. Country nameSri LankaConcept priority no. Name and contact details of project counterpart and counterpart institutionDr.Damayanthi Kusum Kumari Nanayakkara Head – Nuclear Medicine Unit Senior Lecturer in Nuclear Medicine Faculty of Medicine University of Peradeniya, PERADENIYATitleIntroduce hybrid imaging (SPECT/CT) application in cancer care and degenerative Brian disease in Sri Lanka Field of activity27 Nuclear Medicine Analysis of gaps /problems/needsGive an in-depth analysis of the major problems/needs to be addressed by the project, as well as of their causes and effects and explain how these are linked to national development plans or programmes and/or the Country Programme Framework (CPF). Refer to past efforts made in addressing these problems/needs, if any, and explain how the current project proposal builds upon them.Attach any supporting documents (e.g. texts of national development programmes). Sri Lanka has a population of just over 20 Million. Cancer incidence and degenerative brain disease in Sri Lanka are steadily on the rise. The countrys cancer incidence rate has doubled since the eighties and due to aging population, number of degenerative brain diseases is rising. The increase in cancer incidence was higher for females at 79 in 2006. However, the death rates from cancer were higher for males at 63.6 compared to 48.7 for females. Among women, breast cancer was the most prevalent at 27, followed by cervix uteri at 12. Among men, 42 of cancers occurred at lip, oral cavity, pharynx, trachea, bronchus, lungs and esophagus. Cancer, which is categorized as a Non-Communicable Disease (NCD) is responsible for nine percent of NCD deaths in Sri Lanka, despite the fact that breast, cervix and oral cancers are preventable and effectively curable when detected early. According to the World Health Organization (WHO), Sri Lanka ranks the highest in NCDs in Southeast Asia. Sri Lankas cancer trend is similar to that of Western countries, However, to some extent, early diagnostic facilities like molecular imaging are lacking hence the early detection and treatment is not possible for many cancer patients. It is evident that a large number of cancer deaths occurred due to late presentation and inadequate facilities for accurate diagnosis. Though the hybrid nuclear imaging provides better evaluation of the tumour anatomy with function, that facility is not yet available to patients in Srilanka. However, patients demand for cancer diagnosis and treatment far exceeds the available Nuclear Medicine facilities in the country. Nuclear Medicine facilities are extensively used in detection of cancers, staging and monitoring cancer treatment worldwide. Use of SPECT/CT is relatively low cost compared to the PET/CT and it improves the diagnosis accuracy. Furthermore this technology is widely used in the diagnosis of degenerative brain disease, coronary artery diseases and orthopaedic practice. . Absence of such advanced technology keeps a big gap with available facilities and patient care. However, the specific issues related to the established new technology were partially solved under previous IAEA technical corporation projects (SRL 6032 and SRL 6034) and the government support. Therefore the NMU of University of Peradeniya is now capable of practicing with modern Nuclear Medicine imaging facilities like in other countries. New duel head SPECT received from IAEA in 2014 is upgradable to SPECT/CT. Due to lack of finances it was delayed. However the infrastructure facilities have been developed to house the new system. If this is achievable it will help us to introduce hybrid imaging facilities to improve cancer diagnosis and follow up in Sri lanka. University of Peradeniya is the only institute in the country that has an established Nuclear Medicine unit which provides clinical service, teaching and research. We had the IAEA external audit (QUANUM) in 2016 and successfully implemented the international slandered in our clinical practice. Our aim is to promote this institute as a centre of excellence in Nuclear Medicine practice and to make it as a regional training centre. In order to achieve such status the Government of Sri Lanka (University of Peradeniya) provided funds to improve the infrastructure facilities as well as for the equipment under a cost sharing basis. If we could improve the existing facilities further we would be able to achieve our goal by the end of 2022. Previous IAEA Tc projects and RCA/RTC helped in manpower development to a certain extent. However, introduction of new equipment and practicing new procedures needs further training to understand the technology related to software as well as hardware use for better utilization of those facilities. Once this SPECT/CT is available for function we need expert support (EM) to disseminate the knowledge to end users (referring clinicians ), . Further upgrading will require few more adjustments in the present building to achieve adequate radiation protection for CT facilities. However space for CT component is already adjusted at the time of installation of the SPECT system. Stakeholder analysis and partnerships Describe the stakeholder analysis conducted, specifying all the interested or affected parties, end users, beneficiaries, sponsors and partners identified, with clearly defined roles for each entity. Main counterpart of this project is the Nuclear Medicine unit , Faculty of Medicine, University of Peradeniya. CPF has identified that Nuclear imaging facilities for Cancer detection, vascular diseases related to the brain, assessing renal diseases and cardiac functions need to be strengthened by means of improving technology and professional skill development. End users will be oncologists, neurologists, psychiatrists, cardiologists, nephrologists and all other referring clinicians for these investigations to enhance their patient care. Beneficiaries will be the patients who seek treatment from both government and private sector No identified sponsors. However, sustainability of the system is with the government support through the ministry of health and higher education which are responsible for health care services in the country. Overall objective (or developmental objective)State the objective to which the project will contribute, and demonstrate its linkage with a national or broader development programme or priority. It has to be in line with the problems/needs identified. IAEA has provided assistance to the University of Peradeniya to upgrade the facilities at the NMU since 2012. As a result new technology is applied and provides clinical services and teaching using those facilities. This unit provides continuous nuclear medicine