Future of Imaging - Q1 - Feb 2019 by Mediaplanet UK&IE

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DR JANE PHILLIPS-HUGHES After the commemoration of Godfrey Hounsfield, what’s next for imaging? » p2

DR HUGH HARVEY Within radiology, I see AI as the future. » p4

PHILIP WARD Top trends in radiology by Aunt Minnie Europe’s Editor in Chief. » p6

Future of Imaging HEALTHAWARENESS.CO.UK

ECR 2019: where 28,000 imaging professionals get up to speed How do imaging professionals keep up with the relentlessly expanding boundaries of imaging science? Events like the European Congress of Radiology (ECR) have the answer.

wo numbers hold special significance for the European Society of Radiology (ESR) in early 2019. One we already know: 25. This is the number of ECRs that will have been held in Vienna by the time ECR 2019 has run its course from February 27 to March 3. The other number we will only find out later but, if the current trend continues, it ought to be somewhere above 28,474 – the number of attendees at last year’s ECR. The former is a satisfying milestone for the European Society of Radiology (ESR), and one we will celebrate prominently at this year’s event, but the latter is what counts most for the future. Meetings help imaging professionals keep up with advances Meetings like the ECR are as popular as ever and there is no doubt that they play a crucial role in pushing imaging forward. It can be hard to keep up with

advances in the field, but the ECR gives the whole community an opportunity to take stock of recent progress, and individuals the chance to dive into any chosen topic. Building connections across the spectrum of imaging Tens of thousands of healthcare professionals, students, trainees and industry representatives consider the ECR an unmissable chance to get themselves up to speed. Not only that, but the connections created by bringing together so many people spark all kinds of new initiatives, projects and collaborations. We take it as a great sign for the future of imaging that our community is so keen to be a part of such educational and scientific professional events. AI is a key focus for ECR 2019 So, what can attendees expect when they arrive at ECR 2019? It should

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Tens of thousands of healthcare professionals, students, trainees and industry representatives consider the ECR an unmissable chance to get themselves up to speed.” go without saying that we are fully embracing artificial intelligence (AI) this year. The hottest topic in imaging will be very well represented, with interactive exhibits, an AI theatre, and no fewer than 44 scientific sessions dedicated to the topic. We are also hugely excited to be expanding our CUBE programme, which was launched last year to bring interventional radiology to the fore. It was a great success at ECR 2018, but we hope the ‘CUBE 2.0’ is going to inspire twice as many participants this time around. Naturally, we have a few special ideas lined up to mark that 25th

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LORENZO E DERCHI President, European Society of Radiology (ESR)

anniversary as well, but I do not want to give too much away. Suffice it to say that we have applied this year’s motto, ‘the bigger picture’ in quite a literal sense. From 1991 to the present day, each ESR and ECR president has passed on the fruits of their achievements to the next, resulting in the marvellous, trend-setting congress we know today. They have made the ECR what it is, and that is what we will be celebrating in Vienna. Science with style Every year, a tremendous amount of work goes into building a programme that meets the needs of all our attendees, but just as much effort goes into creating an atmosphere where people feel welcome and comfortable, but also suitably inspired. Our attention to detail, from the overall design to the fun extras (virtual skydives, table football tournaments and even ice stock lanes) is a key part

of what makes the ECR successful. We are certain this is one reason our onsite participation keeps growing. Stream the ECR via our free, live broadcasting We are also building a significant online following, by embracing the potential of live broadcasting. Anyone interested in the ECR can use our streaming platform ECR online free of charge. You will miss out on the networking aspect (one of the main benefits of attending), but you will still get a lot out of it. This is another great example of how the ESR always tries to do what it can to make knowledge accessible for the benefit of the specialty. I am sure the ECR will continue to find other new ways to push the boundaries of what a scientific meeting can be, long into the future.

