“Advancing Healthcare”

Exploring the Frontiers of Nuclear Medicine

In the field of healthcare innovation, nuclear medicine and radiopharmaceuticals stand out for their remarkable contributions to diagnosis and treatment. These technologies offer personalized approaches and targeted therapies, which are revolutionizing patient care. However, to ensure access to these cutting-edge treatments for all, it’s crucial to support and strengthen the entire supply chain, from production to delivery.

To delve into the multiple aspects of this field, exploring current trends, challenges, and future directions, we interview Dr Sarah Baatout, Deputy Director of the Nuclear Medical Applications Institute at the Belgian Nuclear Research Centre SCK CEN (ENS Corporate Member). She has been contributing to research into personalised medicine, both for cancer patients and astronauts, for more than 20 years. Since last November, Dr Baatout is also a member of the ENS High Scientific Council.

As a Deputy Director of Nuclear Medical Applications at SCK CEN, you are one of the central figures in Belgium and Europe regarding the medical applications of nuclear energy. What are some of the advances in nuclear medicine that you are most looking forward to?

As Deputy Director of Nuclear Medical Applications at SCK CEN, I am deeply immersed in the dynamic field of nuclear medicine, where exciting advancements rapidly shape the future of healthcare. One of the most promising developments that I am eagerly anticipating is the exponential evolution of targeted radionuclide therapy for cancer treatment. This innovative treatment combines a radioactive isotope with a specially designed molecule (called a vector) to create a “radiopharmaceutical” that targets cancer cells or the cancer microenvironment, while protecting healthy tissue.

Targeted radionuclide therapy offers unprecedented precision in cancer treatment, reducing side effects and improving patient outcomes. Furthermore, it provides tailored therapies for individual patients, even for cancers resistant to other treatments, offering hope for those with advanced or recurrent disease.

As a nuclear medicine scientist, I am particularly excited about the advances in synthesis technologies that allow for the development of new radiopharmaceuticals, addressing previously untreatable cancers. Preclinical research, in which I am involved, combined with clinical trials using radioisotopes like Lutetium-177, Actinium-225, Terbium-161, Lead-212 and Astatine-211 show promising results, signalling a new era in cancer care. With over 200 global clinical trials underway, we expect positive outcomes of targeted radionuclide therapy for various cancers within the coming years.

In my role, I also witness how advancements in imaging technologies, such as PET (Positron Emission Tomography), SPECT (Single Photon Emission Computed Tomography), and hybrid systems like PET/MRI (Magnetic Resonance Imaging), have revolutionized medical diagnostics. These technologies offer enhanced capabilities for early disease detection, allowing healthcare providers to identify abnormalities at their earliest stages when treatment options may be most effective. Additionally, they provide more accurate staging of diseases, enabling clinicians to better understand the extent and severity of the condition, which is crucial for determining the most appropriate treatment approach. Furthermore, these imaging modalities play a vital role in monitoring treatment response, allowing healthcare providers to assess the effectiveness of interventions and make necessary adjustments to optimize patient outcomes.

In parallel, artificial intelligence (AI) and machine learning (ML) algorithms have emerged as powerful tools in nuclear medicine. These technologies have the potential to significantly improve diagnostic precision and treatment planning by analyzing large volumes of medical imaging data with remarkable speed and accuracy. AI and ML algorithms can detect subtle patterns and abnormalities in imaging scans that may not be apparent to the human eye, leading to earlier and more accurate diagnoses. Moreover, they can assist clinicians in developing personalized treatment plans tailored to each patient’s unique characteristics and medical history. By harnessing the capabilities of AI and ML, nuclear medicine practitioners can optimize patient care and outcomes while also streamlining workflow efficiencies within healthcare systems.

Overall, I believe these advancements accelerate personalized medicine by combining molecular and genetic insights to tailor treatments to individual patients. This patient-centered approach promises better outcomes and improved quality of life. Nuclear medicine’s transformative potential thus revolutionizes patient care, shaping the future of oncology and healthcare.

Collaboration and interdisciplinary research play crucial roles in driving innovation in nuclear medicine. From your perspective, what are some of the most exciting collaborative initiatives or research partnerships that are shaping the future of nuclear medicine?

Certainly, collaboration and interdisciplinary research are pivotal in driving innovation within nuclear medicine. From my perspective, some of the most exciting collaborative initiatives or research partnerships that are shaping the future of nuclear medicine involve collaborations among academic institutions, research organizations, and industry partners. These collaborations allow us to advance nuclear medicine research and training by leveraging world-leading nuclear research facilities and expertise to develop novel production methods for radionuclides and radiopharmaceuticals for the benefit of patients. Such partnerships support the discovery and development of new health interventions, addressing the increasing global need for new radiopharmaceuticals and the shortage of skilled scientists and clinicians as well as the shortfall in production capacity. They also facilitate the translation of basic research discoveries into clinical applications, accelerating innovation in the field. Moreover, international collaborations, such as those within the European Nuclear Society (ENS) and the European Association for Nuclear Medicine (EANM), along with national nuclear medicine societies, enable knowledge sharing and standard harmonization, further propelling advancements.

