FNCA

Cyclotron and PET in Medicine workshop

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Project Review

Introduction of
the Project Leaders


Guideline
"Radiation Protection and Performance Evaluation of PET-CT Imaging"
"Quality Assurance and Quality Control of 18F-FDG"

Workshop
FY2010
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FNCA 2010 Workshop on Cyclotron and PET in Medicine

Report of
FNCA Workshop on Cyclotron and PET in Medicine Project 2010
March 4 - 5, 2011
Bangi, Malaysia


The 5th FNCA Workshop (JFY2010) on Cyclotron and PET in Medicine Project was held in Bangi, Malaysia from 4 to 5 March, 2011. 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 30 participants from Bangladesh, China, Indonesia, Japan, Malaysia, The Philippines, Thailand and Vietnam.
This project targets the improvement and dissemination of nuclear medicine diagnostic technologies for people in Asia, which can contribute to the earlier detection and treatment of diseases. Since JFY2006, the project has been working under the leadership of Malaysia for five years, and was completed in JFY 2010.
In the final workshop of this project, the participants reported the current status of PET and Cyclotron in each country and new clinical cases as well. The result of "Surveillance on Personal Dose" implemented on the subject "Radiation Safety" of the 2nd phase of this project was reported. Also, participants reviewed the achievements in the 5 years' project activities. (Please refer to the report below.)

Country Report

The country reports by each country are summarized as below.

Bangladesh (Dr. Mohammed Fazlul Kabir)
Since the cost of PET Examinations has not been covered by the health insurance and people had to pay for that themselves in Bangladesh, it was unavailable to set up the business for PET Examinations. However, the grand-funding from the government enabled the investment for the facilities and also the research and development. At present, 2 PET Centers are under construction in Dhaka. They will be in operation within 1 year.

China (Prof. Chen Shengzu and Prof. Dang Yaping)
In 2005, there were 50 PET Centers in China but it has increased up to 160 currently. The number of PET (including PET/CT) has increased dramatically from 55 to 118. In the framework of FNCA, China's contribution ranges from setting up the guidelines and submitting many clinical cases for Atlas. China has been making the most use of FNCA activities in standardization and improvement for clinical management of PET/CT and also putting the Quality Assurance / Quality Control (QA/QC) of PET and Cyclotron into action, based on the FNCA guideline.

Indonesia (Dr. Kardinah)
The first domestic FDG production was started in 2010. The medical services, research activities and education programs are being carried out by Ministry of Health and National Nuclear Energy Agency (BATAN). As of 2010, 4 PET Centers (private:2 national:2) are in operation in Indonesia.

Japan (Prof. Dr. Hidehiko Okazawa)
Since the 1/3 of Japanese people die of cancer nowadays, they are becoming interested in the diagnosis and therapies of cancer. In the survey of 2009, tumor occupies 98% of PET Examinations. In 1985, there were 5 PET Centers and the number has been rising to 21 in 1995, to 29 in 2000, and up to 273 in 2010. The 273 PET Centers are divided into 136 (Users of 18F-FDG-delivery) and 137 (holding Cyclotrons). The delivery of 18F-FDG by private companies was started from 2005 and the PET Centers without Cyclotrons are provided with 18F-FDG from 8 basis of Japan.

Malaysia (Dr. Fadzilah Hamzah and Assoc Prof. Dr. Abdul Jalil Nordin)
The PET Examination was started from 2005 in Malaysia and 8 PET/CT instruments are installed in 8 PET Centers as of 2010. Also, 3 Cyclotrons are installed in 3 Centers. Ministry of Health (MOH) adopted the registration system of Nuclear Medicine Specialty in 2009 with the opinion that the examinations of nuclear medicine should be conducted under the control of the specialists. Malaysian Nuclear Medicine Specialty Committee consists of 7 members. 3 of them belong to MOH.

The Philippines (Mr. Joselito Manalo De La Cruz)
The first PET and Cyclotron were installed in St. Luke Medical Center in 2001 and now there are 3 PET (including PET/CT) and 1 Cyclotron in the Philippines. Since March of 2011, there is a change in dosage of 18F-FDG-PET to the patients. The dosage is becoming smaller and adjusted based on the patient's weight, which could lead to the reduction of radiation exposure.

Thailand (Assoc. Prof. Dr. Rujaporn Chanachai)
Thailand has 6 PET Centers and 2 (out of the 6) Centers are equipped with Cyclotron. National Cyclotron and PET Centre is delivering 18F-FDG to PET Centers unequipped with Cyclotron. Total number of domestic PET-CT Case Study in 2006 was 866 but it went up to 2316 in 2009. Currently, other than 18F-FDG such as F-DOPA and 11-C Cholin are also used for clinical examinations as PET Tracer.

