Diagnostic Imaging Research Research Articles

Surgical treatment of feline inductive odontogenic tumor by marginal resection in a cat.

A 1-year-old mixed-breed cat was referred for an approximately 2-cm mass centered on the upper right canine tooth. Computed tomography (CT) revealed the lesion extended to the nasal cavity and orbit, causing thinning and expansion of the adjacent cortical bone. Excisional biopsy confirmed the diagnosis of a feline inductive odontogenic tumor. Based on the findings of CT imaging, the primary alveolar bone lesion was removed with the tumor, while the adjacent bones, which had been expanded and thinned, were preserved by marginal resection including the surrounding periosteum-like membrane. No local recurrence was observed for seven years. To validate the therapeutic outcome of this case, further research in diagnostic imaging and pathology will be crucial.

Third-Generation Cardiovascular Phantom: The Next Generation of Preclinical Research in Diagnostic Imaging.

Different types of preclinical research tools used in the field of diagnostic imaging such as dynamic flow circulation phantoms have built the foundation for optimization and advancement of clinical procedures including new imaging techniques. The objective was to introduce a third-generation phantom, building on the limitations of earlier versions and unlocking new opportunities for preclinical investigation. A third-generation phantom was designed and constructed comprising physiological vascular models from head to toe, including a 4-chamber heart with embedded heart valves and a controllable electromechanical pump. The models include modular segments, allowing for interchangeability between healthy and diseased vessels. Clinical sanity checks were performed using the phantom in combination with a dual-head power injector on a third-generation dual-source computed tomography scanner. Contrast media was injected at 1.5 g I/s, and the phantom was configured with a cardiac output of 5.3 L/min. Measurements of mean transit times between key vascular landmarks and peak enhancement values in Hounsfield units (HUs) were measured to compare with expected in vivo results estimated from literature. Good agreement was obtained between literature reference values from physiology and measured results. Contrast arrival between antecubital vein and right ventricle was measured to be 13.1 ± 0.3 seconds. Transit time from right ventricle to left ventricle was 12.0 ± 0.2 seconds, from left internal carotid artery to left internal jugular vein 7.7 ± 0.4 seconds, and 2.9 ± 0.2 seconds from aortic arch to aortic bifurcation. The peak enhancement measured in the regions of interest was between 336 HU and 557 HU. The third-generation phantom demonstrated the capability of simulating physiologic in vivo conditions with accurate contrast media transport timing, good repeatability, and expected enhancement profiles. As a nearly complete cardiovascular system including a functioning 4-chamber heart and interchangeable disease states, the third-generation phantom presents new opportunities for the expansion of preclinical research in diagnostic imaging.

The contribution of laboratory animals to diagnostic imaging research in Greece

Biomedical research in Greece has rapidly developed during the last 30 years. Diagnostic imaging groundwork is a significant field of interest which has been developed by taking advantage of the basic and applied research capacities including the use of small and large animal models, conventional and/or genetically modified ones. This important outbreak in research has been enhanced by the construction of modern facilities in universities, medical and other academic research centers, the use of new advanced installed equipment, modern imaging techniques, specific contrast media and, of course, specialized personnel. In this manuscript, the research performed regarding diagnostic imaging techniques using animal models in Greece since 1983 is presented. More specifically a recording of the Greek research centers, the number of researchers, species and figures of animal models, diagnostic imaging techniques used, as well as the contribution of projects in the evolution of diagnostic imaging in medicine and veterinary science is presented.

