Molecular era heralds role changes for staff

Prof. Michael Phelps, Ph.D., of the University of California, Los Angeles, the co-inventor of the PET scanner, discussed the exciting future of molecular imaging at the 2004 RSNA meeting.¹ The combination of medical imaging, genetics, biology, and patient therapy and the ability to image and diagnose at the cellular level could bring untold benefits in diagnostic and treatment regimens. This will, of course, have important ramifications for those involved in delivering medical imaging and therapy.

Emerging technologies will have an acute impact on the training, role, and function of technologists and radiologists. The need to plan for changing roles is increasingly urgent.

Tertiary education institutions are reviewing curricula for technologists, to plan for a move toward molecular imaging. Medical imaging technology courses in many countries within Asia and Australasia generally focus on one of three specific disciplines: diagnostic radiography, radiation oncology, or nuclear medicine. The only exception is Japan, where graduates emerge with entry-level competence in all three areas. Specialist training in ultrasound, CT, and MRI is usually offered at a postgraduate level.

The gradual introduction of PET/CT and SPECT/CT scanners will lead to a significant input of CT in nuclear medicine training courses. Students of nuclear medicine will need to know about 3D anatomy and workstations. Radiation oncology courses will have to reflect the expanding role for CT and MRI in treatment planning, while technologists will be required to learn more about biology. Such changes will also be reflected in the training regimens of radiologists and nuclear medicine physicians, as the three disciplines move closer together.

Promising research findings have already been reported. Dr. Histaka Kobayashi, a staff scientist at the Japanese National Cancer Institute, has focused on techniques to image lymphatic spread from breast cancer.² This early work has possible applications in staging melanoma.

In therapy monitoring, Umar Mahmood, Ph.D., an assistant professor of radiology at Massachusetts General Hospital, has shown that fluorescent imaging techniques can monitor the impact of methotrexate when given to mice infected with rheumatoid arthritis.

The ability to image cell changes at their earliest stage and to use emerging optical technologies, such as near-infrared imaging and fluorescent probes, to monitor therapeutic techniques is exciting. Technologists must be educated to support these endeavors in clinical settings as well as in research.

Pharmaceutical companies plan to invest several billion U.S. dollars and have created molecular imaging focus groups.

Optical imaging faces many physical challenges, and it is likely that PET will lead the way in research and clinical implementation. Advances in CT and functional MRI, however, illustrate how rapid the pace of change can be. But enthusiasm should be tempered by an awareness of the long processes required to substantiate and validate such techniques.⁴ An extremely long period of time elapsed between early research work into PET and regular clinical installations of the modality. Yet, as the case of CT angiography shows, techniques with significant promise for improving patient management may be fast-tracked into clinical practice.

The basic principle of molecular imaging-imaging at the cellular level-is producing great optimism. Perhaps the only groups watching these developments with some apprehension are the politicians and bureaucrats who will have to find ways of funding them.

References

1. Phelps ME. Molecular imaging: from nanotechnology to patients. Eugene P. Pendegrass New Horizons Lecture. Chicago: RSNA meeting, 2004.

2. Bankhead C. Nano-sized dendrimer MR contrast tracks lymphatic drainage of breast cancer. Molecular Imaging Outlook 2004;2(3):4.

3. Lane L. Biomarker imaging magnifies nuts and bolts of disease. Molecular Imaging Outlook 2004;2(3):1-2.

4. Lane L. Institutional pressures impede translational research. Molecular Imaging Outlook 2005;3(1):1-3.

Mr. George is vice president, Asia/Australasia, of the International Society of Radiographers and Radiological Technologists.