Communicating nuclear energy matters under stress

On July 28, 199,  Shri Karan Thapar, the then Executive Producer H T V Limited  interviewed me for his EYE WITNESS Video Magazine programme . Thapar allowed me to record in my tape recorder the audio part of the programme. The interview took place in the office of the Branch Secretariat, Department of Atomic Energy ,South Block, Delhi.

The interview was consequent upon a request made to the Prime Minister and to the Minister of Public Grievances  Shrimathi Margarat Alva by the producers of the programme.

The following is the full unedited text of the interview. After a few days, the EYE WITNESS released  video cassettes which contained an edited version of the interview. The journalist may clarify that the editing   was done for the sake of brevity. It is partly true. If you read the edited text and the original you may also feel that the shortening was to bias the viewer to a certain point of view.

 The TV Channel also published a news release which contained incorrect   information. The issue led to a controversy which spilled over the pages of leading news papers. Shri George Fernandes raised the issue in Parliament.  He quoted that according to the film fallout from the pollution has resulted in a number of children being born with genetic defects and physical deformities.

The Link: http://parliamentofindia.nic.in/ls/lsdeb/ls10/ses1/0116099105.htm

Though I based my assertions on scientific facts, state –of- the- art measurements etc, I could not change his perception. Successful communication demands mutual trust, opportunity for dialogue devoid of jargon and prejudice. We need such an ambiance for the success of any programme where perceived risk is much more than the real risk. Nuclear community and regulators must transparently   communicate   with all stakeholders to break the barrier. If there are other agendas even humongous efforts will fail.

I cannot claim that I  was altruistic and had no agenda. My agenda was to assert that the Atomic Energy Regulatory Board  constantly monitors  the releases from all nuclear installations  to ensure that they comply with the prescribed limits. Thapar wanted there should be an investigation.  His enthusiasm to overwhelm me by a fusillade of questions and  editing  the script suitably were  pointers to facilitating his agenda. Edited portions included my statements on the existence of comprehensive environmental radiation monitoring at the nuclear power plants.

A specialist with many decades of experience in communication cautioned me about the possible approach of Thapar. However, I do not envy anyone answering  40 questions in 10 minutes! It is “stressful”  to put it mildly!

Rarely one gets an opportunity to record an entire review and to compare the unedited script with the final product. More often, the reporters come with their own view of a matter and then the interview is like a typical fishing expedition. I leave it to the readers to arrive at their own conclusion after calm contemplation.

The full interview with edited portions marked

Mr.  Karan:      Are you ready?

Mr.Karan:         Dr. Parthasarathy, Is it true that Rajasthan Plant was shut down 250 times in its first decade?

   Dr. KSP:        In a way, there is an element of truth in this. But the word “shutdown” is used by the media as if there is a safety concern in every shutdown. In all these shut down none of them caused any radiation leak to public.

Mr. Karan:        But it was shutdown 250 times?

Dr.KSP:            It was shutdown- Yes

Mr. Karan:        It is true that Candu reactors have been shut longer than they were in operation?

Dr.KSP:            This is not true

Mr. Karan:        How long has it been shut down?

Dr.KSP:            For instance in the case of Rajasthan Atomic Power Station I, the first Candu type of reactor. There was a problem; a hairline crack appeared on the end shield.

Mr. Karan:        Which the film talks about.

Dr.KSP:            Which the film talks about. They had no shutdown for about 3 years. That is the longest. Now…….

Mr. Karan:        (Interrupting) Were there any leak of heavy water involved in it.

Dr.KSP:            No, No. It is light water. Let me make it clear. The end shield will get hot when the reactor operates. Now this has to be cooled because it is a structural part. That cooling is done by ordinary water. But if there is a leakage that ordinary water goes and the cooling is not effective and that will have safety concern. Such a reactor could not be operated at full power and so on and so.

Mr. Karan:        You talk about ordinary water. Is it true that the water that is used to cool the plant is frequently returned to the same river from where it is drawn?

Dr.KSP:            Yes, it is true. Quit true. Why frequently. For instance, I would have loved to have a nuclear reactor which does not require cooling water. But physics does not allow that. You have to cool the reactor.

Mr. Karan:        But does the water which is returned to the water go back with irradiation.

Dr.KSP:            No, it does not go back with irradiation. What actually happens is that reactor contains radioactivity. Traces of radioactivity may come out; it is permitted to come out. This water which may carry that goes through the outfall and into the lake. It is monitored regularly. For instance hundreds of samples are taken regularly.

Mr. Karan:        There is no health hazard involved?

Dr.KSP:            Not at all. Not only that the limits of the radioactivity that can be given out they are strictly prescribed as per international guidelines by the Atomic Energy Regulatory Board which is the statutory body which has all the authority to do whatever they want as far as the operation of the reactors is concerned.

Mr. Karan:        Do you deny that the link made in the film that because the water is used to cool the plant is returned to the river it is a source of contamination and hazard.

Dr.KSP:            Totally, because this is the water we drink, we mean I don’t belong to the Dept. of Atomic Energy. But the people who work there and in the township drink. The activity that is let out contains such a tiny amount and is monitored. If the level is high we will shut down the reactor. We will not allow it to be operated.

