Tumor growth is dependent on a kinetic model that is based on the progression of cell proliferation and cell loss. The parameters for cell proliferation during tumor progression include the cell-cycle time (Tc), growth fraction (GF), and potential tumor-doubling time (Tpot). In contrast, the cell-loss factor is determined by Tpot and the actual time for doubling of the tumor volume (Td).1 The causes of cell loss include malnutrition and lack of oxygen caused by rapid proliferation, necrosis and apoptosis, immunological attack, escape from the primary site, and exfoliation.2 These conditions can be regarded as stresses for cells residing in a rapidly growing tumor. Whether cells escaping from these stresses inherit or obtain resistance abilities is unknown. The tracking and characterization of living cells in a tumor are important for cancer treatment. Reporter-gene imaging is an indirect approach to labeling cells for image-based in vivo tracking and targeting by different modalities.3 This method is especially important for tracking cell viability in vivo because gene transcription and translation occur only in living cells.4 In addition, the transmission of genes to progeny is in principle not diminished or diluted if the reporter genes can replicate within the genomes of host cells.5 Firefly luciferase and fluorescent proteins are canonical reporter genes used for bioluminescent imaging and optical imaging, respectively. For radionuclide-based reporter-gene imaging, herpes simplex virus type-1 thymidine kinase (HSV1-tk) is commonly used because it can uptake a broad range of radiolabeled nucleoside analogues by substrate phosphorylation for imaging the target cells in vivo.6 Expression of the HSV1-tk reporter gene can be used for living cell tracking by positron emission tomography (PET) or single-photon emission computed tomography (SPECT), depending on the types of radionuclide-labeled substrates. For instance, iodine-123-labeled 5-iodo-2′-fluoro-1-beta-𝒟-arabinofuranosyluracil (123I-FIAU) is the most reliable radiolabeled nucleoside analogues for SPECT imaging of HSV1-tk gene expression because it exhibits high tumor/background ratio in vivo.7, 8 As described above, the sensitivity and specificity of 123I-FIAU on cancer detection is based on the expression of HSV1-tk reporter gene in the transduced cancer cells. These cancer cells can be distinguished from the non-cancer cells without HSV1-tk genes using the radionuclide imaging modality. Technically, cultured cancer cells are stably transduced with HSV1-tk genes and implanted into animals for tumor formation. Using SPECT imaging, this cancer population can be distinguished from non-cancer portion in vivo by injecting 123I-FIAU as a radiotracer that are only accumulated in HSV1-tk gene expressing cancer cells.7 Multimodality reporter-gene imaging using coexpressed luciferase/fluorescent proteins and HSV1-tk has been reported to be a powerful tool for basic biological and preclinical research.9, 10 In addition, PET and SPECT can be merged with computed tomography (CT) to obtain functional/anatomic imaging with high sensitivity and spatial resolution. Although reporter-gene imaging is widely used for functional studies in vivo, concerns regarding the safety and transduction pathways of exogenous genes hamper the clinical application of this approach. Viral-mediated methods are commonly used for the transduction of reporter genes, but the uncontrolled infection and random genomic integration of genes of interest currently limit the clinical application of these methods.11 In contrast, nonviral gene delivery is more acceptable in the clinic because biocompatible materials can be used, and the safety of these approaches is relatively easily assessed by pharmacokinetic and pharmacodynamic studies.12 The piggyBac transposon system has recently attracted a great deal of attention because the system is a nonviral gene-delivery approach that uses DNA-transposition ability for the stable expression of exogenous genes via a ‘cut-and-paste' mechanism.13 The beauty of this system includes its known integration sites at ‘TTAA' sequences and intron-preferred positions, mammalian compatibility, large cargo capacity, and its ability to be removed from the integration site without changing the DNA sequence.14 In practice, this system requires a helper plasmid that encodes the piggyBac transposase gene to facilitate the transposition of exogenous gene.15 The piggyBac transposon system has been applied in induced pluripotent stem cells, cancer research, and immunotherapy.16, 17 However, the use of this system has been less frequently reported in multimodality reporter-gene imaging of tumor progression. Cancer stem cells (CSCs, or tumor-initiating cells) belong to the hierarchy model that a subset of rare cell population inherits stem cell-like characteristics, including self-renewal and generation of non-tumorigenic progeny.18 This theory has intrigued many researchers in recent years because CSCs are resistant to chemoradiotherapy and are likely to be the cause of tumor recurrence and metastasis.19 However, the identification of CSCs in vivo remains a challenge because of the lack of suitable markers for this purpose. If CSCs naturally resist environmental stresses, it would be speculated that this population may also escape from cell loss during tumor progression. More evidence is required to support this hypothesis. The percentage of cell loss during tumor progression is approximately 40–90%, depending on the cancer type.1 The remnant viable cells may be important for promoting tumor growth and metastasis. Reporter-gene imaging should be ideal to track these living cells for further investigation of their characteristics. In this study, we established a syngeneic tumor model derived from 4T1 murine breast carcinomas transduced with monomeric red fluorescent protein (mRFP)/HSV1-tk dual reporter genes using the piggyBac transposon system. A combination of optical imaging and SPECT/CT fusion imaging using 123I-FIAU as a probe was exploited to track the remnant living cells in late-stage primary tumors. Furthermore, ex vivo studies showed that the surviving cells exhibited CSC-like characteristics. These findings may contribute to therapeutic designs for cancer treatment.