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Nuclear Medicine: Past, Present and Future Part I

March 1, 2009
Written by: , Filed in: Nuclear Medicine
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The nuclear medicine specialist of the near future must exhibit excellence in scintillation-generated imaging studies and cross-sectional studies generated from other energy sources

By Stephen R. Baker, MD, Special Presentation, March 2008

The opening words of Dickens’ A Tale of Two Cities is quoted so often, it is almost a cliché.

Yet, it is very apt to nuclear medicine at the present time. It is the best of times and it is worst of times for nuclear medicine, which is, at the same time, poised either to take off, or perhaps to disappear.

Nuclear medicine has a more than a 50-year history of recurrent breakthroughs in instrumentation and advances.

Radiopharmaceuticals have opened wide vistas of opportunity to prospective trainees, encouraging their entry into the specialty.

The simultaneous multimodality growth of non-nuclear imaging has induced consistent competition, sometimes misplacing the preeminence of various nuclear medicine studies in diagnostic protocols and algorithms. Yet nuclear medicine is entering another interval of rapid growth.

The integration of PET-CT and SPECT-CT into contemporary practice has been startling. It has become obvious that PET-CT is vital for the evaluation and management of many cancers.

Furthermore, we are probably on the cusp of wide-spread expansion of PET-CT into cardiology and neurology, and gathering optimism for a continuation of a further diffusion of this modality.

At the same time, we are entering the era of molecular imaging with implications for basic research, translational research, and ultimately their clinical applications.

Although other techniques will be vital participants in the collective molecular imaging project, nuclear medicine has ascended. The number of radiopharmaceuticals other than 18FDG that can be used in PET imaging is expanding.

One example is 11C carbon acetate, which is a useful agent for hepatocellular carcinoma evaluation. A recent study indicated that its sensitivity is 87%, whereas 18FDG has a sensitivity of only 47%.

Other radiopharmaceuticals that show promise are C11 thymidine and 18 pleural thymidine. These two radiopharmaceuticals should both be useful in evaluating the rate of tumor proliferation and DNA synthesis.

Many other radiopharmaceuticals are either available or in development for PET imaging, ensuring its further growth should continue, thus providing a source of research grants, clinical trials, and practice initiatives.

CME Courses Available:

 

PET/CT and SPECT/CT To Plan and Monitor the Treatment of Cancer The precise tailoring of treatment for patients with cancer is an unmet challenge. The goal is to only administer treatments that have a high probability of being effective. Imaging with PET/CT and SPECT/CT provides methods that will help achieve this goal. The program covers the current clinical challenges, the new emerging answers from imaging, and how these methods can be applied to patient care. Read more: Nuclear Medicine: PET/CT and SPECT/CT

 

-- Diagnostic Imaging Review: For Residents, Fellows and Radiologists UCSF’s Department of Radiology and Biomedical Imaging recently conducted its annual radiology review course. It will soon be available in two video formats to meet your needs— DVD and MP4. Order now to get your special pre-publication discount. Read more or order: Diagnostic Imaging Review

PET-CT rewards its users with one of the highest technical rewards in any imaging study. It offers a definitive determination of the presence of metastases, and has thus enabled the reduction in discomfort and cost because of its sensitivity to the detection of tumor spread.

And as far as we have come, the good news is that imaging with nuclear medicine is likely to advance further even beyond PET-CT instrumentation. Perhaps soon to come online will be PET-MR units.

In fact, two of such units are now operational in clinical practice. Although the ultimate use of this hybrid has yet to be determined, the combination of PET and MR offers exciting prospects for the evaluation of neurologic disease.

So what are the bad times I have talked about at the start of this presentation? Nuclear medicine faces many challenges on the horizon, and I would like to outline a couple of them for you.

In Part II, Dr. Baker will look at the future of nuclear medicine.

CME Courses Available:

 

PET/CT and SPECT/CT To Plan and Monitor the Treatment of Cancer The precise tailoring of treatment for patients with cancer is an unmet challenge. The goal is to only administer treatments that have a high probability of being effective. Imaging with PET/CT and SPECT/CT provides methods that will help achieve this goal. The program covers the current clinical challenges, the new emerging answers from imaging, and how these methods can be applied to patient care. Read more: Nuclear Medicine: PET/CT and SPECT/CT

 

-- Diagnostic Imaging Review: For Residents, Fellows and Radiologists UCSF’s Department of Radiology and Biomedical Imaging recently conducted its annual radiology review course. It will soon be available in two video formats to meet your needs— DVD and MP4. Order now to get your special pre-publication discount. Read more or order: Diagnostic Imaging Review
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