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Review
. 2021 Apr;22(4):e136-e172.
doi: 10.1016/S1470-2045(20)30751-8. Epub 2021 Mar 4.

Medical imaging and nuclear medicine: a Lancet Oncology Commission

Hedvig Hricak  1 , May Abdel-Wahab  2 , Rifat Atun  3 , Miriam Mikhail Lette  4 , Diana Paez  4 , James A Brink  5 , Lluís Donoso-Bach  6 , Guy Frija  7 , Monika Hierath  8 , Ola Holmberg  9 , Pek-Lan Khong  10 , Jason S Lewis  11 , Geraldine McGinty  12 , Wim J G Oyen  13 , Lawrence N Shulman  14 , Zachary J Ward  15 , Andrew M Scott  16
Affiliations
Review

Medical imaging and nuclear medicine: a Lancet Oncology Commission

Hedvig Hricak et al. Lancet Oncol. 2021 Apr.

Abstract

The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.

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Conflict of interest statement

Declaration of Interests: HH reports personal fees from Ion Beam Applications (IBA) for service on its Board of Directors, outside the submitted work. She serves without compensation on the following boards and committees: External Advisory Board, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins; International Advisory Board, University of Vienna; Scientific Committee, DKFZ (German Cancer Research Center); Board of Trustees, DKFZ (German Cancer Research Center); Scientific Advisory Board, Euro-BioImaging. JAB reports personal fees from Board of Directors, Accumen, Inc., outside the submitted work. JSL reports personal fees from Clarity Pharmaceuticals, Varian Medical Systems, TPG Capital and InVicro, Inc; equity interests in Telix Pharmaceuticals and Evergreen Theragnostics; preclinical research support from Eli-Lilly, Sapience Therapeutics, Inc, MabVax Therapeutics, SibTech, Inc, Thermo Fisher Scientific, Ground Fluor Pharmaceuticals, Inc, ImaginAb, Merck & Company, AbbVie, Inc, Bristol Myers Squibb, Genentech; fee-for-service work from Y-mAbs and Regeneron Pharmaceuticals; personal fees from, and equity in, pHLIP Technologies; income from licensed intellectual property from Summit Biomedical Imaging, LLC, CheMatech, Elucida , Theragnostics Ltd., Daiichi Sankyo, and Samus Therapeutics LLC., outside the submitted work. AMS reports trial funding from Abbvie, EMD Serono, ITM, Telix and Cyclotek, research funding from Medimmune, AVID, Adalta, and Theramyc, and personal fees from Life Science Pharmaceuticals and Imagion, outside the submitted work.

Figures

Figure 1.
Figure 1.. Major data sources for the IMAGINE database
IMAGINE=IAEA medical imaging and nuclear medicine global resources database.
Figure 2.
Figure 2.. Estimates of the number of CT scanners per million inhabitants
Data are from the International Atomic Energy Agency medical imaging and nuclear medicine global resources database (IMAGINE). The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission.
Figure 3.
Figure 3.. Estimates of the number of PET scanners per million inhabitants
Data are from the International Atomic Energy Agency medical imaging and nuclear medicine global resources database (IMAGINE). The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission.
Figure 4.
Figure 4.. Estimates of the number of mammography units per million inhabitants
Data are from the International Atomic Energy Agency medical imaging and nuclear medicine global resources database (IMAGINE). The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission.
Figure 5.
Figure 5.. Estimates of the number of MRI units per million inhabitants
Data are from the International Atomic Energy Agency medical imaging and nuclear medicine global resources database (IMAGINE). The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission.
Figure 6.
Figure 6.. Estimates of the number of SPECT units per million inhabitants
Data are from the International Atomic Energy Agency medical imaging and nuclear medicine global resources database (IMAGINE). The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission. SPECT=single photon emission CT.
Figure 7.
Figure 7.. Estimated number of radiologists per million inhabitants
Data are from the International Atomic Energy Agency medical imaging and nuclear medicine global resources database (IMAGINE). The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission.
Figure 8.
Figure 8.. Estimated number of nuclear medicine physicians per million inhabitants
Data are from the International Atomic Energy Agency medical imaging and nuclear medicine global resources database (IMAGINE). The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission.
Figure 9.
Figure 9.. Estimated return on investment (comprehensive scale-up of imaging, treatment and quality of care) by country for 11 cancer types
Comprehensive scale-up refers to scale-up of all imaging and treatment modalities and quality of care to the mean amount of that of high-income countries. Returns per US$ invested are estimated for patients diagnosed with cancer in 2020-30, compared with a baseline scenario of no scale-up. Estimates are presented in US$ in 2018 and discounted at 3% annually.
Figure 10.
Figure 10.. Artificial intelligence-driven workflow for imaging in patients with cancer
An illustration of a streamlined, artificial intelligence-driven imaging workflow, in which digital technologies enable the automation, standardisation, and optimisation of every step, from patient registration to imaging acquisition and interpretation.
Figure 11.
Figure 11.. Active International Atomic Energy Agency coordinated research projects in human health
CRPs = coordinated research projects. The map was produced by the International Atomic Energy Agency (Vienna, Austria) and is included here with permission. The color gray indicates the presence of no coordinated research projects.
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