Annual Report 21 Dec 2011

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					             Annual Report on
RCA/UNDP Project on Promoting and Accelerating
  Nuclear SPECT/PET Imaging Technologies
                in the Region




                December 2011




             RCA Regional Office

                      1
                                  Contents

1. Introduction
   1-1 Project Background
   1-2 Project Objective

2. Project Development and Implementation
   2-1 Project Development
   2-2 Activities of Project Implementation
       2-2-1 Project Implementation Process
       2-2-2 Project Activities Undertaken in 2011

3. Project Results and Analysis
   3-1 Overview of Project Results
   3-2 Analysis of Regional Training Courses
   3-3 Analysis of National Activities and Results

4. Lessons Learned and Recommendations
   4-1 Major Issues and Limitations
       4-1-1 Participating Member States
       4-1-2 Regional Training Courses and National Activities
   4-2 Recommendations


5. Conclusion




                                        2
Annexes:

1. Programme and Curriculum of the Regional Training Courses
 (Train-the Trainers and On-site Training Course, 8-26 August 2011, Seoul, Korea)

2. Country Reports
    2-1 Bangladesh
    2-2 Indonesia
    2-3 Malaysia
    2-4 Mongolia
    2-5 Myanmar
    2-6 Nepal
    2-7 Pakistan
    2-8 Philippines
    2-9 Singapore
    2-10 Thailand
    2-11 Vietnam




                                             3
1.   Introduction

1-1 Project Background

With the expansion of life span and consequent demographical shift in the Region, concerns in
public health have moved to diseases that usually affect middle-aged and older people, such as
cancer, neurodegenerative and cardiovascular diseases, which have emerged as major public
health problems in developing countries. It is expected that early detection of these disorders in
developing countries will increase life expectancy and improve quality of life in the Region.

Nuclear Medicine technologies enable us to identify functional and molecular changes in the
living body, which precede morphological and structural changes. They make it possible to
detect unhealthy conditions earlier, monitor their progressions, and evaluate their responses to
therapeutic measures. Furthermore, with the advent of these imaging technologies, it has become
possible to recognize specific biological processes at molecular levels non-invasively, serially,
and quantitatively for health and disease matters. SPECT/PET (Single Photon Emission
Computer Tomography/Positron Emission Tomography) imaging technologies have been widely
used for the diagnosis and evaluation of oncologic, cardiovascular and neurodegenerative
conditions. They play significant roles in early detection and diagnosis, treatment planning, and
monitoring of therapeutic responses of these diseases.

The advantages of SPECT/PET imaging technology can be signified by their clinical
applications. Newer SPECT/PET technology and further advancement in radiopharmaceuticals
enable visualization of metabolism, blood flow, and other pathological information not easily
evaluable with conventional imaging. These amplified functions allow its applications in the
fields of Neurology (e.g. diagnosis and management of epilepsy, dementia and cerebrovascular
disease), Oncology (e.g. cancer screening, staging, recurrence detection and restaging) and
Cardiology (e.g. evaluation of coronary artery disease and myocardial viability).

Recently, there are growing numbers of nuclear SPECT and PET imaging devices and facilities
in developing countries in the region, which could grow exponentially within the next 5-10 years.
However, these countries suffer from lack of imaging technologies, knowledge of application
techniques, and skilled personnel, which hinder them from effectively utilizing these imaging
devices and facilities both for clinical and research purposes.

1-2 Project Objective
This project aims to promote health to the people in the RCA member states through facilitating
and maximizing the application of Single Photon Emission Computed Tomography (SPECT)
and Positron Emission Tomography (PET) for clinical purposes by transferring knowledge,



                                                4
technologies, and sharing practical experiences of the developed countries, especially Republic
of Korea, to participating developing countries of the project.
Nuclear Medicine technologies will be transferred through the project using strategies such as
train-the-trainers, on-site regional workshops, hands-on practices, interactive and customized
training courses, and intra/inter-regional networking. Topics for training courses will include
disease entities relevant to nuclear imaging, radiopharmaceutical production, image acquisition
and processing, image interpretation and clinical applications including molecular imaging
technologies. This will contribute to the progress of clinical sciences by augmenting the
application of imaging technologies and maximizing the use of imaging instruments and
facilities and enhancing science capabilities in the Region.



2. Project Development and Implementation

2-1 Project Development- RCARO will revise this part

The RCA (Regional Cooperative Agreement for Research, Development and Training Related to
Nuclear Science and Technology for Asia and the Pacific) consists of 17 Member States and has
been recognized as an effective partner in providing nuclear technologies that enhance socio-
economic wellbeing and contribute to sustainable development in the region.

RCA Regional Office (RCARO) on behalf of RCA has promoted the peaceful uses of nuclear
technology to assist Member States in addressing regional and national needs as a part of its
activities. The project was initiated by the RCA Regional Office upon recommendation at the
RCARO Workshop in July 2009 to develop the partnership project with the UNDP.

Upon approval by the RCA General Conference Meeting in 2009, RCARO proceeded to
establish a partnership project with UNDP. RCARO prepared the project proposal in conjunction
with Professor Sang Eun KIM and submitted the proposal to UNDP Regional Office in Bangkok
in November 2010. Following the selection notification in the last week of December 2010,
RCARO made a contract with UNDP on 28 December 2010 with a total fund of US$500,000
($300,000 from UNDP and $200,000 by RCARO matching fund for three years) and 12
participating countries including Singapore as technical provider of the project. Since the annual
review meeting in 2011, Australia joined the project also as technical provider. After RCARO’s
preparatory work, the project was launched successfully holding the kick-off meeting in May
2011 in Phuket, Thailand.

RCARO leads the project with the support of RCA Member States and works in conjunction
with Professor Sang Eun KIM, Seoul National University Bundang Hospital, as the leading
country coordinator and the leading technology provider. The project has been also conducted in

                                                5
collaboration with IAEA/RCA, ARCCNM (Asian Regional Cooperative Council for Nuclear
Medicine), ASNM (Asian School of Nuclear Medicine), and local societies of Nuclear Medicine.

The main goal and scope of the project is to promote and accelerate the use of nuclear imaging
technologies in the RCA Region including Australia, Bangladesh, Indonesia, Korea, Malaysia,
Mongolia, Myanmar, Pakistan, Philippines, Singapore, Thailand, Vietnam and Nepal at the
national levels, and specifically the project will focus on the following aims for three years:

   1) To facilitate the application of SPECT and PET imaging for medical clinics in the Region,
      which have immediate impact on clinical practices;
   2) To set-up learning, training and hands-on practice courses, which cover basic pathology
      with relevance to functional and molecular nuclear imaging, radiopharmaceutical
      productions, imaging and image generation, image analysis and interpretation, and their
      clinical applications;
   3) To establish a regional network of experts and facilities for nuclear imaging technologies.
      The network will provide the channels of communication facilitating nuclear imaging
      technologies and exchange of information in the Region; and
   4) To foster the capability of applications of imaging technologies in research and
      development in the Region.




2-2 Activities of Project Implementation

2-2-1 Project Implementation Process

The activities of the project comprised of a kick-off meeting, annual review meeting, basic
training course, on-site training course, establishment and operation of regional network of
experts and facilities.

The project was implemented in two steps. First step was to train the NPCs (National Project
Coordinator) and nominated doctors from participating Member States through the Regional
Training Courses. Second step was to hold national activities by NPCs and NPTs (National
Project Team) for the dissemination of knowledge, skills and new technologies gained through
the Regional Training Courses to the end-users. Training courses, education, sharing information,
mentoring, updating guidelines for the national communities and applications to the patients
resulted from the project.




                                               6
Beneficiaries of the project will be participants in such training courses and workshops held by
NPCs and associated institutes/organizations responsible for transferring the knowledge and
skills gained to the beneficiaries at the national level (e.g. specialists in consulting, diagnosing
and treating patients). The two-step strategy is expected to maximize the effect of the trained
experts of participating Member States.

2-2-2 Project Activities Undertaken in 2011

Upon finalization of the project contract between RCARO and UNDP, RCARO confirmed the
framework of the project; Leading Country Coordinator (LCC), participating Member States and
National Project Coordinators (NPCs) and launched the project. Thirteen participating countries
are Australia, Bangladesh, Indonesia, Malaysia, Mongolia, Myanmar, Nepal, Pakistan,
Philippines, Republic of Korea, Singapore, Thailand and Vietnam. Australia, Republic of Korea
and Singapore participated as technology providers.

The kick-off meeting was held from May 17 to 19, 2011 in Phuket, Thailand with 21 participants
including the LCC, 12 NPCs and National RCA Representative of Thailand and his staff, and
staff of RCARO, ARCCNM and UNDP. At the meeting, NPCs presented each Member State’s
current status of Nuclear Medicine and future national work plans. The meeting reviewed the
work plan for 2011-2013 and 2011 work plan was confirmed.

The meeting decided as follows;

    1. Regional Training Course holding Train-the-Trainers and On-site Training Course
       consecutively on August 8-26, 2011 in Korea.
    2. Two trainees, National Project Coordinator and one nominated doctor will participate in
       the Regional Training Courses from each participating Member State, but the amount
       and allocation of the budget for 2011 work plan could be changed subject to budget
       availability of the project.
    3. Dr. S. Somanesan (NPC of Singapore) agreed to participate as technology provider and
       deliver lectures during the Regional Training Course.
    4. Training materials will be uploaded on the RCA homepage after the completion of the
       training course for dissemination of the training materials to the participants.
    5. Annual review meeting will be held in the beginning of December 2011.
    6. ARCCNM agreed to support the project by providing lectures for the basic training
       course.

Basic Training Course on SPECT/PET Imaging Science and Technology (“Train-the Trainers”)
was conducted from Aug. 8, 2011 to Aug. 19, 2011 at Seoul National University Bundang
Hospital, Korea. Twenty trainees from 11 countries participated in the course and 46 lecturers
including 20 invited lecturers delivered lectures on a wide range of topics covering a total period
                                                 7
of 67 hours during the training course. In addition, alongside of scientific sessions, special
lectures were arranged by ARCCNM on general aspects of Nuclear Medicine including training,
leadership in Nuclear Medicine and strategy to promote and develop Nuclear Medicine in Asia.
The program and curriculum of the Regional Training Courses are given in the Annex 2.1.

Keeping in view of aims and objectives of the project and training course, a Training Protocol
was developed by a 17 member Committee with Singapore NPC, Korean experts and professors
in Nuclear Medicine and RCARO in June 2011 for producing the training material which
comprised of 17 parts, 28 sections and 70 lectures. The training materials including training
protocol and presentations were uploaded on the RCA website for participants of the Regional
Training Courses to be used freely after completion of the training courses.

