Annual Report July 2012 June 2013  Bangladesh Atomic Energy Commission

B. Academic Activities

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  NINMAS is the only institute in the country where a post graduate degree M.Phil.(Nuclear Medicine) course is conducted for the medical graduates under Bangabandhu Sheikh Mujib Medical University (BSMMU). The number of students passed were 8 in the year 2012-2013.
  
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  During this period 8 students completed M.Phil thesis were supervised by the NINMAS personnel under BSMMU.
  
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  Eight (8) doctors completed their one year training program in the field of Nuclear Medicine & Ultrasound from this Institute.
  
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  Six (2 physicians and 3 Technologists) are conducting DAT online education program.
  
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  Weekly journal review as continuous education program was conducted on recent Nuclear Medicine & Allied Sciences related works regularly in this institute.
  
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  Scheduled lectures were delivered to post graduate students of different disciplines of BSMMU.
  

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  Course Completion Program of Resident Nuclear Medicine Physicists under the IAEA/ RCA Project “Strengthening Medical Physics through Education and Training” (RAS/6/038) NINMAS, Dhaka, Bangladesh,12-14 December, 2012.
  
• 
  A Seminar on “Recent advancement in Nuclear Medicine and Thyroid Management’’ based on ‘‘Promoting and Accelerating Nuclear SPECT/PET Imaging Technologies in the Region’’, NINMAS Auditorium, BSMMU Campus, Shahbag, Dhaka, 01 October, 2012.
  
• 
  18^th National Conference of Society of Nuclear Medicine, Bangladesh, 25-26 Junuary 2013, NINMAS Auditorium.
  

The institute has a significant number of both large and small projects and programmes under the auspices of Research and Development division.

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  Strengthening Medical Physics through Education and Training (RAS/6/038).
  
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  Improving Cancer Management with Hybrid Nuclear Medicine Imaging (RAS/6/061).
  
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  Building Capacity with Distance Assisted Training For Nuclear Medicine Professionals(RAS/6/064).
  

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  Promoting and Accelerating Nuclear SPECT/PET Imaging Technologies in the Region CRP (Coordinated Research Project with IAEA) Project
  

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  Development of Quantitative Nuclear Medicine Imaging for Optimized Patient Specific Dosimetry (E2.10.07).
  

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  Establishment of Positron Emission Tomography Computed Tomography (PET-CT) Technology with Cyclotron facilities.
  

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  Changing trend pattern incidences of differentiated thyroid carcinoma.
  
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  Mode of presentation of young patients with differentiated thyroid carcinoma.
  
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  Role of low dose radioiodine in remnant ablation in thyroid cancer and comparison with high dose.
  
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  Demographic pattern of patients and color Doppler assessment of lower limb vessels at INMU.
  
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  Correlation of PI and RI of umbilical and middle cerebral vessels of foetus of normal pregnancy with those in mothers with carcinoma of thyroid.
  
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  Relationship between sonographically detected fatty change in liver and biochemical findings (LFT and lipid profile) and patient’s height, weight, abdominal circumference.
  
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  Comparison of perabdominal and pervaginal ultrasound findings of BPCO with hormone findings.
  
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  Colour Doppler and Power Dopplers evaluation of solid thyroid nodule to predict malignancy.
  
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  Duplex study of vertebral arteries in patients with the.
  
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  Assessment of carotid vessels in DM and TIA.
  
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  Musculoskeletal ultrasonography of different limb joints.
  
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  Duplex study of portal vein in non - cirrhotic condition.
  
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  Duplex study of uterine artery to predict pre- eclampsia. Case- control study.
  
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  Duplex study of penile vessels in erectile dysfunction (Pharmaceutical augmented).
  
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  Less fetal movements and oligohydraamnios associated with high S/D ratio of umbilical artery.
  

The following service oriented works were successfully accomplished:

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  In Vivo Procedures
  
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  Routine diagnostic services
  
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  Scintigraphic studies of Brain, Bone, Liver, Hepatobiliary, Kidney (DTPA & DMSA), Cardiac, HIDA, Lymphoscintigraphy GI Bleeding, Thyroid, Parathyroid, Salivary and Testicles etc.
  

