Interview with ASNC member Dr. Yaming Li – President, Chinese Society of Nuclear Medicine

This article is an interview with Dr. Yaming Li, President of the Chinese Society of Nuclear Medicine (CSNM).  Dr. Li talks about the foundation and growth of nuclear cardiology in China.  He also discusses the current needs of physicians who practice nuclear medicine and how ASNC and the CSNM can work to together to educate and promote the advances in nuclear cardiology. 
1. Why did you decide to be a nuclear cardiologist?
It is well known that nuclear cardiology is an important part of nuclear medicine.  Nuclear medicine physicians can help cardiologists or surgeons make the right therapeutic decisions for patients with suspected or defined CAD.  This is irreplaceable in the role of the diagnosis, risk and prognosis evaluation of CAD. As a chronic disease, CAD has a high morbidity in developed and developing countries, especially in China. So, the correct evaluation, diagnoses and choosing the appropriate therapeutic method for CAD are very important for doctors and patients, these are the key things for patient outcomes and saving medical resources. Frankly, it is an honor to be a nuclear cardiologist.
Dr. Li, CSNM Pres.

2. What are the needs of the physicians practicing nuclear cardiology in China?
How to perform standardized nuclear cardiology procedures is an urgent undertaking for the growth of nuclear cardiology in China.  Nuclear cardiology protocols, such as exercise or pharmaceutical stress, blood glucose modulation before FDG PET imaging, optimal acquisition standards to avoid artifacts and proper handling methods are critical. It is also very important for ASNC to help China set-up a standardized database on nuclear cardiology, this database would have information on stress and/or rest myocardial perfusion imaging (MPI).  As we all know, there are many differences in the size of the heart, body and injection doses of imaging agents for MPI between Easterners and Westerners.  How to properly use some quantitative cardiac software, such as Cedars-Sinai QGS, QPS, EC Toolbox, is important for both nuclear medicine physicians and technicians. For nuclear medicine physicians, how to properly explain the results of MPIs and FDG myocardial metabolic imaging is very important and needs to be further improved.  This is an important part in how to delineate the manifestations of imaging and conclude with proper diagnoses or impressions. 

3. What changes have you seen in nuclear cardiology since you began your practice?
I started my nuclear medicine career in the second affiliated hospital of China Medical University in 1996.  The practice of nuclear cardiology at that time consisted of multi-gated equilibrium imaging, rest myocardial perfusion imaging and nitroglycerin enhanced MPI in the clinic of our hospital from 1996 to 1998.  Stress MPIs were occasionally performed, though not widely available. From the beginning of 1999, the number of gated blood pool equilibrium scans decreased dramatically as ultrasound technology developed quickly and became widely accepted. Now, few multi-gated equilibrium imaging are performed in China. In general, Chinese nuclear cardiology is developing very slowly, except at a few specialized hospitals, such as Beijing Fuwai Hospital. With rapid developments of coronary angiography (CAG) and PCI in China after 2002, cardiologists prefer to select CAG as a first line tool to diagnosis CAD. MPI is regarded as an alternative method when patients have contraindications or do not accept the invasive method. In addition, with large numbers of installations of 64-row high-speed CT and this method being accepted by cardiologists in China, the number of coronary CT angiography has increased quickly. On the contrary, the number of nuclear cardiology examinations has changed little with even less than in the past. The latest statistics in 2012 by CSNM is that the total number of nuclear cardiology examinations is only about 100,000, while the Chinese population is more than 1.3 billion. Whole body bone imaging and dynamic renal imaging are the mainstream for general nuclear medicine in China. In recent years, radionuclide therapy and PET/CT imaging have developed quickly, which is saving Chinese nuclear medicine. Unfortunately, nuclear cardiology is not developing satisfactorily and there is even some regression. Nuclear cardiology in the USA and Europe flourished especially in the period from 2005 to 2012. The big gap between the practice of nuclear cardiology in China and America is of concern to us. Of course, the growth and advances of nuclear cardiology in developing countries gives us inspiration for the future of nuclear cardiology in China.

4. What role do you see for ASNC in promoting nuclear cardiology in China?
The role of ASNC in promoting Chinese nuclear cardiology is very important and irreplaceable. First, American medical standards represent the most advanced level in the world and nuclear cardiology in America has a long history and developed very fast and extensively.  Additionally, nuclear cardiology is widely accepted and receives much attention by clinicians in the USA. Now Chinese medical services are in an era of complexity. Because of the limitations of healthcare and training systems, there is lack of effective communication and trust between clinical departments and imaging departments and sometimes there exists financial conflicts between them. In fact, nuclear cardiology plays an important role in diagnosing, risk evaluation and prognosis for CAD. Nuclear cardiology in China is still in the early stages of struggling to survive and it is developing very slowly. Moreover, cardiologists and cardiac surgeons in China have a smaller role in nuclear cardiology but they are interested in and want to learn an anatomic method to better understand CAD, such as CAG or CCTA. ASNC plays an important role in establishing guidelines on the diagnosis and treatment of CAD and is an authority in the US and worldwide.  The Chinese Society of Nuclear Medicine believes that ASNC will play a great role in expanding nuclear cardiology in China. ASNC's assistance in providing continuing education on nuclear cardiology for Chinese cardiologists and cardiac surgeons will be an effective way to improve the current situation of nuclear cardiology and promote the diagnostic level for CAD using noninvasive methods.
5. How do you see the CSNM and ASNC working together?
The cooperation between CSNM and ASNC will certainly promote faster development of nuclear cardiology in China. Chinese nuclear cardiology is developing slowly compared with the rapid rise of CAD morbidity.  Nuclear cardiology in China does not play a large role in CAD diagnosis and treatment. Cardiologists rely too much on invasive CAG and PCI to evaluate and treat CAD effectively, resulting in over-diagnosis and over-treatment using invasive methods, and also wasting a great deal of public health resources. The high-level of cooperation between CSNM and ASNC, especially in providing extensive information on nuclear cardiology from America to China, will be a successful way to promote its developments.  The key factor is how to make the role of nuclear cardiology widely accepted by the cardiovascular associations, sub-specialty societies and clinicians. At the same time, it is very important for ASNC to help Chinese nuclear physicians and technicians set-up high quality nuclear cardiology laboratories and standardize practices for nuclear cardiology, which is irreplaceable by this form of cooperation.