1. Advancing Nuclear Medicine through Research Jennifer McKenzie, CNMT NUCM 480

2. What is Nuclear Medicine? Nuclear medicine specialists use safe, painless, and cost-effective techniques to image the body and treat disease. Nuclear medicine imaging is unique, because it provides doctors with information about both structure and function. It is a way to gather medical information that would otherwise be unavailable, require surgery, or necessitate more expensive diagnostic tests. Nuclear Medicine imaging procedures often identify abnormalities very early in the progress of a disease long before many medical problems are apparent with other diagnostic tests.

3. Who is it for? Today, nuclear medicine offers procedures that are essential in many medical specialties, from pediatrics to cardiology to psychiatry. New and innovative nuclear medicine treatments that target and pinpoint molecular levels within the body are revolutionizing our understanding of and approach to a range of diseases and conditions.

4. Patient Care Practices Nuclear medicine is divided into two major areas: diagnostics and therapeutics. The diagnostic side is mature, while the therapeutic side of nuclear medicine is in its infancy. Over 100 diagnostic radiopharmaceutical products are available. The largest number of these radiopharmaceuticals have applications in cardiology, followed by oncology and neurology. A few radiopharmaceuticals have applications in other areas, such as infection imaging and nephrology. We use evidence based medicine and patient care practice information to help shape the future of our field as we continually strive to provide patients with the best health care possible.

5. Research in Nuclear Medicine There is no doubt that Nuclear Medicine is a field that witnesses impressive technological progress and changes Clinical research is critical to this progress Some of the effects of both current and past research in Nuclear Medicine include: Improved diagnostic testing Better imaging drugs and radiopharmaceuticals Better treatment therapies Safer patient care practices

6. Development of Imaging Equipment Over the years, nuclear medicine has seen tremendous advances in the way we diagnose disease within the body Exploratory surgery used to be the way doctors investigated health problems Since the 1950s, nuclear technologies have offered an array of different techniques without the pain of surgery Scanners have evolved from single planar to SPECT to PET and now to SPECT/CT and PET/CT PET/MRI and PEM (positron emission mammography) are two others that will soon become more readily available

7. Timeline of Imaging Equipment 1951 – a scintillation detector to “scan” the distribution of radioiodine within the thyroid gland was invented 1954 – photorecording system for radionuclide scanning was invented 1958 – scintillation camera was invented that made it possible to conduct dynamic studies 1959 – first rectilinear scanner 1962 – emission reconstruction tomography was introduced Later to be known as SPECT and PET 1976 – the first general purpose SPECT camera was developed 1983 – first successful PET scan was performed 2008 – the first hybrid PET/MRI system for humans was installed Without research, none of this would be possible or available today! Ref: www.snm.org

8. Diagnostic Radiopharmaceuticals Molecular imaging at a cellular level is currently the main focus in the research of diagnostic radiopharmaceuticals[5] Another focus is working towards the development of new agents for diagnosis with 99mTc radiolabeled drugs[5] Shifting from conventional radiolabeling to a new method that yields a high specific activity, high stability, and site-specific radiopharmaceutical[5] This research allows us to provide safer diagnostic procedures with less radiation exposure to the patients.

9. Advancements with Radiopharmaceuticals The first radiopharmaceutical approved by the FDA for use was I-131 for the treatment of thyroid cancer[1] Since the first discovery that nuclear radiopharmaceuticals could have a diagnostic and therapeutic effect on the treatment of disease, many clinical trials have been conducted. It’s through those clinical trials that new drugs have been developed and utilized for the treatment and diagnosis of disease In the early years, diagnostics largely concentrated on bone scanning and cardiology[4] This has now changed with the changing market and oncology is a rapidly growing and promising area for nuclear medicine research[4]

10. Radioisotope Clinical Trials These are important advancements in current nuclear medicine climate What do Clinical Trails Accomplish? What results have they had? Clinical trials are a step in medical research conducted to allow safety (or more specifically, information about adverse drug reactions and adverse effects of other treatments) and efficacy data to be collected for health interventions e.g., drugs, diagnostics, devices, therapy protocols There is new progress made by using clinical trials almost every day, they include advancements in : Treatment of pain in cancer therapy Treatment of adverse drug reactions Monitoring of recovering organs or diseased organs and pathological processes Diagnoses Emergent treatment options