Mr. Karan:        You said that one of the reactors has been shut down for 3 years. It was an unusually long time

Dr.KSP:            It is an unusually long time. Yes. There was a safety issue at that time AERB was not there. But later there was an equivalent of AERB then. There were consultation and we did not want the reactor to be run.

Mr. Karan:        Has there been any leak that caused danger of any type from the Rajasthan Plant?

Dr.KSP:            The word “leak” generally people survive on “leaks” and “nuclear leak”. “Nuclear leak” is a media perception. You know there were incidents; after all, a lot of fluid is used in the reactor. A flange may have leaked. There were incidents of leakage.

Mr. Karan:        Which caused hazards?

Dr.KSP:            No. None at all, None to the public. Leaks are contained.

Mr. Karan:        But how can you be confident that if there is a leak that did not cause any hazards to the public?

Dr.KSP:            The reason is obviously that as I said. Let me ask you, How many samples will be taken from the power stations each year. There is a regular organization which is outside the periphery of the power station, where they are sampling. How many samples do you think they will be taking?

Mr. Karan:        Let me put back to you the question rather than to answer a question.

                          You have admitted there were leaks?

Dr.KSP:            Yes.

Mr. Karan:        And you have also admitted that one of the reactor were shutdown close to 3 years

Dr.KSP:            I also said that this was ordinary water which does not contain any radioactivity. It is used to cool the end shield.

Mr. Karan:        And you also admit that the water used to cool the plant is often returned to same lake.

Dr.KSP:            Yes, it is true. But let me explain. (interrupting) DR. Parthasarathy, Let me finish my question.

Mr. Karan:        The film says that there is possibly a link between the defective births reported in that area around the plant and the existence of radiation? Can you deny that?

Dr.KSP:            I can totally deny that. But at the same time I wanted to put the issue in perspective. Karan, we are talking about an association. Let me just ask you, say, you are young, very smart, you want to remain  continuously young. Now look at your hair. Your hair is receding, look at Pannoy Roy, Kushwant Singh may be an exception. But suppose I say that this  hair receding started when you started looking at VDU’s (Video display units) and I may be able to produce a paper perhaps that Geriatric Research Centre shows………….

Mr. Karan:        Are you saying that it is just a coincidence.

Dr.KSP:            It is not. The fact is that it is not supported by medical evidence and also the point is

Mr. Karan:        (Interrupting) Is that not the point the film makes that you may not have evidence that suggest that the connection between radiation and defective birth is scientific. Given the fact as the film these defects have doubled during the past few yeas. It is not considered it should be investigated?

Dr.KSP:            No, But first of all this I want to ask you. This film is meant to create, to plant a seed of suspicion. Now let me ask you when the reactor is operated, If there is a radioactive leak coming out, it is measured regularly. 1800 samples are collected. Every data from 1973 we have. In no case it has exceeded a fraction of the permissible limit which is imposed by us and also, if you take the total radiation dose, after all it is the dose that is important. The radiation dose which is monitored by us and the data is inspected by us hardly gave one unit (one millirem) of dose to the villagers where the natural dose itself is about 60 units……….

Mr. Karan:        (Interrupting) Dr. Parthasarathy, you deny evidence of defective births? They doubled in the last few years. What causes them?

Dr.KSP:            I want to argue that you are just suggesting. Is there any medical evidence? It is a suggestion. It is just a suggestion. I suggested that the receding hairline in your hair is due to your watching video display units. I may also get a certificate from your wife that at the age of 25 you had better hair, I can keep all the middle aged husbands away from the drawing room. Just because there is a link between……….

Mr. Karan:        (interrupting) I wish the matter was a simple as that.

Dr.KSP:            No, it is not.

Mr. Karan:        But the problem here is that we are talking about human life, that is it not some thing that we should be investigating.

Dr.KSP:            Now the question is

Mr. Karan:        (Interrupting) Will you investigate it?

Dr.KSP:            No, Let me explain to you what has happened. In 1972 the reactor started to operate. At that time there was not such an investigation or anything. Now currently in this country why isolating only radiation. We have chemical industries, so many other.

Mr. Karan:        (interrupting) you are moving away again from the subject. Can I ask, you conceded that is something to be investigated.

Dr.KSP:            No, What I am telling at the same time is that if the doses are very low and if doses which are 13,000 times more as in the case of Hiroshima and Nagasaki did not create a problem.  You know, the…………

Mr. Karan:        (interrupting) Now let me ask you very bluntly. Do you think, this film raises an issue that you should want to investigate further?

Dr.KSP:            The film does not raise an issue. It creates a seed of suspicion by deliberate propaganda. Now you must give me time. What exactly happened? What is the effect?

2.                       If the dose is going to be there it is going to be measured. We have the record. Now this has never shown anything more than one unit which is equal to, say, suppose somebody sits for the entire year in the village (which ever village) you are talking about, gets one unit. That is something, you may get in some other place 60 units more just because of natural radiation!

Mr. Karan:        Your position is that the film is rubbish, it can be dismissed.

