HISTORY OF NUCLEAR MEDICINE IN THE REGION

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					Korea International Cooperation Agency KOICA



          Medical Applications and
      Utilization of Cyclotrons and Rls


         Uruguay Country Report
                Graciela Lago MD
                Association Professor
                 University Hospital
                 Faculty of Medicine
                     URUGUAY
                             Octuber 14 – November 3, 2004
                                      Seoul, Korea
NOMBRE OFICIAL   República Oriental del Uruguay.
CAPITAL          Montevideo.
SUPERFICIE       176.215 km²
POBLACIÓN        3.386.575 hab. (estimada 2002).
IDIOMA           Castellano.
RELIGIÓN         Católica, protestante, otras.
MONEDA           Peso Uruguayo.
CIUDADES         Salto, Paysandú, Las Piedras, Punta del Este, Colonia,
PRINCIPALES
                 San José de Mayo, Ciudad de la Costa, Maldonado.
Uruguay is a small country in south-eastern
South America. It is bordered by Brasil, the Atlantic
Ocean and Argentina. It is the second smallest
country on the continent. The Uruguay River forms
the entire western boundary. Montevideo is the
country's capital, chief port, and economic centre.
 It has an extension of 176.215
 km2 with a beautiful long coast in
 the Rio de la Plata and the Atlantic
 Ocean. Its landscape is smooth
 with tiny hills and rich natural
 pastures.

Uruguay’s main source of resources
is the cattle raise. It bases its
economy in the stockbreeding and
the agriculture.
More than half of the territory is
destined to pastures for the feeding
of ovine, bovine and ostrich.
                            URUGUAY
                            RIVER OF BIRDS
                           South America



The Uruguayans              3.380.177
Annual Demographic
                            0.6% (Lowest in America)
Growth Rate
Uruguayans per Km2          19
Life expectancy at birth    75,2 years
Infant Mortality Rate       13.9 per thousand liveborn.
Literacy                    97% (2002)
Religion
                            Catholics 56 %, other Christians 2 %, Jews
None official
                            2%, declared non-religious 38%.
Language                    Español
               URUGUAY
               RIVER OF BIRDS
            South America


Phycisians per 1000:            261
Potable Water Supply:           98%

Electricity at home:            98%
Cars per 100                    20
LANDMARKS OF
LATINAMERICAN
NUCLEAR MEDICINE

1930
  The first medical application of radioisotopes in Latin America
  was at the
  Instituto de Biofisica of the Universidade Federal de Rio de
  Janeiro, Brazil, under direction of Dr. C Chagas
  using 32 Ph to study patients with haematological disorders.


1940
  Endemic goiter was studied using 131 I in the Andean region of
  Mendoza Argentina
HISTORY OF NUCLEAR
MEDICINE IN URUGUAY
1962
• The first Nuclear the Medicine Centre was created by the Clinical
  Staff of the School of Medicine in a public hospital of the Ministry
  of Health of Uruguay
• The National Commission of Atomic Energy (CNEA) provided the
  first equipments .
• The AIEA organized the First Regional Course on Nuclear
  Medicine
• The first research project was on the imaging of the hepatic
  hydatic cyst, an endemic parasitic disease in Uruguay.

1971
• The Nuclear Medicine Center is moved to the University Hospital
HISTORY OF NUCLEAR
MEDICINE IN URUGUAY

  1975
   A medical speciality three years course in Nuclear Medicine
   is certified by the School of Medicine.
   The same year a basic course on isotopes for health was
   started.



  1980
   A undergraduate three years course on Nuclear Tecnology
   is started at the Escuela de Tecnologias Medicas by the
   School of Medicine.
NUCLEAR MEDICINE IN
URUGUAY 2004

  NEW CLINICS
  + 6 Nuclear Medicine private clinics,
             5 in the Montevideo.

  HUMAN RESOURCES
  • 16 Nuclear MD Specialists (non radiologists)
  • 40 NM Technologists (20 unemployed)
  • 20 Radiochemists
NUCLEAR MEDICINE IN
URUGUAY 2004

 EQUIPMENTS
 11 Gamma Camaras , 9 of them with Spect
 Count calibrator and Tyroid counting are available in
   all private clinics.

 GENERATORS AND RADIOCHEMICALS
 Generators are imported from Argentina. Ranging
   from 500 mCi to 1 Cu of per week.
 The radiopharmaceutical kits are produced locally.
NUCLEAR MEDICINE IN
URUGUAY 2004


  SAFETY REGULATIONS
  • Similar to any other country in the region,
     – inforced by National Nuclear Technology
       Direction

