Nuclear medicine in China has experienced a significant evolution in both research and clinical applications (1). The field was inaugurated in 1956 with the first isotope use training course in Xi’an, Shaanxi Province, marking the advent of nuclear medicine in the country, and since then, nuclear medicine has begun its integration into clinical practice, serving patients across the nation. However, the subsequent two decades presented challenges due to several devastating events, impacting both researchers and the general population, until the 1980s brought a pivotal shift in China’s reform and opening-up policies. During this period, the Chinese Society of Nuclear Medicine, a branch of the Chinese Medical Association, was established in 1980, and the Chinese Journal of Nuclear Medicine was launched in 1981 (2). These developments signified the resurgence of nuclear medicine in China, setting it on a path of slow yet steady progress.
The advancement of nuclear medicine and molecular imaging in China has been characterized by significant technologic milestones and strategic initiatives (2). The installation of the first SPECT system in 1983 marked the beginning of this era. This was followed by the introduction of the first PET system and medical cyclotron in 1995, the first small-animal PET system in 2000, and the first PET/CT system in 2002. The period from 2000 to 2010 was characterized by learning, accumulation, and significant investment, laying the groundwork for rapid expansion in the subsequent decade. This fast-track phase was highlighted by the installation of the first PET/MRI system in 2012, the launch of the “one nuclear medicine department per county” initiative in 2016, which aimed at improving access to nuclear medicine services nationwide, and the introduction of the first total-body PET/CT system in 2019 (3).
As of now, the National Medical Products Administration in China has approved over 40 radiopharmaceuticals for commercial use (4), which include 18F, 99mTc, 131I, 125I, 153Sm, and 32P. Among these, 23 are 99mTc-labeled radiopharmaceuticals along with their associated kits, one is 18F-FDG, and 9 are therapeutic radiopharmaceuticals such as [131I]NaI oral solution (or capsules), 89SrCl2 injection, and 125I brachytherapy sources (in contrast to other countries, 125I brachytherapy sources are categorized as radiopharmaceuticals by regulatory standards in China). In a significant effort to move the field forward, in June 2021, 8 state departments, including the China Atomic Energy Authority, the Ministry of Science and Technology, and the National Medical Products Administration, jointly issued a mid- and long-term development plan (2021–2035) for medical isotopes (5). This strategic plan outlines key tasks for the development of medical isotope–related industries, particularly radiopharmaceuticals. It aims to advance the research and development of novel radiopharmaceuticals, enhance self-reliance in the production and supply of medical isotopes, and promote their clinical applications. The plan stands as a cornerstone, offering a strategic road map to propel the radiopharmaceutical industry’s advancement in China.
In the last 10 years, remarkable advancements in nuclear medicine have been made in China. The Chinese Society of Nuclear Medicine plays a pivotal role in charting this progress through a biennial national survey (6). However, the 2022 iteration was unfortunately not conducted because of the coronavirus disease 2019 pandemic, a decision reflecting the challenges faced globally during this period. The most recent data, meticulously presented by Yang et al. in this supplement issue to The Journal of Nuclear Medicine (JNM) (7), shows there are over 1,000 departments of nuclear medicine, over 400 PET/CT systems, more than 20 PET/MRI systems, more than 300 SPECT systems, approximately 500 SPECT/CT systems, 16 total-body PET systems, and over 120 cyclotrons in China. This infrastructure supports nearly 1 million annual PET/CT scans, over 14,000 annual PET/MRI scans, and more than 2.5 million annual SPECT scans, engaging a workforce of 12,000 nuclear medicine professionals (Fig. 1 of Yang et al. (7)). With such a vast workforce, state-of-the-art preclinical and clinical equipment, and increased funding from various sources for nuclear medicine and molecular imaging research, we are witnessing the golden era of nuclear medicine and molecular imaging. It is occurring not only in China but also around the world. We eagerly anticipate the exciting developments yet to come in this dynamic field, confident that the future will be bright.
