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The thrust of cancer care in the new millennium is implementing "risk adjusted, patient specific therapy': Cancer is not one disease, it is many, it presents a remarkably different clinical behavior and treatment response even in the same host. Modern cancer treatment planning is guided by two key principles: 1) the choice of therapy must be based on evidence rather than opinion or habit, and 2) the volume and extent of disease should be optimally assessed prior to treatment, in order to allow for the most effective patient-specific therapy. Imaging is emerging as an important adjunct to the clinical assessment of cancer, contributing to tumor detection, characterization, staging, treatment planning and follow-up. Diagnostic imaging is widening its scope from anatomy to adding information about metabolism and function. The general forward direction of medical imaging aims toward increasing sensitivity and specificity, while decreasing invasiveness and minimizing cost. Continuing increases in computer power have fueled the progress, followed by the rapid expansion of communication technology and by the advances in molecular biology. The revolutionary advances in molecular biology and genetics are being introduced into cross-sectional imaging offering great gains to Oncology. Novel imaging paradigms are being developed to provide non-invasive assessment of tissues at the cellular and molecular levels. Imaging modalities of the future will be increasingly biology-centered. At least three modalities are poised to participate in this revolution: magnetic resonance (MR), positron-emission tomography (PET) and optical imaging. Imaging algorithms are already evolving in response to the changes in clinical treatment approaches, scientific discoveries and technological innovations. The technologic advances that are also impacting the daily practice of oncology are PACS, teleradiology and Computer-Aided Diagnosis (CAD). PACS has empowered many leading medical centers in the United States, Western Europe and Japan (with many other countries being in transition) to become "film-less': The daily routine of "reading", flexibility in workflow, the ability to retrieve information in seconds and communicate the findings with referring physicians has dramatically changed the way we practice modern medicine. Teleradiology can provide access to sophisticated subspecialty-imaging interpretation worldwide and may help in overcoming the presently occurring shortage of radiologists in the industrialized world. ComputerAided Diagnosis will, in the future, be an important component of modern imaging and will be essential in screening. CAD when fully developed

Oncologic imaging in 2002 and beyond