetry. There are many areas to be investigated including adaptive treatment planning, the use of radiosensitisers and translational radiation biology. Progress in these areas will result in significant patient benefit and more cost effective use of increasingly expensive therapeutic radiopharmaceuticals. A concerted effort from the community, from funding bodies and from Health Service providers is now needed to address the scientific and logistical changes necessary to realise the potential offered by this currently underused treatment modality.