The implementation of PET technology in Brazil

According to the Brazilian Geography and Statistics Institute, Brazil has an estimated population of 188 million inhabitants spread over 8,500,000 km2: The distribution of resident population in major regions of Brazil is shown: North Region - 7.6%; Northeast Region - 28.1%; Southeast Region - 42.6%; South Region - 14.8%; Central West Region - 6.9%. Nuclear Medicine is growing fast in Brazil and this has resulted in an increasing demand for radioisotopes and radiopharmaceuticals. Positron emission tomography (PET), which is a non-invasive molecular imaging procedure, is one of the causes of this increase. PET detects changes in metabolic activities, which may take place before any detectable change in anatomical structure occurs. PET is used to help diagnose and to plan and assess the treatment of cancer, heart disease, and brain disorders. Taking into account all these advantages, it was decided to start the production of PET radiopharmaceuticals at IPEN - Energy and Nuclear Research Institute of CNEN - the Brazilian National Nuclear Energy Commission, located in the city of Sao Paulo, the largest city in Brazil. The production of FDG started in 1998. In 2003, a second FDG production unit was installed at IEN - Nuclear Engineering Institute of CNEN - in Rio de Janeiro, the second largest city in Brazil. Both have much experience in radioisotope and radiopharmaceutical production, and both centres have had cyclotrons for a long time. It is interesting that the production of FDG has increased more than a factor of 17 since 2000 in Brazil. One of the greatest advantages of PET radiopharmaceuticals is due to their short lives. On the other hand, this is also a problem because it means that the production centre needs to be located not too far from the place where it will be used. This can limit the population access to PET technology. Taking into account this scenario and considering that short-lived radioisotope production was a State monopoly until 2006, the Brazilian Government has decided to disseminate the production of PET radiopharmaceuticals to other populated areas of the country where there is a CNEN institute. The objective is the diffusion of cyclotron produced radiopharmaceuticals in order to improve quality of life for patients by providing them with the benefits of using this technology. This contributes to the Brazilian Multi-Annual Programme related to Health, Science and Technology. Since there are CNEN institutes in the States of Minas Gerais (Southeast Region) and Pernambuco (Northeast Region), which are both heavily populated, it is natural to implement the production of radiopharmaceuticals in these places. Many reasons, beyond the clinical benefits already known, have been considered for this kind of investment in both regions: 1. To create conditions of incrementing research and applications of short-lived radiopharmaceuticals and radioisotopes 2. To encourage personnel qualification, searching the homogenization of the knowledge and development in the country 3. To make possible the use of these facilities for teaching and research. Considering the facts that both places have an adequate hospital infrastructure, a group of qualified physicians to use PET radiopharmaceuticals and a potential demand should give sustainability to this programme. A previous agreement with the local medical community was made to guarantee their commitment to use PET technology, once the needed investment by the hospitals is adequate to support its use. Another relevant aspect is the multipurpose characteristic of the project involving both the production of radiopharmaceuticals and research activities. The design of both projects includes, in both cyclotrons, an external beam, in a separated cave, in order to allow the development of research through the use of a proton or deuteron beam. The rationale behind this, beyond the developments that it can bring, is to stimulate the participation of the scientific community in new projects and, on the other hand, human resources development. The viability of the project i s a significant point to be stressed. The new laboratories are considered a priority project by the Brazilian Government for which costs have reached more than US$12 million. The goal is to have the two facilities operating in 2007. The institutions, CDTN/CNEN (Nuclear Technology Development Center) in Minas Gerais, and CRCNNE/ CNEN (Nuclear Science Regional Center - Northeast) directly involved in this project, will be in charge of PET radiopharmaceutical production and supply for an estimated demand of more than 30,000 PET scan procedures per year. Some important considerations and actions that were taken during the project design included: 1. Development of a clear scenario of the PET technology demand and the available infrastructure necessary and fundamental to achieve sustainability 2. Agreement and participation of the local nuclear medicine group, and other relevant stakeholders 3. Commitment of the local politicians where these units would be set up. The IAEA support to the next phase of the project is fundamental and strategic because it allows personnel capacity building in order to have well trained teams, and also allows technology transfer due to the assistance of experts helping with the implementation of the project