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In 2019, UNC’s School of Medicine (SOM) recognized the need for a clearer understanding of the multi-disciplinary procedural and therapeutic patient care the Department’s Division of Nuclear Medicine facilitates across UNC Medical Center. In November 2019, this clinical unit was renamed the Division of Molecular Imaging and Therapeutics (Mit). The name change is aimed at more accurately describing how significant application of molecular imaging has become to nuclear medicine services at UNC and to the specialty as a whole.

Radiological care offered at UNC grew in the early 1970s when nuclear medicine services were introduced at then-named UNC Hospitals. Using radionuclides for evaluation, diagnosis, and therapeutic application, however, distinguished nuclear medicine from other imaging services. Years later, emphasis on this specialty’s use of molecular imaging better defines its present-day role within multi-disciplinary care. The cutting-edge mechanisms of the division’s imaging modalities – PET and SPECT imaging with radioactive tracers (radiopharmaceuticals) – have long overshadowed the value of molecular imaging to clinical application in cardiac, oncologic and other subspecialty patient care.

Dr. Amir Khandani, Division Chief – Molecular Imaging and Therapeutics (Mit)

Dr. Amir Khandani  Division Chief – Mit

“Our area of radiological care is among the most tightly regulated healthcare services by both federal and state rules. Nonetheless, UNC is a leading site in North Carolina and nationwide for many of our division’s clinical services. For many of our molecular imaging clinical trials, UNC Medical Center is the only host site statewide.

We offer a very broad spectrum of imaging procedures, including [2 SPECT/CT, 6 SPECT and 2 PET/CT and PET/MR cameras]. Our clinical operation covers the UNC Medical Center and Hillsborough Hospital. We perform approximately 12,000 procedures each year, including 5,000 oncology PET studies and about 1000 cardiac PET studies. We cover eight multi-disciplinary conferences where dedicated workstation PET studies are reviewed.

In just four years at UNC Medical Center, [Mit] services have added two new PET radiotracers and two new therapies to its menu of patient care therapeutics. In the next 12 months, we’re prepared to become an expanded access site for new agents for both prostate cancer PET imaging and a prostate cancer therapy, once both are FDA-approved.”

UNC prostate cancer specialist Dr. Young Whang

“For prostate cancer patient care, the availability of new molecular imaging scans like the PET scan with the F-18 fluciclovine tracer and the bone targeting radiopharmaceutical agent Radium 223 will make a big impact.  These new modalities are indispensable for the delivery of state-of-the-art treatment of patients with prostate cancer, and this line of therapeutics offered at UNC will be invaluable to our patient care.”

Dr. Stuart Gold, Pediatric Hematology/Oncology Chief and Division of Hematology and Oncology Distinguished Professor of Pediatrics

“Collaborating with the Division of [Mit] is an integral and essential part of providing cutting-edge care to our pediatric cancer patient population. We could not do what we do, we could not accomplish what we accomplish, without [this division’s] expertise.

PET findings allow oncologists to not only stage solid tumors; these same scans indicate an individual’s response to PET treatment and can guide an oncologist’s therapeutic strategies for the patient. Within one patient appointment, Mit expertise provides timely interpretation for a provider to communicate PET findings to a pediatric patient’s awaiting family shortly after their child has been scanned.

For neuroblastoma, a tumor of the sympathetic nervous system, imaging with MIBG (a radiolabeled analog of the adrenergic neurotransmitter norepinephrine) is essential at diagnosis to look at disease extent. It is also currently being used therapeutically in our upfront clinical trials.  This combination of using the same molecule with a gamma emitter for diagnosis and a beta emitter for therapy called Theranostics (therapeutics and diagnostic). As our knowledge of tumor biology increases, and Theranostics become more available, we will rely on [Mit] to help us integrate these in our clinical practice.

Dr. Deepa Kirk, Medical Director of UNC Hospitals Diabetes and Endocrinology Clinic at Meadowmont

“A strong collaboration between the Division of Molecular Imaging and Therapeutics and UNC’s Division of Endocrinology drives the high-level, personalized care we provide for our patients.  Molecular imaging is key to the diagnosis and treatment of many endocrine conditions, including hyperthyroidism, thyroid cancer, and tumors of the adrenal gland and endocrine pancreas.”

Dr. Larry Klein, Co-Medical Director of the UNC – Meadowmont Cardiology Clinic

“We are fortunate in our division of molecular imaging and therapeutics to be able to offer to our patients, state of the art cardiac imaging.  In cardiology therapeutic care, CT attenuation correction (technetium SPECT & rubidium PET) enables us to offer patients state-of-the-art cardiac imaging.  The results of PET fluorodeoxyglucose (FDG) imaging additionally allows us to guide medical therapy and treat myocardial sarcoid, as well as follow its progression and regression in patients. Similarly, high-quality PET FDG viability studies position us to assist our cardiac surgeons and coronary interventionalist in determining if revascularization is warranted.”

Leading a UNC division renamed to project its imaging and therapeutic application, Khandani is optimistic that his radiological specialty’s facilitation of multi-disciplinary care will keep growing as newly available molecular imaging applications are introduced at UNC.

“UNC Health Care is known across the Southeast as a top-tier imaging and therapeutic provider in our branch of radiological procedural care. The more molecular nature of the clinical services that nuclear medicine has traditionally offered at [UNC] follows the national trend.

Our services are defined by five attending physicians in addition to another 30+ dedicated individuals employed across the School of Medicine, Hospital and University who all make this happen. The disciplines our division supports in turn strengthen what we can and will offer in molecular imaging as new therapeutic care is introduced across UNC Medical Center.”