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Strategic Action for the Promotion of
Nuclear Medicine in Developing Countires
Myung Chul Lee, M.D.
(President, WFNMB)
Department of Nuclear Medicine
Seoul National University Hospital
Seoul, Korea
Radiology Nuclear Medicine
• Society Big Small
• Members Many Small
• Power Strong Weak
• Competition (-) (+)
• Challenges (-) (+)
• Need of multi- (-) (+)
disciplinary scientists
• Regulation (-) (+)
• Recognition Good Poor
• Profit Good Poor
Nuclear Medicine and PET
(Complex Technology)
♣ Need more budget
♣ Need multiple, diverse tasks
♣ Need political support
♣ Need various system
♣ Need fusion or bridging of
multidisciplines
♣ Need potential leadership
Nuclear Medicine and PET
(Complex Technology)
1) Need to maximize the functions of
manpower, facility and system
2) Need to establish integrated cooperation
and collaboration : government, related
national or international organization,
Institutes, societies
Heterogeneity
Interconntinental
Interregional
International
Interinstitutional
Interdepartmental
Number of Gamma Camera/Million
Inhabitants (IAEA Report)
Industrialized Countries Developing Countries
North America 8940 33.0 Eastern Europe 605 2.2
Japan 2700 21.6 Latin America 953 2.1
Australia 300 16.0 West Asia 166 1.0
West Europe 3740 10.3 Asia 879 0.3
Others 500 3.8 Africa 86 0.2
Total 16240 17.7 Total 2689 0.7
Myocardial Perfusion SPECT /
Million Population / Year
1995 1997 2002
USA 12000 15000 20000
Japan 1700 2750 3056
Korea 375 458 1192
UK 820 1120
Belgium 8000
Spain 1100
Czech 1500
Developing nations 50 70 90
EU Optimum Range: 4000-5000
Number of NM Studies
(Number/Million Pop)
Nuclear
Imaging Heart RIA
Japan 14,762 1,700 377,148
Korea 6,809 375 163,830
Thailand 328 NA 4,098
Philippines 551 50 NA
Indonesia 88 NA NA
Bangladesh 23 3 NA
NM Members (MD)
(No / million pop)
Japan 24.0 Korea 3.3
Czech 20.0 China 3.1
Hungary 12.0 Thailand 0.7
Netherlands 6.3 Philippines 0.3
Yugoslavia 6.3 Other Asian <0.1
Countries
Bulgaria 4.7
Number/million population
Institution Camera Members
USA 10.3 34.5 55.2
Japan 9.4 9.4 24.0
Korea 2.5 4.7 3.3
Netherlands 2.5 3.1 6.3
Hungary 4.7 10.0 10.6
Czech 4.7 11.7 28.5
Cyprus 7.1 8.6 28.6
Malta 5.0 5.0 27.5
Slovakia 2.0 4.4 8.0
Bulgaria 2.6 1.5 6.6
Serbia & Mont 1.9 2.3 5.4(14.0)
Numbers/million population
Institution Camera Members
Poland 0.5 1.3 2.1(5.2)
Lithuania 1.4 1.7 5.1
Turkey 0.9 1.7 5.4
Croatia 1.8 5.6 (22.2)
Bosnia 1.3 2.6 6.0
Macedonia 1.0 2.5 (12.0)
Ukraine 0.04 0.3 1.2
Azerbaijan 0.3 0.3 1.3
Estonia 1.3 2.6 4.0
Latvia 1.3 1.7 4.0
Romania 0.9 0.9 3.6
Changes in No of Institutes
1991 2001
Japan 1,210 1,273
Korea 100 120
Thailand 14 19
Philippines 29 17
Indonesia 15 12
Eastern Europe Countries
(No/Million population)
Country Institute Camera Member
„99 „03 „99 „03 „99 „03
Hungary 5.1 4.7 7.6 10.0 12.0 10.6
Czech 5.0 4.7 NA 11.7 20.0 28.5
Slovakia 3.0 2.0 4.4 4.4 NA 8.0
F.R.Yugoslavia 1.7 1.6 2.5 3.1 6.3 5.4
Bulgaria 3.3 2.6 1.9 1.5 4.7 6.6
Poland 2.6 0.5 2.9 1.3 NA 2.1 (5.2)
Romania 1.7 0.9 1.3 0.9 NA 3.6
Number/million pop
Country Institut. Camera Member PET GNP