On-Site Regional Training Course was provided to fifteen trainees from 10 countries from
Aug.22 to Aug.26, 2011 at six hospitals in Seoul.
Supporting six hospitals which conducted the on-site training were as follows:

    1.   Seoul National University Hospital, Yongon-dong 28, Jongno-gu, Seoul 110-744, Rep.
         of Korea
    2.   Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-
         si, Gyenggi-do 463-707, Rep. of Korea
    3.   Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Rep. of Korea
    4.   Yonsei University Severance Hospital, 250 Seongsan-Ro Seodaemun-Gu, Seoul 120-
         752, Rep. of Korea
    5.   Seoul St. Mary’s Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-040, Rep. of Korea
    6.   Korea University Anam Hospital, Anam-dong 5-ga, Seongbuk-Gu, Seoul 13-705, Rep.
         of Korea

The following will be modified at the annual meeting.
The Annual Review Meeting of the project was held from 20 to 21 December 2011, in Kota
Kinabalu, Malaysia, with 21 participants, among whom including LCC, 13 representatives
including first participation from Australia, staff from RCARO and ARCCNM. At the meeting
representatives presented on the national achievement and outcomes in 2011, work plan for
2012 and expected outcomes of each Member State. The meeting reviewed the annual report and
discussed the work plan for 2012-2013.

The meeting agreed that the Regional Training Courses, Training Course (“Train-the-Trainers”,
one week) and On-Site Training Course (two weeks), will be held for three weeks from in 2012 in
Seoul, Korea. And the meeting decided as follows;


3. Project Results and Analysis

                                              8
3-1 Overview of Project Results

The project was implemented successfully according to the initial 2011 work plan.

The Kick-off meeting of the Project was organized by the RCARO in cooperation with the
Office of Atoms for Peace (OAP) of Thailand from May 17-19, 2011 in Phuket, Thailand with
12 National Project Coordinators of the Member States (MSs), namely Bangladesh, Indonesia,
Korea, Malaysia, Mongolia, Myanmar, Nepal, Pakistan, Philippine, Singapore, Thailand and
Vietnam. The purpose of the meeting was to launch the Project officially and share national
status of Nuclear Medicine in the participating countries and consequently discuss the work
plans for next three years for implementation.

Two training courses (Regional Training Courses) were conducted: (1) Basic Training Course on
SPECT/PET Imaging Science and Technology (“Train-the Trainers”) from Aug. 8 to Aug. 19,
2011 at Seoul National University Bundang Hospital, Korea with twenty trainees from 11
countries; and (2) On-Site Regional Training Course was provided to fifteen trainees from 10
countries of the region from Aug. 22 to Aug. 26, 2011 at six hospitals in Seoul.

The two training courses were successfully completed receiving excellent feedback from most of
the participants. It was generally accepted that the courses met the requirements in terms of
preparation, context and quality of trainers.

The Annual Review Meeting of the project was held from 20 to 21 December 2011 in Kota
Kinabalu, Malaysia, with the 13 representatives including Australia. At the meeting, the
representatives presented the national achievements and outcomes in 2011,the work plan for
2012 and expected outcomes of each Member State. The meeting reviewed the annual report and
discussed the work plan for 2012-2013.

No. of participants in project implementation are 65 in total.

Table 3-1.RCA/UNDP Project Activities and Participants

   Project Activities               Male    Female       Total
   Kick-off meeting                 10      4            14
   Basic training on SPECT/PET      15      5            20
   imaging            science and
   technology
   (“Train-the Trainers”)

   On-site regional training        12      3            15
   course
   Annual Review Meeting            10      6            16
   Total                            47      18           65




                                                 9
3-2 Analysis of Regional Training Courses

After its completion, the satisfactory survey on the Regional Training Courses and lectures were
conducted by RCARO which showed that the participants were very satisfied with the Regional
Training Courses in terms of information sharing, training material, quality and content of
lectures, as well as the quality of the trainers and training programme. Participants evaluated the
Regional Training Courses as more satisfactory in comparison to those organized by other
organizations in terms of preparation, context and quality of trainers.

    -   Basic Training Course: Unsatisfied-0.5%, Normal-11.3%, Satisfied- 42.5%, Very satisfied-45.7%.
    -   Evaluation of Lectures: Unsatisfied-0.24%, Normal-14.35%, Satisfied-34.85%, Very satisfied-
         50.56%.

Majority of the participants suggested the following to improve the quality of Regional Training
Courses in the future:

    -   Introduction of current and more advanced nuclear imaging technology
    -   More extensive lectures in radionuclide therapy
    -   Extend the period for the on-site practical training
    -   Linking between theoretical lectures and practical on-site training

From the survey, it is expected that knowledge, skill, and information gained from the Regional
Training Courses will be disseminated to the medical communities in their respective countries.
This would improve the understanding and raises the awareness about recent advances in
Nuclear Medicine imaging technologies including SPECT and PET and lead to wider application
of Nuclear Medicine procedures in health care within Member States.

Moreover, it ought to be stated that it was not easy or possible to address all the needs of
Member States, as some participants expressed their interest to have more advanced training but
others requested a wider range of training programme, including the basic sciences rather than
focusing only on advanced technology. This is due to the heterogeneous status of Nuclear
Medicine practice in the 11 participating countries.

3-3 Analysis of National Activities and Results

Annual reports have been received from 11 Member States. In 11 Member States, 9 countries
conducted a total of 34 National Training Courses (NTCs) or related seminars according to the
national work plans. Out of 20 participants of the Regional Training Courses, 18 participants
contributed to the NTCs. The overall efficiency of the Regional Training Courses participants
was 90% (i.e. 18/20). The number of local participants was 1,924 (male-884, female-1010) and
they are expected to disseminate SPECT/PET techniques nationwide. The number of patients
treated by the participants of the Regional Training Courses and NTCs using knowledge and
skills gained from the Regional Training Courses were 13,835 and 13,436 respectively, with total

                                                 10
               number of patients more than 27,271(Table 3-2). It was noted that there were difficulties for
               some participating Member States to calculate the number of patients at the national level.

               Considering the short implementation period since the Regional Training Courses and the
               inadequate period for statistics gathering, Member States expect to have a larger number of
               patients treated by recipients of these training courses. Member States are advised to provide a
               more detailed statistics of the improved patient workload for 2011 and future review periods.

               The training materials of Regional Training Courses were found to be very useful and provided
               good guidelines for their clinical practice in the Member States.

               Regarding other associated activities to promote Nuclear Medicine, 11 activities have been
               implemented in 6 Member States, 5 of which were new programs related to
               research/education/training, 4 were preparatory works conducted to introduce new techniques. 1
               published monograms on PET/CT and 1 had an interview on radio and TV.

               Table 3-2.Results of the National Activities

Country   Number     Number of       Number of participants        Number of patients diagnosed and          Number of patients diagnosed and   Number       Number of
          of         participants                                  treated by participants of the Regional   treated by participants of the     of           newly
          National   who                                           Training Courses                          national activities                patients     introduced
          Training   contributed                                                                                                                diagnose     techniques
          Courses,   national                                                                                                                   d     and    and related
          Seminars   activities                                                                                                                 treated at   activities
          etc.,      after     the                                                                                                              national
                     Regional                                                                                                                   level
                     Training        Male     Female    Total      Male     Female      Childr   Total       Male   Female    Chil    Total     Total
                     Courses                                                            en                                    dren

BGD       1          2               65       40        105        180      105         15       300         408    532       2060    3000      3300         3
INS       8          2               278      108       386        80       143         20        243        401    592       0        993       1236
MAL       3          2               64       47        111        -        -           -        1936        -      -         -       N/A       1936+        1
                                                                                                                                                N/A
MON       5          2               108     185        293        -        -           -        1750        -      -         -       N/A       1750         2
MYN       5          2               107     257        364        1387     4977        45       6409        670    1914      20      2604      9013
Nepal     -          -               -       -          -          -        -           -        500         -      -         -       N/A       500
PAK       2          2               -       -          30         538      760         230      1528        2800   2750      850     6400      7928         2
PHI       6          2               238     347        585        42       190         -        232         132    200       -       332       564          1
SIN       -          -               Technology provider country                                 -           -      -         -       -         -
THA       2          2               19      46         65         -        -           -        100         -      -         -       N/A       100
                                                                                                 PET/CT                                         PET/CT
VIE       3          2               25       25        50         -        -           -        1080        -      -         -       7500      8580         2
Total     34         18              884      1010      1924       2227     6175        310      14078       4411   5988      2930    20829     32871        11
                                                                                                                                      +N/A      + N/A




               4. Lessons learned and Recommendations
                       4-1. Major issues and limitations
                      4-1-1. At national level of participating Member States
                      Different issues and limitations were posted by MSs, some of the important issues were:
                             - Lack of adequate and experienced manpower; state-of-the-art equipments and
                                  imaging modalities; and funding for maintaining services.

                                                                                   11
      -   Lack of awareness on the part of clinicians and end-users of nuclear medicine
          technology about various indications for referring patients for SPECT/CT and
          PET/CT examinations.
      -   Lack of any serious research activity due to high cost and limited budget for
          research.


4-1-2. Training
      - During the regional training courses due to gross heterogeneity in the status
         and practice of nuclear medicine in the participating Member States, it was a
         rather difficult task to prepare course contents and programs to address the
         needs and demands of all Member States equally. It is well known that there
         are regional differences in the level of human resources, infrastructure,
         technology, equipment and practice among various Member States.
      - At the national level, one of the major limitations was financial constraints to
         organize national activities like training courses, seminars, workshops etc.

 4-2. Recommendations to resolve limitations at national level
      - Need for active canvassing for obtaining Government support, especially at
         the level of Ministry of Health for allocation of additional funds for human
         resources development through individual and group training activities.
      - To maintain local training activities with available resources, even without
         additional funding support
      - Transfer of technology and knowledge; and expand clinical services by means
         of consultation, inter-hospital conferences, scientific meeting and conferences
         by maximizing the use of using available resources whenever appropriate.
      - In countries with very limited number of Nuclear Medicine personnel, there
         are need for linking the project activities with other ongoing national projects
         in other related fields and topics.
      - Good collaboration with Government as well as RCA Member States and
         expert networking such as the Australian, Japanese, Singaporean and Korean
         Nuclear Medline Society and ARCCNM etc. The expert network will provide
         future platform for any further consultation and collaboration.
      - Participation in specialty societies to disseminate the objectives of the project
         and increase the awareness in latest developments in SPECT/PET.
      - Invite clinicians/specialists to Nuclear Medicine meetings/conferences.
      - Engage government officials in the National Project Team as an
         advisor/patron.


 Recommendations resulting in the feedback received from Training Course
 participants:
     - More advanced topics such as SPECT/PET imaging in oncology, neurology,

                                      12
                   cardiology and radionuclide therapy and extended practical training should be
                   considered in the Regional Training Courses
               -   The next training course should be held earlier in the year in order to have
                   sufficient time for effective implementation in order to have greater impact.
                   Impact can be measured towards the end of the year.




