Mathew L. Thakur, PhD, President-Elect of the Society of Nuclear Medicine

In science, it is considered reasonable to propose new hypotheses and predict future possibilities that are supported by present observations. As we look back on the Society of Nuclear Medicine’s first 50 years of existence, we also are contemplating the future of this organization and the specialty it represents. When we gather for our annual meeting, June 19–23 in Philadelphia, we will be celebrating our past, but more importantly, we will be looking to a future that, at present, looks very bright for nuclear and molecular medicine.

The one unique principle that has served nuclear medicine well for the past 50 years, and that distinguishes it from all other imaging or therapeutic modalities, is the radioactive tracer principal. This permits nuclear medicine physicians to determine and monitor, with minimally invasive techniques, the physiologic, pharmacologic, and molecular modulations that form the basis of disease. Using radioactive tracers that are chemically associated with certain biomolecules, nuclear medicine can both diagnose and treat diseases. When these tracers are combined with recent advances in genetics and molecular engineering that allow scientists to target the very molecules where disease processes begin, our techniques have the potential to provide unequaled accuracy in diagnosing disease states and treating them at the cellular level.

Recent advances in tracer techniques have enhanced the ability of nuclear medicine physicians and scientists to target the characteristic molecular receptors expressed on cell surfaces that rapidly follow the genomic modulations in a living cell. These advancements also promise to target the up-regulated copies of the messenger RNA (mRNA) within the rapidly dividing cells. These capabilities might, in the future, allow physicians and scientists to detect a cluster of malignant cells long before the characteristic cell morphology has changed. These morphologic changes are considered the gold standard today for unequivocal diagnosis, but require excision of tissue by invasive intervention. It is not unreasonable to anticipate that before very long, molecular probes—armed with a suitable radionuclide—will allow nuclear medicine physicians to down-regulate the mRNA expression and arrest the division of the malignant cells. In the future, it also might be possible that amyloid plaques could be detected early, noninvasively, and prevented from further growth, and the misery of Alzheimer’s disease could be abated. Similarly, the arterial blockade could be seen early and treated effectively, and mortality from cardiovascular diseases could be reduced significantly.

Such technology, generally called molecular imaging, is emerging rapidly and has deep roots in nuclear medicine. The emphasis of molecular imaging—from targeting nonspecific processes to specific molecular fingerprints—represents a significant paradigm shift, the impact of which will lead nuclear medicine to a much greater ability to characterize diseases, diagnose them at a very early stage, treat them effectively, and even monitor the effectiveness of such treatment. All of these steps are possible without the excessive risk or morbidity that is so frequently associated with treatment for severe diseases.

This ability of nuclear medicine techniques to localize cells in a living body has been complemented by equally significant advances in computer technology and equipment. The added advantage of these outstanding advances in molecular imaging is to quantify results. Even today, images obtained in some cases are not just subjective or qualitative, but can provide meaningful quantitative measures. In the future, these measurements will quantify the biological phenomenon at a cellular level that can be a quantitative indication of the status of a disease, the nature of its aggressiveness, and the measurable effectiveness of disease treatment.

We will become even more efficient at watching the cellular processes of the human body as they are carried out in real time. Imaging of brain chemistry and even our very thought processes promise to transform the practice of neurology and psychiatry. Already, we can watch how a human brain responds to stimuli and how brains that show no evidence of gross pathology can, nevertheless, show signs of abnormal processing that provide keys to abnormal behavior.

In the story of science and its applications, the events and progress of molecular techniques now being developed are as significant as the discovery of X-rays and radioactivity itself. If such accomplishments are nurtured adequately and applied properly, it is not unreasonable to predict that these capabilities, combined with the development of novel molecular probes, will invigorate nuclear medicine even further. Despite the growth of competition, nuclear medicine will remain strong and continue to play a vital role in healthcare in general and patient management in particular—the two important objectives for which the Society of Nuclear Medicine was formed.

We will be discussing these developments with fellow scientists and medical practitioners from all over the world at the Annual Meeting. I hope that all medical imaging specialists who share my enthusiasm for the ability of molecular medicine to revolutionize healthcare will consider attending.

In addition to his duties for the SNM (Reston, VA), Mathew L. Thakur, PhD, is a professor of radiology/nuclear medicine at the Jefferson Medical College of Thomas Jefferson University (Philadelphia).