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When factored for the increase in articles published, there has been a 10-fold increase in the rate of article retraction over the past 20 years. Instances of plagiarism by researchers and physicians around the world, tracing the paths of reputations needlessly marred and public trust in the medical profession eroded.
Growing evidence that plagiarism in submitted materials also hampers dissemination of legitimate findings. A look at how all members of the healthcare field, from students and professors to researchers, physicians and journal editors can implement systems and adhere to practices that can detect and prevent plagiarism and misconduct. The report features exclusive insight from Kim Mitchell, Journal Publications Director at Landes Bioscience. Follow the discussion about the report and share your thoughts by posting a comment on the iThenticate Blog. If you are an iThenticate customer, you may skip filling out the below form and email us for a direct link to the paper. You may trust what your doctors tell you, but studies show they might be working off bad information.
The number of retractions is small compared with the overall amount of research published, but it can have a big impact. There are several ways you can be an empowered patient and protect yourself against treatment based on error and misconduct in medical journals. I know of one Princeton guy who made a career out of libelously misquoting research that was obsolete 40 years ago. I know of a prostate cancer paper that many people in the field agree needs to be retracted because the results can't be repeated and it concludes the very opposite of what is now known about those conditions.
Remember that less scrupulous scientists will carefully study published data and when they base experiments around that expected set of outcomes, they may try to force their own data to fit the expected published data. Wakefield's retracted paper has singlehandedly caused massive issues with vaccines in industrialized countries, created pockets of painful (and sometimes deadly) outbreaks of previously controlled childhood diseases, and sent autism research on a wild goose chase after vaccines for a decade. This smacks of a poorly researched and biased article intended to cause fear and distrust of scientific research in order to sell Ms Cohen's book. The BMJ is a separate medical journal which published an investigation into the integrity of the Wakefiled et al study and publications. I simply could not depart your website prior to suggesting that I extremely enjoyed the standard info an individual supply on your guests? CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service.
Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. The future of medicine lies in early diagnosis and individually tailored treatments, a concept that has been designated a€?personalised medicinea€™ (PM), i.e. Introductiona€?Personalised medicinea€™ (PM) is increasingly becoming a hot topic in all areas related to biomedical research and has the potential to become the paradigm for clinical practice. DefinitionsAccording to Wikipedia, a€?personalized medicine is a medical model emphasizing in general the customization of healthcare, with all decisions and practices being tailored to individual patients in whatever ways possible. Medical imaging in PMIn a critical description on the role of molecular imaging in PM, Adrian Nunn states: a€?For too long, it has been assumed that non-imagers understand the value of imaging not only from the research side, but also from the health care economics side.
Traditionally, medical imaging was a tool for non-invasive mapping of anatomy and for detection and localization of a disease process.
However, implementing imaging-based PM strategies in clinical care is hampered by inadequate regulatory procedures. Essential components of [predictive, preventive and personalized medicine] include well-organized population screening protocols utilizing novel diagnostic biomarkers of disease states, targeted prevention of common human pathologies, optimal treatment planning and personalized medicine thereby resulting in substantial improvement of the quality of life. The flip side of the preventive medicine coin involves incidental findings and overdiagnosis.
Molecular imaging is a new, in vivo approach which is likely to replace several aspects of ex vivo tissue analysis and which will be key in realising PM.
There is one problem with monitoring approaches based on a single marker, a problem which has plagued physicians in oncology and related fields for decades: the heterogeneity of tumours. ConclusionsWhile Jim Thralla€™s 2004 statement that a€?each individual is now an a€?na€™ of onea€? [13] was certainly premature, the essence is correct: PM will probably take over medical care in the near future.
