Celebrating Contributions of Imaging Technology to Fight against Cancer at the 50th NCA Anniversary
2022; Radiological Society of North America; Volume: 4; Issue: 5 Linguagem: Inglês
10.1148/rycan.220085
ISSN2638-616X
AutoresYantian Zhang, Robert J. Nordstrom,
Tópico(s)Radiation Dose and Imaging
ResumoHomeRadiology: Imaging CancerVol. 4, No. 5 Next EditorialFree AccessCelebrating Contributions of Imaging Technology to Fight against Cancer at the 50th NCA AnniversaryYantian Zhang , Robert NordstromYantian Zhang , Robert NordstromAuthor AffiliationsFrom the Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, 9609 Medical Center Dr, Bethesda, MD 20892.Address correspondence to Y.Z. (email: [email protected]).Yantian Zhang Robert NordstromPublished Online:Aug 12 2022https://doi.org/10.1148/rycan.220085MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In IntroductionThe National Cancer Act (NCA) was signed into law in December 1971. In our fight against cancer over the past 50 years, medical imaging has played a major role. It has substantially contributed to our overall efforts and success in understanding and treating cancer, as well as improving patient outcomes. In celebrating the 50th NCA anniversary, we would like to reflect on the scientific and technological advancements in medical imaging over the past 50 years. Advanced medical imaging capabilities are currently broadly applied in cancer research and patient care, and they will continue to help propel us toward our eventual conquest of cancer.Since the first radiographic image in 1895, the development of medical imaging technology has made giant strides in acquiring views of the body at high speed and image quality. Such technologies have also been broadly adopted in animal research and veterinary clinics. Advances in medical imaging in many clinical applications have changed the way cancer is detected, diagnosed, and managed. Today, a patient’s visit to any modern hospital often starts with a physician’s order for an image, with CT, MRI, US, or PET imaging as possible choices. Given these modern medical imaging capabilities, the need for exploratory surgery for treatment decision-making is beginning to fade from memory.Today, many of the major medical imaging modalities that we routinely use in clinics either did not exist 50 years ago or were in the early stages of development. However, we sometimes feel as if these medical imaging capabilities have always existed and do not fully appreciate that they are relatively recent innovations.As with other medical specialties, the practice of clinical oncology has been fundamentally improved by advances in medical imaging technologies in the past 50 years, as most tumor detection is now commonly performed with medical imaging. Image-based assessment plays a critical role in monitoring disease progression, informing and guiding treatment, and evaluating treatment response. New imaging technology developments and their broad use in cancer research have enabled breakthrough advances in our understanding of cancer and have supported development of new cancer treatments across the entire breadth of the cancer research frontier.In this editorial, we briefly reflect on the development and advances of a few modern medical imaging technologies that emerged since the signing of the NCA.CT ImagingThe Nobel Prize in Physiology or Medicine was awarded to Allan Cormack and Godfrey Hounsfield jointly in 1979 “for the development of computer assisted tomography.” Hounsfield described his invention in 1972 (1,2). A special section in a recent Journal of Medical Imaging issue celebrated the 50th anniversary of CT development and provided fascinating accounts of its history (3). The National Cancer Institute (NCI) and other institutes of the National Institutes of Health (NIH) participated in supporting some of the early CT technology development research, as noted in funding support to David Chesler and Gordon Brownell by the NCI R01 grant “Transverse Section X-ray Camera” awarded in 1974. Since its development, CT imaging research and advances have come a long way from fuzzy images to high-resolution three-dimensional images, long acquisition times in tens of minutes per section to state-of-art whole-body scanning in seconds, and simple back projection reconstruction to fan-beam, cone-beam, and artificial intelligence–based reconstructions. As a result of these advances, CT has many indications for use and is broadly adopted in clinical practice. CT is a major workhorse in today’s radiology departments and a major imaging modality used by clinical oncology.CT research continues unabated. Ongoing research by major imaging device vendors and academic investigators, often through their partnerships, aims to improve scanner system performance and lower radiation dose (4). Examples of such research efforts include the development of flat-panel detectors (5) for imaging in radiation therapy applications, dual-energy or spectral CT (6), and photon-counting CT (7). Active research explores the development of new system hardware, as well as new CT imaging clinical applications. The NCI Cancer Imaging Program (CIP) grant portfolio includes many examples of cutting-edge CT cancer imaging applications research, including exploration of reduced-dose quantitative CT imaging for treatment response assessment (8).MRI TechnologyThe beginnings of