Nuclear Diplomacy: Three instances L V Krishnan, NIAS RIS, April 22 - - PowerPoint PPT Presentation

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Nuclear Diplomacy: Three instances L V Krishnan, NIAS RIS, April 22 - - PowerPoint PPT Presentation

Nuclear Diplomacy: Three instances L V Krishnan, NIAS RIS, April 22 2019 1 First Edition: 1956 D S Kothari (Two years before the US AEC published Effects of Nuclear Weapons including hydrogen bombs.) Soon translated into German,


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Nuclear Diplomacy: Three instances

L V Krishnan, NIAS RIS, April 22 2019

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First Edition: 1956

(Two years before the US AEC published “Effects of Nuclear Weapons” including hydrogen bombs.) Soon translated into German, Russian and Japanese.

D S Kothari

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  • Dec 2015

BAEC signed a contract with Russian firm ASE in for building the two 1200 MW VVERs at Rooppur.

  • April 2017 India and Bangladesh signed NCA
  • General agreement with DAE on Peaceful uses of Nuclear Energy
  • Between the Regulatory bodies of the two countries on Exchange
  • f Technical Information and Co-operation in the Regulation of

Nuclear Safety and Radiation Protection

  • Between Global Centre for Nuclear Energy Partnership (GCNEP)
  • f India and BAEC on Cooperation for training staff for NPPs and

consultancy services

  • Mar 2018

Trilateral between Russia, Bangladesh and India on the construction of two Russian reactors in Bangladesh. Indian Firms can bid for construction, installation and supply of materials. HCC has landed a civil contract for Turbine Bldg.

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GCNEP announcement by Indian PM at the Nuclear Security Summit 2010 2017 Agreement with Bangladesh provides for GCNEP assistance in

  • evaluation of Tech documents;
  • review of safety reports;
  • evaluation of suppliers and eqpt;
  • inspection of eqpt;
  • supervision of construction and commissioning;
  • establishment of radiation monitoring,

environmental monitoring and emergency management system;

  • formulation of physical and information security
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Every 2 seconds someone aged 30 to 70 years dies prematurely from noncommunicable diseases

  • cardiovascular disease,
  • chronic respiratory

disease,

  • diabetes or
  • cancer.

Nuclear Medicine Applications Heart Disease (primarily diagnosis) Cancer (Diagnosis, Therapy & Progress assessment) Brain related (Diagnosis – track blood flow, sugar use) Cerebrovascular disease Neurological disorder (Alzheimer, Epilepsy) Endocrine Disorder: Thyroid (Diagnosis & Therapy) Complex conditions Heart disease and Diabetes Cancer and TB

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  • World Medical tourists to all countries in 2017:

14-16 million

  • Americans alone

> 1.4 million

  • Top destinations (alphabetical order):

Cost Rica, India, Malaysia, Mexico, Singapore, S Korea, Taiwan, Thailand, Turkey

  • American medical tourists most likely to go to

South America, Central America, and the Caribbean JCI-accredited (Joint Commission International) hospitals in India >38 Savings from treatment in India compared to US costs while providing quality care 65-90%

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Cancer

Incidence (per lakh) Mortality rate (per lakh) India 99 68 Bangladesh 125 96 Nepal 142 106 Kenya 132 110 S Africa 202 141

Coronary heart disease

Incidence (per lakh) India 146 Uzbekistan 325 Afghanistan 263 Sudan 227 Nepal 158

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The Techniques Computerised Tomography (CT) Single Photon Emission CT (SPECT) Positron Emission Tomography (PET) Nuclear Magnetic Resonance Imaging, MRI Radioisotopes emitting α, β, γ radiation Diagnosis through Imaging

  • Detection of structural abnormality

X-rays / CT Scan

  • Detection of functional abnormality

Injection of radioisotope tracers and use of Gamma Camera

  • Combination of A & B

PET/CT; SPECT/CT with and without MRI

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Therapeutic Techniques in Nuclear Medicine Radiation Therapy (destruction of diseased tissue)

  • Teletherapy
  • External sealed Source (beta/gamma radiation)
  • Radioisotope or Particle Accelerator
  • Brachytherapy (Sealed Source embedded in the body)
  • Radioisotope injection (mainly for thyroid disease)

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Bhabhatron Teletherapy Cobalt Units supplied by India 2010 Vietnam 2010 Srilanka 2015 Mongolia 2016 Kyrgyzstan 2017 Kenya 2018 Madagascar 2018 Nepal 2019 Malawi

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Indian Nuclear Medicine Scene Nuclear medicine departments 293 (86% in Pvt sector) Gamma cameras (SPECT) 163 PET-CT 222 SPECT-CT 70 PET-MRI 3 Medical Cyclotrons 19 Radionuclide Therapy (isolation wards) 92 (200 beds) Myocardial perfusion centers 250 Teaching Hospitals for MD/DNB in NM 18 (50 admitted/year) Admissions in Bachelors/Masters level 120

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  • Society of Nuclear Medicine, SNMI - Estd 1967; 1425 Members

Publishes the Indian Journal of Nuclear Medicine since 1985.

