CHICAGO—Radiology is on the cusp of once again refining the practice of medicine, according to an address Sunday morning by RSNA president Hedvig Hricak, M.D., Ph.D. “Cross-sectional anatomic imaging transformed radiology into an essential guiding hand of medical practice,” she said. “Now we are adding metabolic and functional imaging and evolving from descriptive reporting into precision and quantification.”
In her opening address, “Oncologic Imaging: A Guiding Hand of Personalized Cancer Care,” Hricak noted that the rapid expansion of molecular medicine demands a professional responsibility to adapt and change. Although anatomic imaging is used routinely in all aspects of cancer care, revolutionary advances in molecular imaging are providing new insights into cancer biology and new biomarkers for unprecedented precision in disease characterization. “As a result, our profession now finds itself in a pivotal position,” she said. “Oncologic imaging is paving the road to personalized medicine.” Hricak observed that over the next decade, molecular imaging will become a new subspecialty of radiology. This will require a new breed of physicians with training in nuclear medicine, diagnostic radiology, chemistry, and biology. However, she noted, each radiology practice needs to match its environment. “The expertise of radiologists needs to fit their practice environment,” Hricak said. “General radiologists will always be needed for primary care facilities and subspecialists will be needed for tertiary centers.”
Hricak believes that molecular imaging will enable developments in three areas that will profoundly affect cancer care: Integrated diagnostics that combine imaging and pathology; biology-driven interventional radiology; and theranostics, targeted imaging and targeted therapy. “The pace at which medicine is transformed will be guided not only by the pace of discovery, but also by the pace at which we educate new physicians, ourselves, and our coworkers,” she said.
“With the emergence of molecular medicine and the surge of ‘omic’ biomarkers, we are seeing a paradigm shift in cancer care,” Hricak added. “For many cancers, treatment is now targeted not only to the tumor type and stage, but to the tumor biology and its molecular pathways. We have the ability to provide the right care, to the right patient, at the right time. Imaging is not only following progress in molecular medicine, it is also leading the way. Non-invasive, in vivo molecular imaging is being used to make biologic discoveries and prove or disprove hypotheses generated by in vitro cellular research. As such, it is playing an essential role in the discovery and development of new drugs, and it is leading the field of theranostics.”
Hricak challenged the audience to remain focused on the path of innovation and collaboration in oncologic care. “Although implementing molecular imaging in oncology and medicine in general may seem to be a cumbersome and even intimidating process at times, we must persevere and help our field take a leadership role, remembering that all great achievements were a dream before they became a reality,” she stated. “Only by advancing together into the unknown can we peel away the layers of uncertainty that limit personalized cancer care.”