services for both adult and children, male and female patients. Past regional projects on tumour imaging, good hospital radio pharmacy practice and safe use of radionuclide for cancer therapy, hybrid imaging, and cardiovascular imaging have increased the value of modern Nuclear Medicine practices in the field of Medicine and has provided several training opportunities for nuclear medicine physicians, oncologists, cardiologist and technologist in this country. This proves the importance of awareness among end users to use similar kinds of facilities in Sri Lanka for a better patient care. Under those projects, the benefits of new technology and facilities were emphasized. It also shows values of continuous professional education to obtain new knowledge in the management of patients in different fields. It also requires further professional development regarding new technologies by means of national workshops, fellowships, and SV and expert missionAnalysis of objectivesDraw up an objective tree to highlight the hierarchy of objectives as well as the causeeffect logic that this project is expected to achieve. Sri Lanka is far behind the world in applying NM imaging in clinical practice, This is mainly due to lack of trained and qualified NM physicians in Sri Lanka. Thus without professional training it is big challenge to uplift this special field of medicine compared to the neighbouring countries in this region . Professional training and Standardization of overall Nuclear Medicine practice in the country should be brought upto the international standards (imaging, therapy, teaching, research with international collaboration) All NM facilities should need to follow Quality management system verified through the QUANUM audit mission and the subsequent report. With the second QUANUM audit the Nuclear Medicine Unit of the University of Peradeniya will serve as the centre of excellence in Nuclear Medicine Practice in the country with international recognition. Role of nuclear technology and the IAEAIndicate the nuclear technique that would be used and outline why it is suitable for addressing the problems/needs in question. Is this the only available technique The future of management of non-communicable diseases is closely related with hybrid imaging and radionuclide therapy. Classical treatment and follow up for cancer is closely related to nuclear imaging and radionuclide therapy. Hybrid imaging is the new approach for accurate diagnosis and no other comparative technique available to obtain such information. Does it have a comparative advantage over non-nuclear techniques Yes, Single photon emission computed tomography (SPECT) with low dose CT is the best way of assess the function of the tumour especially after treatment. No other imaging modality could provide such information at molecular level. SPECT/CT has been shown to improve lesion detection compared to two-dimensional planar imaging by removing out of plane information and thus increasing image contrast. However, functional images often lack the anatomic detail necessary for accurate lesion localization, which can decrease reader confidence in image interpretation. Hybrid SPECT/CT has added clinical value over SPECT imaging alone primarily due to more precise anatomical lesion localization. What specific role is the IAEA expected to play in the project Advantages of the using hybrid imaging in cancer management and diagnosis of degenerative brain diseases like parkinsonism, Alzimers disease have been highlighted by several regional and inter-regional IAEA projects through Coordinated Research Projects, involving some of the RCA Member States. It emphasised and identified cost-reduction strategies and published several books indicating how to establish a good Nuclear Medicine practice, and opportunities for NM physicians to learn about the application, reading and improving reporting skills The expected roles of the IAEA to apply this nuclear technology related to this proposal are 1. To provide experts in those areas to conduct national awareness programmes, training programmes for NM professionals who are involved in the delivery of NM and Radioisotope Therapy services in country. 2 To provide scientific visits / fellowships for NM professionals to learn more about these applications especially for reading, interpretation and reporting 3. To provide scientific visits / fellowships for NM technologist to learn more about this software application with hands on training, solving minor hardware problems related to SPECT/CT and computer system, new studies acquisition and data analysis. 4. Provide funds to upgrade the existing SPECT camera to SPECT / CT and installation, onsite training Safety and regulatory infrastructureIndicate whether or not the safety infrastructure and associated standards and procedures at the institutional level are adequate to ensure that the project will be implemented in a safe manner. If not, specify the gaps and indicate how they will be addressed This unit has established under the SLAEB rules and regulations. There are adequate infrastructure and radiation safety facilities available for current practice. If this projects approved this institute will be able to find additional funds to have safe working environment with CT . Project durationIndicate a realistic starting date (bearing in mind that projects cannot start until minimum National Participation Costs (NPCs) have been paid) and the number of years required to complete the project. (In the case of projects expected to exceed four years, an assessment will be conducted before the end of the fourth year to decide on the validity of an additional year.) two years (2)Funding and project budgetProvide an estimate of the total project costs and the funding expected from each stakeholderEuroCommentGovernment cost-sharing 00 (to be sent to the IAEA)Counterpart institution(s) for infrastructure 30000.00Other partnersWho-IAEA Technical Cooperation Fund (TCF)Fellowships / Scientific visits / Training courses / Workshops10000.00Experts80000.00Equipment200000.00TOTAL248000.00 ___________________________________________________________________________ ___________________________________________________________________________ Page PAGE 4 DOCPROPERTY IaeaClassification MERGEFORMAT DOCPROPERTY IaeaClassification2 MERGEFORMAT Page PAGE 5 DOCPROPERTY IaeaClassification MERGEFORMAT DOCPROPERTY IaeaClassification2 MERGEFORMAT DOCPROPERTY IaeaClassification MERGEFORMAT DOCPROPERTY IaeaClassification2 MERGEFORMAT DOCPROPERTY IaeaClassification MERGEFORMAT DOCPROPERTY IaeaClassification2 MERGEFORMAT vv vv vv vv vv vv Y, 4IsNXp
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