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Barnard Institute of Radiology & Oncology, Madras Medical College & Government General Hospital,
and Advanced Nuclear Medicine Research Institute, Chennai. E. Mail – [email protected]
Medical Imaging in Future – Physician’s Perspectives
Dr. E. Prabhu, M.D.(Gen. Medicine), D.R.M., FIMSANuclear Medicine Physician, E.C. member, SNM (India) &
NABH Assessor for Medical Imaging
15th August, 2010
Internal Medicine has always attracted the best students, has prestige, poses intellectual challenge and promises full patient care.
There fore we need periodic up-dates in
Technical advances in genetics and molecular biology
Medical Imaging, Computers and their role in Clinical Decision Making
Political, Economic & Life- style challenges in modern society
Currently, we do not focus only on the causes of our patient’s problems. Instead, we search for modifiable molecular manifestations of the problems in terms of location, structure, function & biochemistry.
K ShellK Shell
L ShellL Shell
M ShellM Shell
DNA Strand
Options in Medical Imaging includes the Digital Radiography, Ultrasound, the Computed Tomography, Optical Imaging, Magnetic Resonance & Functional MR, the SPECT / PET and the PACS for Image Archiving and Communication
Clerca. J et al; Scintigraphic Imaging of Paediatric Thyroid Dysfunction, Horm Res (2008);70:1-13
There are about 20,000 different types of molecules in the body. Either these molecules send wrong messages are don’t receive right messages. Recognition of the molecules is the basic for diseases.
…functions are fast processes of short duration, while structures are slow processes of long duration …
Technological Advances in Medicine for Diagnosis and Treatment are Less Invasive, Precise and
Objective
Modern Medical Imaging helps in Integration and Weighing of Complex Clinical information
This helps us to take Leadership position in Medicine by interpreting bewildering array of information and making wise Clinical decisions
Thyroid Scan & Thyroid SPECT Scan
Parathyroid & Adrenal glands Scan
Spinal Metastasis & Metastatic Disease to the Spine & Related Structures
Approximately 94-98% of these patients present with epidural and/or vertebral involvement. Intradural extramedullary and intramedullary seeding of systemic cancer is unusual; they account for 5-6% and 0.5-1% of spinal metastases, respectively. Patil et al. National inpatient complications and outcomes after surgery for spinal metastasis from 1993-2002. Cancer. Aug 1 2007;110(3):625-30.
99mTc – DTPA 51Cr – EDTA
99mTc – DTPA 51Cr – EDTA
99mTc – MAG3 99mTc – EC131I – OIH
99mTc – MAG3 99mTc – EC131I – OIH
99mTc – DMSA 99mTc – GHA
99mTc – DMSA 99mTc – GHA
Radiopharmaceuticals in Kidney imaging
99mTc-DTPA Dynamic Renal Scan – Left Kidney Outflow Obstruction
11C – Acetate 18F-FDG (Glucose Metabolism)
11C – Acetate 18F-FDG (Glucose Metabolism)
55Co/68Ga – EDTA GFR= 58 – 30ml/min/100g
55Co/68Ga – EDTA GFR= 58 – 30ml/min/100g
15O – H2O Normal 340ml/min/100gC.K.D.
210+110 ml/min/100g
15O – H2O Normal 340ml/min/100gC.K.D.