14.Medical News Today (2009) Imaging crucial for "personalized medicine" to succeed, says report. 23.Smits M et al (2007) Incorporating functional MR imaging into diffusion tensor tractography in the preoperative assessment of the corticospinal tract in patients with brain tumors. 29.Kono K et al (2011) Multi-functional liposomes having temperature-triggered release and magnetic resonance imaging for tumor-specific chemotherapy. 30.Hong SY et al (2010) Filled and glycosylated carbon nanotubes for in vivo radioemitter localization and imaging. 32.Arbab AS et al (2010) Differentiation of glioma and radiation injury in rats using in vitro produce magnetically labeled cytotoxic T-cells and MRI. 34.Moonen CT (2007) Spatio-temporal control of gene expression and cancer treatment using magnetic resonance imaging-guided focused ultrasound. 36.Kwekkeboom DJ et al (2010) Somatostatin-receptor-based imaging and therapy of gastroenteropancreatic neuroendocrine tumors.
Unlike many other published works, where instances of plagiarism mainly pose ethical challenges, misconduct and duplication in medical research can have a direct negative impact on the health and treatment protocol of patients around the world. Publishers of more than 40 journals, one of its journal rejected 221 article submissions for plagiarism in 2012 alone. The 1998 paper supposedly linking autism with childhood vaccines has sparked a major trend in parents choosing not to vaccinate their children for all those years. I've had reviewers of failed grants cite that paper as why a proposal should NOT be funded when the proposed work is excellent and the paper cited is wrong. The author expects the public to be able to go though the literature and make conclusions on the science? If the funding for the study depends on getting the right answer then you are dealing with propaganda, not science. Ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retracted]. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers.
Recently, this has mainly involved the systematic use of genetic or other information about an individual patient to select or optimize that patienta€™s preventative and therapeutic carea€? [5].
This has led to an underestimation of the value of imaging and, for molecular imaging, perhaps an idea that it is a€?sciencea€™ rather than high-value routine health carea€? [7].
However, consecutive to a paradigm shift, it has been demonstrated that a wide variety of new medical imaging techniques and methods produce important biological information about physiology, organ function, biochemistry, metabolism, molecular biology and functional genomics.
According to Jim Thrall, a€?Imaging will play an increasingly important role in the assessment of therapeutic response, especially in cancera€? [13] as this is an area in which variability among patients opens the door for individually tailored medications. Elevated calcium score with associated chronic total occlusion of the left anterior descending coronary artery (LAD) in a 79-year-old male. This approach also offers the advantage of delivering care at potentially reduced costs to the population at large thereby addressing social and ethical issues related to access to and affordability of health care. In a cohort of subjects undergoing a CT angiography of the abdominal aorta and the lower extremities, 15% of patients had incidental findings of potential clinical relevance [17], and similar rates have been reported in healthy subjects undergoing cranial MRI for research purposes [18]. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) in a patient with complaints of early knee osteoarthritis (a) and a patient without knee complaints (b). Molecular imaging can be used to detect diseases much earlier, visualise biological processes at the cellular and molecular level in living organisms and determine changes in local biochemistry [12]. While tumour heterogeneity also explains individual variations in treatment response, a monitoring approach based only on a single marker is sensitive to variations in expression of that marker. However, many reports on PM fail to recognise the important role that medical imaging must play in a PM approach.In the not all too distant future, each patient will expect completely individualised prediction, diagnosis and treatment. Nova Science, New York17.Naidu SG et al (2010) Incidence of highly important extravascular findings detected on CT angiography of the abdominal aorta and the lower extremities. Epidemics of measles and mumps have appeared throughout the USA and spread directly as a result of so many unvaccinated kids. I have also seen more junior people try to replicate published results and not be able to and lose the confidence of their mentor. Granted, it may be a rare case, but bad research can have a huge impact on the health of all of us, not just a single person. If there was an advisory board that would do blind funding for research the results would carry more weight. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.
They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. However, the value of medical imaging in PM is frequently underestimated, as many policy makers forget the all-important right location in the PM paradigm. The European Science Foundation (ESF) has initiated a a€?Forward Looka€™ campaign that should deliver a€?more precise medicine for the diagnosis, treatment and prevention of diseasea€? for the European citizen [2]. In other words, PM describes the concept of delivering the right treatment to the right patient at the right time. Individual assessment of the location and extent of an abnormality is and always has been the basis of medical imaging, whether the a€?abnormalitya€™ is a disease, a malformation or an injury.
These new methods combine the ability to measure and quantify biological processes with the ability to localise the measured entities into a high-quality anatomical image.


