With PET CT lesions are easy to pick up early and accurately - Dr. Shahid Kamal


 Medical Cyclotron and PET CT installed at NMI

With PET CT lesions are easy to pick up
early and accurately - Dr. Shahid Kamal

It helps in treatment response evaluation, staging, end of
treatment assessment, recurrence and restaging - Dr. Shahid Hameed

It can also detect unknown primary source - Dr. Asif Mateen
NMI will provide cost effective treatment and deserving needy
patients will be helped by the Trust - Prof. Sattar Hashim

KARACHI: Neurospinal and Medical Institute (NMI) has added yet another diagnostic facility at its premises i.e. PET Scan and Medical Cyclotron which was formally inaugurated on May 4th 2013. A seminar was also organized on this occasion which was chaired by Prof. S. H. Manzoor Zaidi an eminent cancer specialist and Director Baqai Institute of Oncology. Speaking at the occasion he said that Dr. A. Sattar Hashim has been a trend setter. He first installed CT and MRI which was followed by Gamma Knife for stereotactic surgery. Now he has taken the initiative of installing the 64 slice PET scan making all these sophisticated diagnostic facilities available under one roof. This is going to be very useful in management of cancer in Pakistan. It is extremely helpful in diagnosis as well as assessment of the treatment, he added.

Prof. S. H. Manzoor Zaidi (second from right) chairing the seminar organized by Neurospinal and
Medical Institute at Karachi recently. Also sitting on the dais from (L to R) are Dr. Shahid Hameed
from SKMT, Prof. Sattar Hashim from NMI, Dr.Junaid Ali Shah Sindh Health Minister in
caretaker government and Dr. Shahid Kamal Project Director at NMI

Managing Director of Siemens which has provided this equipment in his speech said that PET scan is very useful in diagnosis of various neurology, cardiology and oncology disorders. It also helps in making accurate computerized diagnostic treatment decisions. He also emphasized the importance of cost effective advanced imaging for diagnosis of diseases.
Prof. Sattar Hashim speaking at the occasion said that it was in 1995 that we introduced the latest diagnostic system with CT, MRI and then we added Gamma Knife in 2008 for stereotactic surgery. Many problems remain with CT and MRI; hence for detection of disease at a very early stage, PET scan has been installed at NMI for better diagnosis. It detects cancer at very early states in the whole body. We will provide cost effective diagnostic facilities and deserving needy patients will also be helped from the Trust which we have set up, he added.
Dr. Shahid Kamal Project Director gave a brief overview of this newly installed facility of PET scan. This, he said, requires strict building codes, radiation safety has to be ensured. This project has its own challenges while we are faced with electricity shortage and law and order situation. He also talked about the main component of cyclotrom and pointed out that one can bombard two targets at a time. Pet scan has automated system control. Over weight patients can be accommodated easily. With 64 slices it is very fast. He then gave details of the basic equipment and software and oncology software. It is much more reliable and we will ensure quality. There is no contamination and the imaging protocol requires that the patient is four hours fasting. It is extremely useful in epilepsy, tumors, dementia, infection, bone lesions are picked up easily. It offers high accuracy and early detection is possible. He then depicted a few slides of PET scan brain scan, high grade gliomas.
Continuing Dr. Shahid Kamal said that PET scan can be used for planning treatment, see the response and continue radiation while it helps in modification of radiotherapy treatment. He also talked about impact of respiratory motion on IMRT, it follows the tumour and spares the healthy tissue targeting the tumors, avoids geographic miss. He then talked about esophageal carcinoma, recurrence of cholangio carcinoma and advances in radiotherapy delivery. It can also hit biological target volume, on floor of the mouth. It is much more accurate. One should use the new devices rationally and it changes management in 36% of cases, he added.
Dr. Asif Mateen chief of radiology at NMI spoke on Multi Modality imaging and RT stimulation. He discussed in detail the anatomical and functional imaging. CT MRI, he said, has high resolution 3D anatomical images. It is helpful for monitoring response and assessment of the disease. It is used for treatment planning, evaluation and response. He also discussed the indications as well as disadvantages and said that it has limited resolution as compared to CT and MRI. Pet scan and CT MRI combined together is an important imaging modality whereby enhanced detection is possible. Pet scan can also detect the unknown primary source. It can be used for monitoring response, overall patient assessment. It has an important role in oncology as it differentiates between benign and malignant disease. It is helpful in planning radiotherapy treatment. He also talked about role of neuro-imaging in radio surgery and use of gamma knife for treatment of settled targets in the brain. Pet scan is also very useful in radiotherapy planning in many solid tumors, he added.

