A country-wide network of nuclear medicine centres is being set up in Russia. The project is conducted by “PET-Technology”, a company belonging to the RUSNANO group, with the participation of private investors. The idea is to create modern highly specialized diagnostic centres based on a method called positron-emission computerized tomography (PET/CT). This is one of the most promising methods for diagnosing cancers, as well as heart and neurological diseases.
PET and CT scans are standard medical procedures provided to cancer patients in all developed countries of the world.
With the help of such a diagnostic tool, it is possible to detect a disease at a very early stage, when the chances of curing it are at their highest.
This method consists in scanning the whole body, thus enabling the detection of even very small or widely scattered metastases. It also contributes towards assessing treatment efficacy: it shows whether a cancerous tumour is increasing or decreasing in size following radio- or chemio-therapy and also how successful surgery has been.
How does it work?
Positron-emission tomography is a radionuclide diagnostic method, under which a radiopharmaceutical agent is introduced into the patient’s body before the procedure is carried out.
These radiopharmaceuticals are selectively absorbed by the cancerous tissues, where the level of metabolic activity is particularly high.
The patient is then placed in a PET/CT scanner which records the gamma-quant radiation produced by the destruction of positrons by electrons in the affected tissues. Thanks to the radiopharmaceuticals, it is not only possible to detect a disease earlier and to a fuller extent than with other diagnostic methods (such as magnetic resonance imaging or MRI), but also to give an accurate assessment of the malignancy of the tumour and of the stage of the disease.
There are many different radiopharmaceuticals. Specialists select specific ones in order to detect a given disease. As explained by Pavel Golovin, medical director of “PET-Technology”, in 90% of cases PET scans are used to detect cancers, and the agent used in this case is the fluorine isotope 18F.
It is obtained from “heavy water” enriched with 18O oxgen, using a cyclotron, and it is then “attached” to a glucose molecule, thus resulting in fluorodeoxyglucose.
Glucose is what is mainly used for nurturing cells, so if fluorodeoxyglucose is “fed” to cells, they will take it up.
As the level of metabolic activity is particularly high in cancerous cells, the tumour will take up much more of the tracer than the surrounding healthy tissues.
Thus, the image provided by the scan will give an accurate representation of the location, size and nature of the tumour.
Fluorine is also handy because of its low radiation level: it can provide a contrast image even at a low dose, which does not represent any risk for the patient’s body. Moreover, the half-life of the fluorine isotope is sufficiently long to be able to transport the radiopharmaceutical from the facility where it is produced to the centre where it is introduced into the patient.
Other isotopes are used in order to detect neurological and heart diseases: 11C and 9N respectively. However, the proportion of these diagnostic procedures is very low in our country, and PET/CT is mainly used in oncology.
The first element of the network
The first centre of this project is already operational: it was opened in the city of Ufa in April 2014, next to the Republican cancer clinic.
This is how it works. First of all, the necessary fluorine isotopes are produced with the help of a cyclotron. They are then immediately transferred to a radiochemical laboratory, where the radiopharmaceutical is synthesized thanks to robotized “hot rooms”. Finally, the agent is submitted to a quality control laboratory.
At the following stage, the radiopharmaceutical is conditioned into individual doses for each patient, according to the latter’s specific characteristics.
The fluorodeoxyglucose is injected into the patient in the treatment room, after which he or she is transferred to a relaxation room for a one hour rest. This time is necessary for the radiopharmaceutical to spread throughout the body and thus obtain the most accurate possible diagnosis. The patient is then placed in a PET scanner, which is combined with a computerized tomograph (CT), and is scanned using both technologies. This method offers the advantages of both technologies: a 3-D image of modifications occurring in tissues plus a high resolution spatial image of the inner organs. The images are studied by a doctor who will then deliver his conclusion.
By the end of December, more than 2500 patients will have been diagnosed in the Ufa centre. This access to modern diagnostic tools is open not only to the population of the Republic of Bashkiria, but also to those living in the neighbouring regions of the federal district of Privolzhsk.