Key clinical benefits of neuroimaging at 7 T

The growing interest in ultra-high field MRI, with more than 35.000 MR examinations already performed at 7T, is related to improved clinical results with regard to morphological as well as functional and metabolic capabilities. Since the signal-to-noise ratio increases with the field strength of the MR scanner, the most evident application at 7T is to gain higher spatial resolution in the brain compared to 3T. Of specific clinical interest for neuro applications is the cerebral cortex at 7T, for the detection of changes in cortical structure, like the visualization of cortical microinfarcts and cortical plaques in Multiple Sclerosis. In imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology may be visualized with excellent spatial resolution. Using Susceptibility Weighted Imaging, the plaque-vessel relationship and iron accumulations in Multiple Sclerosis can be visualized, which may provide a prognostic factor of disease. Vascular imaging is a highly promising field for 7T which is dealt with in a separate dedicated article in this special issue. The static and dynamic blood oxygenation level-dependent contrast also increases with the field strength, which significantly improves the accuracy of pre-surgical evaluation of vital brain areas before tumor removal. Improvement in acquisition and hardware technology have also resulted in an increasing number of MR spectroscopic imaging studies in patients at 7T. More recent parallel imaging and short-TR acquisition approaches have overcome the limitations of scan time and spatial resolution, thereby allowing imaging matrix sizes of up to 128×128. The benefits of these acquisition approaches for investigation of brain tumors and Multiple Sclerosis have been shown recently. Together, these possibilities demonstrate the feasibility and advantages of conducting routine diagnostic imaging and clinical research at 7T.

An Incidental Renal Oncocytoma: 18F-Choline PET/MRI

PET/MRI is a new hybrid imaging modality and has the potential to become a powerful imaging tool. It is currently one of the most active areas of research in diagnostic imaging. The characterisation of an incidental renal lesion can be difficult. In particular, the differentiation of an oncocytoma from other solid renal lesions such as renal cell carcinoma (RCC) represents a diagnostic challenge. We describe the detection of an incidental renal oncocytoma in a 79-year gentleman who underwent a re-staging 18F-Choline PET/MRI following a rise in PSA values (4.07, nadir 1.3).

A Review of the Appropriateness of the Current Italian Guidelines for Noninvasive Imaging Assessment of Focal Liver Lesions.

In 2007 the Italian National Institute of Health issued Guidelines for the use of diagnostic imaging techniques in the detection and the characterization of focal liver lesions. Since the publication of these guidelines in 2008, several studies relating to this topic have been published. Thus, we felt the need to assess whether interval research and new advancements in diagnostic imaging have yielded new evidence that should modify the recommendations that were previously issued. The literature search confirmed the appropriateness of the current guidelines. Although most modalities did not show substantial changes, interval introduction of DW-MRI is a valuable technique with a high diagnostic accuracy in the detection and characterization of FLLs, and its sensitivity is higher when combined with MRI.

Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference.

The 2015 Academic Emergency Medicine (AEM) consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to: 1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; 2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and 3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified prior to the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were 164 individuals involved in the conference spanning various specialties, including emergency medicine (EM), radiology, surgery, medical physics, and the decision sciences. This issue of AEM is dedicated to the proceedings of the 16th annual AEM consensus conference as well as original research related to emergency diagnostic imaging.

Advancing Patient-centered Outcomes in Emergency Diagnostic Imaging: A Research Agenda.

Diagnostic imaging is integral to the evaluation of many emergency department (ED) patients. However, relatively little effort has been devoted to patient-centered outcomes research (PCOR) in emergency diagnostic imaging. This article provides background on this topic and the conclusions of the 2015 Academic Emergency Medicine consensus conference PCOR work group regarding "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The goal was to determine a prioritized research agenda to establish which outcomes related to emergency diagnostic imaging are most important to patients, caregivers, and other key stakeholders and which methods will most optimally engage patients in the decision to undergo imaging. Case vignettes are used to emphasize these concepts as they relate to a patient's decision to seek care at an ED and the care received there. The authors discuss applicable research methods and approaches such as shared decision-making that could facilitate better integration of patient-centered outcomes and patient-reported outcomes into decisions regarding emergency diagnostic imaging. Finally, based on a modified Delphi process involving members of the PCOR work group, prioritized research questions are proposed to advance the science of patient-centered outcomes in ED diagnostic imaging.

Advancing the Use of Administrative Data for Emergency Department Diagnostic Imaging Research.

Administrative data are critical to describing patterns of use, cost, and appropriateness of imaging in emergency care. These data encompass a range of source materials that have been collected primarily for a nonresearch use: documenting clinical care (e.g., medical records), administering care (e.g., picture archiving and communication systems), or financial transactions (e.g., insurance claims). These data have served as the foundation for large, descriptive studies that have documented the rise and expanded role of diagnostic imaging in the emergency department (ED). This article summarizes the discussions of the breakout session on the use of administrative data for emergency imaging research at the May 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The authors describe the areas where administrative data have been applied to research evaluating the use of diagnostic imaging in the ED, the common sources for these data, and the strengths and limitations of administrative data. Next, the future role of administrative data is examined for answering key research questions in an evolving health system increasingly focused on measuring appropriateness, ensuring quality, and improving value for health spending. This article specifically focuses on four thematic areas: data quality, appropriateness and value, special populations, and policy interventions.

