PET/CT is emerging as the pre-radiotherapy planning imaging study of choice for patients with non-small cell lung cancer (NSCLC), usurping the territory of standalone PET and CT.

The nuclear medicine community has learned many lessons from the shortage of molybdenum-99 (99Mo), the mother radioisotope of technetium-99m (99mTc) during the recent shut down of both the Canadian National Research Universal (NRU) reactor in Chalk River, Ontario, and High Flux Reactor (HFR) in Petten, the Netherlands. Both these reactors are back online, but are nearing the end of their lifecycle. How are we positioned for the future?

As disease treatment becomes more individualized, the spectrum of molecular imaging expands. The role of molecular imaging varies from management of various cancers and differential diagnosis of neurological disorders to identifying patients for cardiac revascularization. Four experts discuss the current and future trends in imaging for individualized treatments in oncology, neurology and cardiology.

The earlier we design a treatment and the earlier we know whether it works, the better it is for the patient. Molecular imaging has emerged as a powerful treatment decision-making tool, allowing physicians to make more informed and swift decisions to stop therapy when a patient isnt responding, often very early during the course of treatment. MI is making its mark on a number of cancers, especially breast, esophageal, prostate cancers, gastrointestinal stromal tumor and sarcoma.

PET devices have earned dedicated followings in multipurpose imaging in oncology, cardiology and neurology. While PET/CT largely dominates oncology, the demand for PET imaging for specific diseases is increasing, as does the need for low-cost, smaller dedicated scanners in cardiology and neurology.

The issue of radiation dose is certainly an attention-grabber these daysnot only within the medical community, but from the popular press as well. And the U.S. government also is enhancing its profile in this area, as evidenced by a Congressional hearing held on medical radiation in February, as well as an announcement by the FDA (accompanied by a two-day public hearing on the subject) that it will be working with manufacturers of advanced medical imaging devices to take steps to prevent patients from receiving excessive doses of radiation. So is there a hint of radiation exposure panic in the air in hybrid imaging?

While the diabetic population continues to grow rapidly across the U.S., SPECT holds strong as the gold standard for imaging diabetics, despite the improved prognostic value of PET especially for more complex disease states. Due to the unstable reimbursement environment in the U.S. and large upfront costs of PET, nuclear cardiologists are forced to weigh their options to provide the best patient care, while remaining financially viable.  

The introduction of hybrid imaging, particularly PET/CT, has succeeded in changing the practice of nuclear medicine imaging. Joining CT with PET has lead to calls in various corners of the globe to reappraise who should operate hybrid PET/CT units and what kind of education and training are necessary for nuclear medicine and radiologic technologists to assure safety and effectiveness of each aspect of the study.