Systems-based healthcare hinges on imaging research

Imaging is poised to play a key role in the advancement of 21st century science and healthcare. This will happen only if the radiology community changes its view of imaging sciences, according to Dr. Elias Zerhouni, a radiologist and director of the National Institutes of Health. And if that means researchers adopting unconventional or innovative approaches, so be it.

"The greatest risk in science is to stop taking risks. Let radiologists become what they were before - great risk-takers," he said during Sunday's session on the future of biomedical imaging and imaging research.

One of the greatest weaknesses in medical research is the inability to study complexity, Zerhouni said. This looks set to change as science moves toward systems biology. Investigators in the future will look at disease pathways, not single diseases, and at multiple drug targets. They will study fundamental disease mechanisms, such as inflammation or apoptosis, rather than specific conditions, like arthritis or cancer.

This change in approach will mean a move away from qualitative, unidimensional, nonspecific information.

"We are talking about quantitative, nondestructive, spatially and temporally resolved data. All of these words say 'imaging' to me," he said. "Imaging is the science of extracting spatially and temporally resolved relevant biological information. That's what we do."

Imaging will be relevant to every measurement length scale: angstroms, microns, and meters, Zerhouni said. Existing imaging technologies currently struggle to resolve structures in the 100 to 500 nm range, such as complex macromolecular systems. Researchers are working to plug this gap through the development of innovative imaging technologies.

He predicts that over the next 20 years imaging researchers will continue in their efforts to detect subclinical disease. He would also like radiologists to develop imaging-based in vivo biomarkers that could assist in the study of treatments for long-term chronic diseases. Image-guided interventions and microsampling for disease characterization is another large area ripe for radiology research.

Zerhouni envisages this research endeavour as being truly global and he is keen to foster international collaborations. The NIH will this year invest approximately $1 billion in scientific research outside the U.S., and in collaborative projects with non-U.S. partners. More than 50% of the NIH's partnership projects involve European countries.

"Science advances so fast that any barriers between scientists, wherever they are - within an institution or between institutions in different countries - are an impediment to progress," he said. "In the future, imaging sciences will have to have an international collaborative framework that is easy to travel."

Speaking at the same session, Dr. Liselotte Højgaard, chair of the European Medical Research Council (EMRC) reiterated the importance of international collaboration in imaging research. The EMRC is looking at ways to reciprocate the generosity that the NIH shows to European researchers, she said.

At the moment, however, Europe lags behind the U.S. in terms of R&D investment. In the U.S., 2.6% of GDP is channelled toward R&D, compared with 1.9% in the European Union. Sources for funding are also fragmented, with just 7% to 8% of EU R&D investment coming from the centralised framework funding program. The remainder is provided by national agencies, industry, and charities.

Højgaard encouraged ECR delegates to take advantage of funding opportunities for research. She also welcomed initiatives designed to unite imaging researchers from different backgrounds, such as the newly formed European Institute for Biomedical Imaging Research. She advised radiologists not to become restricted to any one or two methods, but to consider all available tools and techniques that could assist in answering their clinical questions.

"Some radiologists are very much in love with their own methodology and don't look at the methodology next door. They are either a CT person, a PET person, or an MRI person," she said. "Perhaps we should instead be organ experts, so we know, for example, about all the different modalities that could be used for brain imaging.