Advances in Nuclear Medicine

The history of nuclear medicine over the past 50 years reflects the strong link between government investments in science and technology and advances in health care in the United States and worldwide. As a result of these investments, new nuclear medicine procedures have been developed that can diagnose diseases non-invasively, providing information that cannot be acquired with other imaging technologies; and deliver targeted treatments. Nearly 20 million nuclear medicine procedures using radiopharmaceuticals and imaging instruments are carried out annually in the United States alone. Overall usage of nuclear medicine procedures is expanding rapidly, especially as new imaging technologies, such as positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT), continue to improve the accuracy of detection, localization, and characterization of disease, and as automation and miniaturization of cyclotrons and advances in radiochemistry make production of radiotracers more practical and versatile.
Recent advances in the life sciences (e.g., molecular biology, genetics, and proteomics1) have stimulated development of better strategies for detecting and treating disease based on an individual’s unique profile, an approach that is called “personalized medicine.” The growth of personalized medicine will be aided by research that provides a better understanding of normal and pathological processes; greater knowledge of the mechanisms by which individual diseases arise; superior identification of disease subtypes; and better prediction of an individual patient’s responses to treatment. However, the process of advancing patient care is complex and slow. Expanded use of nuclear medicine techniques has the potential to accelerate, simplify, and reduce the costs of developing and delivering improved health care and could facilitate the implementation of personalized medicine.
Current clinical applications of nuclear medicine include the ability to:
- diagnose diseases such as cancer, neurological disorders (e.g., Alzheimer’s and Parkinson’s diseases), and cardiovascular disease in their initial stages, permitting earlier initiation of treatment as well as reduced morbidity and mortality;
- non-invasively assess therapeutic response, reducing patients’ exposure to the toxicity of ineffective treatments and allowing alternative treatments to be started earlier; and
- provide molecularly targeted treatment of cancer and certain endocrine disorders (e.g., thyroid disease and neuroendocrine tumors).
Emerging opportunities in nuclear medicine include the ability to:
- understand the relationship between brain chemistry and behavior (e.g., addictive behavior, eating disorders, depression);
- assess the atherosclerotic cardiovascular system;
- understand the metabolism and pharmacology of new drugs;
- assess the efficacy of new drugs and other forms of treatments, speeding their introduction into clinical practice;
- employ targeted radionuclide therapeutics to individualize treatment for cancer patients by tailoring the properties of the targeting vehicle and the radionuclide;
- develop new technology platforms (e.g., integrated microfluidic chips and other automated screening technologies) that would accelerate and lower the cost of discovering and validating new molecular imaging probes, biomarkers, and radiotherapeutic agents;
- develop higher resolution, more sensitive imaging instruments to detect and quantify disease faster and more accurately;
- further develop and exploit hybrid imaging instruments, such as positron emission tomography/magnetic resonance imaging (PET/MRI), to improve disease diagnosis and treatment; and
- improve radionuclide production, chemistry, and automation to lower the cost and increase the availability of radiopharmaceuticals by inventing a new miniaturized particle accelerator and associated technologies to produce short-lived radionuclides for local use in research and clinical programs.
In spite of these exciting possibilities, deteriorating infrastructure and loss of federal research support are jeopardizing the advancement of nuclear medicine. It is critical to revitalize the field to realize its potential.
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