Funding Research in Emergency Diagnostic Imaging: Summary of a PanelDiscussion at the 2015 Academic Emergency Medicine Consensus Conference.

As part of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," a panel of representatives from the National Institute of Health's Office of Emergency Care Research, the National Institute of Biomedical Imaging and Bioengineering, the Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute was assembled to discuss future opportunities for funding research in this particular area of interest. Representatives from these agencies and organizations discussed their missions and priorities and how they distribute funding. They also addressed questions on mechanisms for new and established researchers to secure future funding.

Monte Carlo reference data sets for imaging research: Executive summary of the report of AAPM Research Committee Task Group 195

The use of Monte Carlo simulations in diagnostic medical imaging research is widespread due to its flexibility and ability to estimate quantities that are challenging to measure empirically. However, any new Monte Carlo simulation code needs to be validated before it can be used reliably. The type and degree of validation required depends on the goals of the research project, but, typically, such validation involves either comparison of simulation results to physical measurements or to previously published results obtained with established Monte Carlo codes. The former is complicated due to nuances of experimental conditions and uncertainty, while the latter is challenging due to typical graphical presentation and lack of simulation details in previous publications. In addition, entering the field of Monte Carlo simulations in general involves a steep learning curve. It is not a simple task to learn how to program and interpret a Monte Carlo simulation, even when using one of the publicly available code packages. This Task Group report provides a common reference for benchmarking Monte Carlo simulations across a range of Monte Carlo codes and simulation scenarios. In the report, all simulation conditions are provided for six different Monte Carlo simulation cases that involve common x-ray based imaging research areas. The results obtained for the six cases using four publicly available Monte Carlo software packages are included in tabular form. In addition to a full description of all simulation conditions and results, a discussion and comparison of results among the Monte Carlo packages and the lessons learned during the compilation of these results are included. This abridged version of the report includes only an introductory description of the six cases and a brief example of the results of one of the cases. This work provides an investigator the necessary information to benchmark his/her Monte Carlo simulation software against the reference cases included here before performing his/her own novel research. In addition, an investigator entering the field of Monte Carlo simulations can use these descriptions and results as a self-teaching tool to ensure that he/she is able to perform a specific simulation correctly. Finally, educators can assign these cases as learning projects as part of course objectives or training programs.

Coherent fiber bundle based integrated photoacoustic, ultrasound and fluorescence imaging (PAUSFI) for endoscopy and diagnostic bio-imaging applications

Recent research in diagnostic imaging and sensing focuses on deriving complementary information from the diagnosed site. From that perspective it is imperative to devise new imaging platforms where multiple distinct modalities are used either simultaneously or sequentially. Increased efforts have been devoted towards establishing such multi-modal imaging systems, which house and operate more than two imaging modalities within a single instrumentation set-up. In this context, we propose a novel multi-modal imaging platform using non-ionizing radiation that has been successfully conceptualized, established and experimentally demonstrated. This proposed GRIN lensed fiber-optic microscope and linear array transducer based PAUSFI (photoacoustic, ultrasound and fluorescence imaging) system makes use of non-ionizing radiation sources to map optical and acoustic heterogeneities (complementary information) along the depth of the tissue at multi-scale resolution (microscopic to mesoscopic). The fiber-optic assembly enables the system to perform minimally invasive remote light delivery and high resolution fluorescence and photoacoustic imaging of inaccessible areas of intact tissues or intra body cavities. It is expected that the proposed multi-modal imaging system could open up niches in bio-imaging research in the near future.

SU-C-12A-04: Diagnostic Imaging Research Using Decedents as a Proxy for the Living: Are Radiation Dosimetry and Tissue Property Measurements Affected by Post-Mortem Changes?

