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Nuclear Medicine



Introduction

The Department of Nuclear Medicine at NTUH is committed to improve health care through radioisotope-based technology in disease management and research, including but not limited in detecting and staging tumors, identifying neurological and cardiac diseases, treating thyroid abnormalities, etc.

Clinical Services
1.Diagnostic Test
-Cardiac perfusion scans
-Bone scans
-Thyroid scans
-Cardiac function scans
-Infection and inflammation scans
-PET/CT scans for cancer detection
-all other functional imaging studies.
2.Treatments
-Radioactive iodine for hyperthyroidism and cancer
-Bone pain palliation in cancer patients
-Lymphoma
3.Radioimmunoassay(RIA)
-Thyroid function tests:T3, T4, TSH, Free T4
-Tumor markers:CEA, CA199, TPA
-Endocrine function tests:Prolactin
-Others:AchRAb, GAD-AB, IA2

The National Taiwan University Hospital PET Center
By Kai-Yuan Tzen, M.D., Sc.M.

Positron Emission Tomography, known as PET scan, is one of the most innovative technology in medicine today.  It is one of the most important tools in clinical application, clinical research and also basic medical research.  Thus it is a must that a modern nuclear medicine department should have to get into the field of Molecular Medicine and Molecular Imaging.

PET scan uses the radiopharmaceuticals produced from a medical cyclotron.  These radiopharmaceuticals are short in their half-lives.  These radiopharmaceuticals can demonstrate various metabolic reaction, receptor distribution and also the action of the pharmaceutical agents.  Under these circumstances, PET can be used for the diagnosis of the diseases of the central nervous system (such as epilepsy, Alzheimer’s disease, Parkinson’s disease), cardiovascular system (such as myocardial viability), and diagnosis, staging, restaging, treatment planning and follow up of malignant diseases (lung cancer, colorectal cancer, esophageal cancer, head and neck cancer, lymphoma, melanoma, breast cancer, thyroid cancer and cervical cancer).  The most common radionuclides used for PET scans include: F-18 (half-life of 109.74 minutes), C-11 (half-life of 20.35 minutes), N-13 (half-life of 9.96 minutes) and O-15 (half-life of 2.04 minutes).  In order to use these radionuclides or radiopharmaceuticals labelled with these radionuclides (with the exception of F-18), a nuclear medicine department should be equipped with a cyclotron so that these agents can be developed and produced nearby.

The NTUH PET Studies 1995-2004
The Center for PET of the National Taiwan University Hospital is located in the B1 level of the East Building.  The total area of the PET Center occupies 1000 m2 and equipped with two PET scanners and one cyclotron with full radiopharmaceutical facilities.

A GE Advance NXi PET scanner was installed in July 1995.  This is the second PET scanner in Taiwan. The system was upgraded with new software and some new hardware during the end of year 2002 and the beginning of 2003.

In the beginning, no cyclotron was planned in the setting up of our PET center. Before year 2001, the required F-18 FDG was supplied by NPCC (National PET and Cyclotron Center) localized in Taipei Veterans General Hospital for research use.  After year 2001, FDG was possible to purchase from INER (Institute of Nuclear Energy Research) for clinical application. The research work in the NTUH was quite limited due to the availability of FDG. Thirty-one research articles using FDG relating to Parkinson’s disease, nasopharyngeal cancer and ovarian cancer have been published in well known medical journals from 1998 to 2004.

A GE Discovery ST-16 PET scanner was installed in July 2004.  This was the 6th PET/CT scanner in Taiwan and the first one with 16 slice spiral CT scanner.  This system generates high quality PET and CT images of a patient in a single study.  Two image data sets can be fused to show both the functional abnormalities and their anatomical location.  The overall scanning time is shortened.  With the aid of attenuation correction by CT mapping, the overall image quality of the PET scan is much improved. The localization of PET abnormalities is more precise.

In year 2005, we performed 1324 PET scans, and in year 2006, 2047.  The national insurance policy affects the PET study trend. More and more PET scans were ordered for the purpose of studying diseases.

The NTUH PET Center 2005-
Ever since 1998 the HCFA of the United States passed the reimbursement of PET scan on lung cancer, there were 8 other cancers get insurance coverage thereafter.  Besides, more and more neurological and cardiac application got reimbursed.  Increasing interests in PET research and application thus caused the booming of PET scanner installation and even cyclotron installation in Taiwan.  In addition to NPCC, there are 8 other medical centers already equipped with cyclotrons in their hospitals.  Recently, the progress in proteomics and genomics bring the unlimited development in the field of molecular medicine, molecular imaging and even nanomedicine.

Thus under the prospective planning for the cyclotron facilities under previous Superintendent Lee and Lin, a budget for setting up a medical cyclotron was supported by the Hospital.  Beginning December 2003, under the leading of then Vice Superintendent Chen, the team of nuclear medicine with Department Director KY Tzen took the full responsibility of purchasing the system. After vigorous open bidding, the Hospital signed contract with GE Health Care for installation of a GE PETtrace cyclotron with self shielding and the full spectrum of laboratory facilities including 8 automatic chemical synthesizers in 7 hot cells, two isolators with autodispensors and other QA/QC equipments on August 12, 2004.  The installation plan was approved by the Atomic Energy Committee on January 27, 2005.  The installation was completed and tested starting May 4.  On July 8, the site was issued with the license for operation of the cyclotron by the Atomic Energy Committee.  We had a grand opening on October 3, 2005.  The pharmaceutical and chemical laboratory were in the environment of class 100,000 cleanroom, while the isolators were in the environment of class 10,000 with their inside of class 100 for the dispensing of radiopharmaceuticals.  On December 16, 2005 we passed the cGMP inspection by the Department of Health.

The team members include one director, three nuclear medicine physicians, one cyclotron operator, two radiochemists, one radiopharmacist, one radio-safety officer, two PET scan technologists and a consultant.  After comprehensive training and practice of our team members, the radiopharmaceutical (FDG) was first available for the first volunteer study on July 21, 2005.  Ever since then this Hospital started using the radiopharmaceuticals produced by herself. Our medical cyclotron and related facilities became the distribution center of 4 other hospitals since January, 2006. In addition to FDG, we started producing FDOPA in October, 2005 for the study of Parkinson’s disease, N-13 ammonia in September, 2006 for myocardial perfusion study and FLT in March, 2007 for the study of malignant diseases.

In July 2007, we installed our animal PET/CT scanner (GE eXplore Vista DR) for molecular imaging researches in animal models of diseases. This research facility was open for service on November 23, 2007. A workshop was given thereafter on December 20, 2007.

In May 2008, we start producing F-18 labeled choline for oncology research. In Novemeber 2009, we produced F-18 fallypride for dopamine D2 receptor imaging for neurology research. We planned to produce more PET radiopharmaceuticals for basic and clinical research and we expected that we will be one of the best PET Centers in Taiwan, or Asia.