Medical Device Daily

CHICAGO — Elias Zerhouni, MD, director of the National Institutes of Health, delivered the Eugene P. Pendergrass New Horizons Lecture, titled "Major Trends in the Imaging Sciences," at the Radiological Society of North America (Oak Brook, Illinois) annual meeting. He said he envisions an emerging healthcare role for which radiologists are uniquely suited.

"Imaging will redefine itself in this century as the core interdisciplinary science for generating, understanding and using spatially and temporally resolved biological information at all levels of intact biological systems," Zerhouni said. And he said that because radiologists routinely deal with a number of specialties, diseases and healthcare professionals, they are suited to lead multidisciplinary approaches to investigation of disease.

Zerhouni said he believes this shift will take place as the public demands that medicine moves away from a curative paradigm "to a preemptive model, where physicians have the information to intervene before disease is expressed in symptoms and loss of function."

Describing what he calls the Future Paradigm, or P4 Medicine, Zerhouni said, "Medicine will be predictive, personalized and preemptive — as we've already seen with advances in Alzheimer's disease, diabetes and in the development of the vaccine for cervical cancer; and, finally, participatory in which we shift to a cooperative network made up of patients and healthcare providers. These trends will be served by changes in science and public health demand."

The population's healthcare needs are changing from acute illnesses to chronic illness, said Zerhouni, noting that 80% of the country's healthcare expenditures are now related to largely chronic, end-stage illnesses.

Zerhouni said that the medical system will be challenged by an aging population and persistent healthcare disparities.

"We will continue to be challenged by the emergence and re-emergence of infectious diseases, as we've seen with resistant staph infections in the past few weeks," he said.

And he drew a laugh from his audience by illustrating one of the ultimate public health challenges with a slide showing the evolution of humans — from lean, primitive-looking creatures to larger, obese human figures. His not-so-humorous analysis of this problem: "We will see non-communicable diseases like obesity determine the shape of things to come."

The transformation from a curative to a preemptive healthcare model, he said, will be based on the many advances that have occurred over the past 10 years "in our understanding of the molecular mechanism of disease."

These advances "clearly point towards a more predictive, and preemptive form of medicine, and in turn, will require the development of better functional and quantitative imaging methods to guide medical interventions."

Exciting developments will occur as frontiers in in vivo imaging are conquered, he said, using multi-photon fluorescent microscopy of the kidney as an example. Illustrating this, he showed a slide in which you could clearly see the action of individual cells overcoming bacteria.

"As you can see it's one cell to one infectious agent," he said. "It's really a 'mano-a-mano' fight."

"New technology allow us to see what is happening in the disease process and track it over time. This may drastically alter the management of autoimmune and inflammatory diseases."

At the tissue and organ levels, Zerhouni said that targeted imaging for both preclinical detection and monitoring during treatment of specific pathologies will remain a top priority, "both for research purposes and for the development of new biomarkers that will be critical to the clinical management of chronic diseases."

As an example, he pointed out that in vivo molecular imaging research in cancer is now driven by the need to monitor the biological response of a tumor even before changes in size may be observed.

This monitoring, he said "allows for the personalization of the treatment approach."

He also emphasized the enormous impact of gathering and making available to radiologists large imaging databases such as the Alzheimer's Disease Neuroimaging Initiative (ADNI). The five-year project includes data on the brains and cognitive function of 800 patients.

Zerhouni expressed optimism that the "next 40 years of imaging research may well be even more exciting than the past 40 years, with a growing impact at all levels of scientific as well as medical applications."

No Comments