SOCIETY COMMUNICATION

European Science Foundation calls for more and bettermedical imaging research

Arturo Brunetti & Alberto Cuocolo

The European Science Foundation (ESF) has called forgreater collaboration across Europe on research on medicalimaging. In October 2007, the medical section of the ESF,the European Medical Research Councils (EMRC), pub-lished a science policy briefing on “Medical Imaging forImproved Patient Care”, based on a workshop attended bykey experts in the field of medical imaging. This policybriefing emphasises the great potential of medical imaging,outlines European issues and challenges and presents policyrecommendations. Within the briefing, the ESF claims thatmedical imaging research in Europe is fragmented and thatcloser cooperation between doctors, scientists and industry

is needed if Europe is to realise the full potential of newtechnological developments and remain globally competi-tive in this field. Medical imaging is one of the fastestgrowing areas within medicine, both in the clinical settingsin hospitals and in research and development. According tothe experts, imaging is making important contributions topreventive medicine and early diagnosis, whilst newimaging technology could result in improved and cost-effective healthcare. But, says the ESF, to obtain themaximum benefit from these exciting advances, researchneeds to be more collaborative than at present. The sciencepolicy briefing contains a number of key recommendationsthat will lead to more and better research into medicalimaging throughout Europe: 1) improved collaborationbetween universities, between imaging specialists and otherscientists, and better ways to bring together different typesof imaging to provide superior information; 2) theestablishment of large interdisciplinary research groupswith access to long-term funding; and 3) better collabora-tion between academia and industry.

Eur J Nucl Med Mol Imaging (2008) 35:1749–1757DOI 10.1007/s00259-008-0861-7

DO00861; No of Pages

A. Brunetti :A. Cuocolo (*)Department of Biomorphological and Functional Sciences,Institute of Biostructures and Bioimages of the National ResearchCouncil, University Federico II,Naples, Italye-mail: cuocolo@unina.it

Foreword

The rapid development in medical research produces acontinuous stream of new knowledge about disease processes,new therapeutic targets and the complex relationship betweena person’s genome and his/her related risk for disease. Newtechnology is being developed for all aspects of patient careand the potential benefits of personalised medicine is gainingacceptance.

Medical imaging can now play a central role in the globalhealthcare system as it contributes to improved patientoutcome and more cost-efficient healthcare in all majordisease entities. More and better research in medical imagingis needed in Europe to increase our knowledge about diseaseprocesses and therapy management with the long-term goalof improving the health of European citizens.

The European Science Foundation’s medical section, theEuropean Medical Research Councils (EMRC) engaged inthis science policy activity because medical imaging plays arole of everincreasing importance at all levels of the healthcaresystem. EMRC assembled a group of European high-levelexperts in this field and conducted a Strategic Workshop inNovember 2006 to put a focus on research in the wide area ofmedical imaging, to analyse the status quo of medical imagingin Europe and to develop a policy for optimal use of researchresources at the European level. Their recommendations aresummarised in this policy briefing. To strengthen Europe’sposition in this truly global scientific field, emphasis has to beput on an increased collaboration, in particular betweendifferent universities, between imaging specialists and clini-cians, between academia and industry, and between differentimaging modalities. The establishment of interdisciplinaryresearch groups of sufficient size provided with access tolong-term funding is a prerequisite to fostering furtherdevelopment of this research area in Europe.

The aim of this science policy activity is to developresearch-based knowledge on how to use medical imagingfor the benefit of improved patient outcome, sustainablehealthcare systems and increased competitiveness in theEuropean medical industry.

Introduction

Medical imaging is one of the fastest growing areas withinmedicine at present, both in the clinical setting in hospitalsand in research and development (R&D).