Different types of hormone analysis i.e. T3, T4, TSH, FT3, FT4, TG, FSH, LH, Oestrogen, Progesterone, Testosterone, Prolactine, PSA, Tg, Ca-125 and Calcitonin etc.

Conventional Ultrasonography & Doppler Ultrasound studies were routinely done as an associated modality to in vivo diagnostic nuclear medicine procedures which plays an important role for the diagnosis of various diseases.

Radionuclide therapy services were applied to the following cases:

Thyroid cancer & Thyrotoxicosis etc. routinely were done. In addition to this treatment was given to the patients of Hypothyroidism and IDD (Iodine Deficiency Disorder).

10.2.3 Health Service and Revenue Collection

Last financial year (2012– 2013) a total of 28127 patients was given health services from this Centre and Total revenue collection was Tk. 1,16,40,920.00 (Taka One Crore sixteen lac forty thousand nine hundred twenty) only.

At present ongoing research projects, are

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  Comparison of IDD situation and goiter prevalence among the children (6-12 years) of endemic and non-endemic area of Bangladesh.
  
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  "First trimester fatal screening for congenital anomalies with sonographic measurement of fatal nuchal translucency (NT)".
  
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  Strengthening Radiation Protection of Patients in Medical Exposure, RAS/9/065,
  

Scheduled lectures were delivered to both under graduate and post-graduate students of DMC, Scientists of this Institute have been delivering scheduled lectures to the post graduate students of ‘M. Phil course in Nuclear Medicine’ conducted by the Faculty of Post Graduate Medicine of Dhaka University. Two students completed their M.Sc. thesis in this Institute.

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  Weekly journal review / seminar on recent advancement of Nuclear Medicine & Ultrasound related works are being done regularly.
  
• 
  During last year, 15 doctors completed their one year training program in the field of Nuclear Medicine & Ultrasound.
  
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  In last year, 6 students of Diploma in Electronics Engineering from Dhaka & Mohila Polytechnic Institutes have completed their Industrial attachment (12 weeks) in the field of Nuclear Medicine equipment.
  

INMAS, Mitford is situated in the campus of Sir Salimullah Medical College and Mitford Hospital in the old part of Dhaka city. A brief description of the services rendered by this centre is highlighted below.

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  SPECT-CT neuroimaging of investigations in the diagnosis of functional neuro-abnormalities.
  
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  Central Nervous System Imaging.
  
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  SPECT neuroimaging of investigations in the diagnosis of functional neuro-abnormalities
  
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  Radiocolloid Liver, biliary tract and gastrointestinal tract imaging.
  
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  Hepatobiliary imaging.
  
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  The gastro-intestinal tract scintigraphy .
  
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  Imaging of skeletal system (Bone scan).
  
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  Salivary gland imaging, parathyroid imaging etc.
  

Renal Scintigraphy provides important functional data to assist in the diagnosis and management of patients with a variety of suspected genito-urinary problems. The available tests at CNMU, Mitford are:

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  Kidney DTPA study ( Renogram)
  
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  Kidney scan-Planar, Spect & SPECT-CT (DMSA)
  
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  GFR + Renogram
  
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  DTPA Captopril Renogram
  
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  Renal cortical scintigraphy
  
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  Testicular scan
  

Thyroid section deals with both diagnosis and therapy of thyroid disorders.

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  Thyroid Uptake test: to exclude thyroiditis from thyrotoxicosis and for dose determination in cases of thyrotoxicosis.
  
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  Thyroid scan: To see the size of the thyroid and to evaluate the functional status of the gland or a nodule.
  
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  Ultra sonogram: High resolution ultrasonogram of the thyroid is also done in this division to see the texture of the gland and nature of any nodule (anatomical delineation).
  
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  In-vitro tests: Huge numbers of hormone assay tests are done in the in vitro division. T3, T4, TSH, FT3, FT4, TG and anti-thyroid antibody levels are analyzed.
  