According to a new market research report, interests from the imaging industry will drive PM in general and molecular medicine in particular [14]. This is a complex proposition given the mass of individual data and treatment options that arise from a PM approach, especially when imaging is involved. When an asymptomatic disease is diagnosed (either by screening or as an incidental finding), we have the potential for overdiagnosis. With dGEMRIC it is possible to quantitatively assess cartilage quality before the onset of morphological changes, by measuring its glycosaminoglycan content. Multiple methods and biomarkers have now been described for imaging the temporal and spatial biodistribution of a molecular probe as well as related biological processes such as cell proliferation, apoptosis, angiogenesis, hypoxia and gene activation and expression [20]. Intense hypermetabolism on FDG-PET corresponds with localisation on CT in a small right supraclavicular lymph node, clearly indicating recurrent lymphoma.
Radiologists need to be prepared for this new paradigm as it will mean changes in training (PM should be included in post-graduate education), in research (e.g. Krestin, Celsos Matos, AndrA?s PalkA?, Siegfried Trattnig) on behalf of the European Society of Radiology (ESR). Accessed 11 April 201122.Basu S (2010) Personalized versus evidence-based medicine with PET-based imaging. Also works are published based on the merit of their data, so just the act of siting a retracted paper does not mean their data is null. That article (now retracted) spurred a major clusterf-ck among foolish parents choosing to not protect their kids. And like Jim said retracted data does not even make it to the clinic becasue it has to be repeated by so many people. Everyone but some guy who got a diploma in medicine because he wanted the fame and the money is stupid, everyone but that money-hungry guy.
That is the people doing the research study would not know who funded it and would not know the answers they are expected to find. No scientific paper is entirely true, and no paper ever makes the final remark on a subject.
Medical imaging has always been personalised as it provides individual assessment of the location and extent of an abnormality, and in the future it will prove fundamental to almost all aspects of PM. Regulatory bodies such as the FDA [3] and EMA [4] have been challenged to find new approaches for registration of emerging PM technologies.
PM is facilitated by newly developed, powerful technologies allowing detection of a€?biological events at the molecular level, even before symptoms appear. Others recognise the threat which in vitro testing poses and maintain that we must rely on the unique ability of imaging to provide regional information, ideally including information on function, which cannot be replaced by ex vivo tests [7].In her Presidential Address at the 2010 RSNA Annual Meeting, Hedvig Hricak, Chair of the Department of Radiology at Memorial Sloan-Kettering Cancer Center in New York, stated that medical imaging has become a€?a a€?guiding handa€™ of personalized medicine for cancer carea€? [15]. Adrian Nunn discusses both short- and long-term solutions: a€?In the short term, a€¦ ways [can] be explored to ease development and regulation of molecular imaging agents to foster development a€?in spite ofa€™ the current framework. Overdiagnosis is the diagnosis of irrelevant diseases, diseases which are so stable or indolent that they would not have become clinically relevant during the subjecta€™s life.
In patient a, decreased dGEMRIC index is shown particularly in the weight-bearing cartilage of the femoral condyle and tibial plateau compared to patient b. These molecular imaging techniques can lead to enhanced, individualised clinical management of diseased patients at an early stage.
It is one thing for an individual to draw conclusions based on a retracted paper but quite another to assume the medical community would be so flippant. Bad data does influence research direction and control future hypothesises but it does not make future data bad, just may influence how it is interperted. Many people believe that if it's published, the paper is right and your data must be wrong. If a funding organization is not willing to submit their project to such requirements they are announcing that they only want a predetermined result and are not really interested in science.