Some important benefits from an increased researcheffort in medical imaging are expected in:

Improved Patient Care

& personalised medicine with individually tailored treatment& more evidence-based decision making within healthcare& less complications during and after surgery& better understanding of the effect of treatments on diseases

Improved Health of European Citizens

& screening of an entire population, e.g. for breast cancer,or targeted subpopulations with increased risk ofspecific disease entities

& better assessment of risk factors and better prevention ofdisease

& shorter time to cure for improved treatment efficacy& less recurrence of disease& decreased mortality and morbidity

Medical Imaging for Improved Patient Care

The European Science Foundation (ESF) provides a platform for itsMember Organisations to advance European research and explore newdirections for research at the European level. Established in 1974 as anindependent non-governmental organisation, the ESF currently serves75 Member Organisations across 30 countries.www.esf.org

Fig. 1 Multiparametric post-processing procedure and visualizationof brain structures (left) and segmentation for tissue volume measure-ments (right) (courtesy of Prof. Bruno Alfano)

John MarksChief Executive, ESF

Liselotte HøjgaardChair, EMRC

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Cost-Efficient Healthcare

& more rapid and accurate diagnosis& less time to best choice of most efficient treatment& quicker recovery after surgery& shorter hospital stays& cost-effective use of expensive diagnostic and surgical

equipment

Socio-Economic Benefits

& less time out of work& less need for long-term nursing

Improved Competitiveness of the European Medical Industry

& research-based development of new innovative technologyand products

& focus on user-friendly equipment tailored for cost-efficient healthcare

Medical imaging has an important role in the care of allorgan systems and disease entities, and better and increasedmedical imaging research may benefit the entire process ofhealth and disease management, including:

& prevention& individual risk assessment& screening targeted subpopulations with increased risk of

specific disease entities& early detection of subclinical disease& optimal choice of treatment based on personalized

medicine& image-guidedminimally invasive surgery and interventions& prognosis& non-invasive monitoring of treatment effects for

response-adjusted treatment in case of poor response& patient follow-up to adjust multidrug therapy in chronic

disease& early detection of recurrence& decision making tool for early-onset disease treatment

and monitoring

Medical imaging covers many different imaging modali-ties: x-ray-based methods such as radiography and ComputedTomography (CT), Magnetic Resonance Imaging (MRI),ultrasound (US), nuclear medicine with Positron EmissionTomography (PET) and Single Photon Emission ComputedTomography (SPECT), and several methods in opticalimaging. An important goal is to exploit the synergies of thedifferent methods. This might be achieved in two ways:

(1) correlative approaches, for example hybrid systemsand image co-registration software (with image fusion

of different modalities, such as PET and CT, MRI andPET, ultrasound and MRI).

(2) standard disease-based protocols for diagnosis andfollow-up.

Traditionally, medical imaging was a tool for noninva-sive mapping of anatomy and for detection and localisationof a disease process. However, consecutive to a paradigmshift, it has been demonstrated that a wide variety of newmedical imaging techniques and methods produce impor-tant biological information about physiology, organ func-tion, biochemistry, metabolism, molecular biology andfunctional genomics (Fig. 1). These new methods combinethe ability to measure and quantify biological processeswith the ability to localise the measured entities into a high-quality anatomical image. Further, advanced imagingtechniques are now used for treatment instead of surgery:e.g. coronary angioplasty, treatment of aortic aneurysm andcoiling of bleeding cerebral aneurysms. Exciting newadvances in medical imaging are based on research in theareas of functional and molecular imaging and in the area ofdevelopment of imaging biomarkers for improved preven-tion, diagnosis and treatment of disease (Fig. 2).

The concept of personalised medicine is based on thepotential for extensive mapping of the disease biology of anindividual patient. Based on this information, treatment canbe tailored to the individual patient’s disease biology andgenetic make-up. Medical imaging research has a crucialrole to play in the development of better and morepersonalised medicine with the important benefits of beingnon-invasive and offering global anatomical coverage andco-localisation of the disease process and the relevantbiological measurements.

Fig. 2 Ultrasound assessment of foetal growth and development ofbrain structures (courtesy of Prof. Sturla Eik-Nes)

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The important and exciting progress in biotechnology,nanomedicine and new innovative therapies is in many caseshighly dependent on integration with medical imaging forsuccessful application into standard clinical practice.

