RCA/UNDP Project Promoting and Accelerating Nuclear SPECT/PET Imaging Technologies in the Region Final Report of National Project Coordinator Participating Country: Nepal NameTitleOrganization Dr. Ram Krishna Shrestha Sr. Nuclear Medicine Physician Metro Radiology and Imaging (MRI)/NAMS, Bir Hospital Tel:

NameTitleOrganization Dr. R.K.Shrestha Head-Nuclear medicine division MRI/BH, Dr. Sagar MaharjanNM PhysicianMRI/BH, Prof. Shanta Lall ShresthaMedical PhysicistMRI/TUTH, Mrs. Smriti SharmaTechnologistMRI/BH, Mr. Dilip ChaudharyTechnologist MRI/BH, Kathmandu National Project Team

Period Covered : May 2011 to December 2013 Kick-off Meeting of the project was held in May Nepal has participated in the meeting as an observer. History as well as current national status of nuclear medicine activity was presented. Private and government efforts in sustaining nuclear medicine services were presented. Urgency of making increased trained nuclear medicine manpower and their advanced training were also highlighted in the meeting.

National Activities Brief history of Nuclear Medicine: The first center in the country was established in 1984 in Bir Hospital, Kat hmandu and services were detained since 1992 up to about a decade. In 2002 Gamma Camera was installed first time in the nation in Pvt. Center (MRI) Kathmandu. In 2011 double head Camera was installed in Bir Hospital, Kathmandu with the financial support from Ministry of Health. One more double head Camera has been installed in Private Centre (Gam ma Imaging & Research Centre). All the gamma cameras has SPECT Capability and services were confined w ithin Kathmandu.

Technical status of Nuclear Medicine in Nepal: Three centers each with one gamma camera having SPECT capability. Nuclear medicine physician-4 Physicist-3 Technologist-3

Services: Diagnostic Procedures – Bone scan – Thyroid Scan – Renal scan-dynamic, static and GFR studies. – Hepato-biliary study – Gastrointestinal study – Myocardial perfusion studies – No RIA service yet. Therapeutic procedures – I-131 therapy for Hyperthyroidism – I-131 low dose treatment for well differentiated thyroid cancer.

End users/beneficiaries The project will be implemented in the nuclear medicine section at MRI, Bir Hospital and Gamma Imaging Center. Tribhuvan University Teaching hospital National Academy of Medical sciences, Bir hospital BPKIHS, Dharan National Kidney Center Bhaktapur Cancer Hospital BPKMCH Cancer Hospital, Bharatpur B&B, and OM Hospitals Army and Police Hospitals

National Activities in 2011 Activity Name Training course, Workshop Seminar, Education, and Mentoring, etc.) Objectives When Where Context : Topics, Outcomes accomplishments Re-establishment of Nuclear Medicine Unit. To provide Nuclear Medicine services to general public NAMS Bir Hospital Double head gamma camera with SPECT capability were installed, and successful started most of the conventional Nuclear Medicine procedures. EducationTo promote Nuclear Medicine among other specialists 2011NAMS Bir Hospital Introduction to Nuclear medicine for Technologists, staffs, registrars and residents of different specialties. Presentation delivered to medical professionals to enhance the awareness of Nuclear medicine procedures.

National Activities in 2012 Activity Name Training course, Workshop, Seminar, Education, Mentoring, etc.) ObjectivesWhenWhereContext : Topics, outcomes, accomplishments Start of Radio-Iodine TherapyTo provide Radioiodine therapy services to the general public Aug 2012 NAMS Bir Hospital Highly subsidized Radioiodine therapy for the benefit of poor general public of Nepal initiated with very good response from the general medical community in Nepal Radioiodine therapy Lectures To provide information to the endocrinologists and ENT specialists Oct 2012 NAMS Bir Hospital Provided lectures regarding the overview of radioiodine therapy in both benign and malignant conditions.