It takes years of peer-reviewed research to produce long-term, major changes in theories and how we care for patients. Stratification based on imaging biomarkers can help identify individuals suited for preventive intervention and can improve disease staging. National governments and public-private collaborations are funding large research programs and infrastructure dedicated to translation of basic PM concepts into clinical trials. The promise of personalised medicine is a future where disease is detected at the earliest possible time, and treatments are tailored to an individual patienta€™s genetic profilea€? [6].Sequencing of the human genome in 2003 opened the way to identify specific genes that are involved in particular diseases and thus to define genetic variants which either predispose a person to that disease or which regulate that persona€™s sensitivity to a given treatment [2]. The total Agatston calcium score in this patient was 637, suggesting increased risk for a coronary event. Overdiagnosis leads to unneeded treatment with potentially harmful side effects and thus causes both economic and emotional burden. This indicates reduced glycosaminoglycan content, and hence reduced cartilage quality, in the early osteoarthritic knee. For instance, a€?reporter genesa€™ which are part of a gene therapy can be used to determine if transfection was successful and to monitor gene activity and distribution in the individual patient [13]. Thus, a€?imaging biomarkers may be used as a surrogate outcome measure for the biological behaviour of different diseasesa€? [9].However, molecular imaging approaches based on a single probe may be insufficient, especially as alternative pathways may replace the function of the targeted pathway [7, 8], resulting in a false negative test outcome.
In order to adapt medical care to the individual situation, knowledge is needed, not only about the biochemical and physiological characteristics of the individuala€™s disease, but also about location, extent and inter- and intra-lesion heterogeneity. Accessed 25 April 20116.Society of Nuclear Medicine a€“ Center for Molecular Imaging Innovation and Translation (2011) Providing personalized medicine with molecular imaging. Accessed 28 April 201126.Janib SM et al (2010) Imaging and drug delivery using theranostic nanoparticles. Even when a sound paper changes the norm, such as the recent breast cancer testing age paper, doctors err on the side of caution. But then again thats what a hypothesis is, an educated guess there is always the posibility that you think A =B and you show this. We must all keep an open mind and sometimes question whether the published values represent what their authors claim. The problem is that if funding organizations were exposed to valid research many research groups wold be out of business overnight.
It really shouldn't matter if certain papers are retracted or not because no research or policy should ever be constructed off a single study.
In vivo visualisation of locoregional physiological, biochemical and biological processes using molecular imaging can detect diseases in pre-symptomatic phases or facilitate individualised drug delivery. Health-policy makers and insurance companies are in search of solutions for future implementation of PM strategies into daily care and reimbursement schemes.Is PM a new concept, or is it only a new look at an old friend?
The concept of using these genetic differences to personalise healthcare has since taken over the perception of PM to such an extent that other means of personalising healthcare are being subsumed.
Exciting new advances in medical imaging are based on research in the areas of functional and molecular imaging and in the area of development of imaging biomarkers for improved prevention, diagnosis and treatment of disease. Hricak names three categories in which imaging impacts PM: treatment decision-making, treatment planning and treatment follow-up. The FDA and EMEA must acknowledge the crucial role of medical imaging in PM in order to achieve durable policies for this field.Medical imaging for personalised disease preventionBiomedical imaging allows non-invasive or minimally invasive assessment of in vivo structural and functional changes that may reflect specific pathology. Molecular imaging is intrinsically different from the large, in vitro genomic or proteomic arrays currently popular. This seeming weakness, however, can actually be a strengtha€”by combining imaging markers from different pathways, it may be possible to assess the type of physiological escape mechanisms of a tumour (or other disease) as well as tumour presence [8], enabling individual treatment to be fitted in real time to the type of response, which is of course PM in its most basic sense. Accessed 23 May 20112.European Science Foundation (2011) Personalised medicine for the European citizena€”towards more precise medicine for the diagnosis, treatment and prevention of disease.
Furthermore, imaging is essential to patient-tailored therapy planning, therapy monitoring and follow-up of disease progression, as well as targeting non-invasive or minimally invasive treatments, especially with the rise of theranostics. Many clinicians would argue that they have always delivered care at the personal level and adapted their therapeutic approach to the individual needs of every patient. However, except for a few monogenic diseases, proteins and other molecules (the a€?omicsa€™ of that specific disease) have a more important influence on determining disease predisposition or therapeutic response than knowledge of the genetic sequence [2, 7].
Recent developments in image data acquisition and analysis enable use of these techniques on a large scale.
