The f-block elements, which comprise both the lanthanide and actinide series, possess interesting spectroscopic, magnetic, and nuclear properties that make them uniquely suited for a range of biomedical applications. In this Forum Article, we provide a concise overview on the different ways that these elements are employed in medicine, highlighting their dual implementation in both diagnostic and therapeutic applications. A key requirement for the use of these labile metal ions in medicine is a suitable chelating agent that controls their in vivo biodistribution. Toward this goal, we also report our research describing the synthesis and characterization of a rigid 18-membered macrocycle called CHX-macropa, an analogue of the previously reported nonrigid ligand macropa (J. Am. Chem. Soc. 2009, 131, 3331). The lanthanide coordination chemistry of CHX-macropa is explored in detail by pH potentiometry and density functional theory (DFT) calculations. These studies reveal that CHX-macropa exhibits an enhanced thermodynamic selectivity for large over small lanthanides in comparison to its nonrigid analogue macropa. DFT calculations suggest that a key factor in the enhanced selectivity of this ligand for the large fblock ions is its rigid macrocyclic core, which cannot adequately distort to interact effectively with small ions. On the basis of its high affinity for large f-block ions, the design strategies implemented in CHX-macropa may be valuable for applying these elements in the diagnosis or treatment of disease.