The power of a proven platform. The perspective of a large axial PET
field of view. Meet nuclear medicine experts who take the potential of
PET/CT further with Biograph Vision Quadra™.
Marcus Hacker, MD, PhD
Medical University of Vienna, Vienna, Austria
After studying medicine at the University of Erlangen and the Technical University of Munich, Prof. Dr. Hacker
trained in nuclear medicine at the University of Munich, Germany. Previously, he was vice chair of the
Department of Nuclear Medicine and the head of the Preclinical Imaging Unit at the Department of Nuclear
Medicine, University of Munich, Germany. Today he is working as a full professor of Nuclear Medicine and the
director of the Division of Nuclear Medicine at the Medical University of Vienna, Austria. He also heads the
Department of Biomedical Imaging and Image-Guided Therapy. Hacker’s main research focus is translational
cardiovascular imaging, precision medicine (theranostics and companion use) in immuno- and oncological
therapies, and network and prevention medicine. Hacker has won both the German Dagmar-Eißner-Award
and the Wolfgang-Becker-Award for nuclear medicine. He was actively involved in the Austrian, German, and
European Associations of Nuclear Medicine as president, board member, and working group leader. Hacker
represents the Medical University of Vienna in the Network Medicine Alliance.
What is whole-person research and network medicine?
Network medicine is interested in the
protein-protein and cellular interactions, as well as inter-organ communication
and social networks and searches for
new mechanistical insights to better
guide therapy and organismal level
and finally improve patients’ outcomes.
We as nuclear medicine physicians
have, in most of our examinations, a
“whole person” view. In whole-body
PET/CT, we are displaying molecular
targets and physiology on a wholeperson
level. So, we are predestined to
be involved in whole-person research.
You spoke at EANM 2023 about how total-body PET/CT fits into whole-person research and network medicine. What is the connection?
With total-body PET/CT, we are able to
display the connectivity or at least the
co-relation between organs and with it
respective changes between healthy
individuals, people with allostatic load,
and people where the presence of
disease was already diagnosed. This is
unique and no other discipline or
technology can provide this information
non-invasively and serially on a wholeperson
level.
During EANM, you said that as a nuclear medicine physician, you are involved in the monitoring of disease but not in the prevention of disease and health. Can you tell us when you first saw the potential of total-body PET/CT imaging in disease prevention?
First, we were inspired by the high
sensitivity of those scanners and the
question how we could make use of it.
Providing whole-body molecular
information ideally beyond 1mSv
including CT, would be the basis for
regular screening with PET/CT. There is
already a huge amount of data on the performance of PET and PET/CT in a
disease screening setting. But now we
can achieve a much higher detection
rate and—as described earlier—can add
inter-organ relations to early detect not
only disease but also allostasis.
In your research, you have observed that emotional stress plays a key role in patient outcomes. What was observed and for what disease states?
There have been already published data on how emotional or post-traumatic stress affects outcome based on patient questionnaires. What is new is the understanding that we can use PET/CT signals from the amygdala to identify an emotional stress activation, and with total-body PET/CT, set these signals directly into relation to peripheral organ metabolism or diseases. In Vienna, we have built the whole translational pipeline from human total-body research back to animals and cells, so that we can understand metabolic signals of single organs better and, with it, understand the changes of signals. In cancer patients, you can even add the analysis of cancer genetics, tumor microenvironment, and inflammatory changes by adding molecular biology analyzing techniques. We could demonstrate how stress in lung cancer patients affects a systemic inflammatory response and, with it, the tumor microenvironment and how this changes survival rates.
The idea is to detect stress activation
and downstream allostatic changes
early, before disease occurs. After
early detection, you can add primary
prevention and observe the return
of the organism in a balanced
homeostatic setting. An image says
more than thousand words, so that
we hope that individuals can be better
guided for prevention like weight loss,
anti-stress training, and changes in
behaviors. Of course, we are also
thinking about medical strategies to
resolve the metabolic dissociation
driving disease development.
What do you hope for the future of molecular imaging?
Ashok MuthuKrishnan, MD
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
After beginning his medical education in India, Dr. MuthuKrishnan completed his
residency in nuclear medicine at the University of Alabama—Birmingham, Alabama,
USA, and his clinical fellowship in PET/CT at the University of Pittsburgh Medical Center.
Since 2019, MuthuKrishnan has held the positions of chief of Nuclear Medicine,
director of Nuclear Medicine Clinical Operations, and director of Theranostics at the
University of Pittsburgh. He is also the founder and chief physician of the Florida
Theranostics Cancer Center, Jupiter, Florida, USA. He is currently a member of RSNA,
SNMMI, and the Indian Society of Nuclear Medicine, among other organizations.
What were your department’s primary factors in deciding to invest in a Biograph Vision Quadra PET/CT scanner?
Describe the research/clinical areas for which Biograph Vision Quadra is used in your nuclear medicine department.
Tell us about one feature that has exceeded the nuclear medicine department’s expectations.
In your opinion, has Biograph Vision Quadra contributed to differentiating your department from other molecular imaging centers? If so, how?
Yes. Our institution is a multi-campus, multi-PET/CT scanner environment where patients go back and forth between different PET/CT scanners for their staging and therapy assessment scans. Once patients have experienced the quick scanning times and their physicians saw the imaging quality from Biograph Vision Quadra, both the referring physicians and the patients never want to go back to a non-Biograph Vision Quadra PET/CT scanner.
What are your aspirations for the future of molecular imaging? How do you foresee total-body PET/CT being a catalyst for progressing the imaging modality?
Studying the pathophysiology of the
tumor environment precisely and
rapidly would open a lot of doors to
more accurate staging and devising
impactful treatment strategies. In a
similar manner, understanding and
quantifying non-tumor pathologies in
ways like never before will pave a new
paradigm shift in treating such disease
processes. Total-body PET/CT is the tool
we have in our hands now that would
get us there in the near future.