In a quest to make treatment more target specific, time and again, scientists have come up with new ways and means to tackle certain diseases in a more effective manner than the conventional method of treatment. Nuclear medicine is one such branch that promises to revolutionise the way diseases are being treated. Use of radioactive material, that too in a controlled and risk free manner, has been touted as one of the most promising weapons to treat diseases such as cancer.
Research at its best
For quite sometime, nuclear medicine has been an area of great interest for Indian researchers. Though the western world has remained a major player in this field traditionally, in India too, nuclear medicine research has started growing by leaps and bounds.
“Major effort is directed towards early diagnosis of debilitating diseases, cancer, heart and neurological diseases such as Alzheimer’s, Parkinson’s and depression. Nuclear medicine techniques are frequently used in development of new pharmaceuticals,” says Padmakar Kulkarni, Professor in Radiology, UT Southwestern Medical Center and Treasurer, Indo-American Society of Nuclear Medicine.
Patients suffering from cancer have benefitted the most with the use of nuclear medicines. As it can highlight the abnormal metabolic activity, spread of cancer in different parts of the body can be discovered with this innovative form of treatment.
 “Nuclear medicine has long been a cornerstone of diagnostic imaging due to its ability to illustrate metabolic activity and provide physicians with the answers they need, sooner than is possible with traditional anatomical modalities.”K N Sudhir Business Head, Molecular Imaging, Siemens Healthcare |
KN Sudhir, Business Head, Molecular Imaging, Siemens Healthcare says, “Nuclear medicine has long been a cornerstone of diagnostic imaging due to its ability to illustrate metabolic activity and provide physicians with the answers they need, sooner than is possible with traditional anatomical modalities. However, globally as well as in India, today’s challenging healthcare environment, where the growing demand for higher-quality, patient-centred care is matched only by the need for definitive and timely answers, the limitations of conventional Positron Emission Tomography (PET)/CT and Single Photon Emission Tomography (SPECT)/CT scanners are becoming more evident.” He further explains, “Nuclear medicine programme is capital intensive, as it requires specialised imaging equipment, needs steady supply of short lived radioisotopes, trained physicians and technologists. Radiation safety is another issue.”
 “Biological processes and the methodologies developed in my laboratory, will not only be useful clinically, but will be very valuable in assessing radiation damage in humans during nuclear terrorism or mass radiation accidents for response planning.”Rao Papineni Scientist and Adjunct Faculty Member at School of Medicine, Kansas University |
Dr. Rao Papineni, Scientist and Adjunct Faculty Member at School of Medicine, Kansas University, explains that body emits light and glows in response to the radiation treatment. This phenomenon of light emitted as packets of photons is biologically called as bioluminescence. Sensitive camera can capture the light that is released by the body. Apart from the natural light produced as bioluminescence, Dr Papineni’s group injected chemical probes in animal models to capture additional form of light called chemiluminescence as a response to the radiation treatment. Papineni says, “This is quite unique from cherenkov light that the tissue produces when the external beam radiation dose is deposited. The illuminating work has been accepted for presentation at 59th Radiation Research Society Meeting at New Orleans, USA in September 2013. Such biological processes and the methodologies developed in my laboratory, will not only be useful clinically, but will be very valuable in assessing radiation damage in humans during nuclear terrorism or mass radiation accidents for response planning.”
Papineni indicates that the chemiluminescent light described here is in response to initial inflammatory response, and further evaluation will pave way to understand and design adoptive cell therapies to aid in improved cancer treatment
Indian market is growing
In the Asia Pacific region, India is seen as the potential market for nuclear medicine. Though countries like Japan have shown the largest use of diagnostic radioisotopes and PET diagnosis, with its rising healthcare budget and growing use of various radiopharmaceuticals in different clinical indications, India is also expected to see an increase in these areas. India’s rising number of cancer patients and talented pool of doctors have further supported analysts’ assumptions that like generic medicines, nuclear medicines will soon become a buzz word in the Indian medicine market.
Dr Prasanta K Pradhan, President, Society of Nuclear Medicine, India, informs, “Nuclear medicine procedures have increased exponentially in India with the availability of positron emission tomography as well as globally. Nuclear medicine research is also growing, which is reflected in the Indian Journal of Nuclear Medicine, an indexed journal in Pubmed. Secondly, the number of abstracts presented in Society of Nuclear Medicine and Molecular Imaging (SNMMI), annual meetings in US and European Association of Nuclear Medicine (EANM) Annual Congress have increased significantly.”
