Nuclear medicine in Uzbekistan: Past, present and future

Full text: Uzbekistan is one of the biggest countries in Middle Asia with a population of about 26.5 million. Nuclear Medicine in Uzbekistan has a long history. The first Nuclear Medicine Departments were organized in the 1950s and spread quickly in the 1960's when the number grew to 22 nuclear medicine centres in whole country. They were equipped with probe renogram, scanners, multiprobes and anger gamma cameras. As far as the Nuclear Medicine Department of Republic Specialized Center of Surgery is concerned, it was organized in 1976 and the first equipment of the institution was the anger gamma camera, ''Nuclear Chicago,'' as well as the probe renogram and multiple probes. At that time, the spectre of Nuclear Medicine examinations included: renoscintigraphy with I-131 hippuran, thyroid scintigraphy with I-131, MUGA, hepatic scintigraphy with sulphur colloid and HIDA, lung perfusion and ventilation, lymphoscintigraphy of low extremities, radiography (investigation of central hemodynamic), dynamic brain perfusion, bone scintigraphy of bone transplant, selective radionuclide angiography (examination of peripheral microcirculation) and phleboscintigraphy of low extremities. Unfortunately, the situation changed during the first years of Uzbekistan independence (1991) due to the economic situation. The number of Nuclear Medicine Departments decreased to 10. However, the NM Department of Republic Specialised Center of Surgery never stopped its clinical and research work. Nonetheless, the number of examinations performed significantly dropped. A new era of Nuclear Medicine in Uzbekistan was started in 2000 when the IAEA approved the TC project ''Introduction of SPECT in Uzbekistan''. With the great help of IAEA, the Republic Specialised Center of Surgery received a single head SPECT gamma camera (E-CAM Siemens). Furthermore, under the next TC project ''Implementation of NM in Uzbekistan,'' the same Center received a second SPECT dual head gamma camera (Nucline Spirit, Mediso). This gave rise to the possibility of introducing new methods of examinations and that we now perform. These examinations we perform now include: Stress/Rest Myocardial Perfusion SPECT, MUGA; Bone: - 3 phases, WB and SPECT; Renoscintigraphy with MAG3, DTPA (with ACH, with furosemid ) and DMSA; Lymphoscintigraphy and phleboscintigraphy of extremities; Esophagoscintigraphy (basis and with atropine probe) to DD Achalasia from Cardiospasm; Hepatic investigation with HIDA (hepatic extraction fraction and T 1/2), with sulfur colloid (hepatic blood flow and liver/spleen ratio); Scintimammography; Thyroid; Parathyroid; Brain SPECT; Scrotal scintigraphy; lung scan with Tc99m SestaMIBI; SLN imagine and intraoperative gamma probe. As far as radionuclide treatment is concerned, in 2006, we started treatment of bone metastases with Sm-153 EDTMP (CISBIO, France). But with regards to further continuation of treatment patients with bone metastasis, we are in the middle of negotiations with the Institute of Nuclear Physics (Tashkent, Uzbekistan) in order to have local production of Sm-153 EDTMP. The main part of radionuclide treatment of Uzbekistan handles the treatment of thyroid diseases, which is often performed at the Institute of Endocrinology. The rate of endemic iodine deficiency in Uzbekistan is 56%. However, it may vary from region to region (from 20% in Tashkent, up to 80% in Fergana). To prevent this deficiency, the country introduced iodized salt in the year 1998. The Institute of Endocrinology in Uzbekistan has nuclear medicine facilities that treat thyroid cancer with radioiodine. The average bed-stay cost for the isolation room, which has only single occupancy, is about US$ 25 per day. The incidence of thyroid cancer in Uzbekistan is 2.5/100,000 overall. Radioiodine is supplied as a liquid at a cost of US$ 6 per 37MBq (1mCi). In Uzbekistan, the legal limit of a single I-131 dose administered to an outpatient is 1.11 GBq (30 mCi). The usual dose range of I-131 for thyroid cancer is about 3,7GBq (100 mCi). The maximum allowable radiation dose for the gen eral public, for both the carer of the patient and a family infant is 1 mSv. The maximum post I-131 therapy hospital discharge dose is 1 mSv at a 1.5 metre distance. An I-131 whole body scan is performed 3 days after I-131 therapy. The patient is followed-up in the nuclear medicine clinic after an additional week. I-131 WBS is performed annually for the first 2 years following radioiodine therapy to monitor the patient's progress. Normally, 185 MBq (5 mCi) scanning dose of I-131 is used. The patient is prepared for scanning by withdrawal of thyroxine suppression therapy 4 weeks prior to the scan. Serum thyroglobulin measurement is available in Uzbekistan at a cost of US$ 6 per sample. It is measured every 3 months routinely during the first 2 years post-radioiodine therapy. A pre-I-131 treatment level is also recorded four weeks after thyroidectomy. Antithyroglobulin antibody assay with appropriate dilutions is also available. Now, we are in negotiations with the IBA Company to introduce cyclotron and PET/CT in Uzbekistan. Thus, we will have the possibility of improving the diagnosis, to assess the response to therapy and monitoring of cancer patients. Nuclear Medicine in Uzbekistan has a bright future. (author)