Lame ducks establish imaging institute within NIH

The end of 2000 signaled the start of a new political age for the imaging community, as the outgoing 106th Congress voted and President Clinton signed legislation creating the National Institute of Biomedical Imaging. As part of the National Institutes of Health, (NIH) the new entity will get a share of the federal budget for the development and application of medical imaging.

Until now, imaging had been viewed as an enabling technology by the mostly disease-based institutes and centers residing on the NIH campus in Bethesda, MD. Each of these administers grants or supports in-house research aimed at its own mission, succinctly expressed in the names: e.g., the National Cancer Institute (NCI) or the National Heart, Lung, and Blood Institute (NHLBI).

The problem, said advocates of the new imaging institute, was the haphazard manner in which radiological research was conducted. Efforts among the grantees of different institutes were uncoordinated, raising the possibility that advances made in response to one need, such as high-speed MRI for diagnosis of brain cancer, might not be applied to another, such as stroke management.

The National Institute of Biomedical Imaging promises to better coordinate these efforts, focusing on the development of new technologies applicable to multiple specialties. The institute will be charged with combining pure science and medical disciplines, conducting technology assessment and outcomes studies, and developing new techniques and tools.

"The hope in establishing this institute is to concentrate all imaging studies into one center in so there can be less duplication of effort and more time devoted to promising research," said Joshua Cooper, director of congressional relations for the American College of Radiology.

Creation of the new institute also signifies a turning point for medical imaging. With a stroke of the president's pen, radiology has gained a share of the political power that guides medical technology development while achieving independent standing in the medical community at large.

The journey to reach this point has been long and difficult. This successful conclusion is due in large part to the Academy of Radiology Research, which mounted a major lobbying effort on Capitol Hill in support of the new institute.

"We talked to a lot of people in Congress-members and staff-about this proposal," said executive director Ed Nagy. "We steadily built support for this."

The process leading to the bill just passed goes back to the mid-1980s, when organized radiology began considering the creation of a dedicated institute or center within the NIH. Research opportunities in radiology were hampered under the system then in place. Radiologists were forced to team with specialists in cardiology or oncology to boost their chances of winning a grant from the NHLBI or NCI, for example.

The final battle began about two years ago when legislation proposing the new institute was introduced into the House of Representatives. Although popular among physicians, professional associations, and companies within the radiology community, the idea was fought by NIH leadership. Institutes cost money to run, and NIH officials spoke publicly about fears that a new institute would drain funds that could otherwise be spent on research rather than administrative matters. Opposition faded, however, as the legislation passed Congress in mid-December of last year and was signed later that month by President Clinton.

There have been and continue to be grant programs aimed directly at radiologists, however. The Imaging Sciences Program, administered by the NIH Clinical Center, has offered opportunities in such research areas as optical imaging, radio-frequency ablation techniques, and PET. But these represent only a small part of the grant money dished out each year by the NIH.

How these other programs involving diagnostic imaging will be affected by creation of the National Institute of Biomedical Imaging is not yet known. Bureaucracies such as the NIH are slow to give ground. And some ground may never be ceded.

"A good deal of imaging research is disease process or organ system specific," Nagy said. "For the most part, that research could remain in the institutes where it now resides."

There will be other roadblocks to centralizing imaging research. NIH administrators will fight to keep as much of their budgets as possible, trying to hold onto imaging programs that account for large blocks of money, which in the federal government translates to power. Progress will be further slowed by the nature of existing grants, which usually extend three to five years. Grants now in effect will not easily be transferred from their current grantors.

"It will be an evolving process, but I imagine that in a few years we will have (imaging research) all centrally located," Cooper said. "Although I'm sure it won't be easy."