PakistanDr. Shabana Saeed
Prof, Head, Dept of Medical Sciences
Pakistan Institute of Eng & Applied Sciences (PIEAS)
Pakistan Atomic Energy Commission
Current Status of Nuclear
Medicine and Radiation Therapy
in Pakistan and Future Actions
Total Population 220 million
Estimated New Cancer cases/yr >148K
People dying from cancer /yr: >101K
Data from IARC GlobalCan (2012)
The Beginning
• First Nuclear Medical & Oncology
centre established at Karachi (Sindh)
in 1960 in JPMC, Karachi in two
room barracks
• Second at Lahore (Punjab) in 1963 in
basement of Mayo Hospital OPD.
Medical Isotope Institute (now called
CENUM)
• Third centre at Jamshoro (Sindh) in
1965. First PAEC centre to have
diagnostic as well as therapy
facilities
Nuclear Medicine & Radiation Therapy in Pakistan
Current Situation46
NM
Institutes/Dept
18
*PAEC
25
Non-
PAEC/private
03
Armed
Forces
03 PAEC NM Centres in pipeline
Nuclear Medicine Institutes / Departments
in Pakistan
Multan
Lahore (2)Faisalabad
Peshawar
Nawabshah
Larkana
Quetta
Bahawalpur
Islamabad
Karachi (2)
Abbottabad
Swat
Bannu
D I Khan Gujranwala
Gilgit
Jamshoro
*Pakistan Atomic Energy Commission
Nuclear Medicine--Human Resources
*Fellow of College of Physicians & Surgeons, Pakistan
Nuclear Physicians(Currently working in Pakistan)
134
Medical Physicists >30
NM Technicians >130
123—MSc (PIEAS)
05 ----MSc (UK)
21-- *FCPS NM
(16 with MSc NM)
7- PhD NM
(All with MSc NM)
01-American Diplomat
13- Radiotherapy
06- Radiology
Gamma camera >90
SPECT-CT 05
PET-CT Scanner 06
Cyclotron 05
NM Main Medical Equipment
In Pipe Line:
SPECT-CT 05
PET-CT Scanner 02
Cyclotron 01
PET-CT Facilities in Pakistan
Centre/Institution PET-CT Camera Cyclotron
Shaukat Khanum Memorial Trust Hospital,
Lahore
Philips ToF Gemini (LSO)
with 16 slice CT
18 MeV IBA
Institute of Nuclear Medicine & Oncology Lahore Discovery STE (BGO), 16 slice CT 16.5 MeV
GE
Neuro Medical Institute, Karachi Siemens (LSO), 64 slice CT 11 MeV CTI
Sindh Institute of Urology, Karachi Philips Gemini TF Astonish (LySO), 64
slice CT
18 MeV
Agha Khan Hospital, Karachi Toshiba Celesteion ToF, High
performance 3D, Lu-based scintillator
32 slice CT
In Pipe Line1. Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN), Khi
2. Nuclear Medicine Oncology Radiotherapy Institute (NORI), Isl
Radioisotopes & Radiopharmaceuticals in Pakistan
Isotope Production Division (IPD)
Pakistan Institute of Nuclear Science &
Technology(PINSTECH), Islamabad December 21, 1965
Production of Radioisotopes
Pakistan Institute of Nuclear
Science and Technology
(PINSTECH) ---two research
reactors (PARR-1 and 2)
Production of radioisotopes in
Pakistan Research Reactor-1
(since1965)
Radioisotope Processing Facilities
Iodine-131 Production Cell (Technique).(Wet Distillation )
Iodine-131 Production Cell (Dry Distillation Technique).
Phosphorus-32 Production Cell (Dry Distillation Technique).
Sulpher-35 Production Glove Box
Molybdenum-99 Loading Facility for preparation of 99mTc
generators.(100Ci/batch)
Mo-99 Production facility. Hot Cell with Master Slave Manipulators.
Fume Hoods and Glove Boxes (for small scale production of different
radionuclides and R&D work)
Workshop for target preparation and sealed source fabrication
Laboratories for determination of radionuclidic, radiochemical and
biological purity
131I Processing Plant (Wet Distillation)
Maximum capacity per batch 10 Ci/370
GBq.
