Interview with Dr. Andrew Scott

ePatient : You have been a member of the nuclear medicine community for a long time and you have been at the helm of the WFNMB for three years. For those who are not familiar with the WFNMB, can you succinctly describe its role for the field of nuclear medicine?

The World Federation of Nuclear Medicine and Biology (WFNMB) is the peak nuclear medicine organisation globally, and has a primary role to progress and promote nuclear medicine throughout the world. It was established in 1970, and its membership consists of countries that have nuclear medicine societies throughout the world, with representatives participating in forums at major nuclear medicine conferences, and contributing to projects aimed at enhancing nuclear medicine practice.

In recent years, the WFNMB has undertaken a series of projects to enhance nuclear medicine practice, particularly in developing countries, and to engage with major international organisations (e.g. IAEA, WHO) in advocacy for nuclear medicine in human health. Current projects of the WFNMB include a global evaluation of access and availability of radiopharmaceuticals (in conjunction with SNMMI), aimed at identifying roadblocks to use of diagnostic and therapeutic radiopharmaceuticals and strategies to improve access; developing guidelines for minimum standards for training of nuclear medicine specialists (in conjunction with IAEA, and all major international nuclear medicine societies); developing a database of evidence based assessments for nuclear medicine procedures, to assist countries with regulatory and funding approvals of new diagnostic and therapeutic studies;
and developing strategies to promote young leaders in Nuclear Medicine from developed and developing countries.
The WFNMB also runs quadrennial congresses, which brings together clinicians and scientists from around the world to engage in educational programs, enhance interactions, and provide a forum for promotion of nuclear medicine activities. It aims to provide both informative and cutting-edge lectures on nuclear medicine topics, and provide a vision of future trends in the field.

The next Congress will be held in Melbourne, Australia from April 20-24, 2018 (www.wfnmb.com).

ePatient: What are the most dramatic changes that you have seen in the field of nuclear medicine over thelast 10 years?

I believe that over the last 10 years there have been a series of major technological and innovative changes in diagnostic and therapeutic nuclear medicine that have dramatically impacted on our field. One of the most important changes has been the expansion of PET/CT in both developed and developing countries, primarily in oncology, but also in other clinical indications (e.g. neurology). This has been largely through the acceptance in the broader medical community of the evidence for FDG PET in cancer patients, and concerted efforts to establish evidence based guidelines that incorporate FDG PET in patient management. In developing countries, the establishment of PET Centres has been gradually increasing, allowing access to FDG PET for cancer patients. The
development and clinical implementation of new PET tracers (e.g. 68Ga-DOTATATE, 68 Ga-PSMA, 18F-amino acids, 18F-ß-amyloid) has also provided an exciting opportunity for impact on patient care, and has generated widespread interest in nuclear medicine and broader medical specialists. There is no doubt that SPECT/CT has enormous potential to enhance the diagnostic utility of many of our established nuclear medicine procedures (e.g. bone scans, lung scans), and has increased the accuracy and clinical relevance of these studies. Finally, a resurgence in therapeutic nuclear medicine, through 223 Radium dichloride, locoregional therapy (e.g. 90 Y-Sirspheres) and more recently the clinical results of multi-centre trials of 177 Lu-DOTATATE and 177 Lu-PSMA, has shown how nuclear medicine techniques can make a major impact in cancer patients far beyond what our traditional areas of therapy (e.g. hyperthyroidism and thyroid cancer) would encompass.

ePatient: How do you see the field of nuclear medicine evolving during the next decade?

I foresee a bright and exciting future for nuclear medicine in the next decade. This will be driven by new diagnostic radiopharmaceuticals, mainly for PET but also SPECT, that will enhance our ability to diagnose pathologic processes in oncology, neurology, cardiology, infectious diseases, and other medical conditions. As the development of new therapies for dementia emerge, the importance of accurate diagnosis of neurodegenerative conditions will mean an increased need for FDG PET and 18 F-β-amyloid, or Tau tracer studies, will occur. A major paradigm shift in how nuclear medicine can impact in therapeutic treatment of patients, particularly oncology, will likely emerge, driven by the enormous potential for 177 Lu-based peptide approaches. Prostate cancer treatment alone (with 177 Lu-PSMA) will likely provide challenges for nuclear medicine departments to meet demands for treatment. The development of theranostic approaches for nuclear medicine therapeutics, as well as for drug development, will also continue to advance and play an increasingly important role in our clinical and research programs. There are a number of challenges we need to face to be prepared for these opportunities in diagnostic and therapeutic nuclear medicine. The first is to ensure we develop co-ordinated multi-centre trial capabilities to generate appropriate evidence of the accuracy and clinical impact of these new diagnostic and therapeutic studies. While pharmaceutical company sponsored trials will occur and lead the field, we must also develop the ability to conduct co-operative group trials that are of a standard that provide relevant evidence suitable for regulatory submissions. Co-ordination of trials,
and sharing of technology assessments, is a key approach we will need to establish as a nuclear medicine community. Secondly, we will need to ensure our clinicians and scientists have sufficient training in these new techniques, and ensure this applies in both developed and developing countries. Workforce issues, and ensuring nuclear medicine as a specialty is promoted and enhanced, is vital to ensuring ongoing innovation and clinical impact of our specialty. Lastly, I believe we must develop a strategic approach to advocacy of nuclear medicine, both for our clinician
colleagues, as well as for Government and funding bodies, to ensure we can achieve acceptance and approval for these new diagnostic and therapeutic nuclear medicine studies.

ePatient: In your opinion, what role do you see the Pangea-ePatient magazine play for nuclear medicine?

Communication is the key to achieving improved awareness of where nuclear medicine is heading in the future, and to bring our global nuclear medicine community closer together. Pangea-ePatient provides an innovative approach to enhancing nuclear medicine practice, and ensuring our clinical and scientific colleagues involved in nuclear medicine can be informed of new trends, major issues facing the profession, and educational information. I hope Pangea-ePatient grows from strength to strength in the future !