Radium has a real commercial footprint in 2025, but not as a mined alkaline-earth metal. The economically relevant market is a tightly controlled isotope business run through the DOE isotope system and the medical-radiopharmaceutical chain. NIDC's catalog shows three live radium offerings: Ra-223, Ra-224, and a Ra-224/Pb-212/Bi-212 generator, all sold in millicurie units. That is the clearest indicator that "radium" in commerce means short-lived radioisotopes and generators, not elemental metal, refinery output, or reserves tables.

The two commercial radium streams have distinct functions. Ra-223 is a finished therapeutic isotope: NIDC supplies it as nitrate solid, while the downstream drug product Xofigo is an FDA-labeled alpha-emitting injection for symptomatic bone-metastatic castration-resistant prostate cancer. Ra-224 is both a directly sold isotope and a generator parent for Pb-212 and Bi-212, which DOE describes as inputs to targeted alpha therapy research. In both cases, the production logic is decay supply from parent isotopes, not mine output.

The supply chain is also unusually path-dependent. DOE sources show Ra-223 coming from Ac-227 cows, Ra-224 coming from Th-228, and part of the wider domestic alpha-emitter system being rebuilt around recovered Ra-226 from legacy medical devices. Public primary sources do not disclose annual global output or price series, so the atlas record is strongest on trade form, production route, and medical end use.