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From the Associate Editor's Notebook |
prove001{at}mc.duke.edu
The contents of the February issue of the AJR reflect the fact that the specialty of radiology is at a crossroads. In Roman mythology the god Janus was depicted as looking simultaneously into the past and into the future. Similar to that Roman deity, this issue presents material illustrating the cutting edge of present-day technology (e.g., articles on MDCT imaging) while also peering into the future with articles on molecular imaging, which is the theme of this issue. The articles describing advances in present-day technology provide material that will be recognizable to radiologists. Many of the topics that fall under that category can be described as an-atomic in nature, i.e., providing improved spatial and temporal resolution for better depiction of the shape and size of lesions. However, the articles on molecular imaging likely introduce concepts that are foreign to most radiologists and so unlike current imaging techniques as to bring to mind Arthur C. Clarke's famous statement that "any sufficiently advanced technology is indistinguishable from magic" [1].
In April 2005, representatives from 15 imaging societies assembled in Oak Brook, Illinois, in a meeting convened by the Society of Nuclear Medicine (SNM) and the Radiological Society of North America (RSNA) to discuss plans for a concerted effort to advance molecular imaging in the scientific community. The author of this editorial attended the session as a representative of the American Roentgen Ray Society (ARRS). A summary of this meeting is provided in the article by Drs. Mathew Thakur (representing the SNM) and Brian Lentle (representing the RSNA), in which the authors outline 12 goals advanced by summit participants [2]. These goals include coordination of collaborative efforts across radiology societies for advocacy of molecular imaging, design of methods for educating imaging scientists and radiologists, and identification of sources of funding to develop and expand research programs and address regulatory issues that might impede development of molecular imaging programs. An important discussion point of the meeting was the need to educate radiologists in general as well as radiology trainees in the clinical possibilities inherent in molecular imaging research. The participants recognized that many molecular imaging techniques are not presently close to clinical use, which makes the job of stimulating the interest of radiologists in these techniques rather difficult. This issue of the AJR, then, is one attempt to disseminate some of the salient points of the molecular imaging initiative to the general readership.
The summit report discussed above provides a high-altitude view of general plans for development of molecular imaging. To complement that global perspective, this issue of the AJR also features an overview from a lower altitude showing some of the main features of the molecular imaging terrain. The reader is invited to peruse an article highlighting some of the more stimulating research presentations from the March 2005 meeting of the Academy of Molecular Imaging [3]. In that article, the reader will find summaries of presentations on molecular imaging techniques related to diseases and therapies that may be of interest to radiologists: innovative techniques for assessment of Alzheimer's disease, stem cell migration, and angiogenesis. These techniques presently are used solely in small animal models; the time interval until they can be applied to humans (if ever) is not known. Nonetheless, such techniques have already begun to provide insights that are not available from solely human studies. For instance, molecular imaging techniques such as bioluminescence imaging are being used in small animal models to screen effects of drugs in a manner that is much more rapid than would be possible using routine methods.
Finally, as opposed to the aerial views of molecular imaging provided by the articles listed above, this issue also presents a ground-level view in the form of a study that describes a novel contrast agent that is based on molecular imaging principles [4]. Mukundan and colleagues (one of whom is the author of this editorial) describe a nanoscale contrast agent composed of liposomes in which a high level of iodine is encapsulated. The article shows that these liposomes can be successfully used as a CT contrast agent. Furthermore, the liposomes also are capable of bearing ligands on their surface that could bind with cell surface receptors, thus potentially providing specificity for tumor cells. An additional intriguing aspect of the study is the fact that various molecules, such as chemotherapeutic agents, can be inserted into liposomes, allowing them to serve as therapeutic vehicles. Thus, the liposomes can potentially selectively target tumor cells while their distribution within the body is mapped using CT imaging. Upon reaching the target, the liposomes can be lysed (using various methods, such as local heating) and their contents deposited directly at the tumor, which should serve to increase tumor cell kill and minimize systemic toxicity.
Radiologists need to be interested in molecular imaging not solely because it is a critical field from which they will likely be excluded if they do not actively participate in the early stages. Equally important is the fact that molecular imaging needs radiologists who recognize the practical concerns involved in imaging of patients and understand well the medical issues in which molecular imaging investigators are interested. Radiologists can become involved in a number of ways. First, radiologists can sponsor molecular imaging research by other radiologists through contributions to the research funds of major radiology societies. As an example of support provided by such societies, the ARRS has recently funded a number of excellent molecular imaging research projects. A contribution to the ARRS's Roentgen Fund (as seen on www.arrs.org), then, would be a good start. Second, radiologists can become aware of molecular imaging research through publications in radiology journals and other journals in other fields. Finally, radiologists at academic institutions can contact molecular imaging researchers at their institution. They may be surprised to find the degree to which their clinical imaging perspectives are welcomed.
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