Overview of Nuclear Technologies in Healthcare Dr Harsh Mahajan, MD Founder & Chief Radiologist, Mahajan Imaging Chairman, Department of Nuclear Medicine & PET-CT, Sir Ganga Ram Hospital Consultant, International Atomic Energy Agency, Vienna

NUCLEAR MEDICINE Nuclear medicine is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear medicine, in a sense, is "radiology done inside out" or "endoradiology" because it records radiation emitting from within the body rather than radiation that is generated by external sources like X-rays.

Applications of Nuclear Medicine Diagnostic Nuclear Imaging Imaging In-Vitro Diagnostics - RIA Therapeutic Radiopharmaceuticals Tumours Thyroid Synovectomy

RADIOTHERAPEUTICS/ RADIOTHERANOSTICS Iodine Therapy I-131 therapy for thyroid Newer pharmaceuticals Yi-90 resins (Sir Spheres) Yi-90 glass microspheres (Theraspheres) Prostate Cancer – Radium-223, Lutetium-177-anti-PSMA Somatostatin Receptor Analogues for NETs

Nuclear Imaging enables us to see body “function” Gamma Camera Most common radiotracer is Tc-99 Gold standard for kidney structure and function Gold standard for heart, brain and thyroid function Other applications include in bone metastasis, PUO etc.

PET scanning has revolutionised diagnosis and staging of cancer Positron Emmission Tomography (PET) Involves injection of radiotracers, most commonly – f-18 Gold standard for cancer staging and response to treatment Excellent for brain and heart functional disorders Increasing use in PUO, TB etc.

Hybrid Imaging

FDG PET and PET-CT: Impact in Oncology Impact on Management: FDG PET: ~30% patients (range 10%-60%) PET/CT: incremental impact on patient management: 10-20% patients, including Planning radiation therapy Guiding biopsies Supplement to JNM;2001:42: May 2001, Guest editor: Sajiv S. Gambhir Supplement to JNM;2004;45: January 2004, Guest editor: Johannes Czernin

Critical needs of the hour Manpower Issues Training Need more nuclear medicine courses – both for physicians and paramedics Need “bridge” courses for nuclear medicine physicians and radiologists given the acute shortage of both in India Standardization Need strong and practical standardized staffing guidelines for the nuclear medicine field to grow further

Critical needs of the hour Availability and production of radio-isotopes Production of more radiotracers in India: currently imported at very high prices and hence unaffordable for most of the population Ease of obtaining licenses for producing and transporting radiotracers Reduced duty and taxes on radiotracers, till we can make our own

Critical needs of the hour Education about Radiation Safety For Radiation Workers Important to be aware of principles related to radiation exposure to patients (ALARA), patients relatives and themselves For Patients Need to be educated about risk-benefit of each investigation / treatment procedure and be informed accordingly – the benefit of getting proper treatment / diagnosis generally outweighs the radiation risk

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