My Vision for 2025

Nuclear Medicine or Molecular Imaging (MI) is a unique modality, which reveals functional images on internal administration of small (tracer amounts) of radioisotopes. With a history of more than 80 years since its inception in medical science, this speciality has seen rapid progress. Nuclear Medicine imaging in India has come a long way from the earlier rectilinear scanning to the present day hybrid imaging of metabolic PET and structural CT or MR imaging.

The emerging trends in positron imaging based on published data have created a noticeable paradigm shift in cancer management as a result of the early diagnosis, accurate staging, and treatment response evaluation resulting in substantial cost cutting by avoidance of unjustified surgeries and toxic-chemotherapies. The availability of wide range of newer biomolecules produced in compact self-shielded medical cyclotrons and easy to use portable PET generators has enabled targeted imaging resulting in the diagnosis of cancer at the time of metabolic dysregulations in the cells that usually predate the anatomical changes, a hallmark of advanced cancer. These developments though exciting are equally challenging for the healthcare providers. Creating PET-CT facilities that are accessible and affordable to resource poor and remote populations requires the highest level of national commitment and a dedicated team of professionals who can oversee the project from conception to commissioning.

Cancer is an important health problem in India with approximately one million new cases occurring every year. GLOBCAN has predicted that the cancer incidence in India will almost double in next 20 years from nearly a million new cases in 2012 to more than 1.7 million new cases by 2035. The number of cancer deaths is also expected to rise from 0.68 million to 1.2 million in the same time period. A meager 1.5 percent of GDP expenditure on healthcare in India is unlikely to reduce cancer mortality in the next decade. The estimated projected incidence of cancer is 1.5 million cases in 2025. At an average of 15 PET-CT scans on one scanner and 300 working days in a year, India needs 1000 PET-CT systems for the 2025, for 100 percent incidence indication. Considering the existing wide gaps between the rural and urban population in healthcare delivery system, the healthcare planners have to ensure a homogenous nation-wide distribution of PET-CT facilities. PET-CT facility needs to be integrated into the National Cancer Control Programme in the first phase and later extended to other need-based remote areas.

The existing situation of cancer care in India compounded by disturbing issues of economical disparities, social inequalities, and geographical disadvantages will continue to be a major challenge in the health-care delivery system of the country even in the next decade. India it still has one of the highest age-related, cancer-related mortalities which is likely to cross 1.2 million in the year 2025.

In the field of cancer imaging, PET-CT has seen a great breakthrough with greater accuracy and enhanced resolution. In future, the advancements in technology and availability of new PET tracers for more tumors, particularly those showing poor FDG avidity will open newer vistas in PET-CT imaging for cancer care.

Over the years, other theranostic radiotracers became available indigenously from the Bhabha Atomic Research Centre (BARC) in the country. Currently Lu-177 is produced in India and peptides like DOTATATE and PSMA are available in a kit form indigenously. At the present time, the radionuclide therapies of oncological disorders which are being performed in India are mainly for neuroendocrine tumors (NET) and metastatic castration resistant prostate cancer (mCRPC). The main constraints pertaining to this concept is the cost of treatment and awareness among the clinicians. The theranostic concept has become popular over the years and has the potential for sustained growth.