Precision medicine is an emerging approach for treating medical disorders, which takes into account individual variability in genetic and environmental factors. Preventive or therapeutic interventions can then be directed to those who will benefit most from targeted interventions, thereby maximizing benefits and minimizing costs and complications. Precision medicine is gaining increasing recognition by clinicians, healthcare systems, pharmaceutical companies, patients, and the government. Imaging plays a critical role in precision medicine including screening, early diagnosis, guiding treatment, evaluating response to therapy, and assessing likelihood of disease recurrence. The Association of University Radiologists Radiology Research Alliance Precision Imaging Task Force convened to explore the current and future role of imaging in the era of precision medicine and summarized its finding in this article. We review the increasingly important role of imaging in various oncological and non-oncological disorders. We also highlight the challenges for radiology in the era of precision medicine.
Introduction
The current era of precision medicine is transforming the practice of medicine with its aim of early diagnosis and personalized treatments, and positively impacting the role of radiology. According to the National Academy of Sciences, “Precision medicine refers to the tailoring of medical treatment to the individual characteristics of each patient, encompassing the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases that may develop, or in their response to a specific treatment” . Preventive or therapeutic interventions can then be directed to those who will benefit, reducing cost and minimizing side effects of therapy.
Precision medicine takes into account individual variability in genetic and environmental factors . Treatments are targeted on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish individual patients from others with similar clinical presentations . Precision medicine is receiving growing recognition by clinicians, healthcare systems, pharmaceutical companies, patients, and the government. Advances in genomics, molecular biology, information technology, and imaging are accelerating the acceptance of precision medicine. It takes less than a day to sequence a genome today, whereas it may have taken about 2 years a decade ago. Accordingly, the cost of a complete genome sequence has decreased from $10 million in 2007 to $21,000 in 2011. Based on the data collected from National Human Genome Research Institute-funded genome-sequencing groups, the cost to generate a high-quality “draft” whole human genome sequence in late 2015 was less than $1500 .
Recently, the precision medicine movement has received vital support from President Barack Obama. In the 2015 State of the Union address, the president allocated $215 million to the National Institutes of Health and other regulatory bodies to support this initiative . The initiative will help identify genomic drivers of malignancy and promote innovation in diagnosis and treatment. The goal is to “pioneer a new model of patient-powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients” . Ultimately, the aim of precision medicine is to administer the precise treatment to the right patient at the right time .
Imaging will play a pivotal role in precision medicine, including screening, early diagnosis, guiding treatment, evaluating response to therapy, and assessing likelihood of disease recurrence . For precision medicine to succeed, it is critically important that imaging be able to help identify and classify patients in different subgroups who have identical disease characteristics and share similar treatment response and prognosis.
Although the term “radiogenomics” is perceived by radiation oncologists to refer to the study of correlation of genetic variation with response to radiation therapy, it has a different meaning in the radiology community. In radiology, the term “radiogenomics” (also called imaging genomics) refers to the correlation of imaging phenotypes with genotypic expressions, and this is the context in which this term is being used in this review . Radiogenomic studies that help determine statistically significant linkage between imaging features and gene expressions may help create models that predict patient outcomes based on imaging features. Radiogenomics has already attracted major interest in the radiology community, with research undertaken in various cancers such as glioblastoma, breast carcinoma, and renal cell carcinoma (RCC).
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Role of Imaging in Oncology in the Era of Precision Medicine
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Breast Cancer
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Brain Tumor
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Lung Cancer
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Genitourinary Malignancies
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Role of Imaging in Non-oncological Conditions in the Era of Precision Medicine
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Challenges for Imaging in the Era of Precision Medicine
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