Dr.KSP:            I don’t want to say that because the question is if you wanted to do a survey we can do that just for public relations.

Mr. Karan:        I don’t want to do a survey, nor do I want to do a survey for public relation. I want to say whether you think that the evidence that the defective birth have increased in this area around the atomic power station, is evidence, which requires investigation.

Dr.KSP:            They way it is presented in the film, by looking at children and suggesting a link is totally unscientific.

Mr. Karan:        But that is just the presentation.  Let us look at the facts. Dou you think the fact needs further investigation? Or can be dismissed.

Dr.KSP:            It can be dismissed in the light of current radiation information available.

Mr. Karan:        Don’ you think you have been careless?

Dr.KSP:            No, not at all- careless.

Mr. Karan:        What about callous?

Dr.KSP:            Pardon me.

Mr. Karan:        What about callous?

Dr.KSP:            No, No. I think what is being callous is to use such a very impossible thing to create a scare in the innocent population around the plant. I have been to Tamlao, I have been to Jharjhani. No this is like any other typical village and we have measurements of dose data for so many years. Karan, you can come and look at the data.

Mr. Karan:        Tell me, what are these deformed, defective births due to?

Dr.KSP:            It could be due to anything, say for instance, suppose you have access to a maternity home any where. You go on counting the babies-one hundred babies, day by day you have to be there for few days. Say something like 10 percent will have some defects or the other. Now all that I am suggesting is that because the radiation levels are certainly low, certainly we know, we measured…………

Mr. Karan:        But since you can be certain what these defective births are due to, why you are ruling out this as a possible cause. Why don’t you want to investigate it?

Dr.KSP:            No, that is what I was telling. Once you just create a suspicion, say for instance that all the birth defects in Hyderabad and any other place where the radiation dose is 60 units more rather than one unit more, it should be due to……………

Mr. Karan:        (interrupting)This is within a range of 25Kms

Dr.KSP:            (interrupting) We have all the data.

Mr. Karan:        You have already admitted there were leaks.

Dr.KSP:            (interrupting) No, you are putting words into my mouth. All that I suggested was that the leak is always contained. Let me tell you that the leak may occur- heavy water for instance is Rs. 10,000/ litre. Every drops of it is collected. Still a few drops may escape. It is washed out . It goes into liquid discharge and we have data for all the measurements done for various years……….

Mr. Karan:        (interrupting) Let me just ask a quick question

Dr.KSP:            (interrupting) Also you seem to believe.

Mr. Karan:        (interrupting)Your position DR.Parthasarathy is that this film raises no issues that worries you.

Dr.KSP:            Scientifically yes, Scientifically yes, yes, you are right. It is a media perception.

Mr. Karan:        Dr. Parthasarathy, Thank you very much indeed.

Dr.KSP:            Thank you for taking interest in this programme. Karan I hope you will put it across, sincerely.

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This case report deserves wider publicity

A case report in the latest issue of  The British Medical Journal (THE BMJ) describing a serious injury to a 36 year old male patient deserves wider publicity as we can prevent such instances by imparting correct information.

Physicians from the Department of Urology, King George’s Medical University, Lucknow, Uttar Pradesh, India authored the case report

The link:      http://casereports.bmj.com/content/2018/bcr-2018-226562.full.pdf

(The photographs which The BMJ carried may shock some readers).

Dr Jamie Well  wrote a news story based on it in one of the dispatches of the American Council on Science and Health (ACSH)

Here is the link:

https://www.acsh.org/news/2018/08/15/yes-you-can-%E2%80%98break%E2%80%99-your-penis-13314.

I feel that the case report must be published in popular dailies and other contemporary publications. I made this suggestion to the concerned physicians. Drugs such as Viagra are reportedly available on line. Patients may come to grief if they consume the drugs  without medical supervision

How accurate antibody tests are for detecting COVID-19?: New Cochrane review

Rapid tests of antibodies to find out whether a person had COVID-19 serves a useful purpose. When the most widely respected Cochrane review examined these tests they could collect data on only 27 tests, a fraction of the over 279 (as on May 21, 2020) tests in the market. They reviewed 54 articles.These studies had several weaknesses.The review showed that antibody tests could have a useful role in detecting if someone has had COVID-19, but the timing of when the tests are used is important.The tests are better at detecting COVID-19 in people two or more weeks after their symptoms started, but we do not know how well they work more than five weeks after symptoms started.Further research is needed into the use of antibody tests in people recovering from COVID-19 infection, and in people who have experienced mild symptoms or who never experienced symptoms.

“Since test, track and treat is the only way to prevent spread of infection and save lives, it is imperative that testing should be made widely available to all symptomatic individuals in every part of the country and contact tracing mechanisms for containment of infection are further strengthened. ICMR advises all concerned State Governments, Public and Private Institutions to take required steps to scale up testing for COVID-19 by deploying combination of various tests.”An ICMR advisory quoted,

The Cochrane Review on the topic provides authentic information to the policy makers worldwide including those in India to make them aware of the status of the technology and the improvements needed for its proper use.