Center
USA 10.3 34.5 55.2 700 40000
Japan 9.4 9.4 24 60 30000
Korea 2.5 4.7 3.3 10 9000
Thailand 0.2 0.4 0.7 1 6000
Philippines 0.2 0.6 0.3 1 4000
Brazil 1.4 3.1 2.6 3 6500
Colombia 1.3 3.7 2.5 0 6200
Uruguay 1.8 3.1 15.8 0 6000
Comparison between Developed
Countries by Economical Status(I)
(No/million pop)
GNP(US$) Country Institution Camera Members
Netherlands 2.5 3.1 6.3
> 20000
Japan 9.4 9.4 24.0
Czech 5.0 NA 20.0
Slovakia 3.0 4.4 NA
8000-11000
Hungary 5.1 7.6 12.0
Korea 2.5 4.7 3.3
Comparison between Developing
Countries by Economical Status(II)
(No/million pop)
GNP(US$)Country Institution Camera Members
Poland 2.6 2.9 3.0
6000-7000 0.2 0.4 0.7
Thailand
Bulgaria 3.3 1.9 4.7
Russia 1.8 1.7 NA
3000-4500 Romania 1.7 1.3 3.6
Philippines 0.2 0.6 0.3
Indonesia 0.07 0.1 0.09
Yugoslavia 1.7 2.5 6.3
China 0.6 0.3 3.1
1000-2000 Pakistan, Vietnam
<0.1 0.1-0.3 <0.1
Bangladesh, India
Conclusion
(Current Status of NM in Developing Countries)
Different Economy, Geography, Culture
• Lack of Awareness
• Lack of Institutes
• Very Poor Facility
• Lack of Qualified Personnel
• Unable to Attend International Meeting
• Lack of Regional Cooperative Activity
Heterogeneity in NM Practice and
Scientific Activity
How to Solve?
: Need Support to Reduce Heterogeneity
• Need Cooperation
• Stimulate Scientific Activity
• Enhance Education
• Financial Support
• Increase of Awareness
Role of International Organization
(CJK, ARCCNM, AOFNMB, WFNMB, IAEA)
Who are the responsible bodies?
• IAEA‟s statutory functions: “to encourage
and assist research on, and development
and practical application of, atomic energy
for peaceful uses (Nuclear Medicine) and
to foster the exchange of scientific and
technical information”
• National Society of Nuclear Medicine
• Government
Strategic Direction
• New way of thinking
• Rapid implementation and innovation
for tangible benefit
• Strengthening capability
• Strengthening cooperation activity
• Encouraging to be self-reliance
Strategic Action
Awareness, Global Recognition
Government Support
Establishment related Functioning Infrastructure
Database Collection and Information Networking
: Global Networking Group
Role of International Organization: IAEA, WHO etc.
Regional Cooperative Activity: ARCCNM
Facilitating the Function of WFNMB
Political Alliance or Pressure Group
Strong National Society of Nuclear Medicine
Powerful Leadership
Trends of In Vivo Studies
(x1000)
500
400
300
200
100
0
PET Application in Korea
(X1000)
20.7
12.5
7.9
4.4
2.4 3.0
1.0 1.2 1.8
„95 „96 „97 „98 „99 „00 „01 „02 „03
SNUH
PET Installation in Korea
1994 – 2002
8 PET Scanner in 7 PET Center
2003
5 PET Scanner and 13 PET/ CT
in 18 PET Centers
13 PET + 13 PET/CT
Number of In Vitro Studies
(x1,000,000)
12
10
8
6
4
2
0 „82 „85 „88 „91 „94 „97 „00 „02 „03
Scientific Activity in SNM from Korea
7.0%(96)
6.3% 6.3%6.3%
5.6%
2.9% 2.9%
0.7%0.7%0.6% 1.0%
0.5%
Most Contributing Factors for Recent
Development of NM in Korea
National economy
Promotion of SPECT and PET technology
Government support
Research activity by young members
Korean Board of NM : Independent Dept.