The JNM—self-published by the Society of Nuclear Medicine and Molecular Imaging—is the top journal for the nuclear medicine and molecular imaging community. JNM offers readers around the globe clinical and basic science investigations, continuing education articles, state-of-the-art reviews, and updates on rapidly changing issues in practice and research. On March 31, 2024, we conducted a PubMed search of “J Nucl Med” [jour] AND “China” [affiliation], and the results over the last 20 years are shown in Figure 1. In the first decade of the 21st century, the number of publications with Chinese affiliations was quite low, typically ranging from 5 to 7 per year. The first 6 years of the second decade witnessed a significant increase in the number of publications in JNM, reaching 5.6% in 2016 (23/408 publications). Starting in 2018, the numbers have increased steadily each year, reaching 6.8% in 2022 (27 of a total of 397 JNM publications).
Number of publications in JNM, number of JNM publications with Chinese affiliation, and percentage over last 20 years. Data are from on PubMed search on March 31, 2024. Steady increase is seen in JNM publications with Chinese affiliations over time, especially during last 5 years.
The past 5 years have represented a rare opportunity for the development of this JNM special issue—a time during which publications with Chinese affiliations have increased significantly. Invited by JNM Editor-in-Chief Johannes Czernin, along with Ken Herrmann and Wolfgang Weber, senior authors from China’s leading institutes and hospitals actively contributed manuscripts, all of which underwent a thorough peer-review process involving at least 2–3 reviewers per submission. Ten articles are featured in this supplement issue, comprising 8 review articles, 1 editorial, and 1 research article.
Beyond the original goal of highlighting the current status of nuclear medicine in China and its implications for the field’s future development, this special issue also seeks to capture the diversity of nuclear medicine and molecular imaging research within the country. This field intersects various scientific and technologic disciplines, ensuring a rich representation of current hot topics, including total-body PET (8–10), fibroblast activation protein inhibitors (11), nectin-4 (12), melanin-targeting radiotracers (13), and other innovative radiotracers (14), along with discussions on their approval pathways in China (15).
Radiopharmaceuticals play a critical role in nuclear medicine, providing novel tools for specifically delivering radioisotopes for the diagnosis and treatment of various cancers. As the starting point for development of radiopharmaceuticals, cancer-specific biomarkers are important and receive worldwide attention. This field in China is currently experiencing a rapid expansion; multiple radiotracers targeting novel targets are being developed and translated into clinical studies. In this supplement, Zhang et al. (14) provides a brief overview of the exploration of novel imaging targets, preclinical evaluation of their targeting ligands, and translational research in China from 2020 to 2023 for detecting cancer, guiding targeted therapy, and visualizing the immune microenvironment.
Among the novel imaging agents, radiolabeled fibroblast activation protein inhibitors and melanin-targeting radiotracers have recently emerged as a focal point in global nuclear medicine, underscored by their promising applications in cancer theranostics. In this supplement, Zhao et al. (11) and Zhang et al. (13) offer an in-depth summary of the existing literature on the evolution and use of fibroblast activation protein inhibitors and melanin-targeting tracers in China, tracing their preclinical, translational, and clinical status and presenting perspectives for broadening their applications. Some promising findings for fibroblast activation protein inhibitor radioligand therapy in China have also been reported in this supplement (Fig. 4 from Zhao et al. (11)). Overall, Chinese nuclear medicine experts are poised to collaborate with international peers, ushering in a groundbreaking phase in the convergence of radionuclide-based cancer diagnosis and therapy. We expect that through unremitting and collaborative efforts, these novel radiopharmaceuticals will play a crucial role in improving and enhancing the quality of human life and health care worldwide.
Nectin cell adhesion molecule 4 (nectin-4) is another key molecular target that is overexpressed on a variety of cancers and plays an important role in oncogenic and metastatic processes. The nectin-4–targeted antibody–drug conjugate enfortumab vedotin has been approved for treating locally advanced or metastatic urothelial cancer. Zhang et al. evaluated the feasibility of nectin-4–targeted PET imaging with 68Ga-N188 as a noninvasive method to quantify membranous nectin-4 expression in multiple tumor types (12), which provided an approach that may provide insight for patient stratification and treatment selection.
