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23. Tumour Imaging Using Radioisotopes (RCA) (RAS/6/042) F1 New CORE FINANCING YEAR Human Resource Components (US $) Procurement Components (US $) TOTAL Experts Meetings/ Fellow- Scientific Group Sub-Total Equipment Sub- Misc. Sub-Total (US $) Workshop ships Visits Training Contracts Comp. 2005 3,290 40,000 0 0 50,000 93,290 0 0 0 0 93,290 2006 13,440 43,000 0 0 55,000 111,440 0 0 0 0 111,440 2007 10,290 36,000 0 0 57,000 103,290 0 0 0 0 103,290 FOOTNOTE-a/ FINANCING YEAR Human Resource Components (US $) Procurement Components (US $) TOTAL Experts Meetings/ Fellow- Scientific Group Sub-Total Equipment Sub- Misc. Sub-Total (US $) Workshop ships Visits Training Contracts Comp. 2005 0 0 0 0 50,000 50,000 0 0 0 0 50,000 First Year Approved: 2005 OBJECTIVES: To improve the management of cancer patients by transferring radionuclide imaging techniques of single photon emission computed tomography (SPECT) and positron emission computed tomography (PET) for cancer detection and monitoring the efficacies of therapies, including validating and developing protocol for sentinel lymph node detection technique in RCA countries. BACKGROUND: Incidents of cancer is rapidly increasing in Asian countries, and the diagnosis of distant metastasis as well as primary tumours has become an urgent need to determine the mode of therapy for achieving the better prognosis. To find distant metastasis that may critically affect the prognosis, whole body and SPECT scans with tumour seeking agents such as technetium-99m- dimercaptosuccinic acid (DMSA (V)), -methoxyisobutylisonitrile (MIBI), gallium-67-citrate, thallium-201-chloride, and fluorine-18-flurodeoxyglucose (FDG) have been employed. They play important roles in visualizing unexpected metastasis and expansion to adjacent tissue or organ. PET is changing the way in which cancer is managed and is forcing a reassessment of conventional staging with computed tomography (CT) and magnetic resonance imaging (MRI) in certain cancer groups. It can be used to plan the delivery of, and assess the response to, therapy, allowing the treatment regimens to be modified without delay if the response is inadequate. The largest influence of PET has been in the management of lung tumours, colorectal tumours and lymphomas. Fluorine-18-FDG is one of the most effective tumour-seeking agents, and it proved cost-effective in the assessment of solitary pulmonary nodules (SPN) and in staging non-small cell lung cancer. Technetium-99m-DMSA (V) is a tumour imaging agent which is able to visualize some malignant tumours such as soft tissue tumour and thyroid medullary carcinoma. The labelling of commercially available DMSA (III) kit with technetium-99m is a quite unique technique but simple. The clinical application may be useful for visualizing tumour distribution. Technetium-99m-MIBI is a radiopharmaceutical for cardiac perfusion imaging but also for tumour imaging. The retention of this radiopharmaceutical in tumour cells can be validated as a predictor of response to chemotherapy in a wide variety of human cancers. The clinical application with a gamma camera may be useful for management of patients that should undergo chemotherapies. Gallium-67-citrate is one of cyclotron-produced radiopharmaceuticals and the clinical use has been limited even in RCA Member States. However, the radiopharmaceutical is very useful for the diagnosis and staging of malignant lymphoma, sarcoma and melanoma. The clinical application with SPECT would be very useful for RCA Member States. RAS6042 Page 2 Thallium-201-chloride is also a cyclotron-produced radiopharmaceutical that is shown to have affinity for brain tumours. It has high sensitivity for detection of new, recurrent, or residual viable tumour, which are difficult to differentiate from post-radiation necrosis and oedema on CT or MRI. Lymphoscitigraphy with a gamma probe has recently acquired an expanding role in clinical medicine for oncology and plays an important role in the detection of sentinel lymph nodes in several types of tumours, primarily breast cancer and melanoma. The project will make it possible for the Member States that do have access to SPECT, PET and sentinel lymph node detection technologies to apply them in the management of cancer patients. NATIONAL COMMITMENT: Participating countries with the suitable infrastructure, such as an advanced gamma camera system and PET system, will provide their facilities for training. They will designate Regional Resource Units for this purpose. OTHER STAKEHOLDERS INPUT: Extrabudgetary contributions are expected from Japan. AGENCY INPUT: The Agency will provide technical and administrative support to the project, including organizing training events, and provision of expert services with a cooperation of the counterpart. OUTCOMES: 1. Transfer of technology for nuclear medicine imaging and sentinel lymph node imaging to participating RCA Member States. 2. Improvement of the clinical management of cancer patients with nuclear medicine techniques. PERFORMANCE INDICATORS FOR OUTCOMES: 1a. At least 100 persons from the Member States will be trained on new nuclear imaging techniques through regional training courses and expert missions before the end of the project. 2a. At least 10% of the nuclear medical centres in the region will apply new nuclear imaging techniques introduced through the project in management of cancer patients within one year after completion of the project. EXPECTED PROJECT IMPACT: A greater awareness among medical professionals on the effectiveness of nuclear medicine imaging techniques and sentinel lymph node detection technique to improve the management of cancer patients will be achieved. This will eventually lead to better clinical management of cancer patients resulting in the possible reduction in mortality and morbidity rates and cost-effectiveness by avoiding unnecessary treatment procedures.
"RAS Tumour Imaging Using Radioisotopes RCA RAS"