Nuclear Medicine and Molecular Imaging Paints Bigger Picture by Linking Testing to Treatment

by Adam Fairbourn, MBA, CNMT

Vizient Senior Portfolio Executive, Diagnostic Imaging

If you’ve never heard of scintillation, it’s the flash of light produced when a charged particle from a radioactive source strikes the detector of a nuclear medicine and molecular imaging (NMMI) system. What’s remarkable is that each flash of light can be converted into a pixelated portion of the final diagnostic image — each a prime opportunity to piece together the bigger picture.

I bring this up because recent innovations in the field of NMMI represent several scintillating moments that have a big-picture effect on health care. Take, for example, the FDA’s March 23 announcement that it approved Pluvicto, a radioactive therapeutic drug used to treat prostate cancer. It was an exciting move for clinicians, patients and technology enthusiasts in the NMMI community, as the announcement marked another major milestone toward wider recognition and acceptance of radiotheranostics, the next frontier in precision cancer treatment.

Radiotheranostics uses ligands to sneak in destructive x-rays that target and destroy cancer cells by initiating cell death without harming any adjacent non-cancerous cells. At the same time, non-destructive x-rays, which can be imaged with incredible resolution, also can be attached to the very same ligands, linking diagnostic imaging and therapeutic treatment in a truly precise and personalized fashion.

In fact, the Cleveland Clinic named a radiotheranostic as the second most important medical innovation for 2022, with only mRNA Vaccinology ranked higher. But it’s not just radiotheranostics that are gaining traction. There’s also a maturing pipeline of novel radiopharmaceutical imaging agents that have the NMMI field poised to promote team-based medicine, grow in demand, and make good on the promise of a bigger-picture approach to healthcare.  

Enabled by digital technology

Current breakthroughs in the NMMI field are bolstered by digital technology such as digital imaging detectors, embedded artificial intelligence (AI) algorithms and optimal connectivity of information technology systems. Most notably, moving NMMI systems from analog to digital detectors has enabled the precision, performance and spatial resolution necessary to support the research, development and clinical confidence to advance innovation. Here are a few ways these digital technologies have helped achieve those goals:

• High-performance digital detectors allow for accurate localization and quantitation of NMMI images, which is crucial to confidence levels during research, staging disease states, planning treatment and making important clinical decisions thereafter. Pictured, I'm holding a digital detector at the 2021 RSNA meeting, with the detector then seen in closeup. It is incredibly compact and efficient compared to previous technology.
• Digital Positron Emission Tomography (PET) and Cadmium-Zinc-Telluride (CZT) detectors offer the high performance needed for these endeavors by allowing direct conversion of emitted energy from radiopharmaceuticals to pixelated high resolution images, which is an important technological advance in this space. The amount of data gathered and processed during image acquisitions can be astounding yet necessary to propel innovation.
• Embedded AI algorithms can aid in collecting, gathering, organizing and storing image data in the proper format that clinicians need to support multidisciplinary decision making required for radiotheranostic treatment. 

Without high-performance detectors and AI-streamlined processing, it is hard to imagine achieving such a high level of precision and efficiency. As innovations like radiotheranostics begin to bridge the gap between testing and treatment, digital connectivity for sharing meaningful information will be key to promoting a team-based approach.

Bridging the gap with team-based care

Healthcare providers continue to strive for patient-centric precision medicine, and advances in NMMI have created opportunities for team-based care, during which patients and multidisciplinary clinical teams work together across the continuum of care.

In a typical healthcare system, the relationship between radiology and other clinical specialties could be considered transactional, with low participation from radiologists beyond the interpretation of radiological images and sending a generic report to the ordering physician. When imaging, treatment, and follow-up are linked at a patient's cellular level, treatments like radiotheranostics call for a new level of collaboration between a patient and provider team.

The process starts with the patient’s unique medical history, followed by several important decisions that need to be agreed upon by the entire team, including the patient. Disparate information that only fractions of this team can access and understand will make this type of team-based care challenging or even unsuccessful. Vizient contracted manufacturers understand and recognize the importance of meaningful sharing of information in the NMMI space, and they are deploying information technology solutions to streamline this process. The potential benefits of team-based patient centered care extend beyond the realm of NMMI, and there is hope that NMMI can be a shining example of those benefits.

Just the beginning

Along with recent FDA approval of radiotheranostics, there are several other radiopharmaceuticals in the development pipeline for the NMMI community to be excited about. Radiotheranostics, and other radiopharmaceuticals have brought great attention to oncology applications in NMMI, but there also are other medical and technological advancements impacting specialties such as cardiology, endocrinology and neurology. In many ways, the blueprint for these applications is similar – visualize and stage disease processes at the cellular level followed by a therapeutic drug that uses the same chemical pathways to treat the disease at the cellular level.

I know this sounds futuristic and that’s because, in many ways, it is. It’s fortunate that much of the digital technology needed to support this future state is in place, but there are likely many challenges that lie ahead. Although many clinical trials are in motion, it’s most likely that the largest obstacle is wider acceptance of these breakthroughs from patients and payers. The NMMI community is charged with proving the clinical value and quality of these innovations to achieve sustainable clinical outcomes and monetary reimbursement. Beyond that, yet another large hurdle remains as demand for these services increases. With looming physician,  technologist and supply chain shortages, there is concern that NMMI departments won’t be able to keep up with the growth of service line offerings.

Despite these challenges, however, the excitement and hope for patients with complicated disease remains – and the NMMI community is well equipped to advance innovation with the launch of a strategic roadmap, The Value Initiative.