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  I-131 therapy for thyrotoxic patient.
  
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  Hypothyroid & thyroiditis.
  
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  I - 131 therapy for differentiated thyroid cancer.
  

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  The in-vitro procedures include radioimmunoassay of hormones, red cell survival test, estimation of red cell mass. The most common label used in this section is I-125 which may be attached to an analyte as in radioimmunoassay (RIA) or to a reagent (antibody) as in radioimmunometric assay (IRMA).
  
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  Assays commonly done are of the following: Serum total T4, total T3, free T4, free T3, serum TSH, serum prolactin, serum follicular stimulating hormone, serum testosterones, serum leutinizing hormone, etc.
  

Another most important diagnostic service at CNMU, Mitford is Bone Mineral Densitometry (BMD), providing detail information about the degeneration of bone related to age and other pathological disorders.

Ultrasound imaging system is playing a very important role in Bangladesh. Trained and experienced manpower is available in this center and complicated cases get enormous benefit from their expertise & experience.

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  All sorts of abdominal USG: Hepatobiliary system, renal system, gynaecological, etc.
  
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  Pregnancy related: pregnancy profiles, biophysical profile, scan for anomalies.
  
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  Small parts USG with high frequency probe: breast, testes, eye, thyroid, parotid, brain, etc.
  
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  Musculoskeletal USG: Hip joint.
  
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  Superficial USG: Subcutaneous lesions.
  

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  Peripheral vascular Doppler: for PVD, DVT, varicose veins etc.
  
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  Portal venous Doppler: for cirrhosis, portal hypertension.
  
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  Carotid Doppler: For ischemia, stenosis.
  
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  Renal Doppler: For renal artery stenosis, transplant study.
  
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  Penile Doppler: For erectile dysfunction.
  
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  Umbilical cord Doppler: IUGR, placental insufficiency.
  
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  Tumor vascularity.
  
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  Testicular torsion.
  

1. 
   Lectures are delivered to M.Phil. students which is conducted by the NINMAS under the BSMMU.
   
2. 
   Lecture and demonstration classes for the 3rd, 4th & 5th year MBBS students of Sir Salimullah Medical College who are placed at this center by rotation.
   
3. 
   On-job training for honorary trainee doctors.
   
4. 
   Seminars are conducted jointly by the INMAS, Mitford and SSMCH on different topics.
   

Institute of Nuclear Medicine & Allied Sciences, Chittagong is one of the oldest Nuclear Medicine Institute in Bangladesh and was established in 1970. Modernization of this institute was completed on 30^th June 2008. This institute is presently functioning with facilities like Dual Head & Single Head SPECT Gamma Camera, CT Scanner, Thyroid Scanner, Ultrasonogram, Colour Doppler and In-Vitro Laboratory for Radioimmunoassay (RIA) with Computerized Gamma Well Counter and other necessary facilities. During the period form 1^st July 2012 to 30^th June 2013, a total of 41,819 diagnostic and therapeutic procedures were performed in this institute from which revenue collection was 1,67,10,450/-

During the period under report patients attended for various diagnostic investigations like scintigraphy of bone, kidneys, thyroid, brain, liver, and other static and dynamic studies. Gamma Camera was used for these studies. Renal differential/split functional analysis (Renogram) is a non-invasive but informative procedure among these.

Estimation of thyroid-related hormones like T3, T4, TSH, FT3, FT4, & TG and also several other hormones like, LH, FSH, Prolactin, Testosterone, Progesterone, Oestradiole, AFP and Cortisol. These hormones were assayed in this institute by radioimmunoassay technique with computerized system using IAEA data processing software.

Ultrasonographic examination is routinely performed in this institute. As a result a good number of patients were able to receive this service. Apart from assessment of Pregnancy, Ultrasonography of Liver, Spleen, Pancreas, Kidneys, Urinary Bladder, Uterus, Ovaries, Prostate, Thyroid, Brain, etc. were also performed.

Different Vascular diseases are diagnosed by colour doppler. Placental circulation can be diagnosed by colour doppler during pregnancy and by observing the blood circulation, one can differentiate normal and abnormal tissues.

