Nuclear Medicine In India: A Futuristic All-Rounder In Medicine

During the current COVID-19 pandemic, Nuclear Medicine has shown utility in the form of ventilation-perfusion scans in patients with COVID related pneumonia, in addition to the already existent portfolio of procedures for patients with various cancers.

New Delhi: Nuclear Medicine is a relatively newer medical specialty, much younger than its traditional counterparts such as Medicine, Surgery, and the closely related branch of Radiology. Nuclear Medicine involves the injection of radioisotopes into the human body to track bodily functions leading to diagnosis of various conditions. Since changes at the functional level precede structural or anatomic changes, Nuclear Medicine investigations play an important role in highly sensitive and early detection of many disease processes. It also includes the usage of radioisotopes for treating different illnesses, mostly cancers. During the current COVID-19 pandemic, Nuclear Medicine has shown utility in the form of ventilation-perfusion scans in patients with COVID related pneumonia, in addition to the already existent portfolio of procedures for patients with various cancers. The COVID-19 has a worse impact on patients with pre-existing morbidities, especially those with cancers undergoing treatment. It becomes imperative, especially in this sub-group of patients, to provide timely, holistic diagnostic and therapeutic care. PET/CT procedures are vital in the management of many of the cancers, including those of breast, lungs, lymphomas, neuroendocrine tumors etc. and thus need to be accessible to the patients, even in these trying times. The initiating step towards its journey in India was the establishment of the Radiation Medicine Centre (RMC) in 1963 by Dr. Homi Jehangir Bhabha, the ‘Father of the Indian Nuclear Programme.’ Since then, the specialty has grown by leaps and bounds in both the public and the private sector. Government institutions such as the PGIMER, Chandigarh, AIIMS, Radiation Medicine Centre, Tata Memorial Hospital and SGPGI, Lucknow are the centres of excellence having state-of-the-art facilities and the most advanced training courses in Nuclear Medicine in India. The private sector is a major player in delivering Nuclear Medicine facilities to the Indian populace and includes several corporate hospitals as well as stand-alone centres. The facilities in these centres, including diagnostic testing and therapies, parallels those in the best centres in the United States and the European Union, and even outperforms them in several areas. A combined approach of academics, research and clinical training has ensured that the Nuclear Medicine trainees are well at par with their global counterparts. The same is witnessed in international conferences, symposia, and is evident by the Indian contribution to the leading international journals of Nuclear Medicine. However, the significant geographical disparity in the availability of Nuclear Medicine procedures in India needs attention, by the policymakers, the healthcare industry leaders, and certainly, by the common man in coercing their elected representatives. The practice of Nuclear Medicine is largely focussed on tier-1 and some major tier-2 cities. Most state-owned medical colleges are yet to start a functioning nuclear medicine department. Again, the number of Nuclear Medicine facilities in the tier-1 and tier-2 cities are limited, leading to a major deficit in the facility: patient ratio. Nuclear medicine departments at government institutions, such as PGIMER remain overburdened and experience huge inflow of the patients, almost always exceeding the facility capacity. The limited permeation of this technology across the country is mostly due to the high setup and maintenance costs, limited availability of skilled manpower and a constant requirement of radioisotopes. The medical cyclotrons are required to provide 18F-FDG, a common radioisotope used in the PET facilities for diagnosis of several cancers and in other non-cancerous conditions. A total of 19 operational cyclotrons and 222 PET/CT facilities were on record in India in the year 2018, for a population of 1.3 billion. The need of the hour is to focus our attention on improving the accessibility of the Nuclear Medicine facilities across the country. The policymakers need to provide exclusive funding to the government institutions for development and functioning of the Nuclear Medicine facilities and incentivize the private players in helping extend its availability. We can also count on international collaborations that would eventually help the facilities in India. In this regard, India -Russia collaboration for the supply of clinically useful radioisotopes and especially the therapeutic radiopharmaceuticals holds a great potential. This kind of initiation at the governmental levels (DAE) between the two countries can help availability, affordability and accessibility of the emerging radiotheranostics to the common patients in India. All the stakeholders need to come together and brainstorm towards addressing this disparity for the benefit of the Indian population. To quote Madam Marie Curie, the discoverer of radioactivity and recipient of the Nobel prize, twice! – ‘I was taught that the way of progress was neither swift nor easy.’ There is a lot that we have achieved, and yet there are miles to go. Together, let us build a better future for the generation to come, with reforming healthcare for one and all. (This article is authored by Dr. Baljinder Singh, Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research (PGIMER)