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Touchscreen tables and giant boards make imaging more visible

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ALEXANDER PECK Superintendent Radiographer and Chartered IT Professional, British Institute of Radiology

Long-imagined in hit TV shows and films, futuristic devices for displaying diagnostic medical imaging data are now becoming a common sight across the NHS and universities. Patients’ diagnostic pathways are now all in one place Until now, a key cause for lost time in medicine was the disconnect between the display of radiology, pathology, cytology and other diagnostic departments’ imaging. Traditionally, diagnostic data remained siloed within separate IT systems, but new technologies – including entire table- or wall-sized touch-screen boards – do away with these boundaries, allowing for a patient’s full diagnostic pathway to be displayed at the same time. For example, in breast cancer care, all portions of the diagnostic imaging process can be collated in one system and viewed in a simple, easy-to-follow, sequential manner. With the ever-increasing complexity and options available within modern healthcare, this is a great timesaver to those involved in both the diagnostic and treatment processes. Quicker collaboration and planning for surgery and treatment Integrated within each of the devices are secure connections to other units, allowing for specialists in different areas of the world to communicate and safely share their personal expertise on individual cases. The secure connections also allow for a surgeon in a single department to pre-plan a more complex procedure in detail, in advance, for themselves or perhaps a colleague, to carry out later. Multi-disciplinary team meetings can also take place in a far more dynamic and interactive manner than the historical ‘lecture theatre’, didactic manner. Secure sharing of anonymised cases opens up the chance for quick collaboration as needed. Less-invasive procedures Millions of autopsies are performed around the world every year. With these new technologies, ‘hands-off’, virtual autopsies can become the norm in a good percentage of cases. These are more compatible with religious requirements, are less invasive and comparatively quicker. Having large format displays, and software pre-loaded to handle advanced 3D reconstruction, virtual dissection and application of AI routines allows for these cross-practise developments. For students attending autopsies to learn about internal anatomy, tables and boards offer fewer physiological barriers to their learning environment. Autopsies no longer require students’ physical attendance during set times of the day, yet provide more consistent teaching outcomes: the students’ learning opportunities are no longer dependant on the cases of the day. Positive student interaction during training Traditionally, as learning opportunities were dictated by the time and complexity of cases available, a busy surgical environment presented challenges for educational efforts. Having access to curated and preprepared cases from around the world on a global education portal now allows for a wider variety of experience to be gained more quickly, in a safe environment and for lower costs. For those setting out in the medical profession, the real-life radiographic imaging can be overlaid with line-drawings of vascular systems or other body components and even compared with built-in textbook cases or typical pathologies to aid understanding. Increased patient engagement and accessibility Patients who become engaged in their treatment pathway and share an understanding of their condition have repeatedly been found to have more positive outcomes. Tables and boards integrated into each hospital’s standard picture archiving and communication system can present the diagnostic imaging in a far more accessible and visual manner than traditional notes and PC monitors on a healthcare professional’s desk. Recently in use at the Nobel Nightcap events, modern technologies such as these educational boards and tables (plus others now becoming more commonplace), give healthcare professionals another tool in their armoury for improving patient care.

4 HEALTHAWARENESS.CO.UK

What the AI revolution could mean for you AI looks set to transform the world of imaging, cutting reading times, boosting accuracy and improving patient care. Where is it now?

Byline: Linda Whitney

DR HUGH HARVEY, MBBS BSC(HONS) FRCR MD(RES) Radiologist

rtificial intelligence (AI) has the power to revolutionise imaging, saving time, money and lives. Within the next few years, it's forecast to be a standard feature of UK healthcare - but what does this mean for patients, radiologists, radiographers and the wider healthcare team? Dr Hugh Harvey, a consultant radiologist who sits on the Royal College of Radiologists informatics committee and is an AI advisory board member, says: “Within radiology, I see AI as the future.” Using AI to help diagnose cancer Dr Harvey, who has been using deep learning – a form of AI – to aid cancer diagnosis using mammograms, says: “In the past year, we have seen the first prospective studies in the UK, which test the algorithms used in AI systems against the judgement of experienced radiologists in detecting breast cancer. “We already have a handful of results, but 2019 will bring more, and within a couple of years we should have a clearer picture of how AI will perform in the real world. The picture looks very promising.” More than tumour detection AI holds out the possibility of faster and more accurate image interpretation, making it easier for radiologists to decide whether cancer is present. But it can do more. Dr Harvey says: “It can highlight regions of interest on scans, such as nodules in the lungs, bleeds in the brain, and bone fractures. It can assist in radiomics, measuring and analysing findings

AI can reduce image reading time to a few seconds, and potentially improve accuracy.” to uncover otherwise hidden disease characteristics.” AI can also be used behind the scenes in the radiology department to help prioritise cases, decide the most appropriate type of scan reduce the time taken for procedures such as MRIs, cut radiation doses, and help schedule appointments. It could also aid in recording conclusions and communicating information to clinics and patients. “No single system can carry out all these tasks yet, but this could be achieved by different systems working together,” says Dr Harvey. Is AI the end of radiologists? “No,” says Dr Harvey. “A few years ago, there were fears in the profession that AI meant radiologists would no longer be needed, but now people are realising that algorithms cannot replicate everything radiologists do. We still need human skills to tie together all the information gathered.” Instead, AI will make life easier, he says. “AI can reduce image reading time to a few seconds, and potentially improve accuracy. There is currently a huge image reading backlog and a shortage of radiologists. AI could help close the gaps. That's why these prospective studies, which aim to show how AI can increase accuracy and save time, are so exciting, though we also need health economics assessments that prove it can pay for itself.”

