Table 2: Potential Systemic Effects Caused by Second Generation Nanodevices^*.

Imaging	Therapeutic	Combined (Detect, Image, Treat, Monitor)
Increased sensitivity and specificity of QDs or other nanodevices could lead to the replacement of existing technologies (e.g., PSA testing, mammogram).	Sudden demand in use of MRI due to use of nanodevices that are activated in the presence of a magnetic field.	Universal demand to detect cancer– how will patients be prioritized for this? Sudden demand in use of MRI due to use of nanodevices that are activated in the presence of a magnetic field.
Cost: possibly more expensive than current screening modalities.	Possibly more expensive than existing therapies (gold nanoshells)	Many functions can be performed on one device → possibly faster, more cost-effective than individual devices.
Report of results: possibly faster than existing technologies.	Possibly faster determination of therapeutic efficacy (vs. existing technologies)	Increase in life expectancy of population? Free-up beds in hospitals?
Nanodevices may be able to pinpoint with more accuracy when cancer starts. Ethical question: when does disease start? Increased demand for imaging by people who are asymptomatic and concerned they may get cancer.	Nano-radiologist or medical nano-oncologist provides treatment rather than conventional radiologists or medical oncologists. Creation of nano-nursing compared to conventional nursing.	Nano-radiologist or medical nano-oncologist provides treatment, rather than conventional radiologists or medical oncologists. Creation of nano-nursing compared to conventional nursing. Uncertainty regarding how many “traditional” cancer radiologists/oncologists should be retained and trained.
New branch of (nano) radiology compared to conventional radiology New/longer training in biochemistry and targeting ligands will be required by nanoradiologists.	More training required for new nano-treatments Patient education – people may be concerned regarding the use of nanodevices inside their bodies.	Longer time to specialize in medicine in order to use nanotechnology clinically? Insufficient number of dendrimer specialists to treat everyone with personalized dendrimers
Restricted to specialized centres Possible in-house nanodevice production required to keep up with the demand for use.	Will the same specialized centres that offer imaging also offer treatment? How many specialized centres will be required?	Only specialized centres can perform this combined imaging/treatment Possible nano-monitoring from patient home via wireless technology. This may free hospital beds for other patients.
After imaging with nanodevices, specifically targeted therapeutic nanodevices may also be required for immediate treatment of the patient. Will both of these nanodevices be commercially available in sufficient quantities?	Possible waiting time for preparation of appropriately targeted nanodevice after imaging (will a therapeutic nanodevice be immediately available?) Will a patient receive conventional treatment if there is a waiting period required to prepare the therapeutic nanodevice?	Will there be a patient waiting time required for preparation of personalized dendrimers (hours, days, weeks after a patient sees a physician)?

^*MRI indicates magnetic resonance imaging; PSA, prostate-specific antigen; QD, quantum dot.