Vietnam (Asso. Prof. Dr. Mai Trong Khoa and Mr. Nguyen Cong Duc)
Vietnam has 27 Nuclear Medicine Centers including 4 PET/CT Centers and 3 Centers with Cyclotron. 2 hospitals holding PET/CT are now under construction in Ho Chi Minh City. 18F-FDG is used for PET examinations and they are performed according to the standard Protocol defined by the specialists and the government. The cost of PET/CXT examinations can be covered by 30-80% by health insurance from 2010. However, the facts that the instruments are not enough, hospitals are relying on the imported radiopharmaceuticals and QA/QC is not well performed due to a shortage of medical physicists and engineers , are the current problems in the country.

Report on Dosimetry Test in PET and Cyclotron Facilities

Regarding the subject of the 2nd phase (from JFY2009) of the project, "Dosimetry Test using Glass Badges in PET and Cyclotron Facilities" was implemented in in Putrajaya Hospital and Wijaya International Medical Center, Malaysia in June of 2010. The report and summary of the results was made by Dr. Noriah Jamal from Nuclear Malaysia, followed by the by Assoc. Prof. Dr. Rujaporn Chanachai's report on the dosimetry test in Chulabhorn Cancer Centre, Thailand. The results from both country showed that Malaysian staffs were exposed to higher radiation than Thai staffs, which turned out to be due to the lower FDG production activity in Thailand (1/2 volume of what of Malaysia). Also, the participants recognized that the dose received by personnel in both Malaysia and Thailand is below the limit and mostly very low, and they safety management was well performed. In addition, participants exchanged information on QC which was done after FDG production.

Clinical ATLAS

Dr. Fadzilah Hamzah (Malaysia) presented the background and current development in compiling Clinical Atals (glossary of clinical cases). Then it was informed that the total cases complied for Atlas is 152 cases and another 20 new cases will be submitted by Vietnam. Moreover, it was announced that MOSTI has established an editorial board to edit the collected clinical cases for publishing a book of Atals. The followings were suggested for compiling the cases. 1) To show the image of each case larger for example, a half size of 1 page. 2) To categorize the cases into each disease and to delete the overlapping diseases. 3) To omit the personal information such as age and exam date. It is expected that the published Atlas will be widely distribute not only to the people involved but also to hospitals and medical schools for effective utilization.

Finalization of Guidelines

Participants reviewed and finalized the two guidelines namely, "Radiation Protection and Performance Evaluation of PET-CT Imaging" and "FDG Quality Assurance and Quality Control". They were produced in the subjects of the 1st phase of the project which are "Imaging Instrument" and "Radiation Safety & PET Radiopharmaceuticals". The modified parts in the discussion will be reflected on the existing guidelines by Malaysia and the both will be on the website of FNCA and Malaysian Nuclear Agency after completion. Also, it was recognized that the people involved should promote the guidelines.

Wrap-Up

Lastly, participants made up the minutes of the workshop and also a final report, reviewing the 5 years' project activities. Dr. Muhd Noor Muhd Yunus, FNCA Malaysian Coordinator/ Deputy Director General (Technical), Nuclear Malaysia, gave closing remarks and the workshop was adjourned.


Minutes of
FNCA Workshop on Cyclotron and PET in Medicine Project 2010
March 4 - 5, 2011
Bangi, Malaysia



  1. Welcoming Remarks
Dr. Muhd Noor Muhd Yunus, Deputy Director General of the Malaysian Nuclear Agency and the National FNCA Coordinator for Malaysia, delivered his opening remarks and officiated the opening of the workshop.

This Workshop is jointly organized by the Malaysian Nuclear Agency, Ministry of Science, Technology and Innovation, Malaysia (MOSTI) and the Ministry of Education, Culture, Sports, Science & Technology (MEXT) of Japan.

Head of the Japanese delegation, Prof. Dr. Hidehiko Okazawa delivered reciprocal remarks.
 
