Background:

The third FNCA Workshop on Cyclotron and PET in Medicine was held from January 6 to 9, 2009, 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 7 FNCA countries namely People's Republic of China, Indonesia, Japan, Malaysia, The Philippines, Thailand and Vietnam. The participants of workshop amounted to 29 persons.

The objectives of this project are
- Improvement of diagnostic technique for nuclear medicine in Asian countries.
- Early detection with advanced technology such as PET and PET/CT, contributes to human health in Asia.

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.

Participants of Workshop

Group 1 - Imaging Instrumentation

The theme for Group 1 is radiation safety, quality assurance and quality control for PET/CT imaging. The activity and target outcome that is expected through group discussions are the establishment of radiation protection and performance evaluation of PET/CT.

Group members drafted the guideline on the performance evaluation of PET scanner and CT scanner, named “guideline for radiation protection and performance evaluation of PET-CT imaging equipment”. This document is expected to be utilized effectively for the improvement of QA/QC in the developing countries.

Group 2 - Radiation Safety and PET Radiopharmaceuticals

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 guidelines for the cyclotron performance, 18F-FDG production and QA/QC for 18F-FDG.

Group members discussed about the contents of the guideline. In the result, they agreed that Malaysian representatives were going to finalize the guideline based on the Japanese reference of the production and QA/QC of FDG, combining the conditions of member countries.

Group 3 - Clinical Diagnosis

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.

They expect the FNCA case review system will be utilized for not only the education item of relevant parties but also the one promoting better understanding of the availability of PET among peoples.

Therefore, they decided in the workshop to add the academic description to every case for the better utilization of users.

The collection of the PET data was continued after the workshop and finally achieved the target value, 100 cases in March, 2009.

Figure a : PET-CT shows an intense brown fat uptake	Figure b: Repeat PET-CT - no brown fat uptake over the neck region after the administration of muscle relaxant

Recommendations

Members of the 3rd FNCA workshop on the Applications of Cyclotron and PET in Medicine have agreed on the following recommendations:

This FNCA project to be extended to include further expansion of the existing scope.

To include preparing the guideline for radiation safety aspect in Cyclotron and PET radiopharmaceutical production.

To include pre-installation and acceptance criteria for Cyclotron.

To develop the Quality Assurance guidelines in all sub groups.

To carry out surveillance on personal exposure dose in PET/CT and Cyclotron facilities for optimization.

Open seminar

Open Seminar was held from January 8 to 9, 2009.

The authorities from Malaysia made 10 presentations, China made 2, and Japan made 3 on the several phases of the nuclear medicine including advanced PET technology and shared a lot of information with the audience.

There were almost one hundred participants including lectures at this event.

Participants of Open Seminar	Seine of Open Seminar

1. Opening Session

Dr. Muhd Noor Muhd Yunus, Deputy Director General representing Director General of Malaysian Nuclear Agency officiated the 3^rd FNCA Workshop on the Application of Cyclotron and PET in Medicine held from 6^th - 8^th January 2009 at the Best Western Premier Seri Pacific 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 (MEXT) of Japan. Dato' Dr. Mohamed Ali Abdul Khader as the Malaysian Project Leader gave welcoming remarks at the opening session. Secondly, on behalf of MEXT, Prof. Keigo ENDO, project leader of Japan, made his remarks and emphasized the significance of this FNCA workshop.

Delegates representing FNCA member countries from People's Republic of China, Japan, Philippines, Malaysia, Thailand, Indonesia and Vietnam attended the workshop.

2. Presentation

This session was chaired by Dr. Zulkifli Mohamed Hashim of Malaysia Nuclear Agency who introduced Dr. Muhd Noor Muhd Yunus as the newly appointed FNCA Coordinator for Malaysia. Dr. Muhd Noor Muhd Yunus introduced the FNCA activities in nuclear medicine, past, present and future status. It is then followed by presentation from Dato' Dr. Mohamed Ali Abdul Khader on the Overview on the Current Situation of Nuclear Medicine in Malaysia and then continued to brief the participants on the objectives and the expected outcome from the workshop. He stressed the importance of finalizing and preparation of the guidelines during this workshop and also reminded all participating member countries that all guidelines should be ready for compilation before mid of February 2009.

