In world practice, radionuclide diagnostics (‘nuclear medicine’) will soon celebrate its 90th anniversary recently, having begun in 1927. Despite this, such techniques are yet to be widely applied in Belarus: we lack specialists and information on practical application.
Generally, they supplement other research methods. “Modern doctors rely on examinations and tests to diagnose patients: x-ray computer tomography, nuclear magnetic resonance and ultrasonic methods,” explains the Head of Minsk’s City Centre for Radionuclide Diagnostics, Vladimir Terekhov. Radionuclide research is a significant weapon in their arsenal, being able to detect myocardial ischemia and hidden ischemia at an early stage. This brings early treatment, avoiding such invasive method of examination as coronary angiography, which can be expensive and more risky.
Naturally, it’s beneficial to reduce healthcare costs and to avoid additional extreme diagnostic interventions. In gaining a full picture of the nature of an illness, efficient treatments can be prescribed (for example, regarding ischemia) — even avoiding surgery. Preventative medicine can be deployed at an early stage, which may prove successful alone. For example, a patient undergoes examination before the first signs of ischemia and is offered a course of treatment. Afterwards, they are re-examined to determine in dynamics whether the treatment has helped.
Radionuclide diagnostics can be used in cases of perfusion of brain tissue, during circulatory problems and heart attack. Belarus actually leads in this sphere, with our Centre for Radionuclide Diagnostics (set up two years ago) studying perfusion of the myocardium and brain. Our methods are actively helping staff at the Republican Cardiology Scientific-Practical Centre operate on brachiocephalic arteries. Moreover, the method of differential diagnostics of renovascular and essential forms of hypertension (kidney or non-kidney pressure) has been modified and is actively implemented. Our staff have been twice awarded — including by the President of Belarus, and the Centre has published two monographs on radionuclide diagnostics while actively participating in lecturing. In the Soviet times, such specialists were trained in Moscow, St. Petersburg and Kiev and, after the USSR’s collapse, our specialists were left on the sidelines. With this in mind, staff training is of vital importance.
What does the future hold?
Future is the launch of hybrid technologies and hybrid apparatuses which will be combining single-photon emission computer tomograph (the sphere of radionuclide diagnostics) and x-ray computer tomograph (roentgenology). This symbiosis of radionuclide and roentgen methods of examination — two in one — allows patients to speed up the process of examination. I would formulate the task of radionuclide diagnostics in the following way: radionuclide diagnostics allows us to gain roentgen tomography data, visualising the structure of organs. We can study their functional condition and peculiarities via one-photon emission tomography, receiving trustworthy and complete information on brain and heart function, the growth of cancers and other abnormalities at cell or sub-cell level. Such equipment will have several applications. At present, the world medicine practice goes away from one-type devices while launching those which combine several diagnostic directions. Another device will be uniting single-photon computer tomography and nuclear magnetic resonance. In Europe, leading companies like Siemens, General Electric and Philips are involved in such development, combining nuclear magnetic resonance, x-ray computer tomography and single-photon emission computer tomography. This will allow examination at molecular sub-cell level. Our country is keen to be at the cutting edge of such science.
Mr. Terekhov advises me to speak to radiologist Anatoly Kharchenko, who has spent forty years in this profession.
What importance do radionuclide diagnostics have? Are they really essential to medical progress?
It’s not only my opinion but that of all those involved in roentgen research; ultra-sound allows us to see the construction of an organ’s tissue. Where heart attack might have been presumed previously, our method can locate other causes for heart malfunction — such as poor blood supply. We recently had a female patient whose ultra-sound and electrocardiogram results pointed to such a conclusion. Our method is unique and a valuable weapon in the medical arsenal.
Several test results can be placed in a computer database, bringing a more accurate diagnosis. One day, we’d like to see ultra-sound diagnostics and radionuclide diagnostics used alongside traditional clinical methods. We’re already working closely with doctors from clinics.
Are achievements in this sphere significant?
Experience comes from practice while methods develop from using new equipment. The first gamma ray chambers had a resolution of 3cm, but this is now down to 1cm — and even 1mm. Improved technology brings better accuracy — especially using computer processing software, databases and modelling.
We have specialists but training is a little haphazard. Doctors, engineers and nurses would benefit greatly from being taught at radionuclide diagnostics courses together, so that they could work in liaison. It’s something for the future.
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Vladimir Terekhov hopes to see the City Centre for Radionuclide Diagnostics gain Republican status, via the setting up of methodical training and the accumulation of clinical practice. Naturally, the regions also need such experience, to allow patients countrywide to benefit. Mr. Terekhov is confident that the time will come but hopes that there is not too long to wait.
By Vladimir Mikhailov