210+110 ml/min/100g
15C– CO gas (Renal Blood
Volume) Young – 19ml/100g Old – 12
ml/100g
15C– CO gas (Renal Blood
Volume) Young – 19ml/100g Old – 12
ml/100g
11C – Gly-Sar (Drug Metabolism)
11C – Gly-Sar (Drug Metabolism)
11C –Zofenopril Calcium ACE binding
11C –Zofenopril Calcium ACE binding
18F –FHBG18F –FHBG
13N –NH313N –NH3
62Cu– PTSM
62Cu– PTSM
(Renal Blood Flow) 300 –
550 ml/min/100g
(Renal Blood Flow) 300 –
550 ml/min/100g
(Monitoring HSV1-tk reporter gene
therapy)
(Monitoring HSV1-tk reporter gene
therapy)11C(R)–PK1119511C(R)–PK11195
(Ischaemia in RAS, Tumour Hypoxia &
Angiogenesis)
(Ischaemia in RAS, Tumour Hypoxia &
Angiogenesis)
11C(L)–753,03711C(L)–753,037
PET Radiopharmaceuticals in Kidney Imaging
99mTc – MIBI Myocardial Perfusion Study
99mTc – MAA Lung Perfusion Scan – Before & After Treatment
PET imaging of the Immune System in Small animals
99mTc- Sulphur Colloid (Normal & Cirrhosis of Liver)
Women Imaging in Nuclear Medicine
Scintimamography and Hysterosalphingoscintigraphy
18F- FDG
99mTc- ECD, HMPAO
18F Carfentanyl (Opoid receptor)
99mTc - RBCs (Blood Volume)
Cerebral Perfusion SPECT with 99mTc-ECD
Acetylcholinesterase & vesicular acetylcholine transporter radiotracers (+)-4- 18F]fluorobenzyltrozamicol
-Amyloid radiotracers N-11C]methylamino-4’-hydroxy-stilbene
2-fluorine-18 fluorodeoxyglucose (18F)FDG
Muscarinic – cholinergic system 11C] scopalamine, 11C]topanyl benzilate
Apoptosis 99mTc] Annexin 4-18F]fluoro benzyl-annexin V
Nicotinic – cholinergic receptors 18F] fluoroNIDA52189
Brain Serotonin system5-HT1A receptor ligands - agonists 11C] carbonyl-WAY-1006355-HT1A receptor ligands - antagonists 11C] O - methyl-WAY-1006355-HT2A receptor ligands 11C]N-methylspiroperidol (NMSP)
Brain Dopamine system
D1 Striatum to s. nigra N-18F] fluropropyl SCH 24518 D2 Striatum to g. pallidus N-18F]fluroalkylspiropiradol D3 N. Accumbens & islands of Calleja 11C raclopride D4 Several
limbic & cortical regions 11C nafadotride D5 Limbic
areas 11C N-2-4-(4-chlorophenyl)- piperazin-1-yl]ethyl]-3-methoxybenzamide (PB-12)
Hypoxia 18F]fluoromisonidazole, 60/62Cu]ATSM
Metabolic Images of the Brain
In modern medicine, orientation towards organs has become old fashion!
MRI / MRS
PET
ANATOMY, ATROPHY, CONNECTIVITY, DIFFUSION, RELAXOMERTY,MAGNETIZAATION
TRANSFER, PERMEABILITY PERFUSION & BLOOD FLOW
GLUCOSE CONSUMPTION
BLOOD / TISSUE OXYGENATION
CELL LABELLING
NEUROTRANSMITTORS
RECEPTOR DENSITY
METABOLITE CONCENTRATIONTISSUE pH
AMINO / NUCLEIC ACID METABOLISM
Structure + Function
Integration
Then Dawn of Fusion & Multidisciplinary Medical Imaging
PET MRI CT PET-MRI PET-CT PET-CT-MRI
Receptors, enzymes, membrane transporters and Signal transduction proteins in renal diseases, Tissue Hypoxia and Apoptosis in renovascular disease and in obstruction
Endothelial dysfunction and assessment of molecular response to drugs and atherosclerosis; Drug delivery systems based on anion, cation, glucose and peptide transporters
Reporter gene therapy and monitoring rejection, Targeting receptors, oncoproteins, growth factors and cytokines
Anatomical and Functional Renal Images PET+CT+MRI
Current trends in Molecular Imaging
131I Whole Body Scan
124I Whole Body PET Scan
18F - FDG Whole Body PET Scan
Funding in Nuclear Medicine
Political and Economic Challenges of Modern Society
Projected Mid-year Population in 2010
26%
17%
96 %
Population Structure by Age & Sex in 2005
SEA Countries
USAMales Females
Burden of Diseases in the USA and Third World
Countries
Public Health Expenditure in Developed Countries
Public Expenditure on Health in SEA Region
Current Research in Medicine and Medical Imaging
‘....in future, diagnoses will be molecular, treatment will be molecular, and monitoring the response to treatment will be molecular...’ .
1970 2010
Personalized Medicine