Please read on for more details:

https://www.m3india.in/contents/editor_pick/140439/how-accurate-antibody-tests-are-for-detecting

When George Fernandez was not convinced about nuclear safety

Today is the birth anniversary of Shri George Fernandez, veteran trade union leader, politician and MP. He held many ministerial portfolios including industry, communications, railways, and defence. The President of India conferred Padma Vibhushan, on him posthumously. He would have been 90 years of age today. He had a love-hate relationship with the Department of Atomic Energy. I have not interacted with him personally. The virtual interaction I had with him taught me a few lessons in communication. Successful communication demands mutual trust, opportunity for dialogue devoid of jargon and prejudice. We need such an ambiance for the success of any program where perceived risk is much more than the real risk. I wrote an article today in memory of Shri George Fernandez. “Though in Mumbai he earned the sobriquet, “bundh-master”, his contributions to the nation are so vast and varied that it is impossible to ignore them.” I concluded. I request you to read the article in its entirety including the contents of the hyperlinks.

The link:https://www.eurasiareview.com/03062020-when-george-fernandes-was-not-convinced-about-nuclear-safety-oped/

Successful MERS vaccine in mice may hold promise for COVID 19 vaccine

A team of researchers at the University of Iowa and the University of Georgia, USA have developed a vaccine that fully protects mice against a lethal dose of MERS, a notorious, close cousin of SARS-COV2 that causes COVID-19. Surprisingly, they found that their MERS vaccine also holds promise for developing vaccines against other coronaviruses diseases, including COVID-19, which at present holds many nations including India to ransom.

mBio, the Journal of the American Society for Microbiology published the results of the study on April 7, 2020.

“Our new study indicates that PIV5 may be a useful vaccine platform for emerging coronavirus diseases, including SARS-CoV-2, the virus causing the ongoing COVID-19 pandemic,” says McCray, UI professor of paediatrics in a press release from the University of Iowa Health Care.

Professor Paul McCray responded promptly to my e-mail queries on the project. Based on the paper and the responses of Professsor McCray I wrote an article in EURASIA REVIEW.

The link: https://www.eurasiareview.com/20042020-successful-mers-vaccine-in-mice-may-hold-promise-for-covid-19-vaccine/

My article on Shri T N Seshan former CEC

I wrote an article on Shri T N Seshan, former CEC. Here is the link.

https://www.rediff.com/news/column/when-keshub-mahindra-silenced-t-n-seshan/20191205.htm

1 sec to determine signs of haemorrhage in an entire head scan by artificial neural network

I wrote a review article in M3 India on the status of Arificial Intelligence in diagnosing certain brain diseases by medical imaging. AI results are comparable to those arrived at by specialists. However,that is not enough. Jury is still out on the use of AI in medical imaging.

Here is the link: https://www.m3india.in/contents/EDITOR_PICK/123436/1-sec-to-determine-signs-of-haemorrhage-in-an

Adult heart contains no stem cells

IMAGE: THE SCAR IN THE MURINE HEART AFTER MYOCARDIAL INFARCTION. SCAR TISSUE IS SHOWN IN RED. HEART MUSCLE CELLS ARE SHOWN IN GREEN. view more 

CREDIT: © HUBRECHT INSTITUTE

Scientists know a lot about human body and the cells, tissues and organs that make it up. However, this knowledge is not complete. We are still learning about even important organs such as the heart.

When  a heart attack occurs, blood supply to part of the heart muscle is cut off. That part dies. Basically, heart is a pump that  maintains the blood circulation through our blood vessels. Death of a part of the heart muscle is a life- threatening event.

When any tissue damages, stem cells that reside in the tissues come forward; they multiply swiftly forming large numbers of daughter cells which quickly replace the damaged cells

For two decades researchers and clinicians have searched for cardiac stem cells, stem cells that should reside in the heart muscle and that could repair the heart muscle after a myocardial infarction. Many research groups have claimed that they identified cardiac stem cells, yet none of these claims have held up. See for instance the following recent press release: “US governments halts heart stem-cell study”. The jury is still out on the existence of cardiac stem cells and their significance for adult hearts. It remains therefore hotly debated.

To solve this debate, researchers from the Hubrecht Institute inUtrecht, the Amsterdam University Medical Center, the École Normale Supérieure(ENS) de Lyon and the Francis Crick Institute London, led by Hans Clevers,focused on the broadest and most direct definition of stem cell function in themouse heart: the ability of a cell to replace lost tissue by cell division. Inthe heart, this means that any cell that can produce new heart muscle cellsafter a heart attack would be termed a cardiac stem cell. The authors generateda ‘cell-by-cell’ map of all dividing cardiac cells before and after amyocardial infarction; they used  advanced molecular and genetic technologies.

The study establishes that many types of cells divide upon damage of the heart, but that none of these are capable of generating new heart muscle. In fact, many of the ‘false leads’ of past studies can now be explained: cells that were previously named cardiac stem cells now turn out to produce blood vessels or immune cells, but never heart muscle. Thus, the sobering conclusion is drawn that heart stem cells do not exist. In other words, heart muscle that is lost due to a heart attack is irreplaceable . This finding -while disappointing- settles a long-standing controversy.

