Background:

The second FNCA Workshop on Cyclotron and PET in Medicine was held from November 19 to 23, 2007, at Kuala Lumpur that is the capital city of Lead Country of this project, Malaysia . It was jointly organized by Malaysian Nuclear Agency (Nuclear Malaysia), Ministry of Science, Technology and Innovation, Malaysia (MOSTI) and Ministry of Education, Culture, Sports, Science & Technology of Japan (MEXT). The workshop was attended by delegates from 6 FNCA countries namely People's Republic of China, Japan, Malaysia, the Philippines, Thailand and Vietnam. The participants of workshop amounted to 25 persons.

Opening ceremony

Opening ceremony started with the national anthem. Dato' Dr. Mohamed Ali Abdul Khader representing Deputy Director General (Medical), Ministry of Health as well as the Malaysian Project Leader has given welcoming remarks at the opening ceremony. Opening speech was delivered by Mr. Adnan Hj. Khalid representing Director General of Malaysian Agency. Then, the Workshop started.

Workshop:

The objectives of this project are
- Improvement of diagnostic technique for nuclear medicine in Asian countries.
- Early detection with advanced technology contributes to human health in Asia.

PET and PET/CT that appeared on medical scene lately are very available for the diagnosis of several cancers. The themes of three areas namely "Imaging instrumentation", "Radiation safety and PET radiopharmaceuticals" and "Clinical diagnosis" were considered through their small-group discussion respectively at the workshop.

The theme of "Imaging instrumentation" is radiation safety, quality assurance (QA) and quality control (QC) for PET imaging. As the result of the discussion, the group reported the evaluation of PET should be based on the standard "NEMA NU-2 2001" and the one of CT should be based on the guideline "AAPM 39". And also they informed Periodic performance evaluation of PET was confirmed to be of importance for QC.

The theme of "Radiation safety and PET radiopharmaceuticals" is the QA/QC for PET radiopharmaceuticals, radiation safety for cyclotron and production of PET radiopharmaceuticals. The group is planning to establish the guideline as the final outcome. They provided a concrete division of roles for writing the guideline among the members and decided the future plan on it.

The theme of "Clinical diagnosis" is publication of case review in clinical PET and the group hopes to introduce the FNCA case review system for clinical PET. The group discussed about the future plan and agreed.

Conclusions; The meeting has agreed on the following.

1. To compiled all necessary documents and submitted to Malaysian project leader according to each group's work plan, recommendation and conclusion.
2. To activate the formation of e-mailing group immediately.
3. Malaysian counterpart of the project will act as the secretariat to compile data and documents from each sub-group. Discussions through e-mail should be done continuously before the next FNCA workshop meeting for each group.
4. All communications regarding the preparation of the documents shall be channeled to participant who has not attended this meeting after their name has been nominated by their FNCA country coordinator.
5. Malaysian FNCA coordinator needs to inform Korea and Indonesia, and also countries who have not nominated their sub-group leader.

Technical tour

Participants went to pay their respects to Dato' Dr. Noorimi Binti Haji Morad, Deputy Director General of Health (Medical), Ministry of Health Malaysia on Wednesday 21st of November.

Dato' Dr. Noorimi Binti Haji Morad expressed the expectation of the workshop attaining great accomplishment and Dato' Dr. Mohamed Ali Abdul Khader, Malaysian project leader, reported their activities had progressed steadily.

Then, participants conducted a Technical Tour to the Putrajaya Hospital. There was an advanced technical facility of Cyclotron and PET/CT with GMP production environment.

Open Seminar

Open Seminar was held from November 22 to 23, 2007. The authorities from Malaysia , China , and Japan made medical presentations and shared several information with the audience. The programs were as below;. "Introduction to the Programmatic Activities of FNCA in Nuclear Medicine" "An overview of the Current Situation of Nuclear Medicine in Malaysia" "PET Technology, Radioisotopes Production and Application of Cyclotron Technology; Radiopharmaceuticals & Radiochemistry" " PET Technology, Radioisotopes Production and Application of Cyclotron Technology; Regulatory Aspects" "Application of PET in Clinical Practice". There were more than 120 participants including lectures at this event.

