Nuclear Diplomacy: Three instances L V Krishnan, NIAS RIS, April 22 2019 1
First Edition: 1956 D S Kothari (Two years before the US AEC published “Effects of Nuclear Weapons” including hydrogen bombs.) Soon translated into German, Russian and Japanese. 2
• Dec 2015 BAEC signed a contract with Russian firm ASE in for building the two 1200 MW VVERs at Rooppur. • April 2017 India and Bangladesh signed NCA Indian Firms can • General agreement with DAE on Peaceful uses of Nuclear Energy bid for • Between the Regulatory bodies of the two countries on Exchange construction, of Technical Information and Co-operation in the Regulation of installation and Nuclear Safety and Radiation Protection supply of • Between Global Centre for Nuclear Energy Partnership (GCNEP) materials. of India and BAEC on Cooperation for training staff for NPPs and HCC has landed consultancy services a civil contract for Turbine Bldg. • Mar 2018 Trilateral between Russia, Bangladesh and India on the construction of two Russian reactors in Bangladesh.
GCNEP announcement by Indian PM at the Nuclear Security Summit 2010 2017 Agreement with Bangladesh provides for GCNEP assistance in • evaluation of Tech documents; • review of safety reports; • evaluation of suppliers and eqpt; • inspection of eqpt; • supervision of construction and commissioning; • establishment of radiation monitoring, environmental monitoring and emergency management system; • formulation of physical and information security
Nuclear Medicine Applications Heart Disease (primarily diagnosis) Every 2 seconds Cancer (Diagnosis, Therapy & Progress assessment) someone aged 30 to 70 years Brain related (Diagnosis – track blood flow, sugar use) dies prematurely from Cerebrovascular disease noncommunicable diseases Neurological disorder (Alzheimer, Epilepsy) • cardiovascular disease, Endocrine Disorder: Thyroid (Diagnosis & Therapy) • chronic respiratory Complex conditions disease, Heart disease and Diabetes • diabetes or Cancer and TB • cancer.
• World Medical tourists to all countries in 2017: 14-16 million • Americans alone > 1.4 million • Top destinations (alphabetical order): Cost Rica, India, Malaysia, Mexico, Singapore, S Korea, Taiwan, Thailand, Turkey • American medical tourists most likely to go to South America, Central America, and the Caribbean JCI-accredited (Joint Commission International) hospitals in India >38 Savings from treatment in India compared to US costs while providing quality care 65-90% 7
Cancer Incidence (per lakh) Mortality rate (per lakh) India 99 68 Bangladesh 125 96 Nepal 142 106 Kenya 132 110 S Africa 202 141 Coronary heart disease Incidence (per lakh) India 146 Uzbekistan 325 Afghanistan 263 Sudan 227 Nepal 158 8
The Techniques Computerised Tomography (CT) Single Photon Emission CT (SPECT) Positron Emission Tomography (PET) Nuclear Magnetic Resonance Imaging, MRI Radioisotopes emitting α, β, γ radiation Diagnosis through Imaging • Detection of structural abnormality X-rays / CT Scan • Detection of functional abnormality Injection of radioisotope tracers and use of Gamma Camera • Combination of A & B PET/CT; SPECT/CT with and without MRI 9
Bhabhatron Teletherapy Cobalt Units Therapeutic Techniques in Nuclear Medicine supplied by India Radiation Therapy (destruction of diseased tissue) 2010 Vietnam • Teletherapy 2010 Srilanka • External sealed Source (beta/gamma radiation) 2015 Mongolia • Radioisotope or Particle Accelerator 2016 Kyrgyzstan • Brachytherapy (Sealed Source embedded in the body) 2017 Kenya • Radioisotope injection (mainly for thyroid disease) 2018 Madagascar 2018 Nepal 2019 Malawi 10
Indian Nuclear Medicine Scene Nuclear medicine departments 293 (86% in Pvt sector) Gamma cameras (SPECT) 163 PET-CT 222 SPECT-CT 70 PET-MRI 3 Medical Cyclotrons 19 Radionuclide Therapy (isolation wards) 92 (200 beds) Myocardial perfusion centers 250 Teaching Hospitals for MD/DNB in NM 18 (50 admitted/year) Admissions in Bachelors/Masters level 120 11
• Society of Nuclear Medicine, SNMI - Estd 1967; 1425 Members Publishes the Indian Journal of Nuclear Medicine since 1985. • Association of Nuclear Medicine Physicians of India, ANMPI - Estd 2003: 248 members. • Nuclear Cardiological Society of India (NCSI) - Est 1996 • Association of Medical Physicists of India, AMPI 800 Members (physicists, radiation oncologists, radiologists & engineers) Publishes the Journal of Medical Physics. An Affiliate of the Indian National Science Academy. • Indian Journal of Radiology and Imaging publication in 1947 A large number of Indian professionals hold senior positions in the US 12
