The Proliferation of Activity and Meetings in MI

This spring and summer was a very busy one in the field of molecular imaging. Starting in May, we had the International Society of Radiopharmaceutical Sciences meeting in Jeju, South Korea. A few weeks later, the 8th Targeted Alpha Emitter meeting was held in Oak Ridge, Tenn. The Society of Nuclear Medicine and Molecular Imaging meeting followed immediately after, with the Radiometals meeting next in Santa Rosa, Calif., that focused exclusively on PET isotope fast on SNMMI’s heels. In early July, across the pond in Nantes, France, the Workshop on Innovation in Personalized Radioimmunotherapy meeting focused on radiopharmaceuticals. There were few who attended all of these meetings given the breadth of topics covered. Yet one important aspect they share is the increasing role molecular imaging is playing in both diagnostic and therapeutic nuclear medicine. 

These meetings also raise an important issue relative to the expansion of MI in medical practice. There continues to be a very strong focus on early stage development of new radiopharmaceuticals and radionuclides to label them. While we wring our hands about the slow regulatory acceptance of these compounds, we also complicate the picture by flooding the field with new probes that often are only marginally better than what we already are using. We then become more frustrated when the reimbursement authorities responsible for approving these agents deny the applications citing the slight difference from current practice. Or even more frustrating, claim that no effective therapy for the disease that is being examined is in itself grounds for denial. Obviously, if one can diagnose a disease that has resisted diagnosis to date, as we saw historically with FDG imaging and Alzheimer’s disease, there is value and benefit to the patients, their loved ones, and caregivers. Even to society as a whole. 

We need to think seriously about a shift in our thinking and actions relative to molecular imaging at this stage of its maturation. Perhaps it is time to spend more resources on development, rather than research, in the timeline of activity for these compounds and their use in medical practice. We already know that those responsible for reimbursement decisions are demanding more information regarding MI. 

Another barrier is the referring physician community that is more skeptical about the latest and greatest development in imaging and is asking more questions about the value of these imaging studies. So, rather than expending resources on exploring new radionuclides where there is no identifiable need, let’s maximize the yield and purity of their production. Develop automation earlier in the development so that production is more reproducible and exposure to personnel minimized. Improve quantitation and resolution of the imaging studies that we perform. And finally, with a very clear mandate given to the imaging community, improve the clinical studies that we publish to include an examination of the economic benefit to the system, e.g. the study avoids x number of unnecessary surgeries. And where possible, detail the impact on patient outcomes, citing perhaps earlier cessation of useless treatment that avoids unnecessary toxicity and cost for the patient and insurer. 

These steps would generate a more useful portfolio of new imaging agents, accelerate their development and acceptance, and ultimately, provide more benefit to the patients we serve.