1. Opening Session

Mr. Adnan Hj. Khalid representing Director General of Malaysian Nuclear Agency has officiated the 2_nd FNCA Workshop on the Application of Cyclotron and PET in Medicine held from 19_th -21_st November 2007 in Chorus Hotel, Kuala Lumpur. The workshop was jointly organized by Malaysian Nuclear Agency, Ministry of Science, Technology and Innovation, Malaysia (MOSTI) and Ministry of Education, Culture, Sports, Science & Technology of Japan (MEXT). Dato' Dr. Mohamed Ali Abdul Khader representing Deputy Director General (Medical), Ministry of Health as well as the Malaysian Project Leader has given welcoming remarks at the opening session.
Delegates from 6 FNCA member countries namely, People's Republic of China, Japan, Philippine, Malaysia, Thailand and Vietnam.

2. Country Presentation

This session was chaired by Dr. Zulkifli Mohamed Hashim of Malaysia Nuclear Agency. Mr. Adnan Hj. Khalid, who is also the FNCA Coordinator of Malaysia introduced the FNCA framework and activities. It is then followed by The Malaysia Project Leader, Dato' Mohamed Ali Abdul Khader gave an Overview on the Current Situation of Nuclear Medicine in Malaysia and then continued to brief the participants on the objectives and the expected outcomes from the workshop. Prof. Dr. Sheng Chen from China presented the overview of current status of the utilization of cyclotron and PET in Medicine in China.

3. Group Discussion

The participants were divided into three groups.

Group 1 - Imaging Instrumentation

Chairperson: Dr. Hideo Muruyama (Japan)
Participants: Dr. Noriah Jamal (Malaysia)
Prof. Dr. Shengzu Chen (China)
Dr. Rujaporn Chanachai (Thailand)
Mr. Nguyen Manh Hung (Viet Nam)
Ms. Ng Yen (Malaysia)

The theme for the Group 1 is radiation safety, quality assurance (QA) and quality control (QC) for PET imaging. The group member also recognize the importance and role of cross calibration in order to confirm the accuracy of the performance of the next generation prototype PET and jPET-D4. Malaysian delegates presented and proposing a draft of guidance note for the evaluation of PET and CT based on the standard of NEMA NU-2 2001 for PET and the Guideline of AAPM 39 for CT. Other issues identified and needed to be considered and documented are:

• Performance evaluation of PET has been put into practice in FNCA countries according to the proposal of previous FNCA workshop.
• Periodic performance evaluation of PET was confirmed to be of importance for QC.
• Cross calibration is an important practice with a pool phantom and a dose calibrator.
• FNCA activity is useful for all the countries which have a plan to establish centre of PET/CT in the future.

Group 2 - Radiation Safety and PET Radiopharmaceuticals

Chairperson: Dr. Zulkifli Mohd. Hashim (Malaysia)
Participants: Dato' Dr. Rehir Dahalan (Malaysia)
Dr. Kazutoshi Suzuki (Japan)
Mr. Yoshihito Kameda (Japan)
Mr. Takehito Kato (Japan)
Prof. Fan Wo (China)
Mr. Jiradanai Sarasamkan (Thailand)
Mr. Syed Asraf Fahlawi Wafa (Malaysia)
Ms. Siti Najila Mohd. Janib (Malaysia)
Mr. Azahari Kasbollah (Malaysia)
Ms. Rasyieda Abdullah (Malaysia)
The theme for Group 2 is the QA/QC for PET radiopharmaceuticals, radiation safety for cyclotron and production of ₁₈F-FDG. The activity and target outcome that is expected through group discussions are the establishment of guidance for the cyclotron performance, ₁₈F-FDG and QA/QC for ₁₈F-FDG. The group began with the presentation from Prof. Dr. Fan Wo, Dr. Kazutoshi Suzuki, Ms. Rasyieda Abdullah and followed by Mr. Jiradanai Saramsamkan. Member of the group was supplied with the documents provided by Japan, that is the Standards of labeled with Positron Nuclides Approved as Established Techniques for Medical Use.

