Nuclear Medicine
Programme Activities of the IAEA's Sub-Programme on Nuclear Medicine
The objective of the sub-programme on Nuclear Medicine is to enhance the capabilities of Member States to address major health problems, like cancer and cardiovascular disease, effectively and efficiently using nuclear medicine techniques when appropriate and in a cost-effective manner. This goal will be achieved by raising Nuclear Medicine practice standards by providing targeted education and training; assisting in establishing new practices; transferring updated technology and implementing appropriate, clinically relevant and updated diagnostic and therapeutic applications.
The subprogramme consists of five main projects, namely:
Nuclear medicine imaging in the management of non-communicable diseases (Project F.2.01)
Rationale: In vivo diagnostic procedures, which involve high technology and high initial investment, constitute some of the most important aspects of nuclear medicine practice for solving clinical problems. Through various regional advisory groups as well as surveys conducted by the subprogram it has been confirmed that a spectrum of non-communicable diseases like cancer, coronary artery disease, degenerative and childhood diseases constitute the major bulk of the clinical problems prevalent in the developing Member States. Radionuclide imaging procedures play an important role in the management of all these problems. While many Member States already have appropriate infrastructure for carrying out gamma camera, SPECT and other in vivo nuclear medicine studies on a routine basis, many still lack in adequate human resources, appropriate equipment, radiopharmaceuticals and basic infrastructure have resulted in an enormous increase in costs and in the need for maintaining quality. There is need for innovative approach in dealing with sophisticated equipment and radiopharmaceuticals, especially in the developing Member States of the Agency, where the needs are high and the resources meagre. Professional training is a critical factor in its development and therefore there is an urgent need to standardize training and target Agency's resources to educate and train a large number of nuclear medicine professionals in the developing countries through creation of centres of excellence in various fields of nuclear medicine, innovative teaching methodologies and effective application of various information and communication tools. In summary there is a need for promotion, standardization and rationalization of all resources and their effective use. Since there is no other international organization except the Agency, which has the mandate to promote nuclear medicine in the developing countries, the role of the Agency for providing technical support to this effect has become extremely important.
Objectives: To establish effective use of appropriate in vivo nuclear medicine procedures in the management of non communicable diseases in the developing Member States through Agency support. To ensure good practice of nuclear medicine through judicious and optimal use of information and communication tools for teaching and training in nuclear medicine and establishment of standardized and uniform quality assurance protocols.
Application of positron emission tomography (PET) in molecular imaging (Project F.2.02)
Rationale: Positron emission tomography (PET) is an excellent diagnostic technique, which provides high sensitivity and resolution in the detection of cancer lesions. Many organic substances can be labelled with C-11, N-13, F-18 or O-15 without altering their biochemical properties. Of these, F-18 fluoro-deoxy-glucose (F-18 FDG) is the most widely applied tracer. Thus, metabolic information, such as the changes in regional distribution of glucose utilisation, fatty acids or amino acids metabolism can be determined. This information can be applied to kinetic models to translate the regional concentrations in the image to assess physiological and metabolic processes. The technique has been found to be useful in the fields of cardiology (myocardial viability studies, myocardial blood flow studies etc), oncology (diagnosis, staging and cancer recurrence detection), neurology (characterization of brain tumours, aetiology of dementia, movement disorders, and location of epilepsy focus) and neuro-psychiatric disorders. Advances in PET make it possible to measure the rate of chemical reactions within the human body. This has resulted in identifying disease at molecular as well as cellular level in living human beings.
Although PET technique has been in existence for the past decades, its wide spread implementation has been restricted due to its costs. There are many small developing countries, however, which have almost reached the level of the developed ones with regard to infrastructure and technology in nuclear medicine. There are also many large developing countries which have excellent pockets of highly developed infrastructure related to all areas of nuclear medicine practice, namely patient care, teaching and research. Many of such countries have the basic manpower and expertise in PET technology, but cannot afford the high costs of PET. However, if given the opportunity, they are able to conduct excellent research, that may significantly contribute to the science in general, and nuclear medicine in particular. For these countries not to lag behind the rest of the developed world, and keep abreast with current developments, it is extremely important for the Agency to provide them support to carry out clinical and basic research tailored to their local conditions using PET. Such support will attract a lot of interest to the Nuclear Medicine specialty and may stimulate and create a proper research environment in relevant clinical fields in the developing countries.
Objective: To establish effective use of molecular imaging using PET in a selected number of developing Member States in the management of oncological, neurological and cardiovascular disorders through Agency support.
Radiopharmacology and application of new radiopharmaceuticals to the management of diseases (Project F.2.03)
Rationale: Clinical applications of radiopharmacology deal with tracer kinetics, and with the development and evaluation of various diagnostic and therapeutic radiopharmaceuticals, and this is one of the most important fields of nuclear medicine. Moreover, in these areas that are not related to cancer treatment, there are radionuclide therapeutic procedures, which in many instances are indispensable and cost effective. Many of these techniques have been initiated by the Agency itself and there is a need for optimization, standardization and promotion of these various treatment procedures in Member States. Only a few developing Member States have appropriate infrastructure for in house preparation of routine radiopharmaceuticals for routine clinical applications, while a vast majority still lack adequate human resources, knowledge and appropriate equipment. This branch of nuclear medicine is most critical and in many instances may act as a bottleneck for its progress in several developing countries. Hence it is extremely important to make available routinely used radiopharmaceuticals at affordable prices to the nuclear medicine community in developing countries. If implemented properly this may have significant impact on their health care services.
Objective: To ensure the availability of diagnostic and therapeutic radiopharmaceuticals for routine use in nuclear medicine facilities in developing countries.
In vitro nuclear medicine, molecular biology and genomic studies applied to communicable diseases, cancer and genetic disorders (Project F.2.04)
Rationale: Being robust, sensitive and not protected by patent and know-how, in vitro nuclear medicine technologies are well suited to the developing Member States for low cost laboratory diagnosis and large scale screening. These also serve as gold standard for research into indigenously developed novel methodology and biotechnology that will form the basic framework for current and future development of immuno-diagnostics. A number of Member States already have appropriate infrastructure for carrying out radioimmunoassay and polimerase chain reaction (PCR) techniques on a routine basis while many still lack in adequate trained personnel, equipment, reagents and basic infrastructure. Hence, there is a need for promoting their use through Agency support for cost effective health care in developing Member States.
Objective: To establish the application of novel nuclear based and related in vitro molecular and biotechnological methods for effective investigation and management of infectious, neoplastic, metabolic, genetic and nuerological degenerative diseases in Member States.
Therapeutic applications of unsealed radioactive sources in the management of Cancer (Project F.3.05)
Rationale: Radionuclide therapeutic procedures, in many instances are indispensable and cost effective, but require special skills, infrastructure and specific beta emitting radiopharmaceuticals, which are not normally available in many developing countries. Only a few developing Member States have appropriate infrastructure for routine clinical application of various radionuclide therapy procedures, while a vast majority still lack in adequate human resources, appropriate radiopharmaceuticals and equipment. This branch of nuclear medicine has seen rapid progress with the introduction of a number of new radiopharmaceuticals and innovative therapeutic techniques, which, if applied properly, may have significant impact on the health care services in the developing countries.
Objective: To establish the effective use of appropriate in vivo therapeutic nuclear medicine procedures in the developing Member States through Agency support.