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Looking inside Hearts in Argentina: Using Nuclear Science to Find Disease


Doctor Roberto Agüero (left) prepares his patient Lola Fiskel (centre) for a SPECT scan at the Nuclear Diagnostics Centre Foundation in Buenos Aires, Argentina, 9 October 2017. (Photo: L. Gil/IAEA)

Buenos Aires, Argentina — Injection in, arms up, eyes closed. This is how 81-year-old Lola Fiskel plunges her body into a futuristic-looking machine at the Nuclear Diagnostics Centre Foundation in Buenos Aires. Thanks to machines like this one, which use radiation to see inside the human body, doctors have been able to diagnose Fiskel’s heart condition early enough to treat her.

In Argentina, heart disease is the number one cause of premature death, as well as in the world. But if diagnosed early enough through nuclear medicine, patients can be treated and saved. The IAEA helps centres like this one provide high-quality nuclear medicine services to its patients through support equipment, expertise and training.

Diego Passadore, General Manager of the Nuclear Diagnostics Centre Foundation in Buenos Aires, Argentina. (Video: M. Klingenböck/IAEA).

“Nuclear medicine is a technology that allows you to look at the heart inside the patient’s chest, without opening it,” said Roberto Agüero, Fiskel’s doctor. In Fiskel’s case, they used a special scan called single photon emission computed tomography, or SPECT, to find out more about her cardiovascular condition (see The Science box).

Last year, Fiskel fainted. “I was walking down the street, with a friend, when I lost sense of everything,” she said. “All I knew when I woke up was that I had fallen in the middle of the street, and that my chest hurt.” Neither ultrasound nor effort tests could reveal the full cause of her fainting or the extent of the damage in her heart — and then she went for a SPECT scan.

Lola Fiskel, patient at the Nuclear Diagnostics Centre Foundation in Buenos Aires, Argentina. (Video: M. Klingenböck/IAEA).

Thanks to SPECT, Fiskel’s doctor identified the cause of her fall: ischemia, or low blood flow. She is now treated with cardiovascular pharmaceuticals and monitored with nuclear medicine.

“These techniques help us to know the precise degree of damage to the heart, something we cannot do otherwise,” Agüero said. “Without this diagnosis, Fiskel’s heart condition could have worsened, and treatment would have been more complicated, including the need for open-heart surgery.”

Nuclear medicine for all

In an effort to increase access to these services for Argentinians across the country, the government has launched a nationwide initiative through the National Atomic Energy Commission (CNEA) that aims at expanding and improving facilities and centres all over the country. The IAEA is helping in this effort through equipment and training.

The multimillion-euro investment involves building six new centres across the country that will offer high-quality nuclear medicine and radiotherapy services. The new centres will be operating in the Argentinian provinces of Río Gallegos, Río Negro, Santiago del Estero, Formosa, Entre Ríos and La Pampa.

“Argentina is a large country,” said Geraldine Arias, manager of the technical cooperation programme for Argentina at the IAEA. “The Government is trying to take their resources out to the regions. But to expand services, they need specialized professionals and up-to-date equipment.”

Diego Passadore, General Manager of the Nuclear Diagnostics Centre Foundation in Buenos Aires. (Video: M. Klingenböck/IAEA).

Nuclear medicine is multidisciplinary, Arias said. “We support all areas. We send experts and train radiopharmacists, medical physicists, medical doctors, technologists.”

A coordinated effort

To look inside a patient’s heart, an entire orchestra of experts, substances and equipment is working behind the scenes. To begin with, medical staff need to produce radiopharmaceuticals and insert them into the patient’s body. Some types are only effective for a short period of time, so they need to be produced close to where they are used. The Nuclear Diagnostics Centre Foundation produces radioisotopes for PET using its own cyclotron — a type of particle accelerator — which is also the only cyclotron in Buenos Aires.

Physicists and chemists on one side produce radiopharmaceuticals in the safe, highly-secured cyclotron. The isotopes then flow underground, through a special drain, into another safe room where a radiopharmacist prepares the material for injection behind protected metal doors, introduces it into a flask, and places it in a robust, shielded metallic cylinder. All these measures are used to avoid exposing medical staff to radiation on a daily basis.

In an adjacent room, a nurse takes the syringe out of that metallic cylinder, injects the radioactive material into the patient and makes him or her wait. After one hour, the patient goes to the examination room and lies down for PET. The machine scans the patient’s body, detecting the radioactivity the drugs are emitting, and producing 3D images of the patient’s organs for the doctor to interpret.

Check this photo essay to see what this process looks like in the Nuclear Diagnostics Centre Foundation of Buenos Aires.

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