Scaling the Summit of Molecular Imaging

At Siemens Healthineers’ recent Molecular Imaging World Summit, nuclear medicine and molecular imaging professionals were optimistic about the future as they examined trends, research, and technological advancements. The Summit fostered inspired discussion around opportunities for molecular imaging and how the field contributes to the expansion of personalized care.

These are exciting times for molecular imaging and, as current applications broaden, more people benefit from today’s best practices. Moving beyond diagnostics into therapy, molecular imaging propels efforts to provide personalized care that improves patient outcomes. Cutting-edge research in areas like artificial intelligence (AI) suggests that tools, such as digital avatars, will soon become available—even if some seem straight out of science fiction.

Upbeat messages dominated the dialog during the Molecular Imaging World Summit in Lausanne, Switzerland. Hosted by Siemens Healthineers, the conference brought together over 240 participants from more than 140 institutions around the world. While the mood was generally hopeful, there were a few pauses for reflection around topics such as the possibilities of AI and pressures to adapt to a changing healthcare landscape.

Optimism populated the Summit’s keynote address, given by John O. Prior, MD, PhD, FEBNM, professor and head of nuclear medicine and molecular imaging at Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. In his opening speech, Prior explained precision medicine occurs when physicians, “make a treatment plan based on the characteristics of the patient.” The concept involves gathering sufficient data about an individual to be able to predict their reaction to a particular treatment, and to adjust treatment based on results. Continued research is needed regarding the potential of molecular imaging in precision medicine, as there are multiple pathways and possible new tracers that could be “exciting,” he emphasized.

Looking into the future, pesenters were keen to focus on quantification. Many noted the movement from a traditional mixture of qualitative and subjective analysis to one that relies on quantitative and objective criteria. This approach continues to evolve as both SPECT/CT and PET/CT develop similar quantitative capabilities and analytical tools become more reliable and sophisticated, such as solutions for quantitative SPECT/CT and multiparametric PET/CT.

Quantitative and objective analysis of data are the central motivators behind the increased focus on phenotypes, which is a significant shift from a past where an emphasis was on genotypes. Molecular imaging can help physicians better understand a patient’s phenotype, therefore making it easier to determine if someone is a good candidate for a certain type of treatment. In the early stages right now, this trend will develop over the next decade as experts anticipate it to engender better use of precision medicine.

Presentations about early diagnosis and planning focused to a large extent on opportunities in neurology and orthopedics.
In aging nations, demand is growing for hybrid neuroimaging of degenerative diseases, said Jun Hatazawa, MD, professor of nuclear medicine at Osaka University in Japan. Quantitative SPECT/CT improves the neurological diagnosis as it provides biopsy-quality neuropathological results without the need for tissue sampling.

Exploring opportunities in orthopedics, Helmut Rasch, MD, of the department of radiology and nuclear medicine at Kantonsspital Baselland in Switzerland, explained how everyone dreams of a “one-stop shop”. Biomechanics, metabolism, and morphology all affect the ability to visualize a bone bruise that causes pain, for example. As SPECT/CT offers metabolic and anatomical information in its hybrid approach, it can provide physicians a wealth of orthopedic information that aids in accurate and quick clinical decision making.

Beyond neurology and orthopedics, a panel of four physicians explored the progression of PET/CT through a review of everyday cases acquired with the Biograph Vision™ PET/CT scanner. The panel vetted the system’s performance, noting the clinical impact they experience with the latest advancements in PET/CT.

Precision medicine, theranostics, and dosimetry loomed large in a talk given by Rodney Hicks, MD, professor of medicine and radiology at the University of Melbourne and director of the Centre for Cancer Imaging at the Peter MacCallum Cancer Centre in Melbourne, Australia. Drawing on the sentiment, “if we can see it, we can treat it,” he emphasized how personalized data opens the door to tailored dosimetry. In a current practice without dosimetry—or a dose-tailored regimen for therapeutic agents—physicians utilize standard protocols even though the treatment option may not help the prognosis for the individual. Dosimetry can aide physicians in adapting the therapeutic dose to more effectively treat patients who might be able to withstand a higher dose, as well as others who may be excluded as therapy candidates but may benefit from lower-dose protocols. Yet Hicks warned against excessive complexity; when talking about his work with dosimetry he said, “we like to keep it simple.”

