Technetium-99m ( Tc) is a widely used radionuclide, and the development of Tc imaging agents continues to be in demand. This overview discusses basic principles of Tc radiopharmaceutical preparation and design and focuses on the Tc radiochemistry relevant to its pharmaceutical applications. The Tc complexes are described based on the most typical examples in each category, keeping up with the state-of-the-art in the field. In addition, the main current strategies to develop targeted Tc radiopharmaceuticals are summarized.