Radiologists need to play vital role in molecular imaging
CHICAGO, Nov. 26—The future is here now, Martin Pomper, MD, PhD, associate professor of radiology, pharmacology & molecular sciences and oncology at Johns Hopkins University in Baltimore, Md., told a packed session room during a Sunday refresher course at the 93rd annual meeting of the Radiological Society of North America (RSNA).
Radiology has evolved from anatomic-based diagnostic imaging to functional and hybrid imaging technologies that make possible molecular imaging or the in-vivo interrogation of cellular and molecular processes. Molecular imaging offers a path to critical advances including early detection of changes in tissue that happen much earlier in the disease process than anatomical changes, a shift to real-time individual patient management or personalized medicine and drug development, said Pomper. Current research is focused on three areas: new imaging probes and technologies, drug development, imaging gene delivery and expression and understanding cellular processes.
“Although molecular imaging encompasses a host of modalities—optical imaging, nuclear scanners, MRI and ultrasound systems—radiopharmalogical techniques, or SPECT and PET, are most translatable into clinical practice,” summed Pomper.
Pomper’s colleague and co-presenter King Li, MD, MBA, associate director of the Radiology and Imaging Sciences Department and director of Diagnostic Radiology at National Institutes of Health Clinical Center, focused on the basics, explaining why molecular imaging is important to clinical radiologists—today. “Radiologists could be taken out of the diagnosis and treatment loops if molecular medicine proceeds without diagnostic imaging,” asserted Li. With molecular imaging providing information that can guide treatment plans, therapeutics are headed toward molecular medicine and personalized medicine. In fact, said Li, the era of personalized molecular medicine has started. For example, when clinicians use molecular data to determine which breast cancer patients will benefit from Herceptin, they are practicing individualized molecular medicine.
To retain their role in the care cycle, radiologists should become molecular imagers who provide information useful in era of molecular medicine, said Li. This shift is based on four stages.
1. Radiologists should repackage themselves and use currently available tools use to provide essential molecular data to their customers. Take an MR scan of liver metastases. Instead of limiting interpretation to imaging basics, the molecular imager provides the oncologist information about what type of anti-angiogenic treatment is most appropriate for the specific patient. In this case, gadolinium-enhanced contrast MR offers a means for radiologists to enhance their diagnostic value and improve clinical care. On the other hand, if a blood test provides similar information, radiologists will lose value.

2. Combine imaging and molecular diagnostic information. Radiologists can offer a whole greater than the sum of the parts by integrating imaging, pathology and histology to provide synergistic data and drive improved care.

3. Use imaging technologies to obtain molecular information.

4. Combine imaging and treatment to facilitate personalized medicine. Molecular imaging techniques and molecular image-guided therapy will allow radiologists to provide a one-stop diagnosis and treatment shop where they play a central role throughout the entire care cycle. 
The future—molecular medicine—is here. It’s up to radiologists to define their role.