International cooperation
Powerful national society
Strong leaders
Related infrastructure
SNUH
Awareness, Global Recognition
• Education
• Newsletter, homepage
• Mass communication
• Scientific communication
:Interdepartmental conference
Active participation for nongovernmental
organization‟s activity
Global Networking
Government Support
National Society
Political Alliance (Pressure Group): lobby
Continuing consultation and interaction
through requesting (national grant project
or infrastructure), stressing, appreciating,
encouraging, taking note, convincing,
recognizing, recalling, emphasizing,
reiterating
Balanced promotion of non-power nuclear
application
3 Stages of Cooperation
(Rule of 3)
1st Stage 2nd Stage 3rd Stage
Negative Breakeven Positive
3yr 3yr 3yr
Dr. Maisey‟s Analysis of Factors
Determining PET Development
in European Countries (EANM,2002)
No relation with
Population
Cancer incidence
Imaging investigation
Health expenditure
National economy
Dr. Maisey‟s Suggestion
(EANM 2002)
Government control (Political)
Reimbursement and Health care system
Clinical / Cost effectiveness
Training
Pressure groups
Related National Infrastructures
• National Atomic Energy Research Institutes
• National Radioisotope Association
• National PET Association
• National Advanced Radiation Technology
Research Center
• National Institute of Radiological and Medical
Sciences (KIRAMS)
• National Radiation Emergency Medical Care
Center
• Radiation Health Research Institute
• Radiation Medicine Research Center
(University)
• Legal body such as foundation
• Related Societies
…………
Infrastructure
• KCNN, KCNC, …..
• KRIA (Korean RI Association)
• KAERI (Korea Atomic Energy Research Institute)
• KIRAMS (Korea Institute of
Radiological and Medical Sciences)
• Regional Cyclotron Center
• Advanced Radiation Technology Research Center
• Korea PET Association
• Radiation Health Research Institute
Related Societies
• National Nuclear Society
• National Societies of Internal Medicine, Radiology,
Radiation Oncology, Cardiology, Neurology…..
• National Association of Radiation Protection
• National Society of Radiation Biosciences
• National Society of Biomedical Engineering
• National Society of Molecular Imaging
• National Society of Human Brain Mapping
• National Council of Nuclear Neurology
• National Council of Nuclear Cardiology
……….
PET Promotion
Education (SNM PET Learning Center)
Publicity for Awareness
Steering Committee
Training
PET related scientific occasion(Symposium)
Cooperation with Government, Administrator,
Related Society, Research Institute
Establishment of PET or Cyclotron
Association( ICP AMI, EANM PET Institute)
Regional Cyclotron Center
Planning
and Korea PET Association
Advisory
Committee
Executive Committee
5 Task Force Groups
(Chairman, Members)
Regional Health Science and Clinical Education
Cyclotron Related Technology PET And
Center Policy Policy Center Publicity
Strengthening National Society of
Nuclear Medicine
• Strengthening the effectiveness and
improving efficiency
• Multiple functioning and integrated
structure
• Integrated or three dimensional approach
• International initiatives
• Evaluation and restructuring
• Powerful leader
3 Major Determining Factors
1) Powerful Leader
2) Excellent Staff, Officers,
Advisory Groups
3) System, Structure, Organization
Aiming of Restructuring
Not Competitive
No splitting
Synergistic,
Maximize function
Need cooperation, collaboration,
coordination
Korean Society of Nuclear Medicine
• President, President-Elect, Chairman
• 10-15 Board of Directors, Advisory
Members, Council Members
• Multiple committees: publication,
financing, scientific, planning, insurance,
education, training and board certification,
information, cooperation etc….
• Multiple task groups
• Affiliated Councils (Korean Councils of
Nuclear Cardiology and Neurology)
• Regional Chapters
• Permanent office
Multiple Tasks and Activities
• Annual Scientific Meeting (March and
November)
• Monthly Seminar
• Winter Meeting (Workshop)
• Continuing Education Programme
• Regional Chapter Meeting
• Study Groups (bilateral or multicenter)
• Special symposium or lecture courses
• Annual Meeting of each Korean
Councils
……….