The authors saw that amazing events do happen  post an infarction.  Connective tissue cells (also known as fibro blasts) that are intermingled with heartmuscle cells respond vigorously to a myocardial infarction by undergoing  multiple cell divisions. In doing so, they produce scar tissue that replaces the lost cardiac muscle. While this scar tissue contains no muscle and thus does not contribute to the pump function of the heart, the fibrotic scar ‘holds together’ the infarcted area. Indeed, when the formation of the scar tissue is blocked, the mice succumb to acute cardiac rupture. Thus, while scar formation is generally seen as a negative outcome of myocardial infarction, the authors stress the importance of the formation of scar tissue for maintaining the integrity of the heart.

India’s Tryst with Nuclear Medicine

Nuclear medicine as a discipline and a medical practice has been developing in India for over 64 years. I could locate a reference to  radioisotopes in medicine in India in a lecture Dr Subodh Mitra, former Director Chittaranjan Cancer Hospital Kolkatta gave in 1954 on ‘Health Protection, and Biological and Medical Applications of Atomic Energy’ at the first National Conference on the peaceful uses of atomic energy organized by Dr Homi Bhabha in Delhi on a suggestion by Pandit Jawaharlal Nehru. The Society of Nuclear Medicine, India completes 50 years of its service this year. They celebrated it  at their annual conference in Chandigarh during 22-25 November this year.

The official journal of the Society of Nuclear Medicine gives a good account of the activities of the Society and various developments during the past 50 years. I hope my article published in The Wire on Nov 25th gives some additional information on the development of the discipline and  how regulatory aspects evolved over the years.

The link:

https://thewire.in/the-sciences/indias-tryst-with-nuclear-medicine

 

India needs a ten-fold increase in facilities and labour to ensure that its population derives the full benefits of this advanced field of medicine.

 

A PET-MRI system. Credit: MR Solutions/Wikimedia Commons, CC BY 3.0

K.S. Parthasarathy

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HISTORY

THE SCIENCES

11 HOURS AGO

Nuclear medicine “is a branch of medical imaging that uses small amounts of radioactive materials” to diagnose and determine the severity of or treat a variety of diseases. This includes many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities. Because nuclear medicine procedures can pinpoint molecular activity within the body, they offer the potential to identify diseases in their earliest stages as well as the patient’s immediate response to therapeutic interventions”. (source)

We need enormous resources to build and operate a comprehensive nuclear medicine facility. Such facilities with all their equipment cost millions of dollars. This is why it is incredible that a field still nascent in the 1950s is today mature and so dynamic in India.

The first reference on the medical use of atomic energy in India is found in a 1954 lecture on ‘Health Protection, and Biological and Medical Applications of Atomic Energy’. It was delivered by Subodh Mitra, former director of the Chittaranjan Cancer Hospital, Kolkata, and included radioisotope-related work in his institution. He revealed that physicists had designed a “hot laboratory” in his institution based on specifications received from the US, and began radioisotope studies in 1951. The hospital imported radioisotopes such as phosphorus-32 from Harwell, England.

(The choice of Subodh Mitra was notable. According to a 2014 biography, he was a “radiologist, radiation oncologist, radiobiologist, cancer epidemiologist and one of the greatest visionaries of cancer that India has ever produced”. He was the founder-secretary of the Indian Radiological Association, and built the Chittaranjan Cancer Hospital in 1950. It was inaugurated by Marie Curie.)

Also read: On IAEA’s 60th Birthday, Remembering Indian Contributions to Nuclear Tech

In the same year – 1954 – Jawaharlal Nehru felt there was a growing communication gap between the Department of Atomic Energy (DAE) and sections of the public. Voices in the Parliament and elsewhere were suggesting that the nation had not achieved much since the Atomic Energy Commission was set up in 1948. Nehru wanted the DAE to use this opportunity to review achievements in the field of atomic energy. So he asked Homi Bhabha to organise a conference.

One hundred persons, including many scientists and engineers, ministers, Members of Parliament and industrialists attended it. Many were from outside the DAE as well. Nehru himself chaired the meeting (except for a short while, when he asked K.D. Malaviya take charge).

Sadly, there have not been many such meetings since. Scientists of the DAE have remained isolated, cocooned in the comfort zones of their labs for many years.

The medical use of radioisotopes grew progressively after the Apsara reactor was commissioned in 1956. Apart from diagnostic applications, specialists began using radioisotopes like iodine-131 and phosphorous-32 in radiotherapy as well. Later, the Bhabha Atomic Research Centre (BARC), Mumbai, added the CIRUS and Dhruva research reactors for these purposes.

The setting up of the Board of Radiation and Isotope Technology (BRIT), on March 1, 1989, was a watershed moment in this field.

In the early 1960s, test monographs for a few radiopharmaceuticals appeared in international pharmacopoeia. According to reports available with the radiopharmaceutical division at BARC, the Drug Control Administration in India considered clearing radioisotopes under licence number 720.

Later, the use of reactor-produced radioisotopes increased rapidly. With regulatory control in mind, the DAE established a Radiopharmaceutical Committee and a Nuclear Medicine committee. They covered all aspects related to the safety of the premises, products, patients, workers and the public.

