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.

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