5. Conclusion
The Project Work Plan in 2011 was conducted successfully. Two regional training courses
(RTCs) were conducted and objectives of the project were achieved through positive feedbacks
received from most participants. The satisfactory survey results showed that the courses had
accomplished their goals in terms of course preparation, training programme, information
sharing, training material, quality and content of lectures, as well as the quality of the trainers. It
is expected that the knowledge gained by participants from the training course will be
disseminated to the medical community in their respective countries, which would improve their
understanding and raise the awareness about recent advances in Nuclear Medicine imaging
including SPECT and PET; leading to a wider application of Nuclear Medicine procedures in the
health care of participating countries.

Annual reports have been received from 11 member states. All have been successful in
identifying members of the National Project Team for the project. Most members have launched
major awareness programs in their countries through this project. 20 participants were trained at
the RTCs. Out of 11 MSs, 9 conducted a total of 34 National Training Courses (NTCs),
meetings, interaction with clinicians and seminars with a total of 1924 local participants. This
figure indicates very effective results of the training despite the short period of time after the
RTCs. Some countries also carried out other innovative activities to promote Nuclear Medicine;
for example introduction of new programs related to research/education/training, introduction of
new techniques, publication of books and monograms on PET/CT and use of media like
radio/TV to promote awareness of Nuclear Medicine in their respective countries.

The recommendations made from the Member States included having RTCs in more advanced
topics on SPECT/PET imaging and radionuclide therapy. The duration of on-site training should
be increased for more practical implementation and significant impact on the project in the future.

Satisfactory progress has been made in the implementation of the project till date. It is expected
that activities and objectives of the project could be smoothly achieved by 2013 as planned.

Given the expected accelerated growth of SPECT/PET technology in Member States, this project
is very timely and beneficial to the Member States in promoting and accelerating Nuclear
Medicine for better health care and cost-effective disease management.




                                                  13
14
Annex
1. Programme and curriculum of the Regional Training Courses
   (Train-the Trainers and On-site Training Course, 8-26 August 2011, Seoul, Korea)

1-1 Curriculum of the Basic Training Course on SPECT/PET Imaging Science and Technology (“Train-the-Trainers”)

Time Table - Week 1
                      Mon (Aug. 8)                    Tue (Aug. 9)                Wed (Aug. 10)              Thu (Aug. 11)          Fri (Aug. 12)

              Welcome address & Introduction   III. Radiation Protection in                                                              IX.
9:00-10:00
              to RCA-UNDP Project (09:30)       Nuclear Medicine & PET                                                            Radioimmunoassay

                                                                                                         VII. Endocrine Nuclear
                                                                              V. G.I. Nuclear Medicine
                                                                                                             Medicine (S1)
10:00-11:00
               I. Nuclear Medicine Physics &   IV. Radiopharmaceuticals &                                                          X. International
                    Instrumentation (S1)           Radiochemistry (S1)                                                             Meeting for RIA
11:00-12:00

12:00-1:00                                                                    Lunch

 1:00-2:00
               I. Nuclear Medicine Physics &   IV. Radiopharmaceuticals &      VI. Musculoskeletal       VII. Endocrine Nuclear   XI. G.U. Nuclear
                    Instrumentation (S2)           Radiochemistry (S2)        Nuclear Medicine (S1)           Medicine (S2)        Medicine (S1)
 2:00-3:00


 3:00-3:30                                                     Intermission


 3:30-4:30       II. Radiation Dosimetry in    IV. Radiopharmaceuticals &      VI. Musculoskeletal          VIII. Infection &     XI. G.U. Nuclear
                      Nuclear Medicine             Radiochemistry (S3)        Nuclear Medicine (S1)      Inflammation Imaging      Medicine (S2)
 4:30-5:30

                        Reception
 5:30-8:00
               (Hosted by Director, RCARO)



                                                                        15
Time Table - Week 2

                Mon (Aug. 15)             Tue (Aug. 16)                Wed (Aug. 17)             Thu (Aug. 18)           Fri (Aug. 19)

9:00-10:00
                 XII. Special
              Lectures (S1): How    XIII. Neuroscience Imaging                                 XV. Cardiovascular     XVI. Introduction of
10:00-11:00                                                      XIV. Nuclear Oncology (S1)
                 to be a good                  (S1)                                           Nuclear Medicine (S1)   Molecular Imaging
                    trainer?
11:00-12:00

12:00-1:00                                                                 Lunch

 1:00-2:00
                                    XIII. Neuroscience Imaging                                 XV. Cardiovascular     XVII. Radionuclide
                                                                 XIV. Nuclear Oncology (S2)
                                               (S2)                                           Nuclear Medicine (S2)        Therapy
 2:00-3:00
                  XII. Special
                Lectures (S2):
 3:00-3:30    Sustained growth of                                     Intermission
               Nuclear Medicine
                    in Asia
 3:30-4:30
                                    XIII. Neuroscience Imaging                                 XV. Cardiovascular
                                                                 XIV. Nuclear Oncology (S3)                              NPC Meeting
                                               (S3)                                           Nuclear Medicine (S3)
 4:30-5:30


 5:30-8:00                                                                                                              Official Dinner




                                                                     16
Time Table - Week 3

              Mon (Aug. 22)           Tue (Aug. 23)               Wed (Aug. 24)           Thu (Aug. 25)       Fri (Aug. 26)

9:00-10:00

              On-Site Regional                                                           On-Site Regional   On-Site Regional
10:00-11:00                      On-Site Regional Training   On-Site Regional Training
                 Training                                                                   Training           Training

11:00-12:00

12:00-1:00                                                             Lunch

 1:00-2:00

 2:00-3:00
              On-Site Regional                                                           On-Site Regional
                                 On-Site Regional Training   On-Site Regional Training                        NPC Meeting
                 Training                                                                   Training
 3:00-4:00

 4:00-5:00

                                                                                                              Farewell Party
 5:00-8:00
                                                                                                            (Hosted by PLCC)




                                                                 17
1-1-1 Contents of lectures in detail & Invited Lecturers

Part I. Nuclear Medicine Physics & Instrumentation (4 hrs)
By S. Somanesan, Ph.D.
Senior Principal Radiation Physicist, Dept of Nuclear Medicine & PET, Operations & QA
Manager, Cyclotron facility, PTPL, Singapore General Hospital, Singapore

Section I (2 hrs)
1. Basic atomic & nuclear physics (40 min)
2. Radiation detection & measurement (40 min)
3. Image acquisition & reconstruction (40 min)

Section II (2 hrs)
4. Gamma camera & Single photon emission computed tomography (60 min)
5. Principles of Transverse Tomography (60 min)

Part II. Radiation Dosimetry in Nuclear Medicine (2 hrs)
By S. Somanesan, Ph.D.
Senior Principal Radiation Physicist, Dept of Nuclear Medicine & PET, Operations & QA
Manager, Cyclotron facility, PTPL, Singapore General Hospital, Singapore

Part III. Radiation Protection in Nuclear Medicine & PET (1 hr)
By S. Somanesan, Ph.D.
Senior Principal Radiation Physicist, Dept of Nuclear Medicine & PET, Operations & QA
Manager, Cyclotron facility, PTPL, Singapore General Hospital, Singapore

Part IV. Radiopharmaceuticals & Radiochemistry (6 hrs)
Section I (2 hrs)
1. Production of radionuclides (1 hr) by Kyo Chul Lee, Ph.D.
Senior Researcher, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
2. Production of radiopharmaceuticals (1 hr) by Seung Jun Oh, Ph.D.
Associate Professor, Department of Nuclear Medicine, Asan Medical Center, Seoul, Korea

Section II (2 hrs)
3. PET radiopharmaceuticals (1 hr) by Dong Wook Kim, Ph.D.
Assistant Professor, Chonbuk National University Medical School, Jeonju, Korea
4. Tc-99m radiopharmaceuticals (1 hr) by Byung Chul Lee, Ph.D.
Cyclotron center, Department of Nuclear Medicine, Seoul National University Bundang Hospital,
Seongnam, Korea

Section III (2 hrs)
5. Other radiopharmaceuticals (1 hr) by Yun-Sang Lee, Ph.D.
Senior Research Scientist, Institute of Radiation Medicine, Seoul National University College of
Medicine, Seoul, Korea
6. Quality assurance of radiopharmaceuticals (1 hr) by Sang-Yoon Lee, Ph.D.



                                               18
Senior Researcher, Neuroscience Research Institute, Gachon University of Medicine and Science,
Incheon, Korea

Part V. Gastrointestinal Nuclear Medicine (3 hrs)
1. Hepatobiliary scintigraphy (60min) by Jae Seung Kim, M.D., Ph.D.
Professor, Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College
of Medicine, Seoul, Korea
2. Liver scan and Hemangioma SPECT (30min) by Sae Jung Na, M.D.
Clinical Fellow, Department of Nuclear Medicine, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Korea
3. GI motility scan and bleeding scan (30min) by Sun-Young Chae, M.D.
Clinical Fellow, Department of Nuclear Medicine, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Korea
4. Salivary scan and Radioisotope salivagram (30min) by Hye Ok Kim, M.D.
Clinical Fellow, Department of Nuclear Medicine, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Korea
5. Other GI scan (30min) by Il Ki Hong, M.D., Ph.D.
Clinical Fellow, Department of Nuclear Medicine, Kyung Hee University Medical Center, Seoul,
Korea

Part VI. Musculoskeletal Nuclear Medicine (4 hrs)
1. Introduction of musculoskeletal Nuclear Medicine and bone PET (2 hrs) by Won Woo Lee,
M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Seoul National University Bundang
Hospital, Seoul National University College of Medicine, Seongnam, Korea
2. Bone scan & bone SPECT (2 hrs) by Sung June Jang, M.D.
Head, Department of Nuclear Medicine, National Medical Center, Seoul, Korea

Part VII. Endocrine Nuclear Medicine (5 hrs)
Section I (3 hrs)
1. Thyroid physiology and thyroid scintigraphy (70 min) by Byeong-Cheol Ahn, M.D, Ph.D.
Professor and Director, Department of Nuclear Medicine, Kyungpook National University
School of Medicine and Hospital, Daegu, Korea
2. Diagnostic and post-therapy radioiodine whole body scintigraphy (30 min) by Byeong-Cheol
Ahn, M.D, Ph.D.
Professor and Director, Department of Nuclear Medicine, Kyungpook National University
School of Medicine and Hospital, Daegu, Korea
3. Other nuclear imaging techniques for thyroid diseases (20 min) by Byeong-Cheol Ahn, M.D,
Ph.D.
Professor and Director, Department of Nuclear Medicine, Kyungpook National University
School of Medicine and Hospital, Daegu, Korea
4. Parathyroid physiology and scan (45 min) by Do-Young Kang, M.D., Ph.D.
Director and Associate Professor, Department of Nuclear Medicine, Dong-A Unversity Medical
Center, Pusan, Korea




