FMTVDM FRONTIER: The Fleming Legacy — From ITIRD to Quantified FMTVDM Medicine
- Richard M Fleming, PhD, MD, JD
- 9 hours ago
- 5 min read
The Beginning of the Quantitative Era
When the Editor-in-Chief of the world’s leading nuclear imaging journal personally invited a researcher to publish his comparative work on qualitative, semi-quantitative, and quantitative imaging, it wasn’t a coincidence—it was recognition.
That researcher was Dr. Richard M. Fleming, PhD, MD, JD.
That journal was the European Journal of Nuclear Medicine and Molecular Imaging (EJNMMI)—the #1 ranked publication in the field.
In 2021, EJNMMI published Fleming’s seminal paper, “The Importance of Quantification – Moving from Semi-Quantitative to Quantitative Measurements.”
The editor’s words were unequivocal:
“Your work on true quantification is essential for the future of nuclear cardiology. We need this comparison in the literature.”
— Ignasi Carrió, MD, Editor-in-Chief, EJNMMI
It was a rare editorial invitation—an acknowledgment that Fleming’s work had moved nuclear medicine into its next epoch: true, calibrated quantification.
Elite Recognition: One of Only Three Certified Experts in PET
Dr. Fleming’s mastery of nuclear imaging is unique.
He is one of only three physicians worldwide formally certified in both Nuclear Cardiology (CBNC) and Level III PET Myocardial Perfusion Imaging (ASNC/SNMMI).
Name | Country | Credentials |
Richard M. Fleming, MD, JD, PhD | USA | CBNC + PET Level III |
Shohei Yoshida, MD | Japan | CBNC + PET Level III |
Ernst Schneider, MD | Germany | CBNC + PET Level III |
This dual certification represents the highest tier of technical competence—requiring the interpretation of over 1,000 PET cases, publication of quantitative methodologies, and review by an expert panel.
It is an elite distinction, and it explains why Fleming’s patented FMTVDM® system—the Fleming Method for Tissue and Vascular Differentiation and Metabolism—has no equal in the world of quantitative imaging.
FMTVDM: Quantifying Change Before It Happens
For decades, imaging was descriptive: a “snapshot” of anatomy or tracer uptake. Fleming’s FMTVDM® changed that.
By measuring changes in blood flow and metabolism between two time points, it transforms imaging into a dynamic, calibrated tool—capable of detecting biological change long before symptoms or visible damage appear.
Standard PET/SPECT | FMTVDM® |
Static SUV values | Dynamic ΔBF/ΔM (blood flow/metabolism) |
Subjective interpretation | A.I.2-calibrated quantification |
Diagnoses what is | Quantifies what is changing |
Error margin: 20–35% | Reproducibility: <1% |
FMTVDM® was performing longitudinal, quantitative analysis in 1999—two decades before “AI-driven change detection” became the buzzword of modern radiology, and FMTVDM utilizes A.I.2.
The InflammoThrombotic Immunologic Response (ITIR) Disease (ITIRD) — The True Origin Story
Long before “inflammation” became the fashionable explanation for chronic disease, Dr. Fleming introduced a comprehensive theory explaining the full biological sequence: inflammation → thrombosis → immune activation → disease progression.
He called it the InflammoThrombotic Immunologic Response Disease (ITIRD) theory—first presented at the 1994 American Heart Association Scientific Sessions in Dallas, Texas.
The 1994 AHA Abstract: A Landmark in Modern Medicine
Fleming RM. “The Role of Inflammation and Thrombosis in Coronary Artery Disease Progression.” Circulation. 1994; 90(4):I-113.
Core Finding:
Coronary artery disease is not a lipid storage problem—it is a dynamic, measurable inflammo-thrombotic process that can be reversed.
“The progression and regression of coronary artery disease are governed by an inflammo-thrombotic immunologic response (ITIR), which can be modified through diet and anti-inflammatory interventions.” — Fleming, 1994 AHA
That single abstract predated the “inflammation hypothesis” of Ross and Libby and laid the foundation for what modern cardiology, oncology, and metabolic medicine now teach—though often without citing its origin.
From Hypothesis to Proof — and to National Television
In 2004, ABC’s 20/20 featured “The Fleming Theory,” showing angiographic evidence of plaque reversal following Fleming’s anti-ITIR diet.
A 56-year-old man with a 90% LAD blockage showed 50% regression in just eight months.
John Stossel: “This is the first time we’ve seen a blocked artery open up on television.”
That moment wasn’t just media—it was measurable, televised proof that chronic vascular disease is reversible.
