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COVID-19 pandemic: Challenges and opportunities for nuclear medicine specialty

COVID-19 pandemic has entered into its sixth month, spreading across multiple continents, affecting lives and livelihood of millions of people.

Nuclear medicine specialty is facing multiple challenges including:

Disruption in supplies of radioactive materials and radiopharmaceuticals. Most of radiopharmaceuticals, non-radioactive raw materials, cold kits etc are imported from other countries. Local production of these radio-pharmaceuticals is still at a nascent stage, despite a big indigenous market. Due to disruption of international air travel, there was unavailability of these medical consumables.

Short term expiry of most radioactive products. Due to short half-lives and short expiry of these products, any nuclear medicine department is unable to stock them for later use.

Lock-down affecting patient numbers. The nuclear medicine departments have seen huge dip in patient footfall in COVID-19 times. One of the major reasons for this was disruption in patient movement and transport facilities. India is one of the major hubs of medical tourism. Due to complete stoppage of international air travel, medical tourism has been badly affected.

Dwindling private investment. Setting up a new nuclear medicine department requires huge investment. This comprises the cost of land, PET CT, or SPECT CT scanners and other allied equipment. Private investment in this branch showed an upward spiral in the last decade. Hence, multiple new stand-alone and hospital based private nuclear medicine centers mushroomed in tier I, II, and III cities. However, with economy taking a hit, future investments may be withheld or postponed till the recovery happens.

However, with every challenge, hidden comes the opportunity. I would like to highlight a few:

Need for self-reliance (AtmaNirbhar Bharat). As previously mentioned that a bulk of our radiopharmaceutical and non-radioactive consumables are imported from west, there is increasing need for self-reliance for these products to tide over such uncertainties in future. Atmanirbhar Bharat policy by Government of India has mentioned priority status for local radio-pharmaceutical production. Local manufacturing is expected to get a boost with increasing investments and public-private partnership (PPP) model. There is huge demand for local production of high-quality radionuclide generators, Iodine131, Lutetium, Yttrium therapies, and high-quality cold kits.   

Preparing for the future. Local production of medical equipment is a core area for Atmanirbhar Bharat program, considering a large market of such products. Currently, all major players have production units of CT, PET CT, SPECT CT scanners, and their components outside India. It is expected that in near future, these equipment will be completely or partially manufactured in India.

Increased COVID-19 testing. COVID-19 testing will become a norm in hospitals before procedures and surgeries. In near future, we see increased availability of rapid kits for COVID-19 testing before routine procedures like PET CT.

Remote-access for social distancing. Software will be sought for managing patient appointments, sending messages, remote reporting of scans, and remote access to scanner console, PACS, HIS etc. Alarms for social distancing may be a norm in the near future.

Specific requirements. There will be increasing demand for techniques for rapid disinfection of PET CT and SPECT CT scanner gantries, rooms and other patient areas in the department.

In the end, I would say that human race has converted such challenges into opportunities in the past. However, we have to be compassionate toward mother earth and be humble for all the blessings nature has showered upon us.

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