History and Perspectives of Nuclear Medicine in Thailand Sombut Boonyaprapa Department of Radiology, Chiang Mai University, Chiang Mai, Thailand
A R T I C L E I N F O
Article type: History and perspective
►Please cite this paper as: Boonyaprapa S. History and Perspectives of Nuclear Medicine in Thailand. Asia Oceania J Nucl Med Biol. 2014; 2(2):143‐148.
In 1955, the first nuclear medicine division was established in Thailand by Professor Romsai Suwannik at the Department of Radiology of Siriraj Hospital, Mahidol University in Bangkok. Four years later in 1959, the second nuclear medicine division was established at the Department of Radiology of Chulalongkorn Hospital in Bangkok, and the third division was founded at Rajavithi Hospital in Bangkok in 1961. In 1965, ten years after the establishment of the first nuclear medicine division in the country, Professor Dusadee Prabhasavat and Professor Sanan Simarak established the fourth nuclear medicine division at Chiang Mai University, which is the first university located outside Bangkok. During the early years of nuclear medicine in Thailand (1955‐1965), Professor Romsri Suwannik at Siriraj Hospital applied clinical nuclear medicine by using colloidal gold (198Au) for palliative treatment of ascites, caused by ovarian cancer. In vivo radionuclide non‐imaging studies mostly focused on 131I thyroid uptake, extracellular fluid volume (82Br‐ distribution space), and exchangeable 24Na. 42K was studied in cholera patients, and 32P was used for radionuclide therapy in malignant pleural effusion and some blood diseases, e.g., leukemia and polycythemia vera. 32P was also used for differential diagnosis of benign and malignant pleural effusions. Since 1965, many radionuclide non‐imaging studies have been performed including blood volume studies, 51Cr red blood cell (RBC) survival and ferrokinetic studies with 59Fe, 51Cr platelet survival and kinetic studies with 125I‐
labeled fibrinogen, and 55Fe and 59Fe absorption studies. Evaluations of renal tubular function using 131I‐hippuran and renal glomerular function using 99mTc‐DTPA are also included in routine clinical services. For radionuclide imaging studies, 113mIn‐ generator and 198Au were used in early years before 99mTc generators became available. In 1969, the first radioimmunoassay laboratory was established for clinical services. Also, since 1983, neonatal screening for congenital hypothyroidism has been performed using nuclear medicine techniques in Thailand. Professor Romsai Suwannik made tremendous efforts for the progress of nuclear medicine in Thailand. One of his well‐known studies in nuclear medicine was about thyroid disease in Thailand (Figure 1). He introduced the addition of iodine into drinking water for people living in the Northern and Northeastern parts of the country, which are the endemic areas of goiter in Thailand. He is also known as the father of nuclear medicine in Thailand, and was awarded the medal of Chevalier de l'Ordre du Mérite (Figure 2). Nuclear Medicine Society of Thailand was established in 1982 with 120 members, and Professor Romsai Suwannik was elected as the first president. At present, this organization consists of 227 members, including 78 nuclear medicine physicians. Many nuclear medicine personnel have made great contributions to the progress of nuclear medicine services in Thailand. Professor Vichai Poshyachinda, who worked during the early years of nuclear medicine in Thailand,
* Sombut Boonyaprapa, Senior Consultant in Nuclear Medicine, Department of Radiology, Chiang Mai University, Chiang Mai, 50200, Thailand. Cell phone: 66 081 671 8239; E-mail: [email protected] © 2014 mums.ac.ir All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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NM Historyy in Thailand
Figure 1. P Professor Romsaai Suwannik, fath her of nuclear m medicine of Thailand and his worrks
c nucllear mediciine developeed many clinical services and perfo ormed various studies in k and other regions of Thailand Bangkok includingg Chiang Mai city. Profeessor Mak kumkrong nda Poshyachin (Figure 3), the heead of Nucclear Mediciine Division at Chulalongkorn Hospital in yeaars 986, and th he presiden nt of Nucleear 1979‐19 Medicinee Society of T Thailand, was also involv ved in the deevelopment o of nuclear meedicine servicces and ressearch in th he early yeaars of nucleear medicinee. He made great efforts fo or the progreess of nucleaar medicine in Thailand.