                                             19
Section II (2 hrs)
5. Adrenal physiology and adrenal cortical and MIBG scan (45 min) by Do-Young Kang, M.D.,
Ph.D.
Director and Associate Professor, Department of Nuclear Medicine, Dong-A Unversity Medical
Center, Pusan, Korea
6. Somatostatin receptor scintigraphy and radiolabeld peptide imaging (45 min) by Kyung Ah
Chun M.D.
Associate Professor, Department of Nuclear Medicine, Yeungnam University Medical Center,
Daegu, Korea
7. PET for neuroendocrine tumor (45 min) by Kyung Ah Chun M.D.
Associate Professor, Department of Nuclear Medicine, Yeungnam University Medical Center,
Daegu, Korea

Part VIII. Infection & Inflammation Imaging (2 hrs)
1. Current imaging of infection and inflammation (1 hr) by Ilhan Lim, M.D.
Staff Physician, Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute
of Radiological and Medical Sciences, Seoul, Korea
2. Principle and Novel imaging of inflammation (1 hr) by Jin Chul Paeng, M.D. Ph.D.
Assistant Professor, Department of Nuclear Medicine, Seoul National University Hospital, Seoul,
Korea

Part IX. Radioimmunoassay (1 hr)
By Ho-Young Lee, M.D.
Clinical Assistant Professor, Department of Nuclear Medicine, Seoul National University
Hospital Boramae Medical Center, Seoul, Korea

Part X. International Meeting for RIA: RIA in Other Asian Countries (2 hrs) arranged by
the Committee of Quality Assurance, Korean Society of Nuclear Medicine
Moderated by Ho-Young Lee, M.D.
Clinical Assistant Professor, Department of Nuclear Medicine, Seoul National University
Hospital Boramae Medical Center, Seoul, Korea

Part XI. Genitourinary Nuclear Medicine (4 hrs)
Section I (2 hrs)
1. Urinary obstruction (30 min), 2. Revovascular hypertension (30 min) by Won-Hyoung Lee
M.D.
Clinical Instructor, Department of Radiology, The Catholic University of Korea, Korea
3. Renal transplant (30 min), 4. Infection, radionuclide voiding cystography & testicular scan (30
min) by Joo-Hyun O M.D.
Clinical Instructor, Department of Radiology, The Catholic University of Korea, Korea

Section II (2 hrs)
5. Renal physiology & radionuclide (30 min), 6. Quantification of Renal Function (30 min), 7.
Image acquisition and renogram (1 hr)
By Kyung-Hoon Hwang, M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Gacheon Medical School, Incheon, Korea

                                                20
Part XII. Special Lectures (7 hrs) arranged by ARCCNM
Moderated by Hee-Seung Bom, M.D., Ph.D.
Professor, Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju,
Korea
 How to be a good trainer? (3 hrs)
 Sustained growth of Nuclear Medicine in Asia (4 hrs)

Part XIII. Neuroscience Imaging (7 hrs)
Section 1
1. Introduction of Nuclear Neuroimaging (40 min) By Yu Kyeong Kim, M.D., Ph.D.
Assistant Professor, Department of Nuclear Medicine, Seoul National University Bundang
 Hospital, Seongnam, Korea
2. Nuclear Medicine in Cerebrovascular disease (60 min) by Sung Jun Jang, M.D.
Assistant Professor, Department of Nuclear Medicine, National Medical Center, Seoul, Korea
3. Alzheimer’s disease and Other Dementias (60 min) by Su Jin Jang, M.D.
Assistant Professor, Department of Nuclear Medicine, CHA Bundang Medical Center, Cha
 University, Seoul, Korea
Section 2
4. Brain Tumor: PET and SPECT (50 min) by Bom Sahn Kim, M.D.
Assistant Professor, Department of Nuclear Medicine, Ewha Womans University, Seoul, Korea
5. Imaging of PET and SPECT in Management of Epilepsy (40 min) by Yu Kyeong Kim, M.D.,
 Ph.D.
Assistant Professor, Department of Nuclear Medicine, Seoul National University Bundang,
 Seoul, Korea
6. Nuclear Neuroimaging in Psychiatric Disorder (50 min) by Ho Young Lee, M.D., Ph.D.
Assistant Professor, Department of Nuclear Medicine, SMG-SNU Borame medical Center, Seoul,
 Korea

Section 3
7. Dopaminergic Imaging in Parkinsonian Syndrome (50 min)
8. Advanced Applications of Functional Neuroimaging (60 min)
By Sang Eun Kim, M.D., Ph.D.
Professor, Department of Nuclear Medicine, Seoul National University Bundang Hospital,
 Seongnam, Korea

Part XIV. Nuclear Oncology (7 hrs)
Section I (3 hrs)
1. FDG PET & PET/CT – Overview (30 min) by Joon Young Choi, M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Korea
2. FDG PET & PET/CT in thyroid, lung and esophageal cancers (75 min) by Joon Young Choi,
M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Korea
3. FDG PET & PET/CT in gastric cancer and sarcomas (45 min) by Tae-Sung Kim, M.D.

                                             21
Staff Physician, Department of Nuclear Medicine, National Cancer Center, Goyang, Korea
4. FDG PET & PET/CT in colororectal cancer (30 min) by So Won Oh, M.D.
Clinical Assistant Professor, Department of Nuclear Medicine, SMG-SNU Boramae Medical
Center, Seoul, Korea

Section II (2 hrs)
5. FDG PET & PET/CT in head & neck cancer, and cancer of unknown primary (30 min) by Gi
Jeong Cheon, M.D., Ph,D,
Associate Professor, Department of Nuclear Medicine, Korea University Anam Hospital, Seoul,
Korea
6. FDG PET & PET/CT in breast cancer and malignant lymphoma (50 min)
7. Non-FDG PET (40 min)
By Jong Jin Lee, M.D., Ph.D.
Assistant professor, Department of Nuclear Medicine, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Korea

Section III (2hrs)
8. FDG PET and PET/CT in Genitourinary Malignancy         (30 min) by Seok-ki Kim, M.D.
Chief, Department of Nuclear Medicine, Molecular Imaging and Therapy Branch, National
Cancer Center, Goyang, Korea
9. FDG PET/CT in Hepatobiliary Malignancy (30 min) by Tae Joo Jeon, M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Yonsei University College of Medicine,
Seoul, Korea
10. FDG PET & PET/CT in Malignant Melanoma (20 min) by Young Hwan Kim, M.D., Ph.D.
Assistant professor, Department of Nuclear Medicine, College of Medicine, Hanyang University
Medical Center, Seoul, Korea
11. Other tumor scans (40 min) by Seung Hwan Moon, M.D.
Clinical Instructor, Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Korea


Part XV. Cardiovascular Nuclear Medicine (7 hrs)
Section I (3 hrs)
1. Instrumentation & analysis (30 min) by Byung Il Lee, Ph.D.
Director, Medical Photonics Research Center, Korea Photonics Technology Institute, Korea
2. Radiopharmaceuticals (30 min) by Kyoung Sook Won, M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Keimyung University Dongsan Medical
Center, Daegu, Korea
3. Myocardial perfusion SPECT (2 hr) by Ihnho Cho, M.D., Ph.D.
Professor, Department of Nuclear Medicine, Yeungnam university hospital, Daegu, Korea

Section II (2 hrs)
4. Ventricular function (30 min) by Kyoung Sook Won, M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Keimyung University Dongsan Medical
Center, Daegu, Korea
5. Cardiac neurotransmission imaging (30 min) by Gi Jeong Cheon, M.D., Ph.D.

                                             22
Associate Professor, Department of Nuclear Medicine, Korea University Anam Hospital, Seoul,
Korea
6. Myocardial viability (1 hr) by Seok Tae Lim, M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Chonbuk National University Hospital,
Chunju, Korea

Section III (2 hrs)
7. CT angiography & cardiac MRI (1 hr) by Song Choi, M.D., Ph.D.
Assistant Professor, Department of Radiology, Chonnam National University Hwasun Hospital,
Hwasun, Korea
8. Cardiac PET & PET/CT (1 hr) by Hee-Seung Bom, M.D., Ph.D.
Professor, Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju,
Korea

Part XVI. Introduction of Molecular Imaging (3 hrs)
By Jung-Joon Min, M.D., Ph.D.
Associate Professor, Department of Nuclear Medicine, Chonnam National University Medical
School, Gwangju, Korea

Part XVII. Radionuclide Therapy (2 hrs)
1. I-131 Therapy for Thyroid Cancer and KTA Guideline (40 min) by Byung Il Kim, M.D., Ph.D.
Director, Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of
Radiological and Medical Sciences, Seoul, Korea
2. Guidelines on I-131 MIBG therapy (20 min) by Iilhan Lim, M.D.
Staff Physician, Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute
of Radiological and Medical Sciences, Seoul, Korea
3. Principle of PRRNT and Clinical Application (20 min) by Byung Il Kim, M.D., Ph.D.
Director, Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of
Radiological and Medical Sciences, Seoul, Korea
4. Radionuclide Therapy for Bone Pain (20 min) by Ilhan Lim, M.D.
Staff Physician, Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute
of Radiological and Medical Sciences, Seoul, Korea
5. Principle of RIT and Clinical Application (20 min) by Byung Il Kim, M.D., Ph.D.
Director, Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of
Radiological and Medical Sciences, Seoul, Korea


1-3 Programme of the On-Site Regional Training Course (Aug. 22, 2011 – Aug. 26, 2011)
    - List of the hospitals and allocated trainees


1. Seoul National University Hospital, Yongon-dong 28, Jongno-gu, Seoul 110-744, Rep. of
Korea
Contact to Dr. Keon Wook Kang (C.P.: 82-10-9096-1927, kangkw@snu.ac.kr)
Participants: Dr. Raihan Hussain (Bangladesh), Dr. Nurun Nahar (Bangladesh),
              Dr. Boon-Nang Lee (Malaysia), Dr. Fadzilah Hamzah (Malaysia)

                                             23
2. Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si,
Gyeonggi-do 463-707, Rep. of Korea
Contact to Dr. Yu Kyeong Kim (C.P.: 82-10-3686-3181, yk3181@snu.ac.kr)
Participants: Dr. Emerita Andres Barrenechea (Philippines), Dr. Francis Gerard Estrada
(Philippines)
       Dr. Nguyen Van Kinh (Vietnam), Dr. Chuong Thanh Nguyen (Vietnam)

3. Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Rep. of Korea
Contact to Dr. Joon Young Choi (C.P.: 82-10-9933-2648, jynm.choi@samsung.com)
Participants: Dr. Tin Swe (Myanmar), Dr. Kyin Myint (Myanmar), Dr. Ram Krishna Shrestha
(Nepal)


4. Yonsei University Severance Hospital, 250 Seongsan-Ro Seodaemun-Gu, Seoul 120-752, Rep.
of Korea
Contact to Dr. Mijin Yun (C.P.: 82-11-9068-7552, yunmijin@yumc.yonsei.ac.kr)
Participants: Dr. Erwin Affandi Soeriadi (Indonesia), Dr. Resnaldi (Indonesia),
               Dr. Chanisa Chotipanich (Thailand), Dr. Usanee Vutrapongwatana (Thailand)

5. Seoul St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-040, Rep. of Korea
Contact to Dr. Ie Ryung Yoo (C.P.: 82-10-4781-1475, iryoo@catholic.ac.kr)
Participants: Dr. Kashif Niaz (Pakistan), Dr. Javaid Iqbal (Pakistan)

6. Korea University Anam Hospital, Anam-dong 5-Ga, Seongbuk-Gu, Seoul 136-705, Rep. of
Korea
Contact to Dr. Gi Jeong Cheon (C.P.: 82-10-8717-7067, larrycheon@gmail.com)
Participants: Dr. Sereegotov Erdenechimeg (Mongolia), Dr. Enkhtuya Byambajav (Mongolia)




2. Country Reports

2-1 Bangladesh

1)   National status


     a) Equipment



                                             24
         Planar Gamma Single          Head Dual  Head SPECT-CT                 PET-CT
         Camera       SPECT                SPECT
             11           11                  14         1                          2

     b) Manpower:
        About 100 Nuclear Medicine physicians, 20 medical physicists, 10 radiochemists and 150
        technologists are working in the country

2) End-users/beneficiaries
   Institute of Nuclear Medicine & Ultrasound (INMU) is the National Coordination Agency in
   Bangladesh. It coordinates and implements training of its own manpower as well as of the
   manpower from the different Nuclear Medicine establishments of the country.