131I Processing Plant (Dry Distillation)
Maximum capacity per batch 10 Ci/370
GBq.
99mTc/99Mo Generators Production in
Pakistan
Regular production of 99mTc/99Mo Generators since 2003
Production of 99mTc/99Mo Generators from locally
produced fission Moly since 2010
Weekly production of 32/34 generators---300-600mCi
PAKGEN
Mo-99 extraction process atPINSTECH
Developed at PINSTECH with the help of Germanexpert for separation of Mo-99 from fission products
Optimization of parameters was achieved in IPDlaboratory
Fission Iodine-131 and Xenon-133 as by-product
Spent HEU in small SS container for easy disposal
Step1: Target Irradiation
Target platesTarget Holder for
PARR-1PARR-1 Core
Target basket for
transportationTarget Container
Step2: Target transportation from PARR-1 to Mo-99 Facility & container docking
Fork lifter for transportation
of target containerMo-99 Hot-
cell (1-3)Target basket
for dissolverDocking of container
below hot cell-1 of
Mo-99 Facility
99Mo Production Facility
Step3: Hot Cell 1 Processes (Dissolution, Filtration, Iodine removal & acidification)
In-cell equipment of Hot cell 1
Filter tower for retaining
radio-iodine
Xenon delay and
decay cascade
Filter cake Solid waste container
In-cell equipment of Hot cell-1
99Mo Production Facility (Continued)
Step 4: Hot Cell 2 Processes (Mo-99 Separation and Purification)
In-cell equipment of Hot cell-2
Medium level
waste container
Intermediate decay and storage
system for liquid radioactive
waste
99Mo Production Facility (Continued)
Step 5: Hot Cell 3 Processes (Mo-99 Dispensing and transportation to
generator production facility )
In-cell equipment of Hot cell-3
Product container Transport of
Product container
99Mo Production Facility (Continued)
Step 6: Mo-99/Tc-99m Generator production facility and its use in medical
center for scanning
Mo-99/Tc-99m
generator
Mo-99/Tc-99m Generator
production facility
Nuclear
Medical Center
Gamma camera
Imaging
Scan
99Mo Production Facility (Continued)
Radioisotopes produced in PARR-1Radio
nuclide
Chemical form Maximum
Activity / Batch
Year
Zn-65 Zinc chloride mCi 1989
Se-75 L-Selenomethionine 10 mCi 1982
As-77 Arsenic chloride mCi 2007
Br-82 Potassium bromide
Ammonium bromide
Dibromobenzene
~ 1 Ci
~ 1 Ci
~ 1 Ci
1972
Mo-99 99mTc-Generator (n,γ) 150 mCi 1973
Mo-99 99mTc-Generator fission
Local production
1Ci 500 mCi 2002
2010
Ag-111 Silver chloride 5 mCi 1995
Sn-113 Tin chloride mCi 1996
Cd-115 Cadmium chloride 15 mCi 1996
Radioisotopes produced in PARR-1
Radio nuclide Chemical form Max Activity
Batch
Year
Sb-125 Antimony chloride mCi 1989
I-131 Sodium Iodide, oral sol
Sodium ortho-
idohippurate
MIBG
7 Ci
20 mCi
30 mCi
1979
1980
2000
Ba-133 Barium chloride micro Ci 1996
Cs-134 Cesium chloride 100 mCi 1993
La-140 Lanthanum chloride 1Ci 2003
Sm-153 EDTMP 1Ci 1999
Eu-152/154 Metal 10 mCi 1995
Ho-166m Holmium oxide Micro Ci 1995
Ho-166 particles >100 mCi 1995
Radioisotopes produced in PARR-1
Radio
nuclide
Chemical form Max Activity
Batch
Year
Lu-177 EDTMP 500 mCi 2008
Re-
186/188
EHDP 100 mCi 1995
W-188 Re-188 generator 5 mCi 1995
Au-198 Colloidal, gold chloride,
Potassium auro cyanide
1Ci 1974
Au-199 Gold chloride 1Ci 2003
Hg-197 Neohydrin 100 mCi 1977
Hg-203 Neohydrin 10 mCi 1977
Po-210 metal Ci 1982
Linear Accelerators 27
Cobolt-60 units 31
Brachytherapy Units 11
Heavy ion units 0
Radiation Therapy
Main Medical Equipment
In Pipe Line:
LINACS 05
Brachytherapy Units 02
Radiation Therapy Centers--------26
Pakistan & Status of Radiotherapy
Facilities in the Region
Country RT
Cent
res
LINA
C
Co-
60
CT
simul.
