Abstract: ²²³Ra is a low toxicity substance α Radiotherapy nuclide, which can be used to treat castrated resistant prostate cancer (CRPC) with symptoms of bone metastasis and no visceral metastasis, was the first approved alpha therapy radiopharmaceutical on the market. In 2013, with the launch of Xofigo (²²³RaCl₂ solution) in the United States, it marked α radionuclide therapy has widely entered people’s field of vision. Compared to other commonly used β、γ medical radioactive isotopes, research on ²²³Ra is still far from sufficient, especially in terms of preparation and separation. In the preparation process of ²²³Ra, there are difficulties in obtaining raw materials, high dosage, cumbersome separation steps, and many isotopic impurities. In response to these difficulties, various methods for preparing ²²³Ra have also been studied. This article mainly reviews the preparation methods and separation processes of ²²³Ra through four methods: separation from natural ores, accelerator preparation, reactor irradiation preparation, and obtaining from actinium/beryllium generators. It also discusses some challenges and prospects in the preparation of ²²³Ra, providing some reference for efficient separation of ²²³Ra.