The challenge for PM is to recognise when the burdens of treatment outweigh the benefits for a given patient, taking into account the individual characteristics of the subject, including his or her personal values and preferences.Medical imaging for personalised diagnosisIn classical diagnostic imaging, information is primarily derived from differences in how various tissues intrinsically respond to the imaging modality or the compartmentalisation of simple contrast agents, thus showing morphology. Such arrays survey a large number of genes or proteins, while molecular imaging concentrates on just one or two proteins. However, a real concern when using expensive molecular imaging agents is cost-effectivenessa€”a€?to demonstrate that the increased cost of the imaging provides a commensurate increase in valuea€? [7].
Genomics- and proteomics-based biomarkers are imperative, as are imaging-based biomarkers.The a€?three Ra€™sa€™ of PM are right treatment, right time, right location. Moreover, individual genetic differences have to be considered in the context of additional external variationsa€”environment, diet, exercise, social circumstancesa€”leading to variation in disease manifestation and drug activity [6].The ESF expects that integration of several different a€?omicsa€™ measurements will be needed to yield clinically useful biomarkers which can be used in tailoring treatment to an individuala€™s physiological and biochemical profile [2].
Hricak expects advances in techniques such as quantitative imaging and volumetric measurements to a€?change the landscape of clinical trialsa€? [15].
This makes it possible to investigate specific pathophysiological substrates of disease in a pre-symptomatic phase and at the population level.
While classical macroscopic imaging provides some of the most important a€?individualiseda€™ information on many diseasesa€”namely their localisation and extenta€”its value for determining the specific aetiology is sometimes limited.
However, the a€?apparent reduction in utility, because of the smaller number of analytes, is more than compensated by the regional and dynamic information [molecular imaging] providesa€? [7].A major area where diagnostic imaging techniques have been used extensively is disease staging. Medical imaging is essential for excellent PM as it is the only patient-friendly means to obtain information on location, especially with regard to heterogeneous expression within an individual patient. Radiologists need to be prepared for this new paradigm as it will mean changes in training, in research and in clinical practice.


Do modern emerging technologies in the era of molecular medicine allow completely new strategies? Population imaging is the large-scale application and analysis of medical images in controlled population cohorts.
Staging, or in other words the description of disease extent (and implicitly severity), has an immediate and important impact on choice of therapeutic options and on personalised prognostic stratification. However, medical imaging can also contribute important information regarding expression patterns, perfusion, metabolic activity etc., which can be pivotal in deciding what the best treatment is, and when is the best time to give it.
And what is the role of medical imaging in this paradigm which mainly focuses on different aspects of a€?disease-omicsa€™? Thus, one of the main aspects of PM will be to identify biomarkers able to characterise a cellular alteration leading to subclinical or manifest disease status as well as its specific reaction to various therapeutic attempts [9].
Population imaging focuses on finding imaging biomarkers that allow prediction and early diagnosis of diseases and preventive therapy.Many common diseases are complex conditions caused by a large number of small, often additive effects arising from genetic predisposition, lifestyle and the environment. Methods commonly used for staging are those that combine fast whole-body coverage with high sensitivity for disease detection.
Furthermore, medical imaging plays a critical role in all aspects of PM: prediction, diagnosis and especially treatment.
Does medical imaging play a role in this new game?Whatever PM is, radiologists and other imaging specialists have to be aware that PM is becoming and will remain the focus of interest in medical research and health-care policy in the coming years.
However, this approach again will lead to categorising or stratifying patients into smaller subgroups related to their risk or potential treatment profiles characterised by a combination of genetic, biochemical and even imaging biomarkers [10].
The development of new prevention strategies, leading to the promotion of health, requires access to and use of searchable repositories of biomedical data from population-based, prospective health surveys. Such information can be obtained by ex vivo analysis of tissue, and image-guided tissue sampling provides the means to target and investigate specific areas of the lesions. The whole-body approach and sensitivity of diffusion-weighted MRI and PET-CT are useful in disease staging, allowing assessment of the disease status of a patient and selection of the most appropriate treatment approach for that patient from a single examination [21, 22]. Medical imaging, on the other hand, is still recognised as one of the motors of medical research and technology innovation, with unprecedented practical achievements over the past 20a€“30 years. Such stratification can be further refined down to the level of an individual patient, and the term a€?individualised medicinea€™ could be more appropriate.