Many experts in nuclearr medicine frrom other co ountries hav ve played major roless in the im mprovement of nuclear m medicine serv vices and reesearch in Thailand. These expeerts are Prrofessor Norman Veall from the U.K, J.D. Peearson from the U.K., Prrofessor Keith h Britton frrom the U.K., Professor Ro oger P. Ekins from the U.K., Professorr Dr. E.H. Beelcher from Australia, A or Donald Raalph Adams from the U.SS.A, Professo Geermann from m the U.S.A,, Professor Peter Ell frrom the U.K.,, Dr. Marinu us Van Kroon nenburgh frrom the Neth herlands, Dr. A.K Basu fro om India, Prrofessor Yasu uhito Sasaki from Japan, P Professor
Figure 2. Professor Romssai Suwannik, reeceiving the meedal of Chevalieer de l'Ordre du Mérite 144
Figure 3. Professo or Makumkrongg Poshyachinda, the head of nu uclear medicine division at the D Department of R Radiology of Ch hulalongkorn Ho ospital, Chulalon ngkorn Universiity, and the prresident of Nucleear Medicine Socciety in Thailand d Asia Oceania O J Nucl M Med Biol. 2014; 2((2):143-148.
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Figure 4. N Number of 131I th herapy for hyperrthyroidism and d thyroid carcino oma in Thailand
dicine studies in T Thailand Figure 5. SStatistics of clinical nuclear med
Shigenob bu Nagataki from Japan, Professor Paaul Blanget from France, Professorr Leif Hallbeerg weden, and Professor Rosalyn R Yalo ow from Sw from thee U.S.A. Most of these nu uclear medicine experts are a nternational Atomic A Enerrgy sponsoreed by the In Agency (IAEA). They intrroduced neew ogies in cliniical servicess and researrch technolo and prov vided trainingg in nuclear m medicine. At prresent, 25 organizations p provide cliniccal nuclear medicine services s in Thailand. T Fiive medical faculties offfer three yeears of nucleear y training,, and eigght medicinee residency companiies supply raadiopharmaceeuticals and//or nuclear medicine equipments. e One of theese
n by the Officce of Atoms ffor Peace faaculties is run in n Thailand (OAP of Thailan nd). dicine physiccians and Today, 62 nuclear med 13 30 non‐medical personneel work in Th hailand to prrovide nucleear medicinee services. The T non‐ medical m perso onnel include medical physicists, p nu uclear mediccine technollogists, radio opharma‐ cists, radioch hemists, and d nuclear medicine urses. Thailand is equipp ped with eigh ht PET or nu PE ET/CT deviices for clinical services and reesearch. Therre are six PE ET or PET/CT T devices in n Bangkok, on ne at Chiang Mai University in the Northern reggion, and o one in Kho on Khen University in the Northeaastern region of the ountry. co
Table 1. The average num mber of nuclear m medicine cardiacc imaging studiess in year 2011 in n Thailand Nuclear meedicine cardiac iimaging studies in Thailand in 2011 Gated Planar Mu ulti‐Gated S SPECT d SPECT MPI M Gateed SPECT MPI ((MIBI) Acquisitio on (MUGA) M MUGA (M MIBI) (Tll‐201) (T Tl‐201) 10 000 11 16 650 11 148 486 4 127 (22.6 61%) (0 0.25%) (37.31%) (25.96%) (10 0.99%) (2 2.87%) Asia Oceannia J Nucl Med Biol. 2014; 2(2):1443-148.