Examples are:

& guidance of biopsy sampling (by ultrasound, CT, MRI andPET) to obtain a relevant material for the in vitro mappingof the genetic expression and biology of the individualdisease

& guidance of targeted drugs and of gene vector therapyand guidance of targeted radiation therapy

& guidance of stem cell therapy& monitoring of cell differentiation and improved function

in stem cell therapy

At present, medical imaging research in Europe is frag-mented, and to a large extent financed by industry. As shown inthe recent report ‘Key figures 2007 on Science, Technology andInnovation1’, medical, precision and optical instruments istwice as R&D intensive and almost 50% bigger in the USAthan in the EU (Fig. 3). Therefore, an increased focus onresearch in this area is important for European competitive-ness. The main goals should be increased public financing andimproved cooperation at the European level.

European Issues and Challenges

Collaboration, Interdisciplinarity, Pooling of Resources,Industry

For success in this research area it is necessary to createtrue multi- and interdisciplinary research environmentswhere medical doctors, physiologists, physicists, chemists,mathematicians, molecular biologists, computer scientistsand other technologists and technicians work closelytogether on the same research projects. These challengesare certainly not restricted to Europe and can only beovercome through long-term funding of large researchprojects. In most cases close collaboration between univer-sities and major research centres is necessary to obtain thewide range of high-level competence, to achieve a researchenvironment of sufficient size, and to obtain the necessaryfunding for infrastructure and large research projects.

A particular challenge is to achieve increased collabora-tion between imaging specialists (radiologists and nuclearmedicine physicians) and the clinicians with knowledge ofdifferent organ systems and disease entities. The lattergroup also knows the special needs of imaging in relation tothe disease areas they specialise in and the workflow inclinical departments.

Traditionally, medical imaging has been an activitywhere an imaging specialist makes an educated evaluationof the patient’s disease, based on visual inspection of alimited number of images. However, we now see twoemerging trends:

& an exponential increase in the number of imagesacquired for each patient

& the possibility of using the images as raw data forquantification in order to measure relevant entities inorgan function, physiology and molecular biology

Medical imaging research must address these changesthrough focusing on Information and CommunicationTechnology (ICT) solutions for decision support forradiologists, nuclear medicine physicians and other physi-cians, and also focusing on improved quantification ofimaging results and biomarkers. The latter is also importantfor longitudinal follow-up of patients and comparability ofresults between centres in multicentre clinical trials.

Initiatives aimed at addressing the need for improvedcooperation at the European level, such as the EuropeanInstitute for Biomedical Imaging Research (EIBIR)2,should be encouraged. However, it is of benefit to have avariety of different organisational structures to fosterEuropean collaboration of different types and at different

Total high-tech

Medical, precision and optical instruments

0.07 0.50

3.71

EUROPE

USA

0.81

0.710.19

BERD(Business R&D

expenditure as % of GDP)

VALUE ADDED AS % OF GDP (Contribution of each industry to GDP)

0.56 3.08

Fig. 3 R&D expenditure for medical precision and optical instru-ments - EU27 compared to USA

1 See report published 11 June 2007 at: http://www.eurosfaire.prd.fr/7pc/doc/1182348125_kf_2007_prepub_en.pdf 2 More at: http://www.eibir.org/cms/website.php

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levels, keeping in mind that they should be next toUniversity Hospitals and Research Hospitals.

Furthermore, the EC ESFRI – European Strategy Forumon Research Infrastructures3 in the first European Roadmapfor Research Infrastructures has put emphasis in theEATRIS4 proposal on the need for high performancefacilities in medical imaging such as NeuroSpin for brainimaging.

Collaboration of academia with industry is important,both to attract funding and to ensure exploitation of R&Dsynergies. However, academia should take the lead indefining the research activities based on the dual goal ofimproved patient outcome and costefficient healthcare. Inthe long term, this approach will also benefit the compet-itiveness of the European medical imaging industry througha focus on R&D that addresses the patients’ and clinicians’needs and encourages user-friendly equipment tailored forcost-efficient healthcare.

