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Linking Radiation Oncology and Imaging through Molecular Biology (or Now That Therapy and Diagnosis Have Separated, It’s Time to Get Together Again!)¹

¹ From the National Cancer Institute, Radiation Oncology Branch, Bldg 10, B3-B69, National Institutes of Health, Bethesda, MD 20892-1002. Received November 29, 2002; revision requested December 16; revision received February 11, 2003; accepted February 20. Address correspondence to the author (e-mail: ccoleman@mail.nih.gov).

View larger version (30K): [in a new window]   Figure 1. Molecular target credentialing. This concept, created by Drs Robert Wittes and Richard Klausner, involves three of the "Extraordinary Opportunities for Research Investment" of the NCI Bypass Budget (1). The concept of radiation therapy is expanded to include the capability of radiation to induce molecular targets in addition to its more traditional uses. Thus, the concept of dose may go beyond the gray unit to include the induction of specific molecular events.

View larger version (40K): [in a new window]   Figure 2. Molecular target credentialing. To best understand imaging and therapy, one needs to understand the basic underlying biologic mechanisms, which herein are called molecular signatures. The fields of imaging and therapeutics are interrelated by way of the field of basic biology.

View larger version (35K): [in a new window]   Figure 3. The new three Ds and credentialing. The new NCI director is emphasizing the importance of filling the gaps in the pathway from discovery to development to delivery for cancer treatment and prevention. With new and enhanced collaborations among the specialties of diagnostic imaging, nuclear medicine, and radiation oncology, which are linked by way of the field of basic biology and technology development, the technology-oriented radiology fields can and should be leaders in molecular oncology.

View larger version (50K): [in a new window]   Figure 4. The 2002 RSNA Annual Oration in Radiation Oncology is dedicated to William Powers, MD (pictured). He and Leonard Tolmach, PhD, published a groundbreaking study, the results of which demonstrated the effect of a hypoxic population of cells on the response to radiation in vivo. The flexure in the survival curve occurs owing to the relative radioresistance of the hypoxic tumor cells. Dr Powers helped launch the field of tumor hypoxia that is now under intense study. (Graph adapted and reprinted, with permission, from reference 75.)