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Country Report Myanmar
IAEA/RCA Project RAS/6/042
on “Tumour Imaging using Radioisotopes”
Country: Myanmar
Title
National Final Report of Tumor Imaging using Radioisotopes RAS/6/042
Background
IAEA project of RAS/6/042 aimed on the “Tumor Imaging Using Radioisotopes”
held the 1st meeting of Project Planning Meeting in Chiba, Japan on April, 2005. Dr.
Kyin Myint of Myanmar who is the Head of Department of Nuclear Medicine, Mandalay
General Hospital attended the meeting. After returning from the meeting he submitted the
“National Work Plan RAS/6/042 on Tumor Imaging Using Radioisotopes” to the
Ministry of Health. Professor Dr Win Mar is appointed as a National Project Coordinator
and planned the 2 year plan starting from October, 2005. National Team of this project is
formed and Dr. Kyin Myint acts as project manager. Dr. Win Mar later attended the
Project Progress Review Meeting held in Hanoi, Vietnam on April, 2007. She submitted
the progress report and the National Work plan of Myanmar in progress were reviewed.
The project in Myanmar is further implemented and preceded with the best participation
of the members and the activities are in progress.
Rationale of the National Project
According to the Tumor Registry of Yangon General Hospital, bronchogenic
carcinoma and breast cancer have the high incidence and morbidity among the
population. The incidence of cancer is increasing and the diagnosis of distant metastasis
as well as primary tumor has become an urgent need to determine the therapy for better
prognosis. There is also an overwhelming increase incidence of lymphoma so that the
nodal staging of individual patient is necessary to determine the plan of management.
Whole body SPECT scans with tumor seeking agents should be employed in visualizing
unexpected metastasis and invasion to adjacent tissue and also employed in the nodal
staging in lymphoma. PET is also used as a primary diagnostic tool and also as a
reassessment of conventional staging like CT & MRI, and it is also be employed as an
assessment of response to therapy.
Myanmar has the infrastructure of Nuclear Medicine Departments at both Yangon
and Mandalay General Hospitals with equipments of gamma camera and SPECT at YGH
and Gamma camera at MGH. Basic knowledge of sentinel node detection technologies
has been attributed. Properly trained personals of Nuclear Medicine have been well
established. With such sustainable infrastructure of the country the National Work Plan
RAS/6/042 is planned to implement in the country.
Overall Objective
To improve the management of cancer patients by radionuclide imaging
technologies of SPECT & PET for cancer detection and monitoring therapies.
Specific Objectives
1. Dissemination of knowledge of Tumor Imaging using radioisotopes among the
health personals and health authorities
2. Implementation of various Tumor Imaging Procedures at each centers
3. Determination of the significance of the Tumor Imaging with radio isotopes at
each centers
Participating Centres
Department of Nuclear Medicine, Yangon General Hospital
Department of Nuclear Medicine, Mandalay General Hospital
Expected outcomes:
 Dissemination of knowledge within the participants and health community
with the aim of proper and effective utility of the facility for the clinical
management in cancer
 Organization of properly trained personals to ensure good QA & QC with
sustainable activities
Outputs:
There are well-organized nuclear medicine departments which have properly
trained and efficient personals especially nuclear medicine physicians following
dissemination of knowledge following RTCs
Some of the projects work well with good results and outcomes and they are
ongoing processes with cooperation of adjoining surgeons and pathologists.
National Work Plan
With the approval of the Department of Health, National Work Plan is formed and
the National Team is organized.
Organization of the National team includes Nuclear Medicine Physicians,
Oncologists, Surgeons and Pathologists from the two centers.
Dr. Win Mar, Professor and Head of Department of Nuclear Medicine, Yangon
General Hospital is appointed as the National Project Coordinator.
Implementation of National Work Plan
• National Work plan is started to fulfill the objectives by accomplishing the phases
of workshops to the persons involved in the nuclear medicine procedures
including nuclear medicine physicians, oncologists, technologists, physicists,
surgeons, radiologists and pathologists
• Phase I: Workshop at MGH attended by the members of work team from
MGH, YGH & NOGH with lectures and demonstrations
• Phase II: Post RTC lectures by attending participants to the local
participants
• Further Dissemination of knowledge and information to other personals of
appropriate hospitals including surgeons, oncologists, pathologists and
radiologists.
• Total number of local trained participants is 24 in number including surgeons,
pathologists, nuclear medicine physicians, oncologists, physicists and
technologists.
Regional Activities
• IAEA/RCA planning meeting, midterm review meeting and final review meetings
are attended by the country representatives
• Project Planning Meeting – April 2005 attended by Dr. Kyin Myint
• Project Review Meeting – April 2007 attended by Dr. Win Mar
• Final Project Review Meeting – April 2008 attended by Dr. Maung Maung
Soe
• RTCs are also attended by the radiologists and nuclear medicine physicians
altogether 5 in number.
