30-Minute-Interview

'India Requires 100 PET CT Centres'

Since its advent 45 years ago in India, nuclear medicine has grown rapidly. Dr Vikram Lele, Head of Nuclear Medicine, Jaslok Hospital, Mumbai speaks about the advancements in his field to Rita Dutta. Excerpts:

Dr Vikram Lele Head of Nuclear Medicine, Jaslok Hospital, Mumbai

What has been technical advancements in molecular imaging since the time it first arrived in India?

Nuclear medicine was the first modality for molecular imaging since it studies physiological processes at a molecular level, using radioisotopes. Nuclear medicine has undergone several technical advances with availability of more advanced SPECT (Single Photo Emission Computed Tomography) scanners, PET-CT (Positron Emission Tomography) scanners and cyclotrons which produce short lived radiopharmaceuticals to study molecular processes. MRI, optical imaging and ultrasonography are other molecular imaging modalities which are being utilised in addition to nuclear medicine.

Who have been the pioneers in nuclear medicine in India?

Brig Muzumdar started the INMAS (Institute of Nuclear Medicine and Allied Sciences) in Delhi in 1961. Radioiodine scans for thyroid were carried out along with treatment for graves disease. Other luminaries who contributed significantly to development of nuclear medicine were Dr SM Sharma, Dr Ganatra, Dr AM Samuel and Padmabhushan Prof Dr RD Lele, who is known as father of modern nuclear medicine in India.

Please mention three technical advancements that gave a boost to molecular imaging?

The three major advances which gave boost to molecular imaging were availability of multi detector Gamma Cameras and new radiopharmaceuticals, the advent of PET-CT and cyclotron in India, and development of high Tesla MRI scanners.

What is the spectrum of diseases for which nuclear medicine is being used in India? Is the spectrum wider in the western countries?

Nuclear medicine is being used in studying the function of every organ in the body. The spectrum of diseases managed with nuclear medicine includes cardio vascular disease (ischemic heart disease), neurological disease (dementias, epilepsy, tumors, psychiatric disorders, Parkinson's disease), kidney disease, liver disease, gastrointestinal disease, lung disease, skeletal disease, thyroid and other endocrine diseases, infections, and cancer. The spectrum is similar as in western countries. Every scan done in western countries is being done in India. Indian nuclear medicine is on par with the best centres in the western world.

How has it aided management of cancer?

Cancer forms 40 per cent of nuclear medicine scans. Cancer management (diagnosis, mapping of extent of disease, monitoring response to therapy, detecting recurrence) is heavily dependent on nuclear medicine including SPECT and PET-CT technologies.

How many centres in India are having molecular imaging department? Are these centres mainly located in tier I cities?

Nuclear medicine centres are located in 42 cities in India. Approximately over 200 centres are having nuclear medicine facilities. Mostly these are in tier I and tier II cities.

How many PET CTs have been installed in India, so far? What is the requirement in India?

Till date, there are nearly 45 PET-CT centres in India. The requirement will be for over 100 centres spread out in different cities rather than many centres concentrated in few cities as is the current situation.

It is said that India's first PET was installed in 2000 and the second one took another five years, because of the expense involved in set up cyclotron units. Though medical equipment companies are propagating the idea of hub and spoke model for distribution of biomarkers, it has not taken off. What are you suggestions so that more centres can install PET CT?

PET-CT scanners and cyclotrons are expensive pieces of equipment, requiring trained personnel and intensive maintenance. The high cost has been the main limitation for rapid spread of this technology.

Due to the short life of the isotopes, rapid delivery to centres using them is necessary. Here handicaps are faced due to lack of good transport infrastructure and excessive regulation of transport of radioactive material due to sometimes exaggerated fear of radiation.

For more centres to come up, cheaper machines with minimum necessary features for high quality images and small 'baby' cyclotrons which are less expensive and available on site and which can produce the commonly used radioisotopes, should be produced. Efforts in this direction are already underway.

What is your take on the kind of PET CT available in the market? Any suggestions for improvement?

The PET-CT machines available are mainly high end machines with many features. A menu of machines needs to be offered tailored to the needs of small low volume centres in periphery to the high end tertiary centres with high volume work and research interests.

What kind of research studies are being undertaken in nuclear medicine right now at the global level? Is India a part of any of these studies?

Tremendous research in underway globally in using new, novel radio tracers which address unique features in disease pathology. New tracers in cancer detection, angiogenesis, Alzheimer's disease, myocardial perfusion, receptor imaging of brain are in pipeline. New therapeutic agents for treatment of cancer with nuclear medicine are being explored. Several centres in India are actively participating in this research effort.

Abroad, radiologists can also handle molecular imaging. Why is that not the case with India? Do you see that happening in India?

In India, nuclear medicine is a separate speciality, while abroad it is part of radiology in many countries. Handling of radioisotopes and interpretation of the images requires specialised training. If the Indian radiologists undergo this training, they will also be able to handle molecular imaging. But since there are no short training programmes in nuclear medicine which will qualify and certify radiologists to practice nuclear medicine in India, currently molecular imaging will be interpreted jointly by radiologists and nuclear medicine physicians.

rita.dutta@expressindia.com