Professor Riemer Slart discusses how nuclear medicine has evolved to play a crucial role in healthcare today, and explains how the European Association of Nuclear Medicine is helping the field to advance.
Nuclear medicine – a medical discipline based on the application of probes labelled with radionuclides (radiopharmaceuticals) to diagnose and treat diseases – has undergone a profound transformation in recent years, evolving from a niche diagnostic specialty into a central pillar of modern, precision-driven healthcare. Once largely confined to gamma camera imaging and a limited set of therapeutic applications, the field was historically viewed as a relatively minor contributor to clinical decision-making.
Today, however, nuclear medicine stands at the forefront of innovation, driven by advances in imaging technology, radiopharmaceutical development, and an increasingly sophisticated understanding of disease biology. Nuclear medicine now plays a critical role in guiding clinical decisions, shaping treatment pathways, and improving patient outcomes.
As the field enters what many describe as a ‘golden era’, its integration into mainstream healthcare continues to deepen, supported by organisations driving standardisation, research, and collaboration across borders. A major player in this effort to improve the field of nuclear medicine is the European Association of Nuclear Medicine (EANM). For over 40 years, the non-profit organisation has been dedicated to advancing nuclear medicine to improve public health, continually evolving to keep pace with advancements in the field. To learn more about its work, Editor Georgie Purcell spoke with Riemer Slart, Editor-in-Chief of EANM Innovation and Professor at the University of Groningen, The Netherlands.
How has the role and potential of nuclear medicine evolved to where it is today? How does it compare to that of 10, 20 years ago?
If you look back to around 10-20 years ago in the nuclear medicine field, it was primarily focused on diagnostics, particularly using the gamma camera technique. It was also limited to therapeutic applications, mainly for thyroid tumours and early-stage lymphoma. It was a very minor player in medicine at the time.
Today, we have a fully integrated nuclear medicine field focused on position imaging, which we do with new camera techniques. We also now have hybrid imaging techniques, such as SPECT/CT, PET/CT and PET/MRI, which are the standard today. In addition, we have more tracers to use in clinical settings. Most importantly, we are also seeing a rise in theranostics. For example, PET/CT or PET/MRI scans are used for prostate cancer detection, as well as somatostatin receptor imaging and neuroendocrine tumour imaging.
Nuclear medicine also now has a strong impact on decision-making in hospitals through imaging, and in the outcome of patients, including through therapy. We are seeing a shift from imaging disease to characterising the biology and treating it.
How does the European Association of Nuclear Medicine work to shape the field of nuclear medicine?
EANM is a very important society for the nuclear medicine sector, driving many important areas. It is the scientific, clinical, and strategic backbone of our field in Europe and beyond. If you look at the key pillars driving EANM’s work, the first is developing guidelines and standardisation in nuclear medicine. These include both clinical and technical procedure guidelines.
EANM is also pushing for harmonisation across countries. Everyone is doing the same thing with imaging techniques, so you can compare imaging data of different camera systems to each other. This is important in a clinic but also for clinical trials, as you can directly compare one vendor to another – enabling harmonisation.
Another big part of our work is education and training. We host the EANM Congress once a year, where everyone comes together to network and exchange knowledge. We also have the European School of Multimodality Imaging & Therapy (ESMIT), offering both offline training via webinars and in-person sessions.
Another component of what EANM does is research innovation. We support multicentre clinical trials and promote translational research – not only clinical but also preclinical research.
Advocacy is also important for us. Our Policy and Regulation Affairs Council (PRAC) coordinates and implements EANM’s policy activities at the EU level through continuous dialogue with EU policymakers and stakeholders.
What are the most promising developments in nuclear medicine today?
Currently, nuclear medicine is in a so-called ‘golden era’, driven by biology-targeted radiopharmaceuticals.
One important area is the theranostics expansion beyond neuroendocrine tumours and prostate cancers. We also have new targets in the field of oncology, with the potential to branch into further disciplines.
