HealthCare Business News recently spoke with Dr. Satoshi Minoshima, professor and chair of Radiology and Imaging Sciences at the University of Utah, to learn the latest about the Society of Nuclear Medicine and Molecular Imaging, and to get his take on the overall state of nuclear medicine today.

HCB News: What inspired you to get involved in healthcare?
Dr. Satoshi Minoshima: It was quite natural. I grew up with a father who was a surgeon. He had a clinic in Tokyo, and I saw how he worked with, cared for, and treated his patients – daytime, nighttime, phone calls, and house visits. Healthcare or patient care was very close to me. He took care of patients right up to two months before he passed away. I asked him once why he didn’t stop working. He was extremely dedicated to his patients. I wanted to follow his path.

HCB News: How did you connect with SNMMI and get involved to the level you’ve reached today?
SM: I have been a member of the SNMMI for 30 years. I became a member when I was a resident. I was fortunate to be involved in various councils and committees in the SNMMI and chaired several committees. I met many extraordinary people in the SNMMI who became my mentors. The field of imaging is still young. Roentgen discovered the X-ray in 1895. Curie coined the term radioactivity in 1898, an entire discipline was founded less than 100 years ago. Since it’s a new field, there’s lots of technology coming in and new value being established. Nuclear medicine and molecular imaging is one of the most exciting fields in medicine. These efforts have been supported by the SNMMI communities.

HCB News: What initiatives will you focus on during your time as president?
SM: When I was a president-elect in 2017, we created the SNMMI Value Initiative. This framework set our societal strategic plan for the next five years. I would like to continue to promote the value of nuclear medicine and molecular imaging for better patient care through high-quality practice, research and discovery, the workforce pipeline, outreach, and advocacy.

It’s all a holistic kind of initiative. For example, in the quality of practice, we are focusing on developing appropriate use criteria for better integration of imaging in patient care. For research and development, we’re looking to help investigators and industries in their discovery and translation of new technology into clinical practice. Our Industry Alliance group is serving a critical role by providing a way to make new technologies and value available to the patients. For the workforce pipeline, we’re redefining the future of nuclear medicine and molecular imaging training with stakeholders. I have a strong and capable leadership group in the SNMMI to guide the Value Initiative, and a multitude of efforts will be moving forward during my presidency.

HCB News: How is nuclear medicine doing in regard to filling staffing positions?
SM: Based on the AAMC data, the number of people in nuclear medicine training is largely proportional to the number of people coming into radiology training. Radiology, in general, had some difficult years during the last several years, but I think we’re coming out from that dip— recognizing this field with new value and technology. But as a whole, across the entire imaging practice, we’re still short of new professionals entering the field, and this is something we are really working hard to change through various societal efforts.

HCB News: Is nuclear medicine moving into any other specialty’s space where it might cause a sense of competition?
SM: Nuclear medicine is an interdisciplinary field. We have, for example, cardiologists and neurologists attending our meeting. We generate new technology, and sometimes we’re giving up some of that to clinical disciplines so they can be better implemented. I think the field really enjoys interdisciplinary collaboration, and it is a strength. We continue to bring new value and technology into healthcare, and we all have to work together to increase value to patients.

HCB News: What do you think are the main challenges facing SNMMI today?
SM: My generation has been really fortunate to directly work with pioneers in the field of nuclear medicine and molecular imaging. We now need to provide strong mentorship to inspire the next generation of our specialists.

There is also the challenge of training pathways for the interdisciplinary fields of nuclear medicine and molecular imaging. We are actively strategizing how best we can provide training for future nuclear medicine/molecular imaging physicians and scientists.

There are challenges that SNMMI may not be able to fully control, such as the regulatory differences in the United States versus Europe, versus Asia, or how nuclear medicine is reimbursed differentially across countries. We are working closely with stakeholders in the U.S. and international partners to address these issues.

HCB News: Are there any recent developments or plans for SNMMI that you can share?
SM: Various leaders and members of the SNMMI are working on multiple initiatives and ongoing projects. These initiatives will be announced at the upcoming annual meeting in Philadelphia in June. There will be a lot of discussions about new theranostic approaches and new tracers for neuroscience, cardiology, and other medical conditions. The field is moving forward rapidly, and there will be very active scientific sessions at the annual meeting.