These repositories include imaging data together with associated information about the individual subject. Staging and stage migration using different cross-sectional imaging techniques such as CT, MRI or PET help avoid futile operations, resulting in improved personalised treatment and reduced patient morbidity. If imaging wants to maintain this leading role, it will have to define its precise position and contribution in this new field.
Similarly, precise delineation of primary and metastatic lesions helps to optimise target volume definition in radiation therapy [22], and knowledge about functional use of brain tracts can aid in optimal surgical planning for tumours of the brain [23].
However, many of the policy papers, programmes and funding schemes described above mention little or nothing about medical imaging nor about the benefits and contributions of imaging research to PM.
The disease prevention focus is on identifyinga€”in an early pre-clinical stagea€”those subgroups of patients at risk of developing symptoms and signs of abnormal morphology and function. Population imaging endeavors to find imaging biomarkers that can predict later development of disease, either on their own or by supplementing established risk factors. Clearly, novel macroscopic and molecular imaging techniques will form the cornerstone of personalised diagnosis in the near future.Medical imaging for personalised therapyMedical imaging contributes to therapeutic PM in several key areas.
Therefore the Research Committee (RC) of the ESR considers it of crucial strategic importance to define and describe how medical imaging benefits from and contributes to the overall conceptual framework of PM. Such personalised prognostic stratification strategies may rely on genetic, environmental, social and other information.
Clinical phenotyping and correlation with genome-wide analysis aid the search for genetic mutations predisposing one to a specific disease by a€?aggregating subjects into groups with higher probabilities of having common genotypesa€? [13]. The role of medical imaging in personal, patient-tailored therapy planning, therapy monitoring and follow-up of disease progression is obvious to most medical professionals, but medical imaging also contributes to personalised therapy via image guidance of minimally invasive interventions as well as targeting of non-invasive focused ultrasound or radiation treatments.In many diseases a€?one size fits alla€™ no longer applies.
Identification of predictive biomarkers (biomolecular or imaging) can help to monitor disease development and preventive interventions. Some even believe that successful identification of prognostic biomarkers will reduce the number of surgeries [2]. The application of medical imaging is changing treatment management to a tailored approach, with both health and economic benefits. Personalised diagnostics implies the identification of the specific molecular substrate of alterations leading to disease.
Several projects performed in healthy populations have already shown that imaging has benefits for the determination of disease predictors and can enable the stratification of a healthy population into different risk categories.
Treatment monitoring helps avoid both unnecessary drug toxicities and ineffective treatments, with resultant reduction in healthcare costs [21].
Molecular imaging not only allows detection of disease in very early or even pre-clinical stages but also helps to determine subsequent personalised therapies. Furthermore, a complete diagnosis also needs information on the physiological characteristics of disease lesions (e.g.
It may be also used for prognostic classification and for the choice of personalised follow-up strategies [21]. Furthermore, a€?molecular imaging may provide unique means for the selection of patients who may benefit from targeted therapies, as well as [allowing] monitoring of early responses to treatment and [enabling] subsequent restaginga€? [20].
Personalised treatment focuses on the identification of patient subgroups likely to give a positive response to a given treatment [11], on the identification of subgroups of patients at risk of side effects during treatment [11], on monitoring of therapy response [11] and on individualised drug delivery systems allowing both real-time modulation of treatment approach and treatment delivery at a specific location. Image-guidance of biopsy sampling (by US or CT) helps to obtain relevant material for the in vitro mapping of the genetic expression and biology of the individual disease, while metabolic imaging using PET-CT is useful for selecting cancer patients who are likely to respond to specific radiopeptide treatments and this examination can also be used as a baseline for response monitoring [22]. In other words, as Michael Berger so eloquently phrased it, a€?medical treatment tailored not just to symptoms, but to the biochemical profile of an individuala€™s disease state (gene expression, proteome, dominant metabolic pathways, etc.)a€? [12]. Food and Drug Administration (FDA) has recognised the new role of medical imaging in drug development and regulatory approval [24]. Biomarkers that indicate response to therapy may be the same as those used for diagnosis or characterisation, but do not have to be.