Translation of New Health Technology into New ClinicalPractice

Translation of new technology into new clinical practice isa significant challenge. Acquisition of new technologywithin healthcare is often linked to marketing strategies ofthe industry and not based on extensive evaluation of whichnew methods may benefit patient care and which technol-ogies have the potential for improving cost-efficiency in thehealthcare system.

New methods in medical imaging are often adoptedwithout sufficient scientific proof; and larger clinical trialswith appropriate end-points to prove the benefits should beplanned. Examples of relevant end-points are better choiceof treatment and/or improved patient outcome due toinformation provided by new imaging techniques.

There are, however, some important challengesconnected to the adoption of strict rules for evidence-basedmedicine in medical imaging. Improvements are oftenincremental with a more or less continuous process oftechnology improvement and new applications. And whenthere are cases of significant improvements, it has oftenbeen argued that the benefit of the technology is self-evident and that study designs with randomisation ofpatients to new and old technology is unethical. Industryshould be requested to prove, prior to marketing, that newexpensive technology is of added value to patient care. It isof importance for clinical research in general and for

medical imaging research in particular that national existingregulations are adapted to allow:

& an easy organisation of good quality clinical researchfor the benefit of patients

& the protection of the individual patient who is includedin a specific clinical study

Clinical imaging research is an area where Europe hastaken on a leadership role that could be of benefit for thecompetitiveness of the European industry.

At the European level there is a need to develop,coordinate and adopt better systems for evidencebasedmedicine and health technology assessment for recommen-dations of standard practice in medical imaging.

For better translation into new clinical practice andwidespread adoption of new advanced methods, it isnecessary to establish two important tools at the Europeanlevel:

& clinical practice standards for optimal use of medicalimaging within each specific disease area

& education and training programmes tailored to bothexpert and non-expert users

Many imaging studies and most new methods inmolecular imaging are based on the administration ofmolecular probes (contrast agents or tracers), currentlymanaged as a generic pharmaceutical product by theregulatory bodies. An important limitation for translationinto new clinical practice is the need for approval of thenew drugs from the appropriate regulatory body, inparticular for molecules administered in tracer amounts.

Two possibly conflicting trends are emerging formolecular imaging diagnostic applications:

& stricter rules for the approval of drugs and moreexpensive clinical trials

& more contrast agents and tracers tailored to specific useand/or small subpopulations of patients

There is the risk that many promising methods with hugepotential benefit for improved patient outcome will neverbe translated into clinical practice because the potentialmarket is too small to cover the costs of development.

Lack of Money and Resources as the Limiting Factorfor Medical Progress

A challenge for the future healthcare system is that lack ofmoney and resources may become the limiting factor forthe services offered to the population. One reason is thedemography arising from the ageing population. Anotherreason is the wide range of progress in medical research fordiagnosis and treatment that is often costly. This challengecan only be met through the dual focus on improved patient

3 More at: ftp://ftp.cordis.europa.eu/pub/esfri/docs/esfriroadmap-report-26092006_en.pdf4 EATRIS – European Advanced Translational Research Infrastructurein Medicine

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outcome and cost-efficient solutions within healthcaresystems.

Medical imaging may become an important contributorto obtain this dual goal. Even if new imaging technology isexpensive it may contribute significantly to cost-efficiencyin a labour-intensive healthcare system if the new methodslead to shorter hospital stays, less use of non-efficienttreatment (surgery, drugs and others), and less recurrence ofdisease. Improved patient outcome will also have an impacton the society through reductions in sick leave, disabilitiesand nursing expenses.

Cost-efficiency can also be obtained through develop-ment of advanced methods in medical imaging into user-friendly tools that can be applied also by non-expert usersat the initial point of care.

Cost-efficiency for the healthcare system should beincluded as a separate end-point for imaging research, andresearchers with competence in how to evaluate economicmeasures should be included in the planning of clinical trials.