MRI as an imaging technology can be traced back to a 1973 publication by Paul Lauterbur in Nature (9). Dr Lauterbur shared the Nobel Prize in Physiology or Medicine with Sir Peter Mansfield in 2003. MRI technology rapidly developed in the 1980s, as demonstrated by the large increase in acronyms for new MRI methods. While developing this nascent imaging modality, the academic MRI research community made great contributions to many critical research innovations. Many MRI methods adopted in commercial imaging systems are based on research originally reported in the academic research journals Magnetic Resonance in Medicine, Journal of Magnetic Resonance Imaging, and Radiology.Many NIH institutes contributed to funding this pioneering imaging research. An interesting example is an NCI R01 grant awarded to Dr Lauterbur in 1974 titled “Application of NMR Zeugmatography in Cancer Research.” Following this award and two successful competing renewals, the NCI supported Dr Lauterbur’s research to develop and explore MRI applications for imaging cancerous surgical specimens and cancers at various organ sites.Similar to the development of CT imaging technology, MRI acquisition speed, image resolution, and other key clinical performance metrics experienced major improvements since the 1980s. Due in part to the complex nature of MRI physics, the history of the development of new imaging acquisition sequences and contrast agents is extraordinarily rich. Important milestones include development of novel spatial encoding schemes, higher field strength magnets, high-performance imaging coils, encoding of blood flow or diffusion, and more recently, parallel imaging and multislice imaging acquisition (10). Development of new endogenous and/or exogenous imaging contrast agents often leverages recent advances in basic cancer research to target key mechanisms of cancer development and progression.Today, MRI is extensively applied in cancer clinical research and care to ultimately improve patient treatment and outcomes. A search of the NCI funding record for recent MRI research demonstrates the vast clinical applications of MRI across the entire spectrum of cancer research and patient care, including early disease detection, diagnosis, prognosis, treatment, and response assessment. For example, MRI is used to identify meaningful disease biomarkers and to study the development of resistance to therapy (11). Development of advanced postacquisition image analyses to extract quantitative measurements further enhances the use of MRI from reporting and monitoring anatomic changes to reporting and tracking more subtle functional changes due to disease progression and treatment response (12). MRI research projects represent a major component of the NCI CIP and regularly make up about one-third of the overall CIP grant portfolio.PET ImagingPET imaging maps the distribution and specific activities of radiotracers to report on molecular interactions of normal and disease-associated changes of biologic processes and functions. The diagnostic accuracy of PET imaging is high in comparison to other imaging modalities due to the high specificity of the radiotracers and the high sensitivity of imaging devices in detecting and localizing activity of the radiolabeled compounds. A group of researchers at Washington University, including Ter-Pogossian, Phelps, Hoffman, and Mullani, contributed to major PET imaging instrumentation and technological development in the early 1970s (13–16), as described in more detail in a 2017 review article (17).Early research on PET applications focused on studying changes in human brain activity associated with cerebral metabolic rate using fluorine 18 fluorodeoxyglucose (18F-FDG) (18). Subsequent research explored the use of 18F-FDG PET to report increased glucose utilization by malignant tumors due to the Warburg effect. This led to early investigations of PET application in oncology (19). In December 2000, the Centers for Medicare and Medicaid Services initiated Medicare coverage of FDG PET scans for oncologic applications for disease diagnosis, staging, and restaging. FDG PET has since become widely used in cancer research and clinical care, driving continued advances in PET imaging technology. NCI funded research to develop a prototype combined PET/CT scanner at the University of Pittsburgh in 1995 (20). The fused images combined metabolic information of PET with CT-provided anatomic localization, which led to improved disease diagnosis and staging. PET/CT scanners from commercial vendors became available in 2001. They have since been broadly adopted clinically. With the development of semiconductor photodetectors that can operate inside an MR magnet, the combined PET/MRI system became feasible around 2005. The imaging research community is actively pursuing PET/MRI research to fully exploit and evaluate the clinical benefits of the combined imaging modality. The NCI CIP contributes to supporting these efforts and to furthering the development of PET imaging technologies, including the whole-body PET system (21,22).Other Imaging TechnologiesThere have been many breakthrough inventions in other imaging and microscopy technologies in the past 50 years (23,24). With the development of laser and new light sources, new optical imaging and microscopy methods and instruments have flourished and become standard fixtures in modern