3) Results of national activities
   a) One major national seminar with a total of 105 participants was successfully conducted.
   b) A total of approximately 1300 patients have been treated by the participants
   c) To promote awareness about NM regular contacts are being made with the clinicians
   d) Encouragement is given to NM personnel to attend international conferences and
      meetings
   e) Lobbying with the government policymakers for establishment of PET-CT & cyclotron
      facility at INMU. Government has recently approved the project.

4)    Major issues and limits
     a) Lack of good number of experienced manpower
     b) Lack of very advanced equipment and imaging modalities
     c) Financial limitation

5) Recommendations to resolve the limits and issues
   a) Proper training of manpower: Through this project it is expected that there will be
      improved quality of trained manpower.
   b) Advanced equipments: The project can give emphasis on quality control and ways of
      proper maintenance of the equipment.
   c) Financial limitation: We should try to convince our authority to provide more financial support.
6) Expected outcomes and long term benefits
   a) Improvement in the nuclear SPECT/PET imaging technologies will contribute to better,
      faster and more accurate diagnosis of the disease process.
     b) Thus this will result in better clinical management
     c) With better and more specific imaging facilities we can avoid many investigations,
        which will reduce the time and cost.


                                                 25
    d) At present many persons go abroad for better treatment, which drains a lot of monetary
       loss of the country. If we can provide better treatment facilities, there will be decrease in
       the numbers.
7) Sustainable capacity development
    a) Development of manpower
    b) Improved protocols
    c) Standardization of the imaging and therapeutic procedures
    d) Close cooperation between the Lead country and the member states.

8) Recommendation
   a) Arranging a Training Program could be recommended in Bangladesh. This will be a great
      opportunity for the local participants to learn directly from the resource persons. For
      practical reasons it is not possible for all of them to visit developed facilities abroad.
   b) Vice-versa this will also create a scope for the resource persons from the developed
      countries to have a first hand impression of the problems in a developing countries.


2-2 Indonesia

1) National status

    a) Technical status of NM Department:
        No of hospital in Indonesia provide Nuclear Medicine services         : 15
        No of institution for Nuclear Medicine specialist educational program : 1
        No of institution for radiophamacist master program                : 1
           No           Equipments                                     Number

            1            Single head SPECT camera


            2            Double head SPECT camera


            3            SPECT/CT camera                                  4

            4            PET/CT camera                                    3

            5            Cyclotron                                        4

            6            Thyroid Uptake System                            2

            7            Renograph probe                                  7



                                                26
             8           Surgical probe                                    2

             9           Gamma counter for RIA                             3


    b) Staff:
             No          Man Powers                                        Number

             1           Nuclear Medicine Physician                        31

             2           Physicist                                         4

             3           Technologist                                      30

             4           Radiopharmacist                                   10

             5           Nuclear Medicine residents                        19

             6           Master Student for Radiopharmacist                4


    c) Services (annually): N/A

2) End-users/beneficiaries
Project will be implemented not only at the 15 hospitals with Nuclear Medicine facilities, but
also all hospitals in Indonesia, particularly closed to Nuclear Medicine facilities, In spite of this,
Nuclear Medicine and non-Nuclear Medicine physicians’ interest in this project will be involved
for transferring the benefits of the project to the beneficiaries.

3) Results of national activities
   a) There are a total of 8 national activities conducted with a total of approximately 387
      attendances. 2 lecturer from Singapore and 8 local lecturers, as well as 2 participants of
      two Training Courses gave lectures in the national activities as follows:
       - Focus Group Discussion on GMP for in house radionuclide and radiopharmaceutical
         productions.
       - Symposia on the Management of the Thyroid Cancer at the Annual Scientific Meeting
         of Oncological Surgeons
       - Symposia on Nuclear Medicine for Non-Nuclear Medicine Physicians,
       - Workshop on QA in radiopharmaceutical
       - Workshop on QC and QA in Gamma Camera and PET/CT Camera
    b) 2 new residents will joint NM specialist program, which will be play important to the
       development of capacity building.
    c) Established contact with cold kit supplier company which solved problem with shortage

                                                 27
       of Radiopharmaceuticals;

4) Lessons learned
   a) Improvement knowledge and skills capability of Nuclear Medicine physicians is very
      important, as well as knowledge of referring physicians on the role of Nuclear Medicine
      in the management of diseases.
   b) Nuclear Medicine techniques on Neurology are still very limited
   c) Needs to convince the government that it is time to upgrade NM facilities, both
      equipment and man power.

5) Major issues and limits
   a) A small number of NM physicians and concentrated in Jakarta
   b) Lack of appropriate equipment particularly at hospitals out of Jakarta and Bandung
   c) Insufficient knowledge of non-NM physicians about Nuclear Medicine.
   d) Availability of radiopharmaceutical

6) Recommendations to resolve the limits and issues
   a) It is important to continue regular activities on dissemination of Nuclear Medicine among
      non-Nuclear Medicine physicians.
   b) Increase number of NM professionals, NM departments & equipments
   c) Expand clinical NM applications
   d) Government financial support

7) Expected outcomes and long term benefits
   a) Increased number of Well trained personnel
   b) Maximized and accelerated of NM applications
   c) Standardized protocols by using national guidelines
   d) Sustainability

8) Sustainable capacity development
   a) Regular training, workshop, conferences
   b) Well designed development Work Plan
   c) Increase number of NM professionals and NM facilities
   d) Good collaboration with Government as well as RCA Member States and expert
   e) network etc.

2-3 Malaysia

1) National status
Essentially, Nuclear Medicine is recognized as an independent specialty by the Ministry of
Health since 2002. Nuclear Medicine has been given departmental status since 2006. All gamma

                                              28
camera systems in the country (public and private) are SPECT capable. PET-CT cameras exist in
public and private sectors. There are presently 3 cyclotrons in the country. Majority of NM work
is provided by the public sector. NM specialists thus far are specialists in other disciplines eg.
Internal Medicine, Radiology, who have had further training in NM. The Masters of Nuclear
Medicine program started in a local university in 2008 – the first batch of NM Specialists is
expected to graduate in June 2012.

2) End-users/beneficiaries
The project was implemented in the Institutes/ hospitals in which trainers are attached i.e. in
Kuala Lumpur Hospital & Penang Hospital. In addition, National seminars/updates/courses were
held [organized by National Committee on Nuclear Medicine (Health Ministry Level)]
    a) Two national activities were conducted with approximately 71 people attending.
    b) Another national activity (through the university) is planned after the Annual Review
       Meeting) – anticipated number of participants – 30 to 40
    c) Continuing contribution in training Masters of Medicine Trainees (6 in final year; 6 in
       Year 3; 7 in Year 2 and 3 in Year 1)
    d) Approximately 1582 diagnostic tests and 354 patients have been treated by the
       participants

3) Results of national activities
   a) Two national activities were conducted with approximately 71 people attending.
   b) Another national activity (through the university) is planned after the Annual Review
      Meeting) – anticipated number of participants – 30 to 40
   c) Continuing contribution in training Masters of Medicine Trainees (6 in final year; 6 in
      Year 3; 7 in Year 2 and 3 in Year 1)
   d) Approximately 1582 diagnostic tests and 354 patients have been treated by the
      participants

 4) Lessons learned
Through this program, we can see the extent advanced Nuclear Medicine can be practiced in a
developed country if there is enough commitment and cooperation from the group of Nuclear
Medicine doctors together with education to non Nuclear Medicine professionals and support
from the government.

5) Major issues and limits
   a) Limited number of trainers so far (about 4 so far contributing to training of Masters of
      Nuclear Medicine candidates) with rather heavy daily work.
   b) Limited training funds for training activities at local (hospital) level and national level.

6) Recommendations to resolve the limits and issues


                                               29
    a) Increase the number of trainers
        when the first batch of Masters of Nuclear Medicine candidates pass in 2012.
    b) Lobbying at MOH level for training funds; continue local training activities even without
       funding support

7) Expected outcomes and long term benefits
   a) Well trained NM professionals together with support groups
   b) Harmonized levels of standards of practice of NM in the country through standardized
      protocols especially in SPECT and PET
   c) Advanced level of practice of NM in the country to be possible and hopefully routine in
      daily patient care

8) Sustainable capacity development
   a) Increased in trainer numbers is a requirement for sustainable human capacity
      development in the country. Support from government and agencies like IAEA-RCA is
      required and funding as well
   b) Regular regional training workshops and conferences especially is a good avenue for
      human capacity development.

9) Recommendation
This project is very beneficial to Malaysia in her efforts to train NM professionals in the country
by providing theoretical and practical knowledge in developed countries for the trainer and
potential trainers alike. The networking achieved will be the further platform for any future
consultations and collaboration.


2-4 Mongolia

1) National Status
 Mongolia has only one Nuclear Medicine Department in whole country (2.75 mln. populations)
at the First State Central Hospital. The FSCH is the largest one among 16 specialized hospitals in
Mongolia with 640 bed and 28 departments.