The Radiopharmaceutical Committee was set up on February 23, 1968. It had V.K. Iya, a pioneer in the field, as its convener and six eminently qualified specialists, including a representative from the Directorate General of Health Services (DGHS), health ministry, as members.

The five-member Nuclear Medicine Committee had members drawn from BARC, the Directorate of Radiation Protection and the DGHS. This committee:

• Evaluated research proposals
• Proposals for diagnostic and therapeutic uses of radioisotopes
• Approved a list of doctors trained in radioisotope techniques for established diagnostic and therapeutic procedures
• Developed procedures for providing standing clearances to established doctors for using standard products without delay, and
• Examined applications from new users and for every new use of medical radioisotopes

Nine years later, the DGHS notified that “radiopharmaceuticals” were exempt from the provisions of Chapter IV of the Drugs and Cosmetics Act 1940. Many considerations must have contributed to this. In particular, the mass of radioactive material in any radiopharmaceutical is too trivial to have toxic effects. Normally used radioactive materials, such as technetium-99m, have very short half-lives. It is not feasible to study them for long periods to evaluate the relevant parameters as is done for conventional pharmaceuticals.

BARC was the only agency preparing radiopharmaceuticals during the 1960s and 1970s. After interacting with specialists at BARC, the officials at DGHS must have realised that granting exemptions were not likely to have serious consequences.

On November 15, 1983, the Centre set up the Atomic Energy Regulatory Board (AERB) to enforce safety provisions under the Atomic Energy Act 1962. The AERB issued the necessary legal documents to enforce safety provisions. The promulgation of Atomic Energy (Radiation Protection) Rules 2004 followed this. (Nuclear medicine professionals can see the relevant provisions for them here.)

Also read: The Complicated History of How MRI Was Invented – and ‘Brought’ to India

In 2009, about 200 physicians were licensed to practice nuclear medicine in the country and the facilities were very modest. Just over 150 hospitals, located mainly in cities, provided the service. But as of July 2018, there are 293 nuclear medicine departments in the country. Some 14% are in the government sector, and the remaining 86% are under private ownership. Other facilities include 23 medical cyclotrons, 233 functioning gamma cameras and 222 PET/CT scanners. There are also 92 radionuclide therapy rooms (isolation), with 200 beds.

These and other details, such as human resource development, diagnostic and therapeutic facilities, etc., were discussed in an exhaustive review published in the Indian Journal of Nuclear Medicine in November 2018.

In 1984, the National Health Technology Advisory Panel, Australia, stated in its report of medical cyclotron facilities that it wasn’t clear if the marginal benefit to patient management and outcome would be sufficient to justify the cost of a medical cyclotron facility. It added that it was likely a cyclotron facility would run at a loss and require ongoing government support.

Many specialists had similar views in 2002, when the Radiation Medicine Centre at BARC installed the first medical cyclotron in India. In the mid-1990s, R.D. Lele, then a member of the AERB and an inveterate optimist, was probably the only specialist in India to predict that medical cyclotrons, a life-saving facility, would be economically sustainable in the country.

Today, India needs a ten-fold increase in facilities and labour to ensure that its population derives the full benefits of this advanced field of medicine.

K.S. Parthasarathy is a former secretary of the Atomic Energy Regulatory Board.

Radio-iodine treatment of low risk thyroid cancer ; lower dose is enough

I am very happy to report that many news outlets and dailies reprinted this special news article of mine, published by the Press Trust of India . 

 

The good news is that researchers in the UK have shown that treating low risk thyroid cancer with lower (30mCi) amounts of radio-iodine is as effective as treating them with a higher (100mCi) amount of activity. 

 

I  kept track of this research since 2012,when the New England Journal of Medicine (NEJM) published the first paper on the project. Then, I have corresponded with Dr Ujjal Mallick who was the Chief Investigator of the project which was being carried out in 29 UK hospitals. Dr. Mallick is from India. 

 

Though the agencies proposing guidelines may take a year to accept the results, many UK hospitals have started implementing the new guideline already, Dr Wadsley, the present Chief Investigator responded to my query. Our physicians are following up the study closely. . AIIMS, Delhi have been pioneers in the field .For instance the number of thyroid cancer patients treated by them has already reached five figures according to sources. They were the first to carry out a similar randomized controlled trial albeit for a much shorter period of one year

 

https://health.economictimes.indiatimes.com/news/diagnostics/people-with-low-risk-thyroid-cancer-can-receive-lower-doses-of-radiation-treatment-study/66764633

People with low risk thyroid cancer can receive lower doses of radiation treatment: Study

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Massachusetts: Hospitals can now treat people having low risk thyroid cancer with a smaller amount of radioactivity after surgery, according to a latest study.

Billed as the world’s longest-running trial of low risk thyroid cancer patients carried out in the UK, the suggested guidelines, when accepted, are likely to benefit thousands of people.

Dr Jonathan Wadsley, a consultant clinical oncologist at the Weston Park Hospital at Sheffield, and chair of the National Cancer Research Institute (NCRI) Thyroid Cancer Subgroup, presented the results at the recently-held 2018 NCRI Cancer Conference in Glasgow.