Activity Name (Training Course, Workshop, Seminar, Education, Mentoring, etc.) ObjectivesWhenWhere Context : Topics, outcomes, accomplishments Overview of Nuclear Medicine Instrumentation and quality controls Provide information regarding the importance of QC in NM Feb 2013 NAMS, Bir Hospital Program designed specifically for technologists and NM Physicians to recognize quality control issues in the images and how to rectify them. Also, demonstration of daily and weekly floods and tuning of gamma camera. QC on dose calibrator also shown. Radiation safety seminar Importance of radiation safety issues for personnel in NM Mar 2013 Metro Radiology & Imaging Provided information related to radiation safety issues and safe handling of radioactive sources during NM procedures by both technologists and physicians Radio-iodine treatment of thyroid cancer and hyperthyroidism April 2013 Bir Hospital Interdepartmental discussion with the related doctors and medical students Seminar on role of nuclear medicine in Nephrology/ Cardiology/Endocrinology Awareness about NM procedures May 2013 TUTH Seminar involving departments of urology/ nephrology/cardiology/endocrinology National Activities in 2013

No. of Participants of National Activities Participants in 2011 Participants in 2012

Participants in 2013 Activity/No. of participants FemaleMaleTotal Activity 1145 Activity Activity 3347 Activity Total213657

Total no. of treated or diagnosed patients Treated or diagnosed patients in 2011 Treated or diagnosed patients in 2012 Category of patientsNumbers Female180 Male270 Children50 Total500 Category of patientsNumbers Female750 Male1015 Children85 Total1850 Category of patients Numbers Female Male Children Total =2050 Treated or diagnosed patients in 2013

Results Analysis of national activities and results o Summarize the national activities implemented - capacity development in terms of achievements (i.e. dissemination of new technologies, knowledge and skills, information to participants). Establishment of new Nuclear medicine units at government and private centers. Initiation of radioiodine therapy for both benign and malignant diseases Departmental level workshops and seminar o Analyze the achievements of national activities implemented: augmentation of national capacity. Installation of a double head SPECT camera at a private centre at Kathmandu was accomplished. A new SPECT/CT camera will be installed in Feburary 2014 at BP Koirala Memorial Cancer Hospital, Bharatpur with the assistance of IAEA. o Successful stories, etc. There has been a very good response regarding nuclear medicine services from the medical community. At the same time nuclear medicine practice in Nepal is becoming familiar to all the medical practitioners in their clinical practice. The future scope of nuclear medicine seems very bright as more and more private and cancer hospitals are likely to be established where installation of new nuclear medicine services including PET-CT is also very likely.

Describe to what extent the objectives of the national work plan were accomplished: Nepal is now a member state of RCA The draft of nuclear law is pending at the cabinet level. Initiation of thyroid clinic and radioiodine therapy at nuclear medicine centers. Describe immediate benefits of national activities: Increased referrals for nuclear medicine procedures Awareness among non-specialists about nuclear medicine procedures. Interaction between NM physician and other medical specialists has increased

Describe long term benefits of national activities Long term benefits are highly likely since the trend at the short term is extremely positive. We are witnessing significant increase in requests for nuclear medicine procedures from non-specialists. Furthermore more specialists and technologists are being trained to meet the demands of the profession. New Developments and unexpected difficulties/problems Installation of new camera and improvements in the logistics of isotope supply Larger centers and hospitals in Nepal still lack nuclear medicine units. Lack of trained manpower in NM and lack of awareness among the stakeholders Actions taken to solve them Awareness campaign about NM services Lobbying the government organizations for establishment of nuclear medicine services in major hospitals of Nepal

Lessons Learned and Conclusion Nuclear medicine in Nepal appears very promising despite several governmental/non-governmental constraints. The professionals involved in nuclear medicine in Nepal are very enthusiastic and hard working which makes the future outlook bright although we need support and encouragement from various governmental as well as international organizations to enhance its capacity in the country. This project is very beneficial to country like Nepal and should be continued in the future as well. It would be even more effective if the NM experts come and provide on-site training in our own setting All RCARO/UNDP project officials and the concerned lecturers had done a tremendous job in successfully conducting and completing this project. All the hospitals in Korea which had provided on –site training facility during this project did a remarkable job.