The future of cancer imaging

Conventional (anatomical, structural) imaging is insensitive to the presence of cancer, often failing to yield the very information needed for accurate diagnosis and staging, for proper treatment selection and monitoring or for effective follow-up after treatment. This, fortunately, is changing. Newer techniques, already in clinical testing, are rapidly pushing clinical imaging in the same direction as the rest of medicine: away from simple detection of the gross structural end-effects of disease, and toward a patient-specific approach based on physiologic, histologic, antigenic, molecular, and (ultimately) genetic markers of disease. By 2010, unimodal, nonspecific, and insensitive radiological images may look as primitive to us as the first Roentgen radiographs. In some cases, these new scans will be so seamlessly integrated into therapeutic treatment that they may not even be thought of as imaging per se. This chapter looks forward to see how imaging for oncology may look in the coming decade, focusing upon near-term trends and techniques by selecting those already demonstrated in vivo in at least animals or which are now under human study, and thus which have moved far enough that they have already begun to impact patient care, or are likely to begin do so in the near future.