Wider applications for AI across cancers and chest X-rays The huge number of images generated by breast cancer screening make it an obvious area for introducing AI, which benefits from having very high numbers of images from which to 'learn' to detect abnormalities. However, it has the potential to revolutionise the detection of a far wider range of conditions. “Chest X-rays still account for the largest volume of images we generate, and there is already work going on to design algorithms to analyse them,” says Dr Harvey, “but the range of pathologies revealed by a chest X-ray is far greater than those revealed by a mammogram, so it is a more complicated task. “We also use imaging in detecting cancers, and work is already underway on using AI in that,” says Dr Harvey. We need a central data hub to ‘train’ AI One of the problems in advancing AI is access to large numbers of images on which to train the algorithms. Dr Harvey has proposed the creation of what he calls the British Radiology Artificial Intelligence Network (BRAIN), a central data science institute to give secure, regulated access to anonymised NHS medical imaging data. “In France and the US, some medical groups are already collecting data centrally. The UK should be doing this too, as AI is clearly a part of the future of imaging.” Read more at healthawareness.co.uk MEDIAPLANET

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Smart scanning and image interpretation PAUL KRUEGEL Global Communications Manager Artificial Intelligence, Siemens Healthineers

he idea is visionary, but nevertheless obvious: could artificial intelligence (AI) make diagnostic scans more precise and meaningful - and thus ultimately make therapy more individual and reliable? Today, AI already supports imaging at various levels, such as recording and processing image data. In the future, however, it will also become increasingly important for image interpretation. As in other areas, such as speech recognition on smartphones, AI in medicine is often based on artificial neural networks. This refers to computer algorithms that imitate the networking and function of the nerve cells in the brain (even if they are by no means a lifelike image of the cerebral cortex). Such algorithms are capable of learning and can, for example, be trained with the data

from computer tomography in such a way that they independently recognise anatomical structures. Paths to individualised computed tomography The practical benefits of AI are now beyond question. For example, Siemens Healthineers has developed an intelligent 3D camera system that recognises the body contours and position of patients in a CT device and individually calculates the optimal height of the scanner table. This makes it possible to achieve better images with lower radiation exposure. Image processing is also considerably facilitated by AI-based anatomical pattern recognition. Thanks to the technology, radiologists can view the right kidney or left acetabulum in seconds. For example, in extensive 3D image

data sets, it can display the correct numbering of ribs and vertebral bodies or precisely compare the images with previous The AI-Rad Companion Chest CT is the latest digital companion offering by Siemens Healthineers scans. Siemens Healthineers recently introduced two digital Images become data sets success of the therapy. companions â&#x20AC;&#x201C; powerful AI-enriched What is particularly fascinating, In other words, AI could make systems called the AI-Pathway however, is that AI algorithms can medical images even more valuable Companion1 and the AI-Rad now also be used by physicians for in the future. This would make them Companion2. The latter, being an the actual diagnosis. One example is all the more beneficial for individual intelligent services platform for the automated analysis of skull CTs in patient care. radiologists, may help to reduce order to promptly detect unexpected Sponsored by the time of interpretation and brain hemorrhages. reporting. It automatically performs Even image information that measurements and prepares results cannot be seen with the naked eye in the form of valuable clinical can be revealed by advanced AI images and reports. AI- applications. For cancer patients, for Rad Companion Chest CT is example, it is in principle possible fully integrated in the image to use computerised image data interpretation workflow and helps analyses to identify specific patterns Read more at to handle the daily workload with that make it possible to better assess siemens-healthineers.com/ ai-rad more ease. the course of the disease or the

1: The product/feature mentioned herein is under development and not commercially available. Due to regulatory reasons its future availability cannot be guaranteed 2: AI-Rad Companion is 510(k) pending, and not yet commercially available in the United States and other countries