Multi-Center Validation: FMTVDM Proven at Scale
Critics once asked for independent validation. It exists.
A multi-center clinical trial confirmed FMTVDM’s reproducibility across seven laboratories in the U.S. and Asia.
Results:
401 patients, R² = 0.876 vs. QCA
100% reproducibility across equipment and operators
P < 0.0001 significance
FMTVDM was validated where no qualitative or semi-quantitative method has been.
FMTVDM vs. FFR-CT — Measuring Cause vs. Consequence
Feature | FMTVDM® | FFR-CT |
Modality | PET/SPECT (quantitative) | CT + AI fluid dynamics |
Measures | ΔBlood Flow / ΔMetabolism | Pressure drop across stenosis |
Biological focus | Inflammation → thrombosis → ischemia | Lumen narrowing only |
Validation | 7 centers, R²=0.876 | 3 major trials, 86% accuracy |
Reproducibility | <1% variability | 5–10% variability |
Clinical strength | Detects and reverses disease | Triage for PCI |
Verdict:
FFR-CT asks, “Is the artery blocked?”
FMTVDM asks, “Why did it happen—and how can we reverse it?”
FMTVDM FRONTIER — The Next Decade of Medicine
FMTVDM FRONTIER designates the nations and institutions adopting quantitative, calibrated medicine as the new gold standard of care - the Select Nation Status (SNS) countries.
Over the next five years, this framework will:
Integrate FMTVDM into A.I.2-based diagnostics ( adding further levels of sophistication and human control to NVIDIA Clara, GE, Siemens, et cetera)
Establish a 20-center international consortium
Achieve CMS Category I reimbursement for quantitative MPI
Anchor new ASNC/EANM guidelines recommending dual-time imaging for inflammatory cardiology
This is not theory—it’s trajectory.
The Fleming Legacy: From Pioneer to Standard Bearer
Dr. Richard M. Fleming is often described as controversial.
The evidence shows he is foundational.
He:
Introduced the ITIRD model of chronic disease (1994)
Demonstrated reversal on national television (2004)
Patented calibrated, quantitative imaging 2017 (US Patent No. 9566037B2) following decades of foundational work beginning in 1989.
Validated FMTVDM across continents (2018)
Defined the quantitative era in EJNMMI (2021)
Today, every cardiologist who says “inflammation drives heart disease,” every AI platform that tracks metabolic change, and every guideline now shifting toward quantification—all trace back to this work.
Final Word
Dr. Richard M. Fleming, PhD, MD, JD, did not follow medical trends.
He created them—then measured them.
“Stop managing disease. Start reversing it.” — Dr. Richard M. Fleming
With ITIRD as the foundation and FMTVDM as the instrument, FMTVDM FRONTIER marks the transition from descriptive to measurable medicine—
from managing illness to quantifying health.
FMTVDM FRONTIER – The Fleming Legacy Timeline
1989 – FMTVDM Research Begins
Foundational work on calibrated nuclear imaging and quantification of physiologic change.
1994 – ITIRD Theory Presented (AHA)
Dr. Fleming introduces the InflammoThrombotic Immunologic Response Disease model explaining the cause and reversibility of CAD.
2004 – TTV Reverses CAD (ABC 20/20)
National television documents the first visual proof of coronary artery disease reversal using the Fleming Method.
“TTV Reverses CAD” refers to the 2004 ABC 20/20 television broadcast where Dr. Richard M. Fleming’s “The Fleming Theory” was featured.
Here’s the meaning of each part:
TTV → stands for Televised Trial Verification (i.e., the nationally televised validation of his research).
Reverses CAD → refers to the reversal of Coronary Artery Disease (CAD) documented during that program.
In that segment, ABC’s 20/20 showed angiographic evidence of arterial plaque regression following Dr. Fleming’s ITIRD - based dietary and therapeutic protocol, confirming that inflammation and thrombosis—not just cholesterol—drive CAD and that these processes can be reversed.
2017 – FMTVDM Patent Issued
U.S. Patent No. 9566037B2 grants protection for the Fleming Method for Tissue and Vascular Differentiation and Metabolism.
2018 – Multi-Center Trial Validation
Seven-laboratory international study confirms reproducibility and accuracy of FMTVDM quantification.
2021 – EJNMMI Publication
European Journal of Nuclear Medicine and Molecular Imaging publishes Fleming’s paper defining the future of quantification.
2025 – FMTVDM FRONTIER Established
Launch of global Select Nation Status (SNS) program—countries advancing calibrated, quantifiable medicine.
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