Translational Research in Radiology

Translational research has, in recent years, become a popular agenda item at the National Institutes of Health (NIH) and within the biomedical community at large. The NIH’s interest in the topic, which arose from the apparent disconnection between basic science discoveries and their implementation in the clinic, is reflected in the Roadmap for Medical Research, announced in 2003 . The Roadmap proposes three trends for the advancement of medical science: “new pathways to discovery,” dedicated to the development of new methods to understand complex biologic systems; “research teams of the future,” aimed at facilitating interdisciplinary research; and “reengineering the clinical research enterprise,” emphasizing clinical and translational or “patient-oriented” research. This has spawned several new initiatives; the most important, with respect to translational research in radiology, are the Institutional Clinical and Translational Science Awards , the NIH Rapid Access to Interventional Development Pilot Program , and the National Center for Biomedical Computing .

Lean et al defined translational research as the process that leads from evidence-based medicine to sustainable solutions for public health problems. This process clearly cuts a wide swath through clinical science, and these authors conceived three crucial phases for its successful pursuit: the exploration of needs for and development of potential treatments in basic laboratory research and testing of safety and efficacy; the assessment of how findings from phase 1 function when applied to routine clinical practice; and the collection of information to convert effective tools found as part of phase 2 research into sustainable solutions and evidence-based policies.

With respect to imaging research, these steps can be viewed as the exploration of the need for and development of more sensitive and specific imaging techniques and/or markers of disease processes, the assessment of their performance in routine clinical practice, and further investigation of these techniques and their implementation at an epidemiologic level to formulate and change the standard of care in imaging.

This is a big challenge, but radiologists can learn from their past success. Indeed, the development of imaging technology and its integration into routine clinical care is one of the prime examples of a successful translational pathway over the past three decades. During this period, three of the top five medical innovations, as ranked by physicians, are related to imaging advances: magnetic resonance (MR) and computed tomographic (CT) imaging, balloon angioplasty, and mammography . It is astonishing that these relatively new techniques are now firmly integrated into clinical practice, and radiology as a discipline deserves tremendous credit for the successful integration of physics and computer technology with clinical applications.

More recently, the development of integrated positron emission tomographic (PET)/CT imaging devices has had a tremendous impact on the diagnosis and management of patients with cancer . The development of the first dual-modality imaging devices for clinical applications occurred in the 1990s. A combined PET/CT prototype underwent clinical evaluation from mid-1998 onward. The results of the initial 3-year evaluation program stimulated the demand for commercial designs, and in 2001, the first commercial PET/CT scanner was installed. Today, there are more than 2500 PET/CT scanners in operation worldwide. PET/CT imaging is widely used in the diagnosis, staging, and follow-up of patients with a large range of malignancies, in many instances changing clinical management.

Given these success stories, can we conclude that the translational research pathway in the world of radiology is a well-established niche that is ready to meet the emerging challenges of molecular-based diagnostic and treatment techniques? Is translational research within radiology capable of coping with rising health care costs and shrinking research budgets?

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References

1. National Institutes of Health, Office of Portfolio Analysis and Strategic Initiatives. NIH Roadmap for Medical Research. Available at: http://nihroadmap.nih.gov/index.asp . Accessed October 15, 2008.
2. National Institutes of Health. RFA-RM-06-002: Institutional Clinical and Translational Science Award. Available at: http://grants.nih.gov/grants/rfa-files/RFA-RM-06-002.html . Accessed October 15, 2008.
3. National Institutes of Health. NIH Rapid Access to Interventional Development (NIH-RAID Pilot). Available at: http://nihroadmap.nih.gov/raid/ . Accessed October 15, 2008.
4. National Institutes of Health. NIH Roadmap Centers for .Biomedical Computing. Available at: http://www.bisti.nih.gov/ncbc/index.cfm? . Accessed October 15, 2008.
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Translational Research in Radiology

References

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