Advances and challenges in precision imaging.

Technological innovations in genomics and related fields have facilitated large sequencing efforts, supported new biological discoveries in cancer, and spawned an era of liquid biopsy biomarkers. Despite these advances, precision oncology has practical constraints, partly related to cancer's biological diversity and spatial and temporal complexity. Advanced imaging technologies are being developed to address some of the current limitations in early detection, treatment selection and planning, drug delivery, and therapeutic response, as well as difficulties posed by drug resistance, drug toxicity, disease monitoring, and metastatic evolution. We discuss key areas of advanced imaging for improving cancer outcomes and survival. Finally, we discuss practical challenges to the broader adoption of precision imaging in the clinic and the need for a robust translational infrastructure.
Competing Interests: Declaration of interests HH serves on the board of directors for Ion Beam Applications; the external advisory board of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University; the international advisory board of the University of Vienna; the scientific committee and board of trustees of the DKFZ (German Cancer Research Center); the board of directors of iCAD; the advisory board of The Lancet Oncology; and receives stock options from iCAD. KH receives grants from Novartis and Sofie Biosciences; has consulted for Advanced Accelerator Applications, Amgen, AstraZeneca, Bain Capital, Bayer, Boston Scientific, Convergent, Curium, Debiopharm, EcoR1, Fusion, GE Healthcare, Immedica, Isotopen Technologien München, Janssen Pharmaceuticals, Merck, Molecular Partners, NVision, POINT Biopharma, Pfizer, Radiopharm Theranostics, Rhine Pharma, Siemens Healthineers, Sofie Biosciences, Telix, Theragnostics, and Y-mAbs Therapeutics; has stock options in Sofie Biosciences, Pharma15, Vision, Convergent, Aktis Oncology, AdvanCell; is an advisory board member of Fusion and GE Healthcare; receives honoraria from PeerView; and has received travel support from Janssen Pharmaceuticals. JSL reports research support from Clarity Pharmaceuticals and Avid Radiopharmaceuticals; has acted as an advisor for Alpha-9 Theranostics, Boxer, Clarity Pharmaceuticals, Earli, Curie Therapeutics, Evergreen Theragnostics, West Street Life Sciences, Inhibrx, Luminance Biosciences, NexTech Venture, Sanofi US Services, Solve Therapeutics, Suba Therapeutics, TPG Capital, Telix Pharmaceuticals, pHLIP, and Precirix; is a co-inventor on technologies licensed to Diaprost, Elucida Oncology, Theragnostics, CheMatech, Daiichi Sankyo, and Samus Therapeutics; is the co-founder of pHLIP; holds equity in Summit Biomedical Imaging, Telix Pharmaceuticals, Clarity Pharmaceuticals, and Evergreen Theragnostics; and is supported by National Institutes of Health grant R35 CA232130. MGP has consulted for CraniUS, UCLA Cancer Center, Ventyx, Einseca, and ModeX; receives royalties from Lantheus Holdings, Novartis, Intuitive Surgical and Cyclotek; has 70 patents issued or filed related to imaging or informatics; and has stock options in D&D Pharmatech, PlenaryAI, Earli, and Immunosity. AMS reports trial funding from EMD Serono, ITM, Telix Pharmaceuticals, AVID Radiopharmaceuticals, Fusion Pharmaceuticals, and Cyclotek; research funding from Medimmune, AVID Radiopharmaceuticals, Adalta, Antengene, Humanigen, Telix Pharmaceuticals, and Theramyc; and payment for participation in advisory boards of Imagion and Immunos. RW has consulted for ModeRNA, Boston Scientific, Lumicell, Seer Biosciences, Earli, and Accure Health. All other authors declare no competing interests.
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