The latest results showed that there was no significant difference in the recurrence of cancer rate between patients given a low radiation dose compared to the standard, higher dose.

When patients received lower activity, they suffered fewer side effects. They faced less risk of feeling sick or suffering damage to the salivary glands, which can potentially lead to a permanently dry mouth, the study found.

Reduced dose reduces the patients’ chance of getting cancer later, it said.

According to experts, many patients find it distressing to remain in isolation rooms in the hospital for two to three days without physical contact with friends and relatives when they receive higher doses.

When applied doses are high, radiation protection regulations demand that the dose should come down before releasing the patient from the isolation room. Health services save money when patients receive low activity. Besides this, hospitals can treat more patients.

Radiation protection enthusiasts endorse for patient’s treatment an amount of radioactivity as low as reasonably achievable without sacrificing clinical benefits.

Researchers at AIIMS, New Delhi, are seen as pioneers in this field. In 1996, AIIMS researchers carried out the first prospective randomised clinical trial with regard to administered dose for destroying remnant cells.

Apart from their study, other two studies were from France (ESTIMABL group) and, the UK (HiLo study).

The latter two had longer follow up. Though physicians used radioiodine for treatment of thyroid cancer for several decades, it continued to be an enigma.

In 2014, in a clinical review of low risk thyroid cancer published in the British Medical Journal, researchers noted that thyroid cancer is one of the fastest growing diagnoses, more cases of thyroid cancer are found every year than all leukemias, and cancers of the liver, pancreas and stomach. They found that most of these incident cases are papillary in origin and are both small and localised.

“Patients with these small localized papillary thyroid cancers have a 99 per cent survival rate at 20 years. In view of the excellent prognosis of these tumours, they have been denoted as low risk. The incidence of these low risk thyroid cancers is growing probably because of the use of imaging technologies capable of exposing a large reservoir of sub clinical disease” they clarified.

The first step in treating thyroid cancer is to remove the thyroid surgically. Even an experienced surgeon may leave some cancer cells and thyroid cells at the site. Some cells may move away. The physicians want to destroy any residual normal thyroid tissue and thyroid cancer cells following surgery. If physicians do not do this, the remnant cells may proliferate, leading to recurrence of cancer later.

The cancer specialists administer radioactive iodine (I-131) in liquid or capsule form to avoid this. The radioisotope concentrates in thyroid cells in the body wherever they are. Radiation emitted from radioiodine destroys the remnant thyroid cells left after surgery.

Dr Wadsley reported results of 434 patients with low risk thyroid cancer from 29 UK hospitals in the HiLo trial with a median (average) follow-up time of 6.5 years.

He confirmed to this writer that many UK centres have already adopted the low doseregimen to treat low risk thyroid cancer patients, following the publication of the primary outcome of the study back in 2012.

“The recently reported longer term follow up data gives us added confidence that use of the lower dose regimen does not lead to an increase in longer term thyroid cancer recurrence,” he asserted.

The Lancet Diabetes and Endocrinology has accepted the study for publication; it is currently undergoing final editorial review.

According to Dr Martin Forster from University College London, who chairs the NCRI Head and Neck Clinical Studies Group but was not involved with this research, “Nearly seven years of follow-up data from the HiLo trial provide us with confidence that the lower radiation dose for patients with low risk thyroid cancer is a safe and effective treatment, and that international guidelines can be updated to reflect this. For many patients, the treatment and how it is delivered, as well as the short and long-term side effects, can have a big impact on their lives.”

(K S Parthasarathy is a former Secretary of the Atomic Energy Regulatory Board).

Tributes to Dr K A Dishaw, an Eminent Specialist

Dr K A Dinshaw, an eminent radiation oncologist died on August 26, 2011 .She was 67. I  had  opportunity to work with her while we were together in an exploratory mission in the field of medical radiology to Italy organized by the Department of Science & Technology in November 1999.  There were other occasions when I interacted with her. I am referring to them in a PTI feature I wrote about her on September 3, 2011.

You may read it and if possible give me feedback at ksparth@gmail.com

PTI FEATURE   

  HEALTH

VOL NO XXVII(36)-2011              Sept 03 2011                 PF-143/2011

Tributes to an Eminent Cancer Specialist

Dr K S Parthasarathy*

 She was an institution builder.  She batted for indigenous equipment and pushed the agenda to develop an indigenous telecobalt unit and christened it Bhabhatron, which is now installed in 20 hospitals in India. Her admirers and peers may find it hard to list her contributions.

Dr (Ms) Ketayun Ardeshir Dinshaw DMRT (Lond), FRCR (Lond), eminent radiation oncologist and former Director of Tata Memorial Hospital (TMH), Mumbai died on August 26, 2011. She was 67.

She was born in a Parsi family in Kolkata; her father, an architect, motivated her to become a doctor. In an informative interview (Journal of Cancer Research and Therapeutics, August 26, 2011), Dr. Dinshaw, known to her close colleagues as Katy, vividly described her career in medicine.  After graduation from Christian Medical College, Vellore (1961-66), she had an inclination towards Surgery for her Master’s degree. She changed her mind and chose Radiotherapy, under Dr Padam Singh, who was then Head of Radiotherapy Department.

