The global healthcare environment is rapidly changing. This is prompted by the overall economic situation and also by the change in healthcare policies and politics that undoubtedly will have a substantial impact on the way medicine is practiced worldwide. 

The current economic crisis affects industry, but also academia, with decreasing federal funds available for medical research. Many of the brightest researchers create and invent novel approaches in academia. On the other hand, scientific discoveries by pharmaceutical, radiopharmaceutical and instrumentation companies frequently need to be tested and validated in collaboration with academia.

Over the past few years, the global nuclear medicine community has been plagued with shortages of medical radioisotopes, which is particularly detrimental for the oft-used molybdenum-99 (Mo-99)the parent isotope of technetium-99m (Tc-99m), the most widely utilized radioisotope in the world for molecular and nuclear diagnostic imaging studies. 

Within the field of molecular imaging, there are quite a few techniques that are well established within routine clinical practice. Other techniques have earned the reputation of being powerful and innovative when it comes to experimental or preclinical research, but have had trouble translating into the clinic. That could be changing, particularly in the area of optical imaging.

The merging of PET and MRI is producing synergies far beyond the capabilities of two distinct imaging modalities. The sum is clearly greater than its parts, according to researchers using both preclinical and clinical PET/MRI prototypes, notably because scanning is simultaneous rather than sequential like its PET/CT cousin, and the excellent soft tissue visualization MRI offers. A clinical prototype is being used to study human brain tumors, and researchers predict integrated whole-body human PET/MRI scanners will be available in the next couple of years.

PET imaging for Alzheimers disease has a fairly long history. As far back as the early 1980s, researchers realized that FDG-PET scans could show changes in brain activity indicative of Alzheimers disease. The Centers for Medicare and Medicaid Services (CMS), however, did not reimburse for the procedure. Consequently, when patients were referred for an imaging exam, clinicians more commonly ordered a SPECT study.

The constant drive to predict and characterize cancerous tumor response to therapy that is earlier, better and more specific, as well as the success of the PET tracer FDG coupled with an established and emergent worldwide PET infrastructure are generating greater interest in the utilization of non-FDG radiotracers for oncology. 

This issue of Molecular Imaging Insight features several discussions about Building the Business of Molecular Imaging. I believe it is important to note that clinical molecular imagingand here most prominently PET/CTis still in its infancy with regards to its utilization.