  • All personnel uses film monitors,
     – checked monthly
NUCLEAR MEDICINE IN
URUGUAY 2004
 The total number of studies is:
 1000 per million inhabitants per month
                               • LUNG
  THE MOST COMMON :
                                  • Perfusion
  • BRAIN SPECT
                                  • Ventilation
     • Dementia
                               • CARDIOVASCULAR
     • Psiquiatric disorders
                                  • Basal
     • Epilepsia
                                  • Stress
                               • BONE
  • TYROID
                               • INFECTION
     • Diagnostic
                               • RENAL
     • Treatments 131 I for
       Hypertyroidism and         • Scintigraphy
       carcinoma                    DTPA,Lasix
                                  • Renal Function
                                    DMSA
                                  • Cistography
NUCLEAR MEDICINE IN
URUGUAY 2004
  • LYMPHOSCINTIGRAPHY
     – Sentinel Node
         • Melanoma
                               • PARATHYROID
         • Breast carcinoma
                               • DACRIOSCINTIGRAPHY
         • Uterine carcinoma   • PAROTID
         • Penile carcinoma    • ONCOLOGY
         • Vulvarcarcinoma        – MIBI in melanoma
     – Limb lymphoedema        • TREATMENTS
  • GASTRO ENTEROLOGY             – 188Re
     – Gastric reflux                 • Pain in metastasis
     – Gastric evacuation             • Brachytherapie
     – Hepato biliary reflux      – 131I
     – Gastric hemorrhage             • Hyperthyroidism
                                      • Breast Cancer
ONGOING RESEARCH PROJECTS
          2004
•ARCAL LXXVIII RLA/9/049 :
   •PROCEDURES IN INTERNAL DOSIMETRY
   “Unification of technical procedures in vivo and in vitro (blood and urine)
   internal dosimetry of the exposed personnel”
•IAEA RESEARCH CONTRACT URU/12451 :
   •“Validation of a new radiopharmaceutical: 188 Rhenium - Colloid for
    Radiosynovectomy”
•ARCAL PROYECT VXXII :
•“Nuclear Telemedicine Network”
•OTHER STUDIES
•“Study of brain lesions in VIH-AIDS patients with 99mTecnesium MIBI”
•“Lowback pain assessement and discrimination of inflamatory or mechanical
origin by gammascintygraphy” IBEROAMERICAN MULTICENTRIC STUDY
ONGOING RESEARCH PROJECTS
          2004

•IAEA Research Contract URU/10497 :”

        “Development of a radiopharmaceutical: 188 Rhenium – HEDP
for the palliative treatment of pain in bone metastases”.
•IAEA - Technical Cooperation Project URU/6/027
        “Development of Pediatric Nuclear Medicine”

   •Improvement of Nuclear Medicine Center facilities for pediatric patients.
   •Development of an area of Centralized Hospital Radiopharmacy.
   •Creation of a Nuclear Medicine Station in the Pediatric Hospital.
BIOMEDICINE RESEARCH PROGRAM
             2004


 • “ Potentiation of the reception of 99m Tc –MIBI mediated
   by synthetic catecholamine on parathyroid cells in vivo
   culture and in a clinical model of hyperparathyroidism”
  PhD Thesis

 • “Therapy of the spino -cellular cancer with Re-188
   patches”
  PhD Thesis
ACTIVITY’S OF THE
NUCLEAR MEDICINE
CENTER

 Education Courses
 • Student of Medicine
 • Endocrinologist
 • Post Graduates Students
 • Others medicals
   specialities

 Clinical Rounds
ACTIVITY’S OF THE
NUCLEAR MEDICINE
CENTER
Other Education Courses
We train MD or Tecnologist or Chemistries from all Latin
America.
The fellowship duration can be a month up to years to complete
their degree.
Country’s involved up to know were Venezuela, Peru, Ecuador,
Chile, Brasil, Cuba, SantoDomingo, Guatemala, Costa Rica,
Nicaragua, El Salvador.

Expertises to: Colombia,Venezuela, Santo Domingo,
Guatemala, Costa Rica, Bolivia, Brasil,Ecuador, Peru,Cuba
Africa: Cameroon,Argelia
Egypt
ACTIVITY’S OF THE
NUCLEAR MEDICINE
CENTER




 Courses
 • Nuclear Medicine Specialist for MD 3 years
 • Technologist 3 years
 • Diploma in Nuclear Medicine for foreign MD 9 month
ACTIVITY’S OF THE
NUCLEAR MEDICINE
CENTER

 Endocrinology Clinic Thyroid Carcinoma
                       Hyperthyroidism
 Neurology            Epilepsy
 Psiquiatry           Frontal Lobe
 Pediatrics           Nephrology
 Cardiology           Chest pain
 Neuropsychology      Dementia
 Radiochemistry       188Re

 Nuclear Center I     Radiopharmaceuticals
LATINAMERICAN ACTIVITY’S
OF THE NUCLEAR MEDICINE
CENTER’S
 Last decade grew the number of Services in Nuclear
   Medicine in America .
 • New instrumentation (Spect system)
 • Local production of radiopharmaceuticals in many countries
 1992 The first PET in Mendoza Argentina

 2002 Chile        1
      Brasil       2
      Argentina 2
      Colombia      1
 AIEA PROMOTE the quality control and the appalicationof
   Spect in cardiology,neurology ,squeletal bone scan.
 • Developping new tracers
ALASBIMN


 Latin America Association of Biology and Nuclear Medicine
 (ALASBIMN) was founded in 1964 in San Pablo Brasil by
 pionners scientists, the Universities and National Atomic
 Energy Commissions of the countries of the regions.
 ALASBIMN has collaborated with the National organization
 and International cooperation IAEA, PAHO, WHO and
 interregionally with Universities and Societies from USA,
 Canada, Europe, United Kingdom, France, Germany, Italy,
 ASIA specially Japan.
ALASBIMN

The first ALASBIMN congress took place in Peru in1966.
In the initial period the AIEA played an important role providing
training courses, visits of experts, fellowships, equipments,
radioisotopes, research contracts of problems of the region
1969 Official publication of ALASBIMN
1970 at the 3rd ALASBIMN Congress in Mexico the WFNMB was
founded.
1974 The first World Congress of Nuclear Medicine in Tokyo
and Kyoto
New links between Latin America and Asia and in subsequent
years were more strength.
2005 Next ALASBIMN Congress in Uruguay Punta del Este.
Thank you