Nuclear medicine comes of age: its present and future roles in diagnosis.

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.