By CT scan, different diseases of brain, lung, chest & abdomen are diagnosed accurately.

A considerable number of thyroid disorders like, Hyperthyroidism, Hypothyroidism & Thyroid cancer patient were treated in this institute. A total No. of 159 hyperthyroid patients were treated by radio-iodine therapy and 60 thyroid cancer patients were treated by radio-iodine ablation therapy. During the period a total number of 18 eye patients were treated by using Sr.-90 beta-applicator for pterygium, corneal vascularization, and chronic conjunctivitis diseases.

(i) Diagnostic (ii) Therapeutic (iii) Research and Development (iv) Education (v) Publication

The following routine diagnostic works are done in this centre:

(a) ¹³¹I Therapy for Thyrotoxicosis. (b) ¹³¹I Therapy for Thyroid Cancer (c) Beta Radiation therapy for certain Eye diseases e.g. Pterygium, Vascularised corneal ulcer etc.

Various Research programmes are going on in relation to hypothyroidism, Thyrotoxicosis, well-differentiated thyroid cancers, renal diseases, fetal maturity, hepatobiliary and pancreatic diseases by using in vivo and in vitro nuclear techniques and ultrasound.

1. Fellowship training on “High Resolution Ultrasonography with Interventional Sonography” in Dokkyo Medical University, Tochigo, Japan, From Sep. 2012 to Feb. 2013.

2. “Reactor Engineering Course at BAEC (NRECB-1)-2013, Two week long. Jointly Sponsored by Japan Atomic Energy Agency and Bangladesh Atomic Energy Commission.

3. “Nuclear and Radiological Emergency Preparedness Course at BAEC (NRECB-1)-2012, One week long”, at BAEC, Jointly Sponsored by Japan Atomic Energy Agency and Bangladesh Atomic Energy Commission.

A Total of 18639 Patients were enrolled for different tests in the Year July 2012 to June 2013. For different tests monthwise total numbers of patients are given bellow:

Total Income in the fiscal year July, 2012 to June, 2013 was Tk. 81,19,600/-.

Institute of Nuclear Medicine & Allied Sciences, Rangpur is located in the northern part of the country in the premises of Rangpur Medical College Hospital. The centre provides diagnostic & therapeutic services to the people of Northern part of Bangladesh covering greater Rangpur, part of greater Bogra & Dinajpur using Nuclear technology & ultrasound system. Since inception in 1989 the centre made a great impact in this region for the betterment of health services. During the period from July 2012 to June 2013 a total number of patients diagnosed & treated are 13,211 & revenue earned amountsTk. 44,80,250 /-.

The activities being carried out in this centre are: 1. Diagnostic 2. Therapeutic 3.Research & development 4. Education 5. Publication.

The following Diagnostic services are done in this centre include a) Thyroid Studies b) Renal Studies c) Bone Scan d) Brain Scan e) Liver Scan f) Tubal Patency g) Ultrasonography of various organs and h) Radioimmunoassay of thyroid hormones e.g. FT₃, FT₄ & Prolactin.

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  Iodine-131 Therapy for Thyrotoxicosis
  
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  Iodine-131 Therapy for Thyroid Cancer
  
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  Beta Radiation Therapy for Pterygium, Vascularised Corneal Ulcer etc.
  

By using invivo & in vitro nuclear techniques & ultrasound, various R & D programmes are going in relation to hypothyroidism, thyrotoxicosis, thyroid cancers, renal diseases, foetal maturity & hepatobiliary diseases, scientific discussions on journals collected through Internet are usually made time to time.

Attendance of patients and revenue collection during July, 2012 to June, 2013.

1. The centre is carrying out academic activities in Collaboration with the Department of Physiology, Endocrinology, Gyenocology & Oncology Dept. of Rangpur Medical College Hospital.

2. Arranged scientific & technical discussions on Nuclear Medicine & Ultrasonography for our newly appointed doctors & scientists.

3. INMAS, Rangpur also offered three months industrial attachment training programme for the final year students of Rangpur Polytechnical Institute.