Members of the group has proposed a template which containing details subject of radiations safety, Flourine-18 and FDG production and QA/AC of PET radiopharmaceuticals to be prepared and compiled. An established guideline of ICRP and NCRP will be used as a benchmark to develop a basic guideline through this FNCA project. It was decided that the quality criteria for the FDG final product should be prepared for non-GMP and GMP production environment.
Malaysia has been assigned to prepare the radiation safety document while participants from Thailand and China need to prepare the F-18 and FDG production. Participant from Japan need to compile the QA and QC of PET radiopharmaceuticals. The work schedule agreed is to submit the draft of each document to Malaysian counterpart before 30_th April, and will be reviewed, and proposed to be compiled and ready by end of May 2008.

Group 3 - Clinical Diagnosis

Chairperson: Dato' Dr. Mohamed Ali Abdul Khader (Malaysia)
Participants: Dr. Fadzilah Hamzah (Malaysia)
Prof. Dr. Dang Yaping (China)
Dr Tomio Inoue (Japan)
Dr Nobukazu Takahashi (Japan)
Dr Pawana Pusuwan (Thailand)
Dr Jonas Francisco Santiago (Philippine)
Dr Le Ngoc Ha (Vietnam)
Group 3 has the theme of publication of case review in clinical PET and thus the group hopes to introduce the FNCA case review system for clinical PET.

4. Conclusions

The 2_nd FNCA workshop on the Applications of Cyclotron and PET in Medicine has agreed to achieve some objectives, that is: (summary from each group)

1. To compiled all necessary documents and submitted to Malaysian project leader according to each group's work plan, recommendation and conclusion. Appendix 1 from Group 1, appendix 2 from Group 2, and appendix 3 from Group 3 are attached.
2. To activate the formation of e-mailing group immediately.
3. Malaysia counterpart of the project will act as the secretariat to compile data and documents from each sub-group. Discussions through e-mail

• Group1 - Imaging instrumentation

  Chairperson:	Dr. Hideo Murayama (Japan)
  Participants:	Dr. Noriah Jamal (Malaysia)
  	Prof. Dr. Shengzu Chen (China)
  	Dr. Rujaporn Chanachai (Thailand)
  	Mr. Nguyen Manh Hung (Viet Nam)
  	Ms. Ng Yen (Malaysia)

• Group2 - Radiation Safety and PET Radiopharmaceuticals

  Chairperson:	Dr. Zulkifli Mohamed Hashim (Malaysia)
  Participants:	Dato' Dr. Rehir Dahalan (Malaysia)
  	Dr. Kazutoshi Suzuki (Japan)
  	Mr. Yoshihito Kameda (Japan)
  	Mr. Takehiko Kato(Japan)
  	Prof. Fan Wo (China)
  	Mr. Jiradanai Sarasamkan (Thailand)
  	Mr. Syed Asraf Fahlawi Wafa (Malaysia)
  	Ms. Siti Najila Mohd. Janib (Malaysia)
  	Mr. Azahari Kasbollah (Malaysia)
  	Ms. Rasyieda Abdullah (Malaysia)

• Group3 - Clinical Diagnosis

  Chairperson:	Dato' Dr. Mohamed Ali Abdul Khader (Malaysia)
  Participants:	Dr. Fadzilah Hamzah (Malaysia)
  	Prof. Dr. Dang Yaping (China)
  	Dr. Tomio Inoue (Japan)
  	Dr. Nobukazu Takahashi (Japan)
  	Dr. Pawana Pusuwan (Thailand)
  	Dr. Jonas Francisco Santiago (Philippine)
  	Dr. Le Ngoc Ha (Viet Nam)