Nuclear Medicine Oncology Research Articles

Radiation levels of isolation rooms used by radio-iodine ablation patients during hospitalization

The use of RAI-131 in thyroid carcinoma patients presents a special concern on the environmental radiation safety for those who come in contact with the patients especially after discharge from the facility because of excretion of I131 through perspiration, salivation, breathing and urination. Methods & Materials: The present study was conducted at Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah (NORIN) Sindh from 2017 to 2021 with the objective to evaluate contamination hazards by Excretion made by thyroid cancer patients received iodine therapy stayed in isolation room with doses ranging from 80–200 mCi. The areas included corridor, sink, patient bed, and toilet bowl of isolation rooms before admission and after discharge using LAMSE RM-1001 survey meter. The minimum background radiation level measured before patient stay in isolation room was 0.07 μSv/h while the maximum was 0.40 μSv/h and the mean background reading was 0.18 ± 0.072 μSv/h. The maximum dose rate after discharge was observed at toilet bowl with mean of 9.69 ± 1.98 µSv/hr and minimum of 5.0 µSv/hr and maximum value 13.77 µSv/hr. The readings recorded for the sink were: 2.0 μSv/h minimum, 20.0 μSv/h maximum with a mean of 5.55 ± 1.57 μSv/h while those for the patient bed 0.41 μSv/h minimum, 6.92 μSv/h maximum and a mean of 2.83 μSv/h. the least dose rate was found in isolation room corridor (1.53 ± 0.78 μSv/h) with maximum and minimum values 0.28 & 3.20 μSv/h respectively. Radiation is harmful; safety measures must be ensured to minimize radiation exposure to the family members as well as community either during hospitalization or after discharge of RAI-131 patients. The radiation levels from toilet bowls, beds, sinks, and corridor of isolation rooms were well within the acceptable limits and hence, do not pose significant hazard to the public

Assessment of Measured and Calculated Dose Rate of Co-60 Teletherapy Machine: 06 Years’ Experience at NORIN Nawabshah, Pakistan

It is essential to determine the absolute output dose of Co-60 source in the radiation treatment periodically. It is because overdosage may cause radiation hazards whereas under dosage may lead to the unsatisfactory treatment of cancer. The current study is focused on the consistency of monthly dose output verification of the cobalt-60 Teletherapy unit which should be within ±2% as per international standards. In the present study, the measured and calculated dose rate of the Co-60 teletherapy unit at Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah (NORIN) for the last 6 years is analyzed. The dose measurement was done in water phantom 30×30×30 cm3 at 80 cm Source to Surface Distance with 5cm depth by using calibrated electrometer and PTW ionization chamber. The measured output dose rate obtained by actual dosimetry is within ±2% of the dose rate calculated by the decay method and the deviation lies within the permissible limit as prescribed by International Atomic Energy Agency (IAEA), International Commission on Radiological Units and Measurement (ICRUM)and American Association of Physicists in Medicine (AAPM). The variation in measurements obtained is within the tolerable limits according to standard protocols and codes. Thus, our study shows a homogenous trend in the dose rate of the Co-60 teletherapy machine.

Measurement of Ambient Ionizing Radiation Exposure in Operating Consoles of Radiation Modalities in Cancer Hospital NORIN Nawabshah, Pakistan

Measurement of Ambient Ionizing Radiation Exposure in Operating Consoles of Radiation Modalities in Cancer Hospital NORIN Nawabshah, Pakistan by Muhammad Waqar 1,* , Touqir Ahmad Afridi 1, Quratulain Soomro 2, Abdul Salam Abbasi 2, Muhammad Shahban 3 1 Medical Physics Division, Nuclear Medicine Oncology & Radiotherapy Institute Nawabshah (NORIN), 67450, Pakistan2 NM & Allied Division, Nuclear

Early postoperative recurrences for colon cancer: Results from a Pakistani rural cohort.