Technical status of NM Department:
    a) Single head SPECT camera (Elscint APEX SP-1)
    b) Thyroid Uptake System –Atomlab 950 PC Spectrometer
    c) Shielded biological safety cabinet
    d) Gamma counter for RIA

Staff:
     a) Nuclear Medicine Physician – 4
     b) Physicist – 1

                                                30
    c) Technologist – 3
    d) No trained Radiopharmacist yet

Services (annually):
    a) SPECT imaging – 1800-2000 patients
    b) Radionuclide therapy 130-150 patients
    c) Radioimmunoassay tests – 3000 patients

2) End-users/beneficiaries
Project will be implemented at the Department of Nuclear Medicine of FSCH. In spite of this,
Nuclear Medicine and non-Nuclear Medicine doctors from 5 follow named specialized hospitals
and Department of Radiology of HSMU of Mongolia will be involved for transferring the
benefits of the project to the beneficiaries.
    a) First State Central Hospital
    b) 2nd General Hospital
    c) Shastin General Hospital
    d) National Cancer Center
    e) Child Care Clinical Hospital
    f) Department of Radiology of HSMU of Mongolia

3) Results of National activities
   a) Five national activities with a total of approximately 290 participants were successfully
      conducted.
   b) A total of approximately 1750 patients have been treated by the participants
   c) Groundwork to introduce new technique: high dose I-131 therapy of Thyroid CA has
      been started
   d) Participation in the RIA IEQAS to achieve quick and accurate RIA diagnostic system in
      Mongolia has been initiated
   e) Established contact with cold kit supplier company which solved problem with shortage
      of Radiopharmaceuticals;

4) Lessons learned
   a) Significant needs to improve recent NM knowledge among both NM and non-NM
      doctors
   b) Nuclear Medicine techniques on Oncology and Neurology in Mongolia are still very
      limited
   c) Needs to convince the government that it is time a) to upgrade NM facilities; b) to start
      planning establishment of PET Center in Mongolia

5) Major issues and limits
   a) A small number of NM professionals

                                              31
    b) Insufficient knowledge of non-NM physicians about Nuclear Medicine
    c) Limits of linking theoretical knowledge with practice due to limited availability of
       facilities and PET/CT technique in Mongolia

6) Recommendations to resolve the limits and issues
   a) Essential to continue regular educational activities
   b) Need to link with other programme and incorporate National workshop due to limitation
      of NM personnel in country
   c) Increase number of NM professionals, NM departments & equipments
   d) Expand clinical NM applications
   e) Government financial support

7) Expected outcomes and long term benefits
   a) Well trained personnel
   b) Maximized and accelerated NM applications in Mongolia
   c) Standardized protocols
   d) Sustainability:
      o Regular training, workshop, conferences
      o Well designed development Work Plan
      o Increase number of NM professionals and NM facilities
      o Good collaboration with Government as well as RCA Member States and expert
         network etc.

8) Recommendation
This project is very useful for Mongolia, and with expected outcomes of the project the progress
of development of NM in Mongolia will be promoted. Recently, our government made a
decision to install PET/CT and cyclotron at the National Diagnostic & Treatment Center by
2013-2014. Therefore, we are expecting that the gained knowledge from the project will be very
valuable input for us to start operate this advanced new technique in Mongolia.


2-5 Myanmar


1) National Status
Although there are five Nuclear Medicine Departments only two tertiary, hospitals in Yangon
and Mandalay have running SPECT Gamma camera facilities with well established in-vitro
isotopic laboratory now.
     a) Equipments
             No        Type                                 Quantity
             1         SPECT Gamma Camera                   2+one will be installed


                                              32
                                                                 in 2012
        2         PLANAR Gamma Camera                      3
        3         Thyroid uptake unit                      2
        4         Gamma Counter for RIA                    2+one will be installed
                                                             in 2012
        5         Laboratory Equipments                    2
        6         Hot lab Equipments                       2
        7         Radiation Monitors                       4
        8         Computer and network system              1

b) Staff of the Department of Nuclear Medicine
         No        Category                                Appointed
         1.        Professor                               Vacant

        2.        Associate Professor                      1

        3.        Consultant                               3

        4.        Specialist AS                            3

        5.        Assistant Physicist                      1

        6.        Technologist In-vivo                     7

        7.        Technologist In-vitro                    4

        8.        Nurse                                    4

        9.        Clerk                                    1

        10.       Menial                                   5


c) Clinical Services

        No        Services                     Quantity
        1         Out-patients clinic          Average    2550   Monthly
        2         SPECT imaging                Average     250   Monthly
        3         RIA - patient                Average     500   Monthly
        4         I-131 therapy                Average      40   Monthly



                                          33
    d) Academic Training Program

        Type                                                          Quantity
        Post-graduate Diploma                                         7
        Post-graduate M.Med.Sc                                        7
        Speciality Training to other post-graduate M.Sc Residents     Uncountable

    e) Government Support
       Infrastructure, Man-power & Maintenance services of the running instruments of all the
       Departments
    f) Guideline for treating Patients
       We have our own hospital guideline for patient care and in-house protocols for all the
       Nuclear Medicine procedures. Radiation protection service was run by the department of
       atomic energy in Yangon under the guidance of IAEA.

2) End-users beneficiaries
All the Nuclear Medicine departments cover the health care system of upper, middle, and lower
Myanmar. As a policy, we run almost free service to the patients. The patient has to pay only a
little charge as a cost-sharing system, though we have no health insurance service at the present
moment. Training of the Nuclear Medicine clinicians to the state-of-the art technologies can
assist the development of health care system in Myanmar, by improving the diagnosis and
treatment methodology.

Although the project is mainly implemented at the department of Nuclear Medicine of Yangon
General Hospital, non Nuclear Medicine doctors of the following five hospitals will be involved
for transferring the benefits to the beneficiaries. They are;
     a) New Yangon General Hospital
     b) Central Women Hospital
     c) Central Children Hospital
     d) East Yangon General Hospital
     e) West Yangon General Hospital

3) Results of national activities
   a) Four national activities with a total of 299 participants were successfully conducted.
   b) A total of approximately 6409 patients have been treated by the participants after
      attending Basic Training Course.




                                               34
    c) A total of approximately 2604 patients diagnosed and treated by doctors/specialists using
       disseminated /transferred knowledge, skills and new technologies by participants in the
       project training.


4) Lessons learned: Major issues and limits
   a) Although we have five Nuclear Medicine departments, Nuclear Medicine specialist
      doctors and technologists are a few numbers. So it needs to expand Nuclear Medicine
      professionals.
   b) Non-Nuclear Medicine doctors are not well known about what Nuclear Medicine is and
      why a Nuclear Scan is needed.
   c) Budgetary constraint is major barrier to purchase new product camera, RI and
      radiopharmaceutical kits.
   d) Poor maintenance service of infrastructure is also one of the limitations.

5) Recommendations to resolve the limits and issues
   a) Improvement of number and quality of Nuclear Medicine professionals and fully
      equipped Nuclear Medicine departments.
   b) It is essential for increased government financial support.
   c) It is needed to participate in monthly CME program, seminars, symposium to talk about
      Nuclear Medicine services and their effectiveness improving awareness in advantages of
      SPECT capabilities to medical doctors as well as the public.

6) Expected outcomes and long term benefits
   a) Narrowing of the gap of Nuclear Medicine facilities between Myanmar and other
      developed countries.
   b) Augmentation of SPECT/PET imaging science and technologies in Myanmar Nuclear
      Medicine societies.
   c) By enriching qualified Nuclear Medicine personnel, knowledge transfer and experiences
      among the Nuclear Medicine and other medical societies in Myanmar.
   d) Improving awareness in advantages of SPECT capabilities to medical doctors as well as
      the public.
7) Sustainable capacity development
   a) Enriching qualified Nuclear Medicine personnel
   b) Share the knowledge and experience among our colleagues, and other specialties such as
      Physicians, Surgeons, Oncologist, Cardiologists and Neurologists at workshop,
      conference and seminar in local region as well as abroad

8) Recommendation



                                              35
      a) As for Myanmar, this project is very precious and fulfilled the advanced SPECT and PET
         technologies.
      b) Nuclear Medicine facilities in Myanmar will be fruitfully promoted very soon.
      c) Implementation of project is essential.




2-6    Nepal

1) National Status
Nepal has only one Nuclear Medicine Centre in whole country (2.60 Million populations) at the
MRI(Pvt.). Recently one more NM unit has been started in an oldest 500 beded centeral
specialized Govt. Hospital, Bir Hospital.

      Technical status of NM Department:
      a) Single head SPECT camera (Seimens E-cam)-MRI
      b) Double head SPECT camera(Mediso)

       Staff:
      a) Nuclear Medicine Physician – 2
      b) Physicist – 2
      c) Technologist – 2
      d) No trained Radiopharmacist yet

      Services (annually):
      Planar imaging – 1,800 patients/Very few no.-SPECT.

2) End-users/beneficiaries
Project will be implemented at the Department of Nuclear Medicine MRI/BH. In spite of this,
Nuclear Medicine and non-Nuclear Medicine doctors from 5 follow named specialized hospitals
and Department of Radiology of HSMU of Mongolia will be involved for transferring the
benefits of the project to the beneficiaries.
    a) B & B hospital
    b) National Kidney Center
    c) Tribhuvan University teaching hospital
    d) Om hospital
    e) BPKIHS, Dharan
    f) Bir Hospital

3) Results of national activities

                                               36
    a) A total of approximately 500 patients have been treated by the participant.

4) Expected outcomes and long term benefits
   a) Well trained personnel
   b) Maximized and accelerated NM applications in Nepal
   c) Standardized protocols
   d) Sustainability

5) Sustainable capacity development
    a) Regular training, workshop, conferences
    b) Well designed development Work Plan
    c) Increase number of NM professionals and NM facilities
    d) Good collaboration with Government as well as RCA Member States and expert network
       etc.
6) Recommendation
This project is very useful for Nepal, and with expected outcomes of the project the progress of
development of NM in Nepal will be promoted. Implementation of the project is needed.