Purpose: Radiation dose (RD) from diagnostic imaging is a growing public health concern. Implanting dosimeters is a more accurate way to assess organ dose, relative to commonly used mathematical estimations. However, performing accurate dosimetry using live subjects is hindered by patient motion and safety considerations, which limit the RD and placement of implanted dosimeters. Performing multiple scans on the same subject would be the ideal way to assess the impact of dose reduction on image quality; however, performing multiple non-standard-of-care scans on live subjects for dosimetry and image quality measurements is generally prohibited by IRB committees. Our objective is to assess whether RD and tissue property (TP) measurements in post-mortem (PM) subjects are sufficiently similar to those in live subjects to justify the use of deceased subjects in future dosimetry and image quality studies. Methods: 4 MOSFET radiation dosimeters were placed enterically in each subject (2 sedated Rhesus Macaques) to measure the RD at 4 levels (carina, lung, heart, and liver) during CT scanning. The CT protocol was performed ante-mortem (AM) and 2 and 3 hours PM. For TP analysis, additional scans were taken at 24 hours PM. To compare AM and PM TP, regions-of-interest were drawn on selected organs and the average CT density with standard deviation (in units of HU) were taken; additionally, visual comparisons of images were made at each PM interval. Results: No significant difference was observed in 8 of 9 measurements comparing AM and PM RD. Only one measurement (liver of the first subject) showed a significant difference (7% lower on PM measurement), possibly due to subject re-positioning. Initial TP visual and quantitative analyses show little to no change PM. Conclusion: Our results suggest that realistic radiation dosimetry and image quality measurements based on tissue properties can be performed reliably on recently deceased subjects.

Rapamycin Enhances Adenovirus-Mediated Cancer Imaging and Therapy in Pre-Immunized Murine Hosts

Tumor-specific adenoviral vectors comprise a fruitful gene-based diagnostic imaging and therapy research area for advanced stage of cancer, including metastatic disease. However, clinical translation of viral vectors has encountered considerable obstacles, largely due to host immune responses against the virus. Here, we explored the utilization of an immunosuppressant, rapamycin, to circumvent the anti-adenovirus immunity in immunocompetent murine prostate cancer models. Rapamycin diminished adenoviral-induced acute immune response by inhibiting NF-κB activation; it also reduced the scale and delayed the onset of inflammatory cytokine secretion. Further, we found that rapamycin abrogated anti-adenovirus antibody production and retarded the function of myeloid cells and lymphocytes that were activated upon viral administration in pre-immunized hosts. Thus, the co-administration of rapamycin prolonged and enhanced adenovirus-delivered transgene expression in vivo, and thereby augmented the imaging capability of adenoviral vectors in both bioluminescent and positron emission tomography modalities. Furthermore, we showed that despite an excellent response of cancer cells to a cytotoxic gene therapeutic vector in vitro, only minimal therapeutic effects were observed in vivo in pre-immunized mice. However, when we combined gene therapy with transient immunosuppression, complete tumor growth arrest was achieved. Overall, transient immunosuppression by rapamycin was able to boost the diagnostic utility and therapeutic potentials of adenoviral vectors.

Multimodality imaging techniques

In multimodality imaging, the need to combine morphofunctional information can be approached by either acquiring images at different times (asynchronous), and fused them through digital image manipulation techniques or simultaneously acquiring images (synchronous) and merging them automatically. The asynchronous post-processing solution presents various constraints, mainly conditioned by the different positioning of the patient in the two scans acquired at different times in separated machines. The best solution to achieve consistency in time and space is obtained by the synchronous image acquisition. There are many multimodal technologies in molecular imaging. In this review we will focus on those multimodality image techniques more commonly used in the field of diagnostic imaging (SPECT-CT, PET-CT) and new developments (as PET-MR). The technological innovations and development of new tracers and smart probes are the main key points that will condition multimodality image and diagnostic imaging professionals' future. Although SPECT-CT and PET-CT are standard in most clinical scenarios, MR imaging has some advantages, providing excellent soft-tissue contrast and multidimensional functional, structural and morphological information. The next frontier is to develop efficient detectors and electronics systems capable of detecting two modality signals at the same time. Not only PET-MR but also MR-US or optic-PET will be introduced in clinical scenarios. Even more, MR diffusion-weighted, pharmacokinetic imaging, spectroscopy or functional BOLD imaging will merge with PET tracers to further increase molecular imaging as a relevant medical discipline. Multimodality imaging techniques will play a leading role in relevant clinical applications. The development of new diagnostic imaging research areas, mainly in the field of oncology, cardiology and neuropsychiatry, will impact the way medicine is performed today. Both clinical and experimental multimodality studies, in humans and animals, will have to demonstrate an efficient use of the imaging information provided by the modalities to affect the future of medical imaging.

