NIH chief cites central role for imaging in medical progress

Integration is an essential theme for National Institutes of Health director Dr. Elias Zerhouni. His vision for medical research revolves around the use of breakthrough science to address major health needs.

Zerhouni, the first radiologist to lead the NIH and manage its $29 billion budget, sees medical imaging as a model for the style of interdisciplinary science that will propel medical progress through the 21st century.

In his Eugene P. Pendergrass New Horizons Lecture at the RSNA meeting Monday, Zerhouni praised radiologists for their ability to reinvent themselves and their medical practice through the creative application of physics and computer science. Three products of their inventiveness - MR and CT, balloon angiography, and mammography - rank among the top five medical innovations of the past 30 years.

"This combination of technological innovation and biological understanding is now even more at the forefront of what drives scientific change," Zerhouni said.

That spirit is evident at the National Institute of Biomedical Imaging and Bioengineering, the newest NIH institute, he said. Under the leadership of another radiologist, Dr. Roderic Pettigrew, NIBIB has changed the research landscape by accelerating the emergence of completely novel technologies for imaging as well as for understanding basic biology.

Zerhouni sees progress toward realizing the goals that he set in 2001 with the introduction of his Roapmap for Medical Research. The Roadmap described an ambitious plan for a molecularly based practice of medicine capitalizing on knowledge generated from then-ongoing work on the Human Genome Project, a federal and private effort to map all the sequences in the human genetic code.

Few genomewide associations with specific diseases were reported between 2001 and 2006, Zerhouni said. They included the 2001 discovery of a link between PPARy factor and the development of type 2 diabetes and the 2003 disclosure establishing a link between the gene CFH and age-related macular degeneration. But Zehouni has seen an explosion of such findings this year.

"This requires us to rethink our management of disease," he said. "We have made tremendous progress in understanding the process of disease, its circuitry. The next step is to understand the underlying pathways of disease, its software."

Imaging is particular well suited to fulfill this latter role, according to Zerhouni.

"Imaging will be key because it is nondestructive, inherently quantitative, and multidimensional," he said.

Zerhouni described a series of emerging imaging technologies that fulfill that role on molecular, cellular, and organ-specific levels. At the molecular level, researchers are using imaging to better understand molecular paths. At the cellular level, it is used to understand trafficking within cell, in tissues, and for cell-to-cell interactions. At the level of organs, it can quantify dynamic changes over time.

"There is no way we can study Alzheimer's disease with one test at one time. The longitudinal information is going to be key," he said.

Early disease detection will be a major activity of imaging. Use of image-guided delivery and retrieval for novel therapies is already breaking into clinical practice.

A new definition of diagnostic imaging may be warranted to acknowledge the implications of such changes, he said. Zerhouni suggested that imaging in the 21st century is at the heart of interdisciplinary science for generating, understanding, and using spatially and temporally resolved biological information.

"One can only come to the conclusion that somehow, somewhere imaging will be core to that process," he said.