De Rimini (Aimn): We are 'good nuclear', expand internship programs

Rome. Nuclear medicine represents one of the most innovative fields of contemporary medicine, capable of integrating advanced diagnostics and targeted therapies thanks to the development of increasingly sophisticated technologies and innovative radiopharmaceuticals.

From oncology to cardiology to the study of neurodegenerative diseases, this discipline is opening up new perspectives in precision medicine. Yet, despite scientific and clinical advances, it remains little known to the general public and faces the challenge of attracting an increasing number of young doctors to specialize. To learn more, Dire interviewed Dr. Maria Luisa De Rimini, president of the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN).

– Dr. De Rimini, nuclear medicine is a highly specialized and technologically advanced discipline, yet it's often little known to the general public. What causes this lack of awareness?

Those who come into contact with our departments understand the value of the diagnoses and treatments we offer, including through new technologies. However, in a more general communication interface, there is a certain difficulty in approaching this, which is due to several factors. Among these, for example, are structural elements: the Nuclear Medicine Units, for radiation protection reasons, are subject to very stringent regulatory standards that limit access and make direct knowledge of our activities less immediate.

All of this is necessary to ensure protection from ionizing radiation, but it can create a greater distance from other disciplines. Then there's the issue of language: nuclear medicine uses complex terms and concepts (think of radiopharmaceuticals, physical decay, or molecular imaging processes) that aren't always easy to explain simply and immediately.

When trying to communicate this content, the initial impression can often be unclear for the listener. Added to this is a cultural element: the word "nuclear" can evoke in the collective imagination dramatic events related to the history of civil or military nuclear power. In reality, all this has nothing to do with nuclear medicine. Ours is a medicine that uses "good" nuclear energy, the kind needed to better diagnose and characterize diseases, to treat them, and to improve the quality and life expectancy of patients.

Over the years, nuclear medicine has undergone profound evolution, both technologically and clinically. How have the diagnoses and treatment of many diseases improved?
Today, nuclear medicine is a clear model of precision medicine. On the one hand, it allows for much earlier and more accurate diagnoses, and on the other, targeted therapies on specific molecular targets.

This shift has profoundly transformed the approach to disease, with significant clinical impact. In oncology, the ability to identify and track certain biological targets of the disease, and in some cases, even use those same targets as therapeutic targets, has revolutionized the interface between diagnostics and treatment. This approach is the basis of so-called theranostics, the ability to use imaging to guide therapy directed at the same biological target of the disease.

Elective specificity in theranostics is a concrete prerequisite for therapeutic success, as it guides the therapy to exert a targeted "tumoricidal" effect on diseased cells, sparing healthy cells. Multimodality tomography systems (PET/CT, SPECT/CT, PET/MRI) guarantee higher diagnostic accuracy. More recently, digital technologies and wide-field systems allow for even more diagnostic images, faster examination times, and significantly reduced radiation doses for patients.

Artificial intelligence also makes a significant contribution, aiding analysis and more complex image integration into the clinical interface. A major breakthrough is also represented by the development of innovative radiopharmaceuticals, which allow the study of a growing number of biological targets, to "make the invisible visible," greatly expanding diagnostic and therapeutic possibilities.

– What are the main clinical areas in which nuclear medicine operates?
The landscape is very broad. In oncology, for example, nuclear medicine not only defines the disease, but tells us "how it behaves"—in essence, it characterizes it. This has changed the way we approach clinical patient management, treatment choices, and monitoring.

For the latter, a PET scan, even during ongoing treatment, allows us to understand whether the therapy is successful or not, deducing the need to continue or modify treatment. This type of approach, initially validated in lymphoma, has a fundamental impact on the patient's health and, naturally, on the appropriate use of healthcare resources, as it allows us to avoid unnecessary or ineffective therapies.

Nuclear medicine also has a long tradition in cardiology, studying myocardial perfusion and contractility. Today, it is possible to study coronary flow and reserve even more closely, to identify, among other things, individuals at high risk for ischemic disease even before clinical manifestations. Furthermore, in certain conditions, such as cardiac amyloidosis, nuclear medicine diagnostics can provide such accurate information that, under certain conditions, it approaches the diagnostic value of an invasive cardiac biopsy, sometimes allowing it to be avoided.

An equally important field is neurology, especially in the study of neurodegenerative diseases, Parkinson's and Alzheimer's. In the latter, PET with amyloid tracers enables early diagnosis and establishes eligibility criteria for new drugs for the treatment of Alzheimer's.

– Meanwhile, in recent years, there has been a progressive reduction in the number of nuclear medicine doctors in Italy. What are the main causes of this phenomenon?
“It's true that in recent years Italy has seen a reduction in the number of applications to specialize in nuclear medicine, although this past year alone has seen a resurgence.

As for the causes, in addition to a general decline in vocations, the reduction in specialists also stems from the need for all universities and institutions to invest more in a program aimed at promoting this discipline. Indeed, nuclear medicine is often little known in the first years of university.

I'm not referring so much to teaching as to the fact that students rarely enter our departments in the early stages of their training. And this is an important factor, because direct experience truly makes a difference. Approaching nuclear medicine images and, thanks to them, assessing different pathological conditions, following and interpreting the progression of the disease is exciting.

In a phase of innovation and growth as significant from a scientific and clinical perspective as nuclear medicine is experiencing today, it's hard to imagine young people not being passionate about this discipline. Therefore, it's essential to foster this connection and improve communication.

– How, in your opinion, can this trend be reversed?
For example, it would be useful to expand internship programs during the degree program, not just in the final years but also in the earlier years of the university curriculum. Indeed, the choice of specialization often arises in the early years, and that's where knowledge of nuclear medicine needs to be promoted.

It is also necessary to update the national planning for these specialists to meet current and future needs, especially considering that therapeutic needs are now in addition to imaging. Nuclear medicine imaging and therapies are now fundamental pillars of medicine: they cannot be marginalized, but must be supported with adequate investment and training plans, also to ensure balanced growth and the capacity of our facilities nationwide.

Institutions must recognize that nuclear medicine is a strategic discipline, precisely because of the central role it plays in diagnosis and treatment. This will ensure adequate skills and professionalism over the years, ensuring citizens equal access to advanced diagnostics and innovative therapies. In short, we need to integrate investment, planning, and a strong commitment to training to truly foster the career paths, scientific interest, and future careers of these young people.