The radiation oncology community has hailed the creation of a National Institute of Biomedical Imaging and Bioengineering, despite concerns that the administrative cost of the new Institute will drain research dollars and undermine current studies.
The bill establishing the new institute within the National Institutes of Health was passed by a voice vote during the waning hours of the 106th Congress. The bill was buoyed by strong bipartisan support and a lobbying effort by a coalition of more than 40 professional organizations led by the American College of Radiology. President Clinton signed the bill into law Dec. 29.
"Medicine now stands at the threshold of a new and exciting revolution in how we think about disease. . . . Virtually everyone agrees that medical imaging must be a critical element in this new paradigm," Bruce J. Hillman, M.D., chancellor of the ACR, testified before the House Commerce Subcommittee on Health and Environment during September hearings.
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"The establishment of another NIH Institute would require an expensive administrative structure, for which additional resources would be required, so as not to rob existing NIH [Institutes and Centers] of their expertise and funds. . . . We have carefully considered various approaches and are convinced that at this time a new Office, rather than a new Institute with its attendant organizational layers and administrative costs, offers the best and most practical opportunity to exploit the many potentials of this critical research," she wrote.
Concerns about the cost of the new institute were also shared by members of the coalition that lobbied for passage of the bill. The American Society for Therapeutic Radiology and Oncology stipulated in a letter of support that future research conducted by the National Institute of Biomedical Imaging and Bioengineering be funded with newly appropriated funds rather than money siphoned from the existing NIH budget.
However, the final version of the bill did not include any language setting aside separate funds for the institute. It is not yet clear how NIH will pay for the imaging institute. It is likely some of the money will come from the now obsolete Office of Bioengineering, Bioimaging and Bioinformatics at NIH and from research funds from imaging studies currently sponsored by other institutes. However, some of the money to establish the new institute will have to come from the NIHs general budget.
Members of the coalition that pushed for the bill hope that the new institute will be able to enter the normal appropriations cycle as early as next year, ensuring it will no longer drain funds from the other institutes.
In her letter, Secretary Shalala also voiced the belief that imaging techniques need to be studied within the context of biological questions.
A coalition of professional organizations that opposed creation of a new institute echoed this sentiment in a letter asking President Clinton to veto the bill. "While we recognize the importance of imaging technology in achieving a number of advances in health research, such progress is contingent on preserving a strong connection between that technology and substantive research areas."
In contrast, in his testimony to Congress, University of Pennsylvania radiology professor R. Nick Bryan, M.D., Ph.D., argued that the unique nature of imaging research is an important reason for it to have its own institute. He testified that imaging research cuts across all disease categories and organ systems. Whereas the science of imaging is based in physics and mathematics, all the other institutes are focused on the biological sciences, making them ill-equipped to explore the full potential of imaging research.
Although imaging is used as a tool in all the institutes, "there is no home at the NIH for the basic research that is essential to develop new imaging techniques and technologies for the 21st century," Bryan said.
Nancy Daly, director of government relations for ASTRO, said in a telephone interview that advances in therapeutic techniques have become closely tied in with advances in imaging. An explosion in new techniques for visualizing tumors has yielded corresponding progress in the ability to more accurately target radiation therapy, she said.
Hillman said in his testimony that NIH currently studies imaging through organ-specific studies conducted at the various institutes. This has led to wasteful overlap and duplication of efforts as well as inefficient use of resources and lost opportunities.
Bryan, who served for 2 years as associate director of the Radiologic and Imaging Sciences Program at the NIHs Warren G. Magnuson Clinical Center, said that trying to promote imaging research at the NIH was a frustrating and often unrewarding exercise.
Initially, "I was skeptical about the need for a new institute. My experience, however, gradually changed my opinion and convinced me that the existing NIH organization will not work for imaging," he explained.
However, since that time, NIH has made a more concerted effort to promote imaging research. Last year, per the request of Congress, NIH established the Office of Bioengineering, Bioimaging and Bioinformatics to coordinate imaging research and assess the potential for establishing such an institute.
Beginning in 1997, the National Cancer Institute began implementing several new programs to promote research exploiting the potential of new imaging techniques for cancer.
This effort should be applauded, Hillman said, noting, however, that though these technologies are "broadly applicable to diseases other than cancer," none of the other institutes have started such a program.
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