Nuclear Medicine in the Third Millennium

Article Information

Lucio Mango1,2*
1Professor of Nuclear Medicine, Medical Radiology Technician degree course, University “La Sapienza”, Rome, Italy
2Director Health Management master’s degree, University of International Studies (UNINT), Rome, Italy
*Correspondence to: Dr. Lucio Mango, Via San Godenzo, 154, 00189 Roma, Italy, Tel: +393358456518; E-mail:
Received: November 28, 2019; Accepted: December 02, 2019; Published: December 05, 2019
Copyright: ©2019 Mango L. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Mango L. Nuclear Medicine in the Third Millennium. J Nucle Med Clinic Imag. 2019; 1(1). 001.

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The advent of extraordinary advances in the field of molecular and cellular biology have substantially modified both the diagnostic and therapeutic approaches of many human pathologies [1,2].

The ability to decode the entire human genome [3], as well as the identification of alterations and molecular genetic mechanisms underlying several diseases [4], or the ongoing identification of new molecular targets, have transformed our ability to identify many pathological processes making possible toset in on their evolution by monitoring them with properly synthesized radioactive molecules [5].

The future development in diagnostic and therapeutic field of Nuclear Medicine consists in validating innovative imaging methods whose purpose is to visualize and quantify in vivo complex cellular processes. Just think of processes such as angiogenesis, apoptosis, pleiotropic drug resistance and gene expression modulation, especially in their application in neoplastic diseases.

The possibility offered to nuclear medicine in this sense therefore allows it to be a primary protagonist in the development of the diagnosis and therapy of complex pathologies, including a series of rare diseases.

The development of new non-invasive and high-resolution imaging technologies, in conjunction with the design, synthesis and characterization of molecular probes directed against specific molecular targets [6] allowed the development of that large area of research called “molecular imaging”, a technique that provides the tools for studying numerous biological processes both qualitatively and quantitatively, and non-invasively.

A role to play through the testing of new diagnostic methods capable of displaying the finest pathogenetic mechanisms, but also test the effectiveness of new therapies aimed at restoring a broken function. All this across the frontier not only of the world of “medical imaging” but also, and above all, of molecular biology and nanotechnology.

It is, therefore, currently easy to take advantage of the potential applications of Molecular Imaging obviously made possible Positronemission tomography (PET), which has already partially solved the “intrinsic” limit of clinical research, i.e. to create “molecular images”, bringing a pharmacological molecule, linked to a radionuclide, into the cellular structure.

The future of Nuclear Medicine is therefore an effective use of radioactivity, which allows us to get more and more into the mechanisms that generate and maintain the disease and eliminate them or, if possible, to correct them.

To achieve this, it is fundamental to characterize in vivo antigen/ antibody, such as receptor/ligand systems and transport/substrate molecules, of which the current modalities of molecular imaging are present and future instruments.

The new millennium has opened with alarming data on infections and antimicrobial resistance. Viral infections (SARS, MERS-CoV, Zika, Chikungunya, West Nile, Ebola virus infection, etc.) emerged or reemerged with threatening foci. Furthermore a new emergency consists in antimicrobial resistance to bacterial infections, which is an extremely important issue in developed and developing countries, where this problem has become a top priority for global policy makers and public health authorities [7] and nuclear medicine can offer valid answers in this area [8].

Speaking of training, it is to be considered that residents and consultants in radiology and nuclear medicine have a great interest in the further formation of mutual specialties [9].

A further impetus to the development of nuclear medicine lies in the conception, design and construction of ever more efficient hybrid machinesin order to provide more information with only one exam [10].

To keep in mind the advent of “artificial intelligence” in our branch, with some fear that makes us lose autonomy and visibility. But artificial intelligence will not destroy our specialty. Rather, it will work alongside us and make our specialty more relevant than ever in providing value-based cancer care [11].

More progress has been made in the field of nuclear medical therapy. In fact, the advent of new radiopharmaceuticals, and in particular alphaemitters, resulted in the achievement of results before unexpected with very effective therapeutic action on neoplastic tissue accompanied by a negligible dose to healthy tissues [12].

