Medical radio-isotopes (RI) are commercially produced by accelerators or nuclear reactors. For more than a half century accelerators have routinely produced medical RI used for radiopharmaceuticals in nuclear medicine. Described here is a general introduction of commercial production of medical RI with an accelerator, and recent topics about technical development of use of an accelerator for production of 99Mo and 225Ac. Nihon Medi-Physics has started a project of 99Mo in-house production with an electron linear accelerator since 2019. Alpha emitting nuclide, 225Ac has attracted much attention recently for therapeutic applications based on the concept of Theranostics. 225Ac supply currently relies solely on 229Th generator but alternative production method with an accelerator has been being developed.