Nuclear medicine has made a significant breakthrough in the diagnosis and treatment of neurological and cardiac disorders and detection of early cancer. In fact, the discipline of nuclear medicine is no longer a separate branch of study, but a well-integrated constituent of the family of medical science, according to Prof. Kakarla Subba Rao, Director of Nizam''''s Institute of Medical Sciences (NIMS), Hyderabad.

He was speaking to Pharmabiz after inaugurating the eighth annual conference of the Society of Nuclear Medicine (India), Southern Chapter, in Hyderabad, recently. Since there is a severe shortage of nuclear medicine practitioners and technicians, NIMS would be starting courses in Nuclear Medicine from the next academic year. At present there were only two institutions offering this course -the Radiation Medicine Centre, BARC, Mumbai, and the Institute of Nuclear Medicine, under the Defence Ministry, in New Delhi.

More than 400 years ago, Shakespeare used the term ''''Atomics'''' in one of his plays, but nobody knew the meaning until the late 18th century when Alfred Nobel realized the destructive power of atom or in 1945 when atom bombs were dropped on Hiroshima and Nagasaki. The latter half of the 19th century saw the emergence of nuclear energy for peaceful purposes. Today it has a wide variety of applications, including the field of medicine, says Prof. Subba Rao.

Radioisotopes are used in the detection and diagnosis of diseases like cancer. The isotopes emit gamma rays, which pinpoint where exactly the lesion is. While ordinary X-rays give a person''''s anatomical structure, isotopes give even the functioning of organs like the kidney, lungs, heart, brain and the central nervous system. The Spect camera, now being used in India, takes several functional images of the organs in seconds, which can be transmitted and stored in a computer.

Dr Subba Rao said though gamma cameras were in use since the 1950''''s they got sophistication only in the ''''70s. Though ECIL manufactured gamma cameras and other equipment, they lacked sophistication, he said. PET (Positron Emission Tomography) scanners were the latest and the most accurate and sophisticated which could detect even a 2mm particle or lesion in the body. PET scanners were not yet available in India, though Tata Memorial Hospital in Mumbai was setting up one. He said NIMS was also trying to get one PET scanner for which a Central team had come to inspect the place. The All-India Institute of Medical Sciences (AIIMS), New Delhi, would also get one with the Central Government funds, he said.

He said cameras alone were not enough. It needed chemicals -pharmaceutical/ instrumentation chemicals or called radioisotopes, which were manufactured only in Trombay. He said the camera would be the same but the chemicals would be different for different organs and diseases.

Dr Subba Rao said NIMS had set up a nuclear medicine centre in the year 1987. There were in all 140 centres for nuclear medicine in the country. According to Dr Subba Rao, the future belonged to nuclear medicine, which would replace all conventional tests and diagnostic systems. He, therefore, stressed the need to increase the number of nuclear medicine centres from the present 140. As there was severe shortage of specialized doctors and technicians, NIMS was planning to introduce courses in nuclear medicine. The Institute would have a three-year degree course in nuclear medicine after MBBS and a two-year diploma in radiation medicine as soon as the Academic Council gave its permission, he said.

Explaining the technical aspects of nuclear medicine, Dr K Kumaresan, chief of the Nuclear Medicine Centre at CARE Hospital, said, "We administer medically designed radio Isotopes into the patients for diagnostic, therapeutic and research applications. The practice of clinical medicine is largely centred around functional imaging known as Radio Nuclide Scanning or Scintigraphy using a gamma camera -Spect or PET Scanners. The camera captures the gamma rays which come from the patient following the injection of the tracer."

The isotopes have a very brief life span and once produced they must be used within the stipulated time. They cannot be stored. In India Isotopes are supplied only by the Board of Radiation & Isotope Technology (BRIT), Anushaktinagar, Mumbai. Cold Isotope kits are available on demand and they are carried in flights to the place of administration since the life span is only for a couple of hours.

According to Dr Kumaresan, Cyclotron is the equipment used to make the Isotope and Technisium-99m is the wonder molecule of the century used in PET Scanners. Technisium-99m is being imported from Israel or the UK. Cyclotron produces radiopharmaceuticals like F-18 FDG (Fluro Deoxi Glucose), which is an ultra short-lived isotope and is used for cancer imaging. Any cancer tissue will take more glucose than the normal tissues. He said Ion Beam Applications (IBA), Belgium, was the largest producer of PET cameras and Cyclotron.

The company, he said, had offered a unit to the Andhra Pradesh Government and no decision had been taken as to where to locate the unit. The company was offering a Rs 20 crore loan, which could be used for purchasing the equipment. The company was setting up two units, one at the Tata Memorial Hospital, Mumbai, and the other at the Variable Energy Cyclotron Centre, an Atomic Energy unit, in Kolkata.

Dr Kumaresan said the nuclear medicine centres were under the restrictive regulation of the Atomic Energy Regulatory Board. Many hospitals had not set up nuclear medicine facilities because of the restrictions, multiple licences and paper work. It was also near impossible to procure isotopes for nuclear medicine practice except BRIT and very often the regulatory board exceeded its jurisdiction. No one would like to invest in a project where controls were too tight and the returns very limited.

Regarding training, Dr Kumaresan said at present two institutions , Radiation Medicine Centre, BARC, Mumbai, and the Institute of Nuclear Medicine, New Delhi, conduct courses in nuclear medicine. But both had failed to keep up the requirements. They also could not produce nuclear medicine teachers nor encourage nuclear medicine practitioners.

At the conference, Dr S S Reddy, medical advisor to Apollo Hospitals, said nuclear medicine had brought about enormous advances in imaging by providing functional imaging. Dr YNI Anand, president, Society of Nuclear Medicine, Southern Chapter, said Hyderabad had emerged as a major centre of nuclear medicine. There was a need to enhance the number of specialists and infrastructure, he added.

A symposium on Nuclear Nephrology was conducted in which several doctors, including Dr Kumaresan, Dr Anshu Rajnish, Dr Ratan Jha, Dr Regi Oomen, Dr Kavitha and Dr Thirumurthy presented papers. This was followed by a panel discussion on Obstructive Uropathy.