Siemens reformulates nuclear medicine into division focused on molecular imaging

Molecular imaging has been wending its way slowly into the vernacular of nuclear medicine. Now it appears this term may someday supplant nuclear medicine altogether, at least if the recent action by Siemens Medical Solutions is any guide.

At the annual meeting of the Society of Nuclear Medicine in Toronto, the company changed the name of its nuclear medicine division to Siemens Molecular Imaging. The change was precipitated by the merger of Siemens with CTI Molecular Imaging, whose portfolio goes well beyond the hardware and software typically associated with nuclear medicine. The acquisition of CTI by Siemens echoes a broad recognition by the imaging community at large that nuclear medicine is irrevocably changing.

"Names are tags, and tags are symbolic of the state of medicine today," said Thomas N. McCausland, president and CEO of Siemens Medical Solutions USA. "Molecular imaging is taking us into areas where we have never been before."

Siemens' $1 billion acquisition of CTI Molecular Imaging, which took effect May 4, is intended to catapult the company into those areas. Less than two years ago, CTI was more an obstacle to Siemens. The Knoxville-based company was then jockeying to become a major provider of both equipment and biotracers, competing directly with Siemens for customers through a direct sales force addressing PET/CT scanners.

CTI PET Systems was an unusual collaboration. The joint venture between CTI and Siemens built PET scanners for direct sale by CTI. These scanners were also supplied to Siemens and Hitachi Medical. (Siemens reciprocated with the supply of CT scanners that CTI combined to create its own line of PET/CT scanners.)

CTI subsidiaries provided other services. PETNET Solutions made and distributed FDG. Mirada Solutions focused on postprocessing tools. Molecular Technologies conducted biomarker R&D. Concorde Microsystems was dedicated to the development of preclinical animal-oriented imaging systems. These and the CPS joint venture now have been merged into the newly reformulated Siemens Molecular Imaging.

"We are making structural changes across both old groups - Siemens Nuclear Medicine and CTI Molecular Imaging," said Michael Reitermann, president of Siemens Molecular Imaging. "New responsibilities have been assigned to reflect the broader picture and opportunities that we have, as these groups now have a wider perspective and have been put under one leadership."

Siemens has put a premium on nuclear medicine since acquiring Chicago Nuclear some 40 years ago. This company, which became the nuclear medicine division of Siemens, established Siemens as the premier vendor of imaging equipment until the 1990s, when single-modality specialist ADAC Laboratories burst into the lead. Siemens wrested control back with the release of its e.cam gamma camera and biograph PET/CT system at the end of the decade. (Soon after, ADAC was purchased by Philips.)

The introduction of PET/CT rejuvenated an otherwise lackluster nuclear medicine marketplace, pitting Siemens against archrival GE Healthcare. GE's purchase of the contrast and radiopharmaceutical company Amersham gave substance to a fledgling philosophy of personalized healthcare. This philosophy would use highly targeted in vitro and in vivo tests to identify the preclinical signs of disease, prompting a shift from the conventional see-and-treat medical paradigm to early identification, preclinical treatment, and monitoring.

Siemens, with its acquisition of CTI Molecular, is now aggressively embracing this philosophy. At the SNM meeting, Siemens assembled an elaborate series of learning stations for booth visitors, demonstrating the importance of in vitro testing and molecular imaging and how they support therapy. These stations - semispheres descending from above or chairs with LCD monitors - were perched beneath a huge, ceiling-hung inflatable ball-and-stick model of a molecule.

A section dedicated to prevention described the need to understand disease, preclinical imaging, and therapy tracking. The diagnosis segment explained clinical biomarkers, new developments in chemistry, SPECT/CT, and PET/CT. The therapy section addressed cardiac imaging, neurological imaging, translational research (studies aimed at proving concepts in animals and applying them to humans), and lymphoscintigraphy. Finally, in the segment focused on patient care, Siemens laid out its approach to therapy planning and drug development, tying all the different elements together.

"We see three pillars of molecular medicine: in vitro diagnostics, molecular imaging, and information technology," Reitermann said. "IT links everything together."

Siemens is already well along in its development of the IT infrastructure needed to implement its concept of personalized medicine. The company's comprehensive Soarian IT platform orchestrates all aspects of medical workflow, addressing administrative, diagnostic, clinical, and financial matters. Each component is a compilation of best practices, compressed into algorithms that streamline and interconnect day-to-day tasks throughout the healthcare enterprise. Operators are guided by a "smart" user interface programmed to anticipate the needs and processes of individual users.

The platform is designed to provide the information needed at each stage of patient management. A key driver of this process will be molecular imaging, defined as the characterization and measurement of cellular or molecular processes operating in the body. The goal is to identify and then visualize the specific molecular mechanisms of disease. To accomplish this, Siemens will require a new breed of biomarkers, which the company hopes to uncover partly through internal research made possible by its acquisition of CTI and through alliances with other companies, as well as universities.

Biomarkers will promote the development and use of scanners. CTI Molecular, through PETNET, provides the distribution channels for getting FDG to Siemens customers. The creation by CTI of a research-oriented biomarker subsidiary, now part of Siemens, will support the development of new biomarkers yet not threaten the providers of radiopharmaceuticals and contrast agents.

"We want to be able to work with partners," Reitermann said.

The CTI acquisition positions Siemens to be a major force in the area of medicine for which it is named. But McCausland and Reitermann acknowledged that molecular imaging ranges beyond the traditional bounds of nuclear medicine to include optical imaging, achieved through bioluminescence, and MR spectroscopy. It may extend further into other modalities, including ultrasound, they said. The company has no plans to corral these different expressions of molecular imaging into one division but expects to work with them as they appear in other areas of Siemens.

"What we have at hand are opportunities and these opportunities are evolving," Reitermann said. "The name, molecular imaging, is reflective of that. It is reflecting how our customers are changing."