  • Association of Nuclear Medicine Physicians of India, ANMPI - Estd 2003:

248 members.

  • Nuclear Cardiological Society of India (NCSI) - Est 1996
  • Association of Medical Physicists of India, AMPI

800 Members (physicists, radiation oncologists, radiologists & engineers) Publishes the Journal of Medical Physics. An Affiliate of the Indian National Science Academy.

  • Indian Journal of Radiology and Imaging publication in 1947

A large number of Indian professionals hold senior positions in the US

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Thank You for Your Patience

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UN sustainable Development Goal 3 Every 2 seconds someone aged 30 to 70 years dies prematurely from noncommunicable diseases

  • cardiovascular disease,
  • chronic respiratory disease,
  • diabetes or
  • cancer.

By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being

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The Techniques Computerised Tomography (CT) Single Photon Emission CT (SPECT) Positron Emission Tomography (PET) Nuclear Magnetic Resonance Imaging, MRI Radioisotopes emitting α, β, γ radiation

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Diagnosis through Imaging

  • Detection of structural abnormality

X-rays / CT Scan

  • Detection of functional abnormality

Injection of radioisotope tracers and use of Gamma Camera

  • Combination of A & B

PET/CT; SPECT/CT with and without MRI

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Nuclear Medicine Applications

  • Heart Disease (primarily diagnosis)
  • Cancer (Diagnosis, Therapy & Progress assessment)
  • Brain related (Diagnosis – tracking blood flow, sugar use)

Cerebrovascular disease Neurological disorder (Alzheimer, Epilepsy)

  • Endocrine Disorder, mainly Thyroid (Diagnosis & Therapy)
  • Complex conditions

Heart disease and Diabetes Cancer and TB

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“Towards health diplomacy: emerging trends in India’s South-South health cooperation” A Chapter in India’s Approach to Development Cooperation Sachin Chaturvedi and Anthea Mulakala (eds.) Routledge Contemporary South Asia Series. NY India’s Development Cooperation

  • sustainable and inclusive
  • based on India’s own developmental experience
  • without conditionalities
  • demand driven
  • based on mutual gains
  • contributing to India’s soft power

Assistance in Nuclear Medicine meets all

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whether refurbished, used, or new, PET systems, are more expensive than SPECT systems in terms of purchase price, ongoing repair, maintenance, and upkeep. Besides camera costs, operational and consumables costs are also higher than SPECT. Radiotracers (Rb-82 or N-13) requires costly, long-term contracts to be committed to before the first scan is provided. Usage depends on reimbursement facility available. 15-25% of MPI studies may benefit if performed as PET MPI

https://www.digirad.com/how-to-know-if-cardiac-pet-makes-sense-for-your-practice/

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Cardiac Systems $55,000 - $70,000 Siemens C.Cam Philips CardioMD GE Myosight GE MPR $95,000 - $125,000 GE Ventri Digirad Cardius 2 SPECT/CT Systems. $120,000 - $200,000 Siemens Symbia T2, T6, T16 $95,000 - $115,000 GE Infinia Hawkeye General Purpose Systems $60,000 - $95,000 GE Millennium MG Siemens E.Cam Siemens Symbia E Philips Brightview GE Infinia $95,000 - $130,000 Siemens Symbia S Equipment Costs

https://info.blockimaging.com/nuclear-camera-price-cost-guide

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AIIMS Data 2014-15

  • 200 sq m area housing one cyclotron, one chemistry module

with 2 PET/CT scanners for diagnosis;

  • 6,785 scan in the period of one year; ave 30 per day; mostly

FDG;

  • Total estimated annualized cost
  • PET/CT scan facility equipment Rs 49,194,701

$768,667 Inclusive of bldg, eqpt, furniture, HVAC $776,619

  • perating cost:

$243,875

  • Unit cost of PET/ CT was calculated to be INR 9,625.22 ($150)
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Needed: Interdisciplinary or interinstitutional collaboration. For example, Bangalore: In Can Indian Institute of Science, DRDO Labs, medical schools, IIMB and hospitals in private sector collaborate to set up a ‘research park’ and facilitate multi-institutional research and training programs Dr Satyanarayan Hegde, Medical Director, University of Chicago https://indiamedtoday.com/india-can-leapfrog-into-the-next-stage-of- healthcare-technology-revolution/