  2. Session I and II: Country/Case Presentations
  2.1 Participants from respective countries reported development and progress in each country for the last five years, for the following items:
a) Number of Medical Institute holding PET facilities
b) Number of PET/CT Cameras
c) Number of Medical Institute with Cyclotron
d) Number of Cyclotron
e) New case studies
  2.2 Presentations were from:
a) Bangladesh by Dr. M. Fazlul Kabir
b) China by Prof. Dr. Chen Shengzu and Prof. Dr. Dang Yaping
c) Indonesia by Dr. Kardinah
d) Japan by Prof. Dr. Hidehiko Okazawa
e) Malaysia by Assoc. Prof. Dr. Abdul Jalil and Dr. Fadzilah Hamzah
f) Philippines by Mr. Joselito De la Cruz
g) Thailand by Assoc. Prof. Dr. Rujaporn Chanachai
h) Vietnam by Assoc. Prof.Dr. Mai Trong Khoa and Mr. Nguyen Cong Duc

  3. Session III: Discussion and Finalization on ATLAS
  3.1 Dr. Fadzilah Hamzah presented the current development in Atlas to the meeting.
  3.2 The meeting was informed that the total cases compiled for ATLAS is currently at about 150 cases including new cases from China, Malaysia, Japan, Philippines. It is also noted to the meeting that another 20 new cases will be submitted by Vietnam.
  3.3 The meeting agreed that Malaysia will appoint an independent editorial board to edit the compilation of cases. This editorial board will review cases which need improvement in images, corrections on grammar and spelling, and other corrections. They will then revert to member countries concerned and request to re-submit the needed images.
The timeframe suggested for this process is 3 months.
  3.4 China suggested on making the images of higher-quality and the size to be about half a page.
  3.5 Japan suggested on harmonizing and anonymizing the data, for example classifying patients in diseases, elimination of age, exam date, etc.
  3.6 It is also suggested to the meeting that the member countries and contributors to the Atlas to sign agreement giving consent and copyright to the Malaysian Nuclear Agency and the Ministry of Science, Technology and Innovation of Malaysia (MOSTI), as publisher. The published book will be jointly owned by Malaysia (MOSTI and Nuclear Malaysia) and Japan (FNCA Secretariat Office).
  3.7 The meeting was also informed that CDs of the PET-CT ATLAS containing cases (in PDF format, without final editing), will be distributed to participants of the meeting later as soon as it is completed.
 
  4. Session IV: Discussion on Radiation Safety
  4.1 These presentations on Radiation Safety were made:
a) Report of dosimetry test in Thailand by Assoc. Prof Dr. Rujaporn Chanachai
b) Report of result and summary of GBs (glass badges) test in Malaysia by Dr. Noriah Jamal
  4.2 The following points were raised and discussed:
a) Vietnam suggested to reduce the dose exposure for Quality Control;
b) The meeting agreed that reducing the exposure need to be considered in compliance to the GMP requirement;
c) It is noted by the meeting that the dose received by personnel is below the limit and mostly very low;
d) The meeting also observed that the dose received by Thai workers is relatively lower than that of by the Malaysian workers, due to the lower production activity.

  5. Session V: Discussion and Finalization of the Guidelines
  5.1 The following guidelines were presented for corrections and discussions:
a) Guideline for QA & QC of 18F-FDG (2-Deoxy-2-fluoro-D-glucose) by Dr. Zulkifli Hashim
b) Radiation Protection and Performance of PET-CT Imaging by Dr. Noriah Jamal
  5.2 Members of meeting made corrections of the two guidelines and noted by the presenters and secretariat.
  5.3 The meeting also discussed on how to promote the Guidelines, and the following points were raised:
a) Members countries are urged to carry on promoting the use of the guidelines in their respective countries
b) The guidelines will be made available on FNCA and Nuclear Malaysia websites to promote the utilization

  6. Session VI: Confirmation of 1) the minutes of the Workshop and 2) Final Report of the overall project in the last 5 years
  6.1 The draft meeting minutes were presented by the secretariat and corrected by the meeting. This draft will be circulated to members of meeting for final confirmation before being adopted.
  6.2 The final report of the overall project was also presented and discussed by the meeting. This draft will also be circulated to members of meeting for final confirmation.
 
  7. Conclusions of the Meeting
The meeting was officially closed by Dr. Muhd Noor Muhd Yunus.


Program of
FNCA Workshop on Cyclotron and PET in Medicine Project 2010
March 4 - 5, 2011
Bangi, Malaysia



