A new world order: training clinicians for a new era in imaging

There are three kinds of people – commonplace men, remarkable men, and lunatics (Mark Twain, Following the Equator). Over the past 15 years or so I have had the distinction of being considered a member of each of the categories of humans identified by the great American humorist, author, and philosopher, Samuel Clemens (alias Mark Twain). My initial exposure to oncological PET as a fellow at the University of Michigan in the late 1980s and early 1990s and the seminal work of Professor Rich Wahl convinced me of the need to correlate PET images with more detailed anatomical studies. I was positive about the potential benefits of a combined device to achieve this end. Consequently, I suggested to an engineer of GE Medical Systems that his company should build such a device. His response was that they could not sell enough PET scanners to make money out of the business, and only a lunatic would suggest making an even more expensive device. In 1996, GE made an unsuccessful attempt to sell its PET business. In retrospect, I am sure that they would agree that this was one of the most fortuitous business strategy failures of all time. GE went on to release the first commercial PET/CT in 2001, followed soon after by Siemens. The latter had initially pioneered work in this field through the efforts of Professor David Townsend. Today, PET/CT is the most rapidly growing imaging modality in the world. In 1996, coinciding with the nadir of corporate enthusiasm for PET, I established a PET facility at the Peter MacCallum Cancer Centre in Australia. This was done without Government capital or operational funding. The focus of our programme was to provide a clinical service to cancer patients. Many of my colleagues considered me a lunatic. PET, they told me, was a research tool, not a routine clinical imaging device. It was, they said, unlikely to be an affordable technique for cancer staging despite encouraging preliminary reports of its accuracy for this purpose. Despite this, by 1999, we had installed a second PET scanner. We were performing over 2000 clinical PET studies annually, and I was considered a remarkable man! As oncologists and imaging specialists became increasingly aware of the benefits of PET and more and more publications attested to its accuracy and patient management quality, it became evident that PET was a revolutionary approach to cancer evaluation. Modern oncology …