Imaging in the Era of Precision Medicine

This post was submitted by James H. Thrall, MD, chairman emeritus of radiology at Massachusetts General Hospital and former ACR Board of Chancellors chair.

The National Research Council defines “precision medicine” (also called “personalized medicine”) as the tailoring of medical treatment to the characteristics of each patient. In practice this means establishing small precise sub-populations of patients that share the same characteristics and prognoses and are likely to benefit from the same treatments.

A new challenge for radiology in the age of precision medicine is to determine whether there are clinically useful linkages between genotype/gene expression and imaging phenotypes (observable disease manifestations). This is the focus of my Moreton Lecture at ACR 2015™ – The College’s all-new, all-radiology annual meeting May 17-21 in Washington, DC.

The term “radiogenomics” refers to the bi-directional study of how genotype and gene expression link to image phenotype— the manifestations of disease documented through imaging. Can we use image findings (imaging phenotype) to predict genotype? What imaging should be performed in the face of a given genotype, for example breast MRI in women with BRCA 1 mutations?

Going forward, information on genotype and the molecular behavior of tissues is becoming more available. Molecularly targeted therapies based on tissue genotype, such as EGFR mutations in NSCLC, are now common in the treatment of cancer. Imaging will serve important roles in precision medicine –remaining a pillar for establishing phenotypes and radiogenomic data will be combined with genetic and molecular data to increase diagnostic and therapeutic precision.

This is a large part of the future of radiology and the future of medicine. I strongly encourage you make the trip to ACR 2015 and to attend the Moreton Lecture. Now, more than ever, it is important that we come together at “The Crossroads of Radiology” and take our next steps toward what remains a bright future for our profession.

Hey USPSTF: Seeing is Believing

This post was submitted by Ally Parnes, M.D., Breast Imager and Breast Cancer Survivor.

After reading the latest U.S. Preventive Services Task Force (USPSTF) draft breast cancer screening recommendations, I would really like to meet with the USPSTF members. You see, not only did I decide after 10 years of medical training that there was plenty of reason (solid, scientific evidence) to dedicate my entire medical career to breast imaging, but also because I’m a 42 year old breast cancer survivor, diagnosed just 2 years ago (by wild coincidence given my chosen career path) from a mammogram.

There is no doubt in my mind that I’d now be dead or close to it had it not been for that exam. My tumor was less than the size of a pea, far back in my left breast. It was the type of tumor that, once seeded outside the breast, likes to come back years later to rear its ugly little head, cropping up in bones, belly, or even brain. But, I was lucky. The day after I sat for my radiology board exam in Louisville, Kentucky I went to the O.R. to have my tiny, early-stage cancer removed, before it could grab a hold of me anywhere else.

A few months later, during my women’s imaging subspecialty training, and while I was also undergoing chemotherapy, I read a less fortunate young patient’s abdominal ultrasound. She was pregnant. She felt a lump. She was diagnosed with breast cancer, an aggressive type, and I was examining images of her liver, and there they were—ugly tumors that had spread to the rest of her body.

If the committee members don’t think young women can benefit from early detection, or that any woman needs a mammogram more often than once every couple of years, they should come to work with me. I’ll show them how easy it is to find a later stage tumor sitting in the breast of a woman who didn’t think it was important to keep up with annual screening. I’ll ask them to tell her how big it is, that they’re not sure where it has spread, or how aggressively it will need to be treated.

I can also introduce them to the 39-year-old young woman that I saw last month with a large, aggressive tumor deep inside her breast that had already spread to her chest wall and lymph nodes… and who is now waiting to learn if any other sites have been infiltrated. Sadly, there are many more women just as young – and just as sick.

Cancer is a war against humankind. You don’t win that war by sitting back and letting it run amuck, then acting at the ninth hour.

To the USPSTF: If life and quality of life are precious to you, meet me and the women for whom I’m privileged to care. Stare cancer in the face not just on my computer monitor, but inside my patients and tell us all how unimportant screening mammograms are. Just try.

Clinical Research Advances Patient Care and Our Practices

The following post was contributed by Donald P. Rosen, MD, chief research officer,  American College of Radiology. 

I think that most radiologists know that clinical research advances our profession regarding improved patient care. Do you think most of us realize that taking part in clinical research can strengthen our practices financially? How about that the American College of Radiology (ACR) can actually help practices take part in clinical research? Well, it can.

In fact, The College is offering a number of clinical research sessions at ACR 2015™, the College’s all-new annual meeting, to help radiology professionals understand:

  • The differences between industry-sponsored, highly-regulated research and government-sponsored research answering scientific hypotheses
  • The requirements to carry out research
  • How research participation can result in additional practice revenue
  • Research as a non clinical career path
  • The non-monetary benefits gained from research participation
  • The critical basic skills needed for writing, reviewing and editing imaging health services research publications

The sessions will help attendees:

  • Describe the importance of imaging research for radiology’s future and for expediting approval of new applications for drugs and devices
  • Analyze the opportunities and challenges for conducting clinical research within the radiology practice to determine the key steps required to initiate a practice-wide research program
  • Describe how industry and radiology practices could benefit from a relationship in research and how the ACR can assist practices in this effort

ACR 2015 clinical research sessions include:

ACR 2015™ – The Crossroads of Radiology – will be held May 17–21 at the Marriott Wardman Park Hotel in Washington, DC. If you have thought about taking part in clinical research, but maybe didn’t quite know how to get started, or how your practice might benefit from it, I strongly suggest attending ACR 2015 and checking out the clinical research sessions while you are there.