Although preclinical development and clinical translation of radiopharmaceuticals are undergoing rapid evolution in China, the radiopharmaceutical industry in China is still in a developing stage, with gaps remaining in several aspects compared with developed countries. In this issue, An et al. provide an overview of the process for acquiring National Medical Products Administration approval for an innovative radiopharmaceutical in China and discuss the current status of research and development of radiopharmaceuticals in China (15). We believe the development and use of radiopharmaceuticals in China will contribute to the growth of nuclear medicine worldwide and improve the management of human diseases in the era of precision medicine.
In addition to the development of novel radiopharmaceuticals, another paradigm shift in PET imaging in China is the development of total-body PET technologies. The introduction of total-body PET/CT technology, particularly the 2-m-long uEXPLORER system (United Imaging Healthcare), represents a quantum leap in PET/CT imaging capabilities. Offering unparalleled sensitivity and comprehensive body coverage, this technology has redefined diagnostic accuracy and patient care. In this supplement, 3 leading institutes in China, including Peking University Cancer Hospital (8), Sun Yat-Sen University Cancer Center (9), and Henan Provincial People’s Hospital, Zhengzhou University (10), share their unique clinical experience and insights on total-body PET in their clinical practice, including disease distribution, patient selection workflow, scanning protocol, and several enhanced clinical applications, along with challenges encountered in routine clinical practice. The 3 articles delve into the bottleneck that impedes the full use of total-body PET in China, accompanied by suggested solutions. Additionally, state-of-the-art total-body PET and its potential roles in pharmaceutical research are explored in these articles.
With the rapid development and extraordinary advancements of nuclear medicine in China over the past few years, the findings reported by the Chinese clinical and research community hold high value for the global community. Beyond the high-quality studies performed at leading institutions, China’s vast population of 1.4 billion offers a unique resource for scientific and clinical investigations. This large demographic includes many patients with rare diseases, presenting numerous opportunities for future collaborations and international multicenter studies. Consequently, with the continuously increasing scientific and clinical caliber of research personnel and clinicians in China, we firmly believe that nuclear medicine studies from the Chinese community will significantly benefit the global nuclear medicine community.
Taken together, over the past 70 years, nuclear medicine in China has achieved tremendous progress, benefiting millions of patients annually. Despite this success, challenges such as shortages of radioisotope supplies and lack of radiopharmaceuticals remain (16). However, the future potential of nuclear medicine in China is enormous. There are more than 3,000 tertiary hospitals, yet only a third of them currently provide nuclear medicine services. The implementation of the mid- and long-term development plan (2021–2035) for medical isotopes is set to significantly promote the clinical application of radiopharmaceuticals and advance the research and development of new radiopharmaceuticals. By 2035, we anticipate overcoming the current shortages, with independent innovation in radiopharmaceuticals flourishing and more advanced, high-quality equipment being produced domestically. The scale of nuclear medicine is expected to increase 3–4 times from today, serving over 10 million patients annually in China. Through continuous efforts, nuclear medicine is poised to play a pivotal role in improving and enhancing the quality of life and health care for the Chinese population.
In summary, this JNM supplement offers a timely overview of the current status of nuclear medicine in China, detailing significant advances in research and development, as well as the clinical translation of novel radiopharmaceuticals. It aims to inform and inspire future international collaborations and multicenter studies, underscoring our belief that this special issue will significantly boost JNM’s global impact over time. As the guest editors of this special issue, we sincerely hope you find enjoyment and value in reading this supplement, discovering information that benefits both your research activities and your daily clinical practice. We are confident that through shared knowledge and collective effort, nuclear medicine in China will play an increasingly vital role in global health care, improving the quality of life and treatment outcomes for patients around the world.
DISCLOSURE
This work is supported by the National Natural Science Foundation of China (82071961). Weibo Cai declares a conflict of interest with the following corporations: Actithera, Inc., Rad Source Technologies, Inc., Portrai, Inc., rTR Technovation Corp., and Four Health Global Pharmaceuticals Inc. No other potential conflict of interest relevant to this article was reported.
- © 2024 by the Society of Nuclear Medicine and Molecular Imaging.
REFERENCES
- Received for publication April 9, 2024.
- Accepted for publication April 9, 2024.
