Thirty-five radiology and nuclear medicine leaders representing national societies from around the world gathered at the RSNA 2009 International Radiology Trends Meeting. The topic was the global status of hybrid imaging, including the importance of continuous research and collaboration, and the critical need for certification and cross-training.
“RSNA provides a wonderful opportunity to bring together world leaders in imaging and gives us a forum to exchange ideas and address the challenges facing us all," said RSNA President Hedvig Hricak, M.D., Ph.D., Dr. h.c., who moderated the session. “We learn from each other and, working together, we can advance biomedical imaging toward global imaging standards and harmonization. We hope the information exchanged will be of great value, not only to the attendees of the meeting, but also to a wider audience through a white paper that will be published later this year."
Dr. Hricak thanked Byung Ihn Choi, M.D., Ph.D., for his help in organizing the 2009 trends meeting. Dr. Choi is a member of RSNA’s International Advisory Committee and president-elect of the Asian Oceanian Congress of Radiology, which chose the topic of the meeting.
Defined as the fusing of imaging technology, hybrid imaging has resulted in imaging modalities such as PET/CT, single photon emission computed tomography (SPECT)/CT, MR imaging/PET, ultrasound/CT and MR imaging/ultrasound, said Dr. Choi, one of seven speakers at the event. “Hybrid imaging is a major enabling tool for the 4 ‘Ps’ of future medicine—predictive, preemptive, personalized and participatory,” he said. “Therefore, it is important to discuss the challenges facing hybrid imaging including training requirements and credentialing for interpretation and to propose global recommendation for the best clinical practices and innovative research in the future.”
Hybrid imaging is becoming more common in Asia, said Kazuro Sugimura, M.D., president of the Japan Radiological Society. He cited a survey of Asian trends in hybrid imaging showing that Japan and Korea have the most PET/CT and PET scanners.
While nuclear medicine physicians interpret PET and PET/CT scans in most countries, nuclear medicine physicians and radiologists often perform a joint reading in Japan and Hong Kong, Dr. Sugimura said. “As for the interpretation of MR imaging/PET, specialization in both nuclear medicine and radiology are considered to be mandatory in most Asian countries,” he said. “When MR imaging/PET is widely applicable, relevant input from radiologists will become more important in the interpretation of PET/CT,” he said.
Molecular Imaging Key to the Future
In the future, linking diagnostics with therapeutics to create “theragnostics” will be critical to medicine, said Steven M. Larson, M.D., chief of the nuclear medicine service in the Department of Radiology at Memorial Sloan-Kettering Cancer Center in New York.
PET will be critically important in the next decade due to the growing importance of molecular imaging, said Dr. Larson. “In particular, there has already been an enormous influence of PET/CT in oncology.”
Fair reimbursement for PET/CT with FDG is a major advancement achieved in part due to the collaboration between nuclear medicine and radiology, according to Dr. Larson, who cited the National Oncology PET Registry as a success story. “There are numerous other radiotracers for which hybrid imaging can be used to disclose key biologic features of human tumors to the benefit of the oncology patient,” said Dr. Larson. “I’m absolutely convinced that we can do big things for individualized medicine through collaboration between nuclear medicine and radiology.”
The pros and cons of integrating nuclear imaging with CT and MR imaging were discussed by Gustav K. von Schulthess, M.D., Ph.D., Dr. h.c., who is director of the Division of Nuclear Medicine at University Hospital Zurich, Switzerland. Potential advantages include “one-stop shopping,” synergies in attenuation correction when CT is part of the system, cost reduction and reduced overall imaging time. Disadvantages include decreased flexibility of patient flow, less efficient use of equipment (one system is idling while the other is operating) and per patient cost, said Dr. von Schulthess, who pointed out the need for careful analysis before devising an integrated imaging, system, especially when considering adoption of MR imaging/PET. Generally, a two-room shuttle integrated system may be a good integrative solution for MR imaging/PET as well as SPECT/CT, he suggested.
Cross-training Critical to Progress
Hybrid imaging requires an in-depth understanding of physiology, anatomy, clinical medicine and technology, said Andrew M. Scott, M.D., director of the Ludwig Institute for Cancer Research in Melbourne, Australia, who spoke on “Hybrid Imaging: Is Fear of a One-Specialty Takeover Slowing Progress?”
Cross-training and specialization are important considerations for new trainees, nuclear medicine physicians and radiologists, he said. “Integration with clinical care meetings is increasingly important,” said Dr. Scott. “Isolated imaging practices will have difficulty integrating into patient care decision making.”
Health technology assessment and funding will be the key drivers of expansion of hybrid imaging, said Dr. Scott, who recommended that experience in basic translational research and clinical trials become part of specialty training.
Maximilian F. Reiser, M.D., a professor and chair of the Department of Clinical Radiology at Ludwig Maximilian University of Munich, Germany, discussed the debate in Europe concerning cross-training. A joint survey by the European Association of Nuclear Medicine and the European Society of Radiology found that a large number of respondents favored an interdisciplinary training program, he said.
A position paper on multimodality imaging issued by the two groups was initially not well received by nuclear medicine physicians concerned that the independence of their specialty was at risk, Dr. Reiser said. However, with ongoing communication between the two specialties, the concerns have been mitigated and the leaders of several European nuclear medicine societies asserted that the position paper could be used as a reference document by politicians, the medical field and financial lobbyists who have an interest in combining radiology and nuclear medicine.
“We must commit to work together, coordinate working practices, recognize each other’s skills and the importance of proper training, and plan to develop common procedural guidelines,” said Dr. Reiser.
Addressing future challenges, N. Reed Dunnick, M.D., Fred Jenner Hodges Professor and chair of radiology at the University of Michigan in Ann Arbor and science liaison for the RSNA Board of Directors, also reminded attendees of the importance of training.
“Despite the equipment we might have and its wonderful capabilities, we need to have people properly trained to operate it,” he said. “Technologists need to be trained and tested to make sure they have gained those skills and maintain that certification. The exact same thing goes for our physicians,” he added. “We need practical training programs,” he said. “We can’t just keep adding years and requirements.” He suggested a six-year integrated training curriculum combining radiology and nuclear medicine, but pointed out that such instruction would require major changes to existing programs.
The discussion following the presentations reemphasized the need for appropriate training curricula. While the curricula for training future generations of diagnostic or nuclear medicine physicians are very similar globally, the challenge is to figure out how best to train and retrain the present generation of nuclear medicine physicians and radiologists to enable them to use all of the information available from hybrid imaging. In the spirit of RSNA 2009: Quality Counts, it was agreed that while any strategy has to be adapted to the local environment, ensuring continuous, lifelong education is essential.
Fonte do artigo: www.rsna.org
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