RADIOLOGY

Time to adopt PET imaging by hospitals in India

Shardul Nautiyal - Mumbai

Even as Positron Emission Tomography (PET) is more accurate and efficient in delivering functional information of body organs in comparison with MRI and CT scan, experts lament the unavailability of PET cameras in hospitals across the country. As of now, India has only one dedicated PET camera at Tata Memorial Hospital and three coincidence gamma PET cameras at Hinduja Hospital, Jaslok Hospital and Bombay Hospital.
PET is a new modality where short-lived Positron Emitting isotopes (produced by a cyclotron) are used to image function and metabolic activity of different organs and disease processes. Diagnostic examination by PET are used to evaluate a variety of diseases ranging from cancer, brain-related diseases like dementia, Parkinson’s Disease, Alzheimer‘s, epilepsy, myocardial perfusion and viability etc.
Experts lament that the government has not been forthcoming in making PET cameras available in many municipal and government teaching hospitals. Lack of funds and expertise are the major constraints, rue radiologists and nuclear medicine experts. According to Dr Inder Talwar, head, radiology department, Bombay Hospital, "The high system cost and space costs are the major roadblocks in installing a PET infrastructure in a healthcare institution."
A dedicated PET camera costs around Rs five crore to Rs 10 crore, and the cost to the patient for PET scanning works out between Rs 15,000 and Rs 20,000 in private hospitals. A coincidence Gamma PET camera costs around Rs 2.5 crore to Rs 3 crore and the cost to patient is Rs 12,500. A co-incidence camera can do three scans per day, while a dedicated one can do eight scans.
"We need to have at least two dedicated PET cameras in place for a city like Mumbai. If government institution has the facility of PET, then it can be made available to the poor people," says Dr Talwar.
Says Dr Vikram Lele, chief, nuclear medicine, Jaslok Hospital, "Apart from lack of funds and expertise, there is lack of a strong lobby of doctors to pursue this further." The Society of Nuclear Medicine and Association of Nuclear Medicine Physicians of India lobbied with the government to bring down the duty on PET cameras from 40 per cent to five per cent last year, added Dr Lele.
According to Dr Shyam Kishore Shrivastava, head, department of radiation oncology, Tata Memorial Hospital, cyclotron is required in the vicinity of the PET scanner as the radioactive substance produced by the cyclotron has short half-life. A cyclotron costs another Rs 12 to Rs 15 crore. Cyclotron produces radio-pharmaceutical material to be injected into the patient for PET imaging.
All the major cities in India like Delhi, Chennai, Kolkata and Bangalore should have one cyclotron each, suggest experts. As of now, there is only one cyclotron in India at Radiation Medicine Centre at Tata Memorial Hospital. In the pipeline, are one cyclotron in Chennai and three in Delhi. However, according to Dr Lele, "Planning to install three cyclotrons for a place like Delhi is a criminal waste of money."
"Many hospitals situated in the vicinity can share the cyclotron. Cyclotron has to be placed preferably close to one of the centres having expertise in use of radioactive substance," Dr Shrivastava added.
The problem of funds-constraint can be sorted out by revenue-sharing by different hospitals, opined Dr Lele. The entire infrastructure for PET would cost around 20 crore for a city like Mumbai which could be a centrally localised place covering around 2000 square feet.
Experts suggest that the need of the hour is to create a demand for PET and that the cost for PET scanning should be borne by the insurance companies in the country to make it affordable. Says B A Krishna, chief of nuclear medicine, P D Hinduja Hospital, "Insurance companies in India should incorporate the diseases recommended for PET scanning in their policy as practiced in the West. This will be instrumental in popularising the technology among the medical fraternity and the public." Companies like GE, SIEMENS, PHILIPS AND IBA are manufacturing new PET cameras and cyclotrons.

shardulnautiyal@rediffmail.com