Keywords
International Atomic Energy Agency - Jamaica - nuclear medicine - radiopharmaceuticals
- trends
Introduction
Nuclear Medicine (NM) is an essential technology of medicine globally in the management
of both communicable and noncommunicable diseases. Evaluated trends have indicated
growth in both diagnostic and therapeutic applications across different regions.[1],[2] In spite of this growth, there exists variations in the provision of NM services
across territories due to differences in factors such as qualified personnel, instrumentation,
radiopharmaceuticals,[1] and financial resources. For example, Canada, in 2017, recorded 330 single-photon
emission computed tomography (SPECT), 261 SPECT/computed tomography (SPECT/CT), and
51 positron emission tomography/CT (PET/CT) units,[3] averaging 17.6/million people, while reports obtained up to April 2016 from Member
States of the International Atomic Energy Agency (IAEA) for Latin America and the
Caribbean have documented that the region possesses a total of 1348 gamma cameras,
averaging 2.25/million inhabitants.[4] With a population of approximately 2.8 million, Jamaica currently has two SPECT
and one PET units available at private institutions.
As a Member State of the IAEA, Jamaica has been a participant of a number of national
and regional projects aimed at developing nuclear technologies. The IAEA Technical
Cooperation Project JAM6012 geared at re-establishing NM capacity in the public health
system in Jamaica,[5] has resulted in the training of a NM physician, a technologist, a physicist, and
a radiopharmacist. The project will boost NM services with the addition of a SPECT/CT
gamma camera at the University Hospital of the West Indies (UHWI), which is the largest
hospital in Jamaica and the largest teaching hospital in the region.
This partnership between Jamaica and the IAEA is geared at increasing access to NM
technology for all citizens of the country. While private institutions require full
payment from all patients for services rendered, the offering of NM services by the
UHWI will facilitate a reduction in out-of-pocket expense for patients, and therefore
increase the availability of the technology to a larger proportion of individuals.
This is in keeping with the strategy for universal access to health and universal
health coverage, which Jamaica adopted from the World Health Organization in 2014.[6]
In an assessment of the IAEA initiative to advance NM, Dondi et al. stated that the
process should be guided by trends that match individual country needs.[1] This study sought to evaluate the types and frequencies of NM studies that were
carried out at a privately-run NM facility in Kingston, Jamaica. It is intended to
be used in assessing the diagnostic needs of the Jamaican population, as well as highlight
the prevalence of diseases that require NM technologies for their management. Previous
studies have not been done among this population, therefore the researchers sought
to gather data which may prove to be useful for the growth of NM practice in Jamaica.
Methods
This study was a nonexperimental, retrospective study, aimed at establishing the types
and frequencies of NM procedures that were carried out at a privately-run NM facility
in Kingston, Jamaica. It involved an assessment of the records of all NM patients
who received a radiopharmaceutical during January 1, 2017 to December 31, 2018. It
caters to a maximum of 15 NM patients each day. NM diagnostic procedures that are
offered at the facility include bone, lung, thyroid, parathyroid, renal as well as
gastrointestinal scans. Patients with cancer of the thyroid may also receive NM therapy.
The data extracted included age, gender, radiopharmaceutical administered, indication
for study, and impression from scan. Information gathered from the files of patients
was assessed with the assistance of a consultant radiologist. Ethical approval was
sought and granted from the University of the West Indies Mona Campus Ethics Committee
prior to the commencement of the study (ECP 201, 18/19). All methods and procedures
were performed in accordance with the guidelines and regulations of the committee.
Statistical analysis was performed with the Statistical Package for IBM SPSS Statistics
software (version 22), Armonk, New York, United States and Microsoft Excel 2013. Results
have been expressed as means, medians, or inter-quartile ranges or percentage frequencies
as appropriate.
Results
The total number of NM scans that were carried out at the facility for the period
of January 2017 to December 2018 was 3756. Of this number, 1889 (50.3%) were male
and 1866 (49.7%) were female, with the age ranging from 3 months to 100 years. Of
the 3756 patients, the indications of 2186 patients were documented in their files,
while the age of 23 patients was not recorded. The most frequent indications were
breast, prostate, colon, and cervical cancers for bone scans, urinary tract infection
and hydronephrosis for renal scans, and Graves' disease, hyperthyroidism, and thyrotoxicosis
for thyroid scans [[Table 1]].
Table 1 Most frequently presenting indications for nuclear medicine procedures
Bone scans (2116, 56.3%) accounted for the majority of scans conducted over the study
period, while 867 (23.1%) renal, 307 (8.2%) thyroid, and 254 (6.8%) lung scans were
done. The most frequently used radiopharmaceutical was 99mTc-MDP (2116, 56.3%) for bone scintigraphy. 99mTc-Glucoheptonate (753, 20%) was the radiopharmaceutical of choice for renal scans,
99mTc-Pertechnetate (333, 8.9%) for thyroid and gastrointestinal procedures, and 99mTc-MAA (254, 6.8%) was utilized for lung scans [Figure 1].
Figure 1 Types and frequencies of nuclear medicine procedures and the radiopharmaceuticals
utilized
Patients aged 60 years and over accounted for the majority of the bone scans (1353
of 2116). The age group 26–59 years accounted for most of the scans of the lung (123
of 254), thyroid (209 of 307), parathyroid (34 of 65), and whole body (26 of 34).
Patients under 12 years accounted for the majority of the renal (596 of 867), gastrointestinal
(22 of 26), and hepatobiliary (16 of 28) scans [Figure 2].
Figure 2 Age distribution of patients based on the type of scan
Fifty patients (1.3%) with age ranging from 18 to 71 years, received 131I-sodium iodide
for therapeutic applications.
Discussion
This is the first study to report on the demand for NM technology services in Jamaica.
The primary indications for NM services over the 2 years were found to be related
to bone, renal, thyroid, lung, and parathyroid scans. These findings are consistent
with the IAEA reports from both developing and developed countries.[1],[7]
Most of the bone scans were requested for patients diagnosed with prostate and breast
cancer. These are the leading sites of cancers in Jamaica for males and females,[8],[9] and accounted for 2012 mortality rates of 33% in males and 20% in females.[10] The assessment of bone metastases, a prevalent form of metastases among these patients,
is a crucial component of breast and prostate cancer management.[11],[12],[13],[14] Emphasis should, therefore, be given to advancing the utilization of NM in Jamaica
as a tool for the early detection and management of patients with bone metastases
from these cancers.
Renal scans were the highest for the pediatric population. In pediatric NM units,
nephro-urology scans make up the majority of studies conducted[15] as it is used for the detection of both structural and functional abnormalities,
and for the determination of glomerular filtration rates in this category of patients.[16] Studies have demonstrated a rise in the incidence of chronic renal failure (from
3.2 to 7.83/million) among the Jamaican pediatric population over the 28-year period
1995–2012,[17],[18],[19] and with global trends of pediatric patients presenting with febrile urinary tract
infection,[20] early detection of kidney involvement is of importance.
The audit of the single private NM facility reflects the documented demand of the
IAEA database for Latin America and the Caribbean.[1] However, the findings are limited, as the IAEA database also documented a demand
for cardiovascular and brain NM procedures in these countries, which are not services
offered at the selected private institution.
This investigation provides an assessment of the NM services at a facility in Jamaica
and demonstrates the need for continuity of this specialized service in our population.
The data provided may serve to guide future involvements with the IAEA in its role
to provide support for countries which aim to address health needs through the peaceful
applications of nuclear technologies.