Medical Imaging as a Research Tool

Medical imaging is an important research tool to obtainnew knowledge about disease processes and treatmenttargets. Funding of medical imaging research and infra-structures is also needed for this purpose. Imaging is a non-invasive and well-suited technique for longitudinal studiesthat provides quantitative measures of the disease process-es. Both in a preclinical and a clinical research setting thereis medical imaging technology (equipment, contrast agentsetc.) that will probably never be developed into tools forroutine clinical use on patients, but which still benefitpatient care through the new biomedical knowledgeobtained.

Medical imaging also has an important role to play in thecontext of better and less expensive clinical trials for newdrugs and therapies. Imaging may contribute in severalways:

& better inclusion/exclusion of patients& better subgrouping of patients& imaging biomarkers may be used as a surrogate

outcome measure for the biological behaviour ofdifferent diseases

The importance of this is underlined by the acquisitionof large imaging R&D centres by the pharmaceuticalindustry.

Safety Issues

The different imaging modalities present a wide spectre ofpotential hazards for the patients and for the environment.

A well-defined problem is the ionizing radiation in the caseof x-ray and nuclear medicine. There are also concernsabout potential hazards from magnetic resonance whenmoving to higher fields and from ultrasound when movingto higher frequencies. Many of the advanced methodsinclude injection of new molecular probes (contrast agents,tracers, nanopeptides) with potential toxicity, side-effectsand adverse events. Medical imaging research must alsobe focused on reducing these hazards and finding thebest compromise between patient safety and potentialbenefits.

This safety assessment issue should be pro-activelyaddressed in collaboration between academies, health careindustry and national and EC competent authorities.

Recommendations

The main recommendation is to:

1. Obtain more and better medical imaging research inEurope through:

& improved European collaboration, in particular betweendifferent universities, between imaging specialists andclinical doctors, and between different imaging modalities

& establishment of interdisciplinary research groups ofsufficient size and with access to long-term funding

& improved collaboration between academia and industrywhere research goals are defined by academia

This is important in order to obtain medical imagingresearch with the necessary size and with true interdiscipli-narity, and for research to be adequately focused on the dualgoal of improved patient outcome and cost-efficient health-care for the sake of improving European citizens’ health,better societies in Europe and improved competitiveness ofEuropean medical industry.

Other important recommendations are to:

2. Obtain more evidence-based medicine at Europeanlevel through:

& health technology evaluation& validations of standard clinical practice for optimal use

of imaging& socio-economic measure of these new health technologies

3. Establish appropriate education/training for widespreadtranslation of new technology into new clinical practice.

4. Develop advanced methods within medical imaginginto user-friendly tools that can be applied also by non-expert users at the initial point of care.

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5. Plan and fund both short- and long-term researchactivities:

& short-term applied research is necessary for translationof established new technology into new clinical practice

& long-term basic research is necessary to develop andevaluate new advanced methods, especially in the areasof functional and molecular imaging, and to use medicalimaging as a research tool to obtain new knowledgeabout disease processes and new innovative therapies

Appendix

Some examples of promising new possibilities in medicalimaging

To show the wide variety of the possible roles for medicalimaging, a few examples of new, promising methods andapplications are presented.

Example 1 (screening/risk factors/prevention)

Several imaging techniques are promising for the character-isation of atherosclerotic plaques. A main target is toestablish imaging biomarkers for vulnerable plaques and tobe able to find the patients that have increased risk of plaque-induced myocardial infarction and thrombo-embolic stroke.New imaging techniques and molecular imaging probes inPET, MRI and ultrasound may detect inflammatory andother biological processes in the plaques, and may bedeveloped into a clinical tool for risk assessment of plaquevulnerability. Plaque imaging may also be developed intotools for monitoring the effect of preventive measures toreduce the plaque burden and/or the development intovulnerable plaques as shown in Fig. 4. This may both showthe effect of life-style measures as well as drug therapy.

Example 2 (early detection of subclinical disease)

There is exciting research activity with the combination ofPET and functional MRI for the early diagnosis ofneurodegenerative diseases, with a main focus on Alz-heimer’s disease. There are now PET tracers that arepromising for noninvasive detection of Alzheimer plaques,and functional MRI may detect changes in functional brainactivity. For an optimal strategy for halting and/or postpon-ing the development of dementia using cognitive enhancingdrugs, mental training and others, it is of great importanceto detect the early changes in functional brain activity dueto disease progression.