Extension of the NCAT phantom for the investigation of intra-fraction respiratory motion in IMRT using 4D Monte Carlo

The purpose of this work was to create a computational platform for studying motion in intensity modulated radiotherapy (IMRT). Specifically, the non-uniform rational B-spline (NURB) cardiac and torso (NCAT) phantom was modified for use in a four-dimensional Monte Carlo (4D-MC) simulation system to investigate the effect of respiratory-induced intra-fraction organ motion on IMRT dose distributions as a function of diaphragm motion, lesion size and lung density. Treatment plans for four clinical scenarios were designed: diaphragm peak-to-peak amplitude of 1 cm and 3 cm, and two lesion sizes—2 cm and 4 cm diameter placed in the lower lobe of the right lung. Lung density was changed for each phase using a conservation of mass calculation. Further, a new heterogeneous lung model was implemented and tested. Each lesion had an internal target volume (ITV) subsequently expanded by 15 mm isotropically to give the planning target volume (PTV). The PTV was prescribed to receive 72 Gy in 40 fractions. The MLC leaf sequence defined by the planning system for each patient was exported and used as input into the MC system. MC simulations using the dose planning method (DPM) code together with deformable image registration based on the NCAT deformation field were used to find a composite dose distribution for each phantom. These composite distributions were subsequently analyzed using information from the dose volume histograms (DVH). Lesion motion amplitude has the largest effect on the dose distribution. Tumor size was found to have a smaller effect and can be mitigated by ensuring the planning constraints are optimized for the tumor size. The use of a dynamic or heterogeneous lung density model over a respiratory cycle does not appear to be an important factor with a ≤ 0.6% change in the mean dose received by the ITV, PTV and right lung. The heterogeneous model increases the realism of the NCAT phantom and may provide more accurate simulations in radiation therapy investigations that use the phantom. This work further evaluates the NCAT phantom for use as a tool in radiation therapy research in addition to its extensive use in diagnostic imaging and nuclear medicine research. Our results indicate that the NCAT phantom, combined with 4D-MC simulations, is a useful tool in radiation therapy investigations and may allow the study of relative effects in many clinically relevant situations.

Neuroanatomy of the calf brain as revealed by high‐resolution magnetic resonance imaging

Here, we want to assess the benefit of high-resolution and high-contrast magnetic resonance imaging (MRI) for detailed documentation of internal brain morphology in formalin-fixed whole head specimens of the full-term calf brain (Bos taurus). Imaging was performed on a Siemens 1.5 T scanner. Optimum contrast was achieved using a 3D sequence with a flip angle of 30 degrees , repetition time (TR) of 20 ms, echo time (TE) of 6.8 ms, and an interpolated matrix of 1024 x 1024. In plane resolution was 0.25 mm. Computer-generated three-dimensional images were reconstructed from the original scans in the coronal plane. This study shows that MRI is capable to identify delicate structures in immature brain specimens. The use of MRI in comparative morphology facilitates the examination of series of brains or brain samples in a reasonable time. The comprehensive description of species- and group-specific brain features in MRI scans of Bos taurus will complement existing data for diagnostic imaging and neuromorphological research, in general, as well as for phylogenetic reconstructions.

What, why, and when we image: considerations for diagnostic imaging and clinical research in the Children's Oncology Group.

