The Highlights Lectures, 1981–2009

H.N. Wagner, Jr.

Reston, VA: Society of Nuclear Medicine and Molecular Imaging, 2015, 344 pages, $99.00

For many years, the late Dr. Henry Wagner would review the posters, abstracts, and other research presented at each annual meeting of the Society of Nuclear Medicine and Molecular Imaging and conclude the meeting with a lecture on its highlights. This book, The Highlights Lectures, 1981–2009, is a compilation of Highlights Lectures reprinted from the “Newsline” section of The Journal of Nuclear Medicine.

Instead of being arranged into traditional chapters according to content or theme, the individual Highlights Lectures are listed separately in chronological order, with the table of contents indicating the page number for each lecture.

Dr. Wagner had a wonderful way of presenting information that is clear, convincing, and a joy to read. Written or presented information is good only if people are willing to read or listen to it. Dr. Wagner took great care not only to point people in the direction of useful procedures for a specific patient outcome but also to address any procedures that were not living up to expectations and needed to be replaced by others. This honest perspective by Dr. Wagner assures readers that he would not recommend a procedure, nuclear medicine–related or otherwise, if he did not believe it to be in the best interest of the patient.

Starting with the first lecture, in 1981, Dr. Wagner made an impact by bringing several thoughts to mind, such as the ideas that research is not lost even if it may not be useful for the specific purpose intended, that a long time may be involved for a concept to become a useful procedure, and that a large number of people and a great amount of teamwork are needed to develop concepts into useful procedures.

One example of an early concept that became useful in a variety of ways is the work of Heinrich Schelbert and colleagues at UCLA on glucose metabolism and coronary artery disease. The idea that this research might be useful for PET imaging was mentioned in the Highlights Lecture of 1981. As we read through the subsequent lectures, we see how this information on glucose utilization becomes incorporated into other areas. For example, the 1993 Highlights Lecture, “Oncology: A New Engine for SPECT/PET,” shows glucose utilization being discussed in terms of brain imaging for neuronal activity and in terms of oncologic applications. As the lectures continue through the years, the increasing uses of ¹⁸F-FDG, the relationship between glucose utilization and differentiation of benign from malignant tumors, and the efficacy of treatment for a wide variety of cancers are important themes.

The 1981 lecture also referred to the work of Ronald Jaszczak on improving camera systems and on performing studies using phantoms. The importance of technologic advances, along with advances in radiopharmaceuticals and education, was also stressed. In the 1986 Highlights Lecture, Dr. Wagner stated:It behooves nuclear physicians who plan to be seriously involved in nuclear cardiology to spend the time and effort required to keep up with the important technical advances being made—including the new tracers such as isonitriles, SPECT, automated data processing, and a systematic approach to data handling.

On many occasions, Dr. Wagner commented on important technologic advances, such as advances in radiopharmaceuticals, computer technology, PACS, and the Internet. He also noted how necessary these components are to advancing the fields of nuclear medicine technology and molecular imaging and, most importantly, to improving diagnostic and prognostic methods for patients, and he made predictions about the future of some of the procedures presented.

Throughout the lectures, Dr. Wagner focused on the issues of reimbursement, cost effectiveness of imaging procedures, and what is in the best interest of the patient. The theme of cost containment and reimbursement was introduced in the 1983 Highlights Lecture, in which he stated that “Increased attention to cost-containment is revealing that real savings result from better treatment, rather than from decreasing diagnostic studies.” Some cost containment methods that he mentioned were the use of myocardial perfusion scans for early diagnosis to reduce the number of heart attacks, prognostic uses such as to reveal evidence of distal metastases and thus whether surgery would actually benefit the patient or be unsuccessful, and use of sentinel node imaging and intraoperative probes to help pinpoint the sentinel node and reduce the need for complete lymph node dissection. In the 1997 Highlights Lecture, Dr. Wagner noted that in a study by Valk et al., from Sacramento, California, a savings of $1,800 per patient was calculated. “The finding of distant metastatic disease by whole-body FDG-PET imaging resulted in the cancellation of six lung resections, four lymph node dissections, two liver resections, one laparotomy and one pelvic exenteration.” As Dr. Wagner noted the many examples of cost reduction that would be achieved if diagnostic testing were to prevent surgery, he also noted the fact that these costs were for only the actual surgery, not for possible adverse events from the surgery, and that if these were factored in as well, the cost savings could be much higher.

When a certain diagnostic test was being touted as the best, Dr. Wagner frequently pointed out that the test might be best for certain situations but not others, or that multiple tests should be used, or that there now was a test that would provide better patient results. Dr. Wagner always stressed trying to achieve 100% accuracy with diagnostic tests. He at times advocated for blood tests, CT scans, MRI scans, or SPECT scans. His theme was always that we should not be looking at these as competing modalities but that all modalities were useful and often should be combined. Dr. Wagner supported the use of hybrid imaging, chemistry, genetics, and molecular imaging and had a way of explaining how everything works together.

The later lectures reflect the growth of technology, describing advances in molecular imaging such as somatostatin receptor imaging, new agents to study Parkinson disease, cadmium telluride detectors, and solid-state detectors. It is only fitting that Dr. Wagner should title his final lecture “Creating a New, Smarter Health Care,” as this was his focus throughout the entire lecture series.

These lectures were not intended and should not be used as a protocol or procedure for current practice. The last lecture was presented back in 2009, and in reading this book I find it clear that Dr. Wagner would intend for anyone involved in the field of nuclear medicine or molecular imaging to be constantly and consistently updating their knowledge to reflect the best current practices.

This book will be of interest to physicians, technologists, researchers, authors, residents, and students who wish to learn more about the history of nuclear medicine; the background behind some of the studies currently being performed; and possible future directions for the profession.