• RTC on PET at Fukui Japan at 2005 by a radiologist
• RTC on Sentinal Node Detection at Beijing in 2006 by 2 radiologists
• RTC on PET Application in clinical management at Bangkok in 2007 by a
nuclear medicine physician
Undergoing Projects
• Although PET is not available in Myanmar, the following activities are initiated at
Nuclear Medicine department, Yangon starting mid 2006.
• I-131 and Tc-99m Tetrofosmin Imaging in Thyroid Cancer
• Sentinal Lymph Node Imaging Using Tc-99m Colloid in Carcinoma
Breast
• Radionuclide Imaging of Lymphoma with Tc-99m Tetrofosmin
Results
•
•
•
Whole body and SPECT Imaging with Tc-99m Tetrofosmin has a great impact in
the management of differentiated thyroid cancer patients
In Sentinal Node Imaging, detection rate was 88% and it has become a routine
preoperative assessment in breast cancer patients
In Lymphoma Imaging with Tc-99m Tetrofosmin, the detection rate above the
diaphragm is 87.5%
Conclusions:
Thyroid cancer, breast cancer and lymphoma patients could receive earlier and
prompt management due to noninvasive and cost-effective nuclear imaging modalities.
There are limitations including inadequate supply of Radiopharmaceuticals, lack
of gamma probe and unavailability of PET facility in Myanmar. Therefore we try to
achieve a certain extend with available facilities.
The number of workshops and trained participants are as follows:
No. of Participants in RTCs: 5
No. of National Training Courses: 1
No of the participants involved in the NTCs : 3
No. of Local Participants in NTCs : 24
Efficiency of Participants: 60%
No. of newly introduced techniques: 0
The project is an on-going process and in progress. Local nuclear medicine team
will work hard in cooperation to ensure sustainable development of the project.
Recommendations
RAS/6/042 gave us invaluable assistance on technical support and knowledge
with improvements on sentinel node detection and lymphoma imaging with sustainable
improvements.
Sentinel node detection in breast cancer will become mandatory in breast cancer
management and availability of gamma probe is basic necessity for sentinel node
detection.
Establishment of PET facility is expected to be at Myanmar in future. The
technical assistance and training is necessary. RAS/6/049 will be of great assistance to
accomplish that goal.
Technical Training to the physicists, radiopharmacists and radiographic
technologists in addition to radiologists and nuclear medicine physicians is essential both
for basic necessity to the development of nuclear medicine and radiology and for
preliminary plan for establishment of PET in future.
Summary of Country Report
1. Member state
Myanmar
2. Project Title and Number
Tumor Imaging Using Radioisotopes RAS/6/042
3. National Project Coordinator Dr. Win Mar
Professor/Head
Department of Nuclear Medicine
Yangon General Hospital, Yangon
4. Since PET is not yet available in Myanmar, the following activities are initiated under
the project starting mid 2006
(1) I-131 and Tc-99m Tetrofosmin Imaging in thyroid cancer
(2) Sentinel lymph Node Imaging Using Tc-99m Colloid in Carcinoma Breast
(3) Radionuclide Imaging of Lymphoma with Tc-99m Tetrofosmin
For sentinel Lymph Node Imaging, Nuclear Medicine Physician, Physicist,
Technologist, radiation Oncologist and Surgeon from the Hospital worked together. For
Lymphoma Imaging with Tc-99m Tetrofosmin, Nuclear Medicine Physicians, Physicists,
Technologists, Radiation Oncologists and medical Oncologists from the hospital worked
together.
Regional Activities
The following Nuclear Medicine Team members participated in the regional
events.
1. Dr. Kyin Myint
2. Dr Win Mar
3. Dr. War War Wann Maung
Imaging Using Radioisotopes
4-7 April 2005, Chiba, Japan
Midterm Progress Review Meeting
16-20 April 2007, Hanoi, Vietnam
Regional Training Course on PET
10-14 November 2007, Bangkok, Thailand
No expert mission requested in this project.
Together with Tumor Imaging, in-vitro laboratory services (TG, CEA, CA 153) are also
performed.
Achievements
(1) Whole Body and SPECT Imaging with Tc-99m Tetrofosmin has a great impact in
the management of differentiated thyroid cancer patients
(2) The sentinel node detection rate was 88% and it has become a routine
preoperative assessment in breast cancer patients
(3) In lymphoma Imaging with Tc-99m Tetrofosmin, detection rate above diaphragm
is 87.5%
Nuclear Medicine tem will work hard in cooperation to ensure sustainable development
of the project.
Thyroid cancer, breast cancer and lymphoma patients could receive earlier and prompt
management due to non-invasive and cost-effective nuclear imaging modalities.
The project is on-going process.