3. Group Discussion

The participants were divided into three groups.

• Group 1 - Instrumentation

  Chairperson:	Dr. Noriah Jamal (Malaysia)
  Participants:	Prof. Dr. Ahmad Zakaria (Malaysia) Assoc. Prof Dr. Wan Ahmad Kamil Abdullah (Malaysia) Mr. Ng Aik Hao (Malaysia) Mr. Mohd Aminuddin Said (Malaysia) Dr. Hideo Muruyama (Japan) Prof. Dr. Chen Shengzu (China) Assoc. Prof. Dr. Rujaporn Chanachai (Thailand) Mr. Tran Ngoc Toan (Vietnam) Mr. Alexis Tiongson De Leon (Philippines)

  The theme for Group 1 is radiation safety, quality assurance and quality control for PET/CT imaging. The activity and target outcome that is expected through group discussions are the establishment of radiation protection and performance evaluation of PET/CT.
• Group 2 - Radiation Safety and PET Radiopharmaceuticals

  Chairperson:	Dr. Zulkifli Mohd. Hashim (Malaysia)
  Participants:	Dato' Dr. Rehir Dahalan (Malaysia) Dr. Kazutoshi Suzuki (Japan) Mr. Akihiro Morita (Japan) Mr. Takehiko Kato (Japan) Prof. Dr. Fan Wo (China) Ms. Supaporn Sawadjoon (Thailand) Mr. Nguyen Cong Duc (Vietnam) Ms. Eva Hyacinth Torres (Philippines) Mr. Syed Asraf Fahlawi Wafa S.M. Ghazi (Malaysia) Mr. Azahari Kasbollah (Malaysia) Mr. Suharzelim Abu Bakar (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 guidelines for the cyclotron performance, ¹⁸F-FDG production and QA/QC for ¹⁸F-FDG.
• Group 3 - Clinical Diagnosis

  Chairperson:	Dato' Dr. Mohamed Ali Abdul Khader (Malaysia)
  Participants:	Prof. Dr. Keigo Endo (Japan) Prof. Dr. Dang Yaping (China) Assoc. Prof. Dr Pawana Pusuwan (Thailand) Dr. Kardinah (Indonesia) Dr. Gerard Fabian de Leon Goco (Philippines) Dr. Fadzilah Hamzah (Malaysia)

  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. Group Presentation

Dr. Noriah Jamal presented on behalf of group 1.

Dr. Zulkifli Mohd Hashim presented on behalf of group 2.

Dato' Dr. Mohamed Ali Abdul Khader presented on behalf of group 3.

5. Conclusions

Members of the 3^rd FNCA workshop on the Applications of Cyclotron and PET in Medicine have agreed on the following:

1. To compile all necessary documents and submit to Malaysian project leader according to each group's work plan, recommendation and conclusion latest by 20^th February 2009.
2. Malaysian counterpart of the project will act as the secretariat to compile documents from each sub-group. Discussions through e-mail should be done continuously. The project leader shall review, finalize and approve the documents and send to Malaysian Nuclear Agency for final setting and binding. The deadline for this task is before 25^th February 2009.
3. All communications regarding the final preparation of the documents shall be channeled to participant who has attended this meeting after their name has been nominated by their FNCA country coordinator.
4. Group 2 has decided to exclude preparing the guideline for radiation safety aspect in Cyclotron and PET radiopharmaceutical production in this workshop. It was proposed to prepare such guideline in the next phase of the project, if applicable. This conclusion has been accepted and agreed by all members of the workshop.
5. Group 3 recommended that the category of cases should be extended to include other categories and also to increase the number of cases. This has been accepted and agreed by members of the workshop.

Recommendations:

1. This FNCA project to be extended to include further expansion of the existing scope.
2. To include preparing the guideline for radiation safety aspect in Cyclotron and PET radiopharmaceutical production.
3. To include pre-installation and acceptance criteria for Cyclotron.
4. To develop the Quality Assurance guidelines in all sub groups.
5. To carry out surveillance on personal exposure dose in PET/CT and Cyclotron facilities for optimization.

Adoption:

Dr. Gerard Fabian de Leon Goco proposed to accept the minute of the meeting and seconded by all members.

Date: 8^th January 2009 at 1145 hrs.