From the June 2015 issue of HealthCare Business News magazine


Nuclear medicine hasn’t chosen either of these viable strategies. Over almost four decades I’ve watched the nuclear medicine specialty take a lead-from-behind strategy. This means when there is a scientific breakthrough, application or device, they wait to see if others find it acceptable before moving forward. This is probably a good strategy if you’re traversing a mine field, but not if you wish to maximize the impact of your contribution.

In an age of health care reform one needs to address the viability of the strategy taken so far by nuclear medicine. Whether this strategy of leading from behind will work with today’s changing health care dynamic is unknown. My observation after four decades of experience in and around the field of diagnostic imaging is that the strategy hasn’t worked very well and I don’t believe the increasing pressures on diagnostic imaging make it likely that the strategy will work better in the future.


Here are some examples of the lead from behind strategy. In the 1980s the nuclear medicine profession stood by passively as cardiologists took over perfusion imaging. A nuclear cardiology specialty was created within nuclear medicine and then the cardiologists separated from nuclear medicine, forming their own society, the American Society of Nuclear Cardiology.

In 1986, when NMR was renamed MRI to remove the dreaded “nuclear” component, nuclear medicine stood by while the radiology world worked diligently to demonstrate they can do the same thing with MRI and CT. How many times do I read an article and think, “That’s already been done in nuclear medicine.” I say it a lot.

Early on, I thought the reason for the passive behavior was because nuclear medicine departments wished to remain autonomous and not become part of radiology. After several years I realized it was just the opposite. Radiology was working to keep nuclear medicine out. If you asked a radiologist about nuclear medicine the almost universal response was, “You mean ‘unclear medicine?’” The radiologist compared the nuclear images to their CT or MRI and called the nuclear images “fuzzy.” They didn’t understand nuclear medicine and saw no reason to spend the time to do so.

In the early ‘90s PET started to emerge as a potential big player in nuclear medicine. But the field was cautious. Some demanded equity in reimbursement and acceptance for clinical practice. Others questioned whether letting PET out into the general diagnostic imaging community made sense. When reimbursement started to emerge in the late ‘90s and early 2000s, nuclear medicine began adopting the modality but, as with nuclear cardiology the nuclear medicine community didn’t do enough to promote and hold on to the modality.

June 2015 Magazine

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