Simul. TPS LDR
Manual
LDR
Remot
e
HDR
Ir-192
HD
R
Co-
60
Bangladesh 15 15 12 7 6 14 0 0 4 2
India 333 242 345 68 80 299 80 41 118 3
Nepal 5 6 2 3 3 6 0 0 2 0
Pakistan 26 27 31 5 10 12 3 1 4 3
Srilanka 7 2 11 2 2 7 0 1 2 0
Accelerators in Pakistan
28
Electron Accelerators
Medical Centers of PAEC
Private sector medical centre having LINACS
Cyclotron for isotope production : 5
Not a single electron accelerator for academic/research
Ion Accelerators
NCP, Islamabad (5 MeV Pelletron tandem, NEC, USA)
GCU, Lahore (2 MeV Pelletron tandem, NEC, USA)
GCU, Lahore (1.2 MeV Cockroft-Walton)
PINSTECH (250 keV locally developed)
Near Future Demands 3 times the present number
27
Radiation Oncology-Human Resources
Radiation Oncologists 80 (>55 are MSc
RMO from PIEAS)
Medical Physicists >70 (>65 are MSc
MP from PIEAS)
RT Technicians >145
Few Milestone Achieved
RF Accelerator Design 6 MeV
Indegenous Pulse Modulator 48 kV
Electron Gun 30 keV, 50 keV
Magnetron operation upto 2.5 MW
Pulse Measurements (HV, Microwave)
Electron beam dynamics/diagnostics
Magnetron Assembly
Electron gun & RF Cavities
Vacuum System
RF Pulse Measurement
System
RF Power Control system
4 Port Circulator
• Demonstration of a completely functional proof-of-principle 6 MeV LINAC system
• Cavity conditioning, Frequency tuning and high power transmission up to 2 MW
• Completely indigenous control system for 6 MeV LINAC
6 MeV LINAC Integration & Operation
Collaboration with CERN
CERN is a major Collaborator.
CERN provided trainings in areas:
Accelerator Physics and Accelerator Operations,
Magnets, Simulation,
RF Systems and Controls.
Mechanical
Lectures delivered by CERN officials at Int.
Nathiagali Summer College, Pakistan.
Visits and technical feed back.
Future Actions……
Utilizaion of international support (CERN) to improve nuclear
medicine and radiotherapy services as well as to encourage
research in radiopharmaceuticals and modern radiation
treatments such as Particle Therapy in a number of ways:
Training of personals on accelerator technology---Magnets,
Diagnostics, Rf technology, Electronics for LINAC and in future,
accelerators for advance particle therapy.
Clinical coordination of PAEC hospitals with established Particle
Therapy Centers in developed countries to enroll patients in
heavy ion therapy based clinical trials.
Future Actions……
Better utilization of cell culture labs in Pakistan. The lab along with
relevant expertise in molecular and tumor biology can be utilized
to collaborate internationally on research projects pertaining to
particle therapy, especially its radiobiological aspects.
Use of high speed teleconferencing facility for knowledge sharing.
Willing experts from across the world can be invited by PIEAS in
person or online, to deliver talks to a large audience comprising of
virtually linked PAEC and most private sector cancer hospitals in
the country as well as to universities that are engaged in relevant
radiation research and education.
Future Actions……
Setting up a local team to build a “compact proton
accelerator” with the aim of initiating proton therapy of
ocular tumors etc while minimizing set up cost.
Production of novel radioisotopes for diagnostics and
eventually theronostics
Accelerator-based alternatives to production of
99Mo/99mTc
Production of novel therapeutic radionuclides
Accelerator driven neutron activation------β-emitting
radioisotopes for brachytherapy
Few suggestions
Summary and Conclusion
Pakistan has developed good nuclear medicine and
radiotherapy programmes
It has a skilled and technology driven human resource
Adequate infrastructure for promotion of NM and Radiation
Oncology
A will to provide best and latest health care to the people
for improving the quality of life in Pakistan
CERN Support in our Future Actions/Strategy