Asian nations use UN cash to strengthen PET facilities

Thailand, Malaysia, and other countries have received United Nations aid to implement and upgrade their PET and nuclear medicine capabilities. The nuclear medicine section of the International Atomic Energy Agency, a UN affiliate organization, provides the assistance as part of its mandate to foster peaceful uses of nuclear science and technology.

A model PET facility now exists at Chulabhorn Cancer Center in Bangkok, in addition to a cyclotron that can serve up to five PET scanners. The position of Dr. Pusuwan Pawana is funded by an IAEA fellowship at Mahidol University's Siriraj Hospital in Bangkok.

"Our efforts are aimed at filling in the gaps," said Dr. Maurizio Dondi, head of the nuclear medicine section. "Getting the word out to the international community about the vital role nuclear medicine plays in healthcare is essential to understand and appreciate the peaceful applications of radioactive materials."

The IAEA provides training courses, expert missions, fellowships, scientific visits, and equipment disbursement to qualifying countries. PET/CT systems are the focus, and the IAEA aims to help launch a program that will become self-sustaining in a few years. Because long-term success depends on a well-educated workforce, sharing of expertise is particularly important.

The IAEA's regional Asia group, the Regional Cooperative Agreement, runs two to three training courses each year, where about 25 participants listen to expert lecturers from countries with successful nuclear medicine programs. On a larger scale, the IAEA will host the International Conference on Clinical PET and Molecular Medicine in Bangkok from 10 to 14 November 2007, to evaluate clinical uses of PET and discuss PET in emerging countries. To encourage participation from developing countries, the conference has no registration fee and offers travel grants to some participants. Dr. Peter Conti, past president of the U.S. Society of Nuclear Medicine and a professor of biomedical engineering, radiology, and clinical pharmacy at the University of Southern California, will speak at the event.

The challenges developing nations face when considering a PET facility are immense. Initial costs are about US$1 million to US$2 million for the facility alone and about US$2.4 million for the cyclotron and laboratory, which could be shared among neighboring facilities. Construction expenses and ongoing maintenance costs drive up the price tag even more. In addition to the sheer expense of physical PET facilities, countries often lack the technical expertise of experienced radiopharmacologists, physicists, engineers.

Regions such as North America, Europe, Japan, and Australia can afford equipment and trained professionals. For most of the world, however, PET is unaffordable and unsustainable, even though the need for such cutting-edge technology certainly exists; an estimated nine million new cancer cases will arise annually in developing countries by the year 2020.

In the Czech Republic, the IAEA helped initiate a PET program nearly a decade ago. Today, Prague boasts two cyclotrons (at the Nuclear Physics Institute and the Nuclear Research Institute) and PET systems that have produced thousands of images. Dr. Otakar Kraft, head of nuclear medicine at the University Hospital in Ostrava-Poruba, attended an IAEA workshop on PET and found it very useful. He hopes that his facility will obtain a PET/CT camera within a few years.

Generally, each IAEA PET project lasts about two or three years and costs the IAEA about US$500,000. Long-term two- or three-year fellowships offer a US$40,000 to US$50,000 stipend, and about 10 fellows are funded at a time.

Investment in PET tends to follow economic development, and new projects are cropping up in Central and East Europe, in Serbia, Croatia, Romania, and Bulgaria. Fellows are currently funded at Penang Hospital in Malaysia, the Fundacion Santa Fe de Bogota in Colombia, and elsewhere.

The IAEA was founded in 1957 as a nuclear watchdog group and is best known for its role in international peace and security, most recently with Iran's nuclear energy program. In an attempt to advance safe uses of nuclear technology, however, the IAEA supports the application of nuclear medicine techniques in diseases that could be successfully managed with radioisotopic applications. No other international organization has a similar role in promoting nuclear medicine in developing countries, according to Dondi.

The IAEA calls PET "the most advanced, most expensive, and most sophisticated service in the field of nuclear medicine" and "one of the fastest growing techniques." Still, 90% of the nuclear medicine section budget is devoted to SPECT, not PET. Dondi is reluctant to say whether the PET program will expand.