Dr. M. A. Chaudhry

Dr. M. A. Chaudhry from John Hopkins USA made a presentation on new trends in molecular imaging. Anatom, he said, has been and remains the cornerstone of cancer imaging. Sometimes the treatment stops the cancer cells from growing than killing them. He also discussed limitations of standard imaging. More rapid scans and less motion of patients, high quality transmission/precision, better diagnostic accuracy, renal failure and allergy are no problems. With new diagnostic modalities localization of tumors improves. These new modalities are extremely useful in oncology, cardiology and neurology, for staging and restaging the disease. Pet scan can be cost effective if patients are selected carefully. Some cancers, he said, are very aggressive and do not give any time. Changes in management are still under evolution based on results. He also discussed staging in colorectal cancer, restaging and follow up besides monitoring of therapy for cervical cancer. It aids in optimal radiotherapy treatment planning, provides prognostic information besides significant information in post therapy follow up. While Echo is operator dependent, cardiac diagnostic modalities have its own strength and weaknesses. He concluded his presentation by stating that new diagnostic modalities are extremely useful and provides significant improvement in management of patients with oncology, cardiology and neurological diseases.


Dr. Ahmad Qureshi from INMOL along with Dr. Asif Mateen
photographed during the seminar.

Dr. Ahmad Qureshi from INMOL Lahore discussed role of EET CT in oncology. We have a 16 slice PET CT and so far we have managed fifteen hundred cases, most of the patients were in the field of oncology. It provides all the information which an oncologist requires regarding location of the tumour. Solitary pulmonary nodules are 30-70% malignant. PET CT has 95% sensitivity and 85% specificity. It helps in detection of unknown primary. Role of PET scan in cancer staging is now well established. It can pick up some other lesions which are not picked up on CT; hence it changes the management protocol. It is cost effective but requires lot of capital investment. PET is the finest imaging technology; more than 94% of the cost is related to direct delivery of treatment. It helps avoid un-necessary chemotherapy and surgery. For assessment of cancer, one should do the PET scan first and then start radiotherapy. It helps in diagnosis, staging, restaging as well as prediction of treatment response.
Dr. Shahid Hameed from SKMT Lahore was the last speaker in the session who talked about role of PET CT in radiotherapy and radio surgery planning. This, he said, was very useful in evaluation of treatment response, staging, end of treatment assessment, recurrence, restaging, radiotherapy planning. It is extremely effective in Head and Neck and lung cancers and offers many advantages in this area. However, he cautioned that there is lot of pitfalls in PET scan as well and one has to become familiar with it. It has become more important in follow up. It is a valuable tool in improving diagnostic performance. Talking about the role of PET scan in lung cancer, he said at times the lung is totally collapsed but it is PET scan which can differentiate whether there is some malignancy. It is also a useful tool in 3D based adaptive bracytherapy. 4D PET CT and PET MRI are coming. He then gave information as to when one should do PET scan which is as under:

When to do PET scan
* Post biopsy- 1 week
* Post Surgery 6-weeks
* Post Radiofrequency Ablation 4 weeks
* Post chemotherapy 2-4 weeks
* Post radiation 2-6 months
* Post GCSF one week to one month.

Dr. Syed Junaid Ali Shah, Sindh Minister of Health in the caretaker provincial government also briefly addressed the audience and hoped that this new diagnostic facility installed at NMI will be helpful in early and accurate diagnosis and planning for cancer treatment.

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