4. Lecture/demonstration to the students of Rangpur Medical College about the role & procedures of Nuclear Medicine.

10.8 INSTITUTE OF NUCLEAR MEDICINE & ALLIED SCIENCES, MYMENSINGH

10.8.1 Patient Management

All equipments of this Institute are working properly. A number of new studies were introduced with SPECT-CT gamma camera which are unique to the Institute. Service charge income has been increased in a large scale. The information of the facilities and services of the centre are available in a website: www.inmasmym.org which are updated regularly. System of patient appointment through internet are in the pipeline. During the period of 1^st July 2012 to 30th June 2013 the following number of patients has been evaluated for diagnostic and therapeutic purposes in this Centre and service charges earned:

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  Role of Color Doppler in the evaluation of hepatic neoplasm with cytopathological correlation.
  
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  Ultrasound evaluation of traumatic patients in a tertiary level Hospital.
  
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  Uniformity and multiple Head Registration (MHR)/centre of Rotation (COR) Quality control status of newly installed Hybrid SPECT/CT.
  
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  Effectiveness of Radioiodine therapy in treatment of hyperthyroidism.
  

Institute of Nuclear Medicine and Allied Sciences, Dinajpur was established primarily in the year 1982 at Dinajpur Sadar Hospital campus to serve the endemic goiter zone of greater Dinajpur and Rangpur district. In the following three decades the centre served a huge number of patients with Thyroid Disordes.

Both Diagnostic and Therapeutic facilities are available here.

Both In-vivo and In-vitro techniques are used in this center for diagnosis of diseases.

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  Thyroid Uptake: This test is performed with thyroid uptake system to determine the function of thyroid gland.
  
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  Nuclear Imaging: Diseases of bone, brain, liver, kidney, thyroid gland etc. are detected by taking images of the respective organs with SPECT machine.
  
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  BMD: Bone Mineral Densitometry (BMD) is used to assess bone mineral content of the patient for detection of osteoporosis and osteopenia.
  
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  Renogram: This test is performed with SPECT machine to determine the fnctional status of kidneys.
  

The number of patients attended here from Jyly 2012 to June 2013 was 7190 and Tk. 31,53,450 (Thirty-one lac fifty-three thousand four hundred fifty) only collected as investigation fees.

Institute of Nuclear Medicine & Allied Sciences, Barisal is situated in the campus of Shere Bangla Medical College & Hospital. The Institute deliver its services to the patients attending Sher-E-Bangla Medical College hospital for treatment and also to the people of Barisal division and neighboring districts, like, Madaripur, Goplaganj & Bagerhat. The Institute is equipped with two computerized gamma camera , One small organ scanner, BMD, thyroid uptake, 4D Ultrasonogram and Radioimmunoassay (RIA) laboratory.

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  Ultrasonography & Color Doppler: Ultrasonography is the main diagnostic tool of the Institute. Around 80% of patients are handled through this system. Sonography of abdominal organs, thyroid gland, pediatric brain, testes, mammary gland etc. are highly popular among the referring physicians. Colour doppler studies of the peripheral vessels, carotid arteries and other organs are being done routinely. Endocavitary scan and 4D Ultrasonography of fetus & different organs are also done here.
  
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  RIA laboratory: Serum T₃, T₄, TSH, FT_3, FT_4, FSH, LH, Prolactin, Progesterone, Testosterone are confidently estimated on weekly basis.
  
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  Nuclear Medicine: Bone scan, Renal scan, Renogram, Thyroid scans are routinely done.
  

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  I-131 therapy: I-131 therapy is given to Hyperthyroid & Ca- thyroid patients.
  
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  Follow-up: Toxic & Ca thyroid Patients are then followed up periodically for the rest of their lives.
  
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  Beta-radiation: Beta-radiation is applied to Postoperative Pterygium patients using Sr-90 source.
  

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  Disease spectrum of referred cases in Nuclear Medicine.
  
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  Discussions of Journals collected through Internet are made time to time.
  