He adds, “These procedures require isotopes, chemical ligands and imaging equipment like gamma camera, PET/CT. Most of the equipment are imported. Many of the radioisotopes are imported while some are produced indigenously and are supplied by Board of Radioisotopes Technology, Mumbai (BRIT) which is a Department of Atomic Energy (DAE) unit, Government of India.”
Need for collective support
Nuclear medicine scientists are doing their job of generating new ideas and converting them into reality. However, developing these medicines, working for their practical applications and public awareness are some of the things that require collective efforts. Organisations like Society of Nuclear Medicine, India and Indo-American Society of Nuclear Medicine (IASNM) are working with scientists, industries and governments to achieve this goal.
 “Development of new radioactive tracers would help in assessing the complicated neurophysiology, neurochemistry and efficacy of new therapeutic regimens. Nuclear medicine will likely play a major role in drug development.”Padmakar Kulkarni Professor in Radiology, UT Southwestern Medical Center and Treasurer, Indo-American Society of Nuclear Medicine |
“IASNM participates in the activities of Indian Society of Nuclear Medicine, particularly, annual meetings and special symposia. It recruits distinguished researchers and educators based in US to travel to India, present invited talks at the annual meetings and at hospitals/universities. Travel fellowships are awarded to young investigators from India to participate in annual meetings of Society of Nuclear Medicine, US. The society selects the best abstracts presentations at the annual SNM meetings (in US) from young clinicians and basic scientists from India. A special programme is offered by IASNM, in which two young physician scientists from India will be sponsored to visit Dr Sanjiv Sam Gambhir’s molecular imaging laboratory at the Department of Radiology, Stanford University,” informs Kulkarni.
Society of Nuclear Medicine, India, is also equally pro-active. Pradhan says, “Society of Nuclear Medicine, India encourages each member to do their research and present it at the annual conference as well as the local chapter meetings. We have earmarked a corpus for facilitating their presentation. The members comprises nuclear physicians, physicists, radiopharmacists, scientists and technologists. It also nominates three orations to senior members from India and abroad each year during the annual meeting. It also provides international travel grant to four students each year to present their research at SNMMI, US or EANM Annual Congress each year.”
Future perfect
Nuclear medicine is a very challenging field and is still in its nascent stage in India. It will take some time before it would be accessible to larger populations. However, defying the odds and through trial and errors, scientists are coming up with more sophisticated and easy to apply forms of nuclear medicine.
Kulkarni says, “Advances in any field would be an evolving process. Advances in individual components propel the field. Further advances in development of imaging agents and imaging devices (hardware, software, image processing, and quantification) will influence the field. Development of new imaging systems (particularly, PET-MRI, SPECT-MRI) is on the horizon. These approaches is likely to reduce the radiation dose to the patients and also help the physicians to better interpret the scans. Development of new radioactive tracers would help in assessing the complicated neurophysiology, neurochemistry and efficacy of new therapeutic regimens. Nuclear medicine will likely play a major role in drug development.”
According to Sudhir, diagnostic imaging is expected to deliver definitive and timely answers to clinical questions and, in today’s increasingly competitive and rapidly changing healthcare environment, these answers must be provided in the safest and most efficient way possible. “While every hospital and physician strives to deliver best care, patient expectations for a comfortable, stress-free imaging experience continue to increase. To meet these growing demands for higher-quality and more patient-centred care, nuclear medicine must overcome the limitations defined by conventional technology,” he opines.
Pradhan says, “New clinical PET-MR equipment is also started offering its value in clinics globally. Small animal imaging with micro PET and micro SPECT also furthers nuclear medicine research which will pave the way for many new drug developments.”
India, home to more than a billion people is also home to different disease types. This population has shown its rising vulnerability to diseases like diabetes, neurological disorders and cancer. Lack of target specific treatment is adding to the death toll caused by cancer, which in turn increases the importance of nuclear medicine. Doctors have understood the potential of this field of medicine. Meanwhile, to nullify the cost factor associated with this treatment, producing nuclear medicines indigenously through the collaboration of manufacturers and government will further help the patients.
