Head of NMD of FSCH, Clinical Prof. B.Enkhtuya, RCA/UNDP Project Promoting and Accelerating Nuclear SPECT/PET Imaging Technologies in the Region

Mongolia 2 Mongolia is a landlocked and sparsely populated country in the northern part of Central Asia and located between Russia and China. It has total land area of 1.5 millions square kilometers but contains only 2.8 million population.

Project results of national activities in 2011 The first year of the RCA/UNDP project- Promoting and Accelerating Nuclear SPECT/ PET Imaging Technologies in the Region has been successfully implemented in Mon golia Constructed National Work Plan and National Project Team NPC has been participated in the Kick-off meeting Two nuclear medicine specialists have taken part in the regional training courses and given the positive feedback to the national activities and their center of nuclear medic ine Five national activities with a total of approximately 292 participants were successful ly conducted. A total of approximately 1750 patients have been treated by the participants Participation in the RIA IEQAS to achieve quick and accurate RIA diagnostic syste m in Mongolia has been initiated Established contact with cold kit supplier company which solved problem with shorta ge of Radiopharmaceuticals;

National Activities in There are 5 national activities conducted (3 Korean, 1 Switzerland,2 local lecturers, as well as 2 participants of two regional training courses given lectures Seminar on Management of Thyroid Cancer, FSCH (with Dr. Rolland Yan Switz erland ) Seminars on Management of Thyroid Cancer at the Annual Radiological meeting, Role of PET/CT in the Management of Cancer Patients; I-131 Therapy in Thyroid CA at the FSCH & National Cancer Center (Lecture delivered by Prof. Hee-Seung Bom, President of ARCCNM) Mongolia-Korean joint III symposium on Imaging Diagnostics: -Introduction of Nuclear Medicine and Clinical application of PET/CT (by Prof. Jae Gol Choe, Korea University, Anam Hospital) - Radionuclide Therapy of HCC using Y-90 Microsphere ( by Prof. Kim Yun Hwan, Korea University, Anam Hospital)

Project results of National Activities undertaken in 2011 The purpose to participate in RIA IEQAS was to improve quality of RIA syste m and establish quick and accurate diagnostic laboratory in Mongolia: -Submitted Application form to the office of IEQAS, Korea on July -Received control serum from the office of IEQAS - Made a serum test control with our own kits every month - Since August, 2011 in our Department 2775 RIA tests were performed with controlled kits

Project results of National activities in 2012 There are a total of 4 educational activities conducted with a total of approximately 498 attendances. Two participants of four regional training courses gave lectures in the national activities: I. Lecture for technologists II. Workshop on Nuclear Oncology at the National Oncology Center III. NM introduction lecture among non-NM physician at General Hospitals of Ulaanbaatar city IV. Joint Meeting with Mongolian Radiological Society: Nuclear Medicine Update

Achiements (1) I. Educational training for Technologists Conducted in Q2, with 5 technologists Topics: - Radiation protection - NM instrumentations - QC & QA in NM - Image Acquisition and Processing

Achiements II. Workshop on Nuclear Oncology (Q3) To enhance knowledge of oncologists on SPECT/PET I imaging and therapeutic applications

Achiements

IV. Joint Meeting with Mongolian Radiological Society Nuclear Medicine Update: Hybrid imaging (Q4) About 130 participants

Achiements (2) Published in Mongolian language brochure about Nuclear Medicine procedures dedicated to the public(Q2)

National activities results of There are a total of 3 educational activities conducted with a total of approximately 305 attendances. Two participants of four regional training courses gave l ectures in the national activities: NM introduction lecture among non-NM physician at General hospitals of Ulaanbaatar, Darkhan and Erdenet city Published in Mongolian language brochure about Nucl ear Cardiology procedures dedicated to the public Installed SPECT/CT machine

No. of Participants of National Activities in

NM introduction lecture among non-NM physician at General hospitals of Ulaanbaatar, Darkhan and Erdenet city 14

15

) Published in Mongolian language brochure about Nuclear Cardiology procedures dedicated to the public 16

17

Analysis of national activities and results 18 4 Mongolian nuclear medicine specialists have taken part in the basic and on-site regional training courses of the project and benefit from the training course. The training materials and experiences of the regional training course on SPECT/PET imaging, radionuclide therapy and RIA techniques were very useful and have been used to improve the accuracy and standards of clinical applications. All participants have given the lectures on the national activities. In overall, 13 national educational activities conducted with a total of 993 attendances, including NM and non-NM physicians and technologists. Improved quality of RIA diagnostic system by starting to participate IEQAS.

Analysis of national activities and results 19 Formulated and submitted project proposal to the hospital administration and Radiation Protection office of NEA with purpose to get a legal approval for introducing and starting of high dose I-131 therapy in Thyroid CA patients in Mongolia Standardized and harmonized methods and techniques of nuclear medicine imaging and therapeutic procedures using SPECT and SPECT/CT Two Brochures dedicated to the public were published Upgraded NM technology: SPECT/CT has been introduced in Mongolia Improved and maximized nuclear medicine imaging and therapeutic applications

Treated or diagnosed patients 20 Item Total No. of Female No. of Male No. Children Total

Analysis of project results 21 No. of patients diagnosed and treated by participants in the project training SPECT imaging – about 2100 Radioiodine therapy -247 RIA test – 12775(about 3200 patients) Impacts Imaging report is improved Management with Radioiodine therapy of thyroid CA patients is improved Achieved accurate RIA test system

Long term benefits of national activities Well trained personnel Upgraded facilities Maximized and accelerated NM applications in Mongolia Standardized protocols Sustainability: Regular training, workshop, conferences Well designed development Work Plan Increase number of NM professionals and NM facilities Good collaboration with Government, Partnerships as well as RCA member states and expert network etc.

Recommendations to ensure sustainability of project results; 23 Essential to continue regular educational activities Need to link with other programme and incorporate National workshop due to limitation of NM personnel in country Increase number of NM professionals, NM departments & equipments Expand clinical NM applications Need for Government financial support

Lesson learned INCREASE NUMBER OF WELL TRAINED CORE STAFF COMPREHENSIVE ASSESSMENT OF NEEDS MOBILIZATION OF RESOURCES ENLIST GOVERNMENT SUPPORT AND COMMITMENT BUILDING PARTNERSHIP ARRANGEMENTS STRENGTHENING INFRASTRUCTURE AND EQUIPMENTS Also, we found the RCA-UNDP project plays very effective role to promote Nuclear Medicine in Mongolia, especially for disseminating advanced knowledge of NM among both NM and non-NM doctors. We found positive attitude of police makers to upgrade Nuclear Medicine facilities in Mongolia. Project of establishment of Cyclotron and PET/CT Center has been launched in Mongolia.

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