Reply: Diversity, Not Divisiveness, Is the Future of Nuclear Medicine

REPLY: I greatly appreciate Dr. Noto’s comments about my editorial entitled, “The Standard of Care: from Nuclear Radiology to Nuclear Medicine” (1). The Journal of Nuclear Medicine (JNM) is a great forum for debates about our field. I respect Dr. Noto’s point of view, which many others may share.

I completely agree with the notion that diversity, not divisiveness, is the future of nuclear medicine. It is correct that I sometimes use the JNM platform to advocate for the independence of nuclear medicine toward a model closer to that in Europe (2). However, it is incorrect that I hold radiology responsible for nuclear medicine’s lack of independence. This responsibility is squarely on nuclear medicine. Rather than contributing to the squabbling between nonradiologist nuclear medicine physicians and radiologists, I am advocating for collaboration between the 2 disciplines and for models that best promote a bright academic and clinical future for nuclear medicine. At my institution, we in nuclear medicine have collaborated closely and successfully with our friends in radiology for many years, in a spirit of collegiality and to our mutual benefit.

Here are my key arguments for independence:

• The most forceful drivers of nuclear medicine decisions are nuclear medicine leaders, as they best understand the needs of the field.

• The most important decisions are investment and recruitment decisions.

• Investment and recruitment decisions affect clinical and research operations and are always biased by the preferences of the decider.

• Nuclear medicine investment decisions—from the basic sciences to clinical translation—should be singularly focused on nuclear medicine.

• Such positively biased decisions are best made by the competent leadership of independent departments.

I agree with Dr. Noto that I should concentrate on scientific advances that can move our entire community forward. Research drives our progress. That is why JNM is publishing high-level basic, translational, and clinical research every month. Advancing research is among the strongest reasons that I advocate for independent nuclear medicine programs. Independence does not rule out joint training programs, joint imaging rounds, mutual respect, or multiple collaborations. Independence boosts diversity, fosters creativity, and instills a positive sense of ownership, responsibility, and accountability. In Europe, the major academic breakthroughs and achievements of the last 20 years stem from the academic, fiscal, and operational independence of nuclear medicine departments. It is thus only natural that those who are most deeply involved and invested should be empowered to drive and lead their field independently. I say this with the greatest respect for radiologists and dual-certified experts. Establishing separate departments creates not divisiveness but diversity, as well as a leadership structure that focuses on collaborative progress in research and the clinic.

• © 2020 by the Society of Nuclear Medicine and Molecular Imaging.