Advances in science, technology and social media, plus a $215 million investment in the 2016 federal budget, are aligning to create unprecedented innovations in health care. Using science to precisely target subgroups of patients with similar prognoses to treat them with very specific therapies may sound like something from a futuristic novel, but this process is real. Welcome to precision medicine.

What is precision medicine?

Precision medicine provides a more individualized, molecular approach to specific diseases and therapies for patients. Plans for this initiative include short-term and long-term components.

In the short term, the focus will be on cancers. In the long term, plans cover the entire spectrum of health and disease. According to an article on the New England Journal of Medicine’s website, “A New Initiative on Precision Medicine,” Francis Collins, MD, Ph.D, says, “Both components are now within our reach because of advances in basic research, including molecular biology, genomics and bioinformatics.”

Phenotyping and the importance of imaging

Diagnostic imaging will play an increasingly significant role in precision medicine because of the importance of phenotyping, according to James H. Thrall, MD, FACR, chair emeritus, department of radiology, Massachusetts General Hospital, Boston, and a member of the Institute of Medicine of the National Academies.

On May 19, 2015, at the Annual Meeting of the American College of Radiology in Washington, DC, Dr. Thrall discussed the increased role of imaging in precision medicine and phenotyping. In an online article, “The Key to Precision Medicine: Imaging,” Radiology Business discusses Dr. Thrall’s points, “Phenotyping the physical manifestations of disease to establish cohorts and prognosticate responses to treatments and therapies is a cornerstone of precision medicine… Imaging-based phenotyping can trump other phenotyping methods—i.e. clinical history/physical examination, laboratory testing, and histopathology/immunopathology.”

Dr. Thrall elaborated by saying the key to the practice of precision medicine is “identifying small groups of people who, because they have a similar clinical presentation and biology of their disease, are likely to respond to the same treatments and to have similar prognosis.” As a result, discovering which subpopulations best respond to a particular follow-up treatment clears the way for far more efficient clinical trials as well as the ability to treat patients within the exact characteristics of their disease.

In an online article, the Radiological Society of North America (RSNA) explains why imaging will play an important role in precision medicine:

Conceptually, the radiology report is an enumeration of the imaging biomarker and, as such, constitutes an ‘imaging phenotype’ at that point in time. Imaging phenotypes are systems for scoring, categorizing and classifying disease processes and their severity. They define these ‘precise’ subpopulations. Establishing linkages between genotypes and imaging phenotypes (radio genomics) will serve as the foundation for surveillance of disease manifestation—occurrence, location, extent, severity—and discovery of genetic polymorphisms.

Radiologists will be key for this new model of patient-powered research because of the role imaging plays in phenotyping, thus opening an opportunity for them to be a leader in this exciting era.

Final thoughts | Imaging in the Era of Precision Medicine

As the field of diagnostic imaging becomes more precise, it will become even more critical for imaging providers to ensure they are in compliance with quality guidelines. RadSite’s accreditation programs can help you demonstrate your center’s quality for CT, MRI, PET and SPECT services.

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