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Potential areas where India has the capability Nuclear Techniques Nuclear medicine Medical tourism Cancer diagnosis and therapy Radiation processing Minimise agricultural product losses Manufacture of products Nuclear power Safety analysis / emergency preparedness Environmental monitoring ESL in Rooppur, Bd Pharma S&T STEM education Social sciences

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Nuclear Medicine – Teamwork of NM Technologist, Medical Physicist & Physician

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Telemedicine prospects Capacity building Technology transfer Training and scholarships Development Partnership Assistance

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India’s Development Cooperation

  • sustainable and inclusive
  • based on India’s own developmental experience
  • without conditionalities
  • demand driven
  • based on mutual gains
  • contributing to India’s soft power

Assistance in Nuclear Medicine meets all

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Medical tourist arrivals in India 1.07 million in Jan 2018 (https://www.indiaservices.in/medical/) JCI-accredited (Joint Commission International) >38 in India Compared to American health care costs, treatment in India is estimated to save from 65% up to 90% with patients receiving quality care. Telemedicine is an emerging sector Can bridge the rural-urban divide in availability of medical facilities. Can provide consultation and diagnosis facilities at low cost to the remotest of areas via high-speed internet and telecommunication.

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Nuclear medicine is a rapidly growing discipline employing advanced technology. Medical practice gets significant benefit from molecular imaging procedures such as SPECT, PET, and from novel hybrid techniques like SPECT/CT and PET/CT that provide unique functional and anatomical information relevant for patient management and biomedical

  • research. Molecular-targeted therapy is also growing

fast, with continuous developing approaches aimed to fight several forms of cancer. However, the reality today is that these technologies are not evenly distributed between countries.

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Nuclear medicine has an important role in oncology, both in the diagnostic/prognostic management of cancers, and in therapy. With the exceptions of specific types of tumour, NM has limited role as first-line diagnostic procedure, instead it’s fundamental in the staging assessment of the patients after diagnosis of cancer has been

  • established. Staging is crucial to assess prognosis

and/or to select the most appropriate treatment(s) (surgery, adjuvant or neo-adjuvant therapy, combined regimens). In this context, PET is the most important NM applications and it has become standard of practice for many types of cancer.

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Nuclear Cardiology is a well established technique to assess myocardial perfusion and ventricular function, and its role as a non invasive methodology for the characterization of a variety of cardiac conditions, especially coronary artery disease (CAD) has been extensively evaluated and validated in clinical practice. Nuclear cardiology uses the so-called emission tomography imaging method (single-photon emission computed tomography or SPECT, and more recently positron emission tomography or PET) which renders three-dimensional images depicting the distribution of a radioactive compound in the heart which was previously administered intravenously at rest or during a stress test. Nuclear cardiology is one of the most commonly used procedures for detecting and determining the severity of CAD. It is sensitive, accurate, and cost-effective, and gives excellent prognostic information that is not provided by other diagnostic modalities, useful for patient management based on risk-stratification. Pulmonary scintigraphy is extensively used for the evaluation of lung perfusion and ventilation, and has a principal role in the diagnosis of pulmonary embolism (PE). Despite recent advances in other imaging modalities such as CT pulmonary angiography, the radionuclide technique is considered to have superior sensitivity although with limitations in specificity, being nevertheless the method of choice for ruling out PE.

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The information from the PET scan and from the CT scan is different but

  • complementary. The PET scan shows areas with increased metabolic activity,

while the CT scan shows detailed anatomical locations. A combination of these two images enables a doctor to tell whether a region with high metabolic activity is significant, and if so, to state definitively where that location is. Often the PET/CT is repeated to monitor the effect of treatment of a particular disease. Most commonly PET utilizes 18F-FDG as a radiotracer, the short half-life of which (110 min) reduces radiation exposure compared with

  • ther commonly used radionuclides such as 99mTechnetium (6 hours) and

201Thallium (72 hours). The radiation exposure from 18F results in internal exposure to the patient and low level external exposure to other people in their vicinity. The radiation (X-rays) from the CT scanner only radiates the patient and only during the CT scan. Whenever a repeat PET/CT scan is necessary, it should be performed with low dose CT.

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Cardiac nuclear medicine imaging is also performed: to visualize blood flow patterns to the heart walls, called a myocardial perfusion scan. to evaluate the presence and extent of suspected or known coronary artery disease. to determine the extent of injury to the heart following a heart attack, or myocardial infarction. to evaluate the results of bypass surgery or other revascularization procedures designed to restore blood supply to the heart. in conjunction with an electrocardiogram (ECG), to evaluate heart-wall movement and overall heart function with a technique called cardiac gating.

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