Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | October 03, 2014

Nuclear Medicine is the New Personalized Medicine

Photo courtesy of Siemens Healthcare

Remember the race to map the human genome, when the widest international collaboration in history went up against the efforts of a private corporation, Celera? The race ended in a tie in 2001 with near simultaneous publications in Nature (public effort) and Science (Celera) as both public and private sectors served up analyses of about 80 percent of the genome. Unfortunately, the outcome of this Herculean effort did not come close to meeting expectations. 

Mapping the human genome was supposed to unlock the secrets of disease and make possible truly personalized medicine. It was to have explained why some people fall ill while others do not — and how those who become ill could be best treated. It just didn’t work out that way. 

Now more than a decade later, personalized medicine, based on genetic information, is decades more away. Even just understanding the genome still eludes the grasp of researchers.

What did come from those early days of hyperbole was recognition of how badly the public wants personalized medicine. Patients and providers alike are fed up with medicine as an art. They want it to be a science. That is what personalized medicine was supposed to be. And it is now what nuclear medicine aspires to be.

Once hampered by the negative connotations of its first name, nuclear medicine reinvented itself shortly after the turn of the century, rebranding itself as “molecular imaging.” Measurements of radiotracer uptake complement the visualization of metabolic activity, particularly in positron emission tomography/computed tomography (PET/CT). This hybrid is routinely leveraged to calculate the dose of therapeutic radionuclides and to gauge the effect of therapies on malignant tumors. 

If there’s a fly in the ointment, it’s that the promoters of molecular imaging as the harbinger of personalized medicine may be promising too much. We hear about the commitment of companies in this industry to personalized medicine and the latest gizmo or upgraded gadget that makes it real. To their credit, however, they are careful to describe successes within narrow confines, as in the case of peptide receptor radionuclide therapy (PRRT).

PRRT is on the front lines of this new personalized medicine. Its somatostatin analogs, which selectively bind to the cellular receptors in neuroendocrine tumors, carry a gallium radionuclide that simultaneously emits radiation that kills tumors and makes the analogs visible and quantifiable with PET/CT. The end effect of successful and measurable treatment is decreased tumor size, reduced symptoms and even a halt in tumor progression in many patients with neuroendocrine tumors.

Similar results have been achieved in patients with esophageal and lung cancers, as well as diffuse large B-cell lymphoma, using radiotherapeutic compounds complemented by FDG imaging and quantitation with PET/CT. The potential to do the same with even some advanced forms of single-proton emission computed tomography (SPECT)/CT has also been demonstrated.

Anatomically based tools, such as magnetic resonance imaging (MRI) and CT, pale by comparison. Whereas these modalities record the dimensions of a tumor, those dimensions may be inflamed by the cellular debris that comes from successful chemo- or radiotherapy. Not so with molecular imaging, which demonstrates visually and quantitatively, at least in some cases, the presence of viable tumor. Trends in uptake values graphically show changes in tumor metabolism, giving providers an indication of whether and how well therapies are doing.  

To be sure, molecular medicine is not what personalized medicine was supposed to be. But it is a step in the right direction. Perhaps most importantly, it is a step that can — and is — being taken. 

That it does not spring from knowledge gained by mapping the human genome, I could care less.

Related Content

Novel PET Tracer Clearly Identifies and Tracks Bacterial Lung Infection

Representative PET/CT images of 18F-FDS and 18F-FDG in inflamed mice. Mice were inoculated with dead K. pneumoniae (10^8 CFU/mL). Imaging was performed for days 1, 2, 3 and 4 using 18F-FDG and 18F-FDS. CT images showed clear inflammation on day 2 and day 3 with corresponding high 18F-FDG uptake on PET. No significant uptake of 18F-FDS was detected for any of those 4 days. Credit: J Li et al., University of Louisville School of Medicine, Louisville, Ky.

News | PET-CT | January 22, 2018
January 22, 2018 — Researchers at the University of Louisville, Kentucky, have demonstrated that a new...
Hospital for Special Surgery Invests in Sectra Orthopedic 3-D Planning Software
News | Orthopedic Imaging | January 18, 2018
January 18, 2018 – International medical imaging IT and cybersecurity company Sectra announces that Hospital for Spec
Philips Introduces Technology Maximizer Program for Imaging Equipment Upgrades
Technology | Imaging | January 17, 2018
January 17, 2018 — Philips recently announced the launch of Technology Maximizer, a cross-modality program designed t
Russian Team Developing New Technology to Significantly Reduce MRI Research Costs
News | Magnetic Resonance Imaging (MRI) | January 16, 2018
January 16, 2018 — Researchers from the NUST MISIS Engineering Center for Industrial Technologies in Russia have deve
Smartphone Addiction Creates Imbalance in Brain
News | Mobile Devices | January 11, 2018
Researchers have found an imbalance in the brain chemistry of young people addicted to smartphones and the internet,...
Fat Distribution in Women and Men Provides Clues to Heart Attack Risk
News | Women's Health | January 11, 2018
January 11, 2018 – It’s not the amount of fat in your body but where it is stored that may increase your risk for hea
Emergency Radiologists See Inner Toll of Opioid Use Disorders

Rates of Imaging Positivity for IV-SUDs Complications. Image courtesy of Efren J. Flores, M.D.

News | Clinical Study | January 11, 2018
January 11, 2018 – Emergency radiologists are seeing a high prevalence of patients with complications related to opio
Minimally Invasive Treatment Provides Relief from Back Pain

Lumbar spine MRI showing disc herniation and nerve root at baseline and one month after treatment

News | Interventional Radiology | January 11, 2018
The majority of patients were pain free after receiving a new image-guided pulsed radiofrequency treatment for low back...
CT Shows Enlarged Aortas in Former Pro Football Players

3-D rendering from a cardiac CT dataset demonstrating mild dilation of the ascending aorta.

News | Computed Tomography (CT) | January 11, 2018
Former National Football League (NFL) players are more likely to have enlarged aortas, a condition that may put them at...
Study Finds No Evidence that Gadolinium Causes Neurologic Harm

MR images through, A, C, E, basal ganglia and, B, D, F, posterior fossa at level of dentate nucleus. Images are shown for, A, B, control group patient 4, and the, C, D, first and, E, F, last examinations performed in contrast group patient 13. Regions of interest used in quantification of signal intensity are shown as dashed lines for globus pallidus (green), thalamus (blue), dentate nucleus (yellow), and pons (red).

News | Contrast Media | January 11, 2018
January 11, 2018 — There is no evidence that accumulation in the brain of the element gadolinium speeds cognitive dec
Overlay Init