If you look outside the biology, there is radiopharmaceuticals. We use radionuclides as a theranostic therapy. Beta emitters are key components. However, alpha emitters are now starting to play a more important role as they have a stronger effect on tumours and a higher potency, and may improve the overall therapy effect.
Another promising development is personalised dosimetry – which patient needs how much of a radionuclide therapy dose. A ‘one-dose-fits-all’ approach doesn’t work anymore, and it is now possible to personalise dosimetry to each individual patient.
Furthermore, another rapidly developing area is artificial intelligence (AI). It is already benefitting a variety of applications, such as the reconstruction and interpretation of data from cameras, workflow optimisation, and making more complicated algorithms with machine learning or deep learning algorithms to predict patient responses.
One example of what we are doing in our institute now is automated reporting. For instance, if abnormalities are detected on a PET scan, it can be checked by a nuclear medicine physician, but also by an AI algorithm. Both findings can then be compared, and AI can also carry out an automated report of the PET scan. This will reduce time and offer a more thorough way to check the scan.
EANM is also working on new radionuclide production and strengthening the supply chain. It is important that we have sufficient supply of nuclear materials in Europe, not only for oncology but also other fields – including infection, inflammation, cardiovascular, neurology, etc.
There are also very strong developments in new applications, such as cardiovascular. It’s also not always completely new developments. We have certain tracers that are developed and applied for a particular field, but we can now apply them to other fields. For example, one antibody could be working well for imaging a specific tumour type, but the same antibody can also be used in autoimmune diseases. This helps us to work smarter, saving money and time.
What are the biggest challenges facing innovation and development in nuclear medicine? How is EANM working with partners to overcome these challenges?
In general, innovation in nuclear medicine is moving very fast at present. However, the infrastructure and regulation to support it are lagging. There are some key challenges that we must address. One is regulatory complexity. Radiopharmaceuticals are treated in Europe more like a conventional medical drug. However, a conventional drug is for treatments and, when we are using radiopharmaceuticals, it’s a diagnostic dose – which is extremely low compared to a therapy dose. We must try to convince regulatory bodies in Europe to reframe the way they look at radiopharmaceuticals to reflect this.
There are also supply chain issues when it comes to isotope production. We need to have a sufficient and reliable production of isotopes. When there is a disruption or miscommunication at some point in the supply chain, this can cause serious issues for the supply of radiopharmaceuticals. We have a lack of radiopharmaceuticals in the world, and we need to find a solution for that. The process needs to be smarter, and we need to also have a sufficient backup for the production of radiopharmaceuticals.
Another aspect is workforce and training camps. We really have to work on that because we have a lack of dedicated professionals in our field. The demand for nuclear medicine is also rapidly increasing. We expect the scale of radionuclide therapy to expand five-fold in the next 15 years. This means five times more patients, five times more beds, and five times more radionuclides that you need. To keep pace with this rapid growth, we must have both national and international roadmaps.
To validate new methods or clinical applications, large multicentre trials are required. This is not something that has been a strength of nuclear medicine in the past. However, we are getting stronger and stronger in this area also in collaboration with clinical societies.
EANM can help improve the field of nuclear medicine by implementing better harmonisation with regulators and collaborating further with industry.
What do you expect for the near future of nuclear medicine?
In general, I expect to see more integration with different fields. We are working closely with the clinical field, as well as fields like radiology and radiotherapy, and we must integrate work flows. As previously mentioned, expansion is important because we are facing a large number of new patients and groups.
Integration of our therapies and diagnostics in the standard clinical pathways is important. Of course, there is also a growing emergence of digitalisation and the application of AI in decision-making.
If you look to the near future, nuclear medicine will not be the complementary specialty, but will be more embedded in the core decision-making process of oncology and beyond.
Please note, this article will also appear in the 26th edition of our quarterly publication.
