The Nuclear Medicine Renaissance
Innovation Holds Promise for
Improving Health Care
Groundbreaking research over the last few years has opened the door for doctors to tailor individualized treatment to a person's genetic profile, an approach known as personalized medicine. As this fledgling field grows, a key to unlocking its full potential may lie in a discipline that has existed 50 years. It's called nuclear medicine and uses imaging devices and radioactive biochemical compounds to diagnose and treat diseases.
Nearly 20 million nuclear medicine procedures are carried out each year in the United States to diagnose cancers, cardiovascular diseases, and certain neurological disorders -- as well as to treat several cancers, like breast and thyroid, by delivering doses of radiation to tumor cells in the hope of eradicating them. Nuclear imaging devices work by tracking radioactive chemicals that are swallowed, inhaled, or injected into the body. One common imaging tool is positron emission tomography (PET), which detects cancer sites anywhere in the body. PET is growing faster than any other imaging procedure and has proved less traumatic to patients who would otherwise require surgery or a biopsy to determine a malignancy.
Although nuclear medicine is routinely used in certain areas of medical treatment, its promise is only beginning to emerge in others, like neuroscience, drug development, and preventive health care.
"We are living during a period of rapid advances in the unraveling of the mechanisms that underlie many diseases such as cancer," said Hedvig Hricak, chair of a committee that wrote a new National Academies report on the subject. "Nuclear medicine provides some of the most essential tools for the progress of this research."
An area with prospects for growth is the diagnosis of neurological disorders, including addictions, eating disorders, and depression. Nuclear imaging devices could be used to assess a patient's brain functions and detect biochemical changes, thus revealing links between brain chemistry and behavior. They could also visually track the uptake of drugs in a patient, which could help scientists better understand the mechanisms by which new drugs are absorbed and take effect in the body.
More innovations are also budding for cancer treatments, such as targeted radionuclide therapy. Unlike external radiation therapy -- which kills cancer cells by beaming high-energy X-rays to the identifiable main tumor -- targeted radionuclide therapy functions more like chemotherapy. It delivers toxic levels of radiation not only to primary disease sites but also to adjacent tumor cells, consequently eliminating both the principal tumor and cancer that may have spread elsewhere, including otherwise undetectable malignant cells.
Yet through this glint of promise, more challenges lie ahead. Funding for nuclear medicine has dropped considerably in recent years, and there is currently no commitment by any federal agency to create a long-standing national nuclear medicine research program. The report says the federal government should enhance its commitment to nuclear medicine research.
"If cuts in funding for basic nuclear medicine research are not reversed, progress in personalized medicine will slow down dramatically. There is an especially great need for commitment to core research in chemistry, which underlies many advances emerging in nuclear medicine that could facilitate progress in personalized medicine," Hricak said.
To add to the financial crunch, there is an inadequate domestic supply of medical radionuclides for research. The lack of a dedicated domestic accelerator and reactor facilities for year-round, uninterrupted production of medical radionuclides discourages development and innovation in nuclear medicine.
Moreover, there is a critical shortage of personnel in all nuclear medicine disciplines, with an impending generation gap of leadership in the field. For a "renaissance" in nuclear medicine to occur that could potentially improve health care, the report emphasizes that these challenges need to be addressed. -- Jennifer Walsh
Advancing Nuclear Medicine Through Innovation. Committee on State of the Science of Nuclear Medicine; Nuclear and Radiation Studies Board, Division of Earth and Life Studies, and Board on Health Sciences Policy, Institute of Medicine (2007, 176 pp.; ISBN 0-309-11067-X; available from the National Academies Press, tel. 1-800-624-6242; $48.00 plus $4.50 shipping for single copies).
The committee was chaired by Hedvig Hricak, chairman of the department of radiology at Memorial Sloan-Kettering Cancer Center, New York City. The study was funded by the U.S. Department of Energy and the National Institutes of Health.