Thank You for Your Patience 13
UN sustainable Development Goal 3 Every 2 seconds someone aged 30 to 70 years dies prematurely from noncommunicable diseases • cardiovascular disease, • chronic respiratory disease, • diabetes or • cancer. By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being
The Techniques Computerised Tomography (CT) Single Photon Emission CT (SPECT) Positron Emission Tomography (PET) Nuclear Magnetic Resonance Imaging, MRI Radioisotopes emitting α, β, γ radiation 15
Diagnosis through Imaging • Detection of structural abnormality X-rays / CT Scan • Detection of functional abnormality Injection of radioisotope tracers and use of Gamma Camera • Combination of A & B PET/CT; SPECT/CT with and without MRI
Nuclear Medicine Applications • Heart Disease (primarily diagnosis) • Cancer (Diagnosis, Therapy & Progress assessment) • Brain related (Diagnosis – tracking blood flow, sugar use) Cerebrovascular disease Neurological disorder (Alzheimer, Epilepsy) • Endocrine Disorder, mainly Thyroid (Diagnosis & Therapy) • Complex conditions Heart disease and Diabetes Cancer and TB 17
“ Towards health diplomacy: emerging trends in India’s South- South health cooperation” A Chapter in India’s Approach to Development Cooperation Sachin Chaturvedi and Anthea Mulakala (eds.) Routledge Contemporary South Asia Series. NY India’s Development Cooperation • sustainable and inclusive • based on India’s own developmental experience • without conditionalities • demand driven • based on mutual gains • contributing to India’s soft power Assistance in Nuclear Medicine meets all 18
whether refurbished, used, or new, PET systems, are more expensive than SPECT systems in terms of purchase price, ongoing repair, maintenance, and upkeep. Besides camera costs, operational and consumables costs are also higher than SPECT. Radiotracers (Rb-82 or N-13) requires costly, long-term contracts to be committed to before the first scan is provided. Usage depends on reimbursement facility available. 15-25% of MPI studies may benefit if performed as PET MPI https://www.digirad.com/how-to-know-if-cardiac-pet-makes-sense-for-your-practice/ 19
Equipment Costs Cardiac Systems $55,000 - $70,000 Siemens C.Cam General Purpose Systems Philips CardioMD $60,000 - $95,000 GE Myosight GE Millennium MG GE MPR Siemens E.Cam $95,000 - $125,000 Siemens Symbia E GE Ventri Philips Brightview Digirad Cardius 2 GE Infinia SPECT/CT Systems. $120,000 - $200,000 $95,000 - $130,000 Siemens Symbia S Siemens Symbia T2, T6, T16 $95,000 - $115,000 GE Infinia Hawkeye https://info.blockimaging.com/nuclear-camera-price-cost-guide 20
AIIMS Data 2014-15 • 200 sq m area housing one cyclotron, one chemistry module with 2 PET/CT scanners for diagnosis; • 6,785 scan in the period of one year; ave 30 per day; mostly FDG; • Total estimated annualized cost • PET/CT scan facility equipment Rs 49,194,701 $768,667 Inclusive of bldg, eqpt, furniture, HVAC $776,619 • operating cost: $243,875 • Unit cost of PET/ CT was calculated to be INR 9,625.22 ($150) 21
Needed: Interdisciplinary or interinstitutional collaboration. For example, Bangalore: In Can Indian Institute of Science, DRDO Labs, medical schools, IIMB and hospitals in private sector collaborate to set up a ‘research park’ and facilitate multi-institutional research and training programs Dr Satyanarayan Hegde, Medical Director, University of Chicago https://indiamedtoday.com/india-can-leapfrog-into-the-next-stage-of- healthcare-technology-revolution/ 22
Potential areas where India has the capability Nuclear Techniques Nuclear medicine Medical tourism Cancer diagnosis and therapy Radiation processing Minimise agricultural product losses Manufacture of products Nuclear power Safety analysis / emergency preparedness Environmental monitoring ESL in Rooppur, Bd Pharma S&T STEM education Social sciences 23
Nuclear Medicine – Teamwork of NM Technologist, Medical Physicist & Physician 24
Telemedicine prospects Capacity building Technology transfer Training and scholarships Development Partnership Assistance 25
India’s Development Cooperation • sustainable and inclusive • based on India’s own developmental experience • without conditionalities • demand driven • based on mutual gains • contributing to India’s soft power Assistance in Nuclear Medicine meets all 26
Recommend
More recommend