C Cardiac PET None (0%)
TOTAL 4422 (100%) 145
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Figure 6. R RAS6061/9001//01 IAEA/RCA In nitial Project Coo ordination Meetting in Chiang Maai, Thailand, 19‐23 March 2012
Most in vitro nuclear n med dicine servicces include rradioimmuno oassay of thy yroid and oth her hormonees includingg freeT4, frreeT3, thyro oid stimulating hormon ne (TSH), and a thyroxin ne‐ binding globulin (TBG) antibodiess. Radionucliide 99mTc‐lab belled compo ounds, 131I, an nd 18F‐FDG aare routinely y used for im maging and clinical c nucleear medicinee services in Thailand. 677Ga, 68Ga, 201TL, T 111mIn, 15 53Sm, 131I, 188Re, and 90Y are available ffor R clinical diagnosis an nd radionuclide therapy in ospitals. All institutes ussually perforrm some ho radionucclide 99mTc‐M MDP whole body b scan, sp pot planar, and/or single‐photo on emission CT) imaging for f computeerized tomoggraphy (SPEC the evaluation of bo one metastassis staging and follow‐up after treeatment in patients wiith nt tumours. malignan Radio onuclide 99mTcO T 4 thyroid d imaging and whole body 131I imagging are performed for the t diseases, disttant metastassis, diagnosiis of thyroid d and follow‐up evalu uations afterr treatment in thyroid ccarcinoma paatients. 131I is routinely used for the ttreatment of patients with h hyperthyro oid diseases and thyroid d carcinoma in Thailand, as n Figure 4. shown in Many y institutes perform m myocard dial perfusion imaging (M MPI) with gaated SPECT for f mia, the diiagnosis off myocardial ischem 146
myocardial m in nfarction, an nd evaluation n of left veentricular fu unction (Taable 1). Mu ulti‐gated 99mTc‐labeled RBC planar b blood pool im mages or SP PECT imagees are also o obtained for the ev valuation of lleft ventricular cardiac fu unction in paatients underrgoing chemo otherapy. Thee number off all in vivvo nuclear medicine sttudies in Th hailand is sho own in Figuree 5. Radionuclid de ventilatiion/perfusion n (V/Q) pu ulmonary imaging is usuaally performeed for the diiagnosis of pulmonary p em mboli and ev valuation off pulmonarry function in patien nts with pu ulmonary no odule prior tto surgical trreatment. However, po opularity off radionucliide V/Q ulmonary im maging has d decreased sin nce most pu clinicians preffer pulmonarry CT angiogrraphy for he diagnosis of pulm monary emb boli and th pu ulmonary tum mours. SPECT/CT images are obtained for clinical nu uclear mediciine services aand research.. PET/CT im mages are used u for thee diagnosis, staging, fo ollow‐up, and d treatment p prediction in n patients with w malignan nt tumours, especially non‐small n ceell pulmonaary carcinom ma and co olon and ly ymphoma carrcinomas. At presentt, one trainiing course and a four ed ducational co ourses are heeld in Thailan nd, which arre as follows: Asia Oceania O J Nucl M Med Biol. 2014; 2((2):143-148.
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Figure 7. IAEA INT 6056 Workshop on ”Quality ” Manageement Audits in n Nuclear Mediccine Practices (Q QUANUM) for Asia A and the Pacific Reggion“ Bangkok, T Thailand, 5‐9 November, 2012
uclear Mediccine, three‐yeear Thai Board of Nu trainiing courses fo or M.D. gradu uates, M.Sc. Program in n Medical Phy ysics, two‐yeear trainiing courses aafter B.Sc. graaduate prograam in rad diological tecchnique or sciientific physiics M.Sc. Program in Medical Imaaging, two‐yeear B graduaate educaational courrses after B.Sc. progrram in raadiological techniques t or scien ntific physics, M.Sc. Program in Radiologicall Sciences, tw wo‐ year educational ccourses afterr B.Sc. graduaate t or progrram in radiological technology scien nces, and B.Sc. Program for Radiologicall Technologissts, four‐year educattional coursses after hiigh ol graduation n. schoo
Theree are five nu uclear medicin ne institutes in Thailand d which hold nuclear medicine residen ncy training courses. Th hree of thesee institutes are a one in the No orthern regio on, located iin Bangkok, o Chiang Mai Univeersity, and one in the t n, Khon Kh hen University. Northeasstern region Overall, 20 residen ncy training positions are a availablee each yeaar at these five nucleear medicinee institutes.. The resid dency training Asia Oceannia J Nucl Med Biol. 2014; 2(2):1443-148.
