Nuclear Medicine is a relatively new specialty, we celebrated its 50th anniversary of its introduction in Bulgaria, but it is no older than 60-70 years worldwide – a relatively young and still not so much. Initially, isotopes were used in treating the thyroid gland, then the full range of diagnostic methods were developed”, explained Prof. Dr. Irena Kostadinova, PhD, a National Consultant in Nuclear Medicine, Head of the Department of Nuclear Medicine at the newly opened City Clinic Cancer Center.
This is a specialty dealing with diagnostic and therapeutic applications of traced compounds and radiopharmaceuticals – about 90 per cent of the activity is related to diagnosis, mainly of cancer.
The power of nuclear medicine lies in functional information, unlike other imaging methods such as X-ray. It can clearly show whether a body organ functions normally as well as determine whether its function has been impaired. Thus the effect of prescribed therapy can be assessed.
The advantage of Nuclear Medicine methods is it diagnoses diseases at an early functional stage – even before one can see structural changes in tissues or organs. These methods can provide an image of the entire body – thus showing the spread of the disease, such as metastases of primary tumors.
In addition, it examines many benign diseases showing the altered functions of various organs. For example, the heart – how much of adequate blood supply is provided to the heart muscle. Thus specialists can distinguish angina, a temporary disruption of blood flow to the myocardium, from a heart attack, a permanently damaged blood flow. This technology can save unnecessary coronary angiography, for example, for a patient with an ischemic heart disease.
Moreover, Nuclear Medicine methods study early changes in blood supply flow of the lungs. This is the only diagnosis to non-invasively (without any risk to the patient) and very objectively prove pulmonary embolism when symptoms are not typical. Further assessed functions: kidneys, thyroid gland, epilepsies. It assists the precise localization of breast cancer because mammography and ultrasound often fail to diagnose this type of cancer in women with dense breasts.
The great advantage of scintigraphy is the possibility of whole body scanning – in case of an already widespread cancer disease, it can show all affected areas. This, of course, is relevant to the selection of therapeutic approach.
Hybrid Diagnostic Imaging has evolved since 2000. It combines two imaging methods and has the fastest development worldwide. Most often it is a computed tomography (CT) combined in a single device and providing a scintigraphy image. Using scintigraphy one can achieve very early visualization of early functional changes in the body, while a CT can prove and locate the changes that have already occurred in the structure of organs. Combined, these two methods provide a very informative image not only in diagnosis, but it is crucial for the continued healing process of the patient. If they have only tumor and no metastases, then surgery is crucial. If one already has damage in adjacent or distant structures, therapeutic approaches may include radiotherapy and/or chemotherapy.
Although hybrid exams, such as the Positron Emission Tomography (PET), are expensive (the Health Insurance Fund covers it in Bulgaria; it costs BGN 2,000 – some EUR 1,100 – in other countries it may reach EUR 1,500), American studies show every patient undergoing a PET, is actually saving some USD 1,400 since they do not undergo unnecessary surgery or chemotherapy – besides being expensive, they bring trauma to the patients and often worsen their quality of life.
There are several centers in Bulgaria offering PET-CT scans. The first one was in Varna, the second one – at Alexandrovska Hospital in Sofia and now, at City Clinic Oncology Center – here we boast with the most technologically advanced device and but few countries have such equipment of latest generation.
The uniqueness of the device is it allows radioactivity injected into patients to be less than in other similar devices since it has very sensitive detectors, thus reducing their radiation load. On the other hand, it allows the exam to be conducted fast – it usually takes some 25 minutes, while the new high-tech equipment shortens the duration to 10 minutes, and this is a great benefit for our patients.
“We have signed agreements with the National Health Insurance Fund and we hope our patients shall not to wait for more than 20 days from their booking day to start their life-saving therapy. We are determined to do it. My whole service has passed in the most prestigious state hospital – the Alexandrovska. I have been Head of the Department of Nuclear Medicine, too, but what impresses me the most here are prompt actions, teamwork and excellent logistics. Combined with the professional experience of all physicians and medical staff, it shall surely benefit all our patients”, said Prof. Kostadinova.