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Brexit, artificial intelligence and the long-term effects of MRI PHILIP WARD Editor in Chief, AuntMinnieEurope.com Consulting Editor, ECR Today newspaper

How will Brexit affect European radiologists? How will we ensure AI and machine learning is ethical? And just how safe are gadolinium-based contrast agents for MRI? Brexit's impact on staff recruitment and regulatory affairs Brexit is already exerting an influence on European radiology, having contributed to untold numbers of radiologists and radiographers leaving the UK and returning to their native EU countries. This is a serious blow for the UK, but positive news for the healthcare system of other nations. The unanswered question is how Brexit will affect the future mobility and recruitment of staff. In September 2018, Dr Nicola Strickland, President of the Royal College of Radiologists, predicted that the UK will have a shortage of at least 1,600 radiologists by 2022 and the scale of the crisis cannot be overstated. The loss of EU research grants will be an important factor too, particularly in molecular imaging and basic research. Changes are also occurring in the regulation and supply of devices and drugs, including contrast agents and radiopharmaceuticals. The UK vote to leave the EU has led to the relocation of the European Medicines Agency from London to Amsterdam. It's uncertain how this will affect the regulatory process and drug supply chain in the years ahead.

The UK could have a shortage of at least 1,600 radiologists by 2022.” Growth of artificial intelligence and machine learning Artificial intelligence made sustained progress in 2018. Deep-learning algorithms are being developed and tested at a rapid rate, and AI is starting to permeate nearly every aspect of the radiology practice. The jury's out as to whether the hype about AI is justified. Supporters are convinced AI can fuel the next technological revolution and will have a significant impact, and AI holds great promise for overworked radiologists who want to offload less rewarding chores. Others think a service run by machines, with people being sidelined, is a chilling prospect. The technology is immature, and constant upgrades and updates will be essential, plus an infinite supply of reliable, freely available data for AI remains a distant prospect, say the sceptics. AI’s evolution continues apace, and many new products and services are being unveiled in Vienna. The main challenge, however, is to ensure an ethical approach to AI is taken and adequate regulation is in force to guarantee patient safety and confidentiality and avoid inhuman decisions. Debate over safety and future use of gadolinium MRI contrast Controversy over the safety of gadolinium-based contrast agents (GBCAs) for MRI shows no sign of abating. Most discussion now is on gadolinium deposition in the brain and body tissue of patients after MRI, as scientists strive to build up a better understanding of the mechanism by which deposition occurs. In the US, a road map to guide research investigations has been published. It focuses on issues such as the long-term biodistribution of GBCAs, the potential toxicity of retained gadolinium, and whether certain populations are more vulnerable. Will Europe produce a similar guide? Also, will lawsuits be made against manufacturers, as has happened in the US? The issue is unlikely to disappear during 2019. It will be intriguing to see what new evidence emerges at ECR 2019. As the world of medical imaging gathers in Vienna for ECR 2019, now is an excellent time for everyone to consider the big picture. Read more at healthawareness.co.uk

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How can nuclear medicine, theranostics, and molecular radiotherapy benefit patients? SARAH ALLEN Consultant Clinical Scientist in Nuclear Medicine, Guy’s and St. Thomas’ NHS Foundation Trust

Nuclear medicine diagnostics and molecular radiotherapy (mRT) has always been ahead of the curve. Theranostics, multidisciplinary teams and just-in-time medicine are its business well before these became the future of healthcare. Theranostics For over sixty years, nuclear medicine has used tracer amounts of radioactive radioiodine to diagnose thyroid cancer. Areas of disease are highlighted by diagnostic imaging, meaning they can be successfully treated with larger doses of the same radionuclide. Early-day theranostics, diagnostics and therapy link together to provide upfront assurance that a therapeutic option will target disease. In the case of mRT (or targeted radionuclide therapy), theranostics can optimise the radiation dose to provide a treatment effect with minimum side effects to the patient. Molecular radiotherapy Used to treat thyroid cancer, radioiodine is the bedrock of mRT, but it is challenging. It has its place as a useful therapy as it is a curative option. Treatments with radioactive iodine 131 traditionally require an inpatient stay in rooms with lead shielding. Due to the high-energy gamma emissions, lengthy, complex, post-therapy radiation protection advice is crucial after patients are discharged. This downside has not gone unrecognised and has led to research trials for the introduction of smaller, administered activities in low-risk disease that can be provided as a day case. This has been a great step forward for the management of thyroid cancer and an indication that inpatient stays and long radiation protections restrictions for patients are barriers for acceptance of mRT by patients and healthcare systems. Game changers Treatments using radioactive medical products have always hidden in the shadows due to complex regulatory requirements and specialist facilities. The subtle differences in the physical characteristics of the radiopharmacology are crucial in determining the acceptance of a new procedure. Two newcomers, 223RadiumDiChloride (223RaCl, Xofigo) and the peptide receptor, radionuclide