Day 1. Fri 4th Mar
Opening Session
08:30 - 08:45 Welcome remarks
Dr. Muhd Noor Muhd Yunus
Malaysian FNCA Coordinator
Deputy Director General (Technical)
Malaysian Nuclear Agency (Nuclear Malaysia)
08:45 - 09:00 Remarks by Representative of Japanese Delegation
Prof. Dr. Hidehiko Okazawa
Director, Biomedical Imaging Research Center
Professor, Division of Medical Imaging
University of Fukui
Session 1. Current Project Cycle and Country / Case Presentations
Chair: Dr. Zulkifli Hashim & Prof. Dr. Hidehiko Okazawa
09:30 - 10:30 Status of PET/CT and Cyclotron in Bangladesh (Bangladesh)
Dr. Mohammed Fazlul Kabir
Professor & Director, Institute of Nuclear Medicine and Ultra Sound,
Bangladesh Atomic Energy Commission (BAEC)
Summary Report of FNCA (China)
Dr. Chen Shengzu
Professor
Cancer Hospital of Chinese Academy of Medical Sciences
Case Report (China)
Dr. Dang Yaping
Professor
First Affiliated Hospital of the Xi'an Jiaotong University
Enhancement Nuclear Medicine Services Through Indonesian Cancer Control Program (Indonesia)
Dr. Kardinah
Head of Department Diagnostic Radiology
National Cancer Center, Dharmais Cancer Hospital
  Nuclear Medicine Practice in Japan (Japan)
Prof. Dr. Hidehiko Okazawa
Director, Biomedical Imaging Research Center
Professor, Division of Medical Imaging
University of Fukui
10:30 - 10:45 Coffee Break
Session 2. Current Project Cycle and Country / Case Presentations
Chair: Dr. Zulkifli Hashim & Prof. Dr. Hidehiko Okazawa
10:45 - 12:15 Case Presentation (Malaysia)
Assoc. Prof. Dr. Abdul Jalil Nordin
Director, Diagnostic Nuclear Imaging Center
University Putra Malaysia
Overview of PET-CT Services in Malaysia / Current Scenario & Future Development (Malaysia)
Dr. Fadzilah Hamzah
Penang Hospital
PET/CT in the Philippines (Philippines)
Mr. Joselito Manalo De La Cruz
Manager and Medical Physicist, PET Center
St. Luke's Medical Center
Current Status of PET/CT in Thailand (Thailand)
Assoc. Prof. Rujaporn Chanachai
Head of Division of Nuclear Medicine
Siriraj Hospital, Mahidol University
PET/CT and Cyclotron Develoment in Vietnam, Current Status and PET/CT in Vietnam (Vietnam)
Dr. Mai Trong Khoa
Vice Director - Bach Mai Hospital, Hanoi
Director - Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi
Head of Nuclear Medicine Department, Hanoi Medical University
  FNCA 2011 Workshop on Application of Cyclotron and PET in Medicine Project (Vietnam)
Dr. Nguyen Cong Duc
Vice-Head, PET-CT and Cyclotron Unit
CHO RAY Hospital
12:15 - 14:45 Lunch and Moslem Friday Prayers
Session 3. Discussion and Finalization on Atlas
Chair: Dr. Muhd Noor Muhd Yunus
14:45 - 16:00 Current Development in Atlas
Dr. Fadzilah Hamzah
Penang Hospital
  1. Atlas
2. Utlization of protocols and output for past 3 years
3. Finalization of the Atlas
4. Data-handling rule for use of Atlas (Intellectual Property Rights)
16:00 - 16:15 Coffee Break
Session 4. Disucssion on Radiation Safety
Chair: Dr. Muhd Noor Muhd Yunus
16:15 - 17:30 Radiation Safety - Report of Result and Summary of GBs Test in Malaysia
Dr. Noriah Binti Jamal
Senior Research Officer,Medical Technology Division
Malaysian Nuclear Agency (Nuclear Malaysia)
  Radiation Safety - Report of Dosimetry Test in Thailand
Assoc. Prof. Rujaporn Chanachai
Head of Division of Nuclear Medicine, Division of Nuclear Medicine
Siriraj Hospital, Mahidol University
17:30 Meeting Adjourned

Day 2. Sat 5th Mar
Session 5. Discussion on Finalization of the Guidelines
Chair: Dr. Zulkifli Hashim
09:00 - 10:30 1. Discussion and Finalization of the Guidelines for:
- Guideline for Radiation Protection and Perfoamance of PET-CT Imaging
- Guideline for QA& AC of 18F-FDG (2-Deoxy-2-Fluoro-D-glucose)
2. How to Promote the Guidelines
10:30 - 10:45 Coffee Break
Session 6. Confirmation of
(1) Minutes of the Workshop (2) Final Report of the overall project in the last 5 years.
Chair: Dr. Muhd Noor Muhd Yunus & Dr. Zulkifli Hashim
10:45 - 12:30 Discussion and Confirmation for Minutes and Final Report
12:30 - 14:00 Lunch
Session 7. Confirmation of
(1) Minutes of the Workshop (2) Final Report of the overall project in the last 5 years.
Chair: Dr. Muhd Noor Muhd Yunus & Dr. Zulkifli Hashim
14:00 - 16:00 Discussion and Confirmation for Minutes and Final Report
16:00 - 16:15 Coffee Break
16:15 - 17:30 Discussion and Wrap up by Dr.Muhd Noor Muhd Yunus
Malaysian FNCA Coordinator,Deputy Director General (Technical),
Malaysian Nuclear Agency (Nuclear Malaysia)
17:30 Meeting Adjourned