HCB News: Have there been any recent developments in the nuclear medicine field that you find particularly promising or exciting?
SM: Theranostics for cancer treatments, where imaging diagnosis and targeted therapy are combined, enabling the practice of precision medicine and improving patient outcomes, is very exciting. Theranostics for neuroendocrine tumors has already become available for clinical care. Similar approaches are actively being developed for prostate cancer. Research is ongoing to apply similar approaches to cancers that are difficult to treat, such as pancreatic cancer.

There are also new molecular tracers for neurological disorders. These tracers are already helping drug development for widespread conditions such as Alzheimer’s disease. Observations from these molecular brain imaging investigations are defining disease progression at a molecular level and even contributing to the new diagnostic framework of neurodegenerative disorders.

HCB News: What is the availability of the new molecular tracers? Are they still confined to research hospitals or are they available beyond?
SM: In 2016, two new radiotracers, one for neuroendocrine tumors and the other for prostate cancer, were approved for clinical use by FDA. This year, we have a new radioactive therapeutic drug approved by FDA for neuroendocrine tumor. In 2017, amyloid PET imaging tracers were available throughout the U.S. under the CMS Coverage with Evidence Development. Many institutions are working on the implementation of these new technologies. It is such an exciting time. We can bring the value of the new developments for patient care now.

HCB News: What are the biggest roadblocks to heavier adoption of nuclear medicine and molecular imaging in the U.S. today?
SM: The cost of the procedures and reimbursement are the biggest roadblocks. The SNMMI advocacy group regularly meets with policy makers in DC on behalf of our members. There is also the limited recognition of the value of nuclear medicine and molecular imaging in the U.S., both within the imaging communities and outside referral communities. The SNMMI outreach group is working very closely with patient groups and referral experts to communicate our value clearly to all stakeholders. This has been one of our focused efforts.

HCB News: Has approval for reimbursement of nuclear medicine and molecular imaging procedures become easier to get, harder or remained the same for new uses over the past five years?
SM: I should answer this question with more concrete data, but my impression is that it is more stringent, but it applies to any new technologies. If you look back 20 or 30 years ago, it was certainly easier. We have to establish not only safety and efficacy, but also value to the patients to get reimbursed. This is the right framework moving forward. It’s not just bureaucracy, it’s also the outcome-based evidence needed to get reimbursement. However, we should think about a pragmatic approach to achieve this.

HCB News: Is it possible that the reimbursement approval is more difficult because there’s more of a challenge to make substantial leaps in patient benefits from new procedures now? That there are smaller incremental improvements being introduced today?
SM: To make substantial leaps, it requires not only extraordinary ideas or discoveries, but also the availability of funding that allows high-risk research and development. Because of the constraint in national healthcare finance, and risk aversion by industries, incremental improvements are inevitable, but also necessary. We pursue both groundbreaking innovations and continuing refinements and improvements of current technologies.

HCB News: Do you believe the push for outcome-based medicine will hurt or help nuclear medicine in the short-term? In the long-term?
SM: It is an iterative process to promote and de-promote medical procedures based on outcome evidence that becomes available through well-designed research. This is not unique to nuclear medicine and molecular imaging. SNMMI is very fortunate that there are many members who are actively working on the development of better diagnostic methods and better treatments through vigorous efforts of validation. However, a bigger challenge may be the difficulty in attributing the value of imaging diagnosis to the patient’s final outcome. There are active efforts ongoing in health services research.

HCB News: Can you offer a prediction on where you believe nuclear medicine will be in 10 years?
SM: Nuclear medicine and molecular imaging will continue to advance discovery and innovation, and translation of such advancements to patient care. Some of the new technologies we are investigating now, such as precision theranostics, will be implemented in routine clinical practice in less than 10 years. Molecular imaging will continue to help discover the pathogenesis and pathophysiology of disease, and support better definition of diseases and therapeutic development. The appropriate use of imaging and the care pathway will be defined better in our practice of medicine. Looking at worldwide activities in nuclear medicine and molecular imaging, the field will continue to be one of the most exciting medical disciplines.

HCB News: What are you most excited about with the upcoming annual meeting?
SM: We are changing the format of the meeting with new initiatives this year. Our meeting has been one of the best scientific meetings in the field of imaging, but we’re now adding a lot of “fun” factors for attendees. This year’s highlight country is China, and the Chinese Society of Nuclear Medicine is also planning various activities. I hope to see everyone who shares our goals and enthusiasm in Philadelphia in June!