A multitude of recent publications have revealed the limitations of modern individualised diagnosis and therapy concepts in conjunction with heterogeneity of tumours. High molecular genetic variability could be demonstrated not only within primary tumours but also in comparison to individual metastatic lesions which complicates the validation of individual biomarkers for therapy selection. If genetic analyses solely based on individual tumour biopsies are performed, it often leads to the underestimation of the mutation load and for corresponding therapy to the selection of therapy-refractory clones, which indirectly favours the recurring tumour. This as a result impairs the success of clinical phase I and II studies, if the total tumour load in respect of molecular targets is not characterised sufficiently or supposed toxic therapy effects are not adequately considered.
Functional imaging procedures such as SPECT or PET could be a key influence in future therapy decisions and thus the choice of potential effective drugs with the use of ultra-precise biomarkers for the in-vivo characterisation of tumour lesions and their micro-environment.
These technologies do not facilitate invasive serial recordings of the entire body so that all tumour manifestations within a clinical investigation course can be characterised, whereby the system biological understanding of tumour behaviour is aided.
Another advantage of nuclear medicine technology is the opportunity to use the same basic matrix for both imaging diagnostics and therapies, the so-called radiopeptide or radioimmuno therapies. This concept, which many know from the diagnosis and therapy of thyroid gland tumours using radioactive iod isotope may consequently be considered for modern so-called "theranostic" concepts.
Nuclear medicine imaging technology has rapidly improved too. Thanks to the development of the so-called hybrid scanner such as PET/CT, PET/MR or SPECT/CT, which shall revolutionise the processing of multiple image information in the sense of so-called multi-parametric concepts and takes another step in the direction of a virtual tumour histology. In this case not only is a close interlocking with medicinal physics and bio information technology questioned but also with different radiological disciplines.
All these trends shall facilitate the change in nuclear medicine imaging to a central component of modern personalised medicine.