Non-fungible Tokens (NFTs) in Diagnostic ImagingJarrett Bobrin1, David Weinstein1, Isabelle G. Kim, Andrew Kim1 Temple University Lewis Katz School of Medicine, Philadelphia, PA.Non-fungible tokens (NFTs) have garnered significant media attention in recent years, largely due to the astronomical prices fetched by some digital artworks. They have emerged as a popular medium for buying and selling digital art. Most people associate NFTs with high-profile examples such as the Bored Ape Yacht Club or Beeple’s digital artwork, the latter of which famously sold for over $69 million. Even the world’s first SMS text message was converted into an NFT and sold for over 100,000 euros. In 2021, the NFT market was valued at approximately $41 billion USD, and the term “NFT” ranked among the most popular search terms on Google during both 2021 and early 2022.However, NFTs are more than just digital collectibles; they hold significant untapped potential, particularly in the medical field, including diagnostic imaging. While blockchain technology has been widely explored in healthcare, the specific role of NFTs in diagnostic imaging remains largely unexplored. Although there has been extensive discussion on the use of blockchain in medicine, the application of NFTs in this space is still in its infancy.So, what exactly is an NFT? A non-fungible token is a unique digital asset representing ownership of a specific item or piece of data—whether that be digital artwork, music, or in more recent applications, items in video games or medical records. NFTs are built using the same blockchain technology as cryptocurrencies like Ethereum. However, unlike cryptocurrencies or fiat currencies, NFTs are non-fungible, meaning they are not interchangeable, and each holds a distinct value. Both NFTs and cryptocurrencies rely on blockchain transactions to validate authenticity and ownership. NFTs serve as a digital certificate of ownership, and each time an NFT changes hands, the transaction is recorded on the blockchain decentralized, public ledger.NFTs also incorporate smart contract technology, which is particularly relevant to the field of medicine. For instance, in the art world, the original artist may receive royalty every time their artwork is resold. This same mechanism can be applied to healthcare data, offering both security and potential financial benefits to patients.In the U.S., it is estimated that each patient generates approximately 80 megabytes of health data annually. Utilizing NFTs to manage medical data would allow patients to enhance the confidentiality of their personal health information. Through smart contracts, patients could control and define who has access to their data—whether it’s their primary care physician, an emergency room doctor, a radiologist, or a specialist at a cancer center. Once recorded on a public, decentralized blockchain, this data becomes immutable and highly secure, preventing tampering or unauthorized access.This model empowers patients and shifts control away from commercial or nonprofit institutions that often manage and monetize patient data without individual input. As Dr. Kristin Kostick-Quenet has pointed out, once health information is digitized, it typically falls out of the patient’s control and is commodified by companies for profit. NFTs offer a solution: patients could maintain ownership over their data and even receive financial compensation when it is accessed or utilized.The digital contracts associated with NFTs also allow patients to trace the use of their data—who accessed it, when, how, and why. According to an article from Cointelegraph, the healthcare platform Aimedis plans to tokenize anonymized patient data into NFTs, which can then be sold to pharmaceutical companies. In return, patients may receive revenue from the sales of these NFT tokens. However, a key challenge remains, healthcare IT systems are currently fragmented and not yet optimized for this level of integration. In an ideal future, patients would use a single login interface to manage all their health data.Importantly, NFTs can enhance the quality and accessibility of medical data, making it more suitable for artificial intelligence applications and data mining. Aimedis aims to revolutionize global exchange and monetize de-identified health data using blockchain and NFT technologies.NFTs also have direct applications in radiology. Patients could predefine which radiologists or physicians can access their imaging studies and reports. They could also track who views their data and under what circumstances. If their imaging is later sold or used by a commercial entity—such as a medical center or pharmaceutical company—for research or drug development, the patient could receive royalty payments each time it is used. For example, if a cancer patient undergoes a PET/CT scan and the resulting data is converted into an NFT, a pharmaceutical company using that data in drug research might owe compensation to the patient.Moreover, NFTs could enhance the information available to radiologists. For example, they could include important historical details, such as previous reactions to gadolinium contrast, a history of renal insufficiency, or retained metal that could affect MRI compatibility. Such centralized and accessible data would aid in ensuring patient safety and improving diagnostic accuracy.With the rise of telemedicine, NFTs could also play a key role in verifying transactions between the physical and digital healthcare environments. For example, a doctor’s prescription or imaging order could be tokenized, eliminating any ambiguity regarding its origin or intent. In radiology, this could clarify whether a referring physician wanted a CT scan with or without contrast or preferred a two-view chest X-ray over a portable study—ultimately improving communication between referring clinicians and radiology departments.Teleradiology images could also be tokenized, giving patients visibility over who has accessed their reports and to whom results were sent. In addition, NFTs could be used to verify the credentials of radiologists, such as medical degrees and certifications. Since this information would be recorded on an immutable blockchain, it would be secure and tamper-proof. This could reduce administrative burdens, such as those placed on radiology file rooms by repeated requests for copies of reports or credentials.Tokenized radiology data may also serve as a valuable audit trail, allowing radiologists to confirm that their reports were viewed and used appropriately by referring clinicians.While numerous challenges remain, including legal considerations, government regulations, and the environmental impact of blockchain technology, NFTs are poised to play a growing role in healthcare. Diagnostic imaging, often at the forefront of technological innovation in medicine, is well positioned to benefit from the adoption of blockchain-based NFT applications.References:Conti, R. (2022, August 16). What is an NFT? non-fungible tokens explained. Forbes. Retrieved August 29, 2022, from https://www.forbes.com/advisor/investing/cryptocurrency/nft-non-fungible-token/Culbertson, N. (2021, August 6). 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