Example 3 (decision support for choice of treatment/personalised medicine)

CT, MRI and PET-guided images are used to targetradiation therapy toward the cancer and avoid harmfulradiation to healthy tissue (Fig. 5).

Diagnostic imaging tests could be of great value in theselection of highly expensive treatment procedures: forexample, new implantable pacemakers and arrhythmia defib-rillators with great potential in the therapy of heart failure havehigh costs and only a certain subgroup of patients wouldbenefit from this therapy. New imaging techniques such asadvanced ultrasound techniques, imaging of cardiac innerva-tion and metabolism may enable the identification of thissubgroup of patients that will have an improved prognosiswhen using this expensive form of therapy.

Example 4 (theranostics)

Theranostics is a word to describe combined drug therapyand diagnostics5, and is the ultimate concept in targeted

5 See ESF Forward Look on Nanomedicine at : http://www.esf.org/fileadmin/be_user/research_areas/emrc/Nanomedicine.pdf

Fig. 4 Coronary artery imaging with multidetector CT and post-processing characterisation of coronary plaques (courtesy of Prof.Gabriel P. Krestin)

Fig. 5 Radiation treatment planning (right) of head/neck cancer basedon fusion of morphologic and functional information obtained withPET-CT (left) (courtesy of Prof. Liselotte Højgaard)

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drug delivery. A molecule targeted for the disease tissue(e.g. cancer) is linked both to a nonactivated therapeuticdrug and an imaging contrast agent (tracer). In the case ofultrasound, the drug may be encapsulated in a gas bubbleand after injection the same ultrasound imaging equipmentmay be used first to ensure the correct localisation of thedrug and then activate the drug through bursting of thebubble with ultrasound waves.

Example 5 (image guidance of stem cell therapy)

Image guidance may be applied to stem cell therapy onmany levels. First guidance of the delivery and placementof the stem cells, then tracking of any migration of labelledstem cells, then monitoring of the cell differentiation for thetarget organ, and with functional imaging methods, moni-toring of improved organ function. Imaging techniques thatcould be used for tracking stem cells in human includeMRI, Nuclear Medicine (PET and SPECT) and possiblyultrasound.

Example 6 (monitoring of drug therapy)

New imaging methods from PET and MRI producebiological information on the growth potential of malignanttumours. This may be applied to noninvasive monitoring ofthe treatment effects of cytostatic drug therapy (usually acombination of several drugs). FDG-PET 6 can show adecrease in glucose uptake and different MRI methods canshow reduction in angiogenetic potential. In a case of poorresponse, the treatment may be discontinued early on with achange to other drugs or to other therapeutic methods suchas surgery or radiotherapy. Through this improved managedcare the patient will get fewer adverse reactions, noineffective therapy while it will lead to cost savings forthe healthcare system.

Example 7 (image-guided surgery)

Imaging techniques can assist the surgeon both before andduring surgery. Before surgery, image processing tools canprovide realistic previews of the surgical field and of accesspathways, with an interactive 3D anatomic display forappropriate planning.

During surgery, image guiding can be valuable for targetlocalization and detection of boundaries allowing, forinstance, more complete and accurate resection of tumours,limiting damage to normal tissues.

As an example, in neurosurgery it is important for thesurgeon to avoid damage to the brain structures that will causedramatic functional deficits (limb paralysis, language func-tion, visual etc.). An integrated protocol of new MRI methodsmay, prior to the surgery, delineate important functional areasin the brain and their vital nerve fibre connections. This is ofgreat help to the neurosurgeon in the planning of theoperation, and can also be displayed for the neurosurgeon inthe operating theatre and updated during the surgicalintervention (tumour resection etc.), using image-guidedminimal-invasive surgery with either MRI or ultrasound.

Ultimately, further development of robotic imageguidedsurgery will provide computer assisted tools to facilitateand increase safety of complex surgical procedures in allfields of surgery.