Institute of Nuclear Medicine & Allied Sciences, Khulna is located in the South-west part of the country in the premises of Khulna Medical College Hospital. The institute provides services to the people of greater Khulna and nearby districts using nuclear technology and Ultrasound system.

The activities of the institute during the period may be divided in the following groups:

i) Clinical services, ii) Academic and iii) Research and Development.

i) Clinical service provided

Nuclear Imaging: (1) Thyroid Scan (2) Liver-spleen Scan (3) Bone Scan (4) Brain Scan (5) Renal Scan (6) Renogram (7) Whole Body Radioiodine Scan.

In-vivo non-imaging study: Radioactive Iodine Uptake test.

In vitro nuclear medicine procedure (Radioimmunoassay)

Hormones: T₃, FT₃, T₄, FT₄, TSH, TMAb, FSH, LH, Prolactine, Progesterone, Testosterone, Estradiol, Cortisol.

Cancer marker: AFP, PSA, Thyroglobulin.

ii) Therapeutic Nuclear Medicine:

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  Treatment of Graves’ disease, Toxic Multinodular goitre and Toxic adenoma using low dose Radioiodine – 131.
  
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  Treatment of differentiated thyroid cancer using high dose Radioiodine – 131.
  
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  Brachy therapy of eye using Sr-90 beta applicator in Post-operative Pterygium.
  

(i) General purpose: Abdominal organs, Pregnancy, Paediatric ultrasound. (ii) High resolution ultrasonography: Thyroid, Breast, Testis. (iii) Ultrasound guided aspiration: Liver abscess, Pleural effusion (iv)Transvaginal ultrasound: Uterus, Ovaries, Ectopic pregnancy (v) Transrectal ultrasound (vi) Carotid and vertebral artery Doppler (vii) Peripheral vascular Doppler (viii) Liver Doppler study (ix) Renal Doppler study (x) Aortic aneurysm evaluation (xi)Pregnancy evaluation.

Nuclear Medicine Physicians of the institute offer medical consultation for the patients of various thyroid diseases. Patients are getting advantages of treatment facilities with all diagnostic support for thyroid problem in one station.

During the reporting period, a total number of 27,994 patients were enrolled and total income was Tk. 1,05,56,700/-

• 
  Value of BMD in primary ovarian insufficiency.
  
• 
  Evaluation of renal function using DTPA Renogram in Diabetic individual.
  

The Institutie of Nuclear Medicine & Allied Sciences Bogra is a government institute of specialized and applicable research oriented health service. The government fund and labors are totally used here for public health service and mankind. The main objective of the centre is to apply Atomic Energy in a safe and peaceful way for the Well being of mankind, rather than to use it in destruction. The centre is mainly involved with diagnosis and treatment of various human diseases using radiopharmaceuticals. Academic and research activities are also conducted here. SPECT, Gamma Camera. BMD, Thyroid Uptake System, Gamma counter, Pterygium Application, Ultrasonogram and other associated ultra-modern equipments are available in this Center. At present, 36 officers and stuffs are working here. In 2012-2013 fiscal year, Tk. 92.51 lakh from the revenue budget were allocated for the centre. Expenditure included salary for officers and stuffs, Tk.75.33 lakh, supply & service Tk.14.73 lakh, repair and maintenance Tk.1.95 lakh & asset collect/buy Tk. 0.50 lakh.

The activities of the Centre are divided into following 7 categories:

A) Radioisotope Scan: 1. Brain Scan, 2. Kidney Scan, 3. Liver- Spleen Scan, 4. Bone Scan,

B) SPECT Studies: 1, Bone, 2. Liver, 3. Bone, 4. Kidney.

C) Hormone Assay, D) Bone Densitometry, E) Ultrasonogram.

ii) Treatment/Therapy by radioisotope

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  Radio-iodine therapy for Thyriod Cancer, and Hyperthyroidism.
  
• 
  Beta-Radiation to eye in postoperative Pterygium to prevent recurrence of the disease.
  

a. Bone Density mesasurement in Normal population.

b. Changes in liver tissue in Arsenic Poisoning.

c. Assessment of thyroid hormone status in School going Children.