McAfee J G, Kopecky R T, Frymoyer P A
Department of Radiology, SUNY Health Science Center, Syracuse 13210.
Radiology. 1990 Mar;174(3 Pt 1):609-20. doi: 10.1148/radiology.174.3.2406775.
The current role of nuclear medicine in clinical diagnosis was surveyed in a retrospective review of medical records by two internists. About one radiologic imaging study in 20 was a radionuclide procedure, and a somewhat larger fraction was performed in outpatients. The internists found that diagnostic screening procedures in nuclear medicine influenced patient management in 63% of hospital inpatients, and quantitative/monitoring types of tests influenced management in 56%. Of the projected health care costs in the United States of $490 billion, all imaging procedures will account for only $12 billion, and nuclear medicine procedures will account for about $1 billion. Nuclear medicine research continues to blossom. The National Institutes of Health budget for diagnostic imaging research in fiscal year 1988 totaled $86.6 million; nuclear medicine projects represented 43% of this total, all other projects in radiology represented 30%, and projects outside radiology represented 30%. Research with positron emitters and positron emission tomography totaled $20.5 million, and research with radiolabeled monoclonal antibodies totaled $6.2 million. Two major problems may hinder the future practice of nuclear medicine in the United States compared with that in other developed countries: (a) the serious time lag in the approval process for new radiopharmaceuticals by the U.S. Food and Drug Administration and other agencies and (b) the lack of a facility dedicated to the continuous production of radionuclides for biomedical research. Now, there is sporadic production permitted only during high-energy physics experiments. The recent developments which will probably induce the greatest changes in clinical nuclear medicine in the near future are the improvements in design and utilization of single photon emission computed tomographic devices and prolific generation of new radiopharmaceuticals, especially technetium-99m agents for cerebral and myocardial imaging and tumor agents.
两位内科医生通过对病历的回顾性研究，调查了核医学在临床诊断中的当前作用。每20项放射影像学检查中约有1项是放射性核素检查，且门诊患者中进行此类检查的比例略高。内科医生发现，核医学诊断筛查程序影响了63%的住院患者的治疗管理，定量/监测类检查影响了56%的患者治疗管理。在美国预计的4900亿美元医疗保健费用中，所有影像学检查仅占120亿美元，而核医学检查约占10亿美元。核医学研究持续蓬勃发展。1988财年美国国立卫生研究院用于诊断成像研究的预算总计8660万美元；核医学项目占该总额的43%，放射学的所有其他项目占30%，放射学以外的项目占30%。正电子发射体和正电子发射断层扫描的研究总计2050万美元，放射性标记单克隆抗体的研究总计620万美元。与其他发达国家相比，有两个主要问题可能会阻碍美国未来核医学的应用：（a）美国食品药品监督管理局及其他机构对新放射性药物的审批过程严重滞后；（b）缺乏专门用于生物医学研究放射性核素连续生产的设施。目前，仅在高能物理实验期间允许进行零星生产。近期可能在不久的将来给临床核医学带来最大变化的进展是单光子发射计算机断层扫描设备设计和应用的改进以及新放射性药物的大量涌现，尤其是用于脑和心肌成像的锝-99m制剂以及肿瘤制剂。