In addition to these collaborations, I believe that working closely with organizations like the European Association of Nuclear Medicine (EANM), European Federation of Organizations for Medical Physics (EFOMP), European Federation of Radiographer Societies (EFRS), European Society of Radiology (ESR), and European Society for Radiotherapy & Oncology (ESTRO) is crucial in addressing the challenges faced in nuclear medicine

One particularly exciting collaborative initiative that holds great promise from my perspective is the dialogue between nuclear medicine researchers and the European Medicines Agency (EMA). The EMA plays a pivotal role in regulating and approving radiopharmaceuticals for clinical use across the European Union. Through close dialogue with the EMA, nuclear medicine researchers like myself can work closely with regulatory authorities to ensure the timely approval and safe implementation of innovative radiopharmaceuticals. This partnership facilitates the translation of cutting-edge research findings into tangible clinical applications, ultimately benefiting patients across Europe. For example, by regularly meeting EMA, researchers like myself can navigate the complex regulatory landscape to bring novel radiopharmaceuticals to market more efficiently. This process involves rigorous evaluation of the safety, efficacy, and quality of radiopharmaceuticals, ensuring that they meet the highest standards of patient care and regulatory compliance.

Finally, at the international level, it is also important to engage with advisory and scientific committees such as UNSCEAR (the United Nations Scientific Committee on the Effects of Atomic Radiation). Established by the United Nations General Assembly, UNSCEAR evaluates scientific data regarding radiation and its impacts on human health and the environment. It offers guidance to both the United Nations and its member states. I am privileged to serve as the chair of this committee.

Drawing from your extensive experience as a professor and researcher, you have certainly witnessed the importance of skilled professionals in nuclear medicine. Given the actual risk of a shortage of qualified professionals, what challenges do you perceive in training and nurturing the next generation of professionals in this field? How do you imagine addressing these challenges to ensure a sustainable workforce capable of meeting the increasing demand for nuclear medicine services?

In the past 20 years that I have been active in this field, I have indeed witnessed the critical role that skilled professionals play in advancing a discipline. However, the risk of a shortage of qualified personnel poses significant challenges to training and nurturing the next generation of professionals in this field.

One of the foremost challenges is the lack of coordination at the European level concerning nuclear education and training for healthcare professionals. Without a cohesive framework for information dissemination and collaboration among training institutions, there is a risk of inefficiency and duplication of efforts. Additionally, the absence of interoperability and accreditation standards across training programs further complicates the process of ensuring a consistent and high-quality education for aspiring professionals.

To address these challenges and ensure a sustainable workforce capable of meeting the increasing demand for nuclear medicine services, proactive measures must be taken. Firstly, hosting discussions and fostering collaboration among training institutions can facilitate the exchange of best practices, identify gaps and needs, and streamline accreditation processes. Establishing an EU network of training institutions could further enhance coordination and cooperation across Member States, promoting standardized education and training practices. Furthermore, education providers and existing platforms must unite and expand their learning content to cover the evolving needs of the field. By pooling resources and expertise, they can develop comprehensive curricula that equip students with the necessary skills and knowledge to excel in nuclear medicine.  In Belgium, such a combined programme exists for nuclear engineering. Six universities and SCK CEN joined forces to educate (young) professionals. Its objective is to develop and maintain high-level nuclear competences in Belgium and abroad. BNEN catalyses networking between academia, research centres, industry and other nuclear stakeholders. Moreover, encouraging regulators in the pharmaceutical and nuclear sectors to engage in dialogue regarding the interface between their mandates is essential for ensuring alignment and coherence in regulatory frameworks.

Training the next generation of nuclear medicine professionals is essential for ensuring the continued advancement of the field. One challenge is the interdisciplinary nature of nuclear medicine, which requires expertise in areas such as physics, chemistry, biology, and medicine. To address this challenge, educational programs should incorporate interdisciplinary training and provide opportunities for hands-on experience in clinical settings. Additionally, fostering mentorship and collaboration between experienced professionals and trainees can help to transfer knowledge and skills.

Furthermore, initiatives to raise awareness about nuclear medicine careers and attract young talent to the field are crucial for building a sustainable workforce. It is also important to not only attracting but also retaining young talent in the field of nuclear medicine. Early engagement of students and aspiring professionals is key to fostering their interest and passion for the discipline from an early stage of their education. By providing opportunities for hands-on experience, internships, and mentorship programs, we can inspire the next generation of nuclear medicine specialists and researchers. Moreover, implementing mobility schemes can further enrich the educational experience and broaden the horizons of young professionals. Exposing them to diverse perspectives, methodologies, and healthcare systems through international exchanges and collaborations can enhance their skills, knowledge, and cultural competence. These experiences not only contribute to their personal and professional growth but also foster a sense of global citizenship and collaboration, which are invaluable qualities in an increasingly interconnected world.

Additionally, creating pathways for career advancement and professional development is essential for retaining young talent in the field. Offering opportunities for continued education, specialized training, and leadership roles can empower them to make meaningful contributions and progress in their careers. By investing in their growth and providing a supportive and inclusive work environment, we can nurture a vibrant and sustainable workforce that drives innovation and excellence in nuclear medicine for years to come.