2-7 Pakistan

1) National Status
Nuclear Medicine started in Pakistan in 1963 at Karachi & Lahore under management of
Pakistan Atomic Energy Commission (PAEC). Now 14 PAEC Nuclear Medicine centers (160
million populations) are under operation and 4 new centers are being constructed. This facility is
a part of mission of PAEC to provide state of the art health care diagnostic and treatment
facilities to the needy population specially cancer patients

    Technical status of Nuclear Medicine in Pakistan:
    a) SPECT Gamma Cameras                         32
    b) SPECT/ CT Gamma Camera                      02
    c) PET/ CT Scan                                02
    d) Cyclotron                                   02
    e) Rectilinear Scanners                        03
    f) RIA (Gamma Counters)                        11
    g) Dose calibrators                            15
    h) Bone Mineral densitometry                   01
    i) Urea Breath Test System                     02
    j) Gamma Surgical Probes                       03
    k) RAI Uptake system                           08


                                               37
 Staff:
a) Nuclear Medicine Physicians                  84
b) Nuclear Medicine Technologists               91

Services:

Diagnostic Procedures
a) Myocardial Perfusion SPECT studies
b) Skeletal Scintigraphy
c) Thyroid Imaging
d) Scintimammography
e) Hepatobiliary Scintigraphy
f) Brain Scintigraphy
g) Lung Perfusion Scans
h) Salivary glands imaging
i) Testicular Scintigraphy
j) GFR Studies
k) First pass studies and MUGA studies
l) GI Bleed Scan
m) Dynamic renal scanning
n) Static renal scanning.
o) VUR studies
p) Brain Scans.
q) MIBG Scan
r) Gallium Scan
s) Infection and inflammation imaging
t) Parathyroid scintigraphy
u) Lymphoscintigraphy &Sentinel Lymph node study

Therapeutic Procedures
a) I-131 treatment for Hyperthyroidism
b) I-131 treatment for well-differentiated thyroid cancer
c) Radiation synovectomy
d) P-32 Therapy

Teaching & Training
a) PAEC centers are recognized for the teaching of following programmes
b) FCPS (Nuclear Medicine) from College of Physicians and Surgeons (CPSP)
c) MSc (Nuclear Medicine) from PIEAS


                                           38
     d) DNMT from Universities
     e) IAEA fellow

     Research & Development
     a) Regular lectures and presentation
     b) A society named Pakistan Society of Nuclear Medicine (PSNM) is established
     c) Regular workshops and conferences are held under PSNM
     d) Thesis studies are done for the requirement of FCPS and MSc
     e) IAEA funded projects

2) End-users/beneficiaries
Project will be implemented at the Department of Nuclear Medicine of Karachi Institute of
Radiotehrapy and Nuclear Medicine KIRAN). KIRAN is one of the 14 Nuclear Medicine centers
in the country under management of PAEC. The departments of Nuclear Medicine of all 14
PAEC hospitals, faculty of Nuclear Medicine of Pakistan institute of engineering & applied
sciences (PIEAS) and Pakistan society of Nuclear Medicine (PSNM) will be involved for
transferring the benefits of the project to the beneficiaries.

3) Results of national activities
   a) Two national activities with a total of approximately 30 participants were successfully
      conducted.
   b) A total of approximately 1528 patients have been diagnosed and treated by the
      participants
   c) Started 2 new research studies for the thesis of residents of Nuclear Medicines
   d) Groundwork to introduce new technique PET in the region

4) Lessons learned
   a) The importance of research in the field of Nuclear Medicine is so much to keep alive this
      field in the country
   b) Importance of upgrading the facilities for advanced molecular imaging.
   c) Need to increase the number of cyclotron and PET scanners in all oncology centers in the
      country

5) Major issues and limits
   a) Found very limited time to arrange a seminar/ workshop at national level
   b) Difficult in arranging any international conference due to adverse security situation in the
      country

6)    Recommendations to resolve the limits and issues
     a) The next training course should be held earlier in order to have sufficient time for


                                               39
       evaluating any significant impact at end of the year
    b) Increase number of NM professionals, NM departments & equipments
    c) Expand clinical NM applications
    c) Government financial support and security assurance

7) Expected outcomes and long term benefits
   a) Well trained Nuclear Physicians
   b) Advanced NM applications like PET in the region (Karachi)
   c) Standardized protocols
   d) Sustainability

8) Sustainable capacity development
   a) Regular training, workshop, conferences
   b) Well designed development Work Plan
   c) Increase number of NM professionals and NM facilities
   d) Good collaboration with Government as well as RCA Member States and expert
      net work, etc.

9) Recommendation
The duration of training especially on site training should be increased for successful and
practical implementation and productive results of the project in the future


2-8 Philippines

1) National status
     Nuclear Medicine doctors                79, 61 are actively practicing and some are
                                             training residents

     Nuclear Medicine technologists          112

     Radio chemists                          2

     Radio pharmacists                       7

     Physicists                              7


     Number of nuclear medical centers       36

     Gamma cameras with SPECT capabilities   48

     SPECT-CT                                2


                                             40
     PET cyclotron                              1

     PET-CT                                     2


The Philippines has only one hospital with 2 branches, one in Quezon City and one in Global
City with PET facilities. They share one baby cyclotron located in St. Luke's Quezon City and is
a private hospital. Governmental sector under Philippine National Research Center still
negotiates to have a cyclotron for the country to be shared by several government and private
hospitals. Human recourses enough but with the expanding population we need to train more
doctors and technologists as well as physicists, radio- pharmacists and radio chemists.

2) End-users/beneficiaries
Philippine Society of Nuclear Medicine as the main organization; PNRI as institution and
primarily the Nuclear Medicine physicians have the duties to inform and disseminate the new
technologies to doctors-family physicians, internist/oncologist for the diagnosis and treatment of
patients. They also have a hand in therapy and diagnosis of all these technologies.

3) Results of national activities
   a) Six national activities with a total of approximately 585 participants were successfully
      conducted.
   b) One radio guesting on prime time channel was done reaching the whole country with
      approximate listeners of 10,000 people.
   c) A total of approximately 232 patients have been treated by the participants
   d) Lectures have been scheduled for nationwide promotion for the next 4 quarters of 2012
   e) Participation in future UNDP/RCA meetings are assured
   f) Request for lecturers with expertise in radionuclide therapy in the field of
      neurology/neuroendocrine tumors
   g) Collaboration with more developed countries to provide cheaper radio-nuclides either for
      diagnosis and therapy

4) Lessons learned
The promotion of Nuclear Medicine means a lot to the upkeep of a nation’s health index as it
provides early diagnosis and correct and fast management. To be able to relay these messages
and input we need to promote the specialty to fellow doctors and lay persons as well. To be able
to deliver these messages, a more interesting type of lecture should be undertaken by a sub-group
of doctors from this pool of NPCs.

5) Major issues and limits
Limits of technical capability and information, experts/manpower, Government support, other
factors THE limitations in the implementation of the national activities is the availability and


                                               41
accessibility of SPECT-CT and PET-CT technology to the clinicians outside of Metro Manila
where these facilities are concentrated. Another issue would be the cost of the procedures, these
will also limit the expected outcome since most clinicians will utilize the affordable ancillary
tests prior to doing SPECT and PET CT. In addition, since majority of the country’s population
come from the low income generating families most of them cannot afford to undergo the said
procedures.


6) Recommendations to resolve the limits and issues
Still the high cost of the procedures are primary deterrent for more referrals; also the facilities for
PET/SPECT are only in Manila. Nuclear Medicine is usually the last resort in terms of therapies
for a lot of malignancies. The government support does not prioritize Nuclear Medicine in their
agenda but more on the common ails that afflict the majority of our people. Decreasing the cost
of these procedures would help in increasing the referrals. Hopefully, more hospital
administrators and owners will be informed and be convinced to acquire these machines. This
will make the said technology more accessible

7) Expected outcomes and long term benefits
Promotion of the specialty so that people including doctors and patients may know that such Nm
procedures exists. More lives can be saved by early diagnosis and outright treatment; cheaper
cost as hospitalization and early diagnosis are facilitated.

8) Sustainable capacity development
    a) Involve more doctors in NM to learn the technology.
    c) Regular training, workshop, conferences
    d) Well- designed development Work Plan
    e) Good collaboration with Government as well as RCA Member States and experts

9) Recommendation
 Request the Government for support in the establishment of facilities for PET-CT/ SPECT/
cyclotron.


2-9 Singapore

1) National status

    a) Singapore has public hospitals and private centres providing a whole range of Nuclear
       Medicine & PET/CT imaging services. Nuclear Medicine therapy using Iodine-131,
       Rhenium-188, Yittrium-90 and Lu-177 (to name a few) are performed currently at the
       only tertiary department of Nuclear Medicine & PET at the Singapore General Hospital.

                                                  42
    b) There are currently 13 SPECT gamma cameras, 4 SPECT/CT scanners and 7 PET/CT
       scanners available in these centres serving a local population of about 6 million and
       several thousand foreign patients from the region who seek medical care in Singapore.
       Serving this population size is a healthy number of about 20 Nuclear Medicine specialists,
       in both the public & private centres. universities,
    c) The Radiation Protection Act and the Medicine Act are two of the many legislatures
       governing the use of radiation & radionuclide’s on patients. There are subsidiary
       regulations and guidelines to these legislature confirming Singapore government’s
       support and legal framework for diagnosing and treating patients using Nuclear
       Medicine)
    d) The department of Nuclear Medicine & PET of the Singapore general Hospital is
       responsible for transferring the benefits of the project to the beneficiaries, the Nuclear
       Medicine physician trainees in diagnosing and treating patients with radionuclide’s.

2) End users and beneficiaries
The direct impact of activities of this RCA-UNDP project will be beneficial to the development
of a Nuclear Medicine training program in long term for Singapore. The quality of this training
program will improve by participating in this RCA-UNDP project. The indirect impact to
Singapore of participating in this project will be the growing partnership we will possess with the
RCA member states and especially the South Korean institutions such as the RCARO.

3) Results of national activities
The national activities implemented by Singapore under this RCA-UNDP project has been
successful on capacity development, in terms of acquiring knowledge in new technologies and
imaging aspects in Nuclear Medicine & PET.

4) Lessons learned: Major issues and limits
There were no major issues in the implementation of national activities. There is full
Government support for this initiative.

5) Expected outcomes and long term benefits
   a) The benefits for Singapore in partaking in this project will be the networking and
      partnership that we will develop with this project.
   b) The benefit to Singapore is immense, in improving our national Nuclear Medicine
      training program.

6) Sustainable capacity development
The continued participation in this project will enhance the teaching of Nuclear Medicine & PET
imaging and therapy.



                                                43
7) Recommendation
Even though Singapore is a developed country; our teaching of Nuclear Medicine & PET has
some way to grow in part due to our small size. We recommend that an exception be made to
UNDP policy on rendering assistance to Singapore in developing our teaching of Nuclear
Medicine & PET technology.




2-10 Thailand

1) National status

In Thailand, there are 21 Nuclear Medicine centers, including 9 medical schools, 6 general
hospitals, 3 cancer centers and 3 private hospitals. 12 of 21 centers are located in the capital city,
Bangkok, and 6 of 21 are in other provinces of northern, northeastern and southern regions,
Thailand.

     Instruments:
    a) PET/CT : 6 (in the capital city)
    b) SPECT : 21
    c) SPECT/CT : 3
    d) Cyclotron: 2 (1 in public sector, 1 in private sector)

     Staffs:
    a) NM Physician: 40
    b) Physicist: 15
    c) Technologist: 50
    d) Nurse:30
    e) Radiopharmacist: 5
    f) Radiochemist: 5
    g) Engineer: 2

     Service
    a) Imaging : PET 500-600 patients
    b) SPECT 4,000-5,000 patients
    c) Radionuclide Therapy: 500-600 patients
    d) Radioimmunoassay test : 8,000-9,000 patients

2) End-users/beneficiaries


                                                 44
There are 4 centers responsible for transferring the benefits of the project to the beneficiaries as
follows:
     a) National Cyclotron and PET Centre, Chulabhorn Hospital
     b) Khon Kaen University: Northeastern region
     c) Chiengmai University: Northern region
     d) Prince of Songkla University: Southern region

3) Results of national activities
 Well trained by advanced knowledge and technology
    a) Two activities with approximately 65 participants were successfully achieved.
    b) Settlement of 5 national activities in 2012
    c) PET/CT imaging: approximately 100

4) Lessons learned: major issues and limits
Lack of knowledge on clinical Nuclear Medicine application among clinicians

5) Recommendations to resolve the limits and issue
Transfer know-how and expand clinical service by means of consultant, inter-hospital conference,
organizing scientific meeting. Whenever is appropriate.

