Nuclear Medicine in Pakistan

Durr-e-SabihDirector Multan Institute of Nuclear Medicine

and RadiotherapyPast President Pakistan Society of Nuclear

Medicine

Numbers

o 50 Nuclear medicine centreso 19 owned by the PAECo 4 PET scanners o 200 nuclear medicine physicianso 2 training programmes

• 2 year MS (18 centres )• 4 year FCPS (11 centres)

There are no unemployed nuclear medicine physicians in the

country!

Attrition in the local NM population

o About 30 (~15%) NM physicians have changed their specialty to radiology, radiotherapy, medical oncology, medicine etc !

29 Trainees in NM803 trainees in Radiology

Will we run out of trained nuclear medicine physicians?

Satisfaction survey

o Those who had completed their MSc degree in the last 10 years

o 32 were contactedo 27 responded

o 12 dichotomous questionso 2+1 open-ended questions

The Dichotomous Questions

Question Yes No

1 Are you happy professionally? 11 16 (59.3)

2 Your usefulness in CPCs? 22 4

3 Would you choose NM again, if given a chance? 11 16 (59.3)

4 Is professional infrastructure adequate? 0 25 (100)

5 Does future looks secure? 10 13

6 Does future looks professionally satisfying? 10 16 (59.3)

7 Does future looks financially rewarding? 9 16(59.3)

8 Have you tried to get into FCPS (NM)? 6 20

9 Does MSc provide enough training and knowledge? 15 11 (44.4)

10 Should MSc program continue unchanged? 2 25 (92.6)

11 Have you considered going in private practice? 9 17

12 Is current training enough? 1 25(92.6)

The Dichotomous Questions

Question Yes No

1 Are you happy professionally? 11 16 (59.3)

2 Your usefulness in CPCs? 22 4

3 Would you choose NM again, if given a chance? 11 16 (59.3)

4 Is professional infrastructure adequate? 0 25 (92.6)

5 Does future looks secure? 10 13

6 Does future looks professionally satisfying? 10 16 (59.3)

7 Does future looks financially rewarding? 9 16(59.3)

8 Have you tried to get into FCPS (NM)? 6 20

9 Does MSc provide enough training and knowledge? 15 11 (44.4)

10 Should MSc program continue unchanged? 2 25 (92.6)

11 Have you considered going in private practice? 9 17

12 Is current training enough? 1 25(92.6)

The Open-ended Questions

o Is the professional infrastructure in the country adequate?

o Suggestions for improving the MSc (NM) programme

o Do you need any additional training?

Do you need any additional training?

o 52% wanted radiology trainingo 30% wanted additional training in PETo 11% wanted additional training in

therapeutic nuclear medicine

Why did you leave? o Future did not seem secure (77%)o Not enough opportunity or financial reward (66%)o Did not feel relevant to patient management (55%)o Monotonous and boring work (44%)o Intellectually not stimulating enough (33%)o Not enough patient contact (33%)o Too difficult (0%)

Are we alone?o Should nuclear medicine become part

of radiology?1

o SPECT use will decline over the next decade 2

o Nuclear medicine will be taken over by radiologists 3

1. Wagner, H.N., Jr. and B.L. Holman, The future of nuclear medicine: autonomy or integration? J Nucl Med, 1993. 34(9): p. 27N-29N, 31N, 33N

2. Alavi, A. and S. Basu, Planar and SPECT imaging in the era of PET and PET-CT: can it survive the test of time? Eur J Nucl Med Mol Imaging, 2008. 35(8): p. 1554-9.

3. Holman, B.L., We are training our future. J Nucl Med, 1993. 34(1): p. 167-8.

Training

Worst case scenario

I am afraid to say that the future perspective of nuclear medicine is not so promising because we are standing against many competing modalities and procedures. I am sure that the next 10 years in new millennium must be very critical turning period for promoting of nuclear medicine and it will be a kind of survival game.

Myung-Chul Lee, M.D.Chairman ARCCNM

Reasonso Competition from Radiology at least as

informative, referring physicians are familiar. o PET, the future is PET, which will be available to

only a few, the rest will be left outo Hybrid imaging is the future, and will need

radiological skills to gain maximum benefito Financial opportunity, easier to make money as a

radiologisto Pure nuclear medicine physicians are irrelevant in

today’s medical milieu

Solutionso Broad based training, add other imaging

techniques. Have a major 4-5 year degree, dedicate two years to other imaging modalities

o Create radiologists with special expertise in nuclear medicine

o Emphasize on therapy, dedicate one year to medical training and therapeutic nuclear medicine

o Improve regulatory environment and allow easy setting up of a private nuclear medicine facility

o Improve emoluments, stop discriminating

ASNM, ANMBo Provide material for learning… emphasize on correlative

imaging• For next year ANMB will have questions on cross sectional

imaging• Plan workshops on introduction to CT and MR for nuclear

medicine physicians

o Emphasis on evolving techniques on website with exciting developments in an easily accessible manner

o Make therapy training stronger, accessible…move beyond thyroid

o Push the envelope for providing information and training…Use the internet for e-lectures

Thank you