Cooperation holds key in turf battle-torn molecular imaging

Molecular imaging is hugely expensive, risky, difficult to understand, heavily regulated, without immediate clinical benefit, and not reimbursed. These factors are halting progress in the field. The solutions for radiology are to collaborate, cooperate, co-own, and cotrain.

That’s the opinion of Prof. Gabriel Krestin, a professor of radiology at the Erasmus Medical Center in Rotterdam, the Netherlands. He addressed this emerging area at Sunday afternoon’s professional challenges session about the radiologist of the future.

“Big sharks are waiting out there,” Krestin said, referring to turf battles on the horizon. These battles will be against the powerful, who want to become even more powerful (cardiology, internal medicine, and neurology/neurosciences); the knowledgeable, who know more and do it better (molecular biology and biochemistry); and against the weak, who want to survive (nuclear medicine, neurosurgery).

Radiology must care about molecular imaging (MI) because it represents the future and opens the way for personalized medicine, he said. Furthermore, clinicians will ask for it increasingly often, it boosts imaging research and is a good source of funding, it is sexy, and if radiologists don’t do it, others will.

He estimated the number of MI results on Google at 3.41 million. The figure for MI and MRI together is around 689,000 and for MI and PET together it’s about 327,000. An impressive 17,854 MI papers from 2000 to 2009 are listed on PubMed, of which 4022 (22%) focused on translational research toward clinical applications.

Krestin noted that surveys have shown the following:

• The main focus of MI is oncology, followed by cardiovascular diseases and technology development (U.S.) or neurosciences (EU)

• Most programs, both in the U.S. and the EU, have access to clinical MRI and nuclear medicine modalities, but animal imaging is less frequently available in the EU

• There is a positive correlation between the number of radiologists in a department and available MI modalities and funding, and the amount of grants correlates negatively with the number of exams in the U.S, but this is not the case in the EU

• Larger research-oriented and well-funded departments of radiology in the EU tend to participate in enterprise-wide MI programs

• Multidisciplinary teams are characteristic for MI programs, both in the U.S. and the EU

His short-term recommendations are to create a network of centers of excellence, which could be certified as reference training centers in MI; set up and sponsor workshops and scholarships on MI; guarantee growth of MI topics at major radiology meetings; sponsor young radiologists to attend MI workshops and major MI meetings; and develop collaborations with the other European societies involved in MI (European Association of Nuclear Medicine, European Society for Molecular Imaging) for a common and multidisciplinary approach.

His midterm suggestions are that institutions apply jointly for research grants in MI to develop new applications or new imaging technologies; to set up clinical research grants for development of translational projects or pilot clinical trials in MI; to sponsor training in new hybrid technologies; to build up a web-based collection of teaching materials accessible to ESR members; to raise public and private funds for development of MI in radiology ; and to implement a specific training curriculum for acquiring knowledge in cell and molecular biology, genetics, and MI.

Note: a version of this article appeared in the 2010 ECR Today newspaper.