It was with unusually friendly weather that Birmingham/UK welcomed users and experts mid-October for a discussion of clinical practice and research trends in Nuclear Medicine. More than 5,100 attendees, 108 exhibitors, around 530 talks, and 970 posters – these figures serve to demonstrate the success of this meeting. Target groups of the 24th Annual Congress of the European Society of Nuclear Medicine (EANM, www.eanm.org) included physicians, medical physicists, technologists, radio pharmacists, further healthcare workers as well as technology vendors (›Fig. 1). All who are involved in medical informatics will also find nuclear medicine a challenging field for their activities, summarized Prof. Gill Vivian, Past President British Nuclear Medicine Society and EANM Congress President 2011 (›Fig. 2).
Functional imaging, hybrid technologies, and an interdisciplinary approach – cross-sector work in the context of PET, with a potential of combinations with MR and CT, were in the focus of the event, explained Conference Manager Andreas Felser. Consequently, symposia in cooperation with societies such as ESR, EORTC, ESTRO, ESMI, SNM, and ETA were constitutional elements of the congress.

A discipline on the rise

Molecular imaging and genomics have added impetus to nuclear medicine, described Vivian. This has led to improved knowledge about processes in tumors, in the heart, and basically in every human organ. Outstanding results have been achieved, in recent years, in brain and oncology research. Early diagnosis and individualized medication-based therapy are key benefits.

Adding value through collaboration

Potential diagnostic and therapeutic support from nuclear medicine for fellow physicians in other disciplines, said Vivian, requires an understanding of requirements. Only a close collaboration with clinical routine and research allows for tapping potentials.

Hybrid methods – the search for applications is on

With PET, biochemical and physiological functions can be visualized. In the case of, e.g., glucose metabolism, this permits to identify, e.g., tumor areas. The combination of PET function imaging with anatomical imaging provided by CT adds localization. This decisive benefit has “pushed for rapid growth of PET/CT”, described Prof. Gustav von Schulthess (›Fig. 3) in Birmingham. According to the Director of the Zurich Hospital for Nuclear Medicine, PET/MR is a highly promising technology which, however, is still in search of applications which make its added value tangible. In which respects is the new technology superior to PET/CT? This question provides the background for the “Trimodality Setup” implemented in Zurich – PET/CT and MR, linked by a transport system which allows for moving patients without changing their positions. This system makes possible separate acquisitions using PET/CT or MR as well as an integration with MR; based on this configuration, von Schulthess plans to explore PET/CT and PET/MR methods, and identify discerning benefits.

The key trends

What are the major developments in imaging? Tracer-based molecular imaging will make continued progress through the identification of new agents – e.g. in the context of Alzheimer plaques, predicts the expert. Innovation cycles for new tracers take more time, however. Hybrid imaging, which helps localize metabolic processes, will advance further. Whereas PET/CT is an established technology, PET/MR is still characterized by major technical challenges, in particular with regard to detectors.

The role of Medical Informatics

Enormous expertise from informatics is required for all these imaging technologies, e.g. in image reconstruction, added the expert from Zurich. Technology optimizations based on this know-how have led to iterative reconstruction; visualization of large volumes of data is another valuable field of activities in informatics – information from images needs to be interpreted efficiently and presented to clinicians in a way which supports decision making processes. Last but not least, image guidance is essential in minimally invasive procedures.
Large collaborative projects in nuclear medicine integrate medical informatics and general IT, explained Vivian. The Swedish software specialist Hermes Medical, with its focus on fusion imaging, supports projects such as the European Hodgkin Lymphoma Network with its IT expertise. More than 120 therapy centers within the EU are interconnected, rapid access to medical images as well as diagnostic discussion are made possible. For neuroblastomas, too, a pan-European platform has been implemented for communication and discussion, with the aim of developing a study, described the Congress President. EARL, the EANM Initiative for Multi-Center Nuclear Medicine and Research, integrates activities from medical informatics and aims at establishing standards in this field.

Highlights from the exhibit floor

The big three modality vendors in nuclear medicine – GE, Philips, Siemens – were present in Birmingham; some newcomers, contrast media and instrument manufacturers as well as dedicated IT vendors rounded off the offering. Among the modality manufacturers, patient throughput and reduced dose were key responses to market demand.
Philips (›Fig. 4) – as an example – showcased a comprehensive portfolio of applications for its multi-user and multi-modality platform IntelliSpace Portal. This solution for the processing and visualization of medical images sports functions and features which, previously, had been available only on modality workstations. The company presented current devices and models from its nuclear medicine portfolio, such as the whole body PET/MR Ingenuity TF. – Philips puts great emphasis on the „Time of Flight“ technology realized by the platform Astonish, which, according to the vendor, has helped to achieve significant advances in the speed and resolution of PET scans. The technology produces enhanced and more consistent image quality and allows for an earlier diagnosis of diseases. The PET/CT TruFlight Select is the first device of the below-premium product category which integrates Astonish TF.

Positioning – a major step for the discipline

In nuclear medicine, Clinical Marketing is essential, underlined Scientific Committee Chair Prof. Werner Langsteger. Based on the methods of nuclear medicine and research results, physicians from partner disciplines in hospitals and referring organizations need to be convinced of the value of this discipline. This is the only way to ensure, continued Langsteger in his address, that the discipline will be represented adequately in tumor boards and cardiology conferences. The collaboration with radiologists is key; together with this group, methodical approaches and results for PET/CT can be optimized, and application scenarios for PET/MR can be advanced. In oncology, too, this collaboration is crucial, in particular in the new field of Theranostics, in order to improve dissemination and acceptance for approaches in nuclear medicine.

Next update on nuclear medicine

The EANM Annual Congress 2012 will take place in Milan/Italy from 27 to 31 October 2012. To celebrate its anniversary, the event is returning to its starting point of 25 years ago. Anybody from medical informatics will find inspiration in Milan for activities in this exciting field.

Source: 24th Annual Congress of the European Society of Nuclear Medicine, Birmingham