ObjectivesWe conducted this study to determine the factors associated with early postoperative recurrence in colon cancer patients treated with curative intent.MethodsAll consecutive patients who underwent curative resection for colon cancer between January 2014 and December 2016 were reviewed. All patients received either adjuvant chemotherapy or follow-up at the Bannu Institute of Nuclear Medicine Oncology and Radiotherapy (BINOR). The patients lived in rural areas of southern Khyber Pakhtunkhwa province.ResultsWe enrolled 72 patients, 28 of whom experienced a postoperative recurrence within 2 years (early recurrence). In univariate analysis, postoperative early relapse was significantly correlated with advanced age (>60 years, p = 0.030), nodal status (p = 0.012), pathological stage (p = 0.013), number of nodes removed (p < 0.001), and perineural invasion (p = 0.044). In multivariate analysis, age more than 60 years (p = 0.031) and fewer than 12 lymph nodes removed (p = 0.003) were independent predictors for early recurrence. The liver was the most common site of recurrence (42.8%) in this study.ConclusionOur results showed that advanced age and the removal of fewer than 12 lymph nodes during surgery were significant predictors for early postoperative recurrence. Identification of high-risk patients during follow-up with enhanced therapeutic modalities can improve disease-free survival.

Retrospective Incidence Analysis of Head and Neck Cancer Patients in Rural Areas of Sindh, Pakistan

Background: Head and neck cancer is the most common malignancy in Sindh, Pakistan. The type of cancer can be observed in the oral cavity, lips, buccal mucosa, oropharynx, hypopharynx, nasopharynx, the floor of the mouth and hard palate in Sindh. Objectives: The present study was conducted at the Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah (NORIN), Sindh, with the objective of reviewing descriptive epidemiological characteristics and incidence of head and neck cancer in this rural area. Methods: In this study, we divided head and neck cancer patients according to their gender, age, districts, tumor location, probable causative agents, and stage of cancer when they had been admitted to the Radiotherapy Department of NORIN. Results: In total, 1,030 patients were registered during the study period from January 2012 to December 2016, comprising 56% males and 44% females. The most common site of the head and neck tumors was the oral cavity (58%), followed by the tongue, tonsil, floor of the mouth, gum, hard palate, soft palate, and lips. Other sites of head and neck cancer were hypo-pharynx, nasopharynx, salivary gland, parotid gland, oral-pharynx, and lyrnx. Most patients came in NORIN at stage III and stage IV of their disease and most of them were at the age of 40 - 85 years. Most patients were the residents of Nawabshah and neighboring districts. Conclusions: Head and neck malignancy was the most common type of cancer registered in NORIN in the last five years. Because of the lack of awareness, education, and diagnostic facilities, most patients start cancer treatment at later stages of the disease, which makes it very difficult to cure. Smoking and the use of alcohol, Gutka, Supari, Naswar, Man-Pori, etc., are the main causes of head and neck cancer.

Tumour sidedness and clinicopathological features of resected colon cancer in rural population of Northern Pakistan: single institutional analysis

ObjectivesDifferent clinicopathological and molecular features have been demonstrated between right and left sided colon cancers. We aimed to characterize colon cancer and sidedness among a North-Pakistani rural population diagnosed with colon cancer in our institution. MethodsSeventy patients were included in the study that received adjuvant chemotherapy at Bannu Institute of Nuclear Medicine Oncology and Radiotherapy) Bannu, Pakistan from January 2014 to December 2017. Chi-square test was used for significance of categorical variables. p-Values less than 0.05 were considered significant. ResultsMean age at diagnosis for right side colon cancer patients was 43.94 years and for left side colon cancer, it was 49.83 with no significant difference. Male patients were presented more with right (77% vs. 54%, p=0.044) and females with predominantly left sided tumours i.e. (46% vs. 23%, p=0.044). Right sided cancer tended to be more poorly differentiated (20% vs. 0%, p=0.020). Mucinous adenocarcinoma was seen mostly in right sided colon cancer (37% vs. 3%, p≤0.001). There were more locally advanced presentation of right side colon cancer with more node positive (83% vs. 60%, p=0.025) and lymphovascular invasion (51% vs. 37%, p=0.016). Sigmoid colon was the most common tumour subsite involved. ConclusionOur study is the first report of colon cancer in a rural population in North-Pakistan. An earlier onset of tumours (44–50 years) was observed in comparison with global data.