List of Participants
FNCA Workshop on Cyclotron and PET in Medicine Project 2010
March 4 - 5, 2011
Bangi, Malaysia



Bangladesh

Dr. Mohammed Fazlul Kabir (Project Leader)
Professor and Director
Institute of Nuclear Medicine & Ultrasound Bangladesh
Atomic Energy Commission (BAEC)

China

Prof. Chen Shengzu (Project Leader)
Professor
Cancer Hospital of Chinese Academy of Medical Sciences

Prof. Dang Yaping
Professor
First Affiliated Hospital of the Xi’an Jiaotong University

Indonesia

Dr. Kardinah
Head of Department Diagnostic Radiology
National Cancer Center, Dharmais Cancer Hospital

Dr. Rosalina
Staff, Department Diagnostic Radiology
National Cancer Center, Dharmais Cancer Hospital

Japan

Prof. Dr. Hidehiko Okazawa
Director, Biomedical Imaging Research Center
Professor, Division of Medical Imaging
University of Fukui

Mr. Takehiko Kato
Sales Headquarters
Chiyoda Technol Corporation

Mr. Yoshihito Kameda (Observer)
General Manager, Sales & Marketing Dept.
Quantum Equipment Division
Sumitomo Heavy Industries, Ltd.

Ms. Ai Yamada (Secretariat)
International Affairs and Research Department
Nuclear Safety Research Association (NSRA)

Malaysia

Dr. Muhd Noor Muhd Yunus (FNCA Malaysian Coordinator)
Deputy Director General(Technical) and FNCA Coordinator
Malaysian Nuclear Agency

Dato' Dr. Rehir Dahalan
Director, Medical Technology Division
Malaysian Nuclear Agency

Dr. Noriah Jamal
Senior Research Officer, Medical Technology Division
Malaysian Nuclear Agency

Dr. Zulkifli Mohamed Hashim
Senior Research Officer, Medical Technology Division
Malaysian Nuclear Agency

Mr. Mohd Sidek Othman
Malaysian Nuclear Agency

Prof. Dato' Dr. Humairah Abdul Samad Cheung
President, College of Radiology
Academy Medicine of Malaysia

Assoc Prof. Dr. Abdul Jalil Nordin
Director, Diagnostic Nuclear Imaging Center
University Putra Malaysia

Dr. Fadzilah Hamzah
Penang Hospital

Mr. Mohd Aminuddin Said
Nuclear Medicine Department
Putrajaya Hospital

Mr. Suharzelim B. Abu Bakar
Nuclear Medicine Department
Putrajaya Hospital

Mr. See Jin
Business Development Manager & Radiation Protection Officer
Wijaya International Medical Centre

Ms. Rabiatul Adwiyah Mat Salleh
Wijaya International Medical Centre

Mr. Zaiskandar Mohamad
Radiographer, Wijaya International Medical Centre

Dr. Pirunthavany Muthuvelu
Ministry of Health, Malaysia

Mr. Bazli Sapiin
Ministry of Health, Malaysia

Mr. Ng Aik Hao
Ministry of Health, Malaysia

The Philippines

Mr. Joselito M. de La Cruz
Manager and Medical Physicist
PET Center
St. Luke's Medical Center

Thailand

Assoc. Prof. Rujaporn ChanaChai (Project Leader)
Head of Division of Nuclear Medicine
Division of Nuclear Medicine
Siriraj Hospital, Mahidol University

Mr. Jiradanai Sarasamkan
Radiopharmacist and Quality Assurance Supervisor
Division of Radiopharmaceutical Production
Chulabhorn Cancer Centre, National Cyclotron and PET Center

Vietnam

Dr. Mai Trong Khoa
Vice Director - Bach Mai Hospital, Hanoi
Director - Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi
Head of Nuclear Medicine Department, Hanoi Medical University

Mr.Nguyen Cong Duc
Vice-Head, Radiopharmaceutical Section, PET & Cyclotron Unit, Nuclear Medicine Department
CHO RAY Hospital


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