Example 8 (patient follow-up)

Cardiac ultrasound has reached a level where the myocar-dial wall function can be quantified and 3D visualised.Advanced ultrasound equipment is currently the size of aportable computer and with ongoing research it may reachthe size of a cell phone. With further development in theuser-friendliness of the advanced methods, it may be

Fig. 6 Doppler ultrasound image (top) of metacarpophalangeal jointsshowing active inflammation (sinovitis). Corresponding MRI study(bottom) (courtesy of Prof. Paul Emery)

6 PET scanning with the tracer fluorine-18 (F-18) fluorodeoxyglucose(FDG)

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possible for patients using multidrug therapy in heart failureto have frequent follow-ups with an adjustment of dose,based on ultrasound image quantification of heart function,at the general practitioner’s office.

Likewise as shown in Fig. 6 below, combined morpho-functional imaging approaches (Doppler ultrasound andMRI with conventional and dedicated equipment) can beused for the staged detection of disease activities and forchanges over time in rheumatic diseases, with potentialbeneficial effects for health expenditures.

Experts Group on Medical Imaging for ImprovedPatient Care

Chairs

Arturo Brunetti (Chair), CNR Institute of Biostructure andBiomages, Faculty of Medicine,Medical School, Universityof Naples Federico II, Naples, Italy

Olav Haraldseth (Chair), MR Centre, Department ofCirculation & Medical Imaging, Faculty of Medicine,Norwegian University of Science and Technology,Trondheim, Norway

Scientific Experts

Silvio Aime, Dpto di Chimica Inorganica, Chimica Fisica eChimica dei Materiali, Facoltà di Scienze M.F.N., Universitàdegli studi di Torino, Torino, Italy

Paolo G. Camici, MRC Clinical Sciences Centre,Imperial College London, United Kingdom

Alberto Cuocolo, European Association of NuclearMedicine (EANM), Department of Biomorphological andFunctional Sciences, University of Naples Federico II,Naples, Italy

Sturla Eik-Nes, National Center for Foetal Medicine,Department of Gynecology and Obstetrics, UniversityHospital of Trondheim, Trondheim, Norway

Paul Emery, Academic Section of MusculoskeletalDisease, Chapel Allerton Hospital, Leeds, United Kingdom

Liselotte Højgaard, Clinic of Clinical Physiology,Nuclear Medicine & PET, University of Copenhagen,Rigshospitalet, Copenhagen, Denmark

Juhani Knuuti, Turku PET Centre, Turku UniversityHospital, Turku, Finland

Gabriel P. Krestin, ErasmusMC, Department of Radiology,Rotterdam, The Netherlands

Christiane Kuhl, Radiologische Klinik der UniversitätBonn, Bonn, Germany

George Laking, Christie Hospital NHS Trust, Manchester,United Kingdom

Henrik Larsson, Functional & Diagnostic MR Unit,Glostrup University Hospital, Copenhagen, Denmark

Borut Marincek, European Society of Radiology (ESR),Department of Medical Radiology, University HospitalZürich, Zürich, Switzerland

Chrit Moonen, CNRS, Laboratory for Molecular andFunctional Imaging, University Victor Segalen, Bordeaux,France

Hans Olav Myhre, Norwegian University of Science andTechnology, Trondheim, Norway

Gabor Rudas, MR Research Centre, SemmelweisUniversity, Budapest, Hungary

Jordi Ruscalleda Nadal, European Society of Neurora-diology (ESNR), Servicio de Radiologia-Neuroradiologia,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Markus Schwaiger, TU Klinikum rechts der Isar,Medizinische Klinik München, Munich, Germany

George Sutherland, Department of Cardiological Sciences,St. George’s Hospital, London, United Kingdom

EU Adviser

Tone Woie Alstadheim, Norwegian University of Scienceand Technology, Faculty of Medicine, Trondheim, Norway

ESF-EMRC

Liselotte Højgaard, Chair of EMRC Carole Moquin-Pattey,Head of Unit Thomas Bruhn, Science Officer Gwenaelle LeCochennec, Administrator

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