therapy (PRRT) 177Lutetium Dotatate (Lutathera), have advantages beyond the evidence of excellent clinical outcomes for the patient. 177Lutetium is an isotope with the required beta emissions profile for treatment with the added benefit of a gamma emission. This delivers enough to provide excellent-quality imaging while using standard nuclear medicine equipment but without lengthy gamma emissions, which would require additional radiation protection advice postdischarge. Highly detailed, post-therapy imaging provides clinicians and patients with understanding of the disease status and comparison with pre-therapy theranostics for patients with suspected neuroendocrine tumours (NET) provided by the somatostatin receptor, PET tracer 68Gallium-Dotatate. Greater impact on staff preparing and administering treatments In comparison, 90Yttrium – a pure beta emitter – has the potential for excellent mRT therapy and can be labeled to peptides for PPRT. Unlike 177Lutetium, the beta emissions from 90Yttrium are considerably higher energy and cause more issues for staff preparing and administered treatments. Additionally, there is the added blow that post-therapy imaging using 90Yttrium, although possible, is not good quality and therefore does not facilitate comparisons between cycles of treatment and with detailed images provided by diagnostic PET imaging. Perhaps for these reasons 177Lutetium-Dotatate, with its superior imaging characteristics, attracted initial interest and funding for patient trials, which led to its acceptance as a treatment option for patients with NET. The low-toxicity of 223Ra makes it a versatile treatment option 223Ra-Cl provides palliative treatment of bone pain in men with prostate cancer and is approved by NICE. Translation of this innovative

product, the first clinical use of alpha emitters, was made easier by the physical properties of 223Ra. One per cent of its decay is a gamma emission that conveniently allows the radioactivity to be measured accurately using conventional equipment. Without this, its adoption would be more problematic, slower and costly. So, in a population that needs treatments with low toxicity, it’s a benefit that it can be administered via a quick injection once a month for six months on an outpatient basis. The treatment requires no complicated radiation protection guidance thanks to the properties of alphas; patients can have it and just go home. The importance of discussing post-treatment advice to patients Nuclear medicine does not function without the whole team: the patient, nuclear medicine physicians, radiologists, imaging technologists, nurses and nuclear medicine physicists. mRT has always required the patient to be consulted. Post-treatment advice to family and friends on reducing radiation doses requires two-way conversations on the practicalities of life. There must be compromise and understanding on both sides to ensure the best outcomes. Nuclear medicine theranostics is the ultimate just-in-time medicine. It comprises short-lived radiopharmaceuticals, optimised to deliver high radiation doses to tumours. It benefits from a fast rate of decay, so reduces side effects to other organs. This therapy allows patients to return home with minimal disruption to their lives. Future innovations in mRT need to consider the benefits beyond clinical trials to ensure acceptance in healthcare systems that need simplicity to ensure long-term sustainability.

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Prostate cancer – the power of pairing in diagnosis and treatment

DR PHILIP CAMILLERI Consultant Clinical Oncologist MRCP M.D. FRCR

MR ALAN DOHERTY Consultant Urologist MB BS, Bsc, MD, FRCS(Urol), FEBU

Byline: Linda Whitney

Theranostics coming to the UK in a roll out programme that uses innovative imaging technology and radiopharmaceuticals for diagnosis and treatment.