Success in improving treatment outcomes in childhood cancer has been achieved almost exclusively through multicenter and multidisciplinary clinical and applied research over several decades. While biologically rational as well as empirical approaches have led to combination chemotherapy and multimodality approaches to therapy, which have given rise to evidence-based practice standards, similar scientific rigor has not always been as evidently applied to modalities utilized to assess initial disease burden and, more important, response to investigational approaches to therapy. As the empirical approach to therapeutic advances has likely maximized its benefit, future progress will require translation of biologic discovery most notably from the areas of genomics and proteomics. Hence, attempts to improve efficacy of therapy will require a parallel effort to minimize collateral damage of future therapeutic approaches, and such a parallel approach will mandate the continued dependence on advances in diagnostic imaging for improvements in staging methodologies to best define risk groups for risk-adjusted therapy. In addition, anatomic and functional assessment of response and surveillance for disease recurrence will require improved understanding of the biology as well as natural history of individual diseases, which one hopes will better inform investigators in designing trials. Clinical and research expertise is urgently needed in the selection of specific imaging studies and frequencies that best assess a response as well as to define disease-free intervals. Despite limited resources to develop sufficient infrastructure, emphasis on enabling early assessment of new technology to minimize risks associated with treatment advances and with those critical diagnostic and staging procedures must continue to be a focus of pediatric cancer clinical research.

White paper of the European Society of Radiology (ESR) and the European Association of Nuclear Medicine (EANM) on multimodality imaging

New multimodality imaging systems bring together anatomical and molecular information and require the competency and accreditation of individuals from both radiology and nuclear medicine. This paper sets out the positions and aspirations of the European Society of Radiology (ESR) and the European Association of Nuclear Medicine (EANM) working together on an equal and constructive basis for the future benefit of both specialties. ESR and EANM recognise the importance of coordinating working practices for multimodality imaging systems and that undertaking the radiology and nuclear medicine components of imaging with hybrid systems requires different skills. It is important to provide adequate and appropriate training in the two disciplines in order to offer a proper service to the patient using hybrid systems. Training models are proposed with the overall objective of providing opportunities for acquisition of special competency certification in multimodality imaging. Both organisations plan to develop common procedural guidelines and recognise the importance of coordinating the purchasing and management of hybrid systems to maximise the benefits to both specialties and to ensure appropriate reimbursement of these examinations. European multimodality imaging research is operating in a highly competitive environment. The coming years will decide whether European research in this area manages to defend its leading position or whether it falls behind research in other leading economies. Since research teams in the member states are not always sufficiently interconnected, more European input is necessary to create interdisciplinary bridges between research institutions in Europe and to stimulate excellence. ESR and EANM will work with the European Institute for Biomedical Imaging Research (EIBIR) to develop further research opportunities across Europe. European Union grant-funding bodies should allocate funds to joint research initiatives that encompass clinical research in diagnostic imaging in conjunction with research in mechanical and electronic engineering, informatics and biostatistics, and epidemiology.

White paper of the European Association of Nuclear Medicine (EANM) and the European Society of Radiology (ESR) on multimodality imaging

New multimodality imaging systems bring together anatomical and molecular information and require the competency and accreditation of individuals from both nuclear medicine and radiology. This paper sets out the positions and aspirations of the European Association of Nuclear Medicine (EANM) and the European Society of Radiology (ESR) working together on an equal and constructive basis for the future benefit of both specialties. EANM and ESR recognise the importance of coordinating working practices for multimodality imaging systems and that undertaking the nuclear medicine and radiology components of imaging with hybrid systems requires different skills. It is important to provide adequate and appropriate training in the two disciplines in order to offer a proper service to the patient using hybrid systems. Training models are proposed with the overall objective of providing opportunities for acquisition of special competency certification in multimodality imaging. Both organisations plan to develop common procedural guidelines and recognise the importance of coordinating the purchasing and management of hybrid systems to maximise the benefits to both specialties and to ensure appropriate reimbursement of these examinations. European multimodality imaging research is operating in a highly competitive environment. The coming years will decide whether European research in this area manages to defend its leading position or whether it falls behind research in other leading economies. Since research teams in the Member States are not always sufficiently interconnected, more European input is necessary to create interdisciplinary bridges between research institutions in Europe and to stimulate excellence. EANM and ESR will work with the European Institute for Biomedical Imaging Research (EIBIR) to develop further research opportunities across Europe. European Union grant-funding bodies should allocate funds to joint research initiatives that encompass clinical research in diagnostic imaging in conjunction with research in mechanical and electronic engineering, informatics and biostatistics, and epidemiology.