These terapeutic advantages are even more enhanced by the development of increasingly precise and accurate dosimetry techniques [13] capable of evaluating the dose absorbed by the neoplastic tissue well before the administration of the therapeutic dose, through the application of the theranostic that sees in nuclear medicine its natural dead end [14,15].

I would like to conclude with the words of President Roosevelt, “the only thing we have to fear is fear itself ”. Fear is powerful, but rather than surrender to it, we can choose to create a future in which the members of our specialty are among the leaders in precision medicine and valuebased healthcare.


1. Mazaira GI, Zgajnar NR, Lotufo CM, Daneri-Becerra C, Sivils JC, Soto OB, Cox MB, Galigniana MD. The nuclear receptor field: A historical overview and future challenges. Nuclear receptor research. 2018;5.
2. Avinash MB, Govindaraju T. Architectonics: design of molecular architecture for functional applications. Accounts of chemical research. 2018 Jan 24;51(2):414-26.
3. Jain M, Koren S, Miga KH, Quick J, Rand AC, Sasani TA, Tyson JR, Beggs AD, Dilthey AT, Fiddes IT, Malla S. Nanopore sequencing and assembly of a human genome with ultra-long reads. Nature biotechnology. 2018 Apr;36(4):338.
4. Ameur A, Kloosterman WP, Hestand MS. Single-molecule sequencing: towards clinical applications. Trends in biotechnology. 2019 Jan 1;37(1):72-85.
5. Ilem-Ozdemir D, Gundogdu EA, Ekinci M, Ozgenc E, Asikoglu M. Nuclear medicine and radiopharmaceuticals for molecular diagnosis.In:Grumezescu AM (ed) Biomedical Applications of Nanoparticles.William Andrew Publishing,2019.PP: 457-90.
6. Hattori Y, Aoyama K, Maeda J, Arimura N, Takahashi Y, Sasaki M, Fujinaga M, Seki C, Nagai Y, Kawamura K, Yamasaki T. Design, Synthesis, and Evaluation of (4 R)-1-{3-[2- (18F) Fluoro-4-methylpyridin-3-yl] phenyl}-4-[4-(1, 3-thiazol-2-ylcarbonyl) piperazin1-yl] pyrrolidin-2-one ([18F] T-401) as a Novel Positron-Emission Tomography Imaging Agent for Monoacylglycerol Lipase. Journal of medicinal chemistry. 2019 Feb 12;62(5):2362-75.
7. Petrosillo N. Infections: The Emergency of the New Millennium. InNuclear Medicine in Infectious Diseases 2020 (pp. 1-8). Springer, Cham.
8. Signore A, Lazzeri E, Lauri C. Acquisition Protocols and Image Interpretation Criteria Nuclear Medicine Imaging of Infectious Diseases. InNuclear Medicine in Infectious Diseases 2020 (pp. 61-71). Springer, Cham.
9. Kim SY, Xydias T, Peters AA, Brönnimann MP, Wüthrich M, Heverhagen JT, Maurer MH. Radiologists and nuclear medicine physicians are looking forward to a crosscurricular training. European radiology. 2019 Feb 11:1-9.
10. Mango L, Ventroni G. Hybrid Tecnology: From cars to diagnosis. ARC J Rad Med Imag. 2017;2:1-6.
11. Hricak H. Beyond Imaging-Radiology of Tomorrow.Radiology. 2018; 286(3): 764-75.
12. Mango L, Pacilio M. Therapy with Alpha Rays. ARC J. Radiol. Med. Imaging. 2016;1:1-3.
13. Mango L. Dosimetry for molecular radiotherapy. J Radiol Med Imaging. 2019; 2(1): 1015
14. Mango L. Theranostics: A Unique Concept to Nuclear Medicine. Heighpubs J Cancer Sci Res. 2017; 1:001-004.
15. Miao T, Oldinski RA, Liu G, Chen X. Nanotheranostics-Based Imaging for Cancer Treatment Monitoring. In: Rai P, Morris S (eds) Nanotheranostics for Cancer Applications. Bioanalysis (Advanced Materials, Methods, and Devices).vol 5. Springer, Cham, 2019.