Association of Menopausal Status with Pathological Features of Tumor in Stage I to III A Breast Cancer Patients Treated With Upfront Modified Radical Mastectomy

Introduction: Breast cancer is the commonest malignancy diagnosed among women worldwide. In Pakistan around 90,000 women are diagnosed with breast cancer every year. Lymphnode involvement, tumor size, receptor status, tumor grade, presence of LVI, age and ethnicity are well recognized prognostic factors for breast cancer. The aim of this study was to evaluate the relationship of menopausal status with pathological and prognostic features of tumor in patients with stage I to III A breast cancer treated upfront with modified radical mastectomy. Material and Methods: This was a single institute observational retrospective study conducted at Nuclear Medicine Oncology and Radiotherapy Institute (NORI) Islamabad. A total of 381 patients with histopathologically proven diagnosis of Invasive ductal carcinoma after modified radical mastectomy were included from January 2009 to December 2013. Age, menopausal status, tumor site, tumor size, grade, lymphnode involvement, receptor status and presence of LVI were recorded on a particularly composed proforma. Statistical analysis for determining the association between menopausal status and pathologic features of tumor was performed using Chi-square test. P value < 0.05 was considered significant. Results: The minimum age of study population was 24 years and maximum age was 80 years with a mean age +/- SD of 48.5 +/- 11.1 years. There was a statistically significant association between menopausal status and grade of tumor, lymphovascular invasion and HER2/neuoverexpression (p < 0.05). Conclusion: Grade of tumor, lymphovascular invasion and HER2/neu over expression in stage I to IIIA breast cancer has statistically significant association with menopausal status.

To Investigate Prevalence of Diabetes Type 1 and Type 2 in HCV Infected Individuals

This study was aimed to investigate the prevalence of diabetes mellitus type 1 and 2 in patients infected with hepatitis C virus. This study was conducted in blood collection Centre at Nuclear Medicine Oncology and Radiotherapy Institute (NORI) situated in Islamabad, Pakistan. The duration of study was from March 2014 to June 2014 twice a week. Randomly selected 112 HCV infected patients were included in this study. Patient information form was used to collect information from patients. In addition to this, about 51 patients were tested for random blood glucose levels, by strip based glucose testing method. Our control group consisted of 80 non HCV infected individuals of same age group. The results of the present study showed 7/112 (6.25%) diabetic patients in HCV infected group and 9/80 (11%) in non-infected. Statistical analysis does not support association of diabetes type 2 with HCV infection (OR=0.5926, 95% of CI=0.2116 to 1.6594, P=0.3193). Similarly, when we analyzed diabetes type 1 separately, 3.57% were suffering from type 1 in HCV infected patients, contrary to that there was not a single person was suffering from type 1 diabetes. Statistically, it is insignificant with p value 0.2050. Although insulin resistance is often reported in HCV infection, however, association of diabetes type 2 with HCV seems rare event. Type 1 Diabetes mellitus is reported to be linked with antiviral therapy, but our results show insignificant association.

HBV Genotyping and Phylogenetic Analysis through Multiplex PCR Using Type Specific Primer Pairs in Pakistani Population

