Dr. Zeenat Jabin Dr. Md. Abdul Awal Bangladesh

1. NUCLEAR MEDICINE COUNTRY REPORT Dr. Zeenat Jabin Dr. Md. Abdul Awal Bangladesh

2. Bangladesh Atomic Energy Commission (BAEC) is located at Dhaka, the capital city of Bangladesh. BAEC patronizes research and development in peaceful application of atomic energy as well as focusing on various sectors of the economy, such as health, industries, agriculture and environment working with nuclear technology. BAEC established one Nuclear Medicine Institute and 13 centers of Nuclear Medicine & Ultrasound throughout the country and provides the administrative infrastructure and financial wheel for running these centers.

3. Centers for Nuclear Medicine & Ultrasound Are equipped with • Two gamma cameras and SPECT systems • B mode and Doppler ultrasound machines • Dexa system for bone mineral density estimation • Modern Laboratory for radio-immuno-assay and other in-vitro techniques • Facilities of Therapetic Nuclear Medicine • Research facilities for Nuclear Medicine personnel.

4. We have been working as Nuclear Medicine physicians in our institutes for the last 7and 5 years respectively with 2 years post- graduation degree of masters level in Nuclear Medicine. Present responsibilities Our institute offers both diagnostic and therapeutic Nuclear Medicine services and we have to work in a team which consists of physicians, medical physicists, bio-chemists, technologists and support staff.

5. Routine works include • Scinti-imaging with planar and SPECT gamma cameras in the field of cardiology, neurology, nephrology, oncology, endocrinology etc. • In addition, first pass and gated equilibrium radionuclide angiography and peripheral vascular imaging are also done. Specialized nuclear medicine techniques such as: • SPECT cerebral perfusion • Cisternography to study CSF dynamics in hydrocephalus and for assessment of shunt patency. • Scintimammography

6. Imaging with ADAC SPECT system

7. Conventional studies that are done in our departments: • Ventilation / perfusion scan of lungs • Venography • Lymphoscintigraphy • Parathyroid imaging • DTPA / DMSA renal scans • Skeletal imaging including 3-phase skeletal scintigraphy • Bone mineral densitometry study

8. The endocrinology unit dealing with thyroidology are involved in the total management of thyroid patients especially thyrotoxicosis and thyroid cancer. • Our thyroid clinic arrange a twice weekly body of multidisciplinary specialists concerned with the thyroid diseases and discuss the best options for patient management. Basically facilitating prompt, efficient and complete assessment of selective thyroid disorders. • An efficient and systemic patient follow-up records are maintained throughout the years.

9. 2. Radio-immuno-assay & other in vitro techniques • Blood volume • RBC life span study • GIT absorbtion of vitamin B12 • Radioimmunoassay of thyroid and other hormones 3. Ultrasonographic Imaging Color Doppler and B mode ultrasonogram of abdominopelvic organs and also neonatal brain, breasts and small parts of body are scanned.

10. 4. Therapeutic activity • Radioactive iodine is used for the therapy of thyrotoxicosis and in the management of thyroid cancer patients. • P-32 therapy for myeloproliferative diseases such as polycythaemia vera. • Beta radiation with Sr-90 for pterygium, corneal neovascularization & squamous cell carcinoma of the conjunctiva are routinely done. • We provide brachytherapy service to cervical cancer patients in collaboration with the dept. of gynaecology, urology and radiotherapy.

11. 5. Academic responsibilities • Weekly journal review, case presentations and taking classes of undergraduate students of Sir Salimullah medical college. • Regular publications in the Journal of Nuclear Medicine and other medical journals. • Participate in the demonstration and training courses of the physicians and physicists in the department. • Collection of data and clinical cases with active participations in the research projects of BAEC.

12. Expected outcomes of the training course Institute of Nuclear Medicine is planning to include a PET system with a baby cyclotron and expand its service further by inclusion of Nuclear Magnetic Resonance for imaging and research. So, there will be a good opportunity for us to work with cyclotrons after this training and provide better and modern facilities to our patients.

13. INTRODUCTION TO THE PROJECT (That I took part): Effectiveness of scintimammography with 99mTechnetium Sestamibi for the initial diagnosis of breast cancer. TARGET OF THE DEVELOPMENT: The study was done with 60 cases (20 to 60 yrs, female),where clinically suspected palpable breast lumps were investigated by 99mTc-Sestamibi scintimammography and FNAC of breast with ultrasound scanning of the lesions.

14. MAJOR ACHIEVEMENT: • The study result was very encouraging and the sensitivity and accuracy of scintimammography was 95% and 75% respectively. • The sensitivity of scintimammography was highly significant (P < 0.001) and accuracy was significant too. • Metastatic axillary lymph node was detected in 6 cases. • Scintimammography was particularly helpful in studying edense breasts.

15. Positive scintimammography and ultrasonography images showing breast lump with metastatic axillary lymph-node.

16. Country's policy on Nuclear Medicine 1.Bangladesh Atomic Energy Commission works as the administrative body under the ministry of science, information and communication technology. 2. It regulates the country's policy on Nuclear Medicine. 3. Moreover, research and development in peaceful applications of atomic energy in the fields of agriculture, industries, electronics, physical and biological sciences are the key functions.

17. 4. BAEC gets support from IAEA and various other international organizations like ARCCNM for research, promotion and development of Nuclear Medicine facilities in the country. 5. Our country has strict radiation control law and BAEC provides service to analyze food and other export items, measurement of radiation both in work places and radiation workers as well as standardization of radiation control instruments throughout the years.

18. Development stage of Nuclear Medicine fields 1. Nuclear Medicine is a rapidly growing subject in Bangladesh. Newer technologies are introduced continuously and our research activities and publications are upgrading every year. 2. Nuclear oncology and Nuclear cardiology are the two main aspects where tremendous development has taken place in the recent years. 3. Therapeutic Nuclear Medicine especially palliative treatment of bone pain and other malignancies, radio-immunotherapy and provision of PET and cyclotrons are our future plans to accomplish.

19. IMPORTANT NUCLEAR MEDICINE PROJECTS • Modernization of the Institute of Nuclear Medicine project is undergoing and we hope that we will be able start our new workstation of about 80,000 sq.ft area with provision of a baby cyclotron and PET. • We are running a project for detection of ‘congenital hypothyroidism’ in our country with hope that awareness, early detection and treatment will reduce this illness remarkably in our country.

20. CO-OPERATION IN NUCLEAR MEDICINE WITH SOUTH KOREA. Bangladesh has a very friendly relation with South Korea in Nuclear Medicine field. It would not be inappropriate to mention that we arranged the second annual general meeting of ARCCNM in our country last year and Professor Myung-Chul Lee, M.D. of Seoul National University Hospital was the chairman of ARCCNM, who enlightened us with his lecture titled ‘Current status of PET application’. So we always welcome every Nuclear medicine scientist as a global colleague of us.

21. Thank You