NIH director sees imagingas tool for bold initiatives

Institute takes first steps as engine of discovery

The seeds of new medical technologies are often nourished with federal money, much of which flows from the National Institutes of Health. Until recently, the purse strings for this funding were controlled by agencies with agendas other than imaging and by leaders from disciplines other than radiology. That changed dramatically with the creation in 2001 of the National Institute of Biomedical Imaging and Bioengineering (SCAN 1/17/01) and appointment earlier this year of Johns Hopkins radiologist Dr. Elias Zerhouni (SCAN 5/15/01) as the head of the NIH, which oversees the NIBIB. But these are only the first steps, Zerhouni said.

"NIBIB must define its mission as an engine of discovery and new knowledge," he said in an exclusive interview with diagnosticimaging.com (www.dimag.com/specialreport/). "The question is, where are the priorities? What avenues will best advance the science?"

NIH continues to fund novel ideas, one of which could spur intravascular ultrasound to become an important and widely used method for identifying vulnerable plaques (see cover story this issue). Whether these and other efforts to develop imaging technology should be shepherded by NIBIB alone or by NIH components with a mandate to attack specific diseases needs to be decided case by case, according to Zerhouni.

"I'm cautious about central control," he said. "The spark of the individual creative person is what makes science tick. You don't tend to get that with central planning."

Imaging is too broad a field to cover with a single umbrella agency, he said. The components within the NIH that need imaging technologies in order to accomplish their missions must be able to promote the development of those technologies. But NIBIB can be an important force in developing technologies that cut across multiple disciplines.

"Where are the new forms of physical interaction, computer analysis, image processing, image databasing, and predictive models of specially localized information with both temporal and contrast resolution? Where are the new forms that tell us something about biology we wouldn't have known without using imaging?" Zerhouni said. "That to me is the highest mission I could think of for NIBIB."

The institute must combine the strengths of biomedical imaging and bioengineering, he said. Engineering, physics, and computer sciences are needed to understand the complexity of biological systems. Only through multidisciplinary programs can a comprehensive understanding develop.

"NIBIB's challenge in the next few years will be to guide the discovery process through a quantitative analysis of complex biological systems," he said.

Evolution of the institute may require an evolution of imaging itself. Conclusions drawn from in vivo cellular and molecular imaging may require modeling based on in vitro observations. Pursuing such efforts will require researchers to think in ways they have never done before.

"Clearly, we've developed a remarkable imaging toolbox over the past 25 years, but in this field we need to move away from looking at our tools only as solutions to our problems," Zerhouni said. "It's a great danger sometimes to know a solution. If you limit your field to being a set of topical solutions to problems posed by others, you will have missed the opportunity of the 21st century."

Medicine in this century will present excellent opportunities for researchers to be bold and innovative, he said. And imaging will be the essential tool for understanding the great questions that will be posed.