Nuclear Medicine, Radiation Oncology Get Major Uplift in Bangladesh

For little Mahbub, a PET-CT scan changed his life. He was three years old when doctors at the National Institute of Nuclear Medicine and Allied Sciences, or NINMAS, spotted a cancer lymphoma on Mahbub’s scan in 2015. Alarmed by the advanced stage of the disease, they began Mahbub on chemotherapy. After two sessions, they used a PET-CT again to check his response.

Fortunately, says Shamim Momtaz Ferdousi Begum, Head of PET-CT at NINMAS, Mahbub recovered so fast that the oncologists stopped the chemotherapy. “Instead of the six chemotherapy sessions we would’ve put him through, the boy only received four,” she said. “And he is cured now and under follow up.”

“We were very anxious because we knew we just couldn’t afford it,” said Mahbub’s father Mohammad Murad. “Now we come and do all checkups at NINMAS without having to wait so long, and free of cost. We cannot believe it.”

PET-CT scans are one type of nuclear medicine procedure. These procedures require the use of medical drugs called radiopharmaceuticals that contain medical radioisotopes. Many radioisotopes are produced by cyclotrons, which are a type of particle accelerator.

Currently, Bangladesh operates one cyclotron, twice a week, in a private hospital. It is the only source of radiopharmaceuticals for public and private centres to make PET-CT scans. A new cyclotron facility, expected to be operational this summer at NINMAS, will produce radiopharmaceuticals four to five days a week.

“The new cyclotron will not only allow the existing PET-CT machines to improve their productivity, but will also provide the opportunity for other PET-CT facilities to open and contribute to national cancer management,” said Enrique Estrada, nuclear medicine physician at the IAEA.

Alongside enhancements in nuclear medicine, Bangladesh is going through a major upgrade in radiation oncology thanks to a fleet of staff who have been quietly training for years. Through twenty national training programmes supported by the IAEA technical cooperation programme, several radiation oncologists, medical physicists and radiation technologists from the private and government sectors have attended advanced training courses since 2012.

“It helps to know that we’re doing things right,” said Nazmun Naher Shanta, radiation oncology registrar at the National Institute of Cancer Research and Hospital (NICRH). “Having senior experts from the region verify that what we’re doing is right gives us confidence in our methods and increases the quality of the treatment we provide.”

The challenge professionals in the field are facing is two-fold. On the one hand, there is scarcity of trained manpower. On the other, the population is growing.  While international standards recommend operating one radiotherapy machine per one million inhabitants, Bangladesh still has only 24 machines for its population of 166 million.

In addition, the majority of patients reach hospitals and healthcare centres at a stage of disease so advanced that the only available treatment is palliative care to alleviate pain. This is not only because of a lack of facilities, but also due to a lack of awareness: patients usually do not approach a healthcare centre even if they have the symptoms.

“If we address these problems, that is, accessibility, awareness, and more well-trained medical staff, in ten years things will change dramatically,” Uddin said. He, like many others in the field, are confident that the development of centres beyond the capital is the way to go.

“Bangladesh has motivated, dedicated professionals, and is getting more equipment,” said Syahril Syahril, project manager at the IAEA responsible for technical cooperation with the country. “Although there are challenges ahead, we are working to ensure that the country will continue receive the necessary assistance through IAEA technical cooperation.”