biomedical research laboratories. Examples of these new optical imaging methods include confocal microscopy, multiphoton microscopy, optical coherence tomography, photoacoustic imaging, multiplexed fluorescence microscopy, super-resolution, and light sheet microscopy. Eric Betzig, Stefan Hell, and William Moerner shared the 2014 Nobel Prize in Chemistry for their contributions to the development of new “super-resolved fluorescence microscopy.” Altogether, these new imaging capabilities are broadly adopted in clinical research and practice and have changed the landscape of discovery biomedical research.US imaging is perhaps the most broadly used imaging technology in any hospital today due in part to the lower cost of the instrument and its use. A comparison of the current technological and clinical applications of US imaging with that of the 1970s would show substantial developmental advances that could qualify modern US imaging as an entirely new imaging modality (25). Notable advances include novel transducer design and higher frequency US imaging, Doppler flow imaging, use of microbubble imaging contrast agents, high-intensity focused ultrasound, and US-guided intervention (26). The rich history of US technology development and expansive clinical applications in the past 50 years certainly deserve a lot more than this short paragraph; however, due to page limit of this editorial, we hope to get into this topic with more details in future communications.ConclusionA current area of cancer research is focused on integrating research results across spatial and temporal scales that span several orders of magnitude, from molecular interactions that drive oncogenic events to disease phenotypes at the millimeter and centimeter tissue level depicting tumor host interactions, microenvironment, and heterogeneity. Successful integration of data and results may provide unprecedented insight and understanding of cancer, including response to treatment across oncogenesis, disease progression, development of new cancer therapies, and development of treatment resistance. The current NCI CIP program support for integrating imaging and liquid biopsy (PAR21–290) is an example of our efforts to explore such research opportunities. Imaging across spatial and temporal scales could serve as a bridge to help connect cancer research. Cancer research provides a data-rich environment that will further stimulate advances in imaging and imaging informatics.In commemoration of the NCA 50th anniversary, we briefly reflected on the tremendous advances made in the development and clinical adoption of medical imaging in the past 50 years. While not comprehensive, we highlighted the remarkable achievements of such developments and their contributions to cancer research and patient care. In the future, we hope to look back and view the past 50 years as a period where medical imaging helped us open a “window” through which cancer and other diseases can be investigated and better understood. “Seeing” changes in real time from the cellular to organ and system levels and connecting these changes with our rapidly increased understanding of cancer at the molecular and genetic levels will advance the promise of personalized and precision medicine.Disclosures of conflicts of interest: Y.Z. No relevant relationships. R.N. No relevant relationships.AcknowledgmentsIn preparing this editorial, the authors benefited from discussions with Janet Eary, MD, Chiayeng Wang, PhD, Piotr Grodzinski, PhD, and Lalitha Shankar, MD, PhD.Authors received no funding for this work.References1. Hounsfield GN. Computerized transverse axial scanning (tomography). 1. Description of system. Br J Radiol 1973;46(552):1016–1022. Crossref, Medline, Google Scholar2. Ambrose J. 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Crossref, Medline, Google ScholarArticle HistoryReceived: June 15 2022Revision requested: June 21 2022Revision received: July 4 2022Accepted: July 15 2022Published online: Aug 12 2022 FiguresReferencesRelatedDetailsRecommended Articles Development of Multispectral Optoacoustic Tomography as a Clinically Translatable Modality for Cancer ImagingRadiology: Imaging Cancer2020Volume: 2Issue: 6A Roadmap for Foundational Research on Artificial Intelligence in Medical Imaging: From the 2018 NIH/RSNA/ACR/The Academy WorkshopRadiology2019Volume: 291Issue: 3pp. 781-791Increasing Access to Imaging for Addressing the Global Cancer EpidemicRadiology2021Volume: 301Issue: 3pp. 543-546The QIBA Profile for FDG PET/CT as an Imaging Biomarker Measuring Response to Cancer TherapyRadiology2020Volume: 294Issue: 3pp. 647-657Trends and Developments Shaping the Future of Diagnostic Medical Imaging: 2015 Annual Oration in Diagnostic RadiologyRadiology2016Volume: 279Issue: 3pp. 660-666See More RSNA Education Exhibits Prostate Cancer: What We Already Know About What Is on the HorizonDigital Posters2020Cervical Carcinoma and Updated FIGO Staging: What Should Radiologists Know in 2019?Digital Posters2019Assessing Immunotherapy with Functional and Molecular Imaging and Radiomics: Whence and WitherDigital Posters2019 RSNA Case Collection Locally advanced, metastatic prostate adenocarcinomaRSNA Case Collection2020 Colonic AdenocarcinomaRSNA Case Collection2021Takayasu arteritisRSNA Case Collection2022 Vol. 4, No. 5 Metrics Altmetric Score PDF download
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