Finally, endorsing European-level accreditation or a recommended gold standard model of education and training, as proposed by professional societies like EANM, EFOMP, EFRS, ESR, and ESTRO, can also increase the credibility and quality of training programs. By establishing clear standards and guidelines, these societies can contribute to the development of a skilled workforce capable of navigating the complexities of nuclear medicine and driving innovation in the field. Ultimately, through concerted efforts and collaboration among stakeholders, we can overcome the challenges associated with training the next generation of nuclear medicine professionals and ensure a sustainable workforce to meet the growing demand for services in this vital area of healthcare.

In the scope of the Belgian EU Presidency, you co-organized a day-long workshop focused on radiopharmaceuticals, featuring various stakeholders, from raw material producers all the way to cancer patients. They were all aligned: nuclear medicine must adopt a patient-centric approach. What does it mean in practice and what are the challenges related to it?

During the Belgian EU Presidency, I was happy to help organizing a day-long workshop centered on radiopharmaceuticals, gathering stakeholders ranging from raw material producers to cancer patients. Together, we emphasized the necessity for nuclear medicine to adopt a patient-centric approach. For us, this means placing the needs and preferences of patients at the forefront of the care journey, tailoring treatment plans to their individual characteristics, preferences and values, and involving them in shared decision-making processes.

In my view, embracing a patient-centric approach in nuclear medicine entails ensuring that every individual across Europe, regardless of their location or socioeconomic status, has fair and equal access to nuclear medicine services, particularly radiopharmaceuticals. This involves addressing disparities in access to healthcare resources, such as diagnostic facilities and treatment options, especially in underserved or remote areas. However, achieving equitable access to radiopharmaceuticals poses unique challenges due to the short half-life of the radioisotopes, requiring timely administration once produced.

In line with the objectives of adopting a patient-centric approach, I see the Europe’s Beating Cancer Plan (EBCP) as a significant step forward in ensuring equitable access to high-quality cancer care for all European patients. Launched by the European Commission in February 2021, the EBCP introduces comprehensive strategies aimed at addressing the entire spectrum of cancer care, from prevention to palliative care. By leveraging innovative therapies like targeted radionuclide therapy, the plan seeks to revolutionize cancer care and mitigate health disparities across Europe, aligning with its overarching goal of reducing inequalities in cancer outcomes.

Moreover, I believe that fostering collaboration and communication among multidisciplinary cancer teams is crucial for delivering truly patient-centered cancer care, including targeted radionuclide therapy. This involves integrating input from various healthcare professionals, such as nuclear medicine physicians, oncologists, radiologists, nurses, and support staff, to ensure that cancer treatment plans are comprehensive and coordinated. By addressing these challenges and embracing a patient-centric approach, nuclear medicine can strive towards achieving equitable access to high-quality care for all individuals throughout Europe, prioritizing patient well-being, access to the best available treatment, and satisfaction. Ultimately, the goal is to create a healthcare system that promotes equity and accessibility for all.

What general conclusions about the state and needs of nuclear medicine have we learned during this EU Presidency? How can these lessons practically support the security of supply and R&D of radiopharmaceuticals?

During the Belgian Presidency of the Council of the European Union, it was decided to focus on recognizing the critical role played by radioisotopes in medical diagnostics, therapy and treatments, observing the escalating demand for both diagnostic and therapeutic patient care. It became evident that securing a reliable and stable future supply of radioisotopes within the European Union is paramount, aligning closely with the broader objective of achieving strategic autonomy for Europe while maintaining an open economy.

During the EU presidency, considerable attention was indeed directed towards the status and requirements of nuclear medicine, particularly focusing on the crucial aspects of security of supply and research and development of radiopharmaceuticals. Key challenges highlighted include the need to maintain efforts in securing a reliable supply of source material for radioisotope production and ensuring a sustainable and uninterrupted supply chain for medical radioisotopes to ensure equitable access to radiopharmaceuticals for all European patients. This requires safeguarding facilities such as the BR2 reactor in Belgium capable of meeting long-term needs, optimizing and investing in infrastructures and equipment. Furthermore, addressing workforce shortages and training needs to support the growing demand for cancer patients and the rapid advancements in this thriving field.

During the EU presidency of Belgium, there was also a notable emphasis on enhancing the alignment between EU legal and regulatory frameworks, especially concerning radiopharmaceuticals and radiation protection, aiming to facilitate high-quality and safe patient access without unnecessary delays and by including medical radioisotopes on the critical medicines list.

The lessons gleaned from the EU Presidency underscore the critical significance of collaboration, innovation, and investment across hospitals, reactor and accelerator infrastructures, research institute and academia to safeguard the security of supply and promote the advancement of radiopharmaceutical R&D for clinical use. These lessons underscore the urgent need for cohesive action to fortify healthcare systems and elevate patient outcomes across Europe.

By prioritizing these key areas, policymakers and stakeholders alike can fortify healthcare systems and enhance patient outcomes throughout Europe.