ourse takes tthree years aand includes radiation co scciences, clin nical sciencees, and praactice in nu uclear mediicine under the superv vision of nu uclear mediicine physiciians at the nuclear medicine instit m tutes. After finish hing the threee‐year trainiing, these grraduate residents have to take thee nuclear medicine m natio onal board eexamination, which is seet up every y year by T Thai nationaal board co ommittee of nuclear med dicine. The residents, r who w pass th his board eexamination, will be ceertificated to o practice aas nuclear medicine ph hysicians. m ressearch in Thailand, T Nuclear medicine nu uclear card diology stu udies, and nuclear on ncology research are perrformed in alll nuclear medicine m insttitutes, especcially at uniiversities, ussing SPECT, SPECT/CT, and planar imaging sy ystems. Also,, research u using PET/CT T scan is peerformed at institutes, wh here PET/CT T systems arre available. Academic nuclear meedicine meettings for members of nu m uclear mediciine society arre held at leeast twice a year. One iss the annual nuclear medicine m meeeting in Bangkok, as parrt of the an nnual academ mic meetingg of Royal College of 147
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Radiologists of Thailand, and the other is midyear nuclear medicine academic meeting, which is held by the Nuclear Medicine Society of Thailand. At these two meetings, the findings of nuclear medicine studies of all related institutes are presented. Also, several lectures are presented by nuclear medicine professors from other countries at these meetings each year. In Thailand, we also have the opportunity to annually organize international academic meetings including IAEA and The Asian Regional Cooperative Council for Nuclear Medicine (ARCCNM) meetings (Figures 6 & 7).
Conclusion
Nuclear medicine research and clinical practice in Thailand have greatly improved in recent years and will experience more progress in near future. These achievements contribute to the progress of ARCCNM and Asian countries in this scientific field.
Acknowledgements
The author appreciates Nuclear Medicine Society of Thailand, Professor Makumkrong Poshyachinda, M.D., Professor Snan Simarak, M.D., Dr. Pawana Pusuwan, M.D., Dr. Tawatchai Chaiwatanarat, M.D., Dr. Chanika Sritara, M.D., Dr. Molrudee Ekmahachai, M.D., Dr. Yuthana Saengsuda, M.D., Dr. Supatporn Tepmongkol M.D., Dr. Charoonsak Somboonporn, M.D., Dr. Kanuengnij Thamnirat, M.D., Dr. Samart Raja‐ dara, M.D., Dr. Wichana Chamroonrat, M.D., Dr. Arpakorn Kositwattanarerk, M.D., Dr. Anchali
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Krisanachinda, Nonlak Vilasdechanon, associate professor, Dr. Usanee Vutrapongwatana, M.D., Dr. Pichanun Pothisoonthorn, M.D., and Dr. Siriwattana Sirironnarong, M.D. for providing nuclear medicine information of the hospitals and valuable data on clinical nuclear medicine services and research in Thailand. The author also acknowledges the reports of researchers in Thailand in 2012, “IAEA‐RCA Project Coordination Meeting”, “Task Force Meeting” on 2‐6 July 2012 in Manila, Philippines, “The Developmental Plan of Nuclear Medicine Services for the Diagnosis and Treatment of Malignant Tumors in Thailand in 2007‐ 2009”(by M. Poshyachinda), “Nuclear Medicine in Thailand in 2005” presented at the ARCCNM meeting in August 2005 in Bangkok, Thailand (by M. Poshyachinda), and “Development of Nuclear Medicine in Chiang Mai, Thailand” presented at the first “Mobile Academic Meeting of Nuclear Medicine Society of Thailand”, which was held on 22‐24 November, 2001 (by S. Simarak). The reports of the status of nuclear medicine in 1996 and national health problems in Thailand at the IAEA expert meeting on the development of sectored strategies for use of nuclear medicine in health care in Asia and Pacific region, held on 1‐5 September 1997 in Jakarta, Indonesia (by M. Poshyachinda), are also highly appreciated. The author would also like to thank Professor Dr. Henry Bom, the president of AOFNMB, for his valuable suggestions.
Asia Oceania J Nucl Med Biol. 2014; 2(2):143-148.