How to obtain access and who pays
In Russia, PET/CT scans are at present much less expensive than in Israel or Europe. The early and accurate detection of a disease, for example of a cancerous tumour, has the advantage of making it possible to apply a less aggressive but more effective treatment method, to save money and, last but not least, to save the patient’s life in most cases.
A referral from a cancer clinic will provide access to a PET/CT scan. In this case,
for patients living in regions where centres belonging to the federal network have already been opened, and provided the necessary referral has been delivered, the scan will be free and its cost will be covered by the concerned region’s budget.
Another possibility is to ask directly for an appointment at one of the centres by calling the “hot line”. In that case, the PET/CT scan will cost 44’000 roubles in the centre now open in Ufa. Besides the diagnostic procedure itself, this price also includes a consultation by a doctor and the results of the scan on film and on a CD-disk.
The procedure can only be carried out by prior appointment, as a certain amount of time is required in order to produce the radiopharmaceutical for each patient and to prepare the set-up of the scan.
PET for all
PET scanning is a method which is already used in Russia, for example at the Blokhin Russian Cancer Research Centre and at the Bakulev Scientific Centre for Cardiovascular Surgery, both situated in Moscow. The first PET-centre of the country was opened in 1991 at the Human Brain Institute of the Russian Academy of Sciences in Saint-Petersburg. But the specialists of this Institute mainly focus on diagnosing brain tumours. Centres which combine PET and CT scanning are a rare occurrence in the country, only a handful of them are to be found in Moscow, Saint-Petersburg, Ufa, Khabarovsk, Chelyabinsk, Krasnoyarsk, Khanty-Mansiisk and Kazan.
“In the meantime, in the rest of the world PET scans have become a standard method used in oncology”, according to the words of Pavel Golovin.
An oncologist will simply not accept to treat a patient who hasn’t had a PET scan.
Is there a strong need for PET scans in Russia? According to data from the 2013 federal register, some 3,6 million cancer patients are registered in the country. If the need is estimated only on the basis of the number of patients diagnosed with cancer for the first time, a PET scan would be required for more than half of them; in other words, this would amount to almost 685’000 scans per year.
With the creation of a federal network, the accessibility of this method will reach a new level of quality. The next nuclear medicine centres to be opened will be in the Central Black Earth Region, in the towns of Tambov, Orel, Lipetsk, Kursk and Bryansk. It is not by chance that these regions were picked as future elements of the PET-network: they are all situated around the fallout of the Chernobyl nuclear accident, where the health of the population requires close monitoring. These centres are expected to open in the first half of 2015. In a following stage, further centres will be created in Novosibirsk, Samara, Yekaterinburg, Kaluga, Orenburg, Perm, Izhevsk and Vladivostok.
By 2017, some 16 centres should have been constructed, but the network should continue developing even after this date.
In certain cases, the cyclotron used to produce the isotopes will be situated in a separate facility from the PET-centre, and the radiopharmaceuticals will have to be delivered by special transport. For example, the plant producing radiopharmaceuticals in Yelets (in the oblast of Lipetsk) will supply all the PET-centres of the Central Federal District. The logistics will have to be extremely well organized as the radiopharmaceuticals must be produced in exactly the right quantities and doses required for the patients due to undergo a scan on any given day.
In order to create the first part of the network – in the Central Federal District and in the Republic of Bashkortostan -, “PET-Technology” estimates it will have to spend some 6,4 billion roubles, 2,4 of which will be invested by RUSNANO.
PET scanning is still relatively new to our country, and therefore there are not enough trained specialists capable of applying this method for the time being. They need training, and before opening the centre in Ufa, both medical and technical staff followed training courses for almost one year in leading clinics in Russia, Europe and the USA. These training activities are still going on.
At a later stage, the experts of the federal network intend to connect all the centres to a unified medical information system.
It will thus be possible to carry out a remote analysis of the data produced by scanning and, in complex cases, to seek advice from specialists from leading Russian clinics or from other top-range medical centres throughout the world. All this means that thanks to the creation of the federal network of nuclear medicine centres, Russian cancer patients will be provided with truly accessible and high quality medical care.
Based on information by “Gazeta.ru”