6) Expected outcomes and long term benefits
   a) Well trained personnel
   b) Improvement of health care services by expanding clinical NM services
   c) Collaborative training and research

7) Sustainable capacity development
   a) Work plan development
   b) Improve and expand clinical NM services, leading to the improvement of healthcare
      services
   c) Collaboration between experts

8) Recommendation
    a) Research collaboration.


2-11   Vietnam

1) National status
   a) Practical Nuclear Medicine sites in Vietnam: 22 in Northern part -8, in Middle part -4 and
      in Southern part -10.


                                                45
b) Current status of NM Equipments and Human Resources:

In vivo:
•Planar Gamma Camera 6
•SPECT (single head)   17
•SPECT/CT (dual head) 3
•PET/CT 5 (3 in Hanoi and 2 in HCM) 4 is operating and the new has been installed in 115
People’s Hospital
•Cyclotron              3

In vitro:
•Beta counters              3
•Gamma counters            20

Human Resources (data from 3 main NM sites with PET/CT)
 No    Position           Cho Ray Hosp. Bach Mai Hosp.*          Viet Duc Hosp.
       Physician          06               35                    04
    1.
          Nurse                 03            05                 02
     2.
          Pharmacist            03            1                  NA
     3.
          Technologist          03            03                 02
     4.
          Physicist Engineer    03            05                 02
     5.
          Radiochemist          03            03                 03
     6.
          Others                02            03                 01
     7.
NA: no answer, no data
*: including the NM Dept. of Hanoi Medical University

c) Nuclear Medicine: Education and Training
At this moment, there is only three Nuclear Medicine departments in 3/8 main medical
schools in Vietnam: Hanoi Medical University, 103 Military Medical Institution (the only
place providing PhD program in NM), and HCM Medical University. For example, NM
Dept. of Hanoi Medical University organizes one NM orientation course for about 10-20
participants per year.

d) PET & Cyclotron Development:

                                         46
   PET & Cyclotron sites
   There are four operating PET/CT in Vietnam but only three cyclotrons for
   radiopharmaceutical production. The ongoing PET/CT is being installed in People’s
   Hospital - No115 in HCM city.
   - The PET/CT unit was installed at NM & Oncology Center, Bach Mai Hospital- Hanoi in
     2009. Its radiopharmaceutical is provided by Institute of Nuclear Science and Technology
     and Military Hospital No 108.
   - The PET/CT unit & 11 MeV Cyclotron were installed in Cho Ray Hospital - HCM City in
     2009.
   - The PET/CT unit & 30 MeV Cyclotron center at Central Military Hospital No 108 - Hanoi,
     in 2010.
   - The PET/CT unit was installed in Viet-Duc Hospital (Vietnam – Germany Friendship),
     Hanoi with 9 MeV Cyclotron in 2009.

    Application of PET/CT for simulation in oncology radiation planning in the Nuclear
    Medicine and Oncology Center of Bach Mai Hospital, Hanoi-Vietnam
    PET/CT is used not only for diagnostic but also for simulation to plan 3D CRT (three
    dimensions conformal radiation therapy) or IMRT (Intensity modulated radiation therapy).
    Treatment and follow up has been conducted in the Nuclear Medicine and Oncology Center
    - Bach Mai Hospital, Hanoi-Vietnam

   National standard PET/CT guidelines
   The Ministry of Health has approved and disseminated the national standard PET/CT
   guidelines written by Bach Mai Hospital early 2011. This protocol is now applied in NM
   sites all over Vietnam.

STATUS OF CLINICAL PET/CT APPLICATION IN VIETNAM
(Data as of October 2011)

     BacHo Vie Ch Peo Not
Ho h spit t o ple e
spit Ma al Du Ra Ho
al i No- c y spit
Ind     108 Ho Ho al
ex          spit spit 115
            al. al.

PE 01 01 01 01 01 05
T/C Bio     Bio Bio (tot
T gra       gra gra al)
    ph      ph ph
    Tru     Tru 6


                                             47
    e             e D
    poi           w/
    nt            Tru
                  eV

Stat acti acti acti acti ong
us ve ve ve ve oin
                         g

Cyc no 30 9 11                 *in
lotr   Me Me Me                INS
on     V V* V                  T

Rad18F 11 18F 18F NA
iop - C- - -
har FD Ch FD FD
ma G; olin G; G;
ceu C- e, C- C-
tica 11 18F 11 11
ls AC - AC AC
Usi ET FN ET ET
ng AT a, AT AT
rec E 18F E E,
entl    -      F-
y       thy    18
and     mid    FD
in      ine    OP
the            A,
nea            N-
r              13
futu           NH
re             3

Tot 90 -300 130 400 NA
al 100 mC - -
Act mC i 250 600
ivit i (formC mC
y of    3 i i
18
   F    hos (for
DG      pit 2
pro     als) hos
duc          pit
ed           als)
and
use
d
for
eac
h
bat


                                     48
ch

Tot no no no 195 NA
al           0
Act          mC
ivit         i
y of         for
C-           31
11           bat
pro          che
duc          s
ed
and
use
d
for
exp
eri
me
nts

Tot          7
al           bat
Act          che
ivit         s
y of
C-
11
pro
duc
ed
and
use
d
for
pati
ents

Nu *24 NA NA *25 NA *in
mb -32       -28    cre
er                  ase
of                  d
pati
ents
sca
nne
d
wit
h
PE
T/C

                          49
T
per
wee
k

Nu *10 NA NA *10 NA *in
mb 0-        0-     cre
er 120       110    ase
of                  d
pati
ents
sca
nne
d
wit
h
PE
T/C
T
per
mo
nth

Nu 145 NA NA 163 NA *in
mb 6         7      cre
er (Fr       (Fr    ase
of om        om     d
pati in      Ma
entsthe      rch,
sca end      200
nne of       9)
d 200
wit 9)
h
PE
T/C
T

SE 80- NA 96   85 NA
NSI95     %;   %
TI %      85   80
VI 80-    %    %
TY 85
SP %
ECI
FIC
IT
Y
PP
V
NP

                          50
V
AC
CU
RA
CY



     e) Services (annually): patients
     Ch K Bac 108
     o Hosh Hos
     Raypita Maipita
     Hosl Hosl
     pita    pita
     l       l

SP 768 600 840 350
EC 0 0 0 0
T
ima
gin
g

Rad120 No 720 800
ion 0 ne
ucli
de
ther
apy

Rad168 No 576 50
ioi 00 ne 0
mm
uno
ass
ay
test
s



2) End-users/beneficiaries
Project will be first implemented at the Nuclear Medicine and Oncology Center Bach Mai
Hospital. Bach Mai hospital will become the main Training and Education Center for Nuclear
Medicine in Vietnam. In first stage, Bach Mai Hospital will help these following hospital (to
build up a Nuclear Medicine network) in training Nuclear Medicine staves:

                                             51
    a)   Thai Nguyen Central Hospital
    b)   Viet Tiep Hospital
    c)   Hai Duong Hospital
    d)   Thai Binh University Hospital
    e)   Thanh Hoa General Hospital
    f)   Vietnam-Balan Friendship Hospital

3) Results of national activities
   a) There are a total of 3 national activities conducted with a total of approximately 50
      attendances:
      - Training and seminars on Management and radiation therapy using PET/CT for Lung
         Cancer.
      - Participate in international conference: IPET 2011 and ICRT 2011
      - First implementation regional cooperation with Japanese and Korean Nuclear
         Medicine Society, ARCCNM.
   b) 2 new residents started to get the training to become PhD specialized in NM field, with
      expected total 5 new PhD and 1 Master in 2015, which will be play important to the
      development of capacity building.
   c) A total of approximately 8580 patients have been treated by the participants
   d) 2 PET/CT books in Vietnamese are being published
   e) Establish cooperation with WARMTH and regional NM society such as Japan and Korea

4) Lesion Learned
   a) Significant needs to improve recent NM knowledge among both NM and non-NM
      doctors: we could use the mass media and the internet
   b) Nuclear Medicine techniques on Oncology and Neurology in Vietnam are still limited
      and not adequated to the needs
   c) Needs to convince the government that it is time a) to upgrade NM facilities; b) to start
      planning establishment of NM and Oncology network

5) Major issues and limits
   a) There is no budget to replace or upgrade the existing NM equipments in small hospital.
      Up to now, we do not have formal information about the performance of the provincial
      NM dept.
   b) Formal educational and training materials, standardize the NM procedures are still
      missing.
   c) Small amount of patients would have benefit with high techniques such as PET/CT due to
      high cost, health insurance policy (only partial support for cancer patients), and
      awareness of NM and PET/CT in the community (even in clinical physician) is still
      limited.


                                              52
    d) NM development and research are still weak due to high cost and no research budget.
    e) A small number of NM professionals
    f) Insufficient knowledge of non-NM physicians about Nuclear Medicine

6) Recommendations to resolve the limits and issues
   a) Organize workshops, training seminars on NM procedures such as PET/CT in clinical
      application and cyclotron practice for NM physicians, physicists, radiochemists and
      radiopharmaceutists....
   b) Exchange of experts on functioning, QC/QA practice of cyclotron, PET/CT and other
      NM equipments for medical physicists and engineers.
   c) Organization of multi-center studies on radioisotopes production especially for some new
      products and clinical applications. Essential to continue regular educational activities
   d) Increase number of NM professionals, NM departments & equipments
   e) Expand clinical NM applications
   f) Government financial support

7) Expected outcomes and long term benefits
   a) Well trained personnel
   b) Maximized and accelerated NM applications in Vietnam as well as supporting NM
      establishment and development in Lao and Cambodia
   c) Standardized protocols for NM procedures
   d) Formal education and training program for post-graduate participants
   Sustainability

8) Sustainable capacity development
   a) Regular training, workshop, conferences, update seminars.
   b) National education and training program for NM.
   c) Well designed development Work Plan
   d) Increase number of NM professionals and NM facilities
   e) Good collaboration with Government as well as RCA Member States and expert network
      such as the Japanese and Korean NMS and ARCCNM etc.

9) Recommendation
This project is very useful for Vietnam, and with expected outcomes of the project the progress
of development of NM in Vietnam will be promoted. Implementation of the project is needed.




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