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Nuclear Medicine in Jordan Therapeutic Radiopharmaceuticals 19-23 October 2009 Manila, Philippines

Nuclear Medicine Facilities in Jordan. There are 8 hospital-based nuclear medicine labs.There are 3 private nuclear medicine clinics.Most of them have single and/or dual head gamma cameras.There are 3 PET/CT scanners.There are two coincidence gamma cameras for PET acquisition.There is one baby

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Nuclear Medicine in Jordan Therapeutic Radiopharmaceuticals 19-23 October 2009 Manila, Philippines

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    1. Nuclear Medicine in Jordan Therapeutic Radiopharmaceuticals 19-23 October 2009 Manila, Philippines Kusai Al-Muqbel, MD American Board in Nuclear Medicine Assistant Professor-Jordan University of Science and Technology

    2. Nuclear Medicine Facilities in Jordan There are 8 hospital-based nuclear medicine labs. There are 3 private nuclear medicine clinics. Most of them have single and/or dual head gamma cameras. There are 3 PET/CT scanners. There are two coincidence gamma cameras for PET acquisition. There is one baby cyclotron

    3. Radiopharmaceutical Manufacturing in Jordan F18-FDG is the only radiopharmaceutical manufactured in Jordan. One baby cyclotron is available in military medical services in Amman.

    4. Imported Radiopharmaceuticals Tc-99m Generators Cold pharmaceutical kits Ready SPECT radiopharmaceuticals Therapeutic radiopharmaceuticls

    5. Radiopharmacy QC equipment Status in Jordan They are not available in hospital hot labs (radiopharmacy). They are not required by local licensing body for initial and renewal licensing of hot labs. Licensing body in Jordan is “Jordan Atomic Energy Commission”.

    6. Radiopharmacy QC in Jordan No QC procedures are being performed since they are not required by local atomic energy commission licensing.

    7. Therapeutic Radiopharmaceutical Activity in Jordan Ablation of thyroid gland in hyperthyroidism with I131 Ablation of remnant thyroid tissue in thyroid cancer with I131 Treatment of metastatic thyroid cancer with I131 Bone pain treatment with radiopharmaceuticals (Sm153, Re186, P32).

    8. Source of Therapeutic radionuclides Imported from outside (Syria, Turkey, Poland, Hungary and UK)

    9. I131 It is administered as an out patient for doses of 30 mCi and less. It is administered as an inpatient for doses > 30 mCi. Documentation of the process is according to hospital policy and JAEC regulations. Radiation protection instructions are implemented.

    10. Bone pain Treatment Limited cases (10-15 cases per year). Confined to cancer patients with bone metastatic disease associated with bone pain. Radiopharmaceuticals used are P32, Sm157 or Re186.

    11. Limitations Oncologists are still in doubt about the benefits of these radiopharmaceuticals in cancer patients. The high price of those radiopharmaceuticals is a major problem for its utilization in clinical practice.

    12. Limitations Non-availability of these radiopharmaceuticals on spot is another problem (days and weeks are needed for the dose to reach the patient). Patient fears and concerns about the NUCLEAR MEDICINE ????!!!!!

    13. What we need Cheaper products Trials supported by research grants to involve as many patients as possible. Direct involvement of oncologists and other clinicians in such procedures (for cancer and non-cancer cases).

    14. What we need Continuous nuclear physician training on the clinical indications of such radiopharmaceuticals. Patient education on the safety of nuclear medicine products and applications.

    15. RAS 2013: Good Radiopharmacy Practice and good Manufacturing Practice Jordan participated in “meeting on the Future Direction and Work Planning for Implementation Good Radiopharmacy Practices and GMP” 4/2007 China.

    16. Achievements Re-arrangement of our hot lab Better documentation of all processes involved in hot lab while reconstituting cold kits and dispensing radiopharmaceuticals. Writing the hospital policies dealing with radioactive materials in a way compatible with JCIA. Staff education on the policies.

    17. Achievements One physicist was sponsored for advanced education on medical physics to improve the hot lab performance. On going plan to upgrade our hot lab equipments including daily QC equipments.

    18. Recommendations from practicing nuclear Physician The governments should be involved more in improving the quality of Radiopharmacy practice in the member states.

    19. Suggestions from practicing nuclear Physician Trained pharmacist is available in local atomic energy commission. Hot lab QC equipments should be part of licensing Trained pharmacist or equivalent person is in charge for the hot lab. The hot lab QC records should be checked before license renewal.

    20. Country survey (Jordan) List the most common (at least the top 3) therapeutic procedures being done in your institution/country.  ANS:  # 1-Thyroid ablation (hyperthyroidism and thyroid cancer remnant/mets)________________________ # 2 - Bone pain treatment with radionuclides # 3 ___________________________ 1.1.      What radiopharmaceutical agents are being used most commonly?  ANS:  (for Procedure # 1) Radioactive iodine I131 (for Procedure # 2)Radioactive Phosphorus (P32), Radioactive rhenium Re186   (for Procedure # 3) _ _______________________ 1.2.      What is the estimated number of cases done/year? ANS: (for Procedure # 1) __500-1000 for the whole country (for Procedure # 2) ___10______________________ (for Procedure # 3) _________________________

    21. Survey 2. What is the source of these therapeutic radiopharmaceuticals?  (Please check Yes/No) 2.1. Produced within the country.   YES? _____   NO? _x____ 2.1.1.   If produced within the country, what are the processes involved in the manufacture; Q/A, Q/C, etc? ANS:  _____________________________________________ 2.2.     Imported from other countries.  YES? __x___  NO? _____ 2.2.1.     If imported, from which country/ies?  ANS: Syria, Turkey, Holland, Poland________________________________ 2.2.2.      If imported and comes as finished product, what interventions are still needed? ANS: training on dispensing QC (radiopharmacy)

    22. Survey 3. What are the costs per therapeutic procedure (in US$) in your country? ANS:  (Procedure #1)  US$_400-1000 (Procedure #2) US$_2000-3000 (Procedure #3) US$______________ 4.  What training is provided to the personnel currently doing/assisting in the therapy? ANS: clinical indications, radiation protection, preparation for dose administration, training on dose administration, inpatient monitoring. 5.     Are there governmental or institutional requirements which constrain the use of therapeutic radiopharmaceuticals (e.g. stringent regulations, approval delays, reporting, etc)? Please elaborate. ANS:  Radiation protection regulations by the government            Clinical indications by institutions 6. What therapeutic procedure/s do you think should be made available in your country?  Why is it / are they not available? ANS: Yttrium-90(90Y) ibritumomab tiuxetan (ZevalinR) It is not available because of its cost

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