Nuclear Medicine
- Complex Technology -
Policy
Issues
Scientific
Practice Research
Activity
Inspiration (Spirit)
Aspiration (Passion , Enthusiasm)
Perspiration (Endeavor)
Sustained, Consistent, Systematic Activities
• Appendix
(Number/Million Pop)
Cameras
Institution (%SPECT) Members
Japan 9.4 9.4 (78) 24
Korea 2.5 4.7 (45) 3.3
China 0.6 0.3 (76) 3.1
Thailand 0.2 0.4 (33) 0.7
0.14
Indonesia 0.07 0.09
0.6 (30)
Philippines 0.2 0.3
USA 10.3 34.5 55.2
Main Policy Issues
• Radiobiology for optimal regulation
• Regulations on clinical use of new
radiopharmaceuticals
• Technology to overcome competing
modalities
• Health economics and insurance policy
• Status of education, infrastructure and
nuclear medicine practice
Global Network
Global Networking Group
Chairman : Dr. Chonh-Soon Kim (RHRI, Korea)
Vice Chairman : Dr. Dong Soo Lee (SNU, Korea)
Dr. Jae Min Jeong (SNU, Korea)
Objectives
- To effectively administer the policy issues of the
WFNMB by conducting systematic reviews
- To manage the activities of the task-force groups
- To develop successful policies and programs
utilizing data and research collected by the task-
force groups through ICC and WFNMB
-To preserve and enhance information and knowledge through
networking for future expansion in the application of nuclear
medicine
Strengthening Cooperation
Activity
- Domestic Cooperation :
Related Ministries, Research institutes, Organizations, RI
Association, Related Societies
- Strengthening International Organizations;
IAEA, WHO, WFNMB
- International Associations:
SNM, EANM, AOFNMB, ALASBIMN, AANM, ARCCNM, CJK
(CSNM, JSNM, KSNM) (KRIA, JRIA, CRIA)
- Cooperation of Enterprises :
Action of Industrial Corporate
(Domestic and Global Office)
IAEA WFNMB
Organization Governmental Non - Governmental
Structure Bureaucratic, Voluntary, Autonomous
Non-Flexible Flexible
Budget Member State Contributing companies
Concerns Political issues Scientific issues
Project-based
IAEA/WFNMB
(Joint Relationship)
Complimentary role
Organization of Functioning Body
Regular Bilateral Meeting
Possible IAEA Collaboration
• Special Session by IAEA during 2006 World
Congress
• Conducting surveys for database coordination
concerning political issues
• Encourage political support through
government route
• Initiating regional cooperative organization in
developing countries
• Establishment of regional school of nuclear
medicine
• Promotion of PET and cyclotron technology
ARCCNM
(Asian Regional Cooperative
Council for Nuclear Medicine)
- A Fit Model of New Horizon -
www.arccnm.org
Current Situation of
Related Organizations
AOFNMB (Asia & Oceania Federation of Nuclear
Medicine and Biology)
- To be held every 4 years : Host Nation - China (2004)
- Geographically and culturally heterogeneous
- Two big continents (Middle Asia, Oceania)
CJK Conference
- China, Japan, Korea
- To be held every 2 years (June 2-3, 2002, Dalian, China)
IAEA
- No regular continuous scientific meeting
Asian School of Nuclear Medicine
(ASNM)
Administration : ARCCNM or AOFNMB
Dean of ASNM 20 ~ 30 Faculty Members
Participants: Specialized NM physician,
student,residents
Curriculum: ASNM Seminars 2 ~ 4 days in topics
several comprehensive ASNM Course for 1~2
weeks
ESNM: Fit Model
Regional Cooperative Council
for Nuclear Medicine
Asia : ARCCNM
- Far East Chapter
- South East Chapter
- South Chapters
Africa
- Sub-Sahara RCCNM
- North African RCCNM
Eastern Europe: (ERCCNM)
Arab RCCNM (Middle East)
Central Asian RCCNM
WFNMB 2006
(The 9th Congress of the World Federation
of Nuclear Medicine & Biology)
(www.wfnmb.org)
SEOUL, KOREA October 22~27, 2006
Main Venue
The Largest
Conference
Facilities in Asia
Innovative Multi-
Lingual Simultaneous
Translation
World-class Audio-
visual Equipment
Congress Organizing Committee
: Executive Members
Chairman Honorary
Advisory Committee
Advisory Members
3 Vice Chairmen * (Japan, China)
Secretary General
Fund-Raising
Treasurer
Committee
Global Networking
Group
Technologist
Section Committee
Special Consideration for Developing
Countries
• Exemption or discount for registration fee
for young investigators by awards
• Reasonably cheap priced accommodation
• Continuing education program
• Review lectures for various scientific
sessions
• Providing database and guidelines for the
promotion
• Cooperation with developed countries for
training, publication and collaboration
Main Activity
Successful 9th World Congress
: International Scientific Committee
Facilitating the Role of WFNMB
: International Coordinating Committee
: Advisory Council
: Global Networking Group
(Multiple Task Force Teams)
: World Journal of Nuclear Medicine
: World Radiopharmaceutical Therapy Council
Global Harmonization and New
Horizon of Nuclear Medicine
Seoul
