Quantitative PET as a Catalyst for Precision Oncology

Quantitative PET has evolved from a “lesion-finder” into a whole-body measurement tool that can serve as a cornerstone fo precision oncology. In this Lowenthal Lecture, I will outline how three converging advances are turning PET into a catalyst for personalised cancer care: (i) next-generation total-body PET systems that enable ultra-sensitive, dynamic whole-body imaging and scalable population workflows; (ii) organ-function PET using Gallium-68 tracers – including Ga-68 ventilation/perfusion (V/Q) imaging for regional lung function mapping and treatment planning, and Ga-68 EDTA renal PET/CT to quantify glomerular filtration; and (iii) robust whole-body tumour quantification that transforms PSMA and FDG PET/CT from qualitative interpretation to reproducible metrics as predictive and prognostic biomarkers.

Using prostate cancer as a central exemplar, I will discuss how quantitative PSMA PET/CT can measure total tumour burden and phenotypic heterogeneity, and how paired FDG PET/CT can identify biologically aggressive or “discordant” disease – informing patient selection and expectations for targeted radioligand therapy and systemic treatments. I will also highlight emerging automation (AI-assisted segmentation and workflow) for rapid, standardised whole-body tumour burden reporting, and connect these concepts to dosimetry-driven theranostics where whole-tumour measures link imaging, absorbed dose, and outcomes.

 The development and evolution of a mature nuclear medicine service in a regional metropolitan hospital

 The lecture will, in a sense chronicle a relatively personal journey detailing the development and evolution of a Nuclear Medicine Service in a large regional centre from a rudimentary service into a highly respected and prominent imaging modality within the Illawarra Shoalhaven Local health district and surrounding communities in the south coast of NSW.

The talk will cover the development of a Nuclear Medicine service in the Wollongong region and the NSW south coast, with some interesting anecdotes and experiences that were instrumental in driving the development of a well-regarded department of Nuclear Medicine for advanced training.

In parallel with the development of this service for this large community, I will outline some of the interesting innovations and technical issues that we, as a group dealt with during this evolution.

These achievements also influenced him to participate actively in the state and national Nuclear Medicine Communities, and particularly his involvement with the, what was then the ANZAPAM and serving on the executive and being president for a 2-year period from 2000 to 2002. Some of the experiences at this time will provide some insights into the national nuclear medicine community at that time. In addition to this commitment there was also participation in national conferences.

Furthermore, he has also had an active involvement in teaching and developing a more state based process for training registrars in the early part of his own training and as a young consultant.

Overall, an interesting journey with what he believes is an excellent outcome for what was a regional centre and developed into a level 6 metropolitan hospital with all the appropriate services, and in particular nuclear medicine.