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PGI doctors identify new isotope that dramatically reduces cost of PET scanning

PGI doctors identify new isotope that dramatically reduces cost of PET scanning

Prof Baljinder and colleagues at the department of nuclear medicine at the PGI have developed a nuclear agent that dramatically reduces the cost of PET scanning. It is estimated that the new test will reduce the cost of postoperative scanning of brain tumor patients from Rs 7,000 per month to Rs 500 per month. Moreover, this test can be conducted in rural areas as well as it does not require a state-of-the-art set up like a cyclotron.

“A PET scan for accurately diagnosing of glioma (Brain tumor) requires a highly skilled personnel and high-cost scan costing approx INR 25000-35000/- in private sector. Here the combined efforts of INMAS-PGI has developed a low-cost gamma imaging agent ( [99mTc]MDM )with similar efficacy at a very nominal cost (INR500 per scan),” Prof. Baljinder Singh, Department of Nuclear Medicine, PGIMER Chandigarh told Medical Dialogues.

“This technology is very useful for providing an accurate diagnosis at peripheral centers not equipped with a high-end PET and cyclotron technology,” he added.

Brain tumors constitute 2% of all the number of cancer patients. The patents are generally subjected to surgery and chemotherapy but have to be screened periodically every 3 months by PET scanning for any relapse.  Conventionally, traces (chemicals and isotopes used for PET scan) like C11 -L-methionine and F 18 -FET are used which are very costly. The PG researchers have developed Tc-99 m DTPA-bis methionine a cost-effective agent to be used for scanning

Glioblastoma Multiforme (GBM) is a common form of a brain tumor in adults and is the most aggressive cancer that shows no symptoms until the last stage. “The gold standard treatment that is followed after surgery is that the patients are kept under chemotherapy and radiations. However, follow-ups are required using MRI scans and PET imaging as there are chances of relapse,” said Prof Baljinder Singh, department of nuclear medicine, PGI.

“Therefore, we developed Tc-99 m DTPA-bis methionine, which has a half-life of 6 hours and is less costly. This means that the patients, who invest Rs 25,000 for this scan which is done one time only, will have to immediately be seen within 20 minutes. But, due to patient rush here, it is not possible,” said Nisha Rani, a research scholar, who has developed this kit.

The kit has been used in more than 300 patients at the PGI and has been tested successfully. “This study was supported by the ICMR and continued for 4 years. We have researchers from AIIMS, New Delhi, who are keen on starting this kit for their patients as well,” said Nisha.

“A majority of patients are in the productive age of 25 years to 35 years. Most lose to follow-ups due to the high cost of PET imaging. Every 3-month scan comes around Rs 28,000 a year. But, the new imaging costs them Rs 2,000 only,”  Prof Baljinder told TOI.

The finding of the study on the basis of which this imaging technique has been developed was published in the European journal of nuclear medicine and molecular imaging.

Traditionally, the gold standard method to distinguish between radiation necrosis and the recurrent tumor is a repeat (post-surgical) histological confirmation by biopsy or surgical resection which often is difficult especially in deep-seated brain tumors. So, there is a need for a non-invasive imaging technique for accurate differentiation of tumor necrosis from recurrence as the conventional CT and MRI techniques may have conflicting results.
Advance MR techniques such as perfusion and diffusion MR Spectroscopy (MRS), Dynamic Susceptibility Contrast-Enhanced (DSCE) and SPECT/ PET imaging have been shown to be clinically useful in the detection of the recurrent/residual tumor.
Therefore, the combination of MDM SPECT modality with DSCE MRI provides an accurate differentiation of tumor recurrence from radiation-induced necrosis and could prove to be a promising alternative based for the post surgery and post radiotherapy/chemotherapy follow-up in glioma patients.

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