Everything Old is New Again

Yesterday, I attended the Molecular Summit in Philadelphia. Put on by The Dark Report (http://www.darkreport.com/ ), the meeting was designed to show the need for integration of imaging and diagnostics (think radiology and laboratory), as medicine moves from one size fits all model to a more individualized and personalized molecular medicine model. Many of the sessions were devoted to how information technology could help to integrate the information from both areas, in order to help physicians provide better diagnosis and therapy.

As the speakers discussed the new paradigm that would overlap some of the information from lab with that of radiology, I was reminded that when I studied nuclear medicine in 1983-1984, laboratory experience, in the form of radioimmunoassay (RIA) was an intigral part of nuclear medicine education. Indeed, some of the nuclear medicine technologists working in RIA and clinical imaging were credentialed by the American Society of Clinical Pathologists (ASCP), rather than the American Registry of Radiologic Technologists (ARRT) or the Nuclear Medicine Technologist Certification Board (NMTCB).

Although the participation of nuclear medicine technologists in RIA was begining to fade at that time, education in lab techniques and clinical rotations through the RIA lab were still a required part of the curriculum and questions on lab procedures were still part of the NMTCB exam, although not the ARRT exam, that year. Indeed, I personally felt that just about every third question on the NMTCB exam that year was lab related.

 Looking back in SNM archives, I found a letter to the editor from Volume 13 number 6 of the Journal of Nuclear Medicine, (which translates to about June of 1972), proposing a separate organization outside the ARRT or ASCP to certify technologists in nuclear medicine technology. That organization became the NMTCB.

Eventually the NMTCB and the ARRT became the only certifying and registration organizations for NM technologists and many of the technologists holding ARRT and ASCP certificates took advantage of a grandfathering provision announced in 1990, which recognized nuclear medicine technologist certificates issued by those organizations before 1985 and gave NMTCB certification status to those qualified technologists who requested this offer during that year.

The College of American Pathologists (CAP), meanwhile, also had a impact on nuclear medicine practice. For instance, I found an article in the Archives fo Pathology and Laboratory Medicine written in June 1997 that discussed the early role pathologists played in nuclear medicine. According to the article by Loyd. R. Wagner, in the early days of nuclear imaging an estimated 25 percent of physicians were pathologists and several CAP members were leaders in the specialty, including Tyra T. Hutchens, MD (president of CAP in 1977-1979), who was one of the founders of the SNM. CAP also worked with members of the SNM and the American College of Nuclear Physicians to provide proficency testing and evaluation of images and interpretation by NM physicians, starting with the first Nuclear Medicine survey in 1975. Eventually the American college of Nuclear Physicians assumed full responsibility for these programs in the early 1990s, according to the article.

So pathologists, laboratory technologists, nuclear medicine technologists and nuclear medicine physicians have a history of cooperation in patient diagnosis. Today, however, as medicine moves towards a future of integrated molecular diagnosis and therapy, the visionaries of this new era see a critical need to expand this ability to cooperate and learn from each other into other imaging fields, such as CT, MR, ultrasound, interventional and radiography.