Issn Print: 0143-3636

Publication Date: 2000/03/01


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Editor's comment

A J COAKLEY

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Several articles this month raise issues regarding technology and our ability to use this. Tindale and Barber (pp. 217-219) consider our use of quantitation. Why is it that with techniques that have been around for decades there is a failure to agree on acquisition, processing and display protcols leaving confusion in the specialty and amongst referring clinicians? Our failure to address this issue means sometimes clinicians do not request or act on investigations either because they do not understand the results or do not believe them. The authors urge us to standardize these quantitative techniques as an important step to improving their clinical impact.
PET scanning has become the ‘hot’ area of diagnostic nuclear medicine, with scientific meetings being dominated by PET papers. However, many problems remain and some of these are identified in the Symposium (pp. 221-240). The choice of camera technology is one. Dual coincidence Anger cameras are putting PET technology within the financial reach of many departments, but there is a trade-off - while more affordable they provide less accurate results than dedicated PET cameras. Maisey points out that a similar situation already exists between PET and SPET cardiology, where the differences in technologies are ‘largely one of accuracy rather than new applications’. PET oncology is likely to be the biggest clinical application of PET. The problem is difficult, since the effects of the lower sensitivity of detection with coincidence cameras are not clear. The reviewers point out that the critical issue is not whether additional lesions can be demonstrated by a particular technology, but whether the additional information changes diagnostic staging, whether this leads to changes in management, and whether these improve patient outcome.
Evidence of advances in biotechnology are demonstrated in the paper from the Stanford University team (pp. 241-250). Apoptosis (‘programmed cell death or cell suicide’) holds fascinating potential for study, not just in cancer therapy but in a diverse range of conditions including heart failure, transplantation and osteoporosis. The authors include a table listing possible uses of the technology in the year 2020, but admit that ‘the crystal ball is a bit cloudy’!
Finally, a letter from Ham and Rosenberg (p. 308) casts an eye on information on nuclear medicine tests on the Internet. They gave a clinical vignette to four non-medical volunteers to be referred for a bone scan and asked them to seek information on the Internet. Their findings showed the net to have both positive and potentially negative impact.
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