Background: Hepatitis B virus causing acute and chronic hepatocellular carcinoma relics a serious health issue affecting more than 350 million people worldwide. Geographically, nine genotypes of HBV have been identified so far. Four open reading frames named (ORF P, S, F and X) renders it to specifically targets hepatocyte cells. Additionally, reverse transcription process present in the life cycle of HBV caused four order higher mutation rates as compared to adenovirus. The structural and functional differences between HBV genotypes are the mainstay to severity, complications, treatment and possibly vaccination against the virus. Hepatitis B genotyping is important for assessing its clinical implications and geographical distribution, but the sub-genotypes have been found useful for determination of specific genomic markers related to hepatocarcinogenesis and medical therapies. In Pakistan, there is no reported data available on molecular evolutionary analysis of HBV. A study was, therefore, much needed to evaluate the spectra of dominant strains prevalent here. Objectives: This study was aimed to figure out the prevalence of HBV genotypes among population in Pakistan. In this research, we focused to find out the new strains and sub genotypes of HBV. Pakistan is one of the HBV endemic countries but there is no data on subgenotypes and their recombination or the phylogenetic relatedness of the virus endemic in the country. The present study was carried out in this perspective. This study will help future researcher to study some other aspects of HBV related strains in Pakistan and also about its medical therapies. Place and duration of study: The present study was carried out at Polymerase Chain Reaction (PCR) lab, Nuclear Medicine, Oncology and Radiotherapy Institute [NORI], Islamabad, and the samples were collected between September 2012 to February 2014. Study design: A total of 450 Hepatitis B surface antigen HBsAg and HBV DNA positive samples were collected in the first step during the period of September 2012 to February 2014 and sent to Nuclear Medicine Oncology and Radiotherapy Institute [NORI], for further analysis. All the samples were genotyped by type specific nested PCR primer pair method for 8 HBV genotypes from A through H. The patients were randomly selected irrespective of their age and gender and a written consent (parental consent in case of less than 18 years of age) was obtained. The study was approved by ethical review committee. In our research, we have used the type specific primer technique to find out the dominant strain in Pakistani populations and furthermore its phylogenetic analysis with reference sequences retrieved from NCBI databases. Results: Our results showed a direct relationship between viral load and identified genotypes and pinpointed that genotype D is the most pre-dominant genotype and prevailing in high proportions among all genotypes in Pakistani population. Mix HBV genotype infections of genotype A with B & C, D with B and C constitute about 17 percent of all the samples. Subgenotypes of different HBV strains have been identified on the basis of differences in the complete nucleotide sequences. Positive PCR results were repeated twice for confirmation. Furthermore, phylogenetic analysis revealed a homology between our reported sequences and reference sequences. The phylogenetic method showed that genotypes/sub-genotypes varies in the geographical areas and correlate strongly with ethnicity. Conclusion: Genotype D was identified and come out to be the most dominant genotype in Pakistani community showing sub-genotypes of D1 & D3 in our study. Genotype A and D are present as co-infection with each other and contributed as the second prevailing genotypic group. Additionally, phylogenetic analysis revealed that genotypes varies in the geographical areas and correlate strongly with reference sequences from NCBI.

Synthesis and biological characterisation of novel dithiocarbamate containing 5-nitroimidazole 99mTc-complexes as potential agents for targeting hypoxia

With the aim to develop new potential 99mTc-radiopharmaceuticals for imaging hypoxia based on the formation of Tc-nitrido complexes, two novel dithiocarbamate containing metronidazole derivatives (L1 and L2) have been prepared and characterised. The synthesis of L1 and L2 was achieved in excellent yield and high purity. Labelling with 99mTc was successfully performed using a low ligand concentration (approximately 2–3mg) and the desired products were obtained with high radiochemical purity (>90%). Lipophilicity, plasma protein binding, and biodistribution in normal- and tumour-bearing-CD1 mice studies were performed to asses the potentiality for nuclear medicine oncology. According to the physicochemical and biological behaviour both in healthy animals and in animals bearing solid tumours complex dtcTc1 could be considered as a starting point for the development of new radiopharmaceuticals for imaging hypoxia.

Release criteria from hospitals of 131I thyrotoxicosis therapy patients in developing countries—case study

The current release limit, recommended by the International Atomic Energy Agency (IAEA)(1), from hospitals of patients undergoing 131I thyrotoxicosis therapy is approximately 1100 MBq (approximately 30 mCi). Owing to the difference in socio-economic conditions, literacy rate, family system, etc., this release limit may not be applicable in most of the developing countries like Pakistan. Therefore, the prime objective of this case study was to re-evaluate the release criteria for 131I thyrotoxicosis therapy patients by taking into account their lifestyle, economic conditions and other facilities such as availability of private/public transport, etc. In this context, systematic studies were carried out and 50 patients (i.e. 35 outpatients and 15 inpatients) at the Nuclear Medicine Oncology and Radiotherapy Institute (NORI), Islamabad, were studied. Exposure rate at the surface of the body and at a distance of 1 m from the standing patient was measured. Results obtained from this study showed that the dose equivalent delivered by these patients to their family members (particularly children) and general public was higher than annual dose limits recommended by the International Commission for Radiation Protection in their report ICRP Publication 60(2). In the light of this study, it is recommended that the release activity limit of approximately 370 MBq (or dose rate level of approximately 10 microSv h-1 at 1 m from the patient) be adopted instead of approximately 1100 MBq in developing countries like Pakistan.

Recent Progress in instrumentation and quantification by nuclear medicine imaging

Recent Progress in instrumentation and quantification by nuclear medicine imaging

座長集約(第57回総会学術大会シンポジウムII)(腫瘍核医学技術の新しい展開)

座長集約(第57回総会学術大会シンポジウムII)(腫瘍核医学技術の新しい展開)

Utility and problems of hybrid PET

Utility and problems of hybrid PET