11. Therapeutic Radiopharmaceuticals Research Nuclear Therapy and Treatment for cancer patients are two major areas where nuclear medicine research efforts have been taken. Radionuclide therapy using unsealed radiotherapeudic agents is a fast emerging molecular modality Some of these therapies include: Re-188/186 Sm-153 Y-90 Ho-166 Lu-177 Yb-175

12. Yttrium 90 Received FDA approval in 2000 for treatment of Liver Tumors, mainly those who could not undergo surgical resection of the tumor itself. New Research A study done in 2011 by the Society of Interventional Radiology found alternative methods of radioisotope administration for Liver tumors with Yttrium 90 therapy which extended the patents lives further than the original protocol used in 2000 [7] Yttrium 90 research has helped reduce mortality and morbidity from Liver tumors, and give cancer patients a better quality of life.

13. Bone Pain Palliation Making patients comfortable while they are dealing with pain from bone metastases is a big research area for nuclear medicine Some new drugs that are being research and developed: Re-186 Sm-153-Lu-177 Yb-175 What does this mean for patients? Advancements in treating patients with bone pain from cancer metastases help reduce suffering and morbidity in cancer patients. These advancements were not present 20 years ago in this field, and would not be present today without research progress.

14. The Forefront of Nuclear Medicine Research Yttrium-90 and Bone Pain Palliation Research are just two of the hundreds of research and clinical trials being conducted today. There is also a huge amount of research being done within the PET and oncology setting and the SNM is at the forefront of most of the research that is being conducted today. They provide a forum for nuclear medicine latest and most definitive scientific investigation[1] The Society journals, The Journal of Nuclear Medicine and The Journal of Nuclear Medicine Technologists, are the international standards in the publication of peer reviewed research in clinical and basic nuclear science. New research in the field is fostered by Society fellowships and through the efforts of the Education and Research Foundation.

15. Conclusion With the medical climate progressing in technological advances each year, and new disease processes becoming apparent, medicine must keep up. Medical staff needs to use the advances in research to contribute to maximal patient care. Nuclear Medicine is a rapidly advancing field that has undergone numerous changes over the past 30 years. It is more exciting and challenging than ever, and continues to be an area where new advances are made every day thanks to research efforts across the world.

16. References "Society of Nuclear Medicine." SNM - Advancing Molecular Imaging and Therapy. Web. 21 Apr. 2011. <http://www.snm.org/research/>. "Advancing Nuclear Medicine Through Innovation." The National Academies Press. Web. 21 Apr. 2011. <http://www.nap.edu/catalog.php?record_id=11985>. "Journal of Nuclear Medicine's Impact Reaches New Heights." SNM - Advancing Molecular Imaging and Therapy. Web. 21 Apr. 2011. <http://interactive.snm.org/index.cfm?PageID=7741>. "Future of Nuclear Medicine Part 1: Marketing Research Forecasts." Journal of Nuclear Medicine 32.2 (1998): 27N-30N. www.snm,org. Web. 21 Apr. 2011. <http://jnm.snmjournals.org/cgi/reprint/39/2/27N.pdf>. Kumar, Vijai. "Chapter 3: Radiopharmaceutical Research." BARC Highlights: Chemical Science and Engineering. 21-22. BHABHA Atomic Research Center. Web. 21 Apr. 2011. <http://www.barc.ernet.in/publications/eb/golden/chemical/toc/chapter3/3_4.pdf>. "U.S. DOE Molecular Nuclear Medicine Timeline." U.S. DOE Molecular Nuclear Medicine. Web. 21 Apr. 2011. <http://www.doemedicalsciences.org/timeline.shtml>. "Interventional Radiology Y-90 Liver Cancer-busting Treatment: Safe, Fast, Extends Life." PhysOrg.com - Science News, Technology, Physics, Nanotechnology, Space Science, Earth Science, Medicine. Web. 21 Apr. 2011. <http://www.physorg.com/news/2011-03-interventional-radiology-y-liver-cancer-busting.html>. "Utility of 99m-Tc-MAG3 Renal Scintigraphy in Assessing Cisplatin-induced Nephrotoxicity -- Zehra Et Al. 49 (1001): 137P -- Society of Nuclear Medicine Annual Meeting Abstracts." The Journal of Nuclear Medicine Online. Web. 21 Apr. 2011. <http://jnumedmtg.snmjournals.org/cgi/content/meeting_abstract/49/MeetingAbstracts_1/137P?maxtoshow=>. "Clinical Trial." Wikipedia, the Free Encyclopedia. Web. 21 Apr. 2011. <http://en.wikipedia.org/wiki/Clinical_trial>.