Professor Riemer Slerth discusses how nuclear medicine has evolved to play an important role in medicine today and explains how the European Society of Nuclear Medicine is supporting advances in the field.
Nuclear medicine, a medical science based on the application of radionuclide-labeled probes (radiopharmaceuticals) to the diagnosis and treatment of disease, has undergone significant transformation in recent years, evolving from a niche diagnostic specialty to the core of modern precision-driven medicine. Once confined primarily to gamma camera imaging and limited therapeutic applications, the field has historically been considered to have a relatively small contribution to clinical decision-making.
Today, however, nuclear medicine is at the forefront of innovation, driven by advances in imaging technology, the development of radiopharmaceuticals, and an increasingly sophisticated understanding of disease biology. Nuclear medicine currently plays an important role in guiding clinical decisions, shaping treatment pathways, and improving patient outcomes.
As the field enters what many are calling a “golden age,” its integration into mainstream medicine continues to deepen, supported by organizations that promote standardization, research, and cross-border collaboration. A key player in this effort to improve the field of nuclear medicine is the European Association for Nuclear Medicine (EANM). For more than 40 years, this nonprofit organization has been dedicated to advancing nuclear medicine to improve public health and has continually evolved to keep pace with advances in the field. To learn more about the initiative, editor Georgie Purcell spoke to Riemer Slaat, editor-in-chief of EANM Innovation and professor at the University of Groningen in the Netherlands.
How has the role and potential of nuclear medicine evolved to where it is today? How does it compare to 10 or 20 years ago?
If you look back about 10 to 20 years in the field of nuclear medicine, the focus was primarily on diagnosis, especially diagnosis using gamma camera technology. Additionally, its therapeutic use was primarily limited to thyroid tumors and early-stage lymphomas. At that time, it was a very minor figure in the medical world.
We now have a fully integrated nuclear medicine field focused on positional imaging and are using new camera technology to do this. Hybrid imaging techniques such as SPECT/CT, PET/CT, and PET/MRI have also been introduced, which are now standard. Additionally, more tracers are becoming available for use in clinical practice. Most importantly, we are also seeing an increase in theranostics. For example, PET/CT or PET/MRI scans are used to detect prostate cancer, as well as somatostatin receptor imaging and neuroendocrine tumor imaging.
Nuclear medicine is currently having a strong impact on hospital decision-making and patient outcomes, including treatment, through image processing. We are witnessing a transition from disease imaging to biological characterization and treatment.
How is the European Society of Nuclear Medicine working to shape the field of nuclear medicine?
EANM is a very important society for the field of nuclear medicine and promotes many important areas. It is the scientific, clinical and strategic backbone of our field in Europe and the rest of the world. Looking at the main pillars driving EANM’s work, the first is the development of guidelines and standardization in nuclear medicine. These include guidelines for both clinical and technical procedures.
EANM also promotes harmonization between countries. Imaging data from different camera systems can be compared to each other because everyone is doing the same thing when it comes to imaging technology. This is important not only in the clinic but also in clinical trials. The ability to directly compare one vendor to another allows for harmonization.
Another big part of our work is education and training. We host an EANM conference once a year where everyone comes together to network and exchange knowledge. There is also the European School of Multimodality Imaging & Therapy (ESMIT), which offers both offline training via webinars and face-to-face sessions.
Another component of EANM is research innovation. We support multicenter clinical trials and promote translational research that includes not only clinical research but also preclinical research.
Advocacy is also important to us. Our Policy and Regulatory Affairs Council (PRAC) coordinates and implements the policy activities of the EANM at EU level through continuous dialogue with EU policymakers and stakeholders.
What are the most promising developments in nuclear medicine today?
Nuclear medicine is currently in a so-called “golden age” driven by biologically targeted radiopharmaceuticals.
One key area is expanding treatments beyond neuroendocrine tumors and prostate cancer. The company also has new goals in the field of oncology and may expand into additional fields.
If we look outside of biology, we have radiopharmaceuticals. Our hospital uses radionuclides as a treatment method. Beta emitter is an important component. However, alpha emitters are now starting to play a more important role, as they have stronger effects and higher potency against tumors, potentially improving overall treatment efficacy.
Another promising development is individualized dosimetry of how much radionuclide treatment dose is needed for which patients. The “one dose fits all” approach no longer works, and it is now possible to customize dosimetry to individual patients.
Additionally, another rapidly developing field is artificial intelligence (AI). It is already benefiting a variety of applications, including reconstructing and interpreting data from cameras, optimizing workflows, and creating more complex algorithms using machine learning and deep learning algorithms to predict patient responses.
An example of what we are currently working on in our lab is automated reporting. For example, if a PET scan detects an abnormality, it can be examined not only by a nuclear medicine doctor but also by an AI algorithm. Both findings can then be compared or the AI can even run an automated report of the PET scan. This saves time and provides a more thorough way to check your scans.
EANM is also working on the production of new radionuclides and strengthening its supply chain. Having an adequate supply of nuclear material in Europe is important not only for oncology, but also for other fields such as infectious diseases, inflammation, cardiovascular and neurology.
There are also very strong developments in new applications such as cardiovascular. Nor is it necessarily a completely new development. There are specific tracers that have been developed and applied for specific fields, but they can now be applied to other fields as well. For example, one antibody may work well for imaging a particular tumor type, but the same antibody may also be used for autoimmune diseases. This allows you to work smarter and save money and time.
What are the biggest challenges facing nuclear medicine innovation and development? How is EANM working with partners to overcome these challenges?
In general, innovations in nuclear medicine are currently progressing very rapidly. However, the infrastructure and regulations that support this are lagging behind. There are several important challenges that we must address. One is regulatory complexity. In Europe, radiopharmaceuticals are treated in the same way as conventional medical drugs. But conventional drugs are therapeutic, and when using radiopharmaceuticals, it is a diagnostic dose, which is a very low dose compared to the therapeutic dose. We need to persuade European regulatory bodies to reframe the way they view radiopharmaceuticals to reflect this.
There are also supply chain issues when it comes to isotope production. We need to produce enough and reliable isotopes. Any disruption or miscommunication at any point in the supply chain can cause serious problems in the supply of radiopharmaceuticals. The world is running out of radiopharmaceuticals and we need to find a solution. Processes need to become smarter, and there also needs to be sufficient backup for the production of radiopharmaceuticals.
Another aspect is the workforce and training camps. We really need to work on it because there is a lack of dedicated experts in our field. The demand for nuclear medicine is also rapidly increasing. We expect the scale of radionuclide therapy to grow fivefold over the next 15 years. This means five times more patients, five times more beds, and five times more radionuclides. Keeping up with this rapid growth requires both national and international roadmaps.
Large multicenter trials are needed to validate new methods and clinical applications. This has not been a strength of nuclear medicine until now. However, we are also increasingly working in this area in collaboration with clinical societies.
EANM can contribute to improving the field of nuclear medicine by achieving better harmonization with regulatory authorities and further collaboration with industry.
What do you hope for the near future of nuclear medicine?
In general, we would like to see more integration with different disciplines. We work closely with fields such as radiology and radiotherapy, as well as clinical fields, and we need to integrate our work flows. As mentioned earlier, expansion is important because we are facing a large number of new patients and groups.
It is important to integrate our treatments and diagnostics into standard clinical pathways. Of course, digitalization and the application of AI in decision-making are also progressing.
Looking to the near future, nuclear medicine will become less of a complementary specialty and more integrated into core decision-making processes beyond oncology.
This article will also be published in the quarterly magazine issue 26.
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