Congress has made some proposals in terms of instrument utilization. Right now our utilization rate for the instruments we use in imaging are factored at about 45 percent of the time. Obviously there are times when a patient is getting on and off the machine. The proposal has been that we increase that rate to 90 percent. Eventually the expectation is that every single minute that the clinic is open, somebody should be actively imaged on that machine. People are going to be reimbursed a little less for each imaging procedure because the presumption is that it's being used more efficiently. The perception is that 45 percent is too low and they're trying to bring it up to somewhere in between. The number I've heard in meetings with other radiology societies is that we expect to come out around 75 percent utilization rate. It's still pushing it, but it's better than 90 percent.

In parallel there has been some concern on the part of the companies that make the pharmaceuticals, in particular the positron emitting radiopharmaceuticals. The concern is that we haven't penetrated enough into the field. Probably the most exciting developments have been in the area of oncologic imaging. Some of the new radiopharmaceuticals that are proposed might have some exciting impact on our ability to be even more precise than with radioactive glucose in assessing what's going on with patients.

There are also some pretty exciting compounds that are being developed for imaging and being able to actually diagnose patients who have Alzheimer's or other forms of dementia.

[DM: What other challenges are facing the molecular imaging community?]

RA: Particularly with the PET agents -- we are injecting such a small amount of material that the likelihood of seeing any kind of a pharmacologic or toxic effect on the patient is almost nil, but in the current environment, with the problems that we've had with the MRI contrast agents and some of the ultrasound agents and toxicity associated with those, trying to get the FDA to relax their stand in terms of extremely rigorous toxicity studies for radiopharmaceuticals is almost impossible. That's been one of our challenges, because it's so expensive now to develop new radiopharmaceuticals that you almost have to have the imaging equivalent of a home run.

[DM: Are there any issues with funding for nuclear medicine research?]

RA: In 2006 the Office of Management and Budget (OMB) eliminated the nuclear medicine research funding in the Department of Energy budget. It was very unfortunate, because that funding was involved in supporting some of the very basic science that we do at the interface of the physical sciences and the biologic sciences. We've lost a lot of funding for basic radiochemistry activity and funding for improved instrumentation and improved software to do image analysis. We then started to try to work with Congress and we were finally successful in 2008 in getting that funding restored -- it was only about half of what we had in 2005, but nonetheless it got us going again. The challenge has been that the Department of Energy has been trying to move the focus of that funding toward other bioscience activities. Congress has been willing to work with us to put specific language in the appropriations bills that defines the mission of that funding to be for nuclear medicine research. That was true in 2008 and 2009. Since we're in the appropriations process for 2010, we'll continue to work with Congress to make sure that the funding continues to be defined for use in nuclear medicine research. That's been a constant struggle for us.

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