The interview, given to Dr. Meena Tiwari admirably covers Dr Dinshaw’s magnificent contributions.

Dinshaw completed her post-graduation in radiotherapy from Addenbrooke’s Hospital, Cambridge in November 1973. On her return to India in December 1973, Dr Jussawalla, Director, TMH appointed her as an Assistant Radiotherapist in 1974. Rest is history.

For the next 35 years, she served the hospital with distinction. She retired in November 2008 after remaining as Director for 13 years. Dr Dinshaw worked tirelessly to make TMH an outstanding centre for cancer treatment and research.

With the support of Dr. P B Desai, then Director TMH, she successfully set up a separate radiotherapy department as till then it co-existed with radiology. Among her achievements, she rated getting approval for the introduction of MD seats in radiotherapy as a major leap.

To Dr Tiwari’s query on what has been her biggest challenge as an administrator of Tata Memorial Centre, Dr Dinshaw noted that stepping in as Director of TMC was an uphill task in itself. During those times, the Directors of TMC were heads of the surgery department.

“No women have been at the helm of affairs at TMC. However, the selection committee endorsed my candidature and was very supportive”, she added. Physical renovation of the hospital building with the treatment of patients remaining unaffected was another big challenge.

Setting up  the Digital Library and Telemedicine project which gives unlimited access to professional information worldwide, particularly helping patients in remote areas such as North-East India  to gain easy access to medical expertise were notable achievements.

“She was responsible for TMH fraternity to accept that other than surgery, ‘Radiation’  as an important part of the management of cancer”, Dr K. R. Das who collaborated with her on some important projects noted. “Till then TMH was essentially a surgeon’s world” he added.

Dr Deepak Deshpande, Head, Medical Physics Department, TMH and Das highlighted her role in introducing Iridium 192 wires for interstitial implants in India in 1983. Later it found wide acceptance all over India.

Dr Das and Dr A.Shanta collaborated with her in introducing Iridium 192 wires for breast implants. “Dr Dinshaw was open to suggestions and never turned away from problems”, Das acknowledged.

Dr Dinshaw appreciated the role of medical physicists. “She was responsible for the introduction of counter checks in physics and clinical documentation. She devoted lot of time for medical physics even after becoming Director”, Shri P S Viswanathan, former Head, Medical Physics Department, TMH remembered.

“It is very important to work as a team with medical physicists and technologists. Equally important is to provide opportunity to every one to upgrade their expertise and genuinely make them fell as an important part of a team”, Dr Dinshaw told Dr Meena Tiwari when she sought from her a message to the young radiation oncologists.

Dr Dinshaw played a major role in setting up the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC). With pure research in the field of cancer and a clinical wing, ACTREC is achieving its objective as a centre of excellence.

In a touching tribute, Dr Rajiv Sarin, Director, ACTREC remembered that the internationally renowned cancer specialist lost her personal battle to the disease which she ironically fought as a disciplined soldier and a visionary leader for four decades.

“A staunch patriot and eternal optimist, in various international forums he pitched and batted in style and poise not just for India but for the cause of cancer in the entire developing world”, Dr Sarin noted.

“Her respect and admiration for the serving and retired men and women in the armed forces and their families who came to TMH for treatment or training and her sensitivity to women and children was so special and selfless” Sarin said…“she formed a personal relationship with each one of us which was much beyond her official role as director, head of department or colleague”, he added

“She treated equally all medical and nonmedical staff”, Viswanathan concurred.

“This great connoisseur of music and art was also an ardent admirer of the plant kingdom, ferrying lovely plants from all over the world…almost single-handedly she greened the spawling 60 acre ACTREC campus in Kharghar where there is a Dinshaw Baug full of her plants”, Dr Sarin revealed.

I had many occasions to interact with Dr. Dinshaw. Often I sought her views on patient safety related matters. An incident in Panama and another in Poland compromised the safety of patients.  She was very happy to note that I brought those incidents to the notice of Indian hospitals.

Occasionally, the Atomic Energy Regulatory Board took action against a few hospitals. Some physicians felt that the Board was a bit harsh. Dinshaw concurred with me after listening to my explanation.

We were members of an exploratory mission in the field of medical radiology to Italy organized by the Department of Science & Technology in November 1999. While visiting a hospital, a receptionist asked us to wait in the office of the Director. Shortly, the Director arrived. The first thing he did was to light a cigarette. Dr Dinshaw protested and asked him why he is hanging a “No Smoking” warning in his room. Without batting an eyelid, he told us that the rule does not apply to the Director!

“Cigarette-addicts are the same everywhere”, Dinshaw told him.

Dr Dinshaw received many awards  including Padmashri (2001). She was an institution builder.  She batted for indigenous equipment and pushed the agenda to develop an indigenous telecobalt unit and christened it Bhabhatron, which is now installed in 20 hospitals in India. Her admirers and peers may find it hard to list her contributions. —-PTI Feature

      * Dr K S Parthasarathy was a Raja Ramanna Fellow, Department of Atomic Energy when he wrote this article

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