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A Day with “Dr Dammi”: Nuclear Medicine in Action in Sri Lanka

Undergraduates at the Peradeniya Nuclear Medicine Unit in the Central Province of Sri Lanka (Photo: L. Potterton/IAEA)

“Don’t sit down, this isn’t a lecture,” the doctor cries. As the medical students jump to their feet, she tells them: “We’re in a clinic. You need to get close to the patient.”

Damayanthi Nanayakkara, one of Sri Lanka’s top nuclear medicine physicians, does not have time to waste. She has a clinic full of patients to attend to.

Every weekday at 8:00 a.m. sharp, she arrives at Peradeniya Nuclear Medicine Unit in the Central Province of Sri Lanka, elegantly dressed in a vibrant sari – her “normal workwear” – dons her lab coat and gets down to business.  

Despite her hectic clinical schedule, she makes time once a week to offer hands-on training to students from the Faculty of Medicine of the University of Peradeniya, where she is a senior lecturer.  

Around 200 undergraduates a year have the opportunity to see the doctor and her team at work.

“This university is the only place in the country that offers teaching in nuclear medicine and our facility is unique in Sri Lanka,” says the 53-year-old. “So this is the ideal place for these future doctors to learn.”

Nuclear medicine uses small amounts of radioactive substances for the diagnosis, treatment and monitoring of many health conditions including cancer, kidney, thyroid and cardiovascular diseases.

For examinations, the radiopharmaceuticals – drugs that contain radioactive materials – are usually injected intravenously into a patient and taken up by the organ or part of the body of interest.

The radioactive emissions from these radiopharmaceuticals are detected by a special device known as a “gamma camera” that produces images of the body parts under investigation, allowing physicians to see what is happening within the patient’s body.

Some radiopharmaceuticals, such as Iodine-131 which is taken orally, can be used for therapeutic purposes by killing cancerous cells through their radioactivity.

 “We’re a small unit, with just two medical staff and six technologists, but we do around 5000 scans a year and treat over 200 patients for thyroid cancer,” says Nanayakkara.

“And we do over 30 000 blood tests using the radioimmunoassay technique, which is a highly accurate nuclear medicine method to diagnose disease and to check if treatment is effective or not.”

IAEA support

The Nuclear Medicine Unit in Peradeniya was the first facility of its kind to be established in Sri Lanka. It was opened in 1973 and has been supported for over forty years by the IAEA.

Recently, to cope with the growing demand for its services, it underwent a major upgrade to bring its technical and safety standards into line with those of a modern nuclear medicine facility.

“This upgrade has been a major boost for us,” says Nanayakkara, who has worked at the facility for the past 18 years.  

“We now have highly sophisticated devices, which include a new gamma camera for scanning patients, and our own radiopharmacy laboratory where we can prepare radiopharmaceuticals on a daily basis.”

State-of-the-art storage facilities for the radioactive materials and radiation protection equipment for the staff have been provided through various IAEA projects. Most importantly, the IAEA provides extensive professional training.

“The IAEA doesn’t just buy us the equipment, but also trains our staff on how to use and maintain it,” says the doctor, who has participated in several IAEA-sponsored courses herself.

“In Sri Lanka, we have no proper opportunities for nuclear medicine training, so the IAEA support in this area is vital for us.”

Five of the six technologists, who currently work at the unit, were trained at hospitals and laboratories around the world under the IAEA’s technical cooperation fellowship programme.

One of these is the unit’s senior technical officer, Samantha Herath, who received training in Thailand and at the IAEA’s laboratories in Seibersdorf, Austria.

“This kind of experience is really beneficial,” he says, while preparing the blood samples for analysis: “We get to work at highly reputed facilities and with very knowledgeable medical and technical professionals. We can learn a lot from them and then use the skills gained here in Sri Lanka.”

In Sri Lanka, we have no proper opportunities for nuclear medicine training, so the IAEA support in this area is vital for us.
Damayanthi Nanayakkara, physician, Peradeniya Nuclear Medicine Unit, Sri Lanka

Damayanthi Nanayakkara making her rounds at Peradeniya Nuclear Medicine Unit in the Central Province of Sri Lanka (Photo: L. Potterton/IAEA)

Analysing the scans

Back in the clinic, the patients have all gone home for the day. Now it is time for the doctor to review the results of the scans.

“Today we had 15 cancer patients for a whole body scan,” she says, examining an image on which the bright areas indicate an accumulation of the radiopharmaceutical that had been injected into the patient. These areas are metastases, indicating that a cancer has spread.

“With this method, we can see if treatment is working or if it’s not. There are nine cases that showed the spread of cancer. Now I need to write reports for the oncologists,” adds Nanayakkara sadly.

But it is not always bad news. When 33-year-old Chalani Jayarathne meets the doctor, she is greeted like an old friend.

Together, the two women review the patient’s scan results. They show that her thyroid cancer has been cured.

“In December 2014, I found a lump on the right side of my neck. I was told that it was cancer,” explains Chalani. “I was very upset and afraid. I have two small boys, and I thought I was going to die.”

Following the removal of her thyroid, Chalani was referred to Nanayakkara’s clinic, where she received radioactive iodine treatment. “I got great care here. I’m so happy to be cured of cancer. Now I want to have a third child, hopefully a girl,” says Chalani.

According to the doctor, her patients are often scared when they hear that their treatment will involve the use of radioactive substances.

“But nuclear medicine has been practised for over five decades. It’s safe and painless, and is used widely around the world,” she says.

As for the future, the tireless doctor has plans. Her goal is to develop the facility into a regional training centre and encourage more female doctors to enter “this wonderful medical discipline.”

At the end of a long and busy day, “Dr Dammi” has time for one more question. 

Asked where the Nuclear Medicine Unit would be without IAEA support, she says:  “We would have closed down.”

“Sri Lanka is a country that only recently came out of 30 years of conflict. Without the IAEA’s support, we could not have developed this facility."