Given that validated surrogate endpoints allow dramatic shortening of clinical trials, with associated savings and a faster availability of new treatments, this is an area in which both the pharmaceutical industry and the healthcare authorities are pushing for biomarker use. Molecular imaging and radiopharmaceuticals are particularly important within this context as they allow in vivo visualisation of the effect of the treatment. Indeed, Adrian Nunn feels that the a€?interest in imaging agents generated by the Critical Path Initiative probably means that all new imaging agentsa€”molecular or morphologic, existing technologies or new technologiesa€”will be seen in a new lighta€? [7].TheranosticsAccording to Wikipedia, theranostics is a€?the term used to describe the proposed process of diagnostic therapy for individual patientsa€”to test them for possible reaction to taking a new medication and to tailor a treatment for them based on the test resultsa€? [25]. Theranostics are inextricably linked to PM as they are individualised products providing both diagnosis and treatment.
Targeted radionuclide therapy combines a€?the favorable targeting properties of peptides and antibodies with the effectiveness of radiation-induced cell death. A major advantage a€¦ is the possibility to determine the selective accumulation in the targeted tissue by molecular imaging studies a€¦ using structurally identical diagnostic compoundsa€? [20]. Depending on the exact radionuclide used, theranostics provide both a unique signature for imaging the biodistribution of the target moiety (diagnosis and monitoring) and micro-environmental radiotherapy (treatment) and permit one to predict the biodistribution of radiation dose, stage the tumour and individually monitor the efficacy of treatment with the same basic compound that is being used to target and treat the disease [20]. These a€?visiblea€? pharmaceuticals have enormous potential in PM.The evolving era of nanotechnology will further boost the development and use of theranostics. New materials and techniques are facilitating the production of various nanoparticles suitable both as (targeted) imaging probe and drug carrier. Currently various types of nanoparticles are being investigated as versatile tools for theranostics purposes [26, 27].
A major advantage of nanoparticles for theranostics would be the high payload of both therapeutic agent and imaging probe that can be delivered to the target tissue. Specific examples of theranostic agents currently under investigation include liposomal vesicle formulations containing cytostatic drugs and MR contrast agents [28, 29], carbon nanotubes as multifunctional carriers for radioisotopes for treatment and imaging [30], and dendriworms for efficient delivery of siRNA (small interfering RNA) visualised by optical imaging or MRI [31]. In this approach, cells would be used for diagnostic as well as therapeutic purposes [32, 33].Image-guided interventions and drug deliveryImage-guided interventions provide the means to deliver therapies locally at the disease site, whether the therapies are based on chemical compounds (including drugs and radiotherapeutics), genes, devices (including stents), cells, sound waves (HIFU) or temperature fluctuations (hyper- and hypothermia).
Most current interventional image-guided procedures are individually tailored to the local anatomic and functional circumstances as well as the personal needs of the patient. In this way, image-guided interventions are in themselves an important and integral part of PM.Medical imaging also plays an important role in individualised drug delivery, by providing information about the locoregional physiological conditions (a€?regional proteomicsa€™ [7]) important for drug targeting [10], by triggering nanotechnological carriers to release active drug [10] or by monitoring differentiation of stem cella€“based therapeutics [9]. Although the past 30 years of drug delivery research have focused on targeting carriers such as liposomes, polymeric nanoparticles and micelles to the disease site, new developments promote the selective release of bioactive compound after application of a trigger [10]. The trigger mechanism can be applied locally and at specific times, depending on the individual patienta€™s needs, and can be selectively applied with interventional techniques such as high intensity focused ultrasound (HIFU) under the guidance of MRI [10]. Other molecular imaginga€“based approaches for PM are also invading the field of image-guided interventions, including approaches involving gene expression, drug activation and drug delivery.
These types of techniques can be further combined with specially designed contrast agents or drug delivery systems to achieve even more personalised approaches.Therapy monitoringTherapy monitoring is an area which PM is expected to dominate within a few years.
Current monitoring is based mainly on anatomical imaginga€”frequently still assessed on 2D images (e.g. This field is a paradigmatic example of the gap between current practice and advances in technological imaging.



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