Speaking to the implementation of standardized protocols in therapeutics, an invited industry speaker articulated the viewpoint that a standardized dose regimen for therapeutic agents may accelerate a broad adoption by clinicians. From his perspective, topics like dosimetry could be introduced once therapeutics are clinically routine. What followed was an active debate on dosimetry from a panel of international luminaries, moderated by Professor Dale Bailey, PhD, principal physicist in the department of nuclear medicine at Royal North Shore Hospital in Australia.

As presenters examined the use of molecular imaging in therapy management, the topic centered around prospects for theranostics—the combination of diagnostics and therapy—and immunotherapy.

Treatments considered to have high promise include those designed, “to target a molecular pathway and activate the immune system,” explained Prior. A combination of talks on cancer immunotherapy highlighted how understanding the biology of individual patients can aid in selecting those who are most likely to respond favorably to a particular biomarker, and thus guide first- and second-line therapies. “The fact that molecular imaging can assess heterogeneity and the dynamics of response and adaptive resistance is a key advantage over other techniques,” signaled Olivier Michielin, MD, PhD, head of the precision oncology center at CHUV and group leader at the Swiss Institute of Bioinformatics. “For me the future will be to have a close collaboration between biologists, medical oncologists, and molecular imaging specialists to be able to drive the field forward.”

Progress in the realm of molecular imaging is likely to be split between important, incremental advances and industry game-changers. Examples of relevant developments ranged from continuous bed motion and motion management in PET/CT to possibilities for quantitative cardiac SPECT/CT. In his talk, Frederick Giesel, MD, vice chair of nuclear medicine at the University of Heidelberg, presented the latest results of their work with quinoline-based PET tracers that act as fibroblast activation protein (FAP) inhibitors (FAPIs). An emerging diagnostic method, FAPI PET/CT appears to be viable for imaging a broad range of cancers, while providing specific data. Exciting opportunities for a theranostic adjunct also appear to be feasible.

When shifting to game-changers that impact the future of molecular imaging, AI was a salient example. “AI-assisted software applications are already working on non-small cell lung cancer and lymphoma,” said Marcus Hacker, MD, PhD, head of the clinical department of nuclear medicine at the Medical University of Vienna. Experiments seek to apply Google’s face-recognition technology to identify tumors, and machine learning seems capable of differentiating high- and low-risk tumors, as well as malignant and non-malignant ones. The joint future of AI and molecular imaging could include several major developments: the use of predictive biomarkers, convergent molecular diagnostics—a survival-prediction approach which combines molecular diagnostics with molecular imaging—and applied metabiomics.

Even outside the considerations of AI’s imact, it’s obvious the change of pace in molecular imaging is accelerating: the goal is to gain a clear understanding of disease and utilize this information to better formulate treatment plans that benefit individual patients. When leaders meet again at future world summits, it will be enlightening to see what milestones are achieved and what remains on the horizon. Yet, regardless how many predictions we check “accomplished” or not, it is clear there is a crucial place for molecular imaging and nuclear medicine in the future of healthcare, which is cause for great optimism.

Martin A. Walter, MD, PhD, University Hospital Geneva, makes a series of predictions for the future of molecular imaging.

• The demand for imaging will grow due to aging populations, chronic disease, and reimbursement expansion based on success.
• Due to growing demand, more injection rooms will be required.
• The number of available therapies will increase.
• There will be a shift towards predictive imaging.
• Alongside PET/CT and SPECT/CT, PET/MR will be established clinically.
• The number of personnel per patient will decrease.
• AI will aid image acquisition and interpretation. 

Bill Hinchberger is a Paris-based journalist whose work has appeared in The Lancet, Science, and many other publications.