SNiPs:

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[Colin Miller]

Hello, you're tuned into SNiPs, a reoccurring special segment from our ongoing series, Fractals: Life Science Conversations. Bracken is the professional services firm for life sciences and digital health organizations. Our intelligence ecosystem fulfils consulting, regulatory, marketing and analytics, an integrated and strategic approach.

So, looking ahead, you know, what technologies, developments or even practices will have the most profound impact on life sciences over the next decade? And do you think those will come from nuclear medicine or elsewhere?

[Sandy McEwan]

Well, they're not going to come from nuclear medicine alone, certainly. I think in nuclear medicine, the most important things we need to understand now are the radiobiology of the radiation we're delivering. I think there are nuances and subtleties to it that we don't yet get.

I think we need to understand the relevance, the importance of dosimetry. I think there's no doubt that the dosimetric paradigm we have been applying is that of external beam. And I think as external beam is beginning to look at different fractionation schedules, hypofractionation, we're going to need to understand what learnings we can take from that to biology.

There are some fascinating insights into low dose rate radiobiology that I think can be applied. But if you look broadly, I think clearly the important elements are going to be understanding how to use the genome and the epigenome to broaden our treatment options. How to use AI to maximize individual patient benefit on the basis of large datasets.

I think it will be interesting to see how the pharma industry grapples with the question of the use of AI in looking at clinical trials, either clinical trial design or clinical trial analysis. I think AI, we have only scratched the surface of AI in imaging. I think it has great power in looking at the image, not as a picture, but as a dataset.

I think we also have not talked about the most important element of AI. There's an old saw that the way healthcare is organized at the moment is like putting an ambulance at the bottom of a cliff and picking people up after they've fallen off the cliff. We've got to understand how to put barriers at the top to stop them falling off the cliff.

That in itself will be a massive undertaking, but a huge component of improving population health. So, for a very simple question, the answer could be discussed for days.

[Colin Miller]

I know you've got some sense around that. It's been very much up until, or at least in the early stages, it's just dose as high as we can. But I appreciate you've had some further insights into that and been involved in evaluating that.

I wonder if you'd like to give some more considerations there.

[Sandy McEwan]

Yeah, I think it's fascinating the way we've developed the doses that we have. Again, largely to start with the external beam paradigm that you need to get as big a dose into the tumor as you can while sparing normal tissue. And that really has been a paradigm for fractionated chemotherapy.

It's been the paradigm for how we modulate the dose of isotope therapies. For example, looking at the external beam maximum toxic dose to the kidney or the bone marrow as a limiting factor. If you take out some of the difficulties we have in measuring those accurately, although we can measure them with certainly more precision than 15 years ago, 10 years ago even, there are still some elements of uncertainty in it.

To the fractionation schedules, three months, 10 weeks, eight weeks is arbitrary, relatively arbitrary. Based partly on the half-life of iodine being eight weeks and therefore you would want any nadir of hematological toxicity to disappear. If you apply that, we've probably reached maximum dose.

I'm not sure that we shouldn't start looking at where the chemotherapists are going now, which is to look at biologically effective doses given more frequently. I would argue that perhaps it is better to give multiple doses more frequently but smaller than larger doses less frequently. I think we have again only begun to scratch the surface of the biological impact on it.

[Colin Miller]

Fractals is brought to you by Bracken, the professional services firm for life science and digital health organizations. 

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I'm Colin Miller, wishing you sound business and good health. Thanks for listening.