Abstract: The authors systematically describe the decay characteristics and theranostic value of four α-emitting radionuclides with clinical application potential, namely ²²³Ra, ²²⁵Ac, ²¹³Bi and ²¹²Pb, focusing on their research progress and clinical application status in tumors of the genitourinary system, endocrine system, central nervous system, and hematologic system. α-emitting radionuclides can leverage the theranostics model to synergistically achieve precise targeted tumor therapy and dynamic monitoring of therapeutic efficacy. Currently, this technology still has many limitations, mainly including ectopic migration of daughter nuclides caused by recoil energy and radiation damage to normal tissues. The authors believe that with the integration and innovation of radiopharmaceutical development and molecular imaging technologies, the theranostic model of α-emitting radionuclides will be continuously improved, thereby promoting the development of precision tumor therapy.