new theranostic imaging technique that offers unprecedented levels of accuracy in the diagnosis of advanced prostate cancer will soon be available for treating it, offering the hope of a longer and better quality of life for patients. The new tool is being hailed as a major step forward in diagnosis and treatment of men with metastatic castration resistant prostate cancer (mCRPC), which has relapsed and spread to other sites after standard androgen-deprivation treatment has become ineffective. "These scans can detect a fraction of the amount of cancer than can be picked up by other types of scanning, so we can spot the size and location of the cancer at a far earlier stage," says Dr Philip Camilleri, a clinical oncologist in Oxford. As for the potential to use therapeutic radionuclides to treat mCRPC, he says: "It is a totally new weapon in our anti-cancer armoury." A better way of diagnosing and treating mCRPC could have significant impact: Prostate cancer is the most commonly diagnosed cancer in males and the second leading cause of cancer mortality among men. While many patients are cured of prostate cancer, a significant proportion progress towards mCRPC. So how does this work? The key to the new theranostic MEDIAPLANET

technique is the ‘pairing’ of a radioisotope and in this case it is paired with prostate specific membrane antigen (PSMA), a protein expressed by prostate tissue, including cancerous tissue. This pairing creates a radiotracer which can be injected into a patient and used in molecular imaging such as PET/CT scanning. Pair PSMA with the radio-isotope, gallium, as Ga-68 PSMA, and you have a highly sensitive specific tracer that seeks out cancerous tissue. It is detected on the scan, delivering a more accurate picture of the size and location of areas of prostate cancer than has ever previously been possible. Pair PSMA with the radioisotope, Lutetium, to create Lu-177 PSMA, and you have a tool that combines the ability of a tracer to seek out prostate cancer with the ability to then destroy the cancer cells – a demonstration of the use of theranostics facilitating a highly personalised treatment. Faster, more accurate diagnosis Gallium-PSMA PET/CT scans are already being used routinely for diagnosing, staging and decisionmaking (along with Lu-177 PSMA therapy) in CRPC by GenesisCare Australia, and the diagnostic technique is now provided by GenesisCare in the South-East region, along with London, although it is not funded on the NHS. "These scans can detect a fraction of the amount of cancer than can

Prostate cancer is the most commonly diagnosed cancer in males and the second leading cause of cancer mortality among men.” be picked up by other scans, so we can spot the size and location of the cancer at a far earlier stage," Dr Camilleri says. The technique can detect cancers that are otherwise invisible. Mr Alan Doherty, Consultant Urologist and Surgeon, says: "There are times when a raised level of prostate specific antigen (PSA), a protein produced by the prostate gland, indicates that prostate cancer has returned, even though the prostate has been removed, or the cancer is invisible with most imaging methods. Now, we can use PSMA paired with gallium to detect these cancers." He adds: "I would like to be able to recommend the gallium-PSMA PET scan to all my patients with suspected prostate cancer." Dr Camilleri says: "Traditional scans are less sensitive. Choline PET scans, for instance, require a much larger mass of cancer to be present before they pick it up." The new technique also shows advantages over bone scanning. "Ga68 PSMA scans can pick up cancer in the bones - common in prostate cancer - but elsewhere too," says Dr Camilleri. "It also differentiates

DR YONG DU Consultant in Nuclear Medicine and PET/CT MBBS MSc PhD

between bone damage caused by cancer and that caused by other more common conditions, such as osteoarthritis, which bone scanning cannot." Faster treatment, fewer side effects Dr Yong Du is a consultant in nuclear medicine who has used therapeutic radionuclides to treat around 250 patients with mCRPC - more than anyone else in the UK. "This new theranostic tool delivers more accurate assessment and treatment for mCRPC, he says." The mechanism is fundamental to its effectiveness, he says. "It enables us to target the radiation very accurately and thus spare non-tumour critical organs from radiation, reducing the risk of delivering unnecessary doses to healthy tissue." As a result, patients suffer fewer side effects. "It is more effective than conventional treatments and much less toxic, although a small percentage of patients might develop treatment-induced xerostomia - dry mouth." Dr Du says: "Due to its minimal toxicity, most patients can receive multiple cycles of treatment without developing significant adverse effects." That means faster turnaround times. "Patients can be treated as outpatients in the day unit and the assessment plus treatment can be achieved within two working days. This means that people can be discharged to their home sooner, which is particularly valuable for patients travelling from other parts of the UK and abroad."

Access to therapy At present, PSMA-lutetium treatment is being trialled on patients with mPCRC but GenesisCare will introduce it more widely in the UK soon. "Currently Lu-177 PSMA treatment is only licenced for use in end-stage prostate cancer. Its effectiveness is yet to be fully proven, but it is already showing good results," says Mr Doherty. "It is like a seek and destroy process. It is novel and exciting, and I am looking forward to offering lutetium-paired PSMA treatment on my prostate cancer patients." As Dr Camilleri says: "Lutetium sticks to the cancer cells and kills them. It is not a complete cure, but it looks like it can keep patients alive, with a better quality of life, for longer."