Nuclear Medicine at a Crossroads

Abstract

The growth of molecular imaging heightens the promise of clinical nuclear medicine as a tool for individualization of patient care and for improvement of health-care outcomes. Together with greater use of integrated structure-function imaging, clinical nuclear medicine reaches beyond traditional specialty borders into diagnostic radiology and oncology. Yet, there are concerns about the future of nuclear medicine, including progressively declining reimbursement, the competitive advantages of diagnostic radiology, limited translation of research accomplishments to clinical diagnostic imaging and patient care, and an insufficient pool of incoming highly qualified nuclear medicine clinicians. Thus, nuclear medicine views itself as being at a critical crossroads. What will be important is for nuclear medicine to be positioned as the quintessential molecular imaging modality more centrally within medical imaging and for the integration of nuclear medicine with primary care specialties to be driven more by patient needs than by specialty needs. In this way, the full potential of nuclear medicine as an effective and efficient tool for improving patient outcomes can be realized. Theever-growi ng body of science in molecular imaging heightens the promise of clinical nuclear medicine as a tool for greater individualization of patient care and for improving health-care outcomes. Together with greater use of integrated structure-function imaging, clinical nuclear medicine reaches beyond traditional specialty borders into diagnostic radiology and oncology. Yet, there are concerns about the future of nuclear medicine, including progressively declining reimbursement, the competitive advantages of diagnostic radiology, limited translation of research accomplishments to clinical diagnostic imaging and patient care, and an insufficient pool of incoming highly qualified nuclear medicine clinicians. Thus, nuclear medicine views itself as being at a critical crossroads. NUCLEAR MEDICINE AND MOLECULAR IMAGING: GROWTH WITHOUT BOUNDARIESClinical nuclear medicine as the quintessential clinical molecular imaging specialty has experienced and continues to experience impressive growth. Imaging is no longer confined to diagnosis and risk stratification of disease but contributes to treatment strategies. This especially applies to oncology, in which PET/CT with 18 F-FDG, an indicator of global tumor vitality, has improved the accuracy with which tumors are detected and staged and with which tumor progression or regression in response to treatment is assessed. Other radiotracers complement the diagnostic arsenal; they enable visualization of tumor types that can escape detection by 18 F-FDG, such as liver, prostate, pancreas, and brain tumors. Radioisotopes that do not require on-site cyclotron production, such as 68 Ga, now used clinically in several European countries, promise to expand the clinical range of PET; peptides labeled with 68 Ga have proved effective for uncovering somatostatin receptorexpressing tumors.Other radiolabeled probes ...

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“…One challenge that should be considered by stakeholders is to identity ways to propel existing data on TRT forward more quickly in support of U.S. approvals. Another challenge is to directly address the various logistic problems cited in the workshop: limited access to TRT for patients and providers, perceived high cost, turf issues, patient perceptions and fears, and the need for multidisciplinary teams